Introduction
Cochrane aims to produce high
quality, rigorous health care evidence to inform clinical practice by
the production and dissemination of systematic reviews (SRs), network
meta-analyses and overviews (1). Cochrane reviews are
used in international guidelines, pathways and by international
institutions such as the WORLD Health Organisation. Cochrane
disseminates RCT evidence to these organisations and the Gynaecology and
Fertility Group (CGF), is one of 53 Cochrane review groups responsible
for this dissemination through the production of SRs(2).
To facilitate and support the production of SRs, the CGF maintains a
specialised database containing over 20,000 randomised controlled trials
(RCTs) which are incorporated into SRs by review authors. The trials
come from various sources, including weekly email alerts from MEDLINE,
Embase, CINAHL and PsycINFO, handsearching of conference abstracts and
journal alerts. This database is used for research
projects(3-5) and is imported into CENTRAL on a
regular basis (6).
The CGF Register of trials is an asset, and the best way for RCTs to add
to the evidence base is through incorporation into Cochrane SRs. The CGF
specialised register shows that approximately 480 benign gynaecology
trials are published each year(2). However, we had no
data on whether these trials were incorporated in Cochrane SR’s. A
project carried out by the Cochrane Acute Respiratory Infections Group
found that 41% of the RCTs in this field were not being used in
Cochrane SRs (7)
To negate waste and increase the
impact of research in women’s health we need priority setting exercises
for gynaecology uncertainties, that include all
stakeholders(8). However, a SR evaluating these
studies in women’s health(9) found that benign
gynaecology was vastly under-represented. Endometriosis was the only
area where the top ten priorities had been
published(10).
Unused research comes with huge costs, not only in monetary value but
more importantly, in ethical cost, in terms of the time and potential
risk for the people who volunteer to be randomised into the trials(11). People become involved in trials for various
reasons but an important one is that their experience will help improve
the health of others (12-14). Ethically, it is
important that the information gained from these trials contributes to
the evolution of healthcare (15).
The aim of this project was to identify gaps and extent of research
waste due to the lack of dissemination of gynaecology evidence in the
Cochrane database of systematic reviews (CDSR).