The Cochrane Library

1. The Cochrane Library CHLA Halifax May 30, 2008 Margaret Sampson Children�s Hospital of Eastern Ontario

2. 2 Plan Introductions Cochrane and Systematic reviews What is in the Cochrane Library? Ways to search Cochrane Library Constructing a search strategy Search tips Training resources Examples

3. Cochrane Logo The Cochrane Collaboration logo illustrates a systematic review of data from seven randomized controlled trials (RCTs), comparing one health care treatment with a placebo. Each horizontal line represents the results of one trial (the shorter the line, the more certain the result); and the diamond represents their combined results. The vertical line indicates the position around which the horizontal lines would cluster if the two treatments compared in the trials had similar effects; if a horizontal line touches the vertical line, it means that that particular trial found no clear difference between the treatments. The position of the diamond to the left of the vertical line indicates that the treatment studied is beneficial. Horizontal lines or a diamond to the right of the line would show that the treatment did more harm than good. This diagram shows the results of a systematic review of RCTs of a short, inexpensive course of a corticosteroid given to women about to give birth too early. The first of these RCTs was reported in 1972. The diagram summarises the evidence that would have been revealed had the available RCTs been reviewed systematically a decade later it indicates strongly that corticosteroids reduce the risk of babies dying from the complications of immaturity. By 1991, seven more trials had been reported, and the picture had become still stronger. This treatment reduces the odds of the babies of these women dying from the complications of immaturity by 30 to 50 per cent. Because no systematic review of these trials had been published until 1989, most obstetricians had not realised that the treatment was so effective. As a result, tens of thousands of premature babies have probably suffered and died unnecessarily (and needed more expensive treatment than was necessary). This is just one of many examples of the human costs resulting from failure to perform systematic, up-to-date reviews of RCTs of health care. The Cochrane Collaboration logo illustrates a systematic review of data from seven randomized controlled trials (RCTs), comparing one health care treatment with a placebo. Each horizontal line represents the results of one trial (the shorter the line, the more certain the result); and the diamond represents their combined results. The vertical line indicates the position around which the horizontal lines would cluster if the two treatments compared in the trials had similar effects; if a horizontal line touches the vertical line, it means that that particular trial found no clear difference between the treatments. The position of the diamond to the left of the vertical line indicates that the treatment studied is beneficial. Horizontal lines or a diamond to the right of the line would show that the treatment did more harm than good. This diagram shows the results of a systematic review of RCTs of a short, inexpensive course of a corticosteroid given to women about to give birth too early. The first of these RCTs was reported in 1972. The diagram summarises the evidence that would have been revealed had the available RCTs been reviewed systematically a decade later it indicates strongly that corticosteroids reduce the risk of babies dying from the complications of immaturity. By 1991, seven more trials had been reported, and the picture had become still stronger. This treatment reduces the odds of the babies of these women dying from the complications of immaturity by 30 to 50 per cent. Because no systematic review of these trials had been published until 1989, most obstetricians had not realised that the treatment was so effective. As a result, tens of thousands of premature babies have probably suffered and died unnecessarily (and needed more expensive treatment than was necessary). This is just one of many examples of the human costs resulting from failure to perform systematic, up-to-date reviews of RCTs of health care.

4. The Cochrane Collaboration International organization Not for profit Registered as a charity in the U.K. Main activities are preparing, maintaining and promoting the accessibility of systematic reviews of the effects of healthcare interventions Example is consumer summaries and podcasts Strict conflict of interest guidelines, Example is consumer summaries and podcasts Strict conflict of interest guidelines,

5. Cochrane Collaboration's Vision That healthcare decision-making around the world will be informed by high-quality, timely research evidence, and that The Cochrane Collaboration will play a pivotal role in the production and dissemination of this evidence across all areas of health care, including complementary medicine.

