by Cindy Schmidt, M.D., M.L.S.
updated August 2022
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Instructions:
1. This tutorial may NOT WORK PROPERLY IN INTERNET EXPLORER, Edge, or Google Chrome. Use Firefox or another browser.
2. Use the Arrow icons below the instruction screen to go forwards and backwards in the tutorial.
3. If you want to skip between distant parts of the tutorial, you can use the "Menu/Contents" button above the instruction screen to show the tutorial's "Table of Contents" and can click on the needed section of the tutorial. If the "Contents" menu flickers or jitters, right-click on the light grey bar above the instruction screen and select the "refresh" or "reload" option. Doing this one or more times should solve the problem.
4. Clicking the "Single-page view" link will produce a transcript of the entire tutorial.
After completing this tutorial, the student will:
The Cochrane Library was named for Dr. Archie Cochrane, an early champion of systematic reviews and of meta-analyses.
Dr. Cochrane learned the value of evidence-based care during World War II.
While serving in the Allied forces, he was captured by the Germans. His experience as a prisonor-of-war-camp physician taught him that:
Dr. Cochrane often lacked access to the treatments that he would have prescribed in civilian life, but his fellow prisoners usually recovered anyway.
Occasionally, Cochrane had access to more than one treatment but he rarely had any scientific data on which to base a treatment choice
Shortly before his 1988 death, Archie Cochrane wrote a forward for an Ob/Gyn text. In this forward, he urged the medical community to produce systematic reviews that would summarize all the high-quality evidence on important clinical questions. He emphasized that such reviews need to be updated on a regular basis.
Without such reviews, Cochrane said:
The Cochrane Collaborations were formed in 1992.
Members of the Cochrane Collaborations are experts who volunteer their time to write meta-analyses and systematic reviews in their areas of expertise. Together the members of a Cochrane Collaboration:
The Collaboration members work with paid editors who insure that writing quality and a uniform format are maintained.
The Cochrane Database of Systematic Reviews (CDSR) contains all the current and old versions of the protocols and reviews created by the Cochrane Collaborations.
The CDSR is published by Wiley and is one of several databases that are marketed together as the Cochrane Library.
The McGoogan Library pays a fee to license the Cochrane Library for on- and off-campus use by UNMC-affiliated individuals.
Why search the Cochrane Library?
Many journals require that authors of systematic reviews include a Cochrane Library search in their work (especially searches of the Cochrane Database of Systematic Reviews and The Cochrane Trials Database).
Because of the limited time available to you for this class project, we are not requiring a Cochrane Library or EMBASE search. If you were writing a document for publication or clinical use, you might be expected to complete keyword and subject headings searches in both databases.
The PubMed tutorial that you completed earlier guided you through the steps involved in producing PubMed searches on the topic:
"How strong is the evidence supporting use of eculizumab (Solaris) in paroxysmal hemoglobinuria with thrombosis?"
After completing the PubMed lab, you had finished all the steps involved in producing:
1) a MeSH search for trials. 2) a keyword search for unindexed records. 3) and, optionally, a keyword search for recent meta-analyses
When you completed the PubMed tutorial, you had revised the keyword search for use in searching Clinicaltrials.gov and/or EMBASE.
You had removed the PubMed-specific tags (e.g. [tiab] tags) and filters. These steps produced the following search strategy:
(Eculizumab* OR 219685-50-4 OR h5G1.1* OR h5g11 OR h5G1-1 OR 5G1.1 OR Soliris OR Elizaria OR Alexion OR Acveris ) AND (((intermittent OR paroxysmal ) AND ( haemoglobinur* OR hemoglobinur* OR haematur* OR hematur* OR haematinur* OR hematinur*)) OR PNH OR Marchiafava-Micheli) AND (Clot OR Clots OR budd-chiari OR embol* OR postthromb* OR thromb*)
Copy this strategy.
Warning: occasionally a partially functional version of the Cochrane Library will open. If, during the course of this tutorial, you see an "Unlock abstract" or similar button, look for an "Open Athens" login or institutional login link. You should be able to get to the fully functional version.
In the future, you will need to access the Cochrane Library using links on the Library's website.
To access Cochrane Library (or EMBASE or PubMed) from the Library Home page:
1. Click on "Literature Databases"
2. Click on the relevant database link
3. Login with your UNMC Net ID if asked to do so.
4. If you reach an error message or blank page, try refreshing the page or returning to the page that contains the "Cochrane Library" link and clicking the link again.
There are also links to the Cochrane Library on the homepage of the COP Research Guide (available through the Library link in Canvas).
1) Paste your search statement into the Cochrane Library "Search" box.
2) Use the drop-down next to the search box to select the content you wish to search
(The default setting, "Title, Abstract, Keywords", usually retrieves all relevant results while avoiding retrieval of an overwhelming number of irrelevant results. Try this setting first. You can switch to the full-text option later if you initial search fails to retrieve results.)
