Title: THE DERIVATION OF EVIDENCEBASED MEDICINE
1THE 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
2FIVE 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.
3THE 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
4WHAT 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.
5WHAT 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
6The Cochrane Database of Systematic Reviews (CDSR)
7The 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.
8The 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.
9The Cochrane Database of Systematic Reviews (CDSR)
How large is the database?
- More than 2356 Full Reviews
- More than 1569 Protocols (Reviews in
progress)
10The Cochrane Database of Abstracts of Reviews of
Effects (DARE)
11The Cochrane Central Register of Controlled
Trials (CENTRAL)
12The Cochrane Database of Methodology Reviews
(Methodology Reviews)
13Health Technology Assessment Database (HTA)
14The NHS Economic Evaluation Database (NHS EED)
15The Cochrane Methodology Register (CMR)
16The Cochrane Collaboration and The Cochrane
Collaborative Review Groups
17Finding Information
The Cochrane Library has many features that make
finding the information that youre after fast
and accurate
18Registration
19Go To Cochrane Library
20An 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.
21An 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.
22Reference Linking
23MeSH (Medical Subjects Heading Search)
Use the Thesaurus to search for MeSH descriptors
Add search qualifiers.
Select the MeSH tree you wish to search.
24Search Tips
25Search 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.
26Exporting Citations
27Displaying the CDSR Odds-Ratio diagrams and tables
28Who benefits from the Cochrane Library?
- Health Professionals at all levels, Health
Researchers, Health Policy Makers, Care givers,
the Pharmaceutical Industry, and patients.
29Strengths 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.
30Talk to us today about access to The Cochrane
Library