MEDLINE Search Strategy Research Articles

Findings of extensive variation in the types of outcome measures used in hip and knee replacement clinical trials: A systematic review

To describe the extent of variation in outcome measure usage in hip and knee replacement randomized trial literature, and to summarize this variation in the context of the International Classification of Functioning, Disability, and Health (ICF) conceptual model created by the World Health Organization (WHO). We used a defined search strategy in Medline and EMBase databases to identify articles published from January 2000 to February 2007. Studies were reviewed if they were randomized trials with a >or=6-week followup and if they used noninvasive outcome measures of impaired joint function or whole-person limitations in daily activities or functional status. The WHO ICF model was used to categorize outcome measures. Of 972 studies, 160 were included for review. Of these, 82 were conducted on patients with hip replacements, 75 on patients with knee replacements, and 3 on patients with both. The most common outcome measure in knee trials was the American Knee Society score (used in 48% of reviewed studies), and in hip trials was the Harris hip score (52.4%). At least 20 different outcome measures were used in the hip trials, and at least 14 different measures were used in knee trials. The primary outcome was identified in only 24% of trials. We found extensive variation in outcome measures across trials and saw inconsistency across the components of the WHO ICF model. To improve interpretability, future work should determine whether consensus can be developed for a standardized set of outcome measures for hip and knee replacement trials.

Pharmacological interventions for hypertensive emergencies: a Cochrane systematic review

Hypertensive emergencies occur when high blood pressure is associated with the presence of acute end-organ damage, such as hypertensive encephalopathy. There is controversy as to when and which antihypertensive drugs to use in these situations. Using a comprehensive search strategy in electronic sources, MEDLINE, EMBASE and Cochrane clinical trial register, we conducted a systematic review to look all randomized control trials (RCTs) that compare an antihypertensive drug versus placebo, no treatment or another antihypertensive drug. Fifteen RCTs (representing 869 patients) met the inclusion criteria. Two trials included a placebo arm. All studies (except one) were open-label trials. Seven drug classes were evaluated in those trials: nitrates (nine trials), angiotensin-converting enzyme inhibitors (seven), diuretics (three), calcium channel blockers (six), alpha-1 adrenergic antagonists (four), direct vasodilators (two) and dopamine agonists (one). Mortality event data were reported in seven trials. Due to insufficient data, no meta-analysis was performed for clinical outcomes. Differences in blood pressure changes between antihypertensives were minor. There is no RCT evidence demonstrating that antihypertensive drugs reduce mortality or morbidity in patients with hypertensive emergencies. Furthermore, there is insufficient RCT evidence to determine which drug or drug class is most effective in reducing mortality and morbidity. There were some minor differences in the degree of blood pressure lowering when one class of antihypertensive drug is compared to another. However, the clinical significance is unknown. RCTs are needed to assess different drug classes to determine initial and longer-term mortality and morbidity outcomes.

Developing a Sensitive Search Strategy in MEDLINE to Retrieve Studies on Assessment of the Diagnostic Performance of Imaging Techniques

To prospectively develop a search strategy in MEDLINE for identifying studies on the diagnostic performance of any imaging modality, with maximized and minimized retrieval of relevant and irrelevant studies, respectively. Predefined inclusion criteria were used to conduct a hand search of two sets of radiologic journal articles for studies on assessment of the diagnostic performance of imaging techniques. These two sets of articles formed independent derivation and validation record sets for developing and evaluating the search strategy. The sensitivity and positive predictive values (PPVs) of search terms from the derivation reference-standard set of records were used to select terms and develop two components of the search strategy. The first component was used to identify any study (from the imaging literature) in which diagnostic test performance was assessed. The second component was used to identify studies of any imaging modality. The two components were combined in the final search strategy. The sensitivity, specificity, and PPV of the search strategy in the derivation and validation record sets were calculated. The final search strategy had a sensitivity of 92.8%, a specificity of 58.5%, and a PPV of 25.1% for retrieval of the derivation set of records. Validation with an independent set of records gave a sensitivity of 91.9% (95% confidence interval [CI]: 87.1%, 95.1%), a specificity of 52.2% (95% CI: 49.2%, 55.2%), and a PPV of 25.1% (95% CI: 22.0%, 28.5%). Removal of irrelevant publication types further improved specificity and PPV in the validation set: to 77.6% (95% CI: 75.0%, 80.0%) and 40.9% (95% CI: 36.2%, 45.7%), respectively. The volume of imaging literature retrieved from MEDLINE by using the described search strategy has tripled since 1975. A sensitive search strategy to identify studies of the diagnostic performance of any imaging test was developed and validated. The retrieval estimates of this strategy in MEDLINE are adequate to develop a register of studies.

