Cochrane Clinical Answers - About Us

About Us


About Cochrane Clinical Answers


Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care. Each Cochrane Clinical Answer contains a clinical question, a short answer, and an opportunity to ‘drill down’ to the evidence from relevant Cochrane reviews. The evidence is displayed in a user friendly format, mixing narrative, numbers and graphics. The target audience for Cochrane Clinical Answers is healthcare practitioners and professionals, and other informed health care decision-makers. Cochrane Clinical Answers have been developed by Cochrane Innovations Ltd. and Wiley Online Library.


Find CCA background and training materials here


About the Editorial process


Choosing the Clinical Question


For the first phase of Cochrane Clinical Answer development, there is a one-to-one relationship between each CCA and its corresponding Cochrane systematic review. Future developments aim to leverage the content from multiple Cochrane Reviews and Cochrane overviews to create broader CCAs.


We are using several selection criteria to prioritize selection of Cochrane Reviews on which to base CCAs, including:

      Prevalence and high morbidity of condition (including high hospitalization rates), starting with Diabetes and COPD, & moving on to acute respiratory infection, musculoskeletal disease, ear, nose, and throat disorders, dementia, chronic pain management and palliative care, with the ongoing aim of creating a reasonable cluster of answers across each disease area we cover;

      Newly published or recently updated Cochrane Reviews

     Most accessed Reviews based on data compiled by Wiley for the Cochrane Library impact factor

      Reviews that showcase Cochrane Review development initiatives such as Summary of Findings tables

      Clinical areas of current concern expressed by clinical experts consulted during the development of the project and reviews recommended by Co-Coordinating Editors of Cochrane Review Groups.


Each clinical question is formulated so that it can be answered using the ‘PICO’ framework; all answers provide detail about the Population, Intervention, Comparison, and Outcomes. 


Answering the Clinical Question


The relevant Cochrane Reviews for each clinical question are identified by the Editor, and the data and analyses sections from each Cochrane Review are automatically extracted and populate an evidence template. The Editor checks the automatically extracted data and inserts any additional relevant information from the Cochrane Reviews into the template.

The Associate Editor then ensures that patient-relevant comparisons and clinical outcomes are covered, and they write a clinical answer for each question using the data from the Cochrane Reviews.

The Editor checks the text and liaises with the Associate Editor over any queries before the Cochrane Clinical Answer is signed off by the Editor in Chief. Any queries arising during checking and sign off are handled by the Editor or Associate Editor.


Updating Cochrane Clinical Answers


Each time a new or updated Cochrane review is published that is relevant to an existing Cochrane Clinical Answer, the Cochrane Clinical Answer will be flagged as ‘Under review’ on the Cochrane Clinical Answers website. The new evidence is then reviewed by an Associate Editor, and if the Cochrane Clinical Answer needs to be amended in the light of new evidence, the editorial process begins again. Once the updated Cochrane Clinical Answer is published, it will be flagged as ‘Updated’.

About the data supporting Cochrane Clinical Answers


A template has been developed by the Cochrane Editorial Unit to capture the data required from Cochrane Reviews to answer to each clinical question. Some of this data is automatically extracted from Cochrane Reviews by a python script, and the remainder of the Cochrane Clinical Answer is completed by our Editor and Associate Editors.



Automated data extraction from Cochrane Reviews


The table below shows the pieces of information that are automatically extracted from each Cochrane Review by the python script, before being reviewed by the Editor. The python script extracts all data and analyses sections from the Cochrane review, and is not selective.


Information in the CCA

Source of information from the Cochrane Review


Comparison title


Data and analyses > Comparison title


Population



Methods > Criteria for considering studies for this review > Types of participants


Intervention

Comparator


Methods > Criteria for considering studies for this review > Types of interventions


Outcome name


Data and analyses > Outcome or subgroup title


Narrative result


When there are meta-analyses, the narrative text is automatically generated from several different locations from the Cochrane Review:


·         The number of studies: Data and analyses > No. of studies

·         The number of participants: Data and analyses > No. of participants

·         Intervention and comparator names: Graph labels on the forest plot

·         Direction of effect: the python script calculates whether there is a significant difference between groups, and if so, what the direction of effect is. It then selects a sentence structure depending on these calculations

·         Outcome name: Data and analyses > Outcome or subgroup title


If the data are not meta-analyzed, no information is included in this section, or the quantitative results sections below.


Quantitative result: relative effect or mean difference


·         Direction of effect: the python script calculates whether there is a significant difference between groups, and if so, what the direction of effect is. It then selects a sentence structure depending on these calculations

·         Favored intervention or comparator: Graph label on the forest plot

·         Relative effect/mean difference and associated confidence intervals: Data and analyses > Effect size


Quantitative result: absolute effect


The absolute risks (ARs) for dichotomous outcomes are estimated from relative risks (RRs) as follows, and reported as rates per 100 in earlier CCAs and rates per 1000 in current CCAs.


