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An evidence-based
approach to
research support
Fiona Morgan and Mala Mann
LILAC 1 April 2009
Identifying the Evidence Base
• Background and history
• Outline of systematic review methods
• Identifying the needs of t...
Evidence-based Medicine
• Archie Cochrane
– British medical researcher
– Contribution to development of
epidemiology as a ...
Cochrane systematic reviews
• Evidence-based medicine
– Clinical answers for more effective healthcare
– Pinnacle of the e...
Expansion of evidence-based methods
• 1999 UK Government White Paper
Modernising Government:
“Government must…produce poli...
What does the researcher want?
• A systematic literature search?
– Finding all the information on a topic area
• Literatur...
A systematic review of the literature
• Explicit, reproducible methodology
– Usually conducted by a team
– Systematic lite...
Systematic review or
systematic literature search?
• Same search principles apply
• Methodology adapts effectively
• Aim i...
What is a search strategy?
A search strategy is a plan that helps you
look for the information you need. [PubMed]
Developing a systematic search strategy
1. Define the question and break it down
2. Set limits
3. Search each concept and ...
PICO/PECO
P = Population/problem
I/E = Intervention/Exposure
C = Comparison/Control
O = Outcome
Population/
Problem
Intervention/
Exposure
Comparison/
Control
Outcome
Inner city
residential
area
Intervention:
Neighbour...
Question
PICO
• In an inner-city residential area, does the
introduction of a neighbourhood watch
scheme reduce the level ...
Question must be….
• Clear
• Answerable
• Focused
Counsell C (1997). Annals of Internal Medicine, 127: 380-387
“Ask a poor...
Set Limits
• Consider inclusion/exclusion criteria
– Age group
– Publication date
– Language
– Study design
– Settings
List all relevant keywords
Remember….
• Synonyms and acronyms
• American and British spellings
• Hyphenated vs non-hyphena...
Identify relevant subject headings
• Match keywords to headings
• Check how key papers and
references are indexed
• Subjec...
Wildcards & Truncation
* $(n) ? #
Manag* home$1 Colo?r Wom#n
Manage
Manages
Manager
Managers
Managing
Management
Home
Home...
Combining Search Terms
• Using Boolean Logic
–AND narrows the search
• Papers containing both concepts together will be
re...
ADJn
Retrieves records containing terms in any order within a
specified number (n) of words of each other
eg asthma ADJ in...
Search strategy
1. child abuse.mp. or Child Abuse/
2. child protection.mp.
3. (battered child or shaken baby or
battered b...
Searching for study designs
Search Filters
Collections of search terms designed to
retrieve selections of records
InterTAS...
Balance between sensitivity and specificity
Sensitivity
• Proportion of relevant articles identified by a
search strategy,...
Is the strategy adequate?
• Depends on the size of the evidence base
for the topic.
• Rough guide - 1:10 or 1:20 relevant
...
Range of general, specialist and grey
literature databases
General ASSIA, CINAHL, Cochrane Library
Embase, Medline, Scienc...
Snowballing
• Identify grey literature and new or
missed studies
• Grey literature
– Conference proceedings
– Trial regist...
Record everything
• Systematic review methodology
should be transparent and replicable
• Record sources searched, search
s...
And finally…A few tips
• Check out the literature
• Are there other reviews in the topic
area?
• What sources of informati...
Thank you
morganf1@cf.ac.uk
mannmk@cf.ac.uk
www.cardiff.ac.uk/insrv/sure
An evidence-based approach to research support: applying systematic review methods. Morgan & Mann
An evidence-based approach to research support: applying systematic review methods. Morgan & Mann
An evidence-based approach to research support: applying systematic review methods. Morgan & Mann
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An evidence-based approach to research support: applying systematic review methods. Morgan & Mann

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An evidence-based approach to research support: applying systematic review methods. Morgan & Mann