Antiandrogens for the Treatment of Hirsutism: A Systematic Review and Metaanalyses of Randomized Controlled Trials

The relative efficacy of antiandrogens for the treatment of hirsutism remains unclear. We performed a systematic review and metaanalyses of randomized controlled trials (RCTs) evaluating the effect of antiandrogens on hirsutism. We used librarian-designed search strategies for MEDLINE, EMBASE, and Cochrane CENTRAL (up to May 2006), review of reference lists, and contact with hirsutism experts to identify eligible RCTs. Eligible studies were RCTs of at least 6 months of antiandrogen use in women with hirsutism. Reviewers, with acceptable chance-adjusted agreement (kappa = 0.72), independently assessed eligibility. Reviewers used structured forms to assess and collect methodological quality (allocation concealment, blinding, and loss to follow-up) and study data. Of 348 candidate studies, 12 were eligible (18 comparisons). Their methodological quality was low. Random-effects metaanalyses showed that compared with placebo, antiandrogens reduce Ferriman-Gallwey scores by 3.9 [95% confidence interval (CI), 2.3-5.4; inconsistency (I(2)) = 0%]. When compared with metformin, spironolactone reduced hirsutism scores by 1.3 (CI, 0.03-2.6) and flutamide by 5.0 (CI, 3.0-7.0; I(2) = 0%). For these interventions, two to five women need to receive treatment for one to notice improvement. Spironolactone or finasteride in combination with contraceptives (1.7; CI, 0.1-3.3; I(2) = 0%) or flutamide with metformin (4.6; CI, 1.3-7.9; I(2) = 40%) appear superior to monotherapy with contraceptives and metformin, respectively. Only three RCTs reported patient self-assessments of hirsutism. Weak evidence suggests antiandrogens are mildly effective agents for the treatment of hirsutism.

Toward an Update of the Atlanta Classification on Acute Pancreatitis

The 1992 Atlanta classification is a clinically based classification system that defines the severity and complications of acute pancreatitis. The purpose of this review was to assess whether the terms abandoned by the Atlanta classification are really discarded in the literature. The second objective was to review what new terms have appeared in the literature since the Atlanta symposium. We followed a Medline search strategy in review and guideline articles after the publication of the Atlanta classification. This search included the abandoned terms: "phlegmon," "infected pseudocyst," "hemorrhagic pancreatitis," and "persistent pancreatitis." A total of 239 publications were reviewed, including 10 guideline articles and 42 reviews. The abandoned terms "hemorrhagic pancreatitis" and "persistent pancreatitis" are hardly encountered, in contrast, both "infected pseudocyst" and "phlegmon" are frequently used, and several authors question their abandonment. New terminology in acute pancreatitis consists of "organized pancreatic necrosis," "necroma," "extrapancreatic necrosis," and "central gland necrosis." This review demonstrates that the Atlanta classification is still not universally accepted. Several abandoned terms are frequently used, and new terms have emerged that describe manifestations in acute pancreatitis that were not specifically addressed during the Atlanta symposium.

Cochrane review: Late erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants

Cochrane review: Late erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants

Search Strategies for Retrieving Complementary and Alternative Medicine Clinical Trials in Oncology

Several Medline search strategies exist to retrieve complementary and alternative medicine (CAM) literature related to oncology. The objective of this study was to compare different search methods to ascertain the most optimal strategy. All clinical trials with CAM interventions in patients with cancer, published from 1965 to 2004, were abstracted using 4 different approaches. In the CAM filter search, the PubMed complementary medicine filter was used. The Ovid search was performed using a complex search strategy with the Ovid search engine. CAM keyword and not phytogenic searches involved the CAM filter search with the addition of the search terms "AND (complementary OR alternative)" and "NOT (antineoplastic agents, phytogenic), respectively. Articles were evaluated by 3 reviewers to ascertain whether they were clinical trials, the study intervention was related to CAM, and the condition prevented/treated was cancer related (inclusion criteria). The CAM filter search retrieved 10 718 citations, Ovid retrieved 1190, CAM keyword retrieved 2895, and not phytogenic retrieved 1806. Compared to the CAM filter search, all other methods had significantly lower sensitivity (Ovid 48.3% +/- 3.2%, CAM keyword 5.8% +/- 1.5%, and not phytogenic 77.9% +/- 2.7%, P < .001). The specificity of Ovid (38.4% +/- 2.8%) and not phytogenic (40.8% +/- 2.3%) searches was significantly higher (P < .001) compared to CAM filter (8.8% +/- 0.5%) and CAM keyword searches (1.9% +/- 0.5%). The search strategy using PubMed's complementary medicine filter, although comprehensive, lacks specificity; other methods, although more specific, lack sensitivity. Future indexing of all CAM clinical trials with a common medical subject heading term complementary medicine would enhance efficient retrieval of relevant citations.

