|A/Prof Julian Elliott speaking at the Commonwealth|
Health Minister's award function in June 2017
For some 30 years, international literature about medical and scientific research topics worldwide has been critically reviewed, summarised and distilled for all to use in what are called ‘systematic reviews’. But with an exponential growth in research, about 7% of these reviews are out-of-date on the day they’re published as the field has moved on, while 25% are out-of-date within two years.
Head of Clinical Research in the Department of Infectious Diseases, Associate Professor Julian Elliott, is behind a push for a better model to make sense of this “data deluge”. He and his team are trialing what he has termed ‘living systematic reviews’ (LSR), enlisting methods including online platforms, artificial intelligence and ‘citizen science’ to improve efficiency in the production of the reviews.
“Essentially, it’s just the idea of maintaining the rigour and trustworthiness of the systematic review method but keeping it constantly up to date,” A/Prof Elliott said. “Around 4,000 research articles are published every day. It can take a team a couple of years to summarise an area using the conventional model – we know from previous research that a field can move on substantially within that period.”
Systematic reviews are used to make decisions on health care from the level of consumers wanting information about a particular treatment to governments deciding whether they should fund a particular project or approve a particular drug.
“By using the new model we can dramatically reduce the time it takes for research to translate into practice and impact on the health system and improve health outcomes,” he said.
A/Prof Elliott – who has been interested in developing better ways of managing health data since his time working as an HIV doctor in Cambodia in the mid-2000s – began developing the idea of a living systematic review with colleagues a few years ago, publishing a paper on the concept in ‘PloS Medicine’ in early 2014. He has since established a network of nearly 200 researchers who are supporting the scheme.
“Initially people were very interested and intrigued; the momentum has been building very strongly since then,” he said. Four more papers on the topic have recently appeared in the ‘Journal of Clinical Epidemiology’ providing more detailed guidelines.
In June, A/Prof Elliott won the 2017 Commonwealth Health Minister’s Award for Excellence in Health and Medical Research on the basis of this work. Much of it has been undertaken with Cochrane Australia where he is Senior Research Fellow and Lead for Evidence Systems. Cochrane is a global leader in systematic reviews, overseeing a network of more than 30,000 researchers conducting them.
A/Prof Elliott is heading a major Cochrane project called Project Transform, co-funded by the NHMRC, which is using technology including machine learning and text mining, and crowd sourcing or ‘citizen science’ in which the public helps process articles for inclusion into systematic reviews. The ‘Cochrane Crowd’ has proved highly successful in this, processing more than one million published records and identifying more than 30,000 reports of clinical trials, he said.
At present LSRs are most appropriate for topics meeting the following criteria: when the research is of high priority and may change policy or practice decisions; is about a subject where there is uncertainty among the research evidence; and is in an area where research is emerging rapidly. Examples include the use of a new treatment for arthritis, a second line treatment of advanced lung cancer, and the large amount of research concurrently being conducted into the Zika virus.
A/Prof Elliott’s team is also developing ‘living guidelines’ to take research through to practice. “We’re talking about translating research into action in weeks not years,” he said.
Elliott JH, Turner T, Clavisi O, Thomas J, Higgins JP, Mavergames C, Gruen RL. Living systematic reviews: an emerging opportunity to narrow the evidence-practice gap. PLoS Med. 2014 Feb 18;11(2):e1001603. doi: 10.1371/journal.pmed.1001603. eCollection 2014 Feb.
Elliott JH, Synnot A, Turner T, Simmonds M, Akl EA, McDonald S, Salanti G, Meerpohl J, MacLehose H, Hilton J, Tovey D, Shemilt I, Thomas J; Living Systematic Review Network. Living systematic review: 1. Introduction-the why, what, when, and how. J Clin Epidemiol. 2017 Nov;91:23-30. doi: 10.1016/j.jclinepi.2017.08.010. Epub 2017 Sep 11.
Thomas J, Noel-Storr A, Marshall I, Wallace B, McDonald S, Mavergames C, Glasziou P, Shemilt I, Synnot A, Turner T, Elliott J; Living Systematic Review Network. Living systematic reviews: 2. Combining human and machine effort. J Clin Epidemiol. 2017 Nov;91:31-37. doi: 10.1016/j.jclinepi.2017.08.011. Epub 2017 Sep 11.
Simmonds M, Salanti G, McKenzie J, Elliott J; Living Systematic Review Network. Living systematic reviews: 3. Statistical methods for updating meta-analyses. J Clin Epidemiol. 2017 Nov;91:38-46. doi: 10.1016/j.jclinepi.2017.08.008. Epub 2017 Sep 11.
Akl EA, Meerpohl JJ, Elliott J, Kahale LA, Schünemann HJ; Living Systematic Review Network. Living systematic reviews: 4. Living guideline recommendations. J Clin Epidemiol. 2017 Nov;91:47-53. doi: 10.1016/j.jclinepi.2017.08.009. Epub 2017 Sep 11.