"Understanding The Cochrane Library"
NCDDR Webcast #2
September 11, 2006, 3:00-4:30 PM EDT
Presenter: Ms. Denine Tilery

Edited Transcript

>> JOANN: Good afternoon, everyone. And thank you for joining the webcast on "Understanding the 
Cochrane Library." My name is Joann Starks; I'm with the National Center for the Dissemination of 
Disability Research, known as the NCDDR, and I'll be moderating today's webcast and voicing your 
questions to our presenter, Ms. Denine Tilery. We want to be sure to thank our partners at ILRU in 
Houston, for helping with the technical side of the webcast.

I wanted to let you know that you can submit questions at any time during the webcast. However, I 
encourage you to submit them early if you have them early on. You can submit questions by clicking the 
"Submit Question" button at the bottom of your RealOne Player screen or you can send e-mail to 
webcast@sedl.org 

Questions will be posed to Ms. Tilery upon her request. If time does not allow for your question to be 
answered during the webcast, it will be forwarded to her to be answered via e-mail at a later time. If anyone 
has technical difficulties during the webcast, for assistance, please call ILRU at (713) 520-0232 and dial 0 
for the operator. This number is both voice and TTY capable. 

I also want to point out that today's webcast has a PowerPoint presentation that is posted on the webcast 
Web site as a handout. The presentation is also available in a text-only version as a Word document. If you 
want to follow along or utilize this for notes, you may want to print out a copy of the presentation now if 
you haven't already done so. 

The NCDDR is supported by a grant from the U.S. Department of Education to the Southwest Educational 
Development Laboratory, SEDL, based in Austin, Texas. The grant is funded through the National Institute 
on Disability and Rehabilitation Research, NIDRR. The NCDDR is charged with assisting NIDRR-funded 
researchers to improve the quality of their research design and outcomes so that more NIDRR-funded 
research makes its way into the larger body of research evidence, as identified through systematic reviews, 
and to facilitate the use of this evidence. To help achieve this aim, the NCDDR is providing a new service 
for NIDRR-funded researchers: free-of-charge, online access to the Cochrane Library.

In this webcast, Ms. Denine Tilery will describe the Cochrane Library to help subscribers get the most out 
of using this service. First, she will explain the aim, goals, and structure of the Cochrane Collaboration, the 
developer of the Cochrane Library. Next, she will discuss why systematic reviews are an increasingly 
important source of research evidence. Then she will describe the Cochrane Library databases, what they 
contain and how to search the databases by topic, subject, or in other ways. Finally, Ms. Tilery will explain 
how to use the "My Profile" feature to save advanced searches.

Now, before she begins, I want to take another minute to provide some background information about our 
presenter. Ms. Denine Tilery is Account Development Manager for North and Latin America for John 
Wiley and Sons, Inc./Wiley InterScience, publisher of The Cochrane Library and a partner with the 
Cochrane Collaboration. She has served in this role in publishing for the past six years and is certified 
through Langevin Learning Services as a Training Manager/Director. Ms. Tilery is responsible for training 
Wiley internal (colleagues) and external (customers) on the entire suite of Wiley products, including 
Evidence-Based Medicine resources such as The Cochrane Library. Ms. Tilery has presented on Cochrane 
to numerous corporate, pharmaceutical and non-profit organizations across North America using online, 
hands-on, virtual, and presentation formats. And with that we'll begin the session by turning it over to Ms. 
Denine Tilery. Welcome, Denine.

>>DENINE: Hello, and thank you, Joann and thank you all very much for attending today's presentation of 
Understanding the Cochrane Library. What I'm going to do during our presentation is walk through, as 
Joann mentioned, the Cochrane Library in general. For those of you who may have heard of the Cochrane 
Library before and are not too familiar with it, I hope you find this presentation useful. As you can see, we 
do have a large amount of content that we're going to go through as you can see from the number of slides, 
but I assure you, it will be as painless as possible. 

So with that I'm going to skip through the very first cover page, which says Understanding the Cochrane 
Library. And I'm going to the second slide, which has my information as today's presenter. Again, my name 
is Denine Tilery and certainly if you or any of your colleagues require any further information about the 
Cochrane Library once we've completed this session, please feel free to contact me at any time. What I'm 
going to mention also is that Wiley InterScience is a partner with the Cochrane Collaboration, so we 
certainly look forward to hearing your feedback as you begin to use the products. So that was slide 2 with 
my information and if you're curious about Hoboken, New Jersey, we are right outside ofÑwe're right on 
the Hudson River and the home of Frank Sinatra and baseball for those of you who didn't know that.

I'm going to slide No. 3, Presentation Contents. I wanted to briefly go through our agenda just in a little 
more detail, but Joann did a great job of actually covering most of the content. The first thing is the 
overview, Understanding the Cochrane Library. We're going to go through Module 1, What is the 
Cochrane Library? I think people have many ideas about what is Cochrane, how does it work, or again you 
may have not have heard of it. The secondÑI sort of added this module on, the systematic reviews and 
protocols. I think it's good to define what they actually are. One misconception that a lot of people have 
about the Cochrane Library is that it's as if you're looking through journal articles, which is sort of the 
opposite of what Cochrane is and what they are trying to provide to you. And the third, as can you see, the 
Cochrane Library databases. The Cochrane Library is not just one large database, but there are seven 
databases included in the Cochrane Library we'll be able to review.

We'll go to the next slide, which will show Module 4. Because this is a webcast, we are going to talk a little 
bit however about browsing topics, reviews and protocols, and certainly again if any of you are interested in 
participating in a live demonstration later on down the line, you can contact me and we can walk through 
how you actually search through the actual Web page. We also have Module 5, MeSH, which stands for 
Medical Subject Headings, and advanced search tips and again, just some helpful hints for anyone that is 
searching Cochrane, how to get the most of the content within the Cochrane Library. And as I mentioned 
here, each module includes a list of suggested links that will assist you with using the Cochrane Library. 
When I first started, when I actually learned about Cochrane, I found a number of different resources that I 
think that are incredibly useful that go a little bit outside of Cochrane, but you may be familiar with them. 
Joann, does it sound like I left anything out?

>> JOANN: No, it sounds like you got it covered.

>>DENINE: Now, everyone, you should be on slide 5, which says, "What is the Cochrane Library exactly 
and how did it begin?" And I just wanted to note on this PowerPoint that I have a picture of the Cochrane 
Library home page. And for those of you who may be writing notes down on the PowerPoint, let me give 
you the Cochrane website which is thecochranelibrary.com and when you type in Cochrane to go to the 
website, you must put in the word "thecochranelibrary" as one word. 

So we're going to go to slide 6. Module goalsÑI've actually broken up this PowerPoint into a number of 
modules. You're saying my, how many slides we have. Trust me, it will be great by the time we get to the 
end. I'll talk a little bit on the module goals, introduction to EBM as it's often referred to, Evidence-Based 
Medicine; understanding the Cochrane Library; and including the collaboration. I think if you are interested 
in learning about what is Cochrane, it's important to know who are the people behind the Cochrane Library 
systematic reviews and protocols, and again I'm going recap what are systematic reviews and protocols and 
why are they important. Because as I mentioned in slide 3 that these are not journal articles. So I'm going to 
clarify the differences between that which will give you an idea of why they are so useful, hopefully in your 
daily research.

So we'll go to the next slide, slide 7, and you should see Evidence-Based Medicine and you should see a 
quote that I've actually taken from the Centre for Evidence-Based Medicine, and the quote says, "The 
conscientious, explicit and judicious use of current best evidence in making decisions about the care of 
individual patients." And this is actually part of the definition of Evidence-Based Medicine. If you're 
interested, sometime ago what a lot of clinicians actually talked about, including Dr. Cochrane, but there 
was another clinician whose name is Dr. David Sackett and that is spelled, if you want to look up his name, 
S-A-C-K-E-T-T. He was actually one of theÑthey consider him the Godfather of Evidence-Based 
Medicine because Dr. David Sackett wrote numerous papers about the importance of not only having 
relevant information for clinicians, but having it easily accessible and that's going along talking with his 
colleagues. 

Eventually there became the Centre of Evidence-Based Medicine and you may hear about different studies, 
and the Evidence-Based Medicine resources in Norway and other parts of the world. Well, these people 
actually have gotten together and now the Centre for Evidence-Based Medicine listed on our PowerPoint is 
located in Oxford and this is a really good resource. Again, I highly recommend that you actually highlight 
this link page to take a look. It really explains thoroughly what is this definition of Evidence-Based 
Medicine and why is it important. 

