Changes to the Cochrane Library during the Cochrane Collaboration's first 20 years.

Abstract

Twenty years ago this October, 77 people from nine countries gathered in Oxford, England, to launch The Cochrane Collaboration, under the leadership of Iain Chalmers.[1] The meeting was the culmination of shared ideas and discussions among people with a collective vision to identify randomised controlled trials and to use the findings to prepare systematic reviews to inform healthcare practice and decision‐making. Participants in this meeting share their reflections on this landmark event in the first of a series of videos (available at anniversary.cochrane.org) commissioned by the Collaboration on the ideas, achievements, and people that have contributed to its growth since 1993. Video: Twenty years of The Cochrane Collaboration: looking back on the search for evidence The Cochrane Collaboration has seen remarkable growth in the past 20 years, growing to involve over 27,000 people from over 100 countries.[2]The Cochrane Library, which houses the systematic reviews prepared by the Collaboration's researchers, has also grown and evolved. When the Collaboration was launched in 1993, neither The Cochrane Library nor the Cochrane Database of Systematic Reviews (CDSR) existed. The CDSR was launched in 1995, following on from the Cochrane Pregnancy and Childbirth Database, which itself developed from The Oxford Database of Perinatal Trials (ODPT).[3] The first quarterly issue of the CDSR included 36 Cochrane systematic reviews and 16 protocols for future reviews, and was available as a CD‐ROM or floppy disk. Like its originator, the OPDT, which was launched as a collection of floppy disks and updated twice a year,[3] the CDSR was to be a living resource, updated as new evidence or information became available. A year after, in April 1996, The Cochrane Library was launched as a quarterly publication on CD‐ROM and floppy disk and incorporated the CDSR, the Cochrane Controlled Trials Register (now called CENTRAL), the Cochrane Review Methodology Database, and the Database of Abstracts of Reviews of Effects (DARE), which contains structured abstracts of quality‐assessed systematic reviews. A few months later The Cochrane Library also became one of the first scientific publications to be available online. Today, The Cochrane Library is an online platform (www.thecochranelibrary.com) hosting a range of databases that provides high‐quality, independent evidence to inform healthcare decision‐making. The databases are complemented with Special Collections of Cochrane Reviews, monthly podcasts, Cochrane Journal Club features, and editorials, as well as supplements for Cochrane Methods and abstracts from the annual Cochrane Colloquia. The Cochrane Collaboration prepares four of the databases: the CDSR, which houses all Cochrane Reviews and protocols for Cochrane Reviews; the Cochrane Central Register of Controlled Trials (CENTRAL), a database of reports of studies that may be relevant for inclusion in Cochrane Reviews; the Cochrane Methodology Register, a database of publications that report on methods used in the conduct of controlled trials; and the About The Cochrane Collaboration database, which contains information on the groups, such as Cochrane Review Groups, that make up the Collaboration. The Cochrane Library also includes DARE and two other databases prepared by the Centre for Reviews and Dissemination at the University of York, UK: Health Technology Assessment Database, which brings together details of completed and ongoing health technology assessments; and NHS Economic Evaluation Database, which contains quality‐appraised economic evaluations. The CDSR now includes over 5200 Cochrane Reviews and 7500 protocols for Cochrane Reviews (Figure 1), each a collaboration by a research team and one of 53 Cochrane Review Groups. Each Review Group focuses on a different healthcare area, such as pregnancy and childbirth, infectious diseases, and the effective practice and organisation of care. As the numbers of reviews have increased, there has been growth in the use and impact of Cochrane Reviews, including their inclusion in clinical guidelines. As Peter Langhorne, Co‐ordinating Editor of the Cochrane Stroke Group, says the in video: “All the Western guidelines [on stroke] are similar and all reference Cochrane Reviews in large numbers. It's become embedded in the normal practice of quality improvement.” Cochrane Reviews have also informed aspects of healthcare research and methodology developments for systematic reviews, and have led indirectly to clinical trial registration and improved standards for the conduct and reporting of trials. Open in figure viewer Figure 1 Cochrane Database of Systematic Reviews: number of published Cochrane Reviews and Protocols.[4] CENTRAL, the largest database of randomised controlled trials, developed from the need to identify relevant trials and studies when preparing systematic reviews. As Sir Muir Gray mentions in the video, early members of the Collaboration found that it was difficult to identify randomised controlled trials in MEDLINE: “there was the equivalent of billions of dollars' worth of research that you couldn't find”. Another difficulty was that some trials were never published, and The Cochrane Collaboration was instrumental in encouraging registration of all trials. Kay Dickersin, Director of the US Cochrane Center, notes that “amassing a really large and meaningful register of published trials made a difference, in that we now have trial registration worldwide.” The Cochrane Collaboration invests time, people, and resources in identifying trials and studies for Cochrane Reviews, and these are added to CENTRAL, which by the end of 2012 contained 680,109 records, with the earliest trial dating back to 1898.[5] Since 1996, The Cochrane Library has seen many changes and developments in its online presence, including growth in the volume of translated content,[6] an enhanced user experience (including recent access via an iPad application),[7] and ongoing advances in the search and browse functionality. FFull‐text access and citations continue to grow; Cochrane Reviews have now been cited about 30,000 times.[8]The Cochrane Library is accessed throughout the world, with many people in many countries using free ‘one‐click’ access.[9] Although the Collaboration has made steady progress with The Cochrane Library, it is clear from discussions with stakeholders, including those who use the content to inform healthcare decisions, that further development is needed across the range of Cochrane content.[10] That work has started and will continue over the coming years. Throughout 2013, readers will see the publication of a series of anniversary‐related editorials celebrating landmark reviews and methodological changes, and the people behind them. The editorials will also look forward and explore the challenges the Collaboration faces in the future as it continues to seek to provide the best evidence to inform decision‐making in health. Next month's anniversary editorial is by Lesley Gillespie, who will discuss her 18‐year experience of researching and authoring Cochrane Reviews on interventions for preventing falls in the elderly. For more information on The Cochrane Collaboration's 20th anniversary celebrations, visitanniversary.cochrane.org.