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Systematic Literature searching at NICE
Sarah Glover and Jenny Kendrick
Information Specialists
Information Services, NICE
HSLG Conference, Athlone Thursday 9th February 2012
Outline of presentation• What is NICE?
• Introduction to the Information Services Team
• Brief overview of the Interventional Procedures & the Internal Clinical Guideline programmes at NICE
• Searching for a “needle in a haystack” - the role of the Information specialist in the development of NICE Interventional Procedure guidance
• Searching for Internal Clinical guidelines (ICGs)
Who are we?• The National Institute for Health and Clinical Excellence
(NICE) is an independent NHS organisation.
• Set up 1 April 1999 to ensure everyone has equal access to medical treatments and high quality care from the NHS
• A world leader in setting standards for high quality healthcare
• The most prolific producer of clinical guidelines in the world
• We have offices in London, Manchester and more recently Liverpool
What we do • NICE is responsible for
– providing national guidance on the promotion of good health and the prevention and treatment of ill health
– setting quality standards – managing NHS Evidence
• NICE makes recommendations to the NHS on:– new and existing medicines, treatments and procedures – treatment and care for people with specific diseases and
conditions
• NICE makes recommendations to the NHS, local authorities and other organisations on:– how to improve people’s health and prevent illness and
disease.
Core principles of all NICE guidance
• Expert input• Patient and carer involvement• Based on the best evidence available• Open and transparent process• Independent advisory committees• Genuine consultation• Regular review
The Information Services team at NICE• Associate Director, 23 Information Professionals and an
Administrator
• We offer tailored information support for the different Centres and Directorates within NICE
• Provide professional expertise to enable access to
high quality information to support the development of guidance
• Function as a “matrix structure” to support this
• Offers Institute-wide corporate information services, e.g. library services, current awareness, information skills training courses
• Projects – which focus on research/service improvement ideas
Support for Centres and Directorates
• Systematic literature searching– supporting the development of Interventional Procedure
Guidelines, and Internal Clinical Guidelines.
• Information gathering and literature searching– to aid the development of :
• Technology Appraisals and Technology Appraisal Review proposal projects,
• Clinical Guideline Review proposals
• Public Health topic scopes,
• Medical Technologies and Diagnostics Appraisal briefing notes,
• Quality Standards , QOF & COF briefing notes.
Support for Centres and Directorates
• Quality assurance– quality assuring the work of external review centres which
are commissioned to review the evidence for Public Health guidance
• Support for Topic Selection– including evaluation of topic suggestions and providing
information for topic selection prioritisation.
Corporate information services
• General library services– Access to a range of bibliographic databases– Electronic helpdesk for ad hoc enquiries – Literature searching requests
• Current Awareness– 10 bulletins produced on a monthly basis covering a
range of different areas
• Information skills training– Run a number of different courses twice a year
Projects – completed/ongoing• Recording systematic database searches – is there value in
providing a narrative. Presented at EBLIP conference 2011, and published in the EBLIP journal December 2011
• CINAHL yield: searching for clinical guidelines. Collaboration with National Collaborating Centres. Presented at EBLIP conference 2011, submitted to the Journal of Clinical Epidemiology.
• Searching CDSR and CENTRAL via Wiley & Ovid. Published in HLG newsletter 2011, presenting at HLG conference in July 2012.
• Benefits of multi-file searching within Ovid.
• Value of prognostic and diagnostic filters for guideline reviews.
• Searching CRD via CRD website, Wiley and Ovid.
Any Questions so far?
Overview of the Interventional Procedures (IPs) & the
Internal Clinical Guidelines (ICGs) programmes at NICE
IPs & ICGs
• Interventional procedures– assess the safety and efficacy of (mainly) new procedures that
are used for diagnosis or treatment that involve incision, puncture, entry into a body cavity or the use of ionising, electromagnetic or acoustic energy.
