The cochrane library an introduction for rheumatologists - 17 feb 2014


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  • - Archie was an advocate of randomized controlled trials- Pioneer of evidence based medicine- Cochrane reviews are recognised as the ‘gold standard’ in evidence-based health care- A collection of healthcare databases
  • Listed in order of usage
  • But before we get to that – I will outline the main contents of the Cochrane Library. It’s good value – actually 6 databases in 1. 5 are databases of synthesized material, meaning they have been through a review process.
  • Here is the home page of the Cochrane Library – some of you may access the Cochrane Library through OVID – but for this webinar I will be talking about the features available on the Web version. Even if you don’t have access to the full text of Cochrane reviews some other features are available.
  • Cochrane Library also includes other systematic reviews, non Cochrane, recognizing the value in systematic reviews no matter where they are published.
  • The Cochrane Central Register of Controlled Trials (CENTRAL), which is the most comprehensive source available for controlled trials.In 2011, CENTRAL included over 650,000 records of randomized and quasi-randomised trials of interventions. It incorporates all the records of these trials that have been identified to date from both MEDLINE and Embase. It also includes the results of additional searching for eligible trials done by all the Cochrane Review Groups, including searching other databases, handsearching of individual journals, etc. Historical articles which may be trials but not indexed as such.
  • Useful for health care policymakers, administrators
  • There is a database about research method – unique resource and useful for academic library users.
  • Likewise – cost is not the focus of Cochrane reviews but is important to decision making in most settings.
  • There are several ways that Cochrane reviews can help inform decision making, depending who the audience is.
  • Now for the value added features and the exciting developments of disseminating reviews widely.
  • Less than 5 min in length. Includes a short interview with the author, usually in a question and answer format – you can better understand the rationale and context of the review
  • Very useful in a hospital or teaching hospital – practical way to use cochrane for CME or for trainees
  • Many clinical questions could potentially be answered by one cochrane review – CCA breaks the information down into sections that answer common clinical questions.
  • Also to help support self-directed learning – efficient as it is based on systematic review so give the users a complete view of a problem and solution.
  • Reflects the popularity of new devices and their use by health care practitioners.
  • The search functionality of Cochrane continues to improve, these are new features added just in the last 6 months. –As some of you know, one search covers all 6 databases, so it is also very efficient.
  • I have not covered the practicalities of searching – Wiley provides detailed online training in many aspects of the Cochrane Library. I am happy to make these slides available after the webinar.
  • Similarly – there are webinars about the work being done in the Cochrane Collaboration. Cochrane Canada has a webinar series and a number of training events that may be if interest to you as a patient, or a librarian.
  • There are a number of ways to become involved in cochrane and to learn more about the Library and the Collaboration. 2 ways that are imporatnat to librarians are discussed here. First CLUG – world-wide membership but based in toronto.
  • Once again, I thank you for join us today and happy to answer questions or be contacted after the session.
  • Also thanks to people who helped with this presentation. Some materials used in this presentation have been developed by the Australasian Cochrane Centre and Canadian Cochrane Centre(flip back to contact slide)
  • The cochrane library an introduction for rheumatologists - 17 feb 2014

    1. 1.
    2. 2. Archie Cochrane The Cochrane Collaboration is named in honour of Archie Cochrane, a British medical researcher who contributed greatly to the development of epidemiology as a science. He is best known for his influential book, Effectiveness and Efficiency: Random Reflections on Health Services, published in 1972. The Gold Standard The Cochrane Library contains high-quality, independent evidence to inform healthcare decision-making from Cochrane and other systematic reviews, clinical trials, and more. Cochrane reviews bring together the combined results of the world’s best medical research studies, which are recognised as the gold standard in evidence-based health care. The Library consists of a collection of healthcare databases, providing access to articles reviewing the effects of healthcare interventions.
    3. 3. What is a Systematic review? A systematic review identifies an intervention for a specific disease or other problem in health care, and determines whether or not this intervention works More than 5,000 now online
    4. 4. The output of the Cochrane Collaboration are systematic reviews. These are published in the Cochrane Library
    5. 5.
    6. 6. The Databases 1. Cochrane Database of Systematic Reviews (Cochrane Reviews) 2. Central Register of Controlled Trials (Clinical trials) 3. Database of Reviews of Effects (Other reviews) 4. Health Technology Assessment Database (Technology Assessments) 5. Methodology Register (Methods Studies) 6. NHS Economic Evaluation Database (Economic Evaluations) + About The Cochrane Collaboration and the Cochrane Collaborative Review Groups
    7. 7. • Cochrane Reviews • Other Systematic Reviews • Trials – Cochrane Central • Methods Studies • Technology Assessments • Economic Evaluations 6 databases in 1
    8. 8.
