1. Introduction to The Cochrane Library
During this session I will introduce you to the Cochrane Library, and the Cochrane Collaboration, and provide an overview of the content of the Cochrane Library and show you how you can use it.

2. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. (1996)
What is The Cochrane Library?
A collection of databases that include high quality, independent, reliable evidence from Cochrane and other systematic reviews, clinical trials and more.
Brings together research on the effectiveness of healthcare treatments and interventions from around the world.
Based on the practice of evidence-based medicine
Used by clinicians, policy makers, researchers, educators, students, patients and others.
The Cochrane Library is a collection of databases that include high quality, independent, reliable evidence from Cochrane and other systematic reviews, clinical trials and more - that enable users to make informed choices about diagnostic and treatment options.
Brings together research on the effectiveness of healthcare treatments and interventions from around the world. - Cochrane does not conduct the trials or studies but rather investigates all available evidence and collates the findings into a systematic review.
Based on the practice of evidence-based medicine - which combines the best research evidence with clinical expertise and patient values.
The Cochrane Library is used by clinicians, policy makers, researchers, educators, students, patients and others.
Evidence-based medicine is “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.”
Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. (1996)

3. Who develops the Cochrane Library?
Who develops the Cochrane Library?
The Cochrane Library is published by Wiley for The Cochrane Collaboration.
The Cochrane Collaboration is an international not-for-profit organization:
Aim: to help people make well-informed decisions about health care.
How: by preparing, maintaining and promoting the accessibility of systematic reviews on the effects of healthcare interventions.
The Cochrane Library is published by Wiley for The Cochrane Collaboration.
The Cochrane Collaboration is an international organization that aims to help people make well-informed decisions about health
by preparing, maintaining and ensuring the accessibility of systematic reviews on the effects of healthcare interventions.
It is the world’s leading producer of up-to-date systematic healthcare reviews. ( See more about the Collaboration in the About Us )

4. The Cochrane Collaboration
The Cochrane Collaboration
In early 2009 there were 23,815 contributors from 112 countries.
Member groups of The Cochrane Collaboration include:
Collaborative Review Groups (52) maintain and update Cochrane Reviews.
Cochrane Centres (13) support people in their geographic and linguistic area.
Fields (14) bring together healthcare issues impacting across review groups.
Method Groups (14) develop the methodology of Cochrane Reviews.
Consumer Network represents the interests of healthcare consumers.
In early 2009 there were 23,815 contributors from 112 countries. (This represents a continuing increase in the number of contributors [from 5437 in 2000, to 7728 in 2002, 11,517 in 2004,14,925 in 2006, and 17,637 in 2008], and also of countries [64 in 2000, 78 in 2002, 91 in 2004, 101 in 2006, and 103 in 2008]
Approximately 97% of those contributors do so on a voluntary basis.
Member groups of The Cochrane Collaboration include:
Collaborative Review Groups (52) are made up of people who prepare, maintain and update Cochrane Reviews, and people who support them in this process. (Each Group has an 'editorial base' where a small team of people supports the production of Cochrane Reviews. These Groups focus on particular areas of health such as: Breast Cancer, Infectious Diseases, Multiple Sclerosis, or Tobacco Addiction.)
Cochrane Centres(13) support people in their geographic and linguistic area. (Dependent on available resources, some Centres are able to provide training, help with translations, networking, etc. Newcomers are encouraged to contact their local Cochrane Centre for information about The Cochrane Collaboration; this can save a lot of time and effort.)
Fields/Networks (14) emerge around areas of interest which extend across a number of health problems. (For example, a field coordinator in child health would identify health issues of importance to children and facilitate reviews across the relevant review groups in the interests of this population.)
Methods Groups (13) are made up of people who develop the methodology of Cochrane Reviews.
The Consumer Network provides information and a forum for networking among consumers, mostly patients, and a liaison point for consumer groups around the world.
If you interested in learning more about the Cochrane Collaboration please go to their website
(The Cochrane Manual contains detailed descriptions of the responsibilities of each of these groups of people ('entities'). Cochrane entities receive their funding from different sources, but agree to follow the policies and practices of The Cochrane Collaboration.)

