Archie Cochrane ???????????????????,??????????????,?? Cochrane Collaboration ???????????????

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????????????

• ???
• 2011.04.19

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? ?

• ??????
• ???????????

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Professor Archibald Leman Cochrane, CBE FRCP
FFCM, (1909 - 1988)

• Archie Cochrane ???????????????????,??????????????
  ,?? Cochrane Collaboration ???????????????

• 1972??????- Effectiveness and Efficiency Random
  Reflections on Health Services ???????????
• ????????,??????????????????????
• ?????????(Randomised Controlled Trials,
  RCTs)???,???????????

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??????

• 1979 -gt Archie Cochrane ?????????????????,????????
  ????????,??????????????,???????????

• 1980 -gt ???????????? David Sackett
  ????????????????????????,???????,???????????????

• 1992 -gt ?????? Cochrane??? National Health
  Service (NHS)???????????,?????????????????????????
  ????,?????????????????????????????????

• 1993 -gt Cochrane Collaboration ????

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???????? ????(3E)
Best research evidences
EBM
Clinical expertise
Patient expectations
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??????

• ?????????,???????
• ???????????????????,???????????????????????,??????
  ??,????????,??????????
• http//www.wanfang.gov.tw/ebm/02_ebm/01_intro.htm

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???????????

• ?????????????????
• ???? (background question) v.s. ???? (foreground
  question)
• Patient, ???????????????
• Intervention, ??????????, ????????
• Comparison intervention, ????????????,
  ???????????????
• Outcome ?????, ???????????????
• ?????????
• ??????????????
• ??????????
• ??????????????

?????? ??????????? ?????????
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Oxford Center for Evidence-based Medicine Levels
of Evidence (May 2001)
Level Therapy
1a ????? Systematic review, ???? Meta analysis (????????????, ??????)
1b ????, ???? ????????? (Randomized Controlled Trial ,RCT)
1c All or none
2a ????? (????????, ??????)
2b ???? Cohort study ?????????????
2c "Outcomes" Research Ecological studies
3a ????? (??????-????, ??????)
3b ?? - ???? Case-control study
4 ????????? ????????? ??? - ????
5 ???????????, ????, ????, ????, ???????
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?????????????????????

• Systemic Review
• ??????????????????????????(Meta-Analysis????)
• Non-Systemic Review
• ???????????????,???????????

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??????

• ?????
• ?????? SR,RCT.
• ????
• ??????????????????????

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5S Levels
Systems
Evidence-based textbooks UpToDate, Clinical
Evidence
Prefiltered
Summaries
Evidence-based journal abstracts ACP Journal
Club.
Synopses
Systematic Reviews The Cochrane Library
Syntheses
Studies
Original journal article PubMed
Unfiltered
Modified from R Brain Haynes et al. ACP Journal
Club Nov/Dec 2006 Vol 145 Number 34A8-A9.
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?????????

• Guidelines
• Health Technology Assessment (HTA)
• UpToDate
• The Cochrane Library
• PubMed
• Ovid Medline

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??????
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?????????

• OVID Medline ????
• -- ???? vs. ???? (MeSH)
• -- Explode Focus
• -- Mapping
• -- ????? (adj, adv, near)
• -- ??
• -- ???? (search feedback)
• - ???????????????????
• - Major MeSH ? Pubmed related ??

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?????

• ?????? MeSH ??
• ?????????Subject Headings,????????????
• ????????Subject Headings ????????????????????Subje
  ct Headings???
• Neoplasms

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?????

• ??????
• ????
• ??????(title)???(abstract)??????(registry number
  word)?mesh??, ??????????????????????
• Tumor,Cancer,Carcinoma,Neoplasms

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MESH??-Cancer
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MESH-Explode/Focus
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MESH-scope
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MESH Tree
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????????????
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????