Comparator group AR:


·         Comparator group AR: estimated as the average (weighted median) absolute risk from the trials in the source Cochrane review meta-analysis.

·         Intervention group AR: estimated by multiplying the comparator group AR with the RR taken from the meta-analysis in the source Cochrane review. The confidence interval is calculated similarly, by multiplying the comparator group AR with the lower and upper bounds of the 95% confidence interval in turn.


Manual checks and additional information added by the Editor


The Editor checks each of the fields auto-generated by the python script to confirm they make sense, and then adds any other relevant information from the Cochrane Review to the template. The table below shows the pieces of information that the Editor may add to each template.


Information in the CCA

Additional information added by the editor


Population



The Editor checks that that the participant criteria for inclusion in the review are broadly consistent with the populations of the included studies for the analysis. If the population in the included studies is more specific (e.g. the review inclusion criteria is ‘all people’, but the included studies only enrolled ‘neonates’), details of the specific population are added.


Intervention

Comparator


Where applicable, the Editor adds details about the dose, route, frequency of administration, concomitant therapy, duration of treatment, or, in the case of multifaceted interventions such as education, further detail about the intervention consisted of.


Safety alerts


In addition to using the adverse effects data within the Cochrane review  on which the CCA is based, we ask the Associate Editors to make us aware of any Safety Alerts or serious adverse effects associated with the intervention and asked them to reference any statements using the following sources in order of preference:  another Cochrane systematic review assessing harms of the intervention (there will not be many of these), black box warning from FDA or other national regulatory authority (MHRA, EMEA), or a systematic reviews of harms from another peer-reviewed journal.



Risk of bias of studies/Quality of the evidence


The Editor adds narrative information here about the quality of studies for each outcome. If there is a Summary of findings table in the Cochrane Review, the GRADE rating for the relevant outcome (high, moderate, low or very low-quality evidence) is used and is listed under the heading ‘Quality of the evidence’. If there is no Summary of findings table, the Editor refers to the risk of bias section and the risk of bias tables for the studies relevant to the outcome and writes a summary of the overall risk of bias across studies, listing it under the heading ‘Risk of bias of studies’. If there is no Summary of findings table or risk of bias assessment, the Editor reports the Cochrane review authors’ judgment about the quality of studies from the abstract, or the text of results section of the Cochrane Review.


Narrative result


When data for a particular outcome were not meta-analyzed, the Editor completes the narrative result section. There are a number of scenarios where meta-analyses are not possible, for example, if there were no trials or no trials that assessed a particular outcome, if there was only one study, if data were not in a format that could be used (e.g. medians); if there were wide clinical differences among the studies (e.g. the interventions were very different); or if there was excessive statistical variation for other reasons.  If this is the case, the Editor adds a brief description about why the results were not meta-analyzed. The Editor also adds data from a single study if there is only one study, or adds a narrative synthesis if there are multiple studies not meta-analyzed.


Quantitative result:absolute effect


The Editor reports absolute numbers out of 1000 from the Summary of findings table for every outcome GRADED. We only report numbers identified for the study population assessed in the outcome and aim for consistent reporting of numbers for every outcome. If the SOF reports numbers in a different format (e.g. out of 100) or numbers adjusted for baseline risk, we instead report the absolute numbers out of 1000 calculated by the PICOtron.


Selecting the comparison and outcomes and writing the answer by the Associate Editor


The Associate Editor selects the comparisons and outcomes to report, and removes any they think are not relevant. The following guiding principles underpin their decision-making:


·         The comparisons and outcomes are selected without referring to the results. The Associate Editors don't delete a comparison or outcome because there are no data, or because there is no significant difference between groups in the effect.

·         The Editor selects outcomes that are clinically relevant to patients (e.g. survival, symptoms, quality of life etc.), and removes surrogate markers (e.g. blood levels of different substrates).

·         The Associate Editors always include details about adverse effects if they are available.

·         If there is more than one measurement  for the same outcome (e.g. time point, mean, rate, or risk), the Associate Editor chooses the most appropriate analysis, focusing on analyses that the Cochrane Review authors highlighted as important in the Summary of Finding table, abstract, or discussion section of the Cochrane Review.

·         The Associate Editor selects subgroup analyses to report only if the results for the subgroup differ to that of the main analysis. If subgroup analyses are consistent with the main analysis, the Associate Editor reports this in the narrative summary of results.


The Associate Editor uses the evidence provided in the template, and the Cochrane Review(s) on which the Cochrane Clinical Answer is based. The answer is short (less than 200 words ideally) and is an overarching answer for all the clinically relevant comparisons. If possible, the Cochrane Clinical Answer will quantify the effect size of the intervention in regard to the outcomes, including the absolute effects and confidence intervals. The answers also include statements reflecting the strength and quality of the evidence. The answer aims to put the question into clinical context, and states if there is insufficient evidence to make a judgment about the intervention to draw conclusions. In these cases, the answer focuses on the rationale behind conducting the review.


