The cochrane library an introduction for rheumatologists - 17 feb 2014

www.thecochranelibrary.com


Archie CochraneThe Cochrane Collaboration is named in honour of Archie Cochrane, a British medical researcher who contributed greatly to the development of epidemiology as a science.

He is best known for his influential book, Effectiveness and Efficiency: Random Reflections on Health Services, published in 1972.

The Gold StandardThe Cochrane Library contains high-quality, independent evidence to inform healthcare decision-making from Cochrane and other systematic reviews, clinical trials, and more. Cochrane reviews bring together the combined results of the world’s best medical research studies, which are recognised as the gold standard in evidence-based health care.

The Library consists of a collection of healthcare databases, providing access to articles reviewing the effects of healthcare interventions.

http://www.thecochranelibrary.com/


What is a Systematic review?

A systematic review identifies an intervention for a specific disease or other

problem in health care, and determines whether or not this intervention works

More than 5,000 now online



The output of the Cochrane Collaboration are systematic reviews.

These are published in the Cochrane Library




The Databases

1. Cochrane Database of Systematic Reviews (Cochrane Reviews)

2. Central Register of Controlled Trials (Clinical trials)

3. Database of Reviews of Effects (Other reviews)

4. Health Technology Assessment Database (Technology Assessments)

5. Methodology Register (Methods Studies)

6. NHS Economic Evaluation Database (Economic Evaluations)

+ About The Cochrane Collaboration and the Cochrane Collaborative Review Groups



• Cochrane Reviews• Other Systematic Reviews• Trials – Cochrane Central• Methods Studies• Technology Assessments• Economic Evaluations

6 databases in 1


www.thecochranelibrary.com9

The Cochrane Database of Systematic Reviews (CDSR)• The database that contains all the Cochrane Reviews• Issue 12, 2013 of CDSR (December):

8,190 TOTAL RECORDS:• Comprises 5804 full reviews and 2386 protocols. – in html & PDF format

• Updated daily – (new publish-when-ready model launched in 2013)


• DARE• Called ‘Other Reviews’ in the search results • Sometimes accompanied by assessment or

commentary

Database of Abstracts of Reviews of Effects


Cochrane Central Register of Controlled Trials• Called CENTRAL or (Trials in your search results)• RCTs and quasi-RCTs• includes MEDLINE and Embase

records• records from other

databases, hand-searching journals, and conference proceedings.

CENTRAL650,000 records

MEDLINE375,000

Embase55,000

Other

220,000


• Also called (Technology Assessments)• Example:

Pressure ulcer prevention: pressure ulcer risk assessment and prevention, including the use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care (Structured abstract)

• National Institute for Clinical Excellence. 2003

Health Technology Assessment Database

http://onlinelibrary.wiley.com/o/cochrane/clhta/articles/HTA-32003001248/frame.html






• (Methods Studies)• Reviews of research methods or ‘what works

in research’.• Example:

How effects on health equity are assessed in systematic reviews of interventions Vivian Welch , Peter Tugwell , Mark Petticrew et al.

Cochrane Methodology Register

http://onlinelibrary.wiley.com/doi/10.1002/14651858.MR000028.pub2/abstract

http://onlinelibrary.wiley.com/doi/10.1002/14651858.MR000028.pub2/abstract


• Cost and Cost benefit analysis are part of these reports

• Example: Cost-effectiveness of total knee arthroplasty in the United States: parient risk and hospital volume

• Losina E , Walensky RP , Kessler CL , Emrani PS , Reichmann WM , Wright EA , Holt HL , Solomon DH , Yelin E , Paltiel AD and Katz JN Archives of Internal Medicine, 2009, 169(12), 1113-1121

NHS Economic Evaluation Database (Economic Evaluations)

http://onlinelibrary.wiley.com/o/cochrane/cleed/articles/NHSEED-22009102311/frame.html








Why systematic reviews?• efficient way to access the body of research– saves time required for searching– critical appraisal– interpretation of results

• explore differences between studies• reliable basis for decision making– unbiased selection of relevant information– useful for health care, policy, future research


• SRs are important to:– Practitioners – to determine if an intervention is

effective in a given situation– Consumers – to weigh potential benefits and

harms of alternative courses of care– Policy makers – to help make choices intended to

maximize health for society

How can reviews inform practice?


