THE COCHRANE THE COCHRANE LIBRARYLIBRARY

ON WILEY ON WILEY INTERSCIENCEINTERSCIENCE

Sophia WuSophia Wu

Senior Account ExecutiveSenior Account Executive

John Wiley & Sons (Asia) Pte LtdJohn Wiley & Sons (Asia) Pte Ltd

• The Cochrane Collaboration is named in honor of Archie Cochrane, a British medical researcher who contributed greatly to the development of epidemiology as a science.

• 1992 the first Cochrane centre in Oxford, UK

• 1993 The Cochrane Collaboration

Professor Archibald Leman Cochrane (1909 - 1988)

• Effectiveness and Efficiency: Random Reflections on Health Services published in 1972.

Five steps of practice Evidence-Based Medicine

• Step 1: Converting the need for information (about prevention, diagnosis, prognosis, therapy, causation, etc.) into an answerable question.

– Patient‧Intervention‧Comparison‧Outcome

• Step 2: Searching the best evidence with which to answer that question.

• Step 3: Critically appraising the evidence for its validity (closeness to the truth), impact (size of the effect), and applicability (usefulness in our clinical practice).

• Step 4: Integrating the evidence with our clinical expertise and patients’ unique biology, values and circumstances.

• Step 5: Evaluating our effectiveness and efficiency in executing steps 1-4 and seeking ways to improve them both for next time.

Oxford Centre for Evidence-based Medicine Levels of Evidence (May 2001)

Level Therapy

1a Systemic review (with homogeneity*) of randomized clinical trials

分析同性質隨機臨床對照試驗所得到的系統性文獻回顧評論

1b Individual randomized clinical trial (with narrow Confidence Interval)

設計良好且結果精確的隨機臨床對照試驗

1c All or none

2a Systemic review (with homogeneity) of cohort studies

分析同性質世代研究所得到的系統性文獻回顧評論

2b Individual cohort study (including low quality randomized clinical trial; e.g., <80% follow-up) 

世代研究 ( 包括設計粗糙的隨機臨床對照試驗 )

2c "Outcomes" Research; Ecological studies 預後研究 ; 生態研究

3a Systemic review (with homogeneity) of case-control studies 

分析同性質病例對照研究所得到的系統性文獻回顧評論

3b Individual Case-Control Study  病例對照研究

4 Case-series (and poor quality cohort and case-control studies)

病例集 ( 包括設計粗糙的世代研究及病例對照研究 )

5 Expert opinion without explicit critical appraisal, or based on physiology, bench research or "first principles" 

尚未經過嚴謹評估 , 或僅根據生理實驗、動物實驗甚或基礎研究所得到的專家意見

Cochrane Reviews are now the “gold standard” for systematic reviews in such key publications as The Lancet, New England Journal of Medicine, British Medical Journal, and the Journal of the American Medical Association and routinely appear there as well as in specialised medical journals for various specialty areas.

What is the Cochrane Library?

Health care in the 21st Century relies not only on individual medical skills, but also on the best information on the effectiveness of each intervention being accessible to practitioners, patients, and policy makers. This approach is sometimes known as “evidence-based medicine”.

Just like any library, the Cochrane Library is a collection of resources. It is the main output of the Cochrane Collaboration and aims to bring together in one place reliable information about the effects of health care treatments or interventions.

Assisting clinicians:

Why do we need the Cochrane Library?

Clinicians are overloaded with information, whether in the form of research reported in journals, mailings from professional groups, policy announcements from government, or promotional literature from pharmaceutical companies.

Over 2 million articles are published annually in some 20,000 biomedical journals – equivalent to a pile of paper 500m high (or nearly Taipei 101 building)! It's estimated that the average general practitioner needs to read 19 articles a day just to keep up-to-date with major developments.

Practitioner level change:

Why do we need the Cochrane Library?

Antibiotics for acute otitis media in children (The Cochrane Database of Systematic Reviews 2004, Issue 1.)

• Cochrane Review Objective: to assess the effects of antibiotics for children with acute otitis media

• Dr Chris Cates Project: Given antibiotics prescription, but advised to wait 1-2 days, use only if symptoms remain

• In 2004, the American Academy of Pediatrics and the American Academy of Family Physicians’ guideline revised to include deferring antibiotics for children with ear infections who are not unduly ill

Developing world change:

Why do we need the Cochrane Library?

Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children (The Cochrane Database of Systematic Reviews 2002, Issue 1.)

• Oral rehydration salts (ORS), a mixture of salt and sugar in water. Prevents or treats dehydration caused by diarrhoea a particularly dangerous condition for children in developing countries that can result in death

• WHO and UNICEF hosted a meeting in 2001 to review the available evidence on an improved ORS formulation

• For every 1 million cases of diarrhoea, could prevent 14,000 deaths and save US$7.1 million

Cochrane Collaboration:

How reliable are the reviews?

The Cochrane Collaboration is supported by hundreds of organisations from around the world, including health service providers, research funding agencies, departments of health, international organisations, industry and universities.

Over 12,000 health professionals, researchers, scientists and consumers from 90 countries contribute to the work of the Cochrane Collaboration.

51 Collaborative Review Groups (CRGs)

9 Fields; 10 Methods Groups

12 regional Cochrane Centres and their branches

Cochrane Review Groups (CRGs)Acute Respiratory Infections Group Airways Group Anaesthesia Group Back Group Bone, Joint and Muscle Trauma Group Breast Cancer Group Colorectal Cancer Group Consumers and Communication Group Cystic Fibrosis and Genetic Disorders Group Dementia and Cognitive Improvement Group Depression, Anxiety and Neurosis Group Developmental, Psychosocial and Learning Problems Group Drugs and Alcohol Group Ear, Nose and Throat Disorders Group Effective Practice and Organisation of Care Group Epilepsy Group Eyes and Vision Group Fertility Regulation Group Gynaecological Cancer Group Haematological Malignancies Group Heart Group Hepato-Biliary Group HIV/AIDS Group Hypertension Group Incontinence Group

Infectious Diseases Group Inflammatory Bowel Disease and Functional Bowel Disorders Group Injuries Group Lung Cancer Group Menstrual Disorders and Subfertility Group Metabolic and Endocrine Disorders Group Methodology Review Group Movement Disorders Group Multiple Sclerosis Group Musculoskeletal Group Neonatal Group Neuromuscular Disease Group Oral Health Group Pain, Palliative and Supportive Care GroupPeripheral Vascular Diseases Group Pregnancy and Childbirth Group Prostatic and Urologic Cancers Group Renal Group Schizophrenia Group Sexually Transmitted Diseases Group Skin Group Stroke Group Tobacco Addiction Group Upper Gastrointestinal & Pancreatic Diseases Group Wounds Group

Canadian

US

Brazilian

South African Australasian

UK

Nordic

DutchGerman

ItalianIberoamerican

South Asian Network

Thai Network

Chinese

The Cochrane Collaboration Logo

The Cochrane Collaboration logo illustrates a systematic review of data from seven randomized controlled trials (RCTs), comparing one health care treatment with a placebo.

This diagram shows the results of a systematic review of RCTs of a short, inexpensive course of a corticosteroid given to women about to give birth too early.

This treatment reduces the odds of the babies of these women dying from the complications of immaturity by 30 to 50 per cent.

The Cochrane Library is a collection of Evidence-Based Medicine databases:

The Cochrane Database of Systematic Reviews (Cochrane Reviews)The Cochrane Database of Reviews of Effects (Other Reviews)The Cochrane Central Register of Controlled Trials (Clinical Trials)The Cochrane Database of Methodology Reviews (Methods Reviews)The Cochrane Methodology Register (Methods Studies)Health Technology Assessment Database (Technology Assessments)NHS Economic Evaluation Database (Economic Evaluations)

It also contains information about The Cochrane Collaboration and the Cochrane Collaborative Review Groups

WHAT IS THE COCHRANE LIBRARY?

The Cochrane Database of Systematic Reviews (Cochrane Reviews)

Reviews address clearly formulated questions such as ‘does fluoride help prevent tooth decay in children’ or ‘can antibiotics help in alleviating the symptoms of sore throat’.

Comprehensive and explicit methods are used to track down, select and determine the quality of relevant research. This includes searches for unpublished and non-English records to provide as complete a picture as possible to try to answer the question considered.

