CADTH Webinar — Finding the Evidence


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These slides, presented at the CADTH webinar "Finding the Evidence: Tools and Techniques," show how CADTH Information Specialists use a variety of searching aids to perform comprehensive literature searches. This webinar was delivered on March 26, 2014.

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CADTH Webinar — Finding the Evidence

  1. 1. Webinar March 26, 2014
  2. 2. About Us • Amanda Hodgson ( Manager, Information Services • Hayley Fitzsimmons ( Manager, Information Services • Caitlyn Ford ( Information Specialist
  3. 3. 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.
  4. 4. 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
  5. 5. 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
  6. 6. 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
  7. 7. 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.
  8. 8. 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
  9. 9. Evidence in Medical Literature Clinical Practice Guidelines Health Technology Assessments (HTAs), Systematic reviews, and/or Meta-analysis Source: Trip Database Safety advisories or adverse event reports
  10. 10. Fundamental Challenge of Searching Balancing Recall and Precision = getting “all the evidence" while avoiding "junk"
  11. 11. 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+
  12. 12. Solutions to the Recall versus Precision Conundrum? • Finding the evidence: literature searching tools in support of systematic reviews
  13. 13. Creating YOUR Literature Search • Understanding your research question • PICO • Scope for search terms • Setting your parameters
  14. 14. What is your question? P population I intervention C comparator O outcome
  15. 15. C Adapted with permission: Sampson, M.
  16. 16. Adapted with permission: Sampson, M.
  17. 17. Adapted with permission: Sampson, M.
  18. 18. Adapted with permission: Sampson, M.
  19. 19. Adapted with permission: Sampson, M.
  20. 20. Adapted with permission: Sampson, M.
  21. 21. Adapted with permission: Sampson, M.
  22. 22. 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]
  23. 23. 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: researchers/news/documents/LiteratureSearchingGuidelinesChecklist.pdf Keywords Keywords Keywords Keywords Controlled terms Controlled terms Controlled terms Controlled terms AND O R Translating PICO
  24. 24. Search Translation Could eliminate ‘test’ concept to be more systematic! “AND” with Systematic Review plus RCT filters for best evidence (represents “clinical effectiveness” outcome)
  25. 25. Define Search Parameters
  26. 26. 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
  27. 27. Translating the Search CADTH PubMed cheat sheet s/Search- dev/PubMed_Cheat_ Sheet_external.pdf
  29. 29. Types of Filters • Specific methodology – RCTs, Systematic reviews • Clinical queries – Diagnosis, Prognosis, Adverse events • Population specific – Humans, Pediatrics • CADTH Filters evidence-is/string
  30. 30. Filters
  31. 31. 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
  32. 32. RCT filter would pick up this article…
  33. 33. And this article… “Randomized” in title, but not a study:
  34. 34. But not this one. Study design NOT found anywhere
  35. 35. CADTH Peer Review Checklist for Search Strategies ources/finding-evidence- is/peer-review-search-strat
  36. 36. 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. Electronic-Search-Strategies_tr_e.pdf
  37. 37. 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?
  38. 38. Phase Two Results: Included Rapid Review Reports EFFECT OF PEER REVIEW ON RETRIEVAL 19% 38% 43% 9/47 (19%) searches: No unique articles retrieved 18/47 (38%) searches: Unique articles retrieved, none included in the final report 20/47 (43%) searches: Unique articles retrieved, one or more articles included in the final report
  39. 39. Getting Your Search Reviewed • Colleagues • Listservs • Your librarian • PRESS Forum website. A forum for librarians to request and conduct peer reviews of search strategies.
  40. 40. 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
  41. 41. 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
  42. 42. Grey Matters: A Practical Deep-Web Search Tool for Evidence- based Medicine nding-evidence-is/grey-matters
  43. 43. Health Technology Assessments (HTAs) KEY RESOURCES • Databases: – Centre for Reviews and Dissemination (CRD) – The Cochrane Library ($) – Trip Database • Stand-alone websites: – Health Quality Ontario Publications and OHTAC Recommendations – L’Institut national d’excellence en santé et en services sociaux (INESSS) – Canadian Agency for Drugs and Technologies in Health (CADTH)
  44. 44.
  45. 45. AND
  46. 46. Safety/Advisory HEALTH CANADA • MedEffect Canada mps/medeff/advisories-avis/index-eng.php • CARN mps/medeff/bulletin/carn-bcei_index-eng.php • Canada Vigilance Online Database http://webprod3.hc-
  47. 47. Canada Vigilance Online Database Canada Vigilance Online Database
  48. 48. Safety/Advisory OTHER KEY RESOURCES • U.S. Food and Drug Administration (FDA) MedWatch • European Medicines Agency (EMA) Patient Safety cines/landing/pha_listing.jsp&mid=WC0b01ac058001d126
  49. 49. 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
  50. 50. Clinical Practice Guidelines KEY RESOURCES • Canadian Medical Association CMA Infobase: Clinical Practice Guidelines (CPGs) • National Institute for Health and Clinical Excellence NICE Guidelines • National Guideline Clearing House (NGC)
  51. 51. Follow us on: @CADTH_ACMTS
  52. 52. Closing and Q&A