Errors in search strategies were identified by type and frequency

Objective Errors in the electronic search strategy of a systematic review may undermine the integrity of the evidence base used in the review. We studied the frequency and types of errors in reviews published by the Cochrane Collaboration. Study Design and Setting Data sources were MEDLINE searches from reviews in the Cochrane Library, Issue 3, 2002. To be eligible, systematic reviews must have been of randomized or quasi-randomized controlled trials, reported included and excluded studies, and used one or more sections of the Cochrane Collaboration's Highly Sensitive Search Strategy. MEDLINE search strategies not reported in enough detail to be assessed or that were duplicates of a search strategy already assessed for the study were excluded. Two librarians assessed eligibility and scored the eligible electronic search strategies for 11 possible errors. Dual review with consensus was used. Results Of 105 MEDLINE search strategies examined, 63 were assessed; 31 were excluded because they were inadequately reported, and 11 were duplicates of assessed search strategies. Most (90.5%) of the assessed search strategies contained ≥1 errors (median 2, interquartile range [IQR] 1.0–3.0). Errors that could potentially lower recall of relevant studies were found in 82.5% (median 1, IQR 1.0–2.0) and inconsequential errors (to the evidence base) were found in 60.3% (median 1, IQR 0.0–1.0) of the search strategies. The most common search errors were missed MeSH terms (44.4%), unwarranted explosion of MeSH terms (38.1%), and irrelevant MeSH or free text terms (28.6%). Missed spelling variants, combining MeSH and free text terms in the same line, and failure to tailor the search strategy for other databases occurred with equal frequency (20.6%). Logical operator error occurred in 19.0% of searches. Conclusion When the MEDLINE search strategy used in a systematic review is reported in enough detail to allow assessment, errors are commonly revealed. Additional peer review steps are needed to ensure search quality and freedom from errors.

Making PubMed Searching Simple: Learning to Retrieve Medical Literature Through Interactive Problem Solving

Searching the literature has a direct, beneficial influence on patient care. The amount of medical scientific information has increased to a great extent, while the development of networking technologies has broadened access to online databases. Successful searches depend upon understanding technical librarianship concepts and the skills for mastering searching interfaces. From a problem-oriented approach, concepts like MEDLINE coverage, PubMed resources, Boolean logic, search strategies, and Web sources for full-text articles are introduced along seven online situations: locating a specific publication, answering a complex clinical question, finding information on a general subject, finding publications by a particular author, finding publications in a particular language, finding a specific publication type, and locating the full-text document. Oncologists should face the challenge of performing their own searches. Specific knowledge is mandatory to avoid frustrating, time-consuming work. The objective of this work is to present concepts, strategies, and skills required for medical literature retrieval, easing the incorporation of new and welcomed practices.

Developing efficient search strategies to identify reports of adverse effects in medline and embase

This study aimed to assess the performance, in terms of sensitivity and precision, of different approaches to searching MEDLINE and EMBASE to identify studies of adverse effects. Five approaches to searching for adverse effects evidence were identified: approach 1, using specified adverse effects; approach 2, using subheadings/qualifiers; approach 3, using text words; approach 4, using indexing terms; approach 5, searching for specific study designs. The sensitivity and precision of these five approaches, and combinations of these approaches, were compared in a case study using a systematic review of the adverse effects of seven anti-epileptic drugs. The most sensitive search strategy in MEDLINE (97.0%) required a combination of terms for specified adverse effects, floating subheadings, and text words for 'adverse effects'. In EMBASE, a combination of terms for specified adverse effects and text words for 'adverse effects' provided the most sensitive search strategy (98.6%). Both these search strategies yielded low precision (2.8%). A highly sensitive search in either database requires a combination of approaches, and has low precision. This suggests that better reporting and indexing of adverse effects is required and that an effective generic search filter may not yet be feasible.