A diagrammatic analysis is also provided in the form of an odds-ratio (OR) diagram. These diagrams reveal, at a glance, whether a treatment is beneficial or not.

What’s so important about it?

The Cochrane Database of Systematic Reviews (Cochrane Reviews)

• More than 2249 Full text Cochrane Reviews (html & PDF format*)

How large is the database?

• More than 1539 Protocols (Reviews in progress)

• All Reviews are regularly updated with the latest evidence

The Cochrane Database of Systematic Reviews (Cochrane Reviews)

* Unique feature not available anywhere else!

Cochrane Reviews are conducted to the highest standard of methodological quality.

They have been found to be of comparable or better quality and are updated more frequently than reviews published in print journals.1

1 Source:Jadad AR, Cook DJ, Jones A, Klassen TP, Tugwell P, Moher M, Moher D. Methodology and reports of systematic reviews and meta-analyses: a comparison of Cochrane reviews with articles published in paper-based journals. JAMA 1998;280:278-280.

Why are the Cochrane Systematic Reviews so important?

Cochrane Reviews – who uses them?

• Physicians, consultants, medical staff• Health care service providers• Policy makers• Media• Members of the public

A reliable source that summarises the best evidence on the effects of a particular healthcare intervention at a particular point in time.

“ Those who say that systematic reviews and meta analyses are not “proper research” are wrong; it is clinical trials done in the absence of such reviews and meta-analyses that are improper, scientifically and ethically. Investigators and organisations who undertake and coordinate reviews and meta-analyses now need the funding and recognition they deserve if public trust in biomedical research is to be maintained and resources used in an effective way.”

Putting clinical trials into context, Charles Young and Richard Horton,

The Lancet 2005; 366:107-108

Database of Abstracts of Reviews of Effects (Other Reviews)

• Contains critical assessments and and structured abstracts of reviews.

• Must meet a minimum quality criteria.

• Cover topics yet to be covered in CDSR.

• For Cochrane reviewers and researchers wanting information on reviews of heath care effects from sources outside the Cochrane Library

Cochrane Central Register of Controlled Trials (Clinical Trials)

•Contains a register of studies which may be relevant for inclusion in Cochrane reviews

• World’s largest database of randomly controlled trials

• For Cochrane reviewers needing to identify studies for a Cochrane review and researchers wishing to identifies studies in a different medical disciplines.

Cochrane Database of Methodology Reviews (Methods

Reviews)

• Contains Methodology reviews and protocols.

• Full-text Reviews examine the benefit of methodological studies – e.g. Does editorial peer-review improve the quality of reports of biomedical studies

The Cochrane Methodology Register (Methods Studies)

• Contains a bibliography of publications which report on methods used in the conduct of controlled trials.

• It includes journal articles, books and conference proceedings, these articles are taken from the MEDLINE database and from hand searches.

• Plus information on the Collaboration and its Review Groups.

Health Technology Assessment Database (Technology

Assessments)

• The HTA database brings together details of completed and ongoing health technology assessments (studies of the medical, social, ethical and economic implications of health care interventions) from around the world. The aim of the database is to improve the quality and cost-effectiveness of health care.

NHS Economic Evaluation Database (Economic Evaluations)

• NHS EED assists decision-makers by systematically identifying economic evaluations from around the world, appraising their quality and highlighting their relative strengths and weaknesses. The database contains over 5000 abstracts of quality assessed economic evaluations.

The Cochrane Library has many features that make finding the information you are after fast and accurate…

Finding Information

An Advanced Search of the Cochrane Library…

“searching for all text schizo*, drugs in All

Fields in All of The Cochrane Library"

An Advanced Search of the Cochrane Library…You can toggle between results listed for the different databases in The Cochrane Library here

Use these links to restrict your search results to Reviews only, or Protocols (reviews in progress) only.

Save or edit your search using these links.