And with the Cochrane Library, which we'll go into and talk about, Evidence-Based Medicine is not in an 
ivory tower for just clinicians or researchers. It's also for consumers; anyone who is interested in 
interventions and treatments. The Centre for Evidence-Based Medicine, www.cebm.net, also provides a 
comprehensive glossary of terms, which I've noted in this blue box if you do have this PowerPoint printed 
out in color.

For example, Evidence-Based Medicine talks about the different levels of evidence. We all know that Ð you 
certainly may know a person or a clinician who is an expert in his field, but there are also systematic 
reviews that need to be taken into account, there is information from PubMed, there is information from 
Medline, there are so many different sources from published and unpublished studies that evidence-based 
medicine says just sort of look at all that information as a whole to gather really valid, what's relevant, what's 
valid and put it together so we can use it in treatments and interventions. So again with this slide, I highly 
recommend to you that it has a great glossary of terms and some wonderful online tutorials that talk about 
evidence-based medicine. So no matter if you're searching Cochrane, if you're searching PubMed or you're 
searching journals, you can really learn more about this sort of ideal or the concept behind this and why 
these sorts of tools are growing, such as the Cochrane Library. Evidence-based medicine, just to note, is 
really an approach to decision-making and certainly I just want to stress that again as you'll see in our next 
slide.

We're going to slide 8 and I'm just going to repeat the slide for some of you. Today's medical knowledge 
thrives on the need to be relevant and valid information. I think I mentioned this. And as I'm discussing 
with you today, that this can certainly come from a number of sources, and in a number of formats. Some 
of you may be familiar with PubMed. Clinicians I know very often use UptoDate, which is a great resource, 
however, which I'll sort of mention is more-so "expert opinion." We certainly have Medline, and the 
Cochrane Library, which we're going to take a look at. You can note that it actually links to Medline and 
PubMed resources.

Another great source that we often refer to are practice guidelines and summaries. The Cochrane Library 
certainly understands that, and it takes a look at that information, in guidelines and summaries. Certainly 
one note with the Cochrane Library we often mention, for a clinician to stay current, he would have to read 
over 17,000 articles a day. So imagine out of all those articles, just imagine trying to remember the different 
practice guidelines and summaries on a daily basis. I, myself, worked for a doctor sometime ago when I 
was in college, five or six years, and I can remember the doctor with a stack of journals on his desk and 
trying to remember that we literally didÑhe actually did see 50 patients a day. So having relevant and valid 
information was critical for him to be a successful orthopedic surgeon.

And again, looking at journal articles, certainly we all know that clinicians go to their colleagues for expert 
opinions. Again, if you have a colleague who has been in the business for 25 years, you may refer to him, 
maybe he remembers a guideline, or maybe even a new resident who can actually provide you with 
information on a new study. And certainly clinical trials. So all this information is relevant even if you're 
using the Cochrane Library, but we're going to go into how do we filter through all that information?

So we're going to go to slide 9 next, and you should see the very colorful, if you did print this out in color, 
pyramid and sort of what I talked about. This is the Evidence-Based Medicine pyramid, which again when 
we talk aboutÑif you can see at the bottom you have "clinical reference texts." You may have "other 
reviews of literature," because there are other reviews outside of Cochrane. You can see there is also RCT, 
evidence summaries, some of the things I mentioned on the previous slide. All this information, you as a 
clinician or as a researcher, a librarian, or consumer have to filter through all this information to find out if a 
treatment or intervention works. 

As you can see, ifÑnormally what I do is to circle the very top of the pyramid. You'll see that Cochrane 
Systematic Reviews are at the very top and the reason why that is, if you can note on the side, Cochrane 
reviews are now the gold standard for systematic reviews and key publications. The reason for this is very 
simple. Cochrane filters through all theseÑall this different relevant information to provide you with a 
systematic review. And again, I strongly encourage you to take a look at any of the journals such as The 
Lancet, New England Journal of Medicine and the few journals I've listed here, to see how the Cochrane 
reviews routinely appear there in these specialized medical journals. 

And it wasÑone thing I noted fromÑwe actually have a few colleagues here that note that Evidence-Based 
Medicine is not good or bad, and I think this was really important in why they created the pyramid. Some 
people look at it as if there is bad information or good information. That's not what we're trying to explain. 
We're trying to say that there is a pyramid of gathering the information, filtering through it, so that we can 
use it. And again, Cochrane is at the top of that pyramid as a gold standard for filtering through for that 
information that you need.

I am going to go to the next slide, which is slide 9, and finally we're going to go to some good stuff. So, 
what is the Cochrane Library? The Cochrane Library is the single most reliable source for evidence on the 
effects of health care. And again, you can see the Cochrane Library home page, which is 
www.thecochranelibrary.com, and you can see that the Cochrane Library actually has a number of 
databases. So I just wanted to show you that page. 

We are on 10 and we're going to 11. And as promised we're going to talk about the Cochrane 
Collaboration. When I mentioned Dr. David Sackett, another doctor who did an enormous amount of work 
in this drive for evidence-based medicine was Dr. Archie Cochrane and he was actually theÑthe Cochrane 
Collaboration is named in honor of Archie CochraneÑwho was a British medical researcher who 
contributed greatly to the development of epidemiology as a science. As an epidemiologist, Dr. Cochrane 
really understood the importance of finding relevant information for populations and dealing with diseases 
and treatments or interventions. And if you are curious, I actually have listed on the slide one of his best-
known books, the Effectiveness and Efficiency: Random Reflections on Health Services, which was 
published in 1972.

It was also funny because I read, I actually Googled Dr. Cochrane's name when I first learned about 
Cochrane. Who was this guy? I keep hearing his name, and why they did they name the collaboration after 
him? He was that one clinician when he would go to conferences, when the other clinicians or his 
colleagues would just go, "Make sure you have all your information before you actually present anything 
during a conference because Dr. Cochrane is the type of colleague who would ask you questions. Where 
did you find your information? You know, did you look at published and unpublished information? What 
kind of trials were you referring to?" And really by doing that, he wrote over 80 papers on the 
CochraneÑbefore the Cochrane Collaboration started. So really he was very instrumental in getting people 
to talk about this information.

So we're going to skip to slide 12 or should I say the next page. I apologize. And thus by 1993, as you can 
see here, the Cochrane Collaboration was born. My company, John Wiley and Sons, publishes the 
Cochrane Library for the Cochrane Collaboration and we're actually partners with them. In fact, a few of 
our colleagues are actually Cochrane editors. So again, if you have further questions about the content, I'd 
be happy to assist you. Or even one of the Cochrane editors themselves might actually respond back to 
you.

The structure is very simple. It was established as an international organization in 1993 and it's registered 
as a charity in the UK and certainly in a few other countries such as Scotland, Wales, Australia, and in fact 
in provinces in Canada. Actually, Saskatchewan, which I am proud to say I can spell now. We actually 
trained public librarians how to use Cochrane in five different cities. So every consumer, anyone who wants 
to learn about treatments or interventions, they've gone to their family doctor, they've gone and are sort of 
curious about maybe a particular treatment or intervention being used. They can actually go to the public 
library in Saskatchewan and search the Cochrane Library.

And one state in the United States has access to Cochrane, which is Wyoming, because the librarians got 
together and felt that this was an invaluable resource that should be available. So you can certainly go to 
Wyoming and use Cochrane at any time. The aim is very simple, to help people make well-informed 
decisions about health care and how, which we're going to go into more detail in a few slides, by actually 
preparing and maintaining and promoting access to the reviews; this is what the Cochrane Collaboration 
does to provide you with the systematic reviews of the effects of health care intervention. The publishing 
output is the actual Cochrane Library.

We're going to go to the next slide so we'll get into some graphics. I wanted to showÑwhen I mentioned 
the national site licenses, just to give you an idea of how many countries, now, where just as a consumer 
you can walk in and find more information about the Cochrane Library, and again I should very soon add 
that in the United States that Wyoming is a state where you do have a free subscription to the Cochrane 
Library. Again, all over the world, slowly, more and more people learn about Evidence-Based Medicine 
whether it's patients, librarians, consumers, clinicians, or researchers, it's slowly growing worldwide.

