What Is The Cochrane Library?

The Cochrane Library is the single most reliable source for evidence on the effects of health care.

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 known as “evidence-based medicine”.

What Is The Cochrane Library?

The Cochrane Library provides information and evidence to

support decisions taken in health care and to inform those

receiving care.

THE COCHRANE COLLABORATION

Wiley publishes the Cochrane Library for The Cochrane Collaboration

• Structure - established as an international organisation in 1993, registered as a charity in the U.K.

• Aim - to help people make well-informed decisions about health care.

• How - by preparing and maintaining, and promoting access to, systematic reviews of the effects of healthcare interventions.

• Publishing Output – The Cochrane Library

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

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

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

WHAT IS THE COCHRANE LIBRARY?

More than 3298 Full text Cochrane Reviews (html & PDF format*)

The Cochrane Database of Systematic Reviews

How large is the Cochrane Reviews database?

More than 1755 Protocols (Reviews in progress)

All Reviews are regularly updated with the latest evidence

* Unique feature not available anywhere else!

The authors of a systematic review identify an intervention for a specific disease or other problem in health care, and then ask whether or not this intervention works. In order to do this they locate, appraise and synthesise evidence from as many relevant scientific studies as possible.

They summarise conclusions about effectiveness, and provide a unique collation of the known evidence on a given topic, so that others can easily review the primary studies for intervention.

What is a Systematic Review?

The Cochrane Database of Systematic Reviews (Cochrane reviews)

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?


What magnitude of risk reduction when a patient with Coronary Heart Disease stops smoking?

Does the use of hydrolysed formulas for infant feeding prevents allergy and food intolerance?

Does having a friend for support present during labour and childbirth impact on a woman’s experience?

People who quit smoking after a heart attack or cardiac surgery reduce their risk of death by at least one third.

When babies are not exclusively breastfed, using hydrolysed infant formulas instead of ordinary cow's and soy milk formulas can reduce allergies in babies and children.

Yes. Continuous labour support reduces a woman's likelihood of having pain medication, increases her satisfaction and chances for 'spontaneous' birth, and has no known risks.

What sort of healthcare questions are addressed? …thousands!

Cochrane reviews address clearly formulated questions such as ‘does fluoride help prevent tooth decay in children’ or ‘can antibiotics help in alleviating the symptoms of a 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 diagram. These diagrams reveal, at a glance, whether a treatment works or not.

What is so important about it?


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?


Also includes:

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

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.

Source: Chart by Paul Glasziou

Database of Abstracts of Reviews of Effects - DARE (Other Reviews)

• DARE is the worlds largest database of quality assessed systematic reviews. The database:

•Contains 5,000 quality assessed and critically appraised systematic reviews on the effects of interventions used in health and social care

•Includes short bibliographic references to systematic reviews which are in the process of being assessed or having abstracts written

•Is produced by the Centre for Reviews and Dissemination (CRD) at the University of York, UK.

http://www.york.ac.uk/inst/crd/


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 identify studies in a different medical

disciplines.

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 from over 40 HTA agencies around the world.

•Health technology assessments are evaluations of any treatments, procedures,

interventions or configuration of health services that are or could be used in

health care.

•The abstracts in the database are descriptive rather than analytical and do not

form critical appraisals of the reports.

• The HTA database is produced by the

Centre for Reviews and Dissemination (CRD) at the University of York, UK, UK in

collaboration with the INAHTA Secretariat, based at SBU, Sweden.


NHS Economic Evaluation Database (Economic Evaluations)

Health care decision makers need easy access to reliable information about the

costs as well as the effects of interventions to inform their decisions. The

database:

Includes economic evaluations from around the world,

Contains over 5,000 quality abstracts of quality assessed economic evaluations

Includes short bibliographic references to economic evaluations which are in the

process of being assessed or having abstracts written

NHS EED is produced by the Centre for Reviews and Dissemination (CRD) at the

University of York, UK.


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

Finding Information

“searching for all text schizo, drugs, atypical

and antipsychotic. in All Fields in The

Cochrane Database of Systematic Reviews"

An Advanced Search of the Cochrane Library…

… Returns the following results:

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.

An Advanced Search of the Cochrane Library…

MeSH (Medical Subjects Heading Search)

Let us look at an example

Use the Thesaurus to search for MeSH descriptors


Or use qualifiers.


Search History

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

Your combined search will then appear in your Search History.

Search History

Who benefits from the Cochrane Library?

Health Professionals at all levels, Health Researchers, Health Policy Makers, Care Givers and patients.

FORMATS

• Online via Wiley InterScience - Basic Access License (1 license for 1 user at a time)

• Online via Wiley InterScience - Enhanced Access License (multiple users)

• Online via Wiley InterScience - Personal License (1 private address for 1 user only)

• Online via Wiley InterScience – Regional/National Site Licenses (Residents in a number of countries can access The Cochrane Library for free through a ‘national provision’ or License)

• CD-ROM - institutional• CD-ROM - personal

Strengths of The Cochrane Library on Wiley InterScience.

• Browse and search functionality is customised to the needs of those working with clinical trials. Achieved through deep consultation and testing with Cochrane Review Groups and longstanding users of The Cochrane Library.

• Documents are available in both html and PDF formats• All the component databases are updated every three months.• The Wiley InterScience interface is structured and easy to read.• Wiley InterScience has extensive linking including Crossref linking. • Wiley InterScience alerting service provides users automatic updates in their

chosen area.• Wiley InterScience includes a comments and feedback function to allow users

to communicate with the Cochrane Review Groups.

What next?

Now Science Citation Index listed

ISI Impact Factor early 2008, based on 2005/06/07 data