5. Australasian Cochrane Centre Iberoamerican Cochrane Centre
New Zealand Branch of the Australasian Cochrane Centre Venezuelan Branch of the Iberoamerican Cochrane Centre
Singapore Branch of the Australasian Cochrane Centre Italian Cochrane Centre
Thai Cochrane Network of the Australasian Cochrane Centre Croatian Branch of the Italian Cochrane Centre
Brazilian Cochrane Centre Nordic Cochrane Centre
Canadian Cochrane Centre Finnish branch of the Nordic Cochrane Centre
Francophone Network of the Canadian Cochrane Centre Norwegian branch of the Nordic Cochrane Centre
Chinese Cochrane Centre South African Cochrane Centre
Hong Kong Branch of the Chinese Cochrane Centre Nigerian Branch of the South African Cochrane Centre
Dutch Cochrane Centre South Asian Cochrane Centre
Belgian Branch of the Dutch Cochrane Centre UK Cochrane Centre
German Cochrane Centre Bahrain Branch of the UK Cochrane Centre
US Cochrane Center
San Francisco Branch of the US Cochrane Center

6. The Cochrane Collaboration global community
The Cochrane Collaboration global community
The Cochrane Collaboration, through the Cochrane Library, facilitates a global community approach to healthcare by promoting education, research and accessibility to everyone.
The Cochrane Collaboration reacts quickly to current health issues, such as the Haiti and Chilean earthquakes, making relevant reviews available for free.
In addition they set up specific task forces to investigate and research high impact current issues such as the recent Swine Flu and the Indian Ocean tsunami in December 2004.
The Cochrane Collaboration, through the Cochrane Library, facilitates a global community approach to healthcare by promoting education, research and accessibility to everyone.
The Cochrane Collaboration reacts quickly to current health issues, such as the Haiti and Chilean earthquakes, making relevant reviews available for free.
In addition they set up specific task forces to investigate and research high impact current issues such as the Swine Flu and the Indian Ocean tsunami in December 2004.

7. What can you do with The Cochrane Library?
What can you do with The Cochrane Library?
Use: For improved patient care and outcomes. Based on the best available evidence which have been proven in practice.
Research: The Cochrane Library has an Impact Factor of giving you confidence in quality and relevance.
Provide feedback: Did it work for you? Do you have information relevant to the review?
Contribute: Do you want to be a reviewer? Is there an issue you believe should be reviewed? Go to the “I am here to” tab and click on the “Get involved” link at
Use: For improved patient care and outcomes. Based on the best available evidence which have been proven in practice.
Research: The Cochrane Library has an Impact Factor of giving you confidence in quality and relevance. ( Impact Factor: The 2008 impact factors published by Thomson ISI. The Cochrane Database of Systematic Reviews has an Impact Factor OF and is ranked 12th out of 107 in the ISI category Medicine, General & Internal. See more at )
Provide feedback: Did it work for you? Do you have information relevant to the review?
Contribute: Do you want to be a reviewer? Is there an issue you believe should be reviewed? Click the “Work with us” link at

8. The Cochrane Library databases
The Cochrane Library databases
1. The Cochrane Database of Systematic Reviews
(Cochrane Reviews)
A systematic review investigates the effectiveness of interventions for prevention, treatment and rehabilitation in health care. Now includes reviews of diagnostic test accuracy studies. Now updated monthly!
2. The Database of Abstracts of Reviews of Effects
(Other reviews)
Complements Cochrane Reviews by quality-assessing and summarising reviews which have not been carried out by The Cochrane Collaboration.
The Cochrane Library consists of 6 main databases:
The Cochrane Database of Systematic Reviews. A systematic review investigates the effectiveness of interventions for prevention, treatment and rehabilitation in health care. Now includes reviews of diagnostic test accuracy studies, and is published monthly!
The Database of Abstract of Reviews of Effects complements Cochrane Reviews by quality-assessing and summarising reviews which have not been carried out by The Cochrane Collaboration. (Also known as DARE, is the only database to contain abstracts of systematic reviews that have been quality assessed. Each abstract includes a summary review together with a critical commentary about the overall quality.)
(The bracketed short form of the database name is used on the web site. As at April issue 2010, (1) CDSR had 6,153 records and (2) DARE had 12,594 records)