6. 6 Strength of systematic review is that it is based on MULTIPLE trials Systematic review (synonym: systematic overview)A review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research, and to collect and analyze data from the studies that are included in the review. Statistical methods (meta-analysis) may or may not be used to analyze and summarize the results of the included studies. A Cochrane systematic review Identifies an intervention for a specific disease or other problem in healthcare and determines whether or not this intervention works. To do this, the authors locate, appraise and synthesize evidence from as many relevant scientific studies as possible. They summarize conclusions about effectiveness, and provide a unique collation of the known evidence on a given topic, so that others can easily review the primary studies for any intervention. Strength of systematic review is that it is based on MULTIPLE trials Systematic review (synonym: systematic overview)A review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research, and to collect and analyze data from the studies that are included in the review. Statistical methods (meta-analysis) may or may not be used to analyze and summarize the results of the included studies. A Cochrane systematic review Identifies an intervention for a specific disease or other problem in healthcare and determines whether or not this intervention works. To do this, the authors locate, appraise and synthesize evidence from as many relevant scientific studies as possible. They summarize conclusions about effectiveness, and provide a unique collation of the known evidence on a given topic, so that others can easily review the primary studies for any intervention.

7. 7 What is the Cochrane Library? A collection of databases Main output of the Cochrane Collaboration Highest level of evidence on which to base clinical treatment decisions The Cochrane Library is recognized as The Gold Standard by many publications such as The Lancet, The New England Journal of Medicine, The British Medical Journal (BMJ), and The Journal of the American Medical Association (JAMA). The Cochrane Library is recognized as The Gold Standard by many publications such as The Lancet, The New England Journal of Medicine, The British Medical Journal (BMJ), and The Journal of the American Medical Association (JAMA).

8. 8 What is in the Cochrane Library? Cochrane Database of Systematic Reviews (Cochrane Reviews)Regularly updated summaries of the best available evidence prepared by members of the Cochrane Collaboration. Database of Abstracts of Reviews of Effects (DARE)Other published reviews prepared by people outside of the Cochrane Collaboration. Cochrane Central Register of Controlled Trials (CENTRAL)Where to look if you want to track down the original studies (primary studies) � the largest single source of controlled trials. The first and foremost is the Cochrane Database of systematic reviews. A Cochrane systematic review Identifies an intervention for a specific disease or other problem in healthcare and determines whether or not this intervention works. If there is no review on a specific topic, the other databases in The Cochrane Library will provide information on other good quality reviews and randomized controlled trials. The second database is named other database. Also know as Database of Reviews of Effectiveness (or DARE) it is the only database that contains abstracts of systematic reviews that have been critically assessed. Each abstract contains a summary of the review together with a critical commentary about the overall quality The clinical trials database contains details of published articles taken from bibliographic databases, namely MEDLINE and Embase and other published and unpublished sources. The records contain the title of the article, information on where it was published, and in many cases, a summary of the article. They do not include the full text of the article Cochrane Systematic Reviews (FT) investigate the effects of interventions for prevention, treatment, rehabilitation in a healthcare setting. They are designed to facilitate the choices that doctors, policy makers, patients and others face in health care. Most Cochrane Reviews are based on randomized controlled trials but other types of evidence may also be taken into account, if appropriate. Each review addresses a clearly formulated question, for example; can antibiotics help in alleviating the symptoms of a sore throat? The research is reviewed using stringent guidelines to establish whether or not there is conclusive evidence about a specific treatment (now includes Methodology Reviews) CENTRAL (AB): Includes details of published articles taken from bibliographic databases and other published resources. Records include title of the article, information on where it was published and, in many cases, the abstract. Built from review group specialized registers and handsearching CENTRAL includes details of published articles taken from bibliographic databases (notably MEDLINE and EMBASE), and other published and unpublished sources. CENTRAL records include the title of the article, information on where it was published (bibliographic details) and, in many cases, a summary of the article. They do not contain the full text of the article. About three-fifths of the records in CENTRAL are taken from MEDLINE. In addition, each Cochrane Review Group maintains and updates a collection of controlled trials relevant to its own area of interest, these are called �Specialized Registers�. Each group may also collect items which are not relevant to its own field of interest; these are known as �Handsearch Results�. The registers and handsearch results are assembled and collated by Wiley before incorporation into The Cochrane Library. All Review Groups� specialized registers, the handsearch results register, relevant records retrieved from MEDLINE, and relevant records retrieved from EMBASE, are merged as described here. DARE (AB): Complements The Cochrane Reviews by quality-assessing and summarizing reviews which have not been carried out by The Cochrane Collaboration. DARE is unique in that it is the only database to contain abstracts of systematic reviews that have been quality assessed. Each abstract includes a summary of the review, together with a critical commentary about the overall quality. The database is a key resource for busy decision makers and can be used for answering questions about the effects of specific interventions, whether such questions arise from practice or when making policy. DARE covers a broad range of health related interventions and includes over 3000 abstracts of reviews in fields as diverse as diagnostic tests, public health, health promotion, pharmacology, surgery, psychology and the organization and delivery of health care. DARE complements the Cochrane Database of Systematic Reviews by quality-assessing and summarizing reviews that have not yet been carried out by The Cochrane Collaboration. DARE is produced by the Centre for Reviews and Dissemination (CRD) at the University of York, UK.The first and foremost is the Cochrane Database of systematic reviews. A Cochrane systematic review Identifies an intervention for a specific disease or other problem in healthcare and determines whether or not this intervention works. If there is no review on a specific topic, the other databases in The Cochrane Library will provide information on other good quality reviews and randomized controlled trials. The second database is named other database. Also know as Database of Reviews of Effectiveness (or DARE) it is the only database that contains abstracts of systematic reviews that have been critically assessed. Each abstract contains a summary of the review together with a critical commentary about the overall quality The clinical trials database contains details of published articles taken from bibliographic databases, namely MEDLINE and Embase and other published and unpublished sources. The records contain the title of the article, information on where it was published, and in many cases, a summary of the article. They do not include the full text of the article Cochrane Systematic Reviews (FT) investigate the effects of interventions for prevention, treatment, rehabilitation in a healthcare setting. They are designed to facilitate the choices that doctors, policy makers, patients and others face in health care. Most Cochrane Reviews are based on randomized controlled trials but other types of evidence may also be taken into account, if appropriate. Each review addresses a clearly formulated question, for example; can antibiotics help in alleviating the symptoms of a sore throat? The research is reviewed using stringent guidelines to establish whether or not there is conclusive evidence about a specific treatment (now includes Methodology Reviews) CENTRAL (AB): Includes details of published articles taken from bibliographic databases and other published resources. Records include title of the article, information on where it was published and, in many cases, the abstract. Built from review group specialized registers and handsearching CENTRAL includes details of published articles taken from bibliographic databases (notably MEDLINE and EMBASE), and other published and unpublished sources. CENTRAL records include the title of the article, information on where it was published (bibliographic details) and, in many cases, a summary of the article. They do not contain the full text of the article. About three-fifths of the records in CENTRAL are taken from MEDLINE. In addition, each Cochrane Review Group maintains and updates a collection of controlled trials relevant to its own area of interest, these are called �Specialized Registers�. Each group may also collect items which are not relevant to its own field of interest; these are known as �Handsearch Results�. The registers and handsearch results are assembled and collated by Wiley before incorporation into The Cochrane Library. All Review Groups� specialized registers, the handsearch results register, relevant records retrieved from MEDLINE, and relevant records retrieved from EMBASE, are merged as described here. DARE (AB): Complements The Cochrane Reviews by quality-assessing and summarizing reviews which have not been carried out by The Cochrane Collaboration. DARE is unique in that it is the only database to contain abstracts of systematic reviews that have been quality assessed. Each abstract includes a summary of the review, together with a critical commentary about the overall quality. The database is a key resource for busy decision makers and can be used for answering questions about the effects of specific interventions, whether such questions arise from practice or when making policy. DARE covers a broad range of health related interventions and includes over 3000 abstracts of reviews in fields as diverse as diagnostic tests, public health, health promotion, pharmacology, surgery, psychology and the organization and delivery of health care. DARE complements the Cochrane Database of Systematic Reviews by quality-assessing and summarizing reviews that have not yet been carried out by The Cochrane Collaboration. DARE is produced by the Centre for Reviews and Dissemination (CRD) at the University of York, UK.

