THE DERIVATION OF EVIDENCEBASED MEDICINE

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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

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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.

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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

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WHAT IS THE COCHRANE LIBRARY
The Cochrane Library is the single most reliable
source for evidence on the effects of healthcare.
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.
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WHAT IS THE COCHRANE LIBRARY?
The Cochrane Library is a collection of 7 main
databases and 1 additional databases that
describe Cochrane as an organization. These are

• The Cochrane Database of Systematic Reviews
  (CDSR)
• The Cochrane Database of Reviews of Effects
  (DARE)
• The Cochrane Central Register of Controlled
  Trials (CENTRAL)
• The Cochrane Database of Methodology Reviews
  (CDMR)
• Health Technology Assessment Database (HTA)
• NHS Economic Evaluation Database (NHS EED)
• THE COCHRANE METHODOLOGY REGISTER (CMR)
• About The Cochrane Collaboration and the Cochrane
  Collaborative Review Groups

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The Cochrane Database of Systematic Reviews (CDSR)
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The Cochrane Database of Systematic Reviews (CDSR)
Whats so important about it?
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.
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The Cochrane Database of Systematic Reviews (CDSR)
What sort of healthcare questions are addressed?
What magnitude of risk reduction when a patient
with Coronary Heart Disease stops smoking?
People who quit smoking after a heart attack or
cardiac surgery reduce their risk of death by at
least one third.
Does the use of hydrolysed formulas for infant
feeding prevents allergy and food intolerance?
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.
Does having a friend for support present during
labor and childbirth impact on a womans
experience?
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.
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The Cochrane Database of Systematic Reviews (CDSR)
How large is the database?

• More than 2356 Full Reviews

• More than 1569 Protocols (Reviews in
  progress)

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The Cochrane Database of Abstracts of Reviews of
Effects (DARE)
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The Cochrane Central Register of Controlled
Trials (CENTRAL)
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The Cochrane Database of Methodology Reviews
(Methodology Reviews)
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Health Technology Assessment Database (HTA)
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The NHS Economic Evaluation Database (NHS EED)
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The Cochrane Methodology Register (CMR)
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The Cochrane Collaboration and The Cochrane
Collaborative Review Groups
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Finding Information
The Cochrane Library has many features that make
finding the information that youre after fast
and accurate
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Registration
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Go To Cochrane Library
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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.
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An Advanced Search of the Cochrane Library
Toggle between results listed for the different
databases in the Cochrane Library here
Returns the following results
Save or edit your search using these links.
Use these links to restrict your search results
to Reviews only, or Protocols only.
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Reference Linking
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MeSH (Medical Subjects Heading Search)
Use the Thesaurus to search for MeSH descriptors
Add search qualifiers.
Select the MeSH tree you wish to search.
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Search Tips
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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 come up in your
Search History. Click it to run it.
The combined search (1 AND 2) returns results
across all the databases.
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Exporting Citations
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Displaying the CDSR Odds-Ratio diagrams and tables
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Who benefits from the Cochrane Library?

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

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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.

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