NEWS AND REVIEWS: Short report

What is all about?

Chris Del Mar, MD, FRACGP, is Professor of General Practice, Centre for General Practice, University of Queensland Medical School, and Medical Editor - Research, Australian Family Physician. Jenny Doust, MBBS, FRACGP, is a general practitioner, Centre for General Practice, University of Queensland.

Recently the Australian Minister for Health, the Hon Kay Patterson, announced that Australia is purchasing the Cochrane Library for all Australians. Australians will now have access to the library free of charge through the web.

What is the Cochrane systematic reviews, Effective Care in reviewers submit a question to answer Library and how can it be Pregnancy and Childbirth.4 From this (called a Title at this stage). When used? kernel came the worldwide collabora- accepted, this discourages others The Cochrane Collaboration tion, extending beyond perinatal care. working on the same question (to reduce There are now 50 Collaborative Review duplication of effort). The reviewers are The Cochrane Collaboration is a loose Groups acting as editorial bases to coor- then asked to submit a full Protocol, knit organisation of people located dinate the of the which is the methods intended to throughout the world who are dedicated literature searching for answers about conduct the review. This is subject to to providing the work necessary to different treatments. peer review, and after any necessary produce the Cochrane Library. The amendments are made, the reviewers are library is an attempt to present research How the Cochrane invited to actually complete the review. findings in a way that can be easily Collaboration gets reviews When this is submitted to the undertaken accessed by clinicians. It is named after Collaborative Review Group, another Archie Cochrane, a British epidemiolo- The engine of the Cochrane peer review process is undertaken before gist who highlighted the great gap Collaboration is the systematic review. it is accepted and published in the between research being undertaken, This is a piece of research that attempts Cochrane Library. There are several published and stored carefully in to answer a question of effectiveness for steps to a review (Table 1). From a user’s libraries, and the actual clinical decisions a clinical treatment. The subject matter is point of view, the focus is on the library, made by clinicians.1 The gap seems to be the literature itself. ‘Reviewers’ (as the ie. gaining access to the contents to ever widening: more and more informa- authors of this research are called, rather inform clinical decisions about treat- tion is discovered about diseases and confusingly) systematically search the lit- ments. their best management, but doctors erature for any research that answers the seemed to ignore this information when treatment question. Reviews are pre- Inside the Cochrane Library making clinical decisions. Treatments are sented as a document that looks like a The library has several components being used that are ineffective (or even research paper, ie. there is an abstract, (Figure 1). There is a section that con- harmful), and effective treatments are methods, results and conclusions. tains the Cochrane Reviews described not used.2,3 Sometimes the data from the reviewed above. These systematic reviews and Iain Chalmers, an obstetrician prac- research can be combined, in which case meta-analyses are often the best quality tising in Oxford, attempted to redress the systematic review is called a ‘meta- available.5 There is a section that lists this in the area of obstetrics. He devel- analysis’ (meta meaning after). Cochrane Review Protocols - those oped the Oxford Database of Perinatal The process for completing Cochrane halfway through the process described Trials, which was followed by a series of Reviews is complicated: potential (Table 1). There are nearly 1500

Reprinted from Australian Family Physician Vol. 31, No. 11, November 2002 • 1 n What is Cochrane all about?

MeSH Options

Search term: * [No restrictions] Database Hits [Total] The Cochrane Database of Systematic Reviews Complete reviews 1456 [1456] Protocols 1101 [1101] Database of Abstracts of Reviews of Effectiveness Abstracts of quality assessed systematic reviews 2846 [2846] Other reviews: bibliographic details only 800 [800] The Cochrane Controlled Trials Register (CENTRAL/CCTR) References 348740 [348740] The Cochrane Database of Methodology Reviews Complete reviews 4 [4] Protocols 9 [9] The Cochrane Methodology Register References 3866 [3866] About the Cochrane Collaboration The Cochrane Collaboration 1 [1] Collaborative Review Groups - CRGs 50 [50] Fields 10 [10] Methods Groups 11 [11] Networks 1 [1] Centres 14 [14] Sources of support 1 [1] Health Technology Assessment Database (HTA) Abstracts by INAHTA and other healthcare technology agencies 2569 [2569] NHS Economic Evaluation Database (NHS EED) Critically appraised economic evaluations 3733 [3733] Other economic studies: bibiliographic details 6212 [6212]