MeSH Term I

醫學圖書館標題表（ Medical Subject Headings ，簡稱 MeSH ）

• 是美國國家醫學圖書館（ U.S. National Library of Medicine ，簡稱 NLM ）針對生物醫學資料所整理出的主題詞彙。美國醫學標題表的制定係對同一概念採用固定的詞彙表達方式，以達到控制詞彙目的，方便生物醫學領域的學者或從業人員彼此間的溝通，更可用以陳述資料內容的主題意涵並提供檢索，這也是美國醫學圖書館費心制定醫學標題表之用意。因此，標題詞彙必需能明確表達主題概念，並都是經過美國國家醫學圖書館內的索引專家考證醫學文獻中最常使用，及專家學者或從業人員認同的詞彙表達方式。若是較少使用的詞彙也會在標題表中出現，並指引至正確的標題詞。索引專家們更在眾多標題詞中建立主題關係連結，除了更突顯標題表的功能外，也能藉由醫學標題表的呈現，讓使用者瞭解生物醫學領域的研究範疇。

• 美國醫學標題表是生物醫學領域中使用最普遍，也是最為重視的標題表。它的制定可協助美國國家醫學圖書館在編目時，做為主題編目選用標目之依據，以為讀者查檢館藏目錄時的檢索點之一。現在，美國醫學標題表更可用以作為期刊論文等不同類型記錄主題分析後所使用的標題詞依據，以方便製成書目資料庫後協助檢索之用，如重要的醫學資料庫 MedLine 並是採用 MeSH 做為主題分析的根據。

• 美國醫學標題表的內容分成兩個部分：字母順序標題表及樹狀結構標題表。

MeSH Term II

( 一 ) 字母順序標題表 (Alphabetic List)

字母順序標題表是將所有的醫學標題以字母順序排列呈現，並佐以交互參照 (cross-references) ，這也是一般標題表最常使用的呈現方式。在 Cochrane Library 中 MeSH提供的交互參照為 : see∕X 。

標題表中以“ see” 及“ X” 連結者，表示兩詞彙為同義詞關係，其中一個為標題詞，而另一個則為其同義詞。

( 二 ) 樹狀結構標題表 (Tree Structures)

• 樹狀結構標題表是將所有標題詞分類呈現，並建立每個類別內標題詞間的層級關係。樹狀結構標題表將標題詞分成 15 大類（如分類 A ： Anatomy 、分類 B ： Organisms ），每個大類下又分成多個次類，每個次類下亦分成多個小類目……，最多分至九個層級。這些分類同時亦以英文字母及數字呈現，可更加方便顯示各標題詞間的分類層級。• 樹狀結構標題表中可顯示每個分類的層級關係。最上層顯示者，表示該標題詞所代表的主題意涵較廣，而愈下層顯示者，則表示該標題詞所代表的主題意涵愈為專指。如此上下標題層級的呈現方式，更可比擬為各標題詞間的廣義詞（ broad terms ）及狹義詞（ narrow terms ）關係。樹狀結構標題表的階層關係透過代碼的解讀將更為清楚。

MeSH Tree Structure

MeSH vocabulary is organized by 15 main branches:

A. AnatomyB. OrganismsC. DiseasesD. Chemical and DrugsE. Analytical, Diagnostic and Therapeutic Techniques and EquipmentF. Psychiatry and PsychologyG. Biological SciencesH. Physical SciencesI. Anthropology, Education, Sociology and Social PhenomenaJ. Technology and Food and BeveragesK. HumanitiesL. Information ScienceM. PersonsN. HealthcareO. Geographic Locations

MeSH (Medical Subjects Heading Search)

Use the Thesaurus to search for MeSH descriptors

MeSH (Medical Subjects Heading Search)

Use the Go To Mesh Trees to view a tree structure of related terms

Search History

Select Search History. To combine searches, enter their number together with Boolean operator of choice – in this case AND.

Search History

Your combined search will then come up in your Search History.

Saved Searches

1. Searching by field label is now available

2. Searches can now be saved to a user's desk-top in a Word or other document

3. The display of search results has also been further improved

4. Simplified searching for hyphenated terms has been refined (e.g. searching evidence retrieves the terms evidence based and evidence-based)

5. Search terms are no longer case sensitive (e.g. searching for Liver retrieves both the terms Liver and liver)

6. Improved author searching - recognition of accents and umlauts in authors' names.

Cochrane Search Enhancements on Wiley InterScience

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