9. The Cochrane Library databases
The Cochrane Library databases
3. The Cochrane Central Register of Controlled Trials
(Clinical trials)
Includes details of published articles taken from bibliographic databases – such as MEDLINE and EMBASE - and other published sources.
4. Health Technology Assessment Database
(Technology Assessments)
Brings together details of completed and ongoing health technology assessments from around the world.
The Central Register of Controlled Trials database includes details of published articles taken from bibliographic databases – such as MEDLINE and EMBASE - and other published sources. (The records are unique and the best single source of reports of randomized controlled trials. They include the title of the article, information on where it was published and, in many cases, a summary of the article. They do not include the full text of the article.
c. 580,000 reports of RCTs and other controlled trials
330,000 from MEDLINE [all records indexed as RCT or CCT in PT in humans]
90,000 additional reports of trials from searching EMBASE
160,000 reports of trials from handsearching journals / conference abstracts )
The Technology Assessments database brings together details of completed and ongoing health technology assessments from around the world. The aim of the database is to improve the quality and cost-effectiveness of health care. (studies of the medical, social, ethical and economic implications of healthcare interventions)
(As at April issue 2010, (3) CCRCT had 608,405 records and (4) HTA had 8,273 records)

10. The Cochrane Library databases
The Cochrane Library databases
5. Methodology Register
(Methods Studies)
Presents a bibliography of publications that report on methods used when conducting controlled trials.
6. NHS Economic Evaluation Database
(Economic Evaluations)
Systematically identifies economic evaluations of healthcare interventions from around the world, appraises their quality and highlights their relative strengths and weaknesses.
The Methodology Register is a bibliography of publications which report on methods used in the conduct of controlled trials. (Includes journal articles, books and conference proceedings - these articles are taken from the MEDLINE database and from hand searches.)
NHS EED contains structured abstracts of articles describing economic evaluations of healthcare interventions. It systematically identifies economic evaluations of healthcare interventions from around the world, appraises their quality and highlights their relative strengths and weaknesses.
(As at April issue 2010, (5) MR had 13,164 records and (6) NHS EED had 28,551 records)

11. The Cochrane Database of Systematic Reviews
The Cochrane Database of Systematic Reviews
The “gold standard” for systematic reviews
Combines results of the world’s best
medical research studies
Adhere to a strict process to make them more comprehensive, thus minimizing
bias and ensuring reliability
Updated regularly - ensuring that
treatment decisions can be based
on the most up-to-date, reliable
evidence.
Cochrane Reviews are now considered the “gold standard” for systematic reviews by such key publications as The Lancet, New England Journal of Medicine, British Medical Journal, and the Journal of the American Medical Association and routinely appear there as well as in specialized medical journals for various specialty areas
Cochrane Systematic Reviews differ from other types of reviews because they adhere to a strict process in order to make them more comprehensive, thus minimizing the chance of bias, and ensuring their reliability. In addition they are updated regularly, as new information becomes available, ensuring that treatment decisions can be based on the most up-to-date and reliable evidence.

12. What is a systematic review?
What is a systematic review?
A systematic review identifies an intervention or treatment for a specific disease or other problem in health care
Identifies and includes all up-to-date and relevant studies and trials
Determines whether or not the intervention or treatment works
A systematic review helps practitioners and patients make decisions about appropriate health care interventions and treatments
By first identifying an intervention or treatment for a specific disease or other problem in health care,
Then identifies and includes all up-to-date and relevant studies and trials (One trial – provides limited results. Evaluating several trials is more likely to provide a more valid and reliable result. Each trial should meet same criteria, follow same methods and test against same conditions or parameters)
And determines whether or not the intervention or treatment works

13. Trial is conducted several times
The benefits of a systematic review 10
One trial - provides
limited results
Trial is conducted several times
Evaluating several trials* is more likely to provide a more valid and reliable result
*Each trial should meet same criteria, follow same methods and test against same conditions or parameters…
Cochrane aims to bring together research on the effects of health care from all up-to-date and relevant studies and trials .
The results from several trials rather than just one trial *should provide a more valid and reliable result. *Each trial should meet the same criteria, follows the same methods, test against the same conditions or parameters.

