1、The Cochrane Collaboration is named in honor of Archie Cochrane, a British medical researcher who contributed greatly to the development of epidemiology as a science.1992 the first Cochrane centre in Oxford, UK1993 The Cochrane CollaborationProfessor Archibald Leman Cochrane (1909 - 1988)Effectivene

2、ss and Efficiency: Random Reflections on Health Services published in 1972. Five steps of practice Evidence-Based MedicineStep 1: Converting the need for information (about prevention, diagnosis, prognosis, therapy, causation, etc.) into an answerable question. Patient Intervention Comparison Outcom

3、eStep 2: Searching the best evidence with which to answer that question.Step 3: Critically appraising the evidence for its validity (closeness to the truth), impact (size of the effect), and applicability (usefulness in our clinical practice).Step 4: Integrating the evidence with our clinical expert

4、ise and patients unique biology, values and circumstances.Step 5: Evaluating our effectiveness and efficiency in executing steps 1-4 and seeking ways to improve them both for next time.Oxford Centre for Evidence-based Medicine Levels of Evidence (May 2001)LevelTherapy1aSystemic review (with homogene

5、ity*) of randomized clinical trials分析同性質隨機臨床對照試驗所得到的系統性文獻回顧評論 1bIndividual randomized clinical trial (with narrow Confidence Interval)設計良好且結果精確的隨機臨床對照試驗 1cAll or none2aSystemic review (with homogeneity) of cohort studies分析同性質世代研究所得到的系統性文獻回顧評論 2bIndividual cohort study (including low quality randomiz

6、ed clinical trial; e.g., 80% follow-up) 世代研究(包括設計粗糙的隨機臨床對照試驗) 2cOutcomes Research; Ecological studies 預後研究; 生態研究 3aSystemic review (with homogeneity) of case-control studies 分析同性質病例對照研究所得到的系統性文獻回顧評論 3bIndividual Case-Control Study 病例對照研究 4Case-series (and poor quality cohort and case-control studies

7、)病例集 (包括設計粗糙的世代研究及病例對照研究) 5Expert opinion without explicit critical appraisal, or based on physiology, bench research or first principles 尚未經過嚴謹評估, 或僅根據生理實驗、動物實驗甚或基礎研究所得到的專家意見 Cochrane Reviews are now the “gold standard” for systematic reviews in such key publications as The Lancet, New England Jour

8、nal of Medicine, British Medical Journal, and the Journal of the American Medical Association and routinely appear there as well as in specialised medical journals for various specialty areas.What is the Cochrane Library?Health care in the 21st Century relies not only on individual medical skills, b

9、ut also on the best information on the effectiveness of each intervention being accessible to practitioners, patients, and policy makers. This approach is sometimes known as “evidence-based medicine”.Just like any library, the Cochrane Library is a collection of resources. It is the main output of t

10、he Cochrane Collaboration and aims to bring together in one place reliable information about the effects of health care treatments or interventions.Assisting clinicians:Why do we need the Cochrane Library?Clinicians are overloaded with information, whether in the form of research reported in journal

11、s, mailings from professional groups, policy announcements from government, or promotional literature from pharmaceutical companies.Over 2 million articles are published annually in some 20,000 biomedical journals equivalent to a pile of paper 500m high (or nearly Taipei 101 building)! Its estimated

12、 that the average general practitioner needs to read 19 articles a day just to keep up-to-date with major developments.Practitioner level change:Why do we need the Cochrane Library?Antibiotics for acute otitis media in children (The Cochrane Database of Systematic Reviews 2004, Issue 1.) Cochrane Re

13、view Objective: to assess the effects of antibiotics for children with acute otitis media Dr Chris Cates Project: Given antibiotics prescription, but advised to wait 1-2 days, use only if symptoms remain In 2004, the American Academy of Pediatrics and the American Academy of Family Physicians guidel

14、ine revised to include deferring antibiotics for children with ear infections who are not unduly illDeveloping world change:Why do we need the Cochrane Library?Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children (The Cochrane Database of System

15、atic Reviews 2002, Issue 1.) Oral rehydration salts (ORS), a mixture of salt and sugar in water. Prevents or treats dehydration caused by diarrhoea a particularly dangerous condition for children in developing countries that can result in death WHO and UNICEF hosted a meeting in 2001 to review the a

16、vailable evidence on an improved ORS formulation For every 1 million cases of diarrhoea, could prevent 14,000 deaths and save US$7.1 million Cochrane Collaboration:How reliable are the reviews?The Cochrane Collaboration is supported by hundreds of organisations from around the world, including healt

17、h service providers, research funding agencies, departments of health, international organisations, industry and universities. Over 12,000 health professionals, researchers, scientists and consumers from 90 countries contribute to the work of the Cochrane Collaboration. 51 Collaborative Review Group