Pain in elderly people with severe dementia: A systematic review of behavioural pain assessment tools

BackgroundPain is a common and major problem among nursing home residents. The prevalence of pain in elderly nursing home people is 40–80%, showing that they are at great risk of experiencing pain. Since assessment of pain is an important step towards the treatment of pain, there is a need for manageable, valid and reliable tools to assess pain in elderly people with dementia.MethodsThis systematic review identifies pain assessment scales for elderly people with severe dementia and evaluates the psychometric properties and clinical utility of these instruments. Relevant publications in English, German, French or Dutch, from 1988 to 2005, were identified by means of an extensive search strategy in Medline, Psychinfo and CINAHL, supplemented by screening citations and references. Quality judgement criteria were formulated and used to evaluate the psychometric aspects of the scales.ResultsTwenty-nine publications reporting on behavioural pain assessment instruments were selected for this review. Twelve observational pain assessment scales (DOLOPLUS2; ECPA; ECS; Observational Pain Behavior Tool; CNPI; PACSLAC; PAINAD; PADE; RaPID; Abbey Pain Scale; NOPPAIN; Pain assessment scale for use with cognitively impaired adults) were identified. Findings indicate that most observational scales are under development and show moderate psychometric qualities.ConclusionBased on the psychometric qualities and criteria regarding sensitivity and clinical utility, we conclude that PACSLAC and DOLOPLUS2 are the most appropriate scales currently available. Further research should focus on improving these scales by further testing their validity, reliability and clinical utility.

Developing search strategies in Medline on the occupational origin of diseases

In order to support occupational health practitioners, researchers, and experts (clinical librarians, guideline developers) who search the scientific literature in PubMed (Medline), we developed and evaluated an easy-to-use and effective search strategy. We tested different combinations of search terms, in answering four case vignettes calculating sensitivity and precision in retrieving literature from a gold standard. The use of the Clinical Queries filter from PubMed was evaluated. Based on the outcomes, we developed guidelines for a professional search strategy, using a flow chart. For the occupational health practitioner, we found a sensitivity of at least 65% with a precision of 20%, when terms for occupation and type of industry were combined with terms for disease. For the occupational health expert, a high sensitivity of more than 90% was found adding terms for risk factors to the strategy. Combining the search terms with the sensitive Clinical Queries etiology filter in PubMed, enhanced the precision. Using the specific Clinical Queries etiology filter in PubMed results in a substantial loss of relevant articles. To search for studies on the occupational origin of diseases in Medline, we propose to start with the proper name for the occupational disease. If this does not exist, use a specific term for the occupation and type of industry in combination with terms for disease. To improve the sensitivity of the search, a search term for the specific risk factor should be added. If there is no relevant occupational title available, it is worth trying the general search terms occupational diseases or occupational risk.

Diagnosing Pneumonia by Medical History and Physical Examination

Diagnosing Pneumonia by Medical History and Physical Examination

Optimal search strategies for retrieving scientifically strong studies of treatment from Medline: analytical survey

Objective To develop and test optimal Medline search strategies for retrieving sound clinical studies on prevention or treatment of health disorders.Design Analytical survey.Data sources 161 clinical journals indexed in Medline...

Quality of Reporting of Diagnostic Accuracy Studies

To evaluate quality of reporting in diagnostic accuracy articles published in 2000 in journals with impact factor of at least 4 by using items of Standards for Reporting of Diagnostic Accuracy (STARD) statement published later in 2003. English-language articles on primary diagnostic accuracy studies in 2000 were identified with validated search strategy in MEDLINE. Articles published in journals with impact factor of 4 or higher that regularly publish articles on diagnostic accuracy were selected. Two independent reviewers evaluated quality of reporting by using STARD statement, which consists of 25 items and encourages use of a flow diagram. Total STARD score for each article was calculated by summing number of reported items. Subgroup analyses were performed for study design (case-control or cohort study) by using Student t tests for continuous outcomes and chi(2) tests for dichotomous outcomes. Included were 124 articles published in 2000 in 12 journals: 33 case-control and 91 cohort studies. Only 41% of articles (51 of 124) reported on more than 50% of STARD items, while no articles reported on more than 80%. A flow chart was presented in two articles. Assessment of reporting on individual items of STARD statement revealed wide variation, with some items described in 11% of articles and others in 92%. Mean STARD score (0-25 points available) was 11.9 (range, 3.5-19.5). Mean difference in STARD score between cohort studies and case-control studies was 1.53 (95% confidence interval: 0.24, 2.82). Quality of reporting in diagnostic accuracy articles published in 2000 is less than optimal, even in journals with high impact factor. Authors, editors, and reviewers should pay more attention to reporting by checking STARD statement items and including a flow diagram to represent study design and patient flow.

Optimal search strategies for retrieving systematic reviews from Medline: analytical survey

Objective: To develop optimal search strategies in Medline for retrieving systematic reviews.Design: Analytical survey.Data sources: 161 journals published in 2000 indexed in Medline.Main outcome measures: The sensitivity, specificity, and precision...

