The ICMR Advanced Centre for Evidence Based Medicine grant for five years was awarded in August 2007 to the proposal submitted by Prof. Prathap Tharyan, Professor of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India. The amount sanctioned under this grant was Rs. 1.67.4 Lakh Rupees over five years.
The Centre is located at the Prof. BV Moses Centre for Research & Training in Evidence-Informed Healthcare at Carman Block II Floor, CMC Campus, Bagayam, Vellore. This centre was the coordinating centre for the South Asian Cochrane Network (SACN), a branch of the Australasian Cochrane Centre of the Cochrane Collaboration, at the time of the start of this grant. The SACN has 5 other network sites in India, 2 in Pakistan and one each in Sri Lanka and Bangladesh.
The first instalment of the grant for five years was received in 2007 and 28 computers purchased to aid the conduct of workshops. The centre recruited and trained 10 people to help with activities of the project.
The Goals of the project:
There are two goals from among the five goals of the strategic plan of the South Asian Cochrane Network that were sanctioned in the grant letter from the ICMR (Appendix A). The complete list of goals of the SACN is presented with the Strategic Plan in Appendix B.
These Goals of this project are:
- Goal 1: To improve the quality of Healthcare and health policy in India through:
- Theme 1: The increased capacity among health professionals (and health policy makers) to understand systematic reviews and their role in evidence-based healthcare and and to conduct systematic reviews to provide evidence for interventions used in health care
- Theme 2: Dissemination of the results of systematic reviews of interventions in health care and evaluation of their usefulness to health professionals, health policy makers and people with health care needs.
- Theme 3: Identification of gaps in evidence requiring systematic reviews or new interventional trials
- Theme 4: Improving the quality of design, conduct and reporting of randomized clinical trials
- Goal 2: To partner the Cochrane Collaboration in its mission of preparing, disseminating and maintaining systematic reviews of the effects of interventions though:
- Theme 1: Building capacity among network sites of the South Asian Cochrane Network (SACN) to undertake training workshops in developing and disseminating evidence from systematic reviews
- Theme 2: Establishing a South Asian Cochrane Network and Centre as an independent Centre of the Cochrane Collaboration with the coordinating Centre at CMC Vellore
- Theme 3: Developing and maintaining a register of controlled clinical trials conducted in the region and contributing the reports of previously unidentified trials to the Cochrane Central Register of Controlled Clinical Trials (CENTRAL)
There two goals and themes have pre-stated activities and with each there are achievement indicators that may be used to evaluate the functioning of the centre and network.
The summary of activities and achievements under this project for the period August 2007 to March 2009 are:
Under the first goal of the project to: To improve the quality of Healthcare and health policy in India through:
- Theme 1: The increased capacity among health professionals (and health policy makers) to understand systematic reviews and their role in evidence-based healthcare and and to conduct systematic reviews to provide evidence for interventions used in health care.
The achievements thus far have been the holding of over 15 introductory workshops in Vellore and other parts of the country where over 1000 people have received information about evidence based healthcare. A symposium in April 2008 at Vellore involving over 600 health professionals, policy makers, editors, consumers and students was a major highlight and an essay competition for undergraduate and postgraduate students in health sciences was well received.
Four Interventional Systematic Review Protocol Development workshops, two Diagnostic Accuracy Systematic Review workshops and two Interventional Systematic Review completion workshops were held during this period that were attended by 124 participants. The feedback from participants were largely positive and they found these workshops helped achieve their learning objectives.
A total of 25 new titles for systematic reviews were registered with the Cochrane Collaboration, 11 protocols for systematic reviews were published and 13 systematic reviews completed and published in The Cochrane Database of Cochrane Reviews in the Cochrane Library during this period, far exceeding the targets set.
The total number of Cochrane Systematic review titles, protocols and reviews with Indian contact authors was 109 by January 2009, with 248 total authors from India, and 413 contributors to the Cochrane Collaboration from India. There are 7 editors of Cochrane Review Groups from India with 2 added over the period of the report.
- Theme 2: Dissemination of the results of systematic reviews of interventions in health care and evaluation of their usefulness to health professionals, health policy makers and people with health care needs.
Achievements: The national provision of the Cochrane Library in Feb 2007 via the subscription purchased by the ICMR has resulted in a massive increase in people accessing and downloading full text articles in 2008 (66,303) over 2006 (9338). This license expires in Jan 2010 and it is hoped that the ICMR will renew the national subscription for this useful and increasingly use resource.
Evidence summaries of Cochrane Systematic Reviews are disseminated to general practitioners and the media on a regular basis. The media now carries many evidence based health articles with the number of media hits of Cochrane reviews increasing rapidly.
- Theme 3: Identification of gaps in evidence requiring systematic reviews or new interventional trials
Achievements: A workshop on Evidence Informed Health Policy brought together Health Policy Makers from the central and state health ministries, the Indian Council of Medical Research, WHO-India, epidemiologists from INCLEN, IndiaCLEN, public health specialists and members of the Cochrane Collaboration to identify and discuss barriers, priorities and strategies to implementing evidence-informed health policy and practice in the country and the South Asian region.
A systematic review on Primaquine for Plasmodium Vivax Malaria helped to change one aspect of the National Malaria Control Guidelines
- Theme 4: Improving the quality of design, conduct and reporting of randomized clinical trials
Achievements: Major achievements have been the active participation in activities encouraging and facilitating the prospective registration of trials, input into the design and process of the trials register, prompting trials registration among clinicians and working with medical journal editors to improve the quality of reporting of RCTs and the prospective registration of clinical trials. Another emphasis has been conducting training in the methods of clinical trials and the research ethics.
Under Goal 2 of the Project: To partner the cochrane collaboration in its mission of preparing, disseminating and maintaining systematic reviews of the effects of interventions through:
- Theme 1: Building capacity among network sites of the South Asian Cochrane Network (SACN) to undertake training workshops in developing and disseminating evidence from systematic reviews.
Achievements: The SACN continues to mentor and train review authors but the proposed capacity building activities are being postponed to Year 3 due to delayed funding.
- Theme 2: Establishing a South Asian Cochrane Network and Centre as an independent Centre of the Cochrane Collaboration with the coordinating Centre at CMC Vellore
Achievements: The major achievement has been the registration of the Prof. BV Moses and ICMR Advanced Centre as an independent Cochrane Centre (The South Asian Cochrane Network & Centre) and one of 13 worldwide.
- Theme 3: Developing and maintaining a register of controlled clinical trials conducted in the region and contributing the reports of previously unidentified trials to the Cochrane Central Register of Controlled Clinical Trials (CENTRAL).
Achievements: An online, searchable, database of controlled clinical trials from the South Asian Region (The South Asian Database of Controlled Clinical Trials) was launched on January 1, 2009 and contains abstracts, citations, and links to over 1000 trials from the South Asian Region that are not accessible from other databases, such as Medline. These records are also made available via CENTRAL in the Cochrane Library. This database will continue to search for trials from the region to ensure that they are made accessible to people worldwide.
The period under review saw 32 publications in national and international, peer reviewed journals from the Prof. BV Moses Centre for Research & Training in Evidence-Informed Healthcare and Health Policy.
Plans for the coming year: include capacity building of network partners; the holding of a symposium on evidence informed health care in January 2010; the starting of educational courses on EBM; working with AYUSH on improving trials in Indian systems of medicine and on systematic reviews of such interventions; and working with health policy makers.
We remain ever grateful to the Indian Council of Medical Research for the support to the centre; the setting up and maintenance of the Clinical Trials Registry, India; and for the National Subscription to the Cochrane Library.