Webinar

March 26, 2014

About Us

• Amanda Hodgson (amandah@cadth.ca)

Manager, Information Services

• Hayley Fitzsimmons (hayleyf@cadth.ca)

Manager, Information Services

• Caitlyn Ford (caitlynf@cadth.ca)

Information Specialist

CADTH

CADTH is an independent, not-for-profit producer and broker

of health technology assessments. Federal, provincial, and

territorial health care decision-makers rely on our

evidence-based information to make informed policy and

practice decision about drugs and other health technologies.

www.cadth.ca

Agenda

• Role of the Information Specialist in HTA

• Introduction to “Finding the Evidence” website

• Creating your literature search

• Applying search filters

• Peer review of search strategies

• Grey literature searching

What are Systematic Reviews and Health Technology Assessments?

Scope of CADTH projects:

• Pharmaceuticals

• Medical, surgical and dental devices and procedures

• Diagnostics

Types of CADTH reports:

• Optimal Use reports

• Systematic reviews and economic evaluations

• Rapid reviews

• Horizon scanning reports

Role of the Information Specialist In

HTAs and Systematic Reviews • Experts in technical and methodological

issues of searching

• MLIS/MLS/MISt – educational requirements

• Work with the research team at every stage of review

WHY ARE THEY IMPORTANT?

• Help to mitigate potential biases in search

• Know search resources and how to use them

• Can advise on size and quality of search results

Standards for Systematic Searchers

• Finding what works in health care: standards for systematic reviews. Washington D.C.: Institute of Medicine of the National Academies; 2011.

• Higgins JPT, Green S, eds. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. [Updated March 2011]. The Cochrane Collaboration; 2011.

Major function of the Information Specialist Ensure researchers have all the available evidence on a topic

• failure to retrieve and analyze all relevant evidence on a topic can seriously compromise the quality of HTA and systematic review reports

However… • retrieving too much irrelevant literature can

seriously compromise the timeliness and costs of HTA and systematic review reports

Evidence in Medical Literature

Clinical

Practice

Guidelines

Health Technology

Assessments

(HTAs), Systematic

reviews, and/or

Meta-analysis

Source: Trip Database http://www.tripdatabase.com/

Safety

advisories

or

adverse

event

reports

Fundamental Challenge of Searching

Balancing Recall and Precision =

getting “all the evidence" while avoiding "junk"

http://www.creighton.edu/fileadmin/user/HSL/docs/ref/Searching_-_Recall_Precision.pdf

How Does This Translate Into Literature Searches?

Simple search for “diabetes” in Medline

Search Fields Number of Results

• Subject heading • Title, abstract, all free-text fields

400,000 +

• Title • 2+ times in abstract • Major subject heading

280,000 +

• Title • Major subject heading

160,000+

Solutions to the Recall versus Precision Conundrum?

• Finding the evidence: literature searching tools in support of systematic reviews http://cadth.ca/en/resources/finding-evidence-is

Creating YOUR Literature Search

• Understanding your research question

• PICO

• Scope for search terms

• Setting your parameters

What is your question?

P population

I intervention

C comparator

O outcome

C

Adapted with permission: Sampson, M.

Adapted with permission: Sampson, M.

Adapted with permission: Sampson, M.

Adapted with permission: Sampson, M.

Adapted with permission: Sampson, M.

Adapted with permission: Sampson, M.

Adapted with permission: Sampson, M.

Find controlled vocabulary and

keywords – always use both! Uncontrolled Terms (keywords in PubMed)

[ti] or [tiab] or [tw]

• Words in title & abstract fields

• Synonyms/Acronyms

• Spelling variants

• Old and new terminology

• Brand and generic names

• Lay and medical terminology

• Singular & plural variations

Controlled terms (in PubMed)

• MeSH subject headings [mh] or [major] or [mh:NoExp] or

[major:NoExp]

• Substance name field [nm]

• Pharmaceutical Action field

[pa]

• Registry number field [rn]

Population Intervention Comparison Outcome

Heart failure[mh] Exercise test

[mh] None

Meta-analysis[pt]

Randomized

controlled trial[pt]

(Cardiac OR heart

OR myocardial OR

congestive)

AND Failure

6MWT; SMWT;

Six minute; 6M;

6 Minute; 6Min;

6min

None Systematic

review; RCT;

CCT

Adapted from:http://www.oxfordradcliffe.nhs.uk/research/

researchers/news/documents/LiteratureSearchingGuidelinesChecklist.pdf

Keywords Keywords Keywords Keywords

Controlled terms Controlled terms Controlled terms Controlled terms

AND

O

R

Translating PICO

Search Translation

Could eliminate ‘test’

concept to be more

systematic!

“AND” with Systematic

Review plus RCT filters for

best evidence (represents

“clinical effectiveness” outcome)

Define Search Parameters

Major Medical Databases Medline/PubMed Embase PsycINFO CINAHL Cochrane Central

Focus Biomedical and health sciences

Biomedical and pharmaceutical database

Behavioural sciences and mental health

Nursing and allied health

Controlled clinical trials

Specialization Strong in clinical research; North American focus

Strong in pharmaceutical information; European focus; index conference abstracts

Includes fields such as psychiatry, management, business, education, social science, neuroscience, law, medicine, and social work

Includes fields such as nursing (clinical and theory), nurse education, physiotherapy, occupational therapy

Contains only citations of clinical trials; no need to use an RCT filter

Thesaurus MeSH EMTREE Thesaurus of Psychological Index Terms

CINAHL Headings

MeSH

Date Coverage Begins 1946 1974 1840 1981 circa 1966 (some earlier)

