Posts Tagged ‘systematic reviews’

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Clinical queries & custom filters in PubMed

In Evidence-Based Medicine,How to work better,Web 2.0 & all that,Website reviews on July 7, 2010 by Alan Lovell Tagged: , , , , , , ,

PubMed has a new clinical queries page, apparently. To be honest I used the old one so infrequently that it could have changed six months ago and I never would have noticed. I tend to use PubMed for quick and not so dirty searches of the literature but if I’m doing a “real search” I use Ovid because of its slight value-add functionality plus it has our company’s access to Embase. Perhaps because of this access to Ovid I’ve never really paid all that much attention to the development of PubMed which, particularly over the last six months or so, seems to be whizzing ahead.

Anyway, the clinical queries page is quite fun. You put in your term and get results for “clinical study categories”, “systematic reviews” (not really so much “systematic reviews”, more “aggregate research” or “tertiary research” or similar), and “medical genetics”; you can then click “see all” for, well, seeing all, and there are drop down menus for whether you want therapy or etiology etc, and broad or narrow filters. It’s easiest just to play with it. I like the fact that at the bottom of each list if you click the word “filter” it will show you the actual search string being used to filter your results (for therapy or etiology, broad or narrow etc) and the sensitivity/specificity scores of  said filters (precision would be helpful too) along with the reference to the original paper in which the filters were based. All nice and transparent, and helpful if you wish to translate e.g. the prognosis filter to use in another database.

Of course though many of us want to add our own favourite filters. I always had a rough idea you could do this but had never bothered to really look into it, but it’s an absolute breeze. Fortunately I don’t have to describe how to add your own filters as Laika has already done such a good job of it (with screenshots and everything), and you can now add up to 15 of your own favourite search strings. Not sure what to add? Your friends at CRD/InterTASC will help you out. Once you get started you’ll  be having such a whale of a time that you’ll be looking for excuses to do quick and, as mentioned before, not so very dirty searches in PubMed for all and sundry – dragging people in from the corridor – that sort of stuff. I’m sure you’ve been doing this for years, but it’s all new to me.

I’m really beginning to like PubMed. A big thank you to the US taxpayer.

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‘Expert’ Opinion on ‘Current research’: mental fast food?

In Evidence-Based Medicine on March 19, 2010 by Danielle Tagged: , , , , ,

I work appraising references for inclusion in evidence summaries for a variety of health conditions. I often come across reviews with titles like ‘current research’. Or else I see studies with more benign or vague titles published in ‘Expert Opinion in _____’ [insert name of disease or branch of medicine in the blank] or ‘Current Opinion in _____’. I use the words current/expert/opinion as a red flashing light to indicate that a study is not a systematic review unless the abstract strongly indicates that indeed it is.

My feeling is that ‘current research’ CANNOT actually be searched, as so many abstracts claim. ‘Research papers’ can be searched, but searching only for current research is lazy and pointless. How many papers are churned out each year with this sort of scope? While I understand the current incentive (pun intended) to keep on churning, perhaps publishers (or somebody!) ought to raise the bar for what is publishable.

After all, didn’t the general public lose heart in the Dickensian serials and didn’t that lead to the lean, spare short story?

Putting the section heading ‘recent findings’ into a structured abstract may grab the eye, perhaps without cheapening the content of a study. I believe that perhaps it may be down to the branches of medicine to be choosy- some branches tend to market less in abstracts by declaring their study to be ‘non-randomised’ or ‘unblinded’. This is always a breath of fresh air.

As this is an opinion piece, I welcome your thoughts on whether ‘current research’ adds real value to your life or career.