I'm going to skip to the next slide, which is slide 14. So normally people will say to me when they are on 
the phone, "Well, Denine, I understand that it's a global organization, but who is actually involved in the 
collaboration?" So we're actually going to go through the number of members and the first thing that you 
might want to note on your slides is that this is a volunteer organization. There are a few people who do 
receive stipends, but for the most part, this is completely volunteer. So if you know someone who is 
interested in joining the collaboration, whether it's a consumer or a colleague or friend, they are certainly 
more than welcome to.

And they can join actually one of these listed entities that I have here. The first one is the collaborative 
review groups. Right now, and you may want to note this, there are 51 review groups within the Cochrane 
Collaboration. These are actually the people who prepare, maintain, and update the Cochrane systematic 
reviews that we're going to take a look at very shortly. So for example, when I mentioned Dr. Archie 
Cochrane, he did a great deal of work in the field of pregnancy and childbirth and there is actuallyÑthat 
was actually the name of the very first Cochrane review group, pregnancy and childbirth. There are also a 
number of groups such as schizophrenia, breast cancer, infectious diseases, and the HIV/AIDS group. 
These 51 review groups actually write the systematic reviews and certainly, it's a small group of people, 
which I'll talk about in more detail, that actually write these reviews. Again, I just want to stress the fact that 
they are looking at published and unpublished studies.

The next is the Cochrane Centers, and there are about 11 to 12 Cochrane Centers worldwide and there may 
be some smaller branches locally, but they really try to support people in the geographic areas of the world, 
in particular I have colleagues that are actually interested in Cochrane in China. I actually did a training 
online, and there is a Cochrane Center in China and because the reviews areÑare actually written in 
English, they have people that assist with translating. And again the Cochrane CenterÑthere is actually one 
in Baltimore, Maryland at Johns Hopkins if you're interested in getting in contact with them about what 
other resources they have. They offer these for free, including training courses on how to write a systematic 
review or protocol, if you're interested in that. What is the process, how do I go about it? How can I join a 
review group?

Next, there are different methods groups, and there are about 12 groups that are actually people made up of 
people who develop the methodologies behind the Cochrane reviews. So, again, we knowÑand normally 
again if you could see me, I'll have an arrow going from the methods group to the collaborative review 
groups. There are a lot of different ways that you can write a review. Cochrane, again, because it's the gold 
standard; they want to adhere to certain very particular strict criteria when they are writing the systematic 
reviews and protocols. The methods group not only makes sure of that, they even write reviews on the types 
of reviews being written by the collaborative review groups. So they are really trying to let you know we've 
written a review on breast cancer or a disability for the elderly and a particular intervention, is this the best 
review that we've done? Have we looked at every measure? Has that particular review group rather looked at 
every particular measure to write a systematic review?

Next we have networks or fields and this is constantly growing. Sometimes you'll see it on the Cochrane 
Web site as network or field. I think they're going back and forth on the title. These emerge around areas of 
interest, which extend across a number of health problems. For example, you may have a field coordinator 
in child health that would try to identify health issues that are important to children, and facilitate reviews 
across, from those particular different areas. Or primary care or disabilities. There are certain topics that 
there may not necessarily be a review group yet, but there are members of the Cochrane Collaboration who 
understand that and they are trying to develop this information and trying to gather it. They may eventually 
become a review group on particular areas.

So once our presentation is over and you're taking a look at some of the Cochrane reviews or you're 
browsing through the seven different databases, if you don't necessarily find the information that you want, 
I strongly encourage you to contact a Cochrane Center or directly contact one of the fields or one of the 
field coordinators to ask, "What can I do to help?" "How can I provide more information on this or what is 
your field doing to get additional information on this?" So you might become what they call themselvesÑa 
Cochranite. 

And, finally we have the Cochrane consumer site and this is strictly for plain language summaries on what 
is Cochrane. It's also a great starting point for any of you if you want to go toÑyou might want to write 
this downÑcochrane.org/consumerÑitÕs a website that explains the Cochrane library and the Cochrane 
collaboration in plain language. Again, I say it's a great resource. If you actually have a hypochondriac in 
the family who wants to know about all the treatments or interventions, send them to this site. It's a really 
great resource and a great way to learn about this fine organization.

So I'm going to go to slide 14. And we're going to go into Module 2 and we're going to sort of pick up the 
pace a little bit and talk about what are systematic reviews, and you've all heard me mention the word 
protocols, and why they are important. And a little bit about the criteria to consider when reading the 
reviews within Cochrane, but as well in other review sources. I want after this presentation that you'll be 
able to look at a Cochrane review and see and understand a little bit more about the format, their criteria as 
well, and compare it to reviews you may see outside of Cochrane. You're trying to evaluate and find the best 
information on treatments and interventions. So that was slide 15.

And we are going to slide 16, which talks about "What is a systematic review?" And the definition is very 
simple. This is the easiest definition I've found. They have hundreds but I think this is the best: "A 
systematic review identifies an intervention for a specific disease or other problem in health care and 
determines whether or not this intervention works." So in short, when we're looking at systematic reviews, 
we're really looking at them to help identify which forms of health care work and which do not, and which 
are even harmful, which is another important point when you're looking at evidence-based medicine. 

And you are also trying to look at results from randomized controlled trials. That's also a great term you'll 
learn more about at the Centre for Evidence-Based Medicine. And not only about trials, but how those trials 
are actually assessed together and sometimes you may even see what's called a Meta-Analysis. Some of 
you may be familiar with that already, but we want to look at the quantitative information, the statistics when 
we're looking at how trials are combined together. 

I'm going to slide 17. So why are systematic reviews important? I think the very first oneÑanswer, which 
I've noted here, is very important; "answers to specific health care questions." That's what reviews do. 
Whenever you look at a Cochrane review, you are always going to get a question and an answer, whether or 
not the treatment works. And I want to point that out because there was a time I've had a few people when 
they were on a live demo with me, said, "Denine, I looked up this review and it actually said that there was 
no treatment or intervention. But I went to PubMed or Medline and I found another review or I found other 
information that says this might work." And that's sort of the point of a Cochrane review. They want you to 
really identify and try to look at all the information to see if something works. Even if it's conflicting 
information because that helps you as a clinician or consumer make a better decision. 

So as you can see here, with Cochrane reviews, they really aim to identify and include all relevant trials. 
And they use a lot of preplanned methods. They really go through different studies. They want to limit bias 
and random error, which is very important. That's sort of the focus of evidence-based medicine. Many of 
these will includeÑwhich I talked about very quicklyÑmeta-analysesÑwhich is a statistical synthesis of 
the results of the included studies, again, "show me the numbers." And again, finally, by looking at those 
sorts of things you can help a practitioner and your patients make decisions about appropriate health care. 

We're going to go to the next slide, which talks about how do you consider what to read when you're 
looking at reviews? The title of this slide is "What to consider when reading reviews" and we're on slide 18. 
And I'm not going to go through every single question, but these are sort of the things when you're 
searching through the Cochrane Library that you hope that your review takes a look at. Does the review 
address the sensible clinical questions? What's the objective of the review? There should be one single 
question. Are the studies high quality designs and methods? If you recall when I went back quite a few 
slides ago and I talked about there are method groups. Again, what were the methodologies used behind the 
different reviews? What kind of trials are they looking at? Who were the participants in the trial? Are the 
results from the studies similar or wildly different? And again, whether you're looking at Cochrane or 
another type of review, just sort of put these questions through your mind to see if it's helping you make a 
valuable decision about treatments or interventions.

And I'm going to skip to the next page. I'm turning the pages. And I also wanted to show just an example 
of the systematic review criteria. I always laugh because I think with people, if you ever remember in 
college how you had that one particular professor who always made everyone do the group paper, and I 
used to hate doing the group paper. But you always had a group of people, there was one person who 
wanted to be the researcher, there was one person that, you know, just wanted to do the pictures or wanted 
to do the folder or whatever, but sort of, a systematic review is almost like that same concept. As a review 
group, you all have to follow these certain criteria almost the same way you did in college when a group 
was doing a thesis paper.

So if you just take a look through just very quickly when you get a chance, if you look to the far left and 
you can see the menu bar and you can see the outline about the contents, what is your introduction to your 
systematic review? That is the format of the systematic review. This literally gives you with every systematic 
review and protocol that you'll be looking at in Cochrane, just the different parts. If you look at No. 6 is 
says "assessment of the study quality." There is a glossary of terms. You can see that it's pretty 
comprehensive of what you're taking a look at in the systematic review criteria. There is a purpose for it. 
There is a reason. It's trying to find out relevant information for you.