• Internal Clinical Guidelines– designed to specifically address clinical questions– are recommendations on the appropriate treatment and care of
people with specific diseases and conditions within the NHS in England and Wales
– based on the best available evidence
IPs
Notified directly to NICE – usually by
clinicians
ICGsOverview prepared for IPAC
Advise NHS on new procedures
Safety and efficacy
Currently notified to NICE by the Department of Health
Scoping workshop and scope prepared for GDG
Advise the NHS on patient care
Advise the NHS on patient care
Cost and clinical effectiveness
The literature search
Similarities
Comprehensive
Quality assurance
Methods
Databases and websites
Timelines
Structured
Reproducible
Searching for a “needle in a haystack” Systematic literature searching for
Intervention Procedures
Interventional Procedures search request
– Procedure
– Brief description of the procedure
– Key words
– Key papers
– Core databases/websites to be searched
IP search request example
Endoscopic mastectomy and endoscopic wide local
excision for breast cancer
Keyhole surgery to treat breast cancer
Treatment for early breast cancer usually involves surgery to remove all or
part of the breast. In this keyhole procedure, part or all of the breast tissue is
removed using special instruments inserted through small skin incisions.
The skin envelope of the breast and nipple are left intact, ready for an
implant that can be inserted during the same operation.
So what are we looking for?
• We know that there are other mastectomy procedures available in the NHS
• But we are searching for information on this new procedure only – (Endoscopic or key hole surgery to remove all or part of the breast)
• So we are looking for a subset of results focused on this procedure only, within a vast amount of information that is already out there on other mastectomy procedures
Searching for a “needle in a haystack”
A number of sources are used to find out as much
information on the procedure as possible. These include:
Structuring the search
Traditional PICO
Patient
Intervention
Comparator
Outcome
IP PICO
Procedure
Indication
Comparator
Outcome
PICO example for Interventional Procedures
Searching for a “needle in a haystack”
• Before we being searching, we try to identify all the possible search terms that we can use in PICO
• Use a combination of Medical Subject Headings
(MeSH )and free text searching
• Use truncation to find alternative spellings and word endings
• Use Boolean to combine concepts
• Adj3 operator is often used to help focus the search
Concept 1 – Procedure
• Endoscopy/
• Endoscop*.tw
• Surgical Procedures, Minimally Invasive/
• (minimal* adj3 invasive* adj3 (surg* or procedure* or technique* or excisi*)).tw
• (Key*hole* adj3 (surg* or procedure* or technique* or excisi*)).tw
• (video* adj3 assist* adj3 (surg* or procedure* or technique*)).tw
• Transareolar*.tw
• ((Skin* or Nipple* or Areola*) adj3 Spar*).tw.
The search terms for each concept are explored in Medline
Concept 1 – ProcedureThree concept search strategy:
• Exp Mastectomy/• Mastect*.tw
• Endoscopic mastectomy is a new procedure
• There are no relevant thesaurus heading
• So we need to combine the MeSH headings and free text terms for Endoscopic AND Mastectomy in the Procedure part of the strategy in order to focus the search on this new procedure
Concept 2 – Indication
• Breast Neoplasms/
• (Breast* adj3 (Neoplasm* or Cancer* or Metastas* or Carcinoma* or Adenocarcinom* or Tumour* or Tumor* or Malignan* or Lump* or Masses* or Sarcoma*)).tw
Combining• As with usual searching OR is used to combine the
similar search terms in each concept
• AND is used to combine the Procedure and Indication terms
• Some IP’s require AND to be used within one concept usually the Procedure section.
• In this example AND is also used to combine the different Endoscopy and Mastectomy terms in concept 1 to focus the search.
Limiting search strategies• The only limit used for every IP search is to exclude Animal
studies.
• We don’t tend to use any other limits as it is better to keep the search as inclusive as possible so potential relevant references are not excluded
• If we get quite a large number of results and after discussions with the Analyst we sometimes limit strategies to:– Randomised Controlled Trials – Systematic Reviews– English Language
• Date limits are also sometimes used
Final search strategy1 Endoscopy/
2 Surgical Procedures, Minimally Invasive/
3 Endoscop*.tw.
4 (Minimall* adj3 Invasive* adj3 (Surg* or Procedure* or Technique* or excisi*)).tw.
5 (Key*hole* adj3 (Surg* or Procedure* or Technique* excisi*)).tw.
6 (Video* adj3 Assist* adj3 (Surg* or Procedure* or Technique*)).tw.