4) Click the "magnifying glass" icon.
If you happen to end up on the "Advanced Search" page, you will need to click the "Run Search" button to make the results appear.
If you happen to end up on the "Search Manager" page, you will need to click the result number on the right-hand side of the page to make the results appear.
This result is a full review (see review designation in the green oval in the figure).
Click on the title of the review "Eculizumab for treating patients with paroxysmal nocturnal hemoglobinuria" to see the review.
If you were writing a formulary monograph on our tutorial search topic (eculizumab use in PNH patients with thrombosis), you would want to pay special attention to the following aspects of this CDSR/Cochrane Reviews article.
If the CDSR review is not recent, you might want to seek guidance from both the CDSR review and another, more recent, systematic review located by your PubMed search for indexed and unindexed systematic reviews.
There is a navigation box on the right-hand side of the page. The "Abstract" is shown by default.
Scan the relevant sections of the CDSR article to find answers to the questions below.
The following questions are part of your Canvas-based quiz. You can either record the answers now and enter them in Canvas later, or you can open a new tab or window, go to Canvas and enter answers as you progress through the tutorial .
1. Studies were only considered for review if they were randomized controlled trials published in peer-reviewed journals.
Hint: "types of studies" included, inclusion criteria, search strategies, etc. are described in the "Methods."
2. Which of the following diagnostic criteria were used to determine whether patients would be included?
3. Was the database "International Pharmaceutical Abstracts" included among the databases searched for relevant articles?
4. According to the flow chart, 4161 database records were reviewed. How many trials met the inclusion criteria for this Cochrane Review?
Hint: Look at the "Figures and Tables"
5. Do the authors recommend use of eculizumab in PNH patients?
Let's move on to briefly consider the search results from other Cochrane Library databases.
To return to the Cochrane Library search results page, click on the "Search" or "Advanced Search" or "Search Manager" browser tab.
If you write a systematic review or prepare a formulary monograph and include a Cochrane Library search, be sure to check the "Cochrane Protocols" tab. A Cochrane protocol can be quite helpful to those writing a systematic review on a similar topic.
A Cochrane protocol is created at the beginning of the process of writing a Cochrane systematic review. The authors:
Full reviews are, of course, more useful.
Full reviews include:
Let's now move on to the The Cochrane Library's "Trials" database. This database is also known as the "Cochrane Central Registry of Controlled Trials".
The "Trials" database is maintained to support production of Cochrane Reviews. Records are obtained from many sources, e.g. PubMed, EMBASE, ClinicalTrials.gov, meeting proceedings, etc..
To reach the search results in the "Trials" database:
As mentioned earlier, the Cochrane Central Register of Controlled Trials (abbreviated "Cochrane Trials") contains records for a variety of different sources.
Clinical Trial Registry records
Many of "Cochrane Trials" records provide links to descriptions of ongoing trials that have been entered in clinical trial registries. To see the records that correspond to trials registered with the US government's clinical trials registry, ClinicalTrials.gov:
https://clinicaltrials.gov
There were about 2 clinicaltrials.gov records included among the 83 "Cochrane Trials" search results when this tutorial was last updated. There were another 6 records from the World Health Organization's trial registry (web address prefix = https://trialsearch.who.int )
Many "Cochrane Trials" records contain conference abstracts. New scientific findings are often presented in posters and presentations at scientific meetings before they are disseminated in published journal articles. The Cochrane Trials database and EMBASE are the two databases licensed by UNMC that will be most helpful if you need to find information presented at scientific meetings.
The abstract is often the only section of a conference poster or presentation that is published. So, the information in the Cochrane Trials or EMBASE record is usually the only information available (there's no corresponding full-text article for most of these conference presentation/poster records).
The part of a "Cochrane Trials" record shown on the search results page may not tell you whether an the item represented is a conference abstract or a full journal article.
In this record, there are clues that this item is conference abstract. The article is in "Suppl 1" of volume 197. Journal supplements often contain conference proceedings. The item is only a single page long. It begins on page 136 and extends to page 137. To determine whether a "Cochrane Trials" record does, in fact, represent a conference abstract,
6. When you want to know what's being discussed at scientific conferences before the findings are published in journal article form, which databases should you search?
7. Use the browser's find feature to look for instances of the letters thromb
Are post-eculizumab thrombosis rates discussed in this abstract?
8. Based on this study, which of the following lab values is more closely correlated with quality of life in PNH patients?
Long-term safety and efficacy of sustained eculizumab treatment in patients with paroxysmal nocturnal haemoglobinuria
published in
British Journal of Haematology, 2013, volume 162, issue 1
9. Which of the methods below will be useful when looking for the full text version of an article identified by a Cochrane Trials record? Assume that UNMC licenses the full-text version.
Congratulations! You've finished the tutorial. Please, use the answers you recorded while completing the tutorial to complete the Quiz available through the "Cochrane Library and EMBASE Tutorial and Quiz" link in Canvas.