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).