Prioritising our reviews

What are our priority topics?

Our priority topics are usually related to the four core areas of our scope, namely venous thromboembolism, abdominal and thoracic aortic disease, peripheral arterial disease of the lower limbs, and varicose veins and venous insufficiency.

What is prioritisation?

Prioritisation is making an informed decision about what work you will do, given that you have limited time and resources compared to the amount of work that could potentially be done.

Why do we need to prioritise?

We have over 150 published Cochrane Reviews to update and around 40 new reviews in progress at any one time.  This is a lot of work for editorial and author teams. We need to make the most of our publicly funded resources, by focusing on the most important reviews for people making decisions about their healthcare, and for people deciding on the research agenda to develop new trials.

What are the reasons for prioritising an intervention review?

Reasons for prioritising the update of a given existing review could involve one or more of the following:

  • major new trial published which could change conclusions of the review, strengthen the level of evidence and/or increase the relevance of the review to a broader group of patients and clinicians;
  • considerable uncertainty in the review or evolving clinical area;
  • review highly accessed or cited and it is important to report on whether new trials have been published and/or the methods need updating;
  • review to be included in a forthcoming major clinical guideline;
  • intervention is of particular importance in lower middle income settings.

In general, we aim to update all active reviews regularly, incorporating most recent developments in methodology as well as ensuring readability of the review. If there are no new trials in a given area, and no other reasons to update, then we may make the review stable. In practical terms, it is often the availability of either the original review team, or a new author team, which determines whether an update is feasible at a given time.

Reasons for writing new reviews are:

  • major new trials being published in a given area where we do not already have a review – this is highlighted by our systematic, topic-specific prioritisation exercise undertaken biannually (see below) as well as via our stakeholder engagement;
  • new interventions developed of potential importance to patients, irrespective of health care cost implications – it may be important to write a review to help determine the level of RCT evidence around such interventions, to highlight the need for more (or different) RCTs on such interventions, or to provide evidence of effectiveness across a number of different trials which have already been performed;
  • no high quality and up-to-date non-Cochrane review on the topic already exists. This is particularly important to us, as peripheral vascular disease is a relatively neglected area of healthcare compared with some other vascular and non-vascular diseases. This is despite high levels of morbidity caused by, for example, painful claudication in the legs, venous clots, amputations, and ruptured aneurysms. We feel passionately that part of our role is to champion the cause of the very many patients worldwide suffering from such vascular conditions, and to ensure that these do not become neglected conditions in terms of the amount of research resource expended; 
  • capacity building amongst the academic and clinical community for systematic reviewing is also important to us. Where we are approached by new reviewers, who may need training before completing a review on their preferred topic, we try to build a more comprehensive team including experienced reviewers, and we offer training and support for completion of the review. Depending on resources available to the group, it is not possible to accept all such requests, and reviews are more likely to be accepted if the title is, of itself, high priority.

Reasons for re-structuring reviews are:

  • better answered by incorporating new methodologies e.g. Network Meta-Analysis;
  • recent developments mean that the precise comparisons included in a given review are no longer the most clinically relevant, and/or very similar interventions would be better incorporated into a single review rather than split between reviews, making the review more relevant to consumers;
  • older technologies superseded by newer ones.

What are the reasons for prioritising diagnostic test accuracy or prognosis reviews?

  • diagnostic tests are an area of high importance for peripheral vascular disease as accurate diagnosis is essential for the timely treatment to reduce morbidity and mortality of, for example, DVT and abdominal aneurysms;
  • peripheral vascular disease is a clinical area with a particularly high number of alternative tests used to detect various stages of these conditions, use of which can have an important effect on subsequent treatment;
  • prognosis research can provide information on the likelihood of a particular outcome or disease recurrence; they can identify target groups for treatment, or suggest intervention strategies to modify factors associated with poor outcomes. Such information is required for health care decision-making and is not always available from clinical trials. Stratifying patients with, or at risk from, peripheral vascular disease is particularly important for ensuring personalised treatment and best use of healthcare resources.

What has Cochrane Vascular done so far in terms of prioritisation?

Prioritisation is an ongoing and continuing process. We are working with other Review Groups in our Circulation & Breathing Network to ensure that we have a coherent and realistic prioritisation plan. We have regular Group meetings where we consider the status of every review and protocol in a given sub-topic area, and, depending on resources, we take practical steps to ensure a workable plan to progress the most high priority updates, protocols and new review titles.

We also use the criteria above to identify completely new areas for a review, including searches of the literature to identify clusters of trials within a given area that have not yet been included in a review. Such area suggestions are then considered further for their priority in relation to other ongoing work, and if of sufficiently high priority, active steps are taken to identify a suitable author team.