Gold Standard Health Information from the Cochrane Library: Evidence with a New Look

Ann Barrett and Robin M.N. Parker

Finding reliable and authoritative health information for library users or for ourselves can often be a challenge. Academic articles can be too technical, textbooks out of date and internet sites questionable. One resource that stands out for the quality of health information it provides is the Cochrane Library. This resource is really six databases presented in a single interface, but most users are seeking the full-text Cochrane systematic reviews. These reviews are considered the gold-standard of evidence based health information. But what does that mean?

Evidence-Based Practice

Since the 1990s, Evidence-Based Practice (EBP) has become the standard for excellence in healthcare. EBP is commonly defined as integrating the best research evidence with a practitioner’s clinical experience and with patient preferences on a specific health question.

But isn’t that what health practitioners have always done? Not necessarily! The exponential growth in the volume of health research makes it difficult, if not impossible, for clinicians to stay up to date on every new development. But one important tool designed to help clinicians stay abreast of changing evidence is the systematic review. A systematic review summarizes all the relevant trials (studies) on a clinical question, assesses the quality of the studies and synthesizes the evidence in a way that gives a clear indication of the effectiveness of an intervention and states whether the intervention works, does not work, or if the evidence is not clear and more research is required.

The experts participating in the Cochrane Collaboration produce some of the most stringent systematic reviews through their international, volunteer-based organization. As noted on the Collaboration website, the “work is internationally recognised as the benchmark for high quality information about the effectiveness of health care.”i The most frequently accessed reviews are viewed hundreds of times per week, suggesting a considerable impact on health care practices around the world.ii

Access to the Cochrane Library

The Cochrane Library is a subscription database available through Wiley but access to this resource has improved significantly in the last few years. New Brunswick, Nova Scotia and Newfoundland & Labrador all provide province wide licenses that allow all residents to access the full database through their public library system. Prince Edward Island also has access through healthcare institutions and at UPEI.

This resource was originally developed for clinicians but there have been concerted efforts to make the information more consumer-friendly. Things like ‘Plain language summaries’, podcasts and the recent redesign of the interface help remove some of the intimidation factor from using the Cochrane.

Interface Changes

The Database Home Page has been redesigned to profile new reviews, special collections and services.

The Special Collections brings together reviews on a theme and provides some background and commentary on the research. Topics of interest to the Atlantic Provinces population include Care Homes for Older People, Breast Cancer Detection, and World Asthma Day, amongst others.  Another valuable resource, particularly for anyone leading discussions about health information or looking for more in-depth coverage of the evidence, is the material in the Cochrane Journal Club series. To date, 25 reviews have been prepared for the journal club, complete with presentation slides, discussion points, and additional information from the review authors.

In addition, the Cochrane Library provides a number of education tools and various media formats for accessing select reviews. Readers will find a link on the home page to “Podcasts from the Cochrane Library” leading to a page to browse available audio summaries of recent reviews. To keep up to date, an RSS feed of all new podcasts is also available.

New Reviews are highlighted at the bottom of the Database Home screen and Journal Club and Podcast icons are flagged on the left of the review title when they are available.

Searching and Browsing

Of course most often you’ll be searching for a specific topic. The Basic and Advanced searching remain largely the same in this new interface. The basic search box defaults to searching keyword in title and abstract and returns results from all six separate databases contained in the Cochrane Library. The results default to display the full reviews and protocols first.

For the occasional or novice user the Basic Search designed for keyword entry and the Browse options are usually sufficient to find the information needed. For more involved search strategies the Advanced Search offers more functionality, including field searching, MeSH Headings and boolean capability.

Once you have executed a search, the Brief Summary results page and the Article Display page have a common navigation bar that follows throughout the database. This navigation bar takes you to the browsing view of all Cochrane reviews (by topic, A-Z, etc) or browsing of other databases in the Library.

Clicking on these navigation options takes you to an A-Z listing of titles for all citations. The Clinical Trials database is an exception as it is too large for browsing and requires a search option instead.

