BACKGROUND

One of the Cochrane Collaboration (CC) key principles is to promote access to the Cochrane Systematic reviews. Globally, less than 10% of the Cochrane Reviews are authored by people based in a developing country1. Many topics relevant to the developing world and addressing problems that affect large populations in these countries remain neglected. Without greater involvement of authors and consumers from developing countries, the Cochrane Collaboration will not be able to achieve its objective of promoting evidence based practice.

OBJECTIVES

To document the efforts of Journal of Pakistan Psychiatric Society (JPPS) in disseminating the Cochrane Systematic Reviews (CSR) and to present the results of publishing the abstracts of CSR over the last four years. We also aim to identify appropriate strategies for creating awareness about Cochrane Collaboration and recommend a framework promoting evidence based practice in developing countries.

METHODS

A search and review of JPPS since its inception in2004 for the articles related to evidence based medicine and abstracts of CSR published in a regular feature as ‘‘Cochrane Corner’’. These abstracts were accompanied by critical comments by the editor and associate editor of the journal.

RESULTS

JPPS published abstracts of 13 Cochrane systematic reviews during this period. These covered following topics,

1. Antidepressant prevention of postnatal depression

2. Antipsychotic drugs for non affective psychosis during pregnancy and postpartum

3. Pharmacotherapy for post traumatic stress disorder (PTSD)

4. Psychosocial interventions for conversion disorder

5. Meditation therapy for anxiety disorders

6. Psychosocial and pharmacological treatments for deliberate self harm

7. Aripiprazole for schizophrenia

8. Interventions for preventing depression after stroke

9. Interventions to reduce weight gain in schizophrenia

10. Exercise in prevention and treatment of anxiety and depression among children and young people

11. Drugs versus placebo for dysthymia

12. Marital therapy for depression

13. Behavioral and cognitive behavioral therapy for obsessive compulsive disorder in children & adolescents

The comments accompanying these CSR written by editor and associate editor of the journal helped to put these reviews in context of practice in developing countries.

In the inaugural issue, a Guest Editorial that highlighted the relationship between Cochrane Collaboration and JPPS was published. Articles on evidence based practice, relevance of evidence based guidelines in developing countries and critical reviews related to common problems in developing countries were published.

DISCUSSION

This brief article aims to summarize the experiences in dissemination of CSR from a journal platform. The Journal of Pakistan Psychiatric Society is a nascent journal which has played a pioneering role in promoting evidence based practice and CSR in Pakistan. The ‘‘Cochrane Corner’’ proved to be popular regular feature with the readers. This was appreciated by readers not only in developing countries but also, by its wide readership, in many developed countries where the journal is disseminated.

Encouraged by feedback from the readers, number of other articles were also published which helped to highlight the methodology and role of systematic reviews in Evidence Based Medicine (EBM). As the journal is also available free full text online, www.jpps.com.pk, it has helped to disseminate the message very widely.

The feedback from the readers was very encouraging. Many readers commented with a pleasant surprise that a journal from developing country has taken this initiative. Number of readers appreciated the comments accompanying the CSR. One of the most useful aspects identified by research workers was that the CSR abstracts and accompanying comments helped to identify the gaps in evidence which could be used by the researchers to formulate appropriate research questions for Randomised Controlled Trials Effective dissemination of CSR is essential for promoting evidence based practice in developing countries.

A similar strategy is adapted by Chinese Journal of Evidence-Based Medicine (CJEMB). It is interesting to note that recently Schizophrenia Bulletin, an international journal published from a high income country (UK) has also started publishing the Cochrane Corner as a regular feature.

The institutional, cultural and structural dimensions of developing countries vary and the issues involved are complex2 and no single strategy will be effective for one country. One of the strategy used in China was to organize a group of professional consumers such as medical and English major students, editors, public health researchers, librarians and active patients. Although the number of consumers involved remained low but the strategy was found to be useful.

Our experience suggests that publishing regular feature in a scientific journal is highly effective strategy in promoting evidence based practice in developing countries and increasing the level of practitioner’s knowledge in EBM. However, as this journal is limited to mental health professionals, the impact of these publications remains largely limited.

The Cochrane Collaboration and other organizations promoting evidence based practice should provide institutional support for this. Providing expertise in selecting suitable CSRs and comments on these reviews by the expert reviewers/editors which can help to highlight the significance and relevance of the CSR for practice in developing countries can help to overcome the misconception that the systematic reviews and EBM are not relevant to developing countries. With suitable support, many journals in developing countries can adopt this strategy and this can provide an inexpensive form of promoting access to Cochrane Collaboration outputs.

CONCLUSIONS

Local journals can help to disseminate the evidence based summaries in developing countries. The Cochrane Collaboration and other organizations promoting evidence based practice should provide institutional support and actively encourage the publishers of journals from developing countries to publish evidence based summaries.

ACKNOWLEDGEMENTS

The authors would like to thank Prof. Prathap Tharayan for assistance and encouragement in publication of ‘‘Cochrane Corner’’. He also contributed a special article on the subject.

REFERENCES

1. Crewe E, Young J. Bridging research and policy: context, evidence and links. Working paper 173, Overseas Development Institute, 111 Westminster Bridge Road, London SE1 7JD UK.

2. Zhang M. Dissemination evidence by journals: making the medical journals as readable, reliable and accessible information resource for consumers. Cochrane Collaboration, Colloquia, Abstracts, Ottawa 2004.

3. Zhang M, Liu X. How far away for consumers in developing countries involving in the Collaboration? The experience of the consumer work in China. Cochrane Collaboration, Colloquia, Abstracts, Ottawa 2004.