  1. 1. An evidence-based approach to research support Fiona Morgan and Mala Mann LILAC 1 April 2009
  2. 2. Identifying the Evidence Base • Background and history • Outline of systematic review methods • Identifying the needs of the researcher • Developing a systematic search strategy
  3. 3. Evidence-based Medicine • Archie Cochrane – British medical researcher – Contribution to development of epidemiology as a science • Cochrane Collaboration (1993) – Improving healthcare decision- making globally, through systematic reviews of the effects of healthcare interventions
  4. 4. Cochrane systematic reviews • Evidence-based medicine – Clinical answers for more effective healthcare – Pinnacle of the evidence pyramid • Critical summaries of the evidence – Randomised controlled clinical trials • Clear methodology – Transparent – Reproducible
  5. 5. Expansion of evidence-based methods • 1999 UK Government White Paper Modernising Government: “Government must…produce policies that really deal with problems; that are… shaped by the evidence rather than a response to short-term pressures…. “This Government expects…better use of evidence and research in policy making.”
  6. 6. What does the researcher want? • A systematic literature search? – Finding all the information on a topic area • Literature review • Informs research • A systematic review of the literature? – Finding and using the best available evidence to answer a specific question
  7. 7. A systematic review of the literature • Explicit, reproducible methodology – Usually conducted by a team – Systematic literature search – Study selection using pre-defined inclusion and exclusion criteria – Critical appraisal of included papers – Data extraction – Statistical or narrative summary – Highlights strengths and weaknesses
  8. 8. Systematic review or systematic literature search? • Same search principles apply • Methodology adapts effectively • Aim is to find ALL the relevant evidence • The finished product only as good as the information that underpins it.
  9. 9. What is a search strategy? A search strategy is a plan that helps you look for the information you need. [PubMed]
  10. 10. Developing a systematic search strategy 1. Define the question and break it down 2. Set limits 3. Search each concept and combine 4. Test and refine the search 5. Select databases and other sources of information
  11. 11. PICO/PECO P = Population/problem I/E = Intervention/Exposure C = Comparison/Control O = Outcome
  12. 12. Population/ Problem Intervention/ Exposure Comparison/ Control Outcome Inner city residential area Intervention: Neighbourhood Watch scheme Exposure Living in social housing Similar area no watch scheme Being an owner -occupier Reduction in crime Crime rate
  13. 13. Question PICO • In an inner-city residential area, does the introduction of a neighbourhood watch scheme reduce the level of crime when compared with no watch scheme? PECO • In an inner-city residential area, does the population living in social housing experience a higher level of crime when compared with those living in owner occupied accommodation?
  14. 14. Question must be…. • Clear • Answerable • Focused Counsell C (1997). Annals of Internal Medicine, 127: 380-387 “Ask a poor question and you will get a poor review”
  15. 15. Set Limits • Consider inclusion/exclusion criteria – Age group – Publication date – Language – Study design – Settings
  16. 16. List all relevant keywords Remember…. • Synonyms and acronyms • American and British spellings • Hyphenated vs non-hyphenated
  17. 17. Identify relevant subject headings • Match keywords to headings • Check how key papers and references are indexed • Subject headings – – To explode or not to explode?
  18. 18. Wildcards & Truncation * $(n) ? # Manag* home$1 Colo?r Wom#n Manage Manages Manager Managers Managing Management Home Homes (not homeless or homelessness) colour color woman women
  19. 19. Combining Search Terms • Using Boolean Logic –AND narrows the search • Papers containing both concepts together will be retrieved –OR broadens the search • Articles containing either concept are retrieved • NOT removes a concept • Cuts a concept out of a search
  20. 20. ADJn Retrieves records containing terms in any order within a specified number (n) of words of each other eg asthma ADJ inhaler The words must appear next to one another “an asthma inhaler” Eg asthma ADJ3 inhaler The words must be within 3 of each other (in any order): “an inhaler for asthma” “using an inhaler for moderate asthma”
  21. 21. Search strategy 1. child abuse.mp. or Child Abuse/ 2. child protection.mp. 3. (battered child or shaken baby or battered baby).mp. 4. 1 or 2 or 3 5. (child* or infant* or baby).mp. 6. non-accidental injur*.mp. 7. non-accidental trauma.mp. 8. (non-accidental* and injur*).mp. 9. soft tissue injur*.mp. 10. physical abuse.mp. 11. (or/6-10) and 5 12. 4 or 11 13. fractur*.mp. 14. 12 and 13 15. (investigat* adj3 fract*).mp. 16. (radiolog* adj3 fractur*).mp. 17. (roentgen* adj3 fract*).mp. 18. skeletal survey.mp. 19. bone scan*.mp. 20. Isotope Bone Scan*.mp. 21. radionuclide.mp. 22. scintigraphy.mp. 23. Tomography, X-Ray Computed/ 24. ((paediatric or pediatric) adj3 radiolog*).mp. 25. ((paediatric or pediatric) adj3 nuclear medicine).mp. 26. or/15-25 27. (ageing adj3 fractur*).mp. 28. ((dating or date) adj3 fractur*).mp. 29. (pattern* adj3 fractur*).mp. 30. healing.mp. 31. or/27-30 32. 26 or 31 Kemp et al. BMJ 2008;337:a1518
  22. 22. Searching for study designs Search Filters Collections of search terms designed to retrieve selections of records InterTASC Information Specialists' Sub-Group http:// www.york.ac.uk/inst/crd/intertasc/ McMaster University http://hiru.mcmaster.ca/hiru/HIRU_Hedges_home.asp
  23. 23. Balance between sensitivity and specificity Sensitivity • Proportion of relevant articles identified by a search strategy, expressed as % of all relevant articles on a given topic • The ability to identify all relevant articles on a given topic Specificity • Proportion of relevant articles identified by the search, as a % of all articles (relevant and irrelevant) • The ability of a search to exclude irrelevant articles Centre for Reviews and Dissemination, CRD Report 4 (2009)
  24. 24. Is the strategy adequate? • Depends on the size of the evidence base for the topic. • Rough guide - 1:10 or 1:20 relevant references • Use key papers to test the search strategy – Does the search pick up all key papers? – If key papers have been missed why? – Does search need adjusting?
  25. 25. Range of general, specialist and grey literature databases General ASSIA, CINAHL, Cochrane Library Embase, Medline, Science Citation Index, SCOPUS Social Care Online, Sociological Abstracts, Social Sciences Citation Index Specialist Age Line, ChildData, Community Wise, ERIC, IBSS, IDOX PsycINFO Grey Literature HMIC, Open SIGLE, ReGARD, conference abstracts, websites
  26. 26. Snowballing • Identify grey literature and new or missed studies • Grey literature – Conference proceedings – Trial registers – Internet searching • Google scholar • Web sites of relevant organisations • Contacting experts – Experts in the field and research networks • Reference lists of relevant papers
  27. 27. Record everything • Systematic review methodology should be transparent and replicable • Record sources searched, search strategies and results • Use reference management software to manage the search results
  28. 28. And finally…A few tips • Check out the literature • Are there other reviews in the topic area? • What sources of information do they use – databases, grey literature? • How are key papers indexed in the databases? • Use and adapt other people’s search strategies - it’s not plagiarism.
  29. 29. Thank you morganf1@cf.ac.uk mannmk@cf.ac.uk www.cardiff.ac.uk/insrv/sure

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