THE COCHRANE THE COCHRANE LIBRARY LIBRARY 教育訓練教育訓練

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THE DERIVATION OF EVIDENCE-BASED MEDICINE

• 1972 Archie Cochrane Conscientious, explicit, and judicious use of current best

evidence in making decisions about individual patients. ~ Archie Cochrane 1972

• 1980 Dacvid L. Sackett

• 1992 NHS

• 1993 Cochrane Collaboration

FIVE STEPS OF PRACTICEEVIDENCE-BASED MEDICINE

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

– PICO

• 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.

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

Wiley publishes the Cochrane Library for the Cochrane Collaboration

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

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”.

Website: www.interscience.wiley.com/cochrane

www.thecochranelibrary.com

The Cochrane Library is a collection of 7 main databases and 1 additional databases that describe Cochrane as an organization. These are:

1. The Cochrane Database of Systematic Reviews (Cochrane Reviews)2. Database of Abstracts of Reviews of Effects (DARE)3. The Cochrane Central Register of Controlled Trials (CENTRAL)4. The Cochrane Database of Methodology Reviews (Methodology Reviews)5. The Cochrane Methodology Register (Methodology Register)6. Health Technology Assessment Database (HTA)7. NHS Economic Evaluation Database (NHS EED)

8. The Cochrane Collaboration and the Cochrane Collaborative Review Groups (About)

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)

The Cochrane Database of Systematic Reviews (Cochrane Reviews)

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 labor 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 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?

• More than 2356 Full Reviews

The Cochrane Database of Systematic Reviews (Cochrane Reviews)

How large is the database?

• More than 1569 Protocols (Reviews in progress)

The Cochrane Database of Abstracts of Reviews of Effects (DARE)

The Cochrane Central Register of Controlled Trials (CENTRAL)

The Cochrane Database of Methodology Reviews (Methodology Reviews)

Health Technology Assessment Database (HTA)

The NHS Economic Evaluation Database (NHS EED)

The Cochrane Methodology Register (Methodology Register )

The Cochrane Collaboration and The Cochrane Collaborative Review Groups (About)

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

Finding Information

Registration

Go To Cochrane Library www3.interscience.wiley.com

An Advanced Search of the Cochrane Library

All text search for the terms: schizo*, drugs, atypical and

antipsychotic.

Searching across all databases in the library.

Searching across all records.

Returns the following results…

An Advanced Search of the Cochrane Library

Use these links to restrict your search results to Reviews only, or Protocols only.

Save or edit your search using these links.

Toggle between results listed for the different databases in the Cochrane Library here

Reference Linking

MeSH (Medical Subjects Heading Search)

Add search qualifiers.

Select the MeSH tree you wish to search.

Use the Thesaurus to search for MeSH descriptors

Search Tips

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

Your combined search will then come up in your Search History. Click it to run it.

Search History

The combined search (#1 AND #2) returns results across all the databases.

Exporting Citations

Displaying the Cochrane Reviews Odds-Ratio diagrams and tables

Who benefits from the Cochrane Library?

Health Professionals at all levels, Health Researchers, Health Policy Makers, Care givers, the Pharmaceutical Industry, and patients.

Strengths of The Cochrane Library on Wiley InterScience.

• Browse and searching functionality is customized to the needs of those working with clinical trials. Achieved through deep consultation and testing with Cochrane Review Groups and longstanding users of TCL.

• All of the component databases are loaded and done so in a timely fashion quarterly.

• The Wiley InterScience interface is structured and easy to read.• Wiley InterScience has extensive linking including CrossRef linking. • Wiley InterScience alerting provides users automatic updates in their chosen

area.• Wiley InterScience includes a comments and criticism function allowing the

user to communicate feedback with the Cochrane Review Groups.

THANK YOU!