The Article Display view has the most improvements with the addition of the new tab display providing quick access to major parts of reviews:

Abstract provides a quick summary of the review and at the bottom of the abstract display is the ‘Plain Language Summary’. Scroll down or use the ‘Jump To’ feature for quick access to this section.

Article provides the full review in html as well as links to the PDF format.  This section is typically quite long so use the ‘Jump To’ drop down list to quickly navigate to the key sections of the review like Results or Authors’ conclusions.

Figures provide quick navigation to ‘Forest Plots’iii and Tables provide summaries of findings, data and analysis. The tables and figures look alarmingly small but a click on the image will allow a larger version to open up for much easier viewing.

References has been enhanced with links to CrossRef, PubMed and to full text if you are a subscriber to Wiley titles. Also there are links to Web of Science and an indication of the number of times each reference is cited in that database.

Other versions tab can be useful to trace changes in recommendations over time. Each of the earlier versions of the review is available in full text in this section.

Cited By is a new feature that shows how often the review or protocol has been cited inside Cochrane by other articles from the clinical trials and other sections.

The ‘Additional Information’ section provides some useful features. For academic users ‘How to Cite’ can be a great time saver when they want to include a Cochrane Review in a reference list or bibliography.

Author Information lists the current position held by each of the review authors and lists the contact information for the primary author.

Publication History quickly tells you the date of publication of the latest review and if there have been any changes in conclusions since the last review.

Some nice new features are included in the Article Tools box. ‘More articles like this’ jumps you to the bottom of the Abstract where links to other articles in the same topic area are listed. The ability to share information via email or the social media of your choice like Facebook and Twitter is a handy new option.

Updating and alerting features are available for users who create a personal account in Cochrane Library. Once you have logged into your Cochrane profile you can save searches, as well as initiate email alerts and RSS feeds.

‘Export citation’ is also useful but has not improved from the previous version of the Cochrane Library. Hopefully in future there will be direct links to Refworks and other bibliographic managers incorporated into the interface.

The Cochrane Collaboration and the editors of the Cochrane Library are continually striving to improve the quality and accessibility of this important health information resource. Look for more changes to the search function in the coming year. The Cochrane Library Quick Reference Guide will provide you with more searching and interface tipsiv.

The reviews found in the Cochrane Library are valuable resources for anyone interested in objective summaries of health evidence. It is a key resource for healthcare professionals and, with the Plain Language Summary in the systematic reviews, can also be useful for the general public to gain a better understanding of the research available on a health topic of interest.

Local Cochrane Activity

There are over 150 individuals involved with the Cochrane Collaboration in the Atlantic Provinces. In addition to health care practitioners and researchers contributing as review authors, the Cochrane welcomes the involvement of consumers to ensure the usefulness and usability of the reviews. See the Collaboration website for more information on how to get involved.

For more information about local activities and training, check out the Nova Scotia Cochrane Resource Centre at http://cochrane.che.dal.ca/ or visit the Canadian Cochrane Centre website for the contact information of your regional site representative

i Cochrane Collaboration. (2011). “About Us.” www.cochrane.org/about-us.

ii Cochrane Collaboration, Top 50 Reviews, http://www.cochrane.org/cochrane-reviews/top

iii Forest plots: trying to see the wood and the trees. Lewis S, Clarke M. BMJ. 2001 Jun 16;322(7300):1479-80 http://www.bmj.com/content/322/7300/1479.long

iv Cochrane Library Quick Reference Guide. July 2010 http://www.thecochranelibrary.com/SpringboardWebApp/userfiles/ccoch/file/How%20to%20Use%20The%20Cochrane%20Library/QuickRef_englishv2.pdf

Ann Barrett is Head of Public and Access Services, W. K. Kellogg Health Sciences Library, Dalhousie University.

Robin M.N. Parker is Clinical Research Librarian, Capital Health Library Services, Research Methods Unit, & Nova Scotia Cochrane Resource Centre.