Journals Indexed 5,516 7,500 2,450 3,000 2,400 handsearched

Overlap with other databases

Yes Yes Yes Yes Yes

Translating the Search

CADTH PubMed cheat sheet

http://cadth.ca/media/i

s/Search-

dev/PubMed_Cheat_

Sheet_external.pdf

Visual Example of Typical Search Strategy

POPULATION

TERMS

INTERVENTION

TERMS

STUDY DESIGN

FILTERS

Types of Filters

• Specific methodology

– RCTs, Systematic reviews

• Clinical queries

– Diagnosis, Prognosis, Adverse events

• Population specific

– Humans, Pediatrics

• CADTH Filters http://www.cadth.ca/en/resources/finding-

evidence-is/string

Filters

http://www.cadth.ca/en/resources/finding-evidence-is/string

Filters: Warning

• No filter is infallible

• Filters are regularly being tested, tweaked and updated

but they almost always capture irrelevant records and

sometimes exclude relevant ones

RCT filter would pick up this article…

And this article…

“Randomized” in title, but not a study:

But not this one.

Study design NOT found anywhere

CADTH Peer Review Checklist for Search Strategies

http://www.cadth.ca/en/res

ources/finding-evidence-

is/peer-review-search-strat

CADTH Peer Review Checklist for Search Strategies

• Developed from: Sampson M, McGowan J, Lefebvre C,

Moher D, Grimshaw J. PRESS: Peer review of electronic

search strategies. Ottawa: Canadian Agency for Drugs

and Technologies in Health; 2008.

http://www.cadth.ca/media/pdf/477_PRESS-Peer-Review-

Electronic-Search-Strategies_tr_e.pdf

Peer Review: Does it Make a Difference?

• Recent research conducted to determine whether the

peer review of literature search strategies has an

effect on the number and quality of articles included in

CADTH rapid review reports

• What were the results?

Phase Two Results: Included Rapid Review Reports

EFFECT OF PEER REVIEW ON RETRIEVAL

19%

38%

43%

9/47 (19%) searches: No uniquearticles retrieved

18/47 (38%) searches: Unique articlesretrieved, none included in the finalreport

20/47 (43%) searches: Unique articlesretrieved, one or more articlesincluded in the final report

Getting Your Search Reviewed

• Colleagues

• Listservs

• Your librarian

• PRESS Forum website. A forum for librarians to request

and conduct peer reviews of search strategies.

http://pressforum.pbworks.com/

Best Practices for Search Strategies

1) Understand research question(s)

2) Use keywords and controlled vocabulary

3) Know database indexing and syntax

4) Use filters where appropriate

5) Have searches peer reviewed

6) Use caution: don’t overcomplicate

Why is Searching Grey Literature Important?

• Essential component of a comprehensive search

• Overcomes bias of commercial publications

• Part of evidence base

• Most HTAs created for healthcare decision-makers are

considered “grey literature” and are not found in traditional

databases

Grey Matters: A Practical Deep-Web Search Tool for Evidence- based Medicine

http://www.cadth.ca/en/resources/fi

nding-evidence-is/grey-matters

Health Technology Assessments (HTAs) KEY RESOURCES

• Databases:

– Centre for Reviews and Dissemination (CRD)

http://www.crd.york.ac.uk/crdweb/SearchPage.asp

– The Cochrane Library ($)

http://www.thecochranelibrary.com/view/0/index.html

– Trip Database

http://www.tripdatabase.com/

• Stand-alone websites:

– Health Quality Ontario Publications and OHTAC Recommendations

http://www.hqontario.ca/evidence/publications-and-ohtac-recommendations

– L’Institut national d’excellence en santé et en services sociaux (INESSS)

http://www.inesss.qc.ca/index.php?id=49&L=1

– Canadian Agency for Drugs and Technologies in Health (CADTH)

http://cadth.ca/en/products/health-technology-assessment

http://www.crd.york.ac.uk/crdweb/SearchPage.asp

AND

Safety/Advisory

HEALTH CANADA

• MedEffect Canada http://www.hc-sc.gc.ca/dhp-

mps/medeff/advisories-avis/index-eng.php

• CARN http://www.hc-sc.gc.ca/dhp-

mps/medeff/bulletin/carn-bcei_index-eng.php

• Canada Vigilance Online Database http://webprod3.hc-

sc.gc.ca/arquery-rechercheei/index-eng.jsp

Canada Vigilance Online Database

Canada Vigilance Online Database

Safety/Advisory

OTHER KEY RESOURCES

• U.S. Food and Drug Administration (FDA) MedWatch

http://www.fda.gov/Safety/MedWatch/default.htm

• European Medicines Agency (EMA) Patient Safety http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/landing/pha_listing.jsp&mid=WC0b01ac058001d126

Clinical Practice Guidelines

• A search for clinical practice guidelines may extend

to association websites or organizations dedicated

to a particular disease or patient group, depending

on the requirements of the search

– Guidelines

– Protocols

– Positions statements

– Patient information sheets and resources

– Recommendations

Clinical Practice Guidelines

KEY RESOURCES

• Canadian Medical Association CMA Infobase:

Clinical Practice Guidelines (CPGs)

http://www.cma.ca/clinicalresources/practiceguidelines

• National Institute for Health and

Clinical Excellence NICE Guidelines

http://guidance.nice.org.uk/index.jsp?action=find

• National Guideline Clearing House (NGC)

http://www.guideline.gov/

Follow us on:

@CADTH_ACMTS

Closing and Q&A