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"Evidence-Based Medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research."
Centre for Evidence-Based Medicine, University Department of Psychiatry, Warneford Hospital, Headington, Oxford
Cochrane Collaboration is a not-for-profit international organization established in 1993 that aims to help people make well-informed decisions about health by preparing, maintaining and promoting access to systematic reviews of the effects of healthcare interventions.The Cochrane Library is the main output of the Collaboration, updated quarterly and distributed on an annual subscription basis via the Internet through Wiley Interscience. www.cochrane.org
What is the Cochrane Library?
The Cochrane Library is an evidence-based medicine literature search tool serving as a gateway to reports on clinical trials, systematic reviews and meta-analyses of clinical data. It is designed to provide information and evidence to support decisions of health care professionals and to inform those receiving the care. It is updated four times a year and was first published in 1996. About 300 new reviews and protocols are added each year. Reviews are kept up-to-date to account for new information. Some reviews and protocols get withdrawn, usually due to lack of activity or update. There is a key for the status of the reviews and protocols. (see Sample Review below)
What is included in the Cochrane Library?It is a collection of databases that enables users to make informed choices about treatment (is one intervention more effective that another) and prevention (how do we reduce the risk of a disease) options and to find out about the Cochrane Collaboration.
The Cochrane Database of Systematic Reviews (CDSR) contains 2000+ full-text reviews and 1400+ full-text protocols (reviews in progress). A systematic review identifies an intervention for a specific disease or other problem in health care, and determines whether or not this intervention works. Authors (adhering to a strict design to be comprehensive, minimize bias, and ensure reliability) locate, appraise and synthesize evidence from as many relevant scientific studies as possible. They summarize conclusions, so that others can easily review the primary studies for any intervention.
2.The Cochrane Database of Abstracts of Reviews of Effects (DARE) includes structured abstracts of systematic reviews from around the world which have been evaluated by reviewers at the National Health Service Centre for Reviews and Dissemination in the U.K. Only reviews that meet minimum quality critieria are included. These reviews cover topics yet to be addressed in Cochrane Reviews.
3.The Cochrane Central Register of Controlled Trials (CENTRAL) do not contain the full-text of the articles but the details of published articles taken from bibliographic databases, and other published and unpublished sources. Central records contain the article's bibliographic information and in many cases a summary. Trials are identified from multiple sources.
4.The Cochrane Database of Methodology Reviews (CDMR) contains Cochrane methodology reviews and protocols which are full-text systematic reviews of methodological studies. Each review covers a specific and well-defined area of methodology. Data from studies are often combined statistically to increase the power of the findings of the numerous studies which on their own may be too small to produce reliable results. In such cases, the review may also include graphs presenting the data from each individual study. Protocols provide place-markers for reviews which are currently being written. They summarize the background and rationale of the review.
5.Health Technology Assessment Database (HTA) contains information on healthcare technology assessments giving details of ongoing projects and completed publications from health technology assessment organizations. Records do not contain the full-text of the report but publication details and structured abstracts where available.
6.NHS Economic Evaluation Database (NHS EED)contains structured abstracts of articles describing economic evaluations of healthcare interventions found through searching key medical journals, bibliographic databases and less widely available literature. Articles are included if they provide a comparison of treatments and examine both the costs and outcomes of the alternatives. Also included are other articles examining relevant topics and studies originally published in the Department of Health Register of Cost-Effective Studies. Records do not contain the full-text of the original article.
7.About the Cochrane Collaboration contains a list of articles that provide more information about the Collaboration, including details on the Steering Group, Fields, Methods Groups, Networks and Centers/Centres.
8.List of Review Groups gives all the Cochrane Review Groups and links to information about the group, including their editorial base, the range of topics the group covers, a list of contributors, sources of funding and how to contact them.
Sample review:
An example of a Cochrane Review can be seen here
A key for the status of reviews is:
R = a full review, complete with results and discussion, meta-analysis and an odds-ratio diagram for the review.
P = a protocol which is the outline of a review in preparation, including the background, rationale and methods.
Comment = a full review that also contains commentary/criticism. Readers can submit comments which are incorporated into the review together with answers and feedback from the review authors.
New = a new protocol or review that has been published in the most recent quarter.
Update = a review that has been updated in the most recent quarter.
Withdrawn = a review or protocol that has been withdrawn, usually due to lack of activity or update. Reasons for withdrawal are specified in the article.
How to search?
Advanced Search
Following the Search Tips on the right hand side of the screen, you can select boolean operators (and, or, not) from the pulldown selection boxes or enter directly into the search boxes. You can further restrict your search by selecting field(s) such as Author, Record Title, etc. from the pulldown selection box. You can search for exact phrase(s) by enclosing with quotation marks. You can search all of the Cochrane Library (this is the default mode) or by database; by record status; by date range or year (see below).
Truncation
You can use an asterisk (*) as a wildcard character. Example: carcino* matches carcinogen, carcinoma, etc.
Navigating around an article
When you open a document in the Cochrane Library, it is displayed in frames. The title will tell you the status of the article. Header materials includes the DOI (digital object identifier), when the article was first published, the date of the most recent substantive amendment, and the information needed to cite it. A Table of Contents (TOC) for the article appears on the left of the screen. You can go directly to the section of the article that you want to look at using these links. You can choose to export the citation for this article from the TOC. If there are figures and tables associated with the article, you can also link to them. You can link to primary material cited when you are in the References/Bibliography section of the article by clicking on links next to the cited article. An integral feature of the Cochrane Database of Systematic Reviews is the odds-ratio figures provided for each review. These diagrams provide a clear and concise visual representation of the analyses of results for each trial included in a review, each outcome considered and any meta analysis of the trials data. Use the links to Figures and Tables to display the pop-up screens of these features. A very useful training guide on interpreting these diagrams is available at http://www.york.ac.uk/inst/crd/clibsec3.pdf Click on the "Show Statistical Analysis" link to view an interactive version of the diagram. This will display a screen that allows you to manipulate how you want the data to be displayed.
How to browse?
You can BROWSE the different databases separately: Cochrane Reviews, DARE, CENTRAL, Methodology Reviews, HTA, NHS EED, About, Topics and get an alphabetical title list from which you can make your choice.
How to email, print or save?
There are no special icons for emailing, printing or saving. Please use appropriate web browser icons for emailing and saving. For printing, select the pdf format and use the Acrobat Reader printer icon to print the pages you want.
How to cite Cochrane Reviews?
Using the appropriate citation style (e.g. APA), use the information provided to properly cite a Cochrane Review:
Example: This record should be cited as: Hróbjartsson A, Gøtzsche PC. Placebo interventions for all clinical conditions. The Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD003974. DOI: 10.1002/14651858.CD003974.pub2.
How to export citations?
To export citations for your reference management databases (e.g. EndNote), select which records you would like citations exported from by clicking on the boxes next to them. If you want to export all on that page, click the "Select All" option at the bottom of the page. After selecting all to export, there is no restriction on the number of citations exported, click the "Export Selected Citations" button. A pop up box appears prompting you to select your Format, Export Type and File Type from the drop down boxes. You will be prompted to either open or save the file.
