Lister Hill Letter
Newsletter of the Lister Hill Library of the Health Sciences at UAB

Evidence-Based Health Care and The Cochrane Collaboration

An article in the British Medical Journal explains that "Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.  The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research."   From its beginnings in general medicine, evidence based medicine has evolved into evidence based health care and continues to expand into other areas such as nursing, mental health, cardiology, and primary care.

In the early seventies a British epidemiologist named Archie Cochrane wrote Effectiveness and Efficiency:  random reflections on health services  as an evaluation of the National Health Service.  He considered the value of evidence in medical care and cure, both of which terms he carefully defined.  The use of randomized controlled trials (RCTs) was strongly encouraged and the contributions from those RCTs were evaluated.

Cochrane was a strong proponent of the collection of systematic current reviews of the relevant RCTs of health care.  An initiative developed and funding was provided to establish a Cochrane Centre that opened in Oxford in the fall of 1992.  The intent was to begin a collaboration with other groups to enable systematic reviews of the RCTs both within and beyond the UK.  Shortly thereafter, in October 1993, the New York Academy of Sciences organized a meeting where 77 people representing nine countries co-founded "The Cochrane Collaboration."

The Cochrane Database of Systematic Reviews (CDSR) is the Collaboration's electronic production of their reviews and is part of The Cochrane Library.  Other portions of The Cochrane Library are The Database of Abstracts of Reviews of Effectiveness (DARE), The Cochrane Controlled Trials Register (CCTR), and The Cochrane Review Methodology Database (CRMD).  When compared to Medline, The Cochrane Library presents several differences: the original systematic reviews that are produced include full text as well as graphs; reviews are regularly updated with new information and in response to criticism and comment; information is assessed for quality; there is critical appraisal of material published elsewhere; previously unpublished material including conference proceedings and non-English material is included.

Ovid's new database product "Evidence Based Medicine Reviews (EBMR) contains the Cochrane Database of Systematic Reviews (CDSR).  It will also include Best Evidence which is a database that contains the journals ACP Journal Club and Evidence Based Medicine.

Good news for Lister Hill Library database users!  Both The Cochrane Library and Ovid's Evidence Based Medicine Reviews have been ordered by Lister Hill Library - availability is anticipated sometime during the month of October.  Watch our homepage for the announcement.

Some websites to check:
Centre for Evidence-Based Medicine http://cebm.jr2.ox.ac.uk/
McMaster Univ - a major center in the Cochrane Collaboration http://hiru.mcmaster.ca/cochrane/
Evidence Based Medicine - Bridging Evidence to Practice http://hiru.mcmaster.ca/ebm/
Baltimore Cochrane Center Home Page  http://www.cochrane.org/
MedWeb Evidence-Based Medicine (Emory University) http://www.gen.emory.edu/MEDWEB/keyword/evidence-based_medicine/evidence-based_medicine.html
POEMs:  Patient Oriented Evidence that Matters http://jfp.msu.edu/jclub/jclub.htm

And --- check out the new video available in Media Services entitled "Evidenced-Based Health Care in Action."