In keeping with the theme of this issue of the Journal of Perinatal & Neonatal Nursing, this column focuses on examples of Internet resources for evidence-based practice including sites for systematic reviews and clinical guidelines. The most well-known resource of systematic reviews is The Cochrane Collaboration. The Cochrane Collaboration
is an international not-for-profit and independent organization, dedicated to making up-to-date, accurate information about the effects of healthcare readily available worldwide. It produces and disseminates systematic reviews of healthcare interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions.1
The Cochrane Library (http://www.thecochranelibrary.com/view/0/index.html) consists of 6 databases that "contain different types of high-quality, independent evidence to inform healthcare decision-making."2 These databases are as follows: (1) Cochrane Database of Systematic Reviews; (2) Cochrane Central Registry of Controlled Trials; (3) Cochrane Methodology Register; (4) Database of Abstracts of Reviews and Effects (DARE); (5) Heath Technology Assessment Database; and (6) The National Health Service Economic Evaluation Database.2 All are updated regularly.
The Database of Abstracts of Reviews of Effects is a resource for abstracts of systematic reviews. It is
focused primarily on systematic reviews that evaluate the effects of health care interventions and the delivery and organization of health services. The database also includes reviews of the wider determinants of health such as housing, transport, and social care where these impact directly on health, or have the potential to impact on health.3
The Cochrane Neonatal Group (http://neonatal.cochrane.org/) and the Pregnancy and Childbirth Group (http://pregnancy.cochrane.org/) are collaborative review groups within The Cochrane Collaboration (there are >50 such groups). The Cochrane Neonatal Group focuses on systematic reviews of randomized controlled trials of therapies used in the management of neonatal disorders. Funding for this group is obtained from the National Institute of Child Health & Human Development. The Pregnancy and Childbirth Group focuses on therapies used during pregnancy, childbirth, postpartum (for up to 30 days following birth) and with lactating women. Lists of new and updated reviews, new protocols, and protocols and reviews undergoing review are available (http://onlinelibrary.wiley.com/o/cochrane/clabout/articles/PREG/frame.html).
These abstracts can be accessed at http://www.crd.york.ac.uk/crdweb/. The TRIP (Translating Research into Practice) Database, which can be found at http://www.tripdatabase.com/, is a clinical search tool focusing on identifying high-quality evidence for clinical practice.
The "Netting the Evidence" Resource List has been replaced with a Google custom search engine that focuses on methodologies of evidence-based practice. This link facilitates searches of more than 100 Web sites by specific clinical topics. This customized search engine can be found at http://www.google.com/coop/cse?cx=004326897958477606950%3Adjcbsrxkatm.
The National Guideline Clearinghouse (http://www.guideline.gov/) sponsored by the Agency for Healthcare Research and Quality is a source for evidence-based clinical practice guidelines. This is a searchable database of more than 1000 guidelines. The Agency for Healthcare Research and Quality site (http://www.ahrq.gov/clinic/epcix.htm) is a source of completed reports from the Evidence-based Practice Centers. These reports primarily focus on clinical topics, including those applicable for perinatal and neonatal care, and also include some on healthcare services. Clinical guidelines are also available from the National Institute for Health and Clinical Excellence Web site (http://www.nice.org.uk/) in the United Kingdom, focusing on provision of evidence-based guidance for the National Health Service.
The US Preventive Services Task Force4 (http://www.uspreventiveservicestaskforce.org/uspstopics.htm) maintains a collection of summaries and supporting documentation "to rigorously evaluate clinical research in order to assess the merits of preventive measures, including screening tests, counseling, immunizations, and preventive medications."4 The lists on this site include active, inactive, and in-progress recommendations.
The Web site of the Center for Evidence Based Medicine at the University of Oxford (http://www.cebm.net/index.aspx?sedo=1157) includes links to tools that are used for the critical appraisal of healthcare practices as well as other resources for evidence-based healthcare. Appraisal of Guidelines for Research and Evaluation (AGREE; available at: http://www.agreetrust.org/) is an instrument that can be used to assess practice guidelines.
-Susan Blackburn, PhD, RN, FAAN
Professor Emeritus
Department of Family and Child Nursing
University of Washington, Seattle
References