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Evidence-Based MedicineEvidence-Based Medicine(EBM)(EBM)

and theand theCochrane CollaborationCochrane CollaborationPresented June 24, 1997

Karl Woodworth (Woody)from Emory University

at N.I.L.C.

Tbilisi, Republic of Georgia

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Outline of This Talk

q Introduction to Evidence-Based Medicine

q Some Controversy about EBM

q

EBM: role of Libraries, Information Centersq Understanding Clinical Trial Information

q How the Cochrane Collaboration Began

q The Cochrane Collaboration Nowq List of Cochrane Services and Products

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Introduction to EBM

q Concept began in England and Canada

q Practitioners of EBM use results from

clinical trial studies to guide decisions,actions, in medical practice

q Practitioners do not use peer discussions,

experience, intuition, as the only basis for

decisions, actions in medical practice

q Re-align Medicine with Science

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Contrast: Traditional Mode vs.

Evidence-Based Medicineq TRADITIONAL:

q Identify the Problem

q Use your Experience

q Ask a Colleague

q Consult a Textbook

q Read a Review

q EBM:

q Formulate a Question

q Conduct Search of

Literature

q Select Key Articles

q Critically Judge the

Articlesq Apply result to Patient

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Arguments: Against EBM

q Decisions based on old information

q Disregards value of clinical experience, intuition

q Does not take into account local differences in

environment or characteristics of local population

q Will be misused by Health Insurance Companies,

National Health Organizations to restrict treatmentoptions.

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Arguments: For EBM

q Science (= management of error ) the

only valid foundation for Medical Practice

q Traditional Mode of practice prolongs use

of wrong treatments, faulty diagnosis.

q EBM brings best and most current

knowledge, gained from worldwide

sources, to the diagnosis, treatment of a

patient

q EBM guides, does not dictate, practice

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Role of Libraries and Information

Centers in EBMq Support EBM by providing access to online

databases, clinical trial databanks, literature

q Provide assistance with search strategies

q Encourage rigourous selection of journal

articles by providing knowledge of

publication types, criteria for selection

q 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

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Medical Information

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

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Why Use Randomized

Controlled Trial (RCT) ?q STUDIES NOT

USING CONTROLS:

q 85% Report Success

q STUDIES USING

CONTROLS:

q 19% Report Success

q -- Foulds

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

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Cochrane Collaboration Begins

q < 1980: Archie Cochran chastises medical

profession for lack of scientific rigour

q 1980-1992: Researchers, Clinicians,

Informatitians volunteer to meet, agree on

criteria, share information about clinical

trial data

q 1992: UK Cochrane Center created, to

coordinate worldwide effort

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Cochrane Collaboration 1997

q

UK Cochrane Center is central collectingpoint, producer of products, coordinator.

qNine (9) Regional Centers

q

23 Subject Areas of Reviewq Main Activity: systematic reviews of

clinical trial information

q Reviews continuously updatedq Data is distributed by subscription

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Nine (9) Regional

Cochrane Centersq Australasian

q Canadian

q

UKq Dutch

q Italian

qNordic

q Baltimore, USA

q San Francisco, USA

q

San Antonio, USA

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Cochrane Collaboration:

Subject Areas of Reviewq Vascular/Respiratory:

q Acute Respiratory

Infection

q Hypertension

q Vascular Diseases

q Stroke

q Airways

q Other Systemic Illness:

q Diabetes

q Hepato-Biliary (Liver,

Bile system)

q Cystic Fibrosis

q Peripheral Disease

q Infectious Diseases

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Cochrane Collaboration:

Subject Areas (continued)q Reproductive Health:

q Menstrual Disorder

q Sub-Fertility

q Pregnancy & Childbirth

q Neonates

q Mental Health:

q Schizophrenia

q Depression

q Dementia and

Cognitive Impairment

q Anxiety and Neurosis

q Tobacco Addiction

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Cochrane Collaboration:

Subject Areas (continued)

q Other Miscellaneous:

q Effective Professional Practice

q Oral Healthq Movement Disorders

q Musculoskeletal

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Cochrane Collaboration:

Products

q CDSR - Cochrane Database ofSystematic

Reviewsq DARE - Database ofAbstracts ofReviews of

Effectiveness

q CCTR - Cochrane Controlled Trials Registerq Bibliographies, Contact Lists, Internet Links

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Cochrane Product Detail:

CDSRq Reviews of Controlled Trials

q STRUCTURED REVIEWS using

specific criteria to minimize bias

q Some reviews use META-ANALYSIS,

combining results of small studies to form

an artificial large study

q Continuously updated

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Cochrane Product Detail:

DAREq Structured abstracts of systematic reviews

worldwide

q Critically appraised by reviewers at NHS

(National Health Service), UK

q Other, non-systematic reviews which

provide background information

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Cochrane Product Detail:

CCTRq Worldwide bibliography of controlled trials

q Hand-searching journals all over the world

q

Source of data for systematic reviewersq Includes conference proceedings (!), other

sources not in Medline Database

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Cochrane Products:

Formats and Pricesq FORMATS:

q CD-ROM

q 3.5 Diskette

q Internet

q PRICES:

q Personal Use: $196

q 6-10 User: $630

q >10 User: ???

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Internet URL for More Study

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