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Dismantling IT and urban flu myths

In Evidence-Based Medicine on August 10, 2009 by Hanna Tagged: , ,

According to Pulse (Tories unveil plans to ‘dismantle’ NHS IT infrastructure) a new Conservative government would dismantle the national programme for IT in favour of a lovely local version instead which a bit similar to arguments surrounding local versus centralised medicine albeit this has some degree of logic viz quality; somehow IT projects do get stereotyped as unfathomly unwieldly whatever original size/budget. The BMA welcomed the move but wanted the control of patient records to stay with patients not private companies. It seems it will fall into private hands in any case, with Labour they love a good PPI. Perhaps people should walk around with it round their neck on a secure dongle? It is interesting where this will go now that many people are publishing details freely on the internet and not making the connection…

Meanwhile something I don’t think we have mentioned yet on this blog is avian flu or its many other names. The Lancet sped up a systematic review of the use of Tamiflu et al or neuraminidase inhibitors and found that they are not beneficial when given out to the healthy general populace…hmm evidence based policy is rather thin on the ground now anyone can ring up for their antivirals; one GP says public health is now a patronising public nuisance.

And a last thing I came across today is a blind search engine test. Blindsearch, from a Microsoft employee with no much time on his hands, searches across Google, Yahoo and Bing and gets you to vote for the one you prefer when you’ve seen the results, the search engine is revealed once you’ve voted. It seemed to slide off my page but that might be a local problem, otherwise intriguing.

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Coming soon….Cochrane Overviews of Reviews

In Evidence-Based Medicine on February 5, 2009 by Sarah Tagged: , ,

In Issue 1 2009 of the Cochrane Library, the release notes point to a new type of review, an “Overviews of Reviews”. The aim of such a review is to “primarily to overview multiple Cochrane intervention reviews addressing the effects of two or more potential interventions for a single condition or health problem. Cochrane Overviews highlight the Cochrane reviews that address these potential interventions and summarize their results for important outcomes.” So rather than assessing a single intervention, these “umbrella” reviews will instead look at a condition and include more interventions. At the moment there’s one protocol included for this type of review and I’m a little confused about the value of them, given the criteria for inclusion and the search methods.

Looking at the methods section for Interventions for neovascular age-related macular degeneration, it states that relevant Cochrane reviews will be included as well asNon-Cochrane reviews of randomised controlled trials (RCTs) of interventions not currently the subject of a Cochrane“. Although Cochrane Reviews are seen as a gold standard, what if there’s a non-Cochrane systematic review out there on the same subject which eclipses the Cochrane review in terms of search date, potentially including additional studies not included in older Cochrane Reviews?

Additionally, the same issue arises from the following criteria “Where there is overlap between Cochrane and non-Cochrane reviews, we will compare and comment on the findings, however, the Cochrane review only will be included in the overview.” , again, potentially excluding newer studies only found in non-Cochrane reviews in a summary of the systematic review evidence on a particular condition.

The search sources for non-Cochrane systematic reviews are pretty straightforward and systematic, but there is a date limit. “We will restrict our searches to January 2006 onwards. This is because we feel that reviews published before that time are likely to be out of date.”

This seems rather contradictory as ALL Cochrane reviews will be included regardless of age. Of course, we know that Cochrane reviews are more likely to be updated compared with those published in non-Cochrane journals but a quick scan down the list of Cochrane reviews on asthma reveals one “Last assessed as up-to-date: 2 March 1999“. To get into even deeper nitpicking, there’s currently a Cochrane review on Radiotherapy for neovascular age-related macular degeneration which falls into the scope of this review of reviews protocol. This review on radiotherapy was published in 2004 with search dates around May 2004. With this criteria, this review would be included but as I understand it, no other non-Cochrane reviews would be included even if they were published in the four and a half years subsequently and possibly include studies not in the Cochrane review.

I’ll reserve my judgement until the review is published. The description in the release notes does state that Overviews of Reviews have also been developed outside the Library and can be viewed in the Evidence-Based Child Health Journal: A Cochrane Review Journal at http://www.evidence-basedchildhealth.com.”.

I should add at this stage that I probably have a conflict of interest as my “day job” is to find and assess systematic reviews and RCTs on a variety of topics for a regularly updated, evidence-based resource. If Cochrane were to start publishing overviews of reviews it would possibly make my life a little easier, though judging by these methods, it might be easier to ignore them at the moment as we would include ANY relevant, robust systematic review regardless of source. Although the aim in the release notes clearly states that highlighting Cochrane reviews is the main objective, if so, why bother including non-Cochrane reviews at all?