I'm going to go to slide 20. So on that note, we sort of know a systematic review, tells us in short whether a 
treatment or intervention works. We know that the review groups actually write the reviews. They develop, 
evaluate, they go through published and unpublished studies and just to sort of show you in a graphic 
format what that sort of looks like, this is just my example on slide 20 of the Cochrane review group. And 
you can see the different members that are included in Cochrane reviews; such as there is a trial search 
coordinator. They actually have people who hand search through the material. Again, you may have a 
librarian; you may have a statistician. 

Within the Cochrane itself has what's called a Cochrane steering group, which manages the entire Cochrane 
Collaboration. They really work so you have the right amount of people, the right qualified people working 
in each review group. And this review groupÑagain, the very first review group was pregnancy and 
childbirthÑthey may register a topic with the Cochrane Collaboration. And the next thing, as you can see 
the arrow pointing down, is they actually prepare a protocol. I've seen, the largest protocol, or the lengthiest 
one I've seen, took a year to write. So literally, a protocol is simply a review in progress and you're literally 
gathering the information, writing a protocol. Once the protocol is complete, the next step if we go down to 
the arrow, is we're going to prepare our review. And the protocol that took a year to write, we printed out the 
review and we're like, oh, dear, because it actually took five years to write the final review. And finally, the 
next arrow on the graphic is the Cochrane Library; the review was put into the Cochrane Library. 

And this is sort of just not to confuse everyone, even though the reviews may take a long time to write, the 
Cochrane Library itself updates the database quarterly because in general when you start reading about 
evidence-based medicine, the pointÑanother important factorÑis that it should be always current. So 
Cochrane is constantly updating the information so you'll have new reviews, you'll have updated reviews; 
you may have reviews that are withdrawn because they haven't been updated properly. This is all part of this 
systematic review and protocols process; really, to make sure that this information is current. If a review 
takes five years to write, then naturally it was a protocol for some time and it may become a review for some 
time. And that review is constantly being updated. What you can also see in the Cochrane database when 
you do your own searching, you can see the reviews being constantly updated but you can search for the 
older reviews that were done so you can compare your studies.

So I'm going to skip from slide 20 or go to the next page I should say. And I just wanted to very quickly 
show everyone on this slide, slide 21, a protocol example. Again, we saw the systematic review criteria and 
this gives you an example of what a protocol looks like. If we were on the Wiley InterScience site, if you 
look to the left, we always provide on the left the menu of options so you can easily read through the 
reviews. You can see that you do have a PDF. You can print out in HTML or PDF; it's your option. You 
will always have your abstract within the Cochrane reviews. You'll have your background, your objectives, 
and so on.

And again, what I mentioned about the different methodologies, if you're looking down, you could see that 
we have methods and reviews and the potential conflicts of interest. And if you go down a little bit farther 
down this menu of options on the page 21, you'll see that there is something that says "Add or view 
feedback."  And we actually have a question that someone asked about "Are you allowed to provide 
feedback or suggest new topics to the Cochrane Library?" And you certainly can and this is one of the 
ways that you can do that. Literally you can read a protocol or review and if we were live right now I could 
click on that "Add or view feedback" link and it would open up and you could actually provide information 
to Cochrane and it would be posted. So this will just give you an idea of what a protocol looks like. Again, 
this is a review in progress.

Next, we're going to go to slide 22 and take a look at an actual review. And this one is about patient 
education for adults with rheumatoid arthritis. And just very quickly, you may seeÑI'm not sure if you 
printed this out in colorÑbut there is a very thin dark bar with my name that says Denine Tilery, access to 
reviews. One thing about the Cochrane Library, and you might want to note this on this slide; you can 
actually save your searches, your reviews and protocols. I've actually saved this if we were on a live 
demonstration, so I just wanted to note that. But you can take a look at this whole review and you can see 
again to the far left, you can opt to printout the PDF. This might have been a large review so it might have 
been 50 to 100 pages. I'm not sure about that. 

What I wanted to show, if you see you have Abstract on the left and you will also see something that says 
Plain Language Summary. Again, because the Cochrane Library is for not only clinicians, or researchers, 
anyone interested in the field of medicine, but also for consumers, they do provide plain language 
summaries, for someone who is not as familiar with medical terminology. Again, you have your 
background, your objectives and you can see it's a little more extensive that we go into a finished review. 
Maybe if you go one slide back or just compare your protocol to review, you can actually see how it slowly 
developed a little more comprehensively in taking a look at this. And sometimes, I'm not sure if you can see 
it, but at the far end, I actually had under Sources for Support, on the left of the bar, I actually should have 
printed a copy of that, it says Index terms. Because if you recall, I mentioned that Cochrane actually links to 
Medline and PubMed. So Cochrane in the systematic reviews and protocols will even let you know what 
are the MeSH search terms that are searchable. 

And alsoÑI'm just going through a couple of other thingsÑyou may want to highlight on the left menu 
bar where it says Author's conclusions or put a little asterisk next to Plain Language Summary. These two 
are the same thing. Instead of reading the whole review, like this is 40 to 50 pages, I could read the author's 
conclusions, the implications for practice or for people like me who are not good with medical terminology, 
I could read the plain language summary. So it's totally your option.

And if we look over a little bit to your right to the page, you'll see under the title "Patient Education for 
Adults" you'll also see Cochrane review numbers. I'm not sure if you can see it, but it says C.D. 03688. and 
I'm circling on my PowerPoint right now, but you can evenÑsome people, if you're familiar with Cochrane 
reviews, actually remember the Cochrane numbers when they do a search. That might be a helpful tip for 
you. So again with the slide, a few of the things I showed, you can search the Cochrane Library, you can 
save your searches. My name is listed up top. You can browse through reviews, through the left hand menu, 
protocols, or reviews. You can take a look at the plain language summary or the author's conclusions, 
depending on your level or your experience with medical terminology. And you can print this out in either 
HTML or PDF format. So, that was slide 22.

And we're going to go to the next slide and we're going to go a little farther down. This is actually slide 23. 
I just printed out another part of the systematic review. Again, there is our objective, what is this review 
about? And actually I just wanted to people to see the "criteria for considering the studies for the review." 
Why was this review done and who were the participants and the types of intervention we actually looked 
at? 

So let's go to 24. And this will be a good thing for you to use as a guide when you're searching through 
Cochrane. I also wanted to mention as we looked at slides 22, 23, and 24, that sometimes you will find 
meta-analysis in Cochrane reviews. Again, this can also help practitioners and patients make decisions 
about appropriate health care and when you're reviewing the design and quality and consistency of the 
studies, you really want to sum up the different findings by putting together a few numerical results coming 
from different studies. You may hear the term or some of you may or may not be familiar with it, is 
"numbers needed to treat." Sometimes you'll see a doctor will note this. It will be in capital letters NNT. 
There is a certain number needed to treat, to say the treatment or intervention works.

And that's part of the trial process and again I strongly recommend for you to go to the CEBM website, and 
another useful website is clinicaltrials.gov, if you want to learn more about meta-analysis. It's not just 
looking at one trial that's been done on a group of ten people. We may have to do that trial 20 more actual 
times to find out if whether a treatment or intervention is harmful, whether it works or whether it doesn't 
work. And the reason for that is you may want to look at, there may be participants that have no results, that 
may have no reaction during the trial. There are some people that may have bad or good reaction. We may 
want to do a double-blinded study so the participants and the people administering the trial don't know 
there were different reactions. So meta-analysis is sort of that quantitative portion looking at that, and they 
are included in systematic reviews. 

I'm going to go from slide 24 into 25 so you can take a look at sort of what a meta-analysis looks like on 
the Cochrane Library page. You're going to see a link when we're looking at the systematic reviews, you'll 
see a link that says figures and tables. So if you want to note this actually on the slide, you can say to 
yourself, "click on figures and tables" when looking at reviews. You can actually see the meta-analysis chart 
and this is called the "odds ratio table." This one talks about an outcome of death. I know that's a little 
morbid but it tells you whether that treatment or interventionÑdeath is on one side and the other what is the 
more probable cause for administering a particular steroid. 

