SEARCHING EVIDENCE THROUGHTHE COCHRANE LIBRARY

prepared by Literature Searching TeamLibrary, Faculty of Medicine, UGM

2012

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• Evidence-based medicine

• Evidence-based practice

• Types of clinical questions

• Formulating answerable clinical questions using PICO approach

• What to look for?

• Searching evidence through The Cochrane Library

• Other EBM resources

OUTLINE

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• Evidence-based medicine (EBM) is the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimum clinical care to patients. (Rosenberg W., Donald A. “Evidence-based medicine: an approach to clinical problem solving”, in BMJ 1995; 310: 1122-1126.)

Evidence-based: conclusions based on best available evidence

WHAT IS EVIDENCE BASED MEDICINE?

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Clinical Expertise

EachIndividual

Patient

BestAvailable

Resources

ELEMENTS OF EVIDENCE BASED PRACTICE

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FORMULATE CLEAR CLINICAL QUESTIONS*

SEARCH FOR THE EVIDENCE*

APPRAISE THE EVIDENCE

APPLY THE RESULTS TO CLINICAL PRACTICE

EVALUATE THE IMPACT ON PRACTICE

* Focus of the session

STEPS OF EVIDENCE BASED PRACTICE

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Therapy or Intervention – treatments to patients that - do more good than harm- are worth the efforts and costs

of using them

Prognosis – patient’s likely clinical course over a time and complications of the disorder

Etiology – causes or risk factors of disease

Diagnosis - possible causes of patient’s clinical problems

CLINICAL QUESTIONS CENTRAL ISSUES IN CLINICAL WORKS

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• Ask a question that you would like answered from the literature

Example:Is artesunate better than quinine for treating children with severe malaria?

ASKING A CLINICAL QUESTION

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• P : Patient, Population, Problem

• I : Intervention

• C : Comparison, Comparator

• O : Outcome

PICO APPROACH

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Type of question : THERAPY

Reformatted question:

In children with severe malaria is artesunate more effective than quinine in reducing malaria severity?

REFORMATTING THE QUESTION USING PICO APPROACH

P : children with severe malaria

I : artesunate

C : quinine

O : reduction of malaria severity

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FROM QUESTION TO SEARCH TERMS

Search Terms Alternatives

Patientchildrenmalaria

infants

Intervention artesunate

Comparator quinine

Outcomereduction of malaria severity

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COMBINING SEARCH TERMS

Note: Please refer to Module 1 (Introduction to Literature Search) for search tools to use in formulating a search phrase

Combined search terms or search phrase for reformatted clinical question:

“In children with severe malaria is artesunate more effective than quinine in reducing malaria severity?”

will be: (child* OR infant*) AND malaria AND artesunante AND quinine

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WHAT TO LOOK FOR?

The paper where someone trustworthy has

already answered our question!

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PRIMARY RESEARCH VS SECONDARY RESEARCH

Primary research research undertaken to address a question

Secondary research research undertaken to find the existing primary research that addresses a question

e.g. reviews (systematic, narrative) and meta-analyses

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x

v

NARRATIVE REVIEW VS SYSTEMATIC REVIEW

• Narrative review A narrative review discusses and summarises the literature on a particular topic, without generating any pooled summary figures through meta-analysis.(http://www.nhs.uk/news/Pages/Newsglossary.aspx)

• Systematic review A systematic review is a critical assessment and evaluation of all research studies that address a particular clinical issue.(http://effectivehealthcare.ahrq.gov/index.cfm/glossary-of-terms/?pageaction=showterm&termid=7)

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THE COCHRANE LIBRARY (TCL) A KEY EBM RESOURCE

The Cochrane Library (named after Archie Cochrane) is a collection of databases in medicine and other healthcare specialties provided by the Cochrane Collaboration and other organisations. At its core is the collection of Cochrane Reviews, a database of systematic reviews and meta-analyses which summarize and interpret the results of medical research. The Cochrane Library aims to make the results of well-conducted controlled trials readily available and is a key resource in evidence-based medicine.

(http://en.wikipedia.org/wiki/Cochrane_Library)

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• The Cochrane Database of Systematic Reviews (Cochrane Reviews)

• The Database of Abstracts of Reviews of Effects (DARE)

• The Cochrane Central Register of Controlled Trials (CENTRAL)

• The Cochrane Methodology Register (Methodology Register)

• Health Technology Assessment Database (HTA)

• NHS Economic Evaluation Database (NHS EED)

CONTENTS OF TCL

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THE COCHRANE LIBRARY

Access is unlocked for subscribers

Simple search option

Advanced search option

www.thecochranelibrary.com

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Search boxes for search terms/phrases

DISPLAY OF ADVANCE SEARCH OPTION

Database in TCL

Search tips to guide searches

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SEARCHING THROUGH ADVANCED SEARCH OPTIONPUTTING SEARCH PHRASE IN THE SEARCH BOX

Search phrase:(child* OR infant*) AND malaria AND artesunate AND quinine

Search in all text

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SEARCH RESULT

46 records matched with the search phrase

Click to display search results

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DISPLAY OF SEARCH RESULTS

There are 22 Cochrane Reviews, 2 Other Reviews, and 22 Trials (46 records)

Click to view abstract

Search phrase

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DISPLAY OF ABSTRACT

Options for full article in HTML and PDF format

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DISPLAY OF FULLTEXT IN PDF FORMAT

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OTHER EBM RESOURCES

The following are some other EBM resources:

• BMJ Clinical Evidence – www.clinicalevidence.bmj.com/

• National Institute for Health and Clinical Excellence - www.nice.org.uk/

• NHS Evidence - www.evidence.nhs.uk/

• National Guideline Clearinghourse – public resource for evidence-based clinical practice guideline – www.guideline.gov/

• AAOS Evidence-based Clinical Practice Guideline - www.aaos.org/research/guidelines/guide.asp

• PubMed Clinical Queries - http://www.ncbi.nlm.nih.gov/pubmed/clinical/

• Centre for Evidence-Based Medicine - www.cebm.net/

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• Access to full text of reviews in TCL is available within medical campus

• When you are off campus and need the full text reviews, please contact library staff

END NOTES

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This Power Point Presentation is compiled by

Team of Literature Searching

Library Faculty of Medicine, UGM.