Below are some notes which I hope may be helpful to you in gaining an understanding of evidence-based medicine and the contribution of the Cochrane Collaboration. You will find additional resources on my public health page.

Here is a very broad search on public health and evidence-based medicine using PubMed

Archie Cochrane and the Cochrane Library

Archie Cochrane, a physician and humanitarian (1909-1988), strongly advocated producing systematic reviews of the medical literature as a way of creating "evidence-based medicine." He believed it was not humanly possible for a clinician to keep abreast of the volumes of information that were being generated and summarized this concern in his famous statement, "It is surely a great criticism of our profession that we have not organized a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomized controlled trials." He envisioned an organization which existed for the sole purpose of conducting these systematic reviews in every aspect of medicine. A systematic review is a systematic assembly of the results of studies which use methods that minimize bias and random error.

In 1993, Archie Cochrane's dream came true with the establishment of the Cochrane Collaboration. The Cochrane Collaboration is comprised of health care providers, consumers, and scientists who volunteer time to compile up-to-date systematic reviews of evidence. These reviews are published quarterly in the Cochrane library, The purpose of the Cochrane Collaboration is to prepare, maintain and disseminate systematic reviews of randomised controlled trials (RCTs). Prior to its establishment the vast amount of clinically important information gathered through RCTs often failed to influence clinical practice. This was because of the enormity of the undertaking for any individual to collate research findings dispersed through the world literature in a number of languages and covering several decades.

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The Ten Principles of the Cochrane Collaboration

(extracted from the Cochrane Collaboration Brochure )

The Cochrane Collaboration has evolved rapidly since it was inaugurated at the 1st Colloquium, but its basic objectives and principles have remained the same as they were at its inception. It is an international organization that aims to help people make
well informed decisions about health care by preparing, maintaining and ensuring the accessibility of systematic reviews of the effects of health care interventions. The Collaboration is being built on nine principles:

collaboration
building on the enthusiasm of individuals
avoiding duplication
minimizing bias
keeping up to date
ensuring relevance
ensuring access
continually improving the quality of its work
continuity

Definitions of Terms

This is the definition of evidence-based medicine provided in the Medline thesaurus.

The process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions. Evidence-based medicine asks questions, finds and appraises the relevant data, and harnesses that information for everyday clinical practice. Evidence-based medicine follows four steps: formulate a clear clinical question from a patient's problem; search the literature for relevant clinical articles; evaluate (critically appraise) the evidence for its validity and usefulness; implement useful findings in clinical practice. The term "evidence based medicine" (no hyphen) was coined at McMaster Medical School in Canada in the 1980's to label this clinical learning strategy, which people at the school had been developing for over a decade. (From BMJ 1995;310:1122)

Below is a succinct description of systematic reviews from Undertaking Systematic Reviews of Research on Effectiveness (CRD Report no. 4)

"Systematic reviews locate, appraise and synthesise evidence from scientific studies in order to provide informative empirical answers to scientific research questions. They are therefore valuable sources of information for decision makers. In addition, by identifying what we know and don't know, they are an invaluable first step before carrying out new primary research. Systematic reviews differ from other types of review in that they adhere to a strict scientific design in order to make them more comprehensive, to minimise the chance of bias, and so ensure their reliability. Rather than reflecting the views of the authors or being based on only a (possibly biased) selection of the published literature, they contain a comprehensive summary of the available evidence."

Randomised Controlled Trials

Central to the Cochrane methodology and evidence based medicine is the randomised controlled clinical trial. CONSORT (Consolidated Standards of Reporting Trials) comprises a checklist and flow diagram to help improve the quality of reports of randomized controlled trials. It offers a standard way for researchers to report trials.

The Cochrane Library

The Cochrane Library consists of a number of databases, and these are described in detail at the National Institute of Clinical Studies site.

Books on Evidence-Based Medicine held by the Library

Click here to see a list of books on evidence-based medicine held by the library. The list appears in order by title, but may be resorted by publication date, or by author.

Journal Articles of Interest

Dickersin K. , Scherer R., Lefebvre C. Systematic Reviews: Identifying relevant studies for systematic reviews.
BMJ 1994; 309:1286-91.
Check the appendix at the end of the article for the optimally sensitive Medline search strategy for identifying randomised clinical trials.

And finally, from the BMJ -Sacred Cows: to the abattoir! Down with EBM! and EBM: Unmasking the ugly truth Yes the promoters of evidence-based methods do have a sense of humour!