1 WORK ON COMPUTERS Summer Semester From MEDLINE to the Cochrane Library - the reliable source of evidence for healthcare. 6. Critical appraisal of medical literature. 7. How to read medical journal articles. Worked examples. 8. Bibliometrics. Science Citation Index, journal impact factor.

2 Topic 5 FROM MEDLINE TO COCHRANE LIBRARY Jarmila Potomková Medical Librarian Jan Strojil Department of Pharmacology Palacky University Faculty of Medicine Olomouc, Czech Republic Updated February 2009

3 MEDLINE via PUBMED National Library of Medicine (USA)  Premier bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, the preclinical sciences, and some other areas of the life sciences.  Bibliographic citations and author abstracts over 18 million records dating from the 1950s  Free online access at  PubMed provides links to some full-text Open archives Providers (subscription, licence)

4 Searching for Best Evidence „Well-built Questions“ Are compression stockings effective in preventing travel-related deep vein thrombosis?

5 Foreground Question: PICO Format  P/Patient, population, problem air travellers; deep vein thrombosis  I/Intervention wearing compression stockings  C/Comparison travelling without stockings  O/Outcome prevention of disease

6 Background Question What is Deep Vein Thrombosis?  Deep venous thrombosis (DVT) is the presence of coagulated blood = a thrombus, in one of the deep venous conduits that return blood to the heart.  The clinical „puzzle“ is that symptoms (pain and swelling) are often nonspecific or absent.  However, if untreated, the thrombus may become fragmented or dislodged and migrate to obstruct the arterial supply to the lung, causing a potentially life-threatening pulmonary embolus (PE). Merck Manual of Diagnosis and Therapy. Available from:

7 Merck Manual of Diagnosis and Therapy

8 PubMed Search Consolidation Search Strategy  Selection of search terms Keywords Phrases Synonyms  Combination of search terms Boolean logic  Application of limits Occurrence of search terms  Title, Title/Abstract, All fields Types of articles Age groups Etc.

9 Boolean logic  AND: Combines terms to limit your search as both concepts must be present in all retrieved articles Example: compression stockings AND deep vein thrombosis AND flight  OR: Widens your search as either term can be present in all retrieved articles Example: vein thrombosis OR venous thrombosis OR venous thromboembolism  NOT: Limits your search by excluding a concept as one term must be present and the second term must not be present

10 Truncation *  PubMed finds all terms that begin with a given text string  Example  thrombo*  PubMed retrieves: thrombosis, thromboses, thromboembolism,,,,,,,,,

11 Search Strategy Suggestions Step 1 vein thrombo* OR venous thrombo* Limits: Title/Abstract Step 2 compression stocking* OR elastic stocking* OR flight sock* All fields Step 3 airline OR air travel* OR flight* OR aircraft All fields Step 4 Combine searches #1 AND #2 AND #3

12 History: Combine Searches

13 Results: 33 records

14 History  Registers & holds all your search strategies and search results search statements numbers can be combined or used again  Displays each search query numbers (#1, #2…….), number of records (Results)  Automatically lost after 8 hrs of inactivity.

15 PubMed Search Results  Types of articles All : 33  Reviews: 14  Traditional („narrative“)  Systematic + Meta-analysis (pre- determined criteria of study inclusion)  Cochrane (systematic + regularly updated with new data)

16 Example of Systematic Review (1)  Philbrick JT, Shumate R, Siadaty MS, Becker DM.  Air travel and venous thromboembolism: a systematic review.  J Gen Intern Med Jan;22(1): Review.

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18 Example of Systematic Review (2)  Sajid MS, Tai NR, Goli G, Morris RW, Baker DM, Hamilton G.  Knee versus thigh length graduated compression stockings for prevention of deep venous thrombosis: a systematic review.  Eur J Vasc Endovasc Surg Dec;32(6): Epub 2006 Aug 23. Review.

19 Example of Systematic Review (2) Structured Abstract

20 Systematic Review (2) - Methods

21 Cochrane Review Reference Article in Dutch

22 Cochrane Review  Clarke M, Hopewell S, Juszczak E, Eisinga A, Kjeldstrøm M.  Compression stockings for preventing deep vein thrombosis in airline passengers.  Cochrane Database Syst Rev Apr 19;(2):CD Review.  Update?

– Cochrane Collaboration 50 Collaborative Groups  Worldwide experts interested in developing and maintaining systematic reviews relevant to a particular health area Cochrane Library/Advanced Access Cochrane Library/Advanced Online access to structured abstracts of Systematic Reviews Full versions of systematic reviews for fee  Palacky U licence: Reviews

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25 Cochrane Library Advanced Search

26 Avanced Search : Record Title Database of Systematic Reviews

27 First published 2006; most recent issue 1(2009); status -- unchanged

28 Cochrane Review Full Version EBM Reviews - Pripojit

29 Cochrane Review Full Version

30 Search for the Exact Title

31 Open EBM Topic Review pdf

32 Pdf Fulltext Extent: 45 pages

33 COCHRANE COLLABORATION International non-profit and independent organisation, dedicated to making up-to-date, accurate information about the effects of healthcare readily available worldwide

34 THE NAME & FACE BEHIND COCHRANE COLLABORATION Professor Archibald Cochrane ( )  British epidemiologist  Best known for his book Effectiveness and Efficiency:Random Reflections on Health Services (1972) Resources for health care will always be limited They should be used to provide effective forms of care Importance of using evidence from randomized controlled trials.

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36 COCHRANE COLLABORATION 1993 The major product published quarterly:  The Cochrane Library Most frequently used DBs Cochrane Database of Systematic Reviews (5,676 items) Central Register of Controlled Trials (564,387 items) Health Technology Assessment Database (7,591 items) NHS Economic Evaluation Database (24,432 items) And others.

37 The Cochrane Database of Systematic Reviews (Cochrane Reviews; EBM Reviews))  Growing list of regularly updated summaries of the best available evidence prepared by members of the Cochrane Collaboration Complete reviews (topic reviews)  Full-text articles reviewing the effects of specific health care interventions;  Highly-structured, systematic;  Evidence included/excluded on the basis ofpre-determined quality criteria. Protocols  Information about reviews in preparation, including the background, rationale and methods.