1. SEARCHING EVIDENCE THROUGH THE COCHRANE LIBRARY
prepared by Literature Searching Team
Library, Faculty of Medicine, UGM
 2012

2. OUTLINE 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

3. WHAT IS EVIDENCE BASED MEDICINE?
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: )‏
Evidence-based: conclusions based on best available evidence

4. ELEMENTS OF EVIDENCE BASED PRACTICE
Clinical
Expertise
Best
Available
Resources
Each
Individual
Patient

5. STEPS OF EVIDENCE BASED PRACTICE
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

6. CLINICAL QUESTIONS CENTRAL ISSUES IN CLINICAL WORKS
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

7. ASKING A CLINICAL QUESTION
Ask a question that you would like answered from the literature
Example:
Is artesunate better than quinine for treating children with severe malaria?

8. PICO APPROACH P : Patient, Population, Problem I : Intervention
C : Comparison, Comparator
O : Outcome

9. REFORMATTING THE QUESTION USING PICO APPROACH
P : children with severe malaria
I : artesunate
C : quinine
O : reduction of malaria severity
Reformatted question:
In children with severe malaria is artesunate more effective than quinine in reducing malaria severity?
Type of question : THERAPY

10. FROM QUESTION TO SEARCH TERMS
Alternatives
Patient
children
malaria
infants
Intervention
artesunate
Comparator
quinine
Outcome
reduction of malaria severity

11. 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

12. The paper where someone trustworthy has already answered our question!
WHAT TO LOOK FOR?
The paper where someone trustworthy has
already answered our question!

13. 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

14. 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. (
Systematic review
A systematic review is a critical assessment and evaluation of all research studies that address a particular clinical issue. ( v

15. 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. (

16. CONTENTS OF TCL
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)

17. Access is unlocked for subscribers Advanced search option
THE COCHRANE LIBRARY
Access is unlocked for subscribers
Simple search option
Advanced search option

18. Search tips to guide searches Search boxes for search terms/phrases
DISPLAY OF ADVANCE SEARCH OPTION
Database in TCL
Search tips to guide searches
Search boxes for search terms/phrases

19. SEARCHING THROUGH ADVANCED SEARCH OPTION
PUTTING SEARCH PHRASE IN THE SEARCH BOX
Search in all text
Search phrase:
(child* OR infant*) AND malaria AND artesunate AND quinine

20. SEARCH RESULT 46 records matched with the search phrase
Click to display search results
46 records matched with the search phrase

21. DISPLAY OF SEARCH RESULTS
There are 22 Cochrane Reviews, 2 Other Reviews, and 22 Trials (46 records)
Search phrase
Click to view abstract

22. Options for full article in HTML and PDF format
DISPLAY OF ABSTRACT
Options for full article in HTML and PDF format

23. DISPLAY OF FULLTEXT IN PDF FORMAT

24. OTHER EBM RESOURCES The following are some other EBM resources:
BMJ Clinical Evidence –
National Institute for Health and Clinical Excellence -
NHS Evidence -
National Guideline Clearinghourse – public resource for evidence- based clinical practice guideline –
AAOS Evidence-based Clinical Practice Guideline -
PubMed Clinical Queries -
Centre for Evidence-Based Medicine -

25. END NOTES
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

26. This Power Point Presentation is compiled by
Team of Literature Searching
Library Faculty of Medicine, UGM.