7 Transareolar*.tw.
8 ((Skin* or Nipple* or Areola*) adj3 Spar*).tw
9 or/1-8
10 exp Mastectomy/
11 Mastect*.tw.
12 or/10-11
13 exp Breast Neoplasms/
14 (Breast* adj3 (Neoplasm* or Cancer* or Metastas* or Carcinoma* or Adenocarcinom* or Tumour* or Tumor* or Malignan* or Lump* or Masses* or Sarcoma*)).tw
15 or/13-14
16 9 and 12 and 15
What happens next?• We pass all search results on to the Analysts in the IP team
• An overview is prepared, and is then discussed at the Interventional Procedures Advisory Committee (IPAC)
• NICE issues a consultation document on the safety and efficacy of the procedure
• IPAC then considers the comments from the consultation, and produces final recommendations for the procedure
• The final recommendations are then submitted to NICE for approval
• Once NICE formally approves the final guideline, consultees are notified
• NICE issues the guidance to the NHS
IPG296: Endoscopic mastectomy and endoscopic wide local excision for breast cancer
Date notified to NICE: 25 January 2008
IS searches complete: 05 August 2008
Consultation date: Winter 2008/9
Guidance issued: 22 April 2009
Any questions on Interventional Procedures?
Searching for Internal Clinical guidelines (ICGs)
Who is involved in developing guidelines?
NCC Women & Children’s
GDG
GDG
GDG
GDGGDG
GDG
NCC MentalHealth
GDG
GDG
GDG GDG
GDG
GDG
National Clinical Guidelines
Centre -Acute and
Chronic Conditions
GDG
GRP
GRP
GRP
GRP
NCC Cancer
GDG
GDG GDG
GDG
GDG
GDG
GDG
GDG
GDG
GDG
GDGGDG
GDG
GDG
GDG
GDG
Internal Clinical Guidelines
GDG
GDG
GDG
GDG
NICE Guidelines
Team
GDG
Searching for ICGs
• Referral– Topics are currently referred by the Department of Health and
are usually broad and non-specific
• Scoping searches – ISs conduct comprehensive high level scoping searches for
guidance documents, economic evaluations, and systematic reviews
– aim to identify gaps in evidence to help focus ICGs on aspects of care where current guidance is insufficient or contradictory
– helps to inform the PICO/review protocol
Example of IS role in scoping search:
CG93 Donor breast milk banks (Feb 2010)• Original DH remit
– To produce a short clinical guideline on the use of human donor breast milk in preterm babies
• However scoping search results and experts’ feedback highlighted benefits of donor breast milk for full-term as well as pre-term babies
• In addition, scoping searches and expert feedback from scoping workshop indicated that comprehensive, high quality guidance was required on delivering donor milk bank services
• As a result of these scoping activities, the remit was broadened and the title was changed to
– Donor breast milk banks: the operation of donor breast milk bank services
Developing the search
Example ICG systematic search:
CG96 Neuropathic Pain• Full title - Neuropathic pain: the pharmacological
management of neuropathic pain in adults in non-specialist settings
• 4 guideline review questions on the following pharmacological interventions:
– antidepressants– anti-epileptics– opioid analgesics– topical pain preparations
Development search example
CG96: Neuropathic pain: the pharmacologicalmanagement of neuropathic pain in adults in nonspecialist settings
P - Neuropathic painI - Pharmacological interventionsC - N/AO - N/A
Search example: CG96 Neuropathic pain
1. (neuropathic$ adj3 pain$).tw.
2. Diabetic Neuropathies/
3. (diabet$ adj3 neurop$).tw.
4. Neuralgia, Postherpetic/
5. (postherp$ adj3 neuralg$).tw.
6. Trigeminal Neuralgia/
7. (trigemin$ adj3 neuralg$).tw.
8. (central$ adj3 pain).tw.
9. etc…
10.or/1-9
11.antidepressants search terms
12.anti-epileptics search terms
13.opioid analgesics search terms
14.topical pain preparations search terms
15.or/11-14
16.10 and 15
• A total of 23,207 studies retrieved by the systematic searches
– antidepressants = 2781
– anti-epileptics = 4757
– opioid analgesics = 9612
– topical pain preparations= 6057
• A total of104 studies included in the guideