The University of Adelaide Library

Cochrane

Using Cochrane Library

Part 2 of a 3 part course on Evidence Based Dentistry

Compiled by Mick Draper
Last update January 2007

The Cochrane Library aims to be a source of objective articles on health care interventions. Cochrane Library publishes systematic reviews of interventions either to compare interventions, or to increase the study size for a particular intervention to make results more reliable. Cochrane Library is a very useful first source of objective information for researchers and practitioners in all areas of clinical health science.

Table of Contents

Cochrane Oral Health Group	Selecting and Saving Records
Log on to Cochrane	Limits
Cochrane Library Guides	Saving Search Strategies
Cochrane Databases	Running Saved Searches
Search example	Using Advanced Search
PICO Grid and Search	MeSH Searches
Reviewers' Conclusions	Saving Cochrane Citations to EndNote

Cochrane Oral Health Group
This group of consumers, practitioners and researchers produces systematic reviews of randomized controlled trials on oral health. Viewing abstracts of their work is the quick way to check on Cochrane oral health systematic reviews.
Click on the button below to open this web site in a new window.

Australasian Cochrane Centre Has information about public access to Cochrane Library in Australia. It also includes information about Cochrane reviews that are considered newsworthy.

All internet users in Australia have free access to Cochrane Library

Logon to Cochrane Library
You can open the Cochrane Library by clicking on the button below.

Alternatively open the Uni of Adelaide Library Catalogue Title search and type in
cochrane library
Click on the Search button.

Click on Cochrane library [electronic resource].

Click on the Link to e-Resource.

At this point if you are outside The Uni of Adelaide network you'll be asked to confirm that you are a student or staff member, by providing your email login and password. You could also use your library barcode and LAST NAME in capitals.

If you have difficulties with this authentication process there is help here.

Public access to Cochrane Library from Australia

Cochrane Library Guides
Here is a guide to the Cochrane Library on Wiley Interscience
and
Background Information on The Cochrane Library Compiled by Maureen Bell Public Health Research Librarian at The University of Adelaide Library

Cochrane Library Databases
The Cochrane Library contains several databases.
Systematic Reviews
This database contains full text articles that review interventions. Systematic reviews pool information from several studies to find the effectiveness of interventions. Cochrane systematic reviews are sometimes called the 'gold standard' for evidence based health care.

There are 2 parts
The Reviews
each of which includes
Cover sheet, Background, Methods, Results, Discussion, References and sometimes Tables and Graphs.

Protocols for reviews in preparation
Cover sheet, Background, Methods & References.

Database of Abstracts of Reviews of Effectiveness (DARE)
This database also called Other reviews, are previously published systematic reviews on the effect of health care interventions.
Mostly these reviews include bibliographic details plus an abstract.

Clinical Trials (The Cochrane Central Register of Controlled Trials)
Clinical Trials is a database of publications which report on controlled trials.
Mostly these articles have bibliographic details plus an abstract.

Technology Assessment
Articles on the evaluation and use of health care technologies

Search Example
The father of three patients who range in age from 5 to 13 has read that there is some controversy about the use of fluoridated water for prevention of caries, and wants to know whether there is any evidence that fluoride toothpaste is effective. Instead of having lunch with the movie star who you have treated recently, you decide to find out how good the evidence really is.

Begin by using a grid to define the Population or Patients, the Intervention of interest, any Comparisons with this intervention, and Outcomes desired. You don't have to include all of these factors in the analysis of your search.

PICO Grid

Population a	Population b	Intervention	Outcome
caries	child	fluoride toothpaste	???
cavities	adolescent		restoration of tooth function ?
decay	adolescence		prevention of caries?

This is a simplified grid, there are other terms you could use such as carious, decayed, decaying, childhood, teenager*, youth* etc.
You can truncate search terms using * to search on word roots such as
child*
This will find terms such as child, childbirth, childhood, childish, children, etc.

The search screen of Cochrane Library should look something like this.

Enter the terms from the first column of your grid, joined by OR logic. The database searches most singular and plural forms of each term by default. By typing cavities you will also search cavity.

Type
caries OR cavities OR decay
into the Search box.
Click on the Go button.

Your result appears showing title, authors, and dates of the first 25 of 69 systematic reviews. Notice that there are links to Other Reviews (DARE), Clinical Trials etc.

To continue click on Search History.

Your current search history appears

Continue with the second column from the PICO grid by typing

child OR adolescent OR adolescence

Notice that when you use Search History you can limit your searches by "product", record status, or date range.

To search fluoride toothpaste as a phrase you can either type fluoride NEXT toothpaste or enclose the phrase in double quotes "fluoride toothpaste".
I think fluoride NEXT toothpaste works better because it also finds fluoride toothpastes.

Typing in fluoride toothpaste without quote marks will be searched as (fluoride OR fluorides) AND (toothpaste OR toothpastes)

When you have entered all the column searches using OR logic, join those searches together using AND logic, and the set numbers.

The next stage of your search becomes
#1 AND #2 AND #3

To view the results of the combined search click on the result.

The result from CDSR appears first.

