Evidence-Based Medicine (EBM) and the Cochrane Collaboration

Presented June 24, 1997 Karl Woodworth (Woody) from Emory University at N.I.L.C. Tbilisi, Republic of Georgia

Outline of This Talk

Introduction to Evidence-Based Medicine Some Controversy about EBM EBM: role of Libraries, Information Centers Understanding Clinical Trial Information How the Cochrane Collaboration Began The Cochrane Collaboration Now List of Cochrane Services and Products

Introduction to EBM
Concept began in England and Canada Practitioners of EBM use results from clinical trial studies to guide decisions, actions, in medical practice Practitioners do not use peer discussions, experience, intuition, as the only basis for decisions, actions in medical practice Re-align Medicine with Science

Contrast: Traditional Mode vs. Evidence-Based Medicine

TRADITIONAL: Identify the Problem Use your Experience Ask a Colleague Consult a Textbook Read a Review

EBM: Formulate a Question Conduct Search of Literature Select Key Articles Critically Judge the Articles Apply result to Patient

Arguments: Against EBM

Decisions based on old information Disregards value of clinical experience, intuition Does not take into account local differences in environment or characteristics of local population Will be misused by Health Insurance Companies, National Health Organizations to restrict treatment options.

Arguments: For EBM

Science (= management of error ) the only valid foundation for Medical Practice Traditional Mode of practice prolongs use of wrong treatments, faulty diagnosis. EBM brings best and most current knowledge, gained from worldwide sources, to the diagnosis, treatment of a patient EBM guides, does not dictate, practice

Role of Libraries and Information Centers in EBM

Support EBM by providing access to online databases, clinical trial databanks, literature Provide assistance with search strategies Encourage rigourous selection of journal articles by providing knowledge of publication types, criteria for selection Train students, clinicians in use of electronic databases and search technique

McKibbbon, Ann; CE Session Handout: Evidence-Based Medicine for Librarians: Panning For Gold; 1997

Medical Information

McKibbbon, Ann; CE Session Handout: Evidence-Based Medicine for Librarians: Panning For Gold; 1997

Why Use Randomized Controlled Trial (RCT) ?

STUDIES NOT USING CONTROLS: 85% Report Success

STUDIES USING CONTROLS: 19% Report Success

-- Foulds

McKibbbon, Ann; CE Session Handout: Evidence-Based Medicine for Librarians: Panning For Gold; 1997

Cochrane Collaboration Begins

< 1980: Archie Cochran chastises medical profession for lack of scientific rigour 1980-1992: Researchers, Clinicians, Informatitians volunteer to meet, agree on criteria, share information about clinical trial data 1992: UK Cochrane Center created, to coordinate worldwide effort

Cochrane Collaboration 1997

UK Cochrane Center is central collecting point, producer of products, coordinator. Nine (9) Regional Centers 23 Subject Areas of Review Main Activity: systematic reviews of clinical trial information Reviews continuously updated Data is distributed by subscription

Nine (9) Regional Cochrane Centers

Australasian Canadian UK Dutch Italian Nordic

Baltimore, USA San Francisco, USA San Antonio, USA

Cochrane Collaboration: Subject Areas of Review

Vascular/Respiratory: Acute Respiratory Infection Hypertension Vascular Diseases Stroke Airways

Other Systemic Illness: Diabetes Hepato-Biliary (Liver, Bile system) Cystic Fibrosis Peripheral Disease Infectious Diseases

Cochrane Collaboration: Subject Areas (continued)

Reproductive Health: Menstrual Disorder Sub-Fertility Pregnancy & Childbirth Neonates

Mental Health: Schizophrenia Depression Dementia and Cognitive Impairment Anxiety and Neurosis Tobacco Addiction

Cochrane Collaboration: Subject Areas (continued)

Other Miscellaneous: Effective Professional Practice Oral Health Movement Disorders Musculoskeletal

Cochrane Collaboration: Products

CDSR - Cochrane Database of Systematic Reviews DARE - Database of Abstracts of Reviews of Effectiveness CCTR - Cochrane Controlled Trials Register Bibliographies, Contact Lists, Internet Links

Cochrane Product Detail: CDSR

Reviews of Controlled Trials STRUCTURED REVIEWS using specific criteria to minimize bias Some reviews use META-ANALYSIS, combining results of small studies to form an artificial large study Continuously updated

Cochrane Product Detail: DARE

Structured abstracts of systematic reviews worldwide Critically appraised by reviewers at NHS (National Health Service), UK Other, non-systematic reviews which provide background information

Cochrane Product Detail: CCTR

Worldwide bibliography of controlled trials Hand-searching journals all over the world Source of data for systematic reviewers Includes conference proceedings (!), other sources not in Medline Database

Cochrane Products: Formats and Prices

FORMATS: CD-ROM 3.5 Diskette Internet

PRICES: Personal Use: $196 6-10 User: $630 >10 User: ???

Internet URL for More Study

http://ahsn.lhsc.on.ca/cat/ebm.html