When would you search the Cochrane Library?• What is the effective treatment of y?• What is the effective treatment of y in

condition x?• Is treatment y better than treatment z?• What is the accuracy of a diagnostic text ‘x’?

Boagey, Paul. Using the Cochrane Library. University of Southampton Library, November 2007. http://www.soton.ac.uk/library/subjects/sonm/pptcochranenov2007.ppt

http://www.soton.ac.uk/library/subjects/sonm/pptcochranenov2007.ppt


When NOT to use the Cochrane Library

• General health care information: prognosis, etiology, epidemiology...

• Incidence and prevalence of a condition• Mechanism of action of a drug or technology• Needs assessment studies

Boagey, Paul. Using the Cochrane Library. University of Southampton Library, November 2007. http://www.soton.ac.uk/library/subjects/sonm/pptcochranenov2007.ppt

http://www.soton.ac.uk/library/subjects/sonm/pptcochranenov2007.ppt


• Clinical Problem

• Question formulation

• Searching the Cochrane Library

Using the Cochrane Library


• From clinical problem to answerable questionQuestion formulation (PICO):


A searchable question

• Break your question down into concepts:P I C O

• Population• Intervention• Comparison• Outcome


Your query…You notice at a rheumatology meeting that views are polarised about whether low-dose prednisolone has a place in early rheumatoid arthritis.You wonder what is the evidence that prednisolone reduces joint damage?


PICO

Population = early RAIntervention = low dose glucocorticoids Comparison = placebo or active controlsOutcome = radiological progression


• What are the PICO elements in the following case?

• 5 min

Case #1 Paul


Case study: Paul, age 55, has OA of the knees.

Paul, 55 years old, came to his doctor seeking advice for a 3-year history of progressively worsening pain in both knees. His knees were stiff for about 20 minutes when he woke up in the morning. He could not walk > 30 minutes because of pain, and his symptoms were worsened by kneeling, squatting, or descending stairs. Although sitting and resting relieved the pain, he became stiff if he stayed in one position for too long. His brother thought he should try acupuncture because of a positive report in a newspaper article.


• www.cochranelibrary.com• 15 min• What review did you find?• Did you find any other results?

Finding your answer in the Cochrane Library

http://www.cochranelibrary.com/


• What are the PICO elements in the following case?

• 5 min

Case #2 Barbara


Case Study: Barbara, age 59, faces a decision of whether to take Alendronate to prevent a future bone fracture.

While on holiday Barbara fell and broke her arm and left shoulder. Her arm was put in a sling and she was given painkillers. When she came back home, her doctor referred her for an X-ray which showed she had multiple fractures in her arm and shoulder. Since the fractures seemed excessively severe for the type of fall she had, her doctor arranged a bone density test and examination by a specialist. She was told she was at high risk of having another fracture and should take Alendronate to prevent this.


• www.cochranelibrary.com• 15 min• What review did you find?• Did you find any other results?

Finding your answer in the Cochrane Library

http://www.cochranelibrary.com/


What to consider when reading a review…

Do the studies address a sensible clinical question?

Do the studies possess high quality designs and methods?

Are the results from the studies similar or widely different?

Are the conclusions drawn consistent with the method employed?

Are all relevant and important outcomes considered?

How do the results apply to the care of my patients?



Three broad issues to consider…• Is the review valid?• What are the results?• Will the results help my patients?


Is the review valid?• systematic review methods vary• quality of reporting may vary• caveat emptor: up to you to decide


Is the review valid?• clearly focused question (PICO)• inclusion of relevant, high quality studies• comprehensive and reproducible search strategy• ‘a priori’ method for assessing quality of included

studies


• Some people find systematic reviews unwieldy, too technical, and inaccessible.