9. 9 More Cochrane Library Databases Cochrane Methodology Register (CMR)As exciting as it sounds! Where to find studies which look at the science of systematic reviewing. Health Technology Assessment Database (HTA)An international collection of health technology assessments. NHS Economic Evaluation Database (NHS EED)International economic evaluations of health care interventions.  About the Cochrane Collaboration (About)Where to look for information about Cochrane review groups and other activities of the Cochrane Collaboration. Next is the methodology register. A bibliography of publications that report on methods used in conduct of clinical trials, it includes journal articles, books and conference proceedings. These articles are taken from MEDLINE database and from hand searches of the literature The health technology assessment database brings together details of completed and ongoing health technology assessments from around the world. The aim of the database is to improve the quality and cost effectiveness of health care The NHS economic evaluation database contains structured abstracts of articles describing economic evaluation of health care interventions. The latest database added to the library is Cochrane Review Groups. This database contains information on the Cochrane Collaboration and the Cochrane collaborative review groups.Next is the methodology register. A bibliography of publications that report on methods used in conduct of clinical trials, it includes journal articles, books and conference proceedings. These articles are taken from MEDLINE database and from hand searches of the literature The health technology assessment database brings together details of completed and ongoing health technology assessments from around the world. The aim of the database is to improve the quality and cost effectiveness of health care The NHS economic evaluation database contains structured abstracts of articles describing economic evaluation of health care interventions. The latest database added to the library is Cochrane Review Groups. This database contains information on the Cochrane Collaboration and the Cochrane collaborative review groups.

10. 10 The Cochrane Library 2008 Issue 2 Cochrane Reviews (CDSR) 4400 complete reviews and 2500 protocols Database of Abstracts of Reviews of Effects 8131 abstracts of assessed reviews Clinical Trials (CENTRAL) 533,127 references to trials Methods studies 10,648 references to methodology studies Just to give you an idea of the size of the Cochrane Library�.Just to give you an idea of the size of the Cochrane Library�.

11. Top 10 Accessed Worldwide, 2007 See which reviews are getting the most attention from Cochrane Library users...1. Interventions for preventing falls in elderly people2. Interventions for preventing obesity in children3. Beta-blockers for hypertension4. Low glycaemic index or low glycaemic load diets for overweight and obesity5. Nicotine receptor partial agonists for smoking cessation6. Support surfaces for pressure ulcer prevention7. Interventions to improve hand hygiene compliance in patient care8. Vitamin C for preventing and treating the common cold9. Rosiglitazone for type 2 diabetes mellitus10. Exercise therapy for treatment of non-specific low back pain In the Cochrane Library health care is broadly defined, so in addition to many hundreds of medical conditions, you�ll find information on such diverse topics as injury prevention for pedestrians and cyclists, St John�s wort for depression, programs to reduce juvenile delinquency, the prevention of jet lag, advice on low-fat diets for obesity, and prayer for the alleviation of ill health.In the Cochrane Library health care is broadly defined, so in addition to many hundreds of medical conditions, you�ll find information on such diverse topics as injury prevention for pedestrians and cyclists, St John�s wort for depression, programs to reduce juvenile delinquency, the prevention of jet lag, advice on low-fat diets for obesity, and prayer for the alleviation of ill health.

12. Access to the Cochrane Library www.TheCochraneLibrary.org In Canada, accessible via provincial/territorial licenses Saskatchewan New Brunswick Nova Scotia three northern territories via some associations, e.g. Canadian Association of Occupational Therapists Canada still lacks a national license� Some may access it through Ovid, in which case the interface is same as other Ovid databases, will not focus on that here.Canada still lacks a national license� Some may access it through Ovid, in which case the interface is same as other Ovid databases, will not focus on that here.

13. 13 Ways to search the Cochrane Library From The Cochrane Library homepage you can either choose to browse the content or use one of several search options: Basic Advanced MeSH Multiple ways � some more efficient than others, but each has its placeMultiple ways � some more efficient than others, but each has its place

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15. 15 Let�s say you want to look for a review on low back pain�.Might use the pull down menu to search via the appropriate Cochrane Review GroupLet�s say you want to look for a review on low back pain�.Might use the pull down menu to search via the appropriate Cochrane Review Group

16. 16 See there is in fact a Cochrane Back Group See there is in fact a Cochrane Back Group

17. 17 When you click on the Group, you get an alphabetical list of 1st protocols, and then review titlesWhen you click on the Group, you get an alphabetical list of 1st protocols, and then review titles

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19. 19 Or, you can simply pull up everything by topic, in this case �back�, and browse the hierarchyOr, you can simply pull up everything by topic, in this case �back�, and browse the hierarchy

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21. 21 Searching the Cochrane Library Search using �basic� Searching using �advanced� Search using MeSH (Medical Subject Headings) Devise a complex search strategy