• ?????
• ADJ????????,?????????????,?????????????,?????????
  ?
• NEAR/XX??????????????,??????????????????
• ??Truncation
• ??(STEMMING)?? renal tubul,?? renal tubules,
  renal tubular????
• in OVID Medline
• in Pubmed

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????????? The Lancet?New England Journal of
Medicine?British Medical Journal and the Journal
of the American Medical Association ???? Cochrane
Reviews ?????????????? (gold standard
),???????????????????????
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WHAT IS THE COCHRANE LIBRARY?
The Cochrane Library is a collection of
Evidence-Based Medicine databases

• The Cochrane Database of Systematic Reviews
  (Cochrane Reviews)
• The Cochrane Database of Reviews of Effects
  (Other Reviews)
• The Cochrane Central Register of Controlled
  Trials (Clinical Trials)
• The Cochrane Methodology Register (Methods
  Studies)
• Health Technology Assessment Database (Technology
  Assessments)
• NHS Economic Evaluation Database (Economic
  Evaluations)
• It also contains information about The Cochrane
  Collaboration and the Cochrane Collaborative
  Review Groups

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Cochrane Database of Systematic Reviews (Cochrane
Reviews)

• ?????????????????????????????,?????????????(52????
  ???)
• ??????????????????????????????????????????????????
  ?????????????,??????????????????,?????????????????
  ??
• ?????????????,?????????????????????????,??????????
  ?,??????????????
• 2010??????????????
• ?? 4,152? Reviews? 1,924????? Protocols (February
  2010)

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Cochrane Review Groups (CRGs)
Cochrane Infectious Diseases Group Cochrane
Inflammatory Bowel Disease and Functional Bowel
Disorders Group Cochrane Injuries Group Cochrane
Lung Cancer Group Cochrane Menstrual Disorders
and Subfertility Group Cochrane Metabolic and
Endocrine Disorders Group Cochrane Methodology
Review Group Cochrane Movement Disorders
Group Cochrane Multiple Sclerosis Group Cochrane
Musculoskeletal Group Cochrane Neonatal
Group Cochrane Neuromuscular Disease
Group Cochrane Oral Health Group Cochrane Pain,
Palliative and Supportive Care Group Cochrane
Peripheral Vascular Diseases Group Cochrane
Pregnancy and Childbirth Group Cochrane Prostatic
Diseases and Urologic Cancers Group Cochrane
Public Health Group Cochrane Renal Group Cochrane
Schizophrenia Group Cochrane Sexually Transmitted
Diseases Group Cochrane Skin Group Cochrane
Stroke Group Cochrane Tobacco Addiction
Group Cochrane Upper Gastrointestinal and
Pancreatic Diseases Group Cochrane Wounds Group
Cochrane Acute Respiratory Infections
Group Cochrane Airways Group Cochrane Anaesthesia
Group Cochrane Back Group Cochrane Bone, Joint
and Muscle Trauma Group Cochrane Breast Cancer
Group Cochrane Childhood Cancer Group Cochrane
Colorectal Cancer Group Cochrane Consumers and
Communication Group Cochrane Cystic Fibrosis and
Genetic Disorders Group Cochrane Dementia and
Cognitive Improvement Group Cochrane
Depression, Anxiety and Neurosis Group Cochrane
Developmental, Psychosocial and Learning Problems
Group Cochrane Drugs and Alcohol Group Cochrane
Ear, Nose and Throat Disorders Group Cochrane
Effective Practice and Organisation of Care
Group Cochrane Epilepsy Group Cochrane Eyes and
Vision Group Cochrane Fertility Regulation
Group Cochrane Gynaecological Cancer
Group Cochrane Haematological Malignancies
Group Cochrane Heart Group Cochrane
Hepato-Biliary Group Cochrane HIV/AIDS
Group Cochrane Hypertension Group Cochrane
Incontinence Group
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Database of Abstracts of Reviews of Effects
(Other Reviews)

• DARE??????????????????????????????????,?????????
• ????????????????,???????????????????
• ???????????????????? 3000??????????,??????????????
  ????????????????
• ????????????(University of York)? Centre for
  Reviews and Dissemination (CRD) ???
• ?? 11,887??? (February 2010)

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Cochrane Central Register of Controlled Trials
(Clinical Trials)

• ????MEDLINE?EMBASE?????,??????????????????????????
  ????????????????????,???????
• ????????????MEDLINE???,???????????????????????????
  