And this is actually over a period of time and I know this is rather small when you look at this graphic, but 
you can see it says Alexander, 1972. Actually on this slide you'll see listed a number of years. This trial 
was done over the course of different years. I think it looks like over ten years. And it compares one 
treatment over another and you can see, if you see in the middle of this picture, you'll see these horizontal 
lines and these small little boxes. The boxes are the groups of people in the trial. So that tells you whether 
one side or the next, what more people had a reaction to the trial: the number needed to treat. There is 
certainly a lot of information on meta-analysis within the Cochrane User Guide and on the Cochrane site 
that you can take a look at which is much more comprehensive, if you're interested in this further.

I am going to slide 26, which I just included some sort of quick definitions about meta-analysis. I think we 
covered it but we're looking at a common effect among a set of studies, we are not looking at one trial, and 
we are trying to provide an estimate and we want to investigate whether the effect is constant because we're 
looking at these different number of trials. And finally, we're going to answer the different controversies, if 
this treatment or intervention works, can we generate a new hypothesis, or if there are conflicts when we're 
looking at it. 

So we're going to the next slide and I know during these modules we've gone through a lot of information 
so I just wanted to recap where you can find some of the information that I talked about. Again, I strongly 
recommend as a starting point to go to the Centre for Evidence-Based Medicine, www.cebm.net; take a look 
at that site. Go through the glossary of terms and go through the information. Again, it talks about the 
Evidence-Based Medicine pyramid, why is it important. I also mention you might want to note Dr. David 
Sackett next to that, www.cebm.net. Another thingÑyou're probably doing this already, but read reviews 
from other sources that are not included in the Cochrane Library. 

Finally, number 3 on the PowerPoint, although you subscribe to the Cochrane Library through Wiley 
InterScience, we also link to the Cochrane Collaboration's home page. And I've listed this here for you to 
really find out more information about how they've actually applied the concepts of EBM to reviews and 
protocols at the Cochrane Library. Because I know this is great deal of information, I strongly encourage 
you to walk through that first to give you that basic understanding of the Cochrane Library. Joann, I'm 
sorry, have we gotten any questions yet?

>> JOANN: Well, the question that we just received was someone having some audio problems. But 
nothing specific to the material that you've covered so far.

>>DENINE: Okay. Thank you. So now we're going to go a little more into the Cochrane databases for our 
next module. And I'm going to skip slide 28 and I'm going to slide 29. We're actually going to review the 
Cochrane databases and it's funny, I'm constantly changing that 6ÑI always bold it to remind myselfÑI'm 
constantly changing that to 6, 7 or 8. Because they are constantly adding so much to the Cochrane Library, 
adding a database or maybe adding it with another one. And we're going to talk about browsing and 
searching the topics because one thing about Cochrane which I was really impressed with, again, because 
they are also not only proÑthey are also for the medical practitioner, but they are also pro-consumer. They 
want to make it easy for everyone to be able to use the Cochrane Library. So browsing and searching topics 
is a great way to look through the systematic reviews and protocols.

So from page 29 to 30, I've listed here the different databases of the Cochrane Library. The first one is the 
Cochrane Database of Systematic Reviews. Again, we know a review tells us whether a treatment or 
intervention works. So we've covered that a little bit. So we'll just check mark that. The second database, for 
those of you who were familiar with Cochrane prior to this presentation, they have changed the names of 
the databases within the Cochrane Library. 

The second one is called Other Reviews. The name, which I'm pleased they changed, this one was called the 
Database of Reviews of Effects (DARE). In short when I mentioned there were other reviews outside of 
systematic reviews, Cochrane also includes some of those as one of the databases. 

The third was called the Cochrane Central Register of Controlled TrialsÉa very long name. So now 
because this is what they are, they are called Clinical Trials. 

The next is the Health Technology Assessment database. I have a lot of pharmaceutical companies and 
corporate customers that take a look at that quite often, HTA, and there are resources outside of Cochrane 
you may want to look at, that may be useful. 

NHS, Economic Evaluation Database. I had a doctorÑhe was actually one of the doctors without borders 
and he said he wanted to take a look at how cost affects economics, and I told him this is a good database to 
refer to.

Methodology Register. We always have a bibliographic reference for you about the differentÑyou may 
want to go what was the original journal article, and we'll talk about that. One thing about Cochrane, there is 
certainly no secret about how they gather the information and what is the process or methodologies. So if 
you want to learn more about the Cochrane Collaboration and the review groups beyond this presentation, I 
strongly encourage you to click on the link about either one of those. 

And 8Ñthey've actually addedÑI thought this was incredibly useful. You barely even have to some degree 
search the Cochrane Library. You might want to put a star next to this is the Cochrane Review Groups. The 
51 review groups when you actually search on www.thecochranelibrary.com, they actually list the 
systematic reviews and protocols by review groups. You don't have to be an expert in MeSH searching or 
key word advanced searching. You can actually just go to the Cochrane group that you find interesting or 
relevant and just search what are all the systematic reviews and protocols under that group name. And I sort 
of mentioned this in case we do have people that were familiar with Cochrane before this presentation, the 
Cochrane database of methodology reviews is now included in the Cochrane Database of Systematic 
Reviews. Basically, these are 22 reviews that discussed or sort of evaluated the criteria and methodologies 
used in the Cochrane Library and they've actually; again, if you could actually see me, I take an arrow and 
point it to the first database, the Cochrane Systematic Reviews. I'm just going to give you a moment while I 
turn the page in case you want to note anything or highlight. 

Now I'm on slide 31. So the very first database, and maybe if you would even like to maybe put slide 30 
that actually has the different databases in front of you as well, I'm actually going to note what each 
database; the content of each database. The first one we've covered, reviews and protocols. 

The second, Other Reviews; the second database that was formerly called DARE. There are 4200 plus 
records in this. And these are critical assessments and structured abstracts of reviews. And even though 
these are abstracts, they still have to have particular quality criteriaÑto be included in the Cochrane Library. 
These reviews are yet to be covered in the Cochrane Database of Systematic Reviews, so they are relevant. 
People find they are trying to gather information on those so you can actually look at this different 
database. This is for Cochrane reviewers and researchers wanting information on reviews of health care 
effects from sources outside of the Cochrane Library, so eventually they may become a protocol and then a 
review. For now these are critical assessments that the library last found relevant to the Cochrane user. 

Clinical trialsÑthese are trials that have already been done and as you can see, some people go, really, is it 
475,000 records? Yes, there are. You can actually take a look at those and it contains a register of studies 
that may be relevant for inclusion in Cochrane reviews. So basically, if you went to the clinical trials, if you 
actually did a search maybe on disability and the elderly, you'd type that in to the key word search. And you 
click on clinical trials, the link, you'll see a small table that will actuallyÑwhich is actually a register of the 
different studies done. And this does contain trials, you can actually note this, from Medline and PubMed 
as well. I'm just going to give you a moment.

We are now on slide 32 and we have the Cochrane Database of Methodology Reviews. I think we sort of 
touched on that a little bit already, but we want to contain different reviews on methodologies and protocols 
used and this is in the database of systematic review. 

HTA, Health Technology Assessment, and this contains information on health care technology 
assessments, including details of ongoing projects and completed publications from health technology 
assessment organizations. And if you even Google, you find further information on the HTA, that it 
provides quality information on clinical effectiveness, on cost effectiveness, and even broader impacts on 
drugs and medical technology and health systems. So it's really again another global organization included 
within the Cochrane Library. 

And I actually was trying to do a simple study and here are some of the questions that we saw on some of 
the assessments that they were doing. For example, it was talking about technology for health care in 
Canadians and the questions that they asked from the HTA, well, how will this health technology affect the 
health of Canadians? How does it compare with the alternatives? Does it provide value for an investment? 
So the HTA actually provides typicalÑsort of has an eight-step process. It selects topics that need 
assessment. It defines the research needed. It forms a project team. Almost very similar to what we're 
talking about the Cochrane Library itself. And they are actually writing reports on that technology 
assessment. I know that might have been a lot of information, so we're just going to stop for a moment and 
give you time to write notes. 

And we are on slide 33, the NHS, Economic Evaluation. And I always give this example to people about 
economics and how cost plays an important part. Personally, I always tell people my grandmother had 
medication that cost over $1,200 a month that once Medicare paid for it. And as you can imagine, if she 
lived in a third world country where her annual salary was $250 a year, she certainlyÑthe doctor would 
certainly have to treat her very, very differently than what she is being treated now. The NHS Economic 
Evaluation Database contains structured abstracts on articles that describe economic evaluations for 
healthcare interventions. When you go into the Cochrane Library, they certainly have some cost evaluations, 
some sort of cost tables analysis that you can take a look at and they also provide papers on the comparison 
of treatments and that examined the costs and outcomes of alternatives. So certainly HTA when you're 
looking at drug information a little bit more, and overall, you can also look at the Economic Evaluation 
Database as well. 