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Updated CRD guidance on producing reviews in healthcare

In Evidence-Based Medicine on February 5, 2009 by Sarah Tagged: , , ,

The Centre for Reviews and Dissemination have updated and published their guide to producting systematic reviews. As well as the core principles, the guidance also contains chapters on reviews of prognostic tests and diagnostic tests (an rediscovered interest of mine since a study day in York in December..), public health, economic evaluations and adverse effects. It’s available in electronic book format, a downloadable pdf, or you can purchase a hard copy.

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NHS Evidence; something for everyone, not (apparently)

In Evidence-Based Medicine,Health industry,Information industry,Knowledge Management on December 1, 2008 by Alan Lovell Tagged: , , , , , , , , , , , , , ,

In April 2009, NHS Evidence will apparently be launched. An evidence advisory committee has been set up and the service is intended to be a unified evidence base for everyone in the NHS who makes decisions about treatments or the use of resources. It will also be available for use by patients. According to NICE It will include: 1) a fast, comprehensive search function, 2) access to a resource collating information on new drugs for commissioners, 3) a home page users can personalise. Sounds very much like the National Library for Health (NLH), I thought. I then realised that it was one of Darzi’s big ideas and is planned to replace the NLH (which up until recently the NHS has been spending lots of money on). So, I looked at the briefing document to get some more idea of just how NHS Evidence will be different (and presumably better) than the NLH; it says that:

NHS Evidence will consolidate information from a wide range of sources in one central portal, with a common point of access. The service will provide easy access to information that has traditionally been difficult to find, or available only by searching a variety of different sources, such as drug approval status. Furthermore, information included in the portal will not be limited to research evidence – the service will also aim to provide users with access to tools (such as service models and local policies) that they can use to apply the evidence in their day-to day work.

NHS Evidence will apparently not generate new content, rather it will act as a point of access to information including coverage of:

1) Clinical Evidence, including guidelines, systematic reviews, other synthesised content and primary research and ongoing trials

2) Practical Support, including service guidance, tools and models, care pathways, indicators & metrics and improvement information, local examples and tools

3) Drug and Device Information, including prescribing and safety information, NICE technology appraisals, significant new drugs and devices, diagnostics and interventional procedures

4) Non-Clinical Information, including social care information (assured by SCIE), public health information – evidence and practical support

Well, it’s certainly not a miserly set of aspirations. One thing that worries me a bit is that the document says that “NHS Evidence will be designed to meet the needs of users from across the NHS, including (but not restricted to) clinicians, nurses, pharmacists and commissioners” (i.e. pretty much everyone) followed a couple of sentences later with the statement that “NHS Evidence has a clear scope and objective. It is important that the service does not seek to be ’everything to everyone”. Hmm.

Anyway, the briefing document, of course, does not mention libraries or librarians, apart from the fact that it’s replacing the NLH. And it’s going to be run by NICE. Does that mean that librarians have just lost all control of the NHS online information service? I don’t know – let’s see, it’ll be with us in five months or so.

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If checklists work for surgery, what else could they work for…?

In Health industry,How to work better on November 21, 2008 by Alan Lovell Tagged: , , , , ,

Not so long ago, an error in a Boston hospital led to a patient undergoing ‘wrong-side’ surgery, and the procedure was done on the wrong body part. The hospital and its CEO, Paul Levy, was admirably transparent about the whole situation, letting staff and the wider public know what had happened. As well as an investigation they also set up a “Safety Culture Operational Task Force co-chaired by a nurse, a surgeon, and an anesthesiologist, and engaging almost two dozen other people from a variety of disciplines and positions in the hospital.”

What they came up with was a checklist that all surgical teams have to go through before each surgery: “Responsibilities and the order of events is clearly laid out, even to the point of requiring that any radio in the OR is shut off during the time-out so as to avoid aural distraction. Note the forcing function at the very top of the form: No blades, needles, specula or bronchoscopes can be within reach of the surgeon until the full time-out is completed” (they have an online version to fill out too). A bunch of “secret shoppers” has also been set up to audit compliance. While I know nothing about surgery, I am a big fan of the simple process of checklists and how they can help improve even the most difficult of procedures…

Surgery checklist

Surgery checklist

… such as systematic searches. Go on, introduce one into your own working day!