22. Basic Search The most basic search can be done from The Cochrane Library homepage When using this basic search option, searches are performed across all the databases Select the database from the results page

23. 23 If we were looking for a single topic, let�s say, we could enter a term in the basic search dialog box in the upper right corner. Let�s say we want to find articles on aquatic treatment for hip or knee osteoarthritis. We could go through the list of references (reviews, clinical trials, etc.) on osteoarthritis until we hit upon an appropriate reference or review. When using this basic search option, searches are performed across all the databases If we were looking for a single topic, let�s say, we could enter a term in the basic search dialog box in the upper right corner. Let�s say we want to find articles on aquatic treatment for hip or knee osteoarthritis. We could go through the list of references (reviews, clinical trials, etc.) on osteoarthritis until we hit upon an appropriate reference or review. When using this basic search option, searches are performed across all the databases

24. Advanced Search For greater flexibility choose the Cochrane Advanced Search The Advanced Search screen allows you to build searches by combining several different concepts using Boolean operators (AND, OR or NOT) and lets you limit your search according to particular databases, types of record or year(s). Advanced Search is more flexible�Advanced Search is more flexible�

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26. Boolean Logic AND retrieves results that include all the search terms; use AND to narrow results by combining concepts OR retrieves results that include at least one of the search terms; expanding possibilities of retrieval; use OR to group synonymous terms together NOT excludes the retrieval of terms from your search.

27. Boolean Logic

28. 28 Advanced Search - Truncation Use * for wildcard and truncation to search for multiple characters before, within, or after a search string. Examples aquatic exercis*, for exercise, exercises, or exercising isch*mic stroke, for ischaemic stroke, ischemic stroke Advanced Search is more flexible� LIVE example: �arthritis near elder*� in TITLE, ABSTRACT, or KEYWORDS (retrieves 2 SRS, 50 trials, etc.) Ask what is missing (example could change to �arthriti* near (elder* or older*)� (retrieves more trials) Limits � to SR, to protocols, reviews, etcAdvanced Search is more flexible� LIVE example: �arthritis near elder*� in TITLE, ABSTRACT, or KEYWORDS (retrieves 2 SRS, 50 trials, etc.) Ask what is missing (example could change to �arthriti* near (elder* or older*)� (retrieves more trials) Limits � to SR, to protocols, reviews, etc

29. Advanced Search - Proximity Use NEXT to find adjacent words aquatic NEXT exercise Aquatic exercise for the treatment of knee and hip osteoarthritis. Use NEAR with a number to indicate proximity of terms either before or after each other (default is 6). aquatic NEAR exercise* Aquatic therapy exercise for treating rheumatoid arthritis. Aquatic exercise =Acquatic AND exercise �Aquatic exercise� = aquatic NEAR exerciseAquatic exercise =Acquatic AND exercise �Aquatic exercise� = aquatic NEAR exercise

30. Advanced Search � Phrase Search Exact phrase search: Insert a term within quotation marks to create an exact match. �water gymnastics� The review found that specifically tailored strengthening exercise, sitting pelvic tilt exercise programs and water gymnastics all reported beneficial effects

31. Advanced Search � Fields Title, Abstract and Keywords: pre-defined includes keyword field along with terms in the title and abstract Keywords: searches index terms, including MeSH headings and check tags MeSH option: allows you to explode subject headings All text: searches the full text of review

32. Help Sheet

33. If we were looking for a single topic, let�s say, we could enter a term in the basic search dialog box in the upper right corner. Let�s say we want to find articles on aquatic treatment for hip or knee osteoarthritis. We could go through the list of references (reviews, clinical trials, etc.) on osteoarthritis until we hit upon an appropriate reference or review. When using this basic search option, searches are performed across all the databases If we were looking for a single topic, let�s say, we could enter a term in the basic search dialog box in the upper right corner. Let�s say we want to find articles on aquatic treatment for hip or knee osteoarthritis. We could go through the list of references (reviews, clinical trials, etc.) on osteoarthritis until we hit upon an appropriate reference or review. When using this basic search option, searches are performed across all the databases

34. Another favoured approach is to use, wherever possible, MeSH headings. MeSH or Medical Subject Headings is the controlled vocabulary or thesaurus vocabulary developed by the U.S. National Library of Medicine and used to index articles for Medline, PubMed, and used here in the Cochrane Library as well. Another favoured approach is to use, wherever possible, MeSH headings. MeSH or Medical Subject Headings is the controlled vocabulary or thesaurus vocabulary developed by the U.S. National Library of Medicine and used to index articles for Medline, PubMed, and used here in the Cochrane Library as well.