About the Editorial team


Associate Editors


All our Associate Editors are currently practicing clinicians. They write the summary for each Cochrane Clinical Answer, combining their clinical expertise with the randomized controlled trial data meta-analyses from Cochrane Reviews.


Editor and Clinical Editors


The Editor and Clinical Editors have editorial oversight of each CCA, extracting and summarizing outcome data to supplement the python script automatic data extraction, liaising with the Associate Editors to complete the draft Clinical Answer, and responding to internal peer review.


Editor


Karen Pettersen


Karen joined John Wiley & Sons Ltd. in January 2012 to work on the project to develop Cochrane Clinical Answers. She is based partly in Wiley and partly in the Cochrane Editorial Unit. Karen has extensive experience of systematic reviewing, having been involved with the BMJ Publishing Group’s EBM journal, Clinical Evidence, since its inception in 1999, starting as an Information Specialist for the journal and working as Deputy Editor for five years. She contributed to a wide range of projects to allow Clinical Evidence to move forward in line with the many advances in evidence-based medicine that happened since the product was launched, playing a key role in projects to improve the accessibility of Clinical Evidence such as developing key take home messages for all reviews and adapting the GRADE system for use in Clinical Evidence. While editing Clinical Evidence, Karen worked intensively with Cochrane Reviews, engaging directly with enumerable forest plots and enjoying the new Summary of findings tables. She has also liaised with many Cochrane authors who generously shared their expertise by authoring for Clinical Evidence. Karen recognizes the quality and depth of knowledge within Cochrane Reviews and the commitment of all members of the Collaboration to improving health care through promoting evidence-based medicine and looks forward to the contribution that Cochrane Clinical Answers can make to achieve this aim.


Clinical Editors


Sera Tort


Sera joined the Cochrane Editorial Unit in July 2013 to work on derivative products of the Cochrane Library. She has been involved with the Cochrane Collaboration since 2002, when she started working at the Iberoamerican Cochrane Centre with clinical practice guidelines and as a Managing Editor and Joint Co-ordinating Editor of the Lung Cancer Group since 2004. Sera qualified as a doctor in 1989 and after gaining experience for some years, including a year in Mozambique as a district doctor, did her vocational training in general practice in Scotland from 1996 to 1999 and worked for several years as a family doctor before joining the Cochrane Collaboration.


Jane Burch


Jane joined the Cochrane Editorial Unit (CEU) in March 2014 to work on Cochrane Clinical Answers (CCAs). Jane both produces CCAs and helps with the continuing development of the process. Before joining the CEU, Jane worked for 10 years as a systematic reviewer, producing and disseminating the results of different types of systematic reviews, including reviews of diagnostic and prognostic tests. During this time, Jane also produced critical abstracts for the Database of Abstracts of Reviews of Effects (DARE), and for over two years provided editorial and methodological support to the Cochrane Wounds Group. Jane believes that Cochrane derivative products that target a specific audience are a good way to disseminate the results of complex research such as systematic reviews, and will broaden the audience-base for Cochrane Reviews.


Editor in Chief


The Editor in Chief oversees the strategic content development of Cochrane Clinical Answers.


David Tovey


David has been the Editor in Chief of the Cochrane Library since January 2009. He worked previously as Editorial Director for the BMJ Evidence Centre, which is the division of the BMJ Group that produces Clinical Evidence and its counterpart for the public BestTreatments, BMJ Point of Care, and Best Practice. At the BMJ, David was initially Deputy Editor of Clinical Evidence under Fiona Godlee, moving to the Editor role when she became Editor of the BMJ. David worked as a General Practitioner in an urban practice in South London for 15 years until 2003. During that time he also undertook roles in continuing professional development for primary care professionals, and was a clinical governance lead for a Primary Care Group.


Get involved


Cochrane Clinical Answers


If you would like to join the clinical answers authoring team, please contact Karen Pettersen at the Editorial Office on kpettersen@wiley.com; Telephone: +44 (0)1243 770522.


The Cochrane Collaboration


The Cochrane Collaboration is an international organization whose primary aim is to help people make well-informed decisions about healthcare and health policy by preparing and maintaining high-quality systematic reviews. Learn more about getting involved with the Collaboration.


About Cochrane Innovations

Cochrane Innovations Limited is a trading company registered in the UK and wholly-owned by The Cochrane Collaboration. Charlotte Pestridge is its CEO and Lorne Becker, Karen New, Denise Thomson and Mark Wilson have been appointed as its Directors.

The mission of Cochrane Innovations is to develop business opportunities on behalf of The Cochrane Collaboration, based on its products and activities. Cochrane Innovation is charged to act as a vehicle for new projects while ensuring that the Collaboration does not lose its focus on its primary product – Cochrane Systematic Reviews in the Cochrane Library.


About Wiley Online Library


Cochrane Clinical Answers is hosted on Wiley Online Library platform, the world's broadest and deepest multidisciplinary collection of online resources covering life, health and physical sciences, social science, and the humanities. Find out more about Wiley Online Library.