The Cochrane Library.
PRICE: The CD-ROM and on-line versions are $225 for individuals per year and include quarterly updates. Organizational site licenses for the CD-ROM are $430 for 1 to 5 users and $630 for 6 to 10 users; on-line licenses are $400 for a single concurrent user and $80 for each additional concurrent user. Prices are subject to handling and other charges.
DOCUMENTATION: Training materials and sessions are available through the University of York (www.york.ac.uk/inst/crd/cochlib.htm).
HOW SUPPLIED: CD-ROM or through connection to the Internet.
HARDWARE/SOFTWARE REQUIREMENTS: The CD-ROM version requires a PC running Microsoft Windows with a 386SX processor and 4MB RAM and a CD-ROM drive. The on-line version is not limited to machines running Microsoft Windows but requires a standard Internet Web browser, such as Mosaic, Internet Explorer, or Netscape.
CUSTOMER SUPPORT: Training materials and sessions are available through the University of York (www.york.ac.uk/inst/crd/cochlib.htm).
The medical information explosion has compelled physicians to seek efficient ways to access information. Electronic databases are available to help meet this need. However, the most clinically useful databases are those that have been appropriately filtered to provide physicians with material that is relevant and valid.
The Cochrane Database of Systematic Reviews contained within The Cochrane Library is a clinical database made up of monographs about treatment of clinical conditions. It emphasizes evidence about treatment on the basis of controlled trials and, when appropriate, meta-analysis. Details about the relevance and validity of potential therapies are illustrated graphically for easy viewing and decision making. Relevance and validity are priorities during the peer-review and editing processes for topics in the database. An updated revised database is distributed quarterly.
The search capabilities in The Cochrane Library CD-ROM are similar to other popular medical databases (eg, MEDLINE). Searches are run against all the databases in The Cochrane Library, and results are displayed as a list from each database.
Once the desired topic is found, a summary of the results of major studies can be displayed in a graphic format called Metaview, that compares outcomes in the intervention groups versus the control groups. Users can rapidly assess relevance by scanning this graph for patient-oriented outcomes. Data for any outcome can be examined in more detail with a double click, which brings up a second graphic containing data from all of the studies that included the outcome of interest. Each outcome identified in the systematic review can be evaluated for its clinical significance using an odds ratio, relative risk, or risk difference.
For example, the Figure illustrates a search on treatment of hypertension in diabetes using the key words "diabetes" and "hypertension." Various outcomes for treatments of hypertension in diabetes are listed. Detailed information is obtained by doubleclicking on individual outcomes. All of the studies used to calculate the odds ratio appear in the window. Pull-down menus allow the user to change the statistical analysis presented. For example, instead of odds ratio or relative risk, the program will calculate and present risk differences, thus allowing easy calculation of numbers needed to treat.
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In addition to the Metaview, text accompanies each review outlining the methods used to find and evaluate individual studies, providing an overview of results, and presenting implications for practice and for research. In the near future, comments from users will be incorporated with each review.
The strengths of The Cochrane Library include the relevance of its clinical topics, the validity of its review process, its ease of use, its graphic representation of results using Metaview, and the ease of converting to alternative statistical views, including the ability to calculate number needed to treat. Users can do a quick visual survey of results or a detailed analysis. The Cochrane Library also contains one of the largest obstetric databases of controlled clinical trials. Weaknesses of the CD-ROM include the limited number of topics currently included. The Cochrane Library is a work in progress with continued efforts to expand topics in all areas of medicine including alternative medicine. In my experience, however, the information contained within The Cochrane Library is highly relevant to family practice.
Other databases in The Cochrane Library software include: The DARE Database, which is produced by the NHS Centre for Reviews and Dissemination at the University of York, and provides critical assessments and structured abstracts published elsewhere; the Cochrane Controlled Trials Registry, a bibliography of more than 100,000 controlled trials that have been identified by contributors to the Cochrane Review Groups; and the Cochrane Review Methodology Database, a comprehensive bibliography of articles and books about methods used in producing reviews.
In the future, The Cochrane Library will present in a user-friendly fashion an enormous amount of clinically relevant evidence-based information that has undergone the closest scrutiny. The speed and ease of use will allow integration of evidence-based medicine on the front lines of clinical practice. The collection of systematic reviews in The Cochrane Library is one of the largest of its kind in electronic database format today.
--Gene Bailey State University of New York Health Science Center at Syracuse
Editor's Note: I would like to reinforce that The Cochrane Library is a project in evolution. This and similar databases may in the foreseeable future assist front-line clinicians and patients make real-time optimal evidence-based decisions about care choices. Currently, the most highly developed portions of The Cochrane Library are those that deal with obstetrics and gynecology. Potential users can obtain a good sense of what The Cochrane Library's current contents are by perusing the list of collaborative review groups at the Cochrane Collaboration's World Wide Web site, hiru.mcmaster.ca/cochrane/cochrane/ revabstr/abidx.htm. The abstracts are accessible for free on-line. Product purchase is required to obtain the full review.
--Gary N. Fox, MD Editor, Software Reviews