35. Tip Sheet

37. 37 Organizing the search�. PICO - A well-formulated question makes it easier to produce the strategy and find the evidence Strategy will be based on controlled vocabulary (Medical Subject Headings), and text words (develop list of key terms, synonyms) An even more effective way to search in order to obtain a more precise set of records, rather than having to wade through huge amounts of irrelevant records in order to find the ones of interest, is to develop a search strategy using the PICO model. An even more effective way to search in order to obtain a more precise set of records, rather than having to wade through huge amounts of irrelevant records in order to find the ones of interest, is to develop a search strategy using the PICO model.

38. 38 Start with PICO Evidence-based searching begins with PICO: before you start to search, think about what you�re really asking and what you�re really looking for This is the step where you start to formulate your question To compare the effectiveness and safety of aquatic-exercise interventions in the treatment of knee and hip osteoarthritis. Examples: Patients with knee or hip osteoarthritis Aquatic exercise interventions ? May be several??? Is it safe and effective No time period indicatedEvidence-based searching begins with PICO: before you start to search, think about what you�re really asking and what you�re really looking for This is the step where you start to formulate your question To compare the effectiveness and safety of aquatic-exercise interventions in the treatment of knee and hip osteoarthritis. Examples: Patients with knee or hip osteoarthritis Aquatic exercise interventions ? May be several??? Is it safe and effective No time period indicated

39. 39 Framing the question Are aquatic-exercise interventions in the treatment of knee and hip osteoarthritis effective and safe? In patients with knee or hip osteoarthritis (population) Are aquatic-exercise interventions (intervention) No comparator (comparison) Effective and safe? (outcome)?

40. 40 PICO Patient group Knee osteoarthritis Hip osteoarthritis Intervention Aquatic exercise interventions To compare the effectiveness and safety of aquatic-exercise interventions in the treatment of knee and hip osteoarthritis.To compare the effectiveness and safety of aquatic-exercise interventions in the treatment of knee and hip osteoarthritis.

41. 41 PICO Patient group osteoarthritis, knee (MeSH) osteoarthritis, hip (MeSH) (osteoarthritis OR osteoarthros*) AND (knee OR hip) Intervention hydrotherapy (MeSH) balneology (MeSH) swimming (MeSH) balneotherap* aquatic NEXT exercis* (aquatic OR water) NEXT sport* pool NEXT therap* water NEXT aerobic* water NEXT exercis* water NEXT run* water NEXT training water NEXT gymnastic* (water* OR aquatic OR pool) AND physiotherapy During this talk about Boolean AND, OR, NOT During this talk about Boolean AND, OR, NOT

42. 42 Speech and language example Speech and language therapy for aphasia following stroke The objective of this review was to assess the effects of formal speech and language therapy and non-professional types of support from untrained providers for people with aphasia after stroke. P � patients with aphasia after stroke I - formal speech and language therapy C � non-professional types of support from untrained providersP � patients with aphasia after stroke I - formal speech and language therapy C � non-professional types of support from untrained providers

43. 43 PICO Patient group People with aphasia after stroke Intervention Formal speech and language therapy Comparator Non-professional types of support from untrained providers

44. Aphasia search Patient/Population aphasia (MeSH) aphasi*:ti,ab,kw dysphasi*:ti,ab,kw Intervention rehabilitation of speech and language disorders (MeSH) speech NEAR therap* language NEAR therap* language therap*:ti,ab,kw remedial NEAR therap* therap* OR treatment* OR rehabilitat* OR remediation* 44 Aphasia A cognitive disorder marked by an impaired ability to comprehend or express language in its written or spoken form. This condition is caused by diseases which affect the language areas of the dominant hemisphere. Clinical features are used to classify the various subtypes of this condition. General categories include receptive, expressive, and mixed forms of aphasia. Aphasia A cognitive disorder marked by an impaired ability to comprehend or express language in its written or spoken form. This condition is caused by diseases which affect the language areas of the dominant hemisphere. Clinical features are used to classify the various subtypes of this condition. General categories include receptive, expressive, and mixed forms of aphasia.