Again, these are the main databases of the Cochrane Library and the final one, the Methodology Register; 
this is simply a bibliography. Some people will say, "What journal articles are they looking at? Where are 
they finding this information?  You said Medline, or PubMed." You can actually go through the 
Methodology Register and look at a bibliography of the information that includes journal articles, the 
books, and the conference proceedings. And again they even provide the information that was hand-
searched from Medline.

So we're on Module 4, and normally I'll do a live demonstration and I want to show a little bit about how 
you can actually browse topics and reviews and protocols. And again, we strongly encourage, Joann and 
her colleagues or myself are more than happy to assist people with this, but certainly if you go to 
www.thecochranelibrary.com, you can certainly go to the site and look at the systematic reviews available 
on the Cochrane Library and who knows, if there is information not available, you may actually have to 
write a systematic review, right, Joann?

>> JOANN: There you go. A reminder that the people that go to the library through the NCDDR access 
need to come through the NCDDR home page to actually get to that library page. 

>>DENINE: Correct. Thank you, Joann. So everyone should be looking, let's just imagine we're on our 
computers right now and if some of you are, I certainly encourage you to do this as well. You can click 
through that way if you have questions, Joann can send them over to me or just say the question out loud. 
But this is again the Cochrane Library home page. So what I'm going to go do is just walk through the 
main page of the Cochrane Library. I'm going to start at the very top under the Your URL button. You can 
see Wiley InterScience home and you can sort of see my name, Denine Tilery. 

You can set up a personal profile and save your searches in the Cochrane Library. That way they are saved 
indefinitely and Joann and her team can certainly help you with that. And you may ask, well, how can I 
actually do that? If you just look across where it says Log Out, if you put there instead of Log Out, for you 
it will say Log In, and you can do this one-time registration. That way you can save your settings on your 
computer and I strongly encourage that, especially when you're using the Cochrane Library and doing a lot 
of searches. 

Next we can see there is a Home button. If I had clicked on "About Cochrane" I would have learned more 
of the definition, what are systematic reviews, what are protocols, what is the Cochrane Library? And this 
would actually also link you to the Cochrane home page. You can certainly do that. Again, the Cochrane 
Collaboration and Wiley are partners so you can link back and forth between the sites. You don't have to 
save different browsers. You can just link back and forth. Access to Cochrane, Joann already very clearly 
let us know that you certainly have already easy access, which is great. We can use that and Joann is going 
to be our Cochrane guru soon, right, Joann?

>> JOANN: Working on it.

>>DENINE: There is information about authors if you're interested and again if you want to become a 
Cochranite, you can certainly do that. We do provide a Help button, if you need some quick reference help, 
you can certainly do that. We're going to go down a little bit and on the PowerPoint, I think you should see, 
it's supposed to be a red circle but I actually circled the browse feature of the Cochrane Library. We're 
going skip that a minute and I want you to go onÑwe're still on Slide 36, but I want you to look to the far 
right where it says, "Help, New Users Start here." I strongly encourage you, if you may orÑif you're not 
too computer savvy, just take a walk through. We have a lot of Cochrane User Guides. This is how you 
would get started. I know this is an incredible amount of information on the PowerPoint, but if you're 
curious, you can also see that if you were a clinician, researcher or patient or even a policymaker, we give 
you reasons why the Cochrane Library would be relevant to you.

There is also in the middle of the page, you probably notice we have a survey. We are constantly adding 
information about Cochrane and sometimes we link it here. You can see Access to the Cochrane Library or 
About Cochrane. Again, just trying to provide you with a lot of helpful notes. If we move back over to the 
left of the page, you'll see "What's New in Issue 3." That's the issue that we're on. They'll sometimes 
highlight some interesting systematic reviews here on the page; but I think the PowerPoint sort of cut off 
my page. I think there are over 111 new reviews listed and you can see there are 58 updated reviews, and so 
on. So this just gives you a sort of preview of what's cooking in this Issue. 

And at the bottom you may see it says "Release Notes." If you are an avid searcher or someone who knows 
about clinical treatments, I strongly encourage you to look at the Release Notes. They are constantly 
updating with new features, how to browse, search, how to be quicker. Everything is listed here that we do 
on the Cochrane site; never a problem. If you have any questions, and again, Joann is there able to help you 
with this as well. 

Back up top, and I almost forgot, if we go to "Welcome to the Cochrane Library," what are systematic 
reviews and protocols, it certainly gives you a more comprehensive definition if you clicked on that link and 
see where it says product description, that next hyperlink? You can just put the Cochrane databases if you 
want to note that. It just gives you the definition of the database and some links you can take a look at. 

But back up top we're going to go through the Browse menu bar. This is exactly what you're going to see 
when you're searching if you're not doing that already. You may browse Cochrane reviews by topic. So 
there may be a particular topic you're interested in: HIV and AIDS; ear, nose and throat; pregnancy and 
childbirth. There are new reviews; you may say, "Hmm, what are the latest reviews done by the Cochrane 
Library?" The next are "Updated Reviews." Some reviews are updated. Again, we're constantlyÑthe 
Cochrane Library is updated on a quarterly basis so you want to take a look at those.

Or you can take the easy, easy way and you can see that we have an A to Z listing, or again this is my 
favorite, Joann, by Review Groups, which is the best because literally by each of those 51 review groups, 
you can look at whatever systematic review or protocol they have ever done.

>> JOANN: We do have a question that came in that I would like to pass on. If you do a search and save it 
as you had mentioned previously, is there a way to then go back in and just search for the new information 
like you are talking about, the things that are updated? Or would your search just be a new search that 
would cover everything againÑor just the new part?

>>DENINE: That's actually a wonderful question, whoever asked that. You will receive updates on your 
searches, which is nice. That's one the new features they decided to add. 

>> JOANN: That's great.

>>DENINE: Hopefully it's working correctly, whoever asked that, or you can e-mail me back. Thank you. 
And let's see, as you can see here under Browse and I just have the other resources, some of you are 
probably taking a look at this now. If you click on each link from Other Reviews to Clinical Trials, you can 
actually do a few searches and look at the other databases. 

And finally, we have our Search box, which is listed and this is just the quick search box for those of you 
who are not in front of the computer. This is just a very easy way, if you're familiar with Cochrane, for 
example if we typed in disability in geriatrics, we can type that in and see what we would find. And the 
default is title abstract or key words, but if I clicked on that default button, and I don't have my computer 
open, but it would do a search all text, we could do an author search. We certainly have some options to do 
that. 

And you can see underneathÑand the reason why I thought it was important to kind of stress the 
searching, because you can do an advanced search. You can do MeSH, which is Medical Subject Heading 
searching, by the National Library of Medicine. And the person who asked, too, you'll have a search history 
and I kind of want to stress this, Joann, because a lot of people aren't familiar with this. The search history 
will just save your searches for that day, but if you have a profile, the way I do with my name up top, 
everything will be under "Saved Searches." So that's the difference. Because if people go to search history 
and say, "What happened to my searches?" And that's why. And under the search history, for those of you 
interested, you can combine your searches. So if I have 20 searches, for example, they'll list 1 through 20. 
If I go under advanced search I can do No. 1 AND No. 2. So you can do that as well and you can actually 
restrict your results. How are we doing for time, Joann?

>> JOANN: I was just going to mention that to you. It's a little bit after 3 so we have about 25 more 
minutes.

>>DENINE: Great. Okay. Thank you, Joann. I'm going to run through this. If we're on Slide 37, I wanted 
everyone to see very quickly, because this is actually one of the questions we also received earlier about 
withdrawal of a systematic review. This is actuallyÑI just searched how to browse through the systematic 
reviews. You can see that you can actually restrict your search to just the protocols, just the reviews, or 
protocols and reviews, and you can see that you have the option to view the HTML and PDF. And again if 
you circled A to Z, you can actually see it. We'll let you know by these different icons, the R. is actually a 
dark blue, the P. is light blue, and you'll see sometimes the word "withdrawn," you may see the word in 
green "comment." They will actually let you know if a review has been withdrawn and the reason why. 
Why they actually do this, because, again, information should be updated on a regular basis. So the 
Cochrane review group is saying, okay, we had to withdraw this review because maybe the group lost their 
funding, people haven't more found relevant information. There may be another review that addresses this 
topic a little better. They will let you know if you click on that HTML, and look at that withdrawn review.