    9. 9. 9 The Cochrane Database of Systematic Reviews (CDSR) • The database that contains all the Cochrane Reviews • Issue 12, 2013 of CDSR (December): 8,190 TOTAL RECORDS: • Comprises 5804 full reviews and 2386 protocols. – in html & PDF format • Updated daily – (new publish-when-ready model launched in 2013)
    10. 10. • DARE • Called ‘Other Reviews’ in the search results • Sometimes accompanied by assessment or commentary Database of Abstracts of Reviews of Effects
    11. 11. Cochrane Central Register of Controlled Trials • Called CENTRAL or (Trials in your search results) • RCTs and quasi-RCTs • includes MEDLINE and Embase records • records from other databases, hand-searching journals, and conference proceedings. CENTRAL 650,000 records MEDLINE 375,000 Embase 55,000 Other 220,000
    12. 12. • Also called (Technology Assessments) • Example: Pressure ulcer prevention: pressure ulcer risk assessment and prevention, including the use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care (Structured abstract) • National Institute for Clinical Excellence. 2003 Health Technology Assessment Database
    13. 13. • (Methods Studies) • Reviews of research methods or ‘what works in research’. • Example: How effects on health equity are assessed in systematic reviews of interventions Vivian Welch , Peter Tugwell , Mark Petticrew et al. Cochrane Methodology Register
    14. 14. • Cost and Cost benefit analysis are part of these reports • Example: Cost-effectiveness of total knee arthroplasty in the United States: parient risk and hospital volume • Losina E , Walensky RP , Kessler CL , Emrani PS , Reichmann WM , Wright EA , Holt HL , Solomon DH , Yelin E , Paltiel AD and Katz JN Archives of Internal Medicine, 2009, 169(12), 1113-1121 NHS Economic Evaluation Database (Economic Evaluations)
    15. 15. Why systematic reviews? • efficient way to access the body of research – saves time required for searching – critical appraisal – interpretation of results • explore differences between studies • reliable basis for decision making – unbiased selection of relevant information – useful for health care, policy, future research
    16. 16. • SRs are important to: – Practitioners – to determine if an intervention is effective in a given situation – Consumers – to weigh potential benefits and harms of alternative courses of care – Policy makers – to help make choices intended to maximize health for society How can reviews inform practice?
    17. 17. 17 When would you search the Cochrane Library? • What is the effective treatment of y? • What is the effective treatment of y in condition x? • Is treatment y better than treatment z? • What is the accuracy of a diagnostic text ‘x’? Boagey, Paul. Using the Cochrane Library. University of Southampton Library, November 2007.
    18. 18. 18 When NOT to use the Cochrane Library • General health care information: prognosis, etiology, epidemiology... • Incidence and prevalence of a condition • Mechanism of action of a drug or technology • Needs assessment studies Boagey, Paul. Using the Cochrane Library. University of Southampton Library, November 2007.
    19. 19. • Clinical Problem • Question formulation • Searching the Cochrane Library Using the Cochrane Library
    20. 20. • From clinical problem to answerable question Question formulation (PICO):
    21. 21. A searchable question • Break your question down into concepts: P I C O • Population • Intervention • Comparison • Outcome
    22. 22. Your query… You notice at a rheumatology meeting that views are polarised about whether low-dose prednisolone has a place in early rheumatoid arthritis. You wonder what is the evidence that prednisolone reduces joint damage?
    23. 23. PICO Population = early RA Intervention = low dose glucocorticoids Comparison = placebo or active controls Outcome = radiological progression
    24. 24. • What are the PICO elements in the following case? • 5 min Case #1 Paul
    25. 25. Case study: Paul, age 55, has OA of the knees. Paul, 55 years old, came to his doctor seeking advice for a 3-year history of progressively worsening pain in both knees. His knees were stiff for about 20 minutes when he woke up in the morning. He could not walk > 30 minutes because of pain, and his symptoms were worsened by kneeling, squatting, or descending stairs. Although sitting and resting relieved the pain, he became stiff if he stayed in one position for too long. His brother thought he should try acupuncture because of a positive report in a newspaper article.