• New features aim to make the messages in Cochrane reviews clear and easier to use in decision-making.

New formats to disseminate review results


Podcasts from The Cochrane LibraryEssential audio summaries of key reviews

■ More than 250 Podcasts available for download

■ Podcasts include key new reviews, most accessed reviews and key topics

■ Download or listen to the latest podcasts online at www.cochrane.org/podcasts


■ Read the original review article for FREE ■ Podcasts: download or listen online ■ PowerPoint Slides: download or view online ■ Interactive: ask the authors a question and

receive a reply ■ Discussion Points: what are the questions

you should be asking as you read this paper?

Cochrane Journal Club“If you are running a journal club, or interested in doing so, we provide the materials to help you plan a session concentrating on an important, practice changing, Cochrane Review.” -Dr David Tovey, Editor-in-Chief


Cochrane Clinical Answershttp://cochraneclinicalanswers.com/

■ A point-of-care clinical support tool for busy health professionals

■ Distills high-quality evidence from Cochrane systematic reviews into practical answers to common clinical questions

■ Designed to mimic the way health professionals gather information

■ New questions continually added to ensure broad coverage across a range of medical topics

■ Available now for purchase by Cochrane Library subscribers

Pettersen, Karen - Chichester


■ A suite of online learning activities designed for health care professionals

■ Learning activities are based upon high-quality evidence from Cochrane systematic reviews

■ Reflective evaluation encourages practice change

■ Meets the rigorous accreditation standard of the ACCME*

■ Launching in 2013*Accreditation Council for Continuing Medical Education

Cochrane Learning


■ Access a monthly selection of specially curated Cochrane Reviews via The Cochrane Library iPad Edition

■ Each issue includes a selection of new and recently updated reviews specially abridged for iPad users

■ Includes podcasts, Slide decks and Cochrane Editorials

■ Monthly issues automatically download to your Newsstand

■ FREE app available in iTunes

Cochrane iPad Edition


New Search ToolsThe Cochrane Library’s new search interface launched September 15. Highlights of the new search features include:

■ Auto-suggest features within both basic and MeSH search functions ■ Updated display of search results

and filtering options ■ Ability to view search terms

and results on the same page ■ Ability to insert lines and add

one search to another ■ Improved MeSH look-up feature ■ Hover-over Tool Tips


Online Training

■ Monthly instructor-led training sessions with a focus on how to search The Cochrane Library

■ Navigate your browser tohttps://wiley-onlinelibrary.webex.com/to register and attend a session

■ Or contact Gavin Stewart at Wiley ([email protected]) if you require a bespoke session for your team

https://wiley-onlinelibrary.webex.com/

mailto:[email protected]


Cochrane Canada Live Webinar

series http://ccnc.cochrane.org/training-and-events


• Cochrane Musculoskeletal Group: musculoskeletal.cochrane.org

• Cochrane Back Group: back.cochrane.org

• Cochrane Child Health Field: childhealth.cochrane.org

Ways to get involved:


The Cochrane Library Users’ GroupOffers:Answers from the expertsA forum for information-sharingAn opportunity for feedback

To get involved:www.CLUG.iwh.on.ca

Or contact Emma Irvin [email protected]

http://www.clug.iwh.on.ca/

mailto:[email protected]


What to do when there is no Cochrane review


PubMed Clinical Queries


Turning Research into Practice (TRIP) Database


Thank you for joining us today!

ccc.cochrane.org/[email protected]


Acknowledgements• Based on materials by the Australasian

Cochrane Centre and Canadian Cochrane Centre, also with thanks to Wiley.

• Thank you to Eileen Vilis, Miranda Cumpston, and Gavin Stewart for help with the slides.

The cochrane library an introduction for rheumatologists - 17 feb 2014

Documents

database of reviews

cochrane reviews issue

cochrane collaboration

cochrane methodology

reviews of effects

honour of archie cochrane

health equity

health services