14. The plan or set of steps to be followed in the systematic review
What is a protocol?
The plan or set of steps to be followed in the systematic review
Should describe the rationale for the review, the objectives, and the methods that will be used to locate, select, and critically appraise studies, and to collect and analyse data from the included studies
To ensure that the reviews are valid and reliable, and the process is systematic, a protocol is established.
This protocol establishes a plan or set of steps to be followed in a study.
It should describe the rationale for the review, the objectives, and the methods that will be used to locate, select, and critically appraise studies, and to collect and analyse data from the included studies.
(Protocol prevents authors from improvising during the review process – thereby decreasing risk of bias and invalid results.)

15. Rank World -full text accesses
Top 10 reviews – worldwide 2008
Review Title
Rank World -full text accesses
Interventions for preventing falls in elderly people 1
Interventions for preventing obesity in children 2
Cranberries for preventing urinary tract infections 3
St John's Wort for major depression 4
Interventions for enhancing medication adherence 5
Nicotine replacement therapy for smoking cessation 6
Antioxidant supplements for prevention of mortality in healthy participants and patients
with various diseases 7
Water for wound cleansing 8
Support surfaces for pressure ulcer prevention 9
Exercise for improving balance in older people 10
根據德國研究人員所進行的研究顯示, 全球目前最受歡迎的草藥之一 St John's Wort (金絲桃科, 聖約翰草) 對於輕度到中度的憂鬱症的治療效果, 和常見的精神科處方藥 imipramine 效果幾乎一樣好, 而且臨床上面所見到的副作用更少
經過324個德國病人的臨床研究, 醫師認為 , 75mg的imipramine每天兩次用量連續六周, 與 250mg的 St John's Wort 每天兩次的劑量效果相當
St John's Wort 在德國是很多年的傳統藥草, 它的主要成份在許多臨床研究證明對於輕度的憂鬱症狀具有改善效果, 在美國則以健康食品的膠囊或錠劑食品上市
不過許多學者認為, 雖然St John's Wort 具有很好的療效, 它也會帶來白內障等等副作用, 如果以食品販賣, 一般民眾很容易因為未對於副作用的詳細情況不瞭解, 而影響到健康
該篇德國論文發表於九月份的British Medical Journal <英國醫學期刊>中, 這是在醫藥界非常知名的醫學期刊, 具有相當的公信力

16. Prepare protocol Register title Prepare review The Cochrane Library
Publishing reviews in The Cochrane Library
Authoring team
Expertise might include:
Clinical knowledge
Searching skills
Relevant statistics
Prepare protocol
(3 months to one year)
Register title
Prepare review
(one to five years)
The Cochrane Library
(CDSR and About updated monthly other databases updated quarterly)
A review may take from one to five years to be published on the Cochrane Library.
Timeframe is effected by voluntary status of the majority of contributors and the time required to find, review and collate all relevant randomized clinical trials.

17. What to consider when reading reviews
What to consider when reading reviews
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 all relevant and important outcomes considered?
Are the conclusions drawn consistent with the method employed?
How do the results apply to the care of your patients?
Do the studies address a sensible clinical question? (Such as “Interventions for treating wrist fractures in children” )
Do the studies possess high quality designs and methods? (Check the Criteria for considering studies for this review, Search methods for identification of studies, Methods of the review, Description of studies, Methodological quality)
Are the results from the studies similar or widely different? (Similar leads to relatively conclusive results – though not set in concrete, while widely different is still a valid result and should suggest further research is required.)
Are all relevant and important outcomes considered?
Are the conclusions drawn consistent with the method employed?
How do the results apply to the care of your patients?

