Jane Cracknell

Co-ordinator and Managing Editor of the Cochrane Anaesthesia Review Group, The Cochrane Collaboration

Q: What is the Cochrane Collaboration?

A: The Cochrane Collaboration is an international not-for-profit and independent organization, dedicated to making up-to-date, accurate information about the effects of healthcare readily available worldwide. It produces and disseminates systematic reviews of healthcare interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. The Collaboration is based on ten values: collaboration; building on the enthusiasm of individuals; avoiding duplication; minimizing bias; keeping up to date; striving for relevance; promoting access; ensuring quality; continuity; and enabling wide participation. The Collaboration is comprised of a steering group; geographical Centres such as the UK Cochrane Centre which offers training to new UK authors; Method Working Groups (which develop the methodology of the reviews); Fields, which emerge around areas of interest which extend across a number of health problems, for example the Prehospital and Emergency Health Field. Fields often provide peer reviewers; the Consumer Network (who comment on Cochrane reviews ensuring that they are understandable and of relevance to a non-medical audience); and Collaborative Review Groups (CRGs). The CRGs produce and publish the reviews which are then published in The Cochrane Library. You can find out more about The Cochrane Collaboration by going to the Collaboration’s website www.cochrane.org

Q: Who or what is ‘Cochrane’?

A: Archie Cochrane was a British epidemiologist who had pointed out in 1972 that little was known about the effects of health care treatments, or interventions. He said that the people who want to make good decisions about health care were overwhelmed with unmanageable amounts of information. He recognized that people who want to make more informed decisions about health care did not have ready access to reliable reviews of the available evidence. In 1979, he wrote “It is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomized controlled trials” There is a growing and unmanageable amount of evidence available today. More than two million articles are published every year in about 25,000 journals. How can someone find relevant, manageable and up to date information from that amount of data? That is where The Cochrane Collaboration comes in. The goal of The Cochrane Collaboration is to publish high-quality up to date information which is of use and benefit to clinicians, policy makers and of course patients, all of whom are busy people with little time to waste hunting for relevant information.

Q: What is your role in the society?

A: I am the Co-ordinator and Managing Editor of the Cochrane Anaesthesia Review Group; which is commonly known as CARG (www.carg.cochrane.org). CARG is based in Copenhagen, Denmark. We publish systematic reviews of interventions specifically in the areas of: Anaesthesia; Perioperative Care Medicine; Postanaesthetic Care; Intensive Care Medicine; Prehospital Medicine; Resuscitation; Emergency Medicine. The reviews can be found in The Cochrane Library (www.thecochranelibrary.com) I liaise with, and support, authors, editors, peer reviewers and consumers. I co-ordinate the production of all the Anaesthesia reviews from title registration, through the editorial process, to publication first as a protocol, then as a review and finally as an updated review in The Cochrane Library. The CARG’s editorial base provides an input to the review process from the very beginning: from submission of title. Normally review teams contact me and express an interest in writing a title. (We insist that all review teams consist of a content specialist, methodologist and have access to a statistician. At least one member of the team needs to have had experience of writing a systematic review or performing a meta-analysis. We ask authors to submit a CV and sign a declaration of interest form.) I check that the title does not overlap work already published with The Collaboration and then forward the title onto all the CARG editors for commenting on. I collate the comments and send to the authors to enable them to revise their title. The amended title is then approved by the Co-ordinating editor before it can be registered. Once the title is successfully registered, authors then start work on their protocol which sets out what they plan to study and what methods they plan to use. Once the protocol is approved for publication, they work on the main review. Once the review is published they need to think about the updates. It is a continuous process involving a great deal of work on the part of authors and editorial team. At all stages of the process, the work is carefully checked by members of the CARG editorial team and by external referees to ensure its quality. Cochrane is a collaborative review process; if we accept a review title then we actively work with the authors and help them at all stages. It is a long editorial process but for a very good reason – we work with authors from title to review and then onto updates. Basically what you need to know is that if you decide to be an author of a Cochrane systematic review there is an experienced editorial team to help you in a structured way throughout the process.

Q: Who should use the library website?

A: The Cochrane Library website (www.thecochranelibrary.com) does not just contain Cochrane systematic review but also regularly updated evidence-based healthcare databases. It is aimed at clinicians, researchers, policy makers and patients. There is free access in the UK to The Cochrane Library. It is possible to read the reviews in html or PDF format. There are three types of PDFs: the Abstract PDF which contains the abstract and the plain language summary of the review; the Standard PDF which contains everything except the analysis graphs and appendices; and the Full PDF which contains all parts of the review. Cochrane reviews all contain plain language summary which aim to summarize the review in a straightforward style that can be understood by consumers of healthcare; so it could be given to your patients.

Q: How can the society improve the future of research in anaesthesia?

A: By continuing to disseminate information about opportunities for junior anaesthetists to undertake research. By encouraging your members to become involved in research by undertaking randomized clinical trials. Your members can find out where clinical trials are needed by going to The Cochrane Library and reading the reviews; many of the conclusions state ‘more research is needed’. Your members could use this as the basis for future research. By making them aware that if they would like to write a systematic review then The Cochrane Collaboration provides good author support; is a collaborative process; recognized as high-quality and they will make friends and contacts inside and outside anaesthesia worldwide. Sometimes, established review teams need new co-authors to help them complete their systematic review; frequently we have reviews that need updating. I would be glad to hear from anyone interested in becoming involved with The Cochrane Collaboration.

Q: I’m interested, how do I go about writing a systematic (Cochrane) review?

A: Start by defining the clinical question; this forces you to think about what you really want to know. Clinical questions consist of three parts: the patient or population, the interventions to be compared and the clinically relevant outcomes. The clinical question can be about a single patient, or any group of patients. It can be narrow and thus specific, or it can be wide and sensitive. The intervention can be compared to nothing, to a placebo or to any other relevant intervention or interventions. The outcomes should be clinically relevant; all important outcomes should be considered. Systematic reviews ask clearly defined questions using systematic approaches to minimize bias and errors. A well-defined question is a good starting point for finding relevant literature. Do a quick basic search so you know roughly how many randomized controlled trials (RCTS) have been published in the area. At protocol and review stage we expect authors to search widely, to not just restrict their searches to English language papers. We ask authors to include all their search terms for all their databases in their appendices, but for now all you need is a quick search. Remember that a well thought out title form will give the outline for the protocol. A well written protocol will form the skeleton of the review, making it easier to flesh the bones out.

Q: Are there research grants available?

A: Cochrane does have quite a few research grants, bursaries and prizes available but those are only available to contributors to The Cochrane Collaboration and usually to people who have already registered a title. More details will be found on The Cochrane Collaboration website:


To contact Jane, please email her at jane_cracknell@yahoo.com