• ????????????????????
• ??608,405??? (February 2010)

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Cochrane Methodology Register (Methods Studies)

• ?????????????????????????
• After the Womens Health Initiative
  decision making and trust of women taking hormone
  therapy. ??????????????????
• ?? ???2002?7?WHI???????????????????
• ????????????????????????MEDLINE???????
• ?????????????? (????),????????????,???????????
• ?? 12,778??? (February 2010)

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Health Technology Assessment Database
(Technology Assessments)

• ?????????????? (???????) ???,?????????????????????
  ???????,???????????,????????????
• ??????????????????
• ????????????(University of York)? Centre for
  Reviews and Dissemination (CRD)
  ???,????????INAHTA???????????
• ?? 7,724??? (February 2010)

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NHS Economic Evaluation Database (Economic
Evaluations)

• ???????????????,??????????????????
• ??????????????????????,?????????????????
• ?? 5000?????????????????
• ????????????(University of York)? Centre for
  Reviews and Dissemination (CRD) ???
• ?? 28,159??? (February 2010)

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????
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??

• ??hypothermia????comatose cardiac
  arrest??,????standard normothermic????????????????
  ?

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????therapy

• Pcardiac arrest
• I hypothermia
• Cstandard normothermic management
• Omore favorable neurological outcome, reduction
  in mortality

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UpToDate
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The Cochrane Library
????
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The Cochrane Library
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The Cochrane Library
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The Cochrane Library
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The Cochrane Library
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The Cochrane Library
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PubMed
? ??Clinical Queries
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PubMed
v
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PubMed
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Ovid Medline
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Ovid Medline
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• ??????

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The necessary of surgery for asymptomatic
intestinal malrotation

• ??????????
• ???? X??????????
• ??????,???????
• ???????????????
• ????? PICO
• - Population
• - Intervention
• - Comparison
• - Outcome

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Advanced Search - Example
???? ?????????, ???????????????,
???????????,??????????????????????????
?????? (PICO) Patient ?? Intervention
????? Comparison Outcome ???????
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Advanced Search - Example
?????????????(???????????????????????????DOI?)????
????????????,?? wild card (???)???????(AND?OR?NOT
), ????????????????,???????????? ?????
antibiotic ? otitis ? (??????)
?????????, ????????????????????????? Search All
Text ??????????? All of The Cochrane Library"
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??????????????
?????The Cochrane Library???????????,????????????
??????????????,????????????????????
Reviews ???????????????????? Protocols
reviews?????(????),?????????? Comment
???????????????????,??????????????????? New
???????????protocol?review Updated ?????????????
(?????????) Withdrawn ????review?protocol,???????
????????? Conclusions changed Review????????? Maj
or change protocol ?????????????????
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Advanced Search Example (MeSH Search)
?? Go To MeSH Tree ?????????????
?? Thesaurus ???? MeSH ???
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Advanced Search Example (MeSH Search)
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Search Results
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Full Text
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• Antibiotics for acute otitis media in children
  (The Cochrane Database of Systematic Reviews
  2004, Issue 1.)
• Cochrane Review Objective to assess the effects
  of antibiotics for children with acute otitis
  media
• Dr Chris Cates Project Given antibiotics
  prescription, but advised to wait 1-2 days, use
  only if symptoms remain
• In 2004, the American Academy of Pediatrics and
  the American Academy of Family Physicians
  guideline revised to include deferring
  antibiotics for children with ear infections who
  are not unduly ill

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QA?