Use of Intravenous Immunoglobulin for Treatment of Neurological Conditions: A Systematic Review.

Purpose: Given the increasing use of intravenous immunoglobulin for various neurological conditions, its significant cost and the uncertainty pertaining to its benefits and harms, we conducted a systematic review of randomized controlled trials that compared intravenous immunoglobulin to other current therapies.Methods: A systematic search strategy of Medline (1966-June 2003) and the Cochrane Registry of Controlled Trials (June 2003 edition) was developed to identify randomised controlled trials. Two authors (BH, DF) independently reviewed all citations retrieved from the electronic search to identify all potentially relevant trials for this review. In cases where a unanimous decision could not be reached, a third party was consulted. To be eligible, studies had to be randomised controlled trials comparing intravenous immunoglobulin to either placebo or an active control and evaluating clinical outcomes. Measures of effect were calculated for each trial independently, and studies were pooled based on clinical and methodologic judgment as to its appropriateness. Fixed effects and random effects models were selected for each meta-analysis based on appraisal of the clinical homogeneity of patients across studies, as well as from testing for heterogeneity between studies. In circumstances where pooling of trials was inappropriate or not feasible, a qualitative discussion of the findings was developed.Results: Thirty-seven trials representing 14 conditions were identified. Results from meta-analysis suggest that intravenous immunoglobulin therapy is effective for the treatment of multiple sclerosis (pooled 1-year EDSS change −0.46, 95% CI [−0.92,0.01] in favor of IVIG; pooled change in annual exacerbation rate −0.82, 95% CI [−1.54, −0.11] in favor of IVIG; pooled odds of remaining exacerbation free 0.24, 95% CI [0.12, 0.50] in favor of IVIG ) and idiopathic chronic inflammatory demyelinating polyneuropathy (pooled change in disability score −0.67, 95% CI [−1.04, −0.30] in favor of IVIG; pooled odds of achieving treatment response 4.43, 95% CI [2.20, 8.91] in favor of IVIG). There was insufficient evidence to determine whether this therapy was more effective for Guillain-Barré Syndrome than plasma exchange (pooled change in disability score −0.11, 95% CI [−0.37,0.14]; pooled odds of improving by 1 or more grades on the Hughes disability scale 1.91, 95% CI [1.11, 3.28] in favor of IVIG; pooled odds of mortality 0.84, 95% CI [0.31, 2.29]). There was also insufficient evidence regarding paraprotein-associated chronic inflammatory demyelinating polyneuropathy and multifocal motor neuropathy. No evidence of benefit was observed for inclusion body myositis and myasthenia gravis. Based on evidence from lone randomised trials, there also exists evidence indicating that IVIG may be useful for treatment of dermatomyositis, stiff person syndrome and Lambert-Eaton Syndrome.

Patient selection in ambulatory anesthesia - an evidence-based review: part II.

This is the second of two reviews evaluating the management of patients with selected medical conditions undergoing ambulatory anesthesia and surgery. Conditions highlighted in this review include: diabetes mellitus; morbid obesity; the ex-premature infant; the child with an upper respiratory infection; malignant hyperthermia; and the use of monoamine oxidase inhibitors. Medline search strategies and the framework for the evaluation of clinical evidence are presented in Part I. Diabetes mellitus has not been linked with adverse events following ambulatory surgery. The morbidly obese patient is at an increased risk for minor respiratory complications in the perioperative period but these events do not increase unanticipated admissions. The ex-premature infant may be considered for ambulatory surgery if post-conceptual age is > 60 weeks and hematocrit is > 30%. The child with a recent upper respiratory tract infection is at an increased risk for perioperative respiratory complications, particularly if endotracheal intubation is required. Patients with malignant hyperthermia may undergo outpatient surgery but require four hours of postoperative temperature monitoring. Sporadic cases of drug interactions have been reported when meperidine and indirect-acting catecholamines are administered in the presence of monamine oxidase inhibitors. Ambulatory anesthesia and surgery is safe if these combinations of drugs are avoided. Ambulatory anesthesia can be performed in, and is being offered to, a variety of patients with significant coexistent disease. In many cases there is little evidence documenting the outcomes expected in such patients. Prospective observational and interventional trials are required to better define perioperative management.

A resource guide for practice development through technology

A resource guide for practice development through technology

Optimal search strategies for retrieving scientifically strong studies of diagnosis from Medline: analytical survey

Objective To develop optimal search strategies in Medline for retrieving sound clinical studies on the diagnosis of health disorders.Design Analytical survey.Setting Medline, 2000.Participants 170 journals for 2000 of which 161...