Prioritisation: focusing our work on the questions and outcomes that matter to patients

New: COVID-19 pandemic 2020

The 2020 COVID-19 pandemic has presented enormous challenges for healthcare systems globally. In Cochrane ENT, we have prioritised and fast-tracked reviews to inform the evidence base during and beyond the crisis:

Antimicrobial mouthwashes and nasal sprays

In collaboration with Cochrane Oral Health we have produced three systematic reviews on the use of antimicrobial mouthwashes and nasal sprays to protect healthcare workers and patients from COVID-19 infection:

These reviews will be regularly updated as data from the clinical studies currently in progress become available.

Prevention and treatment of anosmia

As it has become clear that olfactory dysfunction/anosmia (disorder of the sense of smell) is a common and sometimes persistent symptom of COVID‐19 infection, Cochrane ENT has prioritised a set of living systematic reviews on the prevention and treatment of olfactory dysfunction following COVID-19 infection. Work on the reviews began in September 2020 and the first versions of these living systematic reviews can be read in the Cochrane Library:

We are now working on the first updates of these living systematic reviews, which will be completed shortly. We will also be completing a companion systematic review of ‘Interventions for the treatment of post-viral anosmia’ to capture other evidence that might helpfully inform treatment of patients with this symptom. We are grateful to the National Institute for Health Research (NIHR themed call - COVID-19: Recovery and Learning) for funding this work.

Prioritisation in ENT

It is increasingly important that we focus our efforts on the right topics for new reviews and updates, in the context of 'fewer, better reviews'. Cochrane globally is being encouraged to work more strategically to meet the needs of our funders and stakeholders. Cochrane ENT is working to prioritise our future workplan by carrying out scoping exercises in key topic areas followed by suites of prioritised reviews.

Scoping - a new approach for prioritising Cochrane ENT reviews

In 2016, Cochrane ENT was commissioned by NIHR to identify areas of priority for new evidence syntheses and updates in patients with chronic rhinosinusitis and to conduct these reviews. We approached this request by developing an innovative prioritisation process, which was based on a formal scoping project undertaken by a professional systematic reviewer in association with clinical experts. This resulted in the prioritisation of an initial six topics on the medical management of chronic rhinosinusitis for new Cochrane reviews. The chronic rhinosinusitis scoping project involved assessment of existing Cochrane and other reviews, comprehensive searches to estimate the amount of new evidence available and extensive discussion with, and input from, clinicians. We found this process to be a highly efficient way of developing these new reviews, as it allowed us to base all of them on an optimal, shared protocol with a well-designed and consistent set of outcome measures. Some older reviews in the Cochrane Library were also superseded by the new reviews and replaced.  

A scoping project on chronic suppurative otitis media, led by a team in Australia, is now complete with the first new reviews published in 2019.

A similar scoping project on tinnitus, led by the NIHR Nottingham Hearing BRC, has also been conducted with the first reviews published in 2018.

Our current scoping prioritisation projects are on:

Future scoping areas may include:

  • Allergic rhinitis
  • Voice
  • Otitis externa
  • Epistaxis

In addition, to ensure that we focus on the most important reviews we consult with our editorial panel, look at which reviews feature in clinical practice guidelines, monitor our top cited and accessed reviews, and keep abreast of other prioritisation work in ENT in general, such as the GENERATE project.

Cochrane globally also maintains a list of priority review topics. We have 4 on the list, all of which are now in progress:

  • Aural toilet (ear cleaning) for chronic suppurative otitis media
  • Systemic antibiotics for chronic suppurative otitis media
  • Topical versus systemic antibiotics for chronic suppurative otitis media
  • Topical antibiotics with steroids for chronic suppurative otitis media