You can scroll through the results and click on Record to read reviews and protocols. Notice that there is an R or a P next to the hypertext for the record. This tells you whether the title is a review or a protocol.

You can use the side bar on the left of a record to find particular sections of the review or protocol, or to download the pdf.

Authors' Conclusions
For the purposes of evidence based practice it's useful to view the Authors' conclusions first. If the intervention isn't effective, or is harmful then there is no point reading more of the review for clinical practice.

If the authors conclude that the intervention is useful for patients, then you must look at the methods used and the results to decide if the conclusions are correct. Many reviews present results as tables and graphs that can be found only from the side bar.

Click on Back on your browser to return to the list of titles.

Selecting and Saving Records
You can click in the small boxes to the left of any Reviews and Protocols that you want to save.
When you have selected all those you want, click on the Export Selected Citations button that's found at the bottom of the screen. This will save citations you have selected from all the Cochrane databases.

To save all the citations from a single database that is showing on the screen click on the Export All Results button.

Choose whether you want to include an abstract.

Click on the search result again to view records in Other reviews (DARE), Clinical Trials and other parts of Cochrane Library.

Search Limits
You can limit your searches to particular years, types of records

or particular parts of the records. You can look for words in the title, or an author's name etc.

You can limit the results in CDSR to just reviews or just protocols.

Saving Search Strategies
Registration
As a preliminary to saving search strategies you must register a login and password.
Click on Log in on the top right of the Cochrane screen.

Click on Register Now in the top right of the screen.

Fill out the form and click on the Submit Registration button on the bottom left of the screen.
You need to register once only.

Return to the Cochrane Library screen.
Databases/Cochrane Library/Search History

Click on the Save Search Strategy button.

Give the search strategy a name and click on the Save Search Strategy button.

Running Saved Searches
Click on the Saved Searches link when you open Cochrane Library.

Locate the appropriate search and click on Run.

You can also run saved searches whenever you see the Saved Searches link.

Using Advanced Search
Use advanced search if you want to make your search more specific by searching in the title, author, or record number.
Click on the Advanced Search Link.

Make sure that the search field under In: is the one you want.

Notice that Advanced Search provides the option to search All Text. This would find keywords or phrases in all parts of Cochrane records including the full text of systematic reviews. This will usually find more records but some of them (perhaps many of them) may not be relevant.

You need to be very careful using Advanced search and the logic supplied. The search below will actually find

hypersensitiv* OR (sensitiv* AND toothpaste*)

This means that the search could find records with the keywords hypersensitive or hypersensitivity but not toothpaste!

A better option would be to use just the first search box and use brackets to ensure that your search logic is what you want.

You can also get access to All Text from the Search box near the top right of the screen.

MeSH Searches
MeSH stands for Medical Subject Heading. MeSH are subject terms assigned by experts to describe the content of articles indexed in the Cochrane databases. Not all the databases are fully indexed with MeSH. Recent Cochrane reviews (CDSR) might not have MeSH and Clinical Trials is only partially indexed.

To search by MeSH click on the link.
If the link to MeSH Search doesn't appear on your screen, click on Search History and it should appear on the following screen.

Type in a single subject.
Click on the Go To MeSH Trees button.

If the term you entered is a MeSH it will appear in a hierarchical list of Medical Subject Headings.
If your term isn't a MeSH, the Cochrane Library will take you to the Thesaurus where you can find an appropriate MeSH.

Notice that [+8] appears at the end on Dental Cements in the list.
There are 8 more specific terms indented below Dental Cements. These are specific cements or types of cement.

Notice that there is a [+1] next to Glass Ionomer Cements. This means that there is a more specific MeSH included under Glass Ionomer Cements.
When you search for the term Dental Cements in MeSH, not only will every citation indexed in Cochrane Library as being about dental cements be found by your search, but so will every citation indexed with one of the more specific 8 MeSH and any articles indexed with the more specific MeSH listed under Glass Ionomer Cements.

You can add 'Qualifiers' or subheadings to your MeSH search to make it more specific.

Click on the View Results button.

If you click in the box to the left of Go directly to Search History you'll see the results of your search in the Search History area and you can combine this result with others.

In the search history below, the MeSH search for dental cements finds fewer references than the search using the All Fields search (#2).

When the MeSH and All Fields or MeSH and ti,ab,kw searches are combined using OR logic you can see that there are some records in each search that are not included in the other.
To make your searches comprehensive you should include a MeSH search. MeSH searches are also more likely to include relevant material.

Cochrane Library enables you to quickly get an idea of what reasonably objective research there is available on your topic. The database is small, so you might find nothing, especially in CDSR.

Saving Citations to EndNote

[This is covered in more detail in Part 3 of this course Using PubMed in Evidence Based Dentistry]

There is a filter for importing Cochrane Library citations (and abstracts) into EndNote available from the Uni of Qld Library site
Scroll down the screen to find the Cochrane Library filter.
Hold down your shift key while you click on the filter.

Save this filter to your EndNote Filters file.

If you need more info on a research topic then try PubMed. PubMed incorporates the journal articles from Dental abstracts.

Go to Part 3 Using PubMed in Evidence Based Dentistry
Back to Part 1 Evidence Based Dentistry Introduction