>> JOANN: One of our other questions had to do with that, can you or how would you set up an alert for a 
particular topic so you can be notified by e-mail when a record is updated, withdrawn, or there is a comment 
made?

>>DENINE: You'll see it when you save your searches and you'll just click on that save search link. You 
can also, which is nice about Cochrane, you can actually search, when I click on advanced search, you can 
actually search through all withdrawn reviews or all commented reviews, which is a great feature as well. 

And thank you and I just wanted to show people again the different review groups. I'm actually on slide 38 
and more on tips on browsing Cochrane. This was a new feature that I mentioned, that you can search 
through systematic reviews by review group. Joann, this is a blessing. You don't have to worry too much 
about searching if you didn't want to, but you can go in by review group and select the reviews. For all of 
you that are new to Cochrane this might be a good way to take a look at it. Remember, the index terms are 
listed in the Cochrane Library, so you can actually see how they are indexed.

Speaking of which, we are going to finish up with a few tips on searching and we're in Module 5, MeSH - 
Medical Subject Heading and the advanced searching and that is Slide 39. We're going to skip through 39, 
and 40 is my introduction page in case the PowerPoint is very large. We sort of broke it out in modules for 
you in case you wanted to break it up. MeSH, if some of you are not familiar with MeSH offhand, is the 
Medical Subject Heading search that is based on the National Library of Medicine's controlled vocabulary 
thesaurus of medical subject headings. I've actually provided the National Library of Medicine's link here. 
They have free courses on how to search. I don't know, Joann, if you ever noticed.

>> JOANN: No, I wasn't aware of that. That's interesting to know.

 >>DENINE: I took the course. It's free. It's usually a day course from 9 to 4 and you're just in a room 
learning how to do advanced searches, how to search PubMed and Medline, and I encourage it for people. 
You can take it every year if you like. I'm skipping throughÑI apologize, I just ran through; I'm on slide 42 
and I wanted to give you an example of what a MeSH search is. As I mentioned, it is a controlled 
vocabulary; it's a thesaurusÑand how would that work? Let's suppose for a quick moment that Joann is a 
cardiologist and I'm her new nurse or just not kind of sure of all the medical terms. Joann may be writing a 
paper that uses the word heart infarction and meanwhile I know it, just fresh out of school, as heart attack. 
So with MeSH when we're in the Cochrane Library, if you type in heart attack or heart infarction, it will 
come upÑwe'll get the same results. So that's what MeSH is used for. 

What I have here on slide 42 is each term is actually indexed with a number and they call these numbers 
"descriptors." So you'll see this when you search. This is, recently Cochrane actually did aÑlast year 
actually,Ñthey did a course for ophthalmologists on how to search in systematic reviews. The doctors 
could easily search and use MeSH. They would type in the term "eye" and what MeSH is doing is asking 
you, "We understand you wanted the eye, but do you want the eyebrows, the eyelids or eyelashes? What 
part of the eye do you want?" Think of these descriptors as a social security number for each part of the 
eye, if that makes sense. Each part of the body has that. So that again you can identify no matter how you're 
searching it. If you're writing a review or paper, we all may use different terminology, but there has to be 
something simple to find the information. 

And I'm going to skip to slide 43. You can go to the National Library of Medicine but this is just basically 
a Cochrane review that lets you know, again if you're a PubMed searcher, how the terms are indexed. So 
you can take a look and one thing, Joann, if people take a look when they are searching the reviews, these 
terms will also be highlighted and go directly to other reviews.

>> JOANN: Great.

>>DENINE: So that's something you can take a look at and another thing I don't think I've added it, and 
certainly we can all turn to Slide 44. The Cochrane review groups themselves actually provide the index 
terms under each review group. They'll let you know if you go to the collaborative review group, they'll let 
you know the terms they've used in their reviews, in a glossary of terms. Advanced search terms using key 
words, very simply, if we just know Boolean logic tips: AND, OR, NOTÑyou are certainly more than 
welcome to use those when you are searching the Cochrane Library. I just gave some basic examples here. 
Joann, are you an expert at key word searching? Can you do those long search strings?

>> JOANN: I used to do more than what I've been doing lately.

>>DENINE: Oh, so I can just call you.

>> JOANN: Those require some practice.

 >>DENINE: And again, thank you. I want to mention to everyone, again if you have maybe 20 searches 
that you've done in your search history, you can combine those searches and search string No. 1 and No. 2, 
and not 4, to make even a larger more in-depth search string. If you take a look on Slide 45, let's say for 
example, we clicked on, if you remember, on the home page of Cochrane, you can just look at this picture 
right here, if I would have clicked on advanced search, it would have taken me to this page that you're 
looking at right now and you can see that they've done quite an extensive search on schizophrenia, and as 
you can see there is a drop down menu instead of title, abstract or key word; now we're searching all text or 
I can fill it in, in the boxes that have been added here. And if I were to scroll slightly down more, let me 
make sure I didn't put it on the next page; you can actually restrict your search by product. And right now if 
you can see the tiny checker, I'm searching from all of the Cochrane Library and normally I would 
recommend those of that you are searching now to leave it on that box. Don't search it by a different 
database and I'll show you why in a moment. 

If everyone can just go to Slide 46. The reason why, because an advanced search of the Cochrane Library 
automatically cross searches all of the databases that we have here. So literally you can just toggle between 
the different results. For this result that we've actually done, we see that there are over 2,000 reviews that 
have just been done, systematic reviews. There are over 200,000 clinical trials. So literally you can click on 
each one of the databases to see based on the search that you did what were the actual results. And for the 
person who asked earlier, you can save if you see in the far right, actually save your search or if you wanted 
to say, I think I want to edit my search slightly, if you click on that edit button, it will take you back to the 
search screen where you typed in your term.

>> JOANN: That sounds pretty flexible for being able to modify as you go along.

 >>DENINE: They are slowly starting to work on it, little by little. And if you go to 47 I don't want to take 
up too much of the time, but I wanted to just show you what you the MeSH search screen looked like. 
Again, if I were that ophthalmologist, cardiologist, or urologist, if we typed in "kidney failure," if I had 
clicked on the MeSH search box it would have taken me to this MeSH screen. I have tips from people who 
are very familiar with Cochrane, they normally, one person actually recommended try a MeSH search first, 
just click on MeSH. Type in your search term and Joann, I donÕt know if you noticed that, there is actually 
a definition key?

>> JOANN: No, that's great.

>>DENINE: And I can tell you that's very helpful. I had a person from Croatia, who typed in a term and 
she was misspelling it and the definition key helped us because she was off by one letter. And if you can 
see there is a "view results" button. If you click on that it will actually take you to results that have the term 
kidney failure. Or, if you see at the bottom, you don't have to, when I talked about that MeSH screen, you 
can see tree No. 1 slightly on the slide but you can go though that. And then you can hit view results. 

And on the next slide, which is 48, I just have an example that you can actually use a thesaurus, maybe you 
want to know breast cancer, which I learned, was breast neoplasm. If you want to look through the different 
descriptors, you can just play around. It's very straightforward on how it would work. And for some of you 
I'm not sure if you noticed on the far right of the box, we actually have search tips. So again you certainly 
have Joann and her colleagues to help and you also have some search tips here. Sometimes Joann, I have 
this search tips in a PowerPoint we can send that out to people as well. That's helpful. 

We're going to slide 49 and I just wanted to show you the drop-down menu of the qualifiers. Again, we're 
still in MeSH. There are also qualifiers as part of the hierarchy. I have something else, Joann, I should have 
sent you earlier. I only have a print copy of the qualifiers under each category which would be very useful 
to people. And I know we're going through this rather quickly, but for those of you who are not very 
experienced with MeSH, it is very simple to use, you just have to know the different qualifiers and names, 
and we can certainly assist you with that. 

And I'm going to go to 49 and next we're going to 50 and we're looking at search history. And again, this is 
what I sort of mentioned earlier, you do have a search history where you can combine your searches if you 
want, if we had 20 or 30 searches, we can combine them together.

>> JOANN: If you have duplicates from your searches, would those be eliminated when you combined 
them or would you have it listed two or three times if it were in two or three different searches?