    26. 26. • • 15 min • What review did you find? • Did you find any other results? Finding your answer in the Cochrane Library
    27. 27. • What are the PICO elements in the following case? • 5 min Case #2 Barbara
    28. 28. Case Study: Barbara, age 59, faces a decision of whether to take Alendronate to prevent a future bone fracture. While on holiday Barbara fell and broke her arm and left shoulder. Her arm was put in a sling and she was given painkillers. When she came back home, her doctor referred her for an X-ray which showed she had multiple fractures in her arm and shoulder. Since the fractures seemed excessively severe for the type of fall she had, her doctor arranged a bone density test and examination by a specialist. She was told she was at high risk of having another fracture and should take Alendronate to prevent this.
    29. 29. • • 15 min • What review did you find? • Did you find any other results? Finding your answer in the Cochrane Library
    30. 30. What to consider when reading a review… Do the studies address a sensible clinical question? Do the studies possess high quality designs and methods? Are the results from the studies similar or widely different? Are the conclusions drawn consistent with the method employed? Are all relevant and important outcomes considered? How do the results apply to the care of my patients?
    31. 31. Three broad issues to consider… • Is the review valid? • What are the results? • Will the results help my patients?
    32. 32. Is the review valid? • systematic review methods vary • quality of reporting may vary • caveat emptor: up to you to decide
    33. 33. Is the review valid? • clearly focused question (PICO) • inclusion of relevant, high quality studies • comprehensive and reproducible search strategy • ‘a priori’ method for assessing quality of included studies
    34. 34. • Some people find systematic reviews unwieldy, too technical, and inaccessible. • New features aim to make the messages in Cochrane reviews clear and easier to use in decision-making. New formats to disseminate review results
    35. 35. Podcasts from The Cochrane Library Essential audio summaries of key reviews More than 250 Podcasts available for download Podcasts include key new reviews, most accessed reviews and key topics Download or listen to the latest podcasts online at
    36. 36. ■ Read the original review article for FREE ■ Podcasts: download or listen online ■ PowerPoint Slides: download or view online ■ Interactive: ask the authors a question and receive a reply ■ Discussion Points: what are the questions you should be asking as you read this paper? Cochrane Journal Club “If you are running a journal club, or interested in doing so, we provide the materials to help you plan a session concentrating on an important, practice changing, Cochrane Review.” -Dr David Tovey, Editor-in-Chief
    37. 37. Cochrane Clinical Answers ■ A point-of-care clinical support tool for busy health professionals ■ Distills high-quality evidence from Cochrane systematic reviews into practical answers to common clinical questions ■ Designed to mimic the way health professionals gather information ■ New questions continually added to ensure broad coverage across a range of medical topics ■ Available now for purchase by Cochrane Library subscribers
    38. 38. ■ A suite of online learning activities designed for health care professionals ■ Learning activities are based upon high-quality evidence from Cochrane systematic reviews ■ Reflective evaluation encourages practice change ■ Meets the rigorous accreditation standard of the ACCME* ■ Launching in 2013 *Accreditation Council for Continuing Medical Education Cochrane Learning
    39. 39. ■ Access a monthly selection of specially curated Cochrane Reviews via The Cochrane Library iPad Edition ■ Each issue includes a selection of new and recently updated reviews specially abridged for iPad users ■ Includes podcasts, Slide decks and Cochrane Editorials ■ Monthly issues automatically download to your Newsstand ■ FREE app available in iTunes Cochrane iPad Edition
    40. 40. New Search Tools The Cochrane Library’s new search interface launched September 15. Highlights of the new search features include: ■ Auto-suggest features within both basic and MeSH search functions ■ Updated display of search results and filtering options ■ Ability to view search terms and results on the same page ■ Ability to insert lines and add one search to another ■ Improved MeSH look-up feature ■ Hover-over Tool Tips
    41. 41. Online Training Monthly instructor-led training sessions with a focus on how to search The Cochrane Library Navigate your browser to to register and attend a session Or contact Gavin Stewart at Wiley ( if you require a bespoke session for your team
    42. 42. Cochrane Canada Live Webinar series
    43. 43. • Cochrane Musculoskeletal Group: • Cochrane Back Group: • Cochrane Child Health Field: Ways to get involved:
    44. 44. 44 The Cochrane Library Users’ Group Offers: Answers from the experts A forum for information-sharing An opportunity for feedback To get involved: Or contact Emma Irvin
    45. 45. What to do when there is no Cochrane review
    46. 46. PubMed Clinical Queries
    47. 47. Turning Research into Practice (TRIP) Database
    48. 48. Thank you for joining us today!
    49. 49. Acknowledgements • Based on materials by the Australasian Cochrane Centre and Canadian Cochrane Centre, also with thanks to Wiley. • Thank you to Eileen Vilis, Miranda Cumpston, and Gavin Stewart for help with the slides.