18、s (CRGs) 9 Fields; 10 Methods Groups12 regional Cochrane Centres and their branchesCochrane Review Groups (CRGs)Acute Respiratory Infections Group Airways Group Anaesthesia Group Back Group Bone, Joint and Muscle Trauma Group Breast Cancer Group Colorectal Cancer Group Consumers and Communication Gr

19、oup Cystic Fibrosis and Genetic Disorders Group Dementia and Cognitive Improvement Group Depression, Anxiety and Neurosis Group Developmental, Psychosocial and Learning Problems Group Drugs and Alcohol Group Ear, Nose and Throat Disorders Group Effective Practice and Organisation of Care Group Epile

20、psy Group Eyes and Vision Group Fertility Regulation Group Gynaecological Cancer Group Haematological Malignancies Group Heart Group Hepato-Biliary Group HIV/AIDS Group Hypertension Group Incontinence Group Infectious Diseases Group Inflammatory Bowel Disease and Functional Bowel Disorders Group Inj

21、uries Group Lung Cancer Group Menstrual Disorders and Subfertility Group Metabolic and Endocrine Disorders Group Methodology Review Group Movement Disorders Group Multiple Sclerosis Group Musculoskeletal Group Neonatal Group Neuromuscular Disease Group Oral Health Group Pain, Palliative and Supporti

22、ve Care GroupPeripheral Vascular Diseases Group Pregnancy and Childbirth Group Prostatic and Urologic Cancers Group Renal Group Schizophrenia Group Sexually Transmitted Diseases Group Skin Group Stroke Group Tobacco Addiction Group Upper Gastrointestinal & Pancreatic Diseases Group Wounds Group

23、CanadianUSBrazilianSouth AfricanAustralasianUKNordicDutchGermanItalianIberoamericanSouth Asian NetworkThai NetworkChineseThe Cochrane Collaboration LogoThe Cochrane Collaboration logo illustrates a systematic review of data from seven randomized controlled trials (RCTs), comparing one health care tr

24、eatment with a placebo.This diagram shows the results of a systematic review of RCTs of a short, inexpensive course of a corticosteroid given to women about to give birth too early.This treatment reduces the odds of the babies of these women dying from the complications of immaturity by 30 to 50 per

25、 cent.The Cochrane Library is a collection of Evidence-Based Medicine databases:The Cochrane Database of Systematic Reviews (Cochrane Reviews)The Cochrane Database of Reviews of Effects (Other Reviews)The Cochrane Central Register of Controlled Trials (Clinical Trials)The Cochrane Database of Method

26、ology Reviews (Methods Reviews)The Cochrane Methodology Register (Methods Studies)Health Technology Assessment Database (Technology Assessments)NHS Economic Evaluation Database (Economic Evaluations)It also contains information about The Cochrane Collaboration and the Cochrane Collaborative Review G

27、roupsWHAT IS THE COCHRANE LIBRARY?The Cochrane Database of Systematic Reviews (Cochrane Reviews)Reviews address clearly formulated questions such as does fluoride help prevent tooth decay in children or can antibiotics help in alleviating the symptoms of sore throat.Comprehensive and explicit method

28、s are used to track down, select and determine the quality of relevant research. This includes searches for unpublished and non-English records to provide as complete a picture as possible to try to answer the question considered.A diagrammatic analysis is also provided in the form of an odds-ratio

29、(OR) diagram. These diagrams reveal, at a glance, whether a treatment is beneficial or not.Whats so important about it?The Cochrane Database of Systematic Reviews (Cochrane Reviews) More than 2249 Full text Cochrane Reviews (html & PDF format*)How large is the database? More than 1539 Protocols

30、(Reviews in progress) All Reviews are regularly updated with the latest evidenceThe Cochrane Database of Systematic Reviews (Cochrane Reviews)* Unique feature not available anywhere else! Cochrane Reviews are conducted to the highest standard of methodological quality. They have been found to be of

31、comparable or better quality and are updated more frequently than reviews published in print journals.11 Source:Jadad AR, Cook DJ, Jones A, Klassen TP, Tugwell P, Moher M, Moher D. Methodology and reports of systematic reviews and meta-analyses: a comparison of Cochrane reviews with articles publish

32、ed in paper-based journals. JAMA 1998;280:278-280.Why are the Cochrane Systematic Reviews so important?Cochrane Reviews who uses them?Physicians, consultants, medical staffHealth care service providersPolicy makersMediaMembers of the public A reliable source that summarises the best evidence on the

33、effects of a particular healthcare intervention at a particular point in time.“Those who say that systematic reviews and meta analyses are not “proper research” are wrong; it is clinical trials done in the absence of such reviews and meta-analyses that are improper, scientifically and ethically. Inv

34、estigators and organisations who undertake and coordinate reviews and meta-analyses now need the funding and recognition they deserve if public trust in biomedical research is to be maintained and resources used in an effective way.”Putting clinical trials into context, Charles Young and Richard Hor