45. 45 Occupational Therapy example Occupational therapy for patients with problems in activities of daily living after stroke To determine whether occupational therapy focused specifically on personal activities of daily living improves recovery for patients following stroke.

46. 46 Occupational Therapy example Patients/Population Stroke patients Intervention Occupational therapy

47. 47 Occupational Therapy example Patient/Population cerebrovascular disorders (MeSH) stroke* cva* cerebrovascular* cerebral vascular* cerebral OR cerebellar OR brain* OR vertebrobasilar infarct* OR isch*emi* OR thrombo* OR emboli* OR apoplexyn cerebral OR brain* OR subarachoid h*emorrhage* OR h*ematoma* OR bleed* #8 AND #9 hemiplegia (MeSH) hemipleg* OR hemipar* OR post-stroke OR poststroke #1 OR ���. Intervention occupational therapy (MeSH) activities of daily living (MeSH) rehabilitation (MeSH) self care (MeSH) automobile driving (MeSH) task performance and analysis (MeSH) time and motion studies (MeSH) work simplification (MeSH) leisure activities (MeSH) recovery of function (MeSH) Work (MeSH) social adjustment (MeSH) social support (MeSH) counseling (MeSH) goals (MeSH) occupational NEAR therap*

48. 48 Occupational Therapy example Intervention rehabilitat* ((self OR personal) NEXT (care OR manage*)) dressing OR feeding OR eating OR toilet* OR bathing OR mobil* OR driving public NEXT transport* ((daily OR domestic OR house OR home) NEAR (activit* OR task* OR skill* OR chore*)) Leisure recover* NEAR function*

49. 49 Occupational Therapy example Intervention (social) NEAR (activit* OR function* OR support* OR skill* OR adjust* OR behavio*r OR facilitat*) counsel*ing OR work OR employment # 14 OR �.. #14 AND #39

50. Reading the Reviews Results screen defaults to the Cochrane Database of Systematic Reviews (CDSR) Reviews and Protocols (restrict to reviews) Layers of detail The Abstract summarizes the objectives, methods, results and conclusions. The Synopsis is a 100-word plain language summary found directly beneath the abstract, with pointers to sections of the full review. (http://www.nicsl.com.au/cochrane/guide_tell.asp) Full review provides background, detailed methods, details of the individual trials, reviewers� conclusion and maybe comments posted by readers, and the authors� responses.

51. Lead-in Tools MeSH thesaurus (www.pubmed.org) Mayo Clinic Wikipedia Structured vocabulary and introductory material on the topic Searcher may be yet unfamiliar with the condition and treatments Structured vocabulary and introductory material on the topic Searcher may be yet unfamiliar with the condition and treatments

52. Accessibility Podcast summaries of certain topic http://cochrane.org/podcasts/index.htm

53. Cochrane Library Tutorials The Cochrane Library � An Introduction (8 minutes) Tips on Advanced and MESH searching (7 minutes) Setting up Saved Searches and e-mail Alerts (7 minutes)

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55. Public Libraries and Health Information From 6-20% of reference request in a public library are health related Even patrons with Internet access at home depend on public libraries to locate appropriate, understandable health and medical information

56. Barriers to Provision of Information Lack of expert knowledge Limitations in the library collection Concerns about providing what could be considered �health advice�.

57. Situating the User Self Determined Compliant

58. Evidence-Based Medicine Evidence Experience Needs and values

59. Sources of health information Look on the Internet Your GP Books and magazines Family and Friends Public library �other health professional, pharmacist, health food store�.

60. Most trusted sources Your GP Public library Other health professional Family/ friends Pharmacist � 8. Online health information

61. Promotion Press release suitable for distribution to local media outlets Brochures for your library Contact Janet Joyce, Cochrane Canada janet.joyce@uottawa.ca

62. Thanks Sponsors CHLA/ABSC Nova Scotia Library Organizers Shelley McKibbon Cochrane Canada Janet Joyce, Education Coordinator Wiley Training password to June 6 2008 Username: ccnc@cochrane.com PW: wiley