Figure1. Entering the Cochrane Library

Table 1. Steps to a review Table 2. within the Cochrane Library Reviewers actions Cochrane processes 1 Selecting a clinical question submitting a Title: Best checking for duplication 1 Cochrane review 2 Deciding the important outcomes submitting the Protocol 2 Other reviews (in the Database of Peer review Abstracts of Reviews of Effectiveness, 3 Searching the literature and the Health Technology 4 Deciding on the quality of what was found Assessment Database) 5 Deciding what it means submitting the Review 3 Controlled Trials Register Peer review 6 Publishing the Review in the Cochrane Library 7 Updating the review (go back to 3 above) submitting the Updated Review Peer review Updating the Review in the Cochrane Library

2 • Reprinted from Australian Family Physician Vol. 31, No. 11, November 2002 What is Cochrane all about? n

Cochrane Reviews, perhaps summarising Searching is undertaken in a query approximately 10% of all trials. Of course window, and the ‘hits’ are displayed in the the question you have may not even have different sections (Figure 1). The number been subject to a trial. Therefore, there of hits yielded by the search are displayed are many questions that may not have beside each section. There is a help been reviewed. button to assist in searching - something However, there is other information not always straightforward to learn. It is that may be very useful. First, there is a best to begin at the best level of evidence listing of systematic reviews not under- (Table 2). taken by the Cochrane Collaboration but by other organisations (these are assem- Conclusion bled by the NHS Centre for Reviews and The Cochrane Library is designed to Dissemination in the Database of make life easier. It pays to learn one’s Abstracts of Reviews of Effectiveness) way around the library. There is a huge (Figure 1). These are only published in amount of information available. summary form. Moreover our patients now have access to Second, there is a list of trials, many the library - it will be worth knowing with abstracts. These include trials that something about it for that reason alone! can easily be found on electronic data- bases such as Embase and Medline. In References addition, trials have been identified by 1. Cochrane A L. Effectiveness and efficiency: Random reflections on health services. people in the Cochrane Collaboration London: Nuffield Provincial Hospitals from either those less well indexed by Trust, 1972. hand searching journals or from the ‘grey’ 2. Haynes B, Haines A. Barriers and bridges to evidence based clinical practice. Br literature (conference proceedings for Med J 1998; 317:273-276. example, which are not automatically 3. Antman E M, Lau J, Kupelnick B, Mosteller electronically indexed). This Controlled F, Chalmers T C. A comparison of results of meta-analyses of randomised control Trials Register is a very useful source of trials and recommendations of experts. information about trials of treatments. JAMA 1992; 268:240-248. Many recently developed health tech- 4. Chalmers I, Enkin M, Kierse M, eds. nologies and pharmaceuticals have been Effective care in pregnancy and childbirth. Oxford: Oxford University Press, 1989. reviewed by government and other health 5. Petticrew M, Wilson P, Wright K, Song F. care technology agencies and summaries Quality of Cochrane reviews is better than of these are provided in the Health that of non-Cochrane reviews. Br Med J 2002; 324:545. Technology Assessment Database. AFP Finally, there are sources of informa- tion about method issues, and the governance of the Cochrane Collaboration that are often less interest- ing to clinicians chasing a question.

How to use the Cochrane Library The library is electronic. It exists either as a set of CDs or through a web interface. The latter is likely to be the way most commonly accessed by people, however, the CD version will be of special benefit to those who cannot use the web. There is a front page that helps direct you to the library’s different sections.

Reprinted from Australian Family Physician Vol. 31, No. 11, November 2002 • 3