35、ton, The Lancet 2005; 366:107-108Database of Abstracts of Reviews of Effects (Other Reviews) Contains critical assessments and and structured abstracts of reviews. Must meet a minimum quality criteria. Cover topics yet to be covered in CDSR. For Cochrane reviewers and researchers wanting information

36、 on reviews of heath care effects from sources outside the Cochrane LibraryCochrane Central Register of Controlled Trials (Clinical Trials)Contains a register of studies which may be relevant for inclusion in Cochrane reviews Worlds largest database of randomly controlled trials For Cochrane reviewe

37、rs needing to identify studies for a Cochrane review and researchers wishing to identifies studies in a different medical disciplines.Cochrane Database of Methodology Reviews (Methods Reviews) Contains Methodology reviews and protocols. Full-text Reviews examine the benefit of methodological studies

38、 e.g. Does editorial peer-review improve the quality of reports of biomedical studiesThe Cochrane Methodology Register (Methods Studies) Contains a bibliography of publications which report on methods used in the conduct of controlled trials. It includes journal articles, books and conference procee

39、dings, these articles are taken from the MEDLINE database and from hand searches. Plus information on the Collaboration and its Review Groups.Health Technology Assessment Database (Technology Assessments) The HTA database brings together details of completed and ongoing health technology assessments

40、 (studies of the medical, social, ethical and economic implications of health care interventions) from around the world. The aim of the database is to improve the quality and cost-effectiveness of health care. NHS Economic Evaluation Database (Economic Evaluations) NHS EED assists decision-makers by

41、 systematically identifying economic evaluations from around the world, appraising their quality and highlighting their relative strengths and weaknesses. The database contains over 5000 abstracts of quality assessed economic evaluations. The Cochrane Library has many features that make finding the

42、information you are after fast and accurateFinding InformationAn Advanced Search of the Cochrane Library“searching for all text schizo*, drugs in All Fields in All of The Cochrane Library An Advanced Search of the Cochrane LibraryYou can toggle between results listed for the different databases in T

43、he Cochrane Library here Use these links to restrict your search results to Reviews only, or Protocols (reviews in progress) only.Save or edit your search using these links.MeSH Term I醫學圖書館標題表（醫學圖書館標題表（Medical Subject Headings，簡稱簡稱MeSH） 是美國國家醫學圖書館（U.S. National Library of Medicine，簡稱NLM）針對生物醫學資料所整理出

44、的主題詞彙。美國醫學標題表的制定係對同一概念採用固定的詞彙表達方式，以達到控制詞彙目的，方便生物醫學領域的學者或從業人員彼此間的溝通，更可用以陳述資料內容的主題意涵並提供檢索，這也是美國醫學圖書館費心制定醫學標題表之用意。因此，標題詞彙必需能明確表達主題概念，並都是經過美國國家醫學圖書館內的索引專家考證醫學文獻中最常使用，及專家學者或從業人員認同的詞彙表達方式。若是較少使用的詞彙也會在標題表中出現，並指引至正確的標題詞。索引專家們更在眾多標題詞中建立主題關係連結，除了更突顯標題表的功能外，也能藉由醫學標題表的呈現，讓使用者瞭解生物醫學領域的研究範疇。 美國醫學標題表是生物醫學領域中使用最普遍，

45、也是最為重視的標題表。它的制定可協助美國國家醫學圖書館在編目時，做為主題編目選用標目之依據，以為讀者查檢館藏目錄時的檢索點之一。現在，美國醫學標題表更可用以作為期刊論文等不同類型記錄主題分析後所使用的標題詞依據，以方便製成書目資料庫後協助檢索之用，如重要的醫學資料庫 MedLine 並是採用MeSH做為主題分析的根據。 美國醫學標題表的內容分成兩個部分：字母順序標題表及樹狀結構標題表。MeSH Term II(一一) 字母順序標題表字母順序標題表 (Alphabetic List)字母順序標題表是將所有的醫學標題以字母順序排列呈現，並佐以交互參照(cross-references)，這也是一般

46、標題表最常使用的呈現方式。在Cochrane Library 中 MeSH提供的交互參照為: seeX 。標題表中以“see”及“X”連結者，表示兩詞彙為同義詞關係，其中一個為標題詞，而另一個則為其同義詞。(二二) 樹狀結構標題表樹狀結構標題表 (Tree Structures) 樹狀結構標題表是將所有標題詞分類呈現，並建立每個類別內標題詞間的層級關係。樹狀結構標題表將標題詞分成15大類（如分類A：Anatomy、分類B：Organisms），每個大類下又分成多個次類，每個次類下亦分成多個小類目，最多分至九個層級。這些分類同時亦以英文字母及數字呈現，可更加方便顯示各標題詞間的分類層級。 樹狀結構標題表中可顯示每個分類的層級關係。最上層顯示者，表示該標題詞所代表的主題