Friday, September 9, 2011

The Cochrane Library: Systematic Reviews and More for Health Care

The Cochrane Library is a collection of six databases containing different types of high-quality, independent evidence to inform healthcare decision-making:

  • Cochrane Database of Systematic Reviews - The Cochrane Database of Systematic Reviews (CDSR) is a leading resource for systematic reviews in health care. A systematic review attempts to identify, appraise and synthesize all the empirical evidence that meets pre-specified eligibility criteria to answer a given research question. Researchers conducting systematic reviews use explicit methods aimed at minimizing bias, in order to produce more reliable findings that can be used to inform decision making. There are three types of Cochrane Review:

    1. Intervention reviews assess the benefits and harms of interventions used in healthcare and health policy.
    2. Diagnostic test accuracy reviews assess how well a diagnostic test performs in diagnosing and detecting a particular disease.
    3. Methodology reviews address issues relevant to how systematic reviews and clinical trials are conducted and reported.

    The CDSR includes all Cochrane Reviews (and protocols) prepared by Cochrane Review Groups in The Cochrane Collaboration. Each Cochrane Review - focusing on a specific topic area - is a peer-reviewed systematic review that has been prepared and supervised by an expert editorial team.
  • Cochrane Central Register of Controlled Trials - Provides details of published articles taken from bibliographic databases (notably MEDLINE and EMBASE), and other published and unpublished sources.
  • Cochrane Methodology Register - A bibliography of publications that report on methods used in the conduct of controlled trials. It includes journal articles, books, and conference proceedings, and the content is sourced from MEDLINE and hand searches. CMR contains studies of methods used in reviews and more general methodological studies that could be relevant to anyone preparing systematic reviews.
  • Database of Abstracts of Reviews of Effects - Contains abstracts of systematic reviews that have been quality-assessed. Each abstract includes a summary of the review together with a critical commentary about the overall quality. DARE is a key resource for busy decision-makers and can be used for answering questions about the effects of specific interventions, whether such questions arise from practice or when making policy. DARE covers a broad range of health related interventions and thousands of abstracts of reviews in fields as diverse as diagnostic tests, public health, health promotion, pharmacology, surgery, psychology, and the organization and delivery of health care.
  • Health Technology Assessment Database - Brings together details of completed and ongoing health technology assessments (studies of the medical, social, ethical, and economic implications of healthcare interventions) from around the world. The aim of the HTA Database is to improve the quality and cost-effectiveness of health care.
  • NHS Economic Evaluation Database - This database systematically identifies economic evaluations of competing healthcare interventions from around the world, appraising their quality, and highlighting their relative strengths and weaknesses.
A 12-page User Guide and a three-part online tutorial [Part 1: Introduction (8 minutes); Part 2: Searching and MESH (7 minutes); Part 3: Saved Searches and Email Alerts (4 minutes)] are available to provide students and faculty with an orientation to the Cochrane Library. If you have questions about the database, please contact Richard Kearney (x2165 / kearneyr at wpunj dot edu).

Thursday, September 8, 2011

Clinical Evidence: A New Resource for Our Health Professions Programs

Clinical Evidence, produced by the BMJ Publishing Group, is a decision-support resource for health professionals providing evidence on the effects of common clinical interventions and systematic reviews of important clinical conditions. Clinical Evidence systematic reviews summarize the current state of knowledge and uncertainty about the prevention and treatment of clinical conditions, based on thorough searches and appraisal of the literature. It describes the best available evidence from systematic reviews, randomized controlled trials, and observational studies where appropriate, and if there is no good evidence it says so.

Clinical Evidence covers common or important clinical conditions seen in primary and hospital care. To decide which conditions to cover its editors review data on consultation rates, morbidity and mortality, take account of national priorities for health care such as those outlined in the UK National Service Frameworks and in the US Institute of Medicine reports, and take advice from generalist clinicians and patient groups. In common with other evidence-based medicine resources, including producers of guidelines, the Clinical Evidence database attempts to answer the "what" questions that doctors and patients might ask. Each systematic review contains a page that lists key clinical questions and interventions and describes whether they have been found to be effective or not.

The questions in Clinical Evidence concern the benefits and harms of preventative and therapeutic interventions, with emphasis on outcomes that matter to patients. Questions are selected for their relevance to clinical practice by section advisors and contributors, in collaboration with primary care clinicians and editors. Each month Clinical Evidence includes new questions as well as updates of existing questions.

In addition to its systematic reviews and summaries, Clinical Evidence provides:

  • Drug Safety Alerts - If important information on drug safety is issued from regulatory authorities or any other reputable source before a review is updated, Clinical Evidence aims add a drug safety alert to all reviews mentioning the drug within 72 hours. The alert contains a link to the source of the drug safety alert for more information. The information prompting a drug safety alert is processed together with any new evidence found for the next update of the review.

  • Guidelines - To help clinicians put evidence into practice, Clinical Evidence reviews have links to the full text of major guidelines relevant to the review's clinical area. All linked guidelines have been produced by national or international government sources, professional medical organizations or medical specialty societies, and have met predetermined quality requirements. New guidelines are added regularly, and old guidelines are replaced by their revised versions as these are published.

  • Updates - Clinical Evidence aims to update its reviews annually. In addition to this cycle, details of clinically important studies are added to the relevant reviews throughout the year using the BMJ Updates service. BMJ Updates is produced by collaboration between the BMJ Group and McMaster University's Health Information Research Unit to provide clinicians with access to current best evidence from research. All citations (from over 110 premier clinical journals) are rated by trained researchers for quality, and then rated for clinical relevance, importance and interest by at least three members of a worldwide panel of practicing physicians. The final content is indexed by health professionals to allow news of studies to be added to all relevant Clinical Evidence reviews.

A 12-page User Guide (in PDF format) is available to help you get started with Clinical Evidence.