18.
Thank you...
If you would like to learn more about The Cochrane Library or any of our other products please go to
Explore The Cochrane Library at
Explore The Cochrane Collaboration at
Browse the Cochrane Handbook for Systematic Reviews of Interventions
Find your nearest Cochrane Centre
The Australasian Cochrane Centre’s Guide to the Cochrane Library
If you would like to learn more about The Cochrane Library or any of our other products please go to
You can explore The Cochrane library at and the Cochrane Collaboration web site where you can browse the Cochrane Handbook for Systematic Reviews of Interventions and find your closest Cochrane Centre. The Australasian Cochrane Centre’s Guide to the Cochrane Library is also a useful resource.

19. Wiley-Blackwell’s Evidence-Based Medicine databases
ebmg.wiley.com
heed.wiley.com
Wiley-Blackwell’s Evidence-Based Medicine databases
The Cochrane Library
What works and what doesn’t? Assists healthcare decision making by bringing together research on the effectiveness of healthcare treatments and interventions.
Essential Evidence Plus
What tools are available? Provides evidence and tools to assist in critical patient care decisions. Download to PDA to access information at point of care.
EBM Guidelines
How do I apply the evidence to my patient? Clinical guidelines, graded evidence summaries, images, audio samples and videos to guide in applying evidence in practice.
Health Economic Evaluations Database
What are the costs involved? Provides comparative analysis of costs and consequences of health interventions to aid decision makers.
The Cochrane Library is part of the Wiley-Blackwell portfolio of evidenced-based medicine (EBM) databases which aim to answer key medical questions…(as per slide as time permits)

20. Reading Odds Ratio Tables
Reading Odds Ratio Tables
Describes the odds of an experimental patient suffering an adverse event relative to a control patient. Size of blue or green square relates to weight % and diamond indicates overall odds.
compression stockings for preventing deep vein thrombosis in airline passengers
航空旅客穿著彈性襪(又稱醫療襪、壓力襪或健康襪)預防深部靜脈栓塞
最左邊的Study代表每個研究的出處，第二欄代表實驗組的成功人數比上分組人數，第三欄代表對照組的成功人數比上分組人數，第四欄的每一條水平線代表一個研究的勝算比的 95%信賴區間，中央的方塊大小代表參與實驗人數多少，若方塊越大的 95%信賴區間越小。
右邊的 weight 代表進行 meta-analysis 時每個研究的加權值，以人數多少來計算加權大小。
最下方的菱形代表經過 meta-analysis 計算之後的勝算比及 95%信賴區間，若菱形的邊緣沒有碰觸到 1.0，則具有統計學上的意義。到底勝算比大於一還是小於一代表治療有效，不同的作者可能有不同的定義，故在最下方勝算比的刻度上，有說明哪個方向代表有效（Favors treatment）。
森林圖（Forest Plot）是表現 meta-analysis 結果的圖形，熟悉如何判讀也是實證醫學重要的技能之一。

21. Importing Cochrane citations to EndNoteTM
Importing Cochrane citations to EndNoteTM
When you have completed your search, tick the references that you wish to download.
Click on the "Export Selected Citations" button.
At the next screen, at "Export Type" select "Abstract and citation".
Click on the "Go" button.
Save results as a text file (cit-abs-plain-.....txt)
Go to EndNote - click on File/Import
When the Import dialog box opens, under the Import data file option click on "Choose file" and select the text file that you saved.
Under the Import Option, click on the drop down arrow and choose "Other Filters". Then find Cochrane (Wiley). Click on "Choose".
Click on "Import".
Results will differ depending on which style you have selected in EndNote.
If you are not happy with the results, you will need to edit manually.

22. Importing Cochrane citations to RefWorksTM
Importing Cochrane citations to RefWorksTM
In Cochrane
Select and mark records.
At the bottom left of the screen, select Export selected citations.
Change to Abstract and citation if you wish, and Mac if you use one
You will get a text file that you can either save, or copy and paste into RefWorks. (see red note below)
Go to RefWorks
Select References > Import.
Select The Cochrane Library as the import filter and database you used.
Select an import folder if you wish.
Click Import data from the following Text, and then either
browse for your saved file, select and click Import OR
copy and paste the text into the box and click Import.
(I am not sure which step is the right one and am waiting on feedback)