>>DENINE: Does itÑI'm trying to remember because they just changed it a little bit. Sometimes it does 
show duplicates. They're kind ofÑ

>> JOANN: At least it would put them together, I guess.

>>DENINE: Right. Definitely. It's a little tricky because they're trying to update that. But you'll let me 
know how it goes. Again, right here this is why I mentioned how you can combine the searches. So if I did 
a search and again I have 1 and 2. I can put No. 1 and No. 2 in this box if you're looking on Slide 51. 

And we're on Slide 52 and just a recap, because again I know this is a lot of information. Again, you can 
certainly browse and search. We really tryÑthe benefits of using the Cochrane Library on Wiley 
InterScience, I think personally, is just a browse and search functionality is very helpful. We're trying to 
constantly update it so that again, not only medical practitioners can use it, but consumers; again, you don't 
have to feel like you're a search expert, but it is a good resource to use. The review groups are longstanding 
users of the Cochrane Library. One other thing, before we updated the Cochrane site, the Cochrane review 
groups sat down with our Wiley project managers and said we like this, we don't like this, why does this 
work; and they are also using it as well. So this is nothing unusual to them. 

Documents are available in the HTML or PDF formats. It's your choice, especially how you would like to 
print them out and take a look at it. The databases are updated on a quarterly basis. You're looking at new 
reviews and updated reviews. And we hope that Wiley InterScience is structured and easy to read for you. 
If not I'm sure they'll do more improvements on that and I sort of mentioned but I didn't do a slide. I have 
here Wiley InterScience has extensive linking including Crossref. Within the systematic review, if you go 
down to the references, you'll see at the bottom of the page, you'll see the word "link" and you are able to 
link to Medline or PubMed. And again, we have alerting services that we sort of touched on. You can 
certainly receive e-mail alerts. You have to have a personal profile and again Joann can help you with this as 
well. You can save your searches. You can receive alerts. 

And again within the Cochrane Library it's actually easy because you can just click on new reviews, or if 
you want updated reviews as well. And lastly we have a comments and feedback function and believe me, 
I've found a few comments and feedback from people. Whether you're a consumer or a medical 
professional, they will post your communications that you've had with the Cochrane review groups. 

And finally, I just wanted to add a few more helpful links. I'm on Slide 53. I've actually provided the link to 
HTA and a few others and these are actually listed on the www.Cochrane.org site as well. If you want to 
just take a look at these at any time and sort of find out more information about Evidence-Based Medicine 
and the Cochrane Library. And Joann, I'm sorry, did I leave anything out?

>> JOANN: I don't think so. You covered a lot of material here. We do have a few minutes left and a 
couple of other questions have come in. Some of them I think you may have kind of touched on but I may 
go ahead and ask them and you may be able to clarify them a little more.

>>DENINE: Please do.

>> JOANN: How would one suggest a new topic, or can you suggest a new topic for the Library to 
research and produce a review?

>>DENINE: You are going to submit them to the U.S. Cochrane Center. Any time if you're interested, if 
you actually contact and they are at Johns Hopkins in Baltimore, Maryland. You can actually call them 
directly and on the Cochrane site, under review groups, they'll give you their address, phone numbers, and 
e-mails. You can actually contact them directly. And also I really encourage people, if you're interested 
more in what is a systematic review, how do they actually develop it, the actual process? You can contact the 
Cochrane Center.

>> JOANN: To get more information there?

>>DENINE: Definitely.

>> JOANN: Is there a way to search the library by the funding source, for example, we work with 
researchers that are funded by NIDRR. Would there be a way to go in and identify reviews or authors that 
have been funded by them or by any other particular entity?

>>DENINE: You can look by author name and I do believe if we go in the Cochrane drop-down menu, it 
actually has a drop-down menu for funding which I'm actually going online now. I believe they have added 
that, which I can tell you in two seconds. Oh, you can ask me another question as well. And, yes, when you 
search Cochrane, you can search by author, title, and key words as well. I'm just making sure they haven't 
added funding. They do have source, but they don't necessarily have funding.

>> JOANN: Okay. How would one take the information and put it into something like "End Notes" or 
another kind of package for a reference list?

>>DENINE: I'm sorry, I did skip that. You can do so if you actually pull up a list of reviews, if someone 
actually does a search now, like diabetes and pregnancy and when we're looking at the results, you are 
actually going to see, you click on search. You're going to see a blue button, that's a white and blue button 
that says "export all results," but if you scroll down the page of your results, you'll see that you can export 
certain results to EndNotes or ProCite. So we do have that available. Again, I strongly encourage people to 
look by review groups and their contact information to take a look at that. And the different references 
available.

>> JOANN: I think most of these other questions you've covered. Can I search all the holdings at once or 
only within a particular database? I think you mentioned that with the advanced search it would 
automatically search all the databases.

>>DENINE: Correct, within Cochrane you can always search across all databases. You put in the terms or 
you can restrict it by product. I just recommend leaving it on all of the Cochrane Library, simply because it 
does it automatically for you.

>> JOANN: Do you know what part of the Library is actually used the most? Do you have data on that?

>>DENINE: That's an interesting kind of fun question. I'm not sure what part is the most used. They do 
list the number of records in each database. Maybe that's sort of some kind of indication, but I'm not sure. 
That's kind of a marketing question. That would be fun to ask them that actually. I've found that so many 
people with Cochrane just think it's one big database or just think it is systematic reviews that theyÑI think 
people need to learn more about it like HTA, or the economic evaluation database.

>> JOANN: One of the questions we received, is if qualitative research is reported in the Cochrane Library?

>>DENINE: Yes, it is. They are looking at everything, which is one thing that is impressive about the 
Cochrane Library.

>> JOANN: They've done all the hard work to go through everything that's out there.

>>DENINE: Definitely. And it's interesting, I'm looking at how to cite. I went under About Cochrane and 
how you actually cite Cochrane information. There are a lot of training resources on the Cochrane.org page 
for those of you that are really interested in more about Cochrane. I strongly encourage you to take a look 
at that, especially if you want to learn about how they actually hand search the material. They have author's 
handbook and they have some tools on Review Manager software. I don't know, Joann, if I had mentioned 
that to youÑRevMan?

>> JOANN: I've heard of it, but no, we didn't talk about it yet.

>>DENINE: They actually do have that on how they write the systematic reviews and protocols. They have 
a separate page for that, that you can go into.

>> JOANN: Would people be able to download that software or is that something you get once you're a 
part of the Collaboration?

>>DENINE: It looks like it's free. I'm on the site right now and it looks like you download it if you need it. 

>> JOANN: Well, I think you've covered a lot of material for us. And I really appreciate it. I haven't seen 
any more questions come in, so we may be kind of winding down. Some people may need to digest this a 
little bit and then come up with their questions and I know you said you'd be able to answer those after the 
fact. Your e-mail is there on the second page of the PowerPoint presentation (Dtilery@wiley.com).

>>DENINE: Certainly, anyone, if you have any questions, please contact me and certainly if you can copy 
Joann on the message as well so she can follow up, too.

>> JOANN: Right. Absolutely.

>>DENINE: Thank you all. I know it's a lot of information, but again, Cochrane is considered the gold 
standard of Evidence-Based Medicine and again you're looking at whether treatments or interventions work 
through systematic reviews and protocols.

>> JOANN: Thank you very much, Denine and I want to thank everyone for participating in the webcast. 
And if you do need any help to register for access to the Library, please be sure to go to our home page at 
www.ncddr.org. And look for the box on the right that says Cochrane Library. If you need to register, there 
is a link there to "Register" or if you are registered, you can get to the Library by going to "Log-in." If you 
do need any more help, be sure and call our toll free number, which is 800-266-1832. Or you can send e-
mail to admin@ncddr.org. 

And I wanted to let everyone know that the audio file and transcript of the webcast will be available on the 
ILRU website archive page in a couple of days, that you can find by visiting www.ilru.org. I want to thank 
the National Institute on Disability and Rehabilitation Research, NIDRR, that provided funding for the 
webcast and I also want to thank especially the staff at ILRU, because without their efforts, the webcast 
could not have taken place. And those include Tajauna Arnold, Marj Gordon, Sharon Finney, Dawn 
Heinsohn, Vinh Nguyen, Maria del Bosque, and we had John Searle doing our technology and Marie 
Bryant is our realtime captioner. And this is Joann Starks with the NCDDR. I want to thank you again for 
coming and we hope you'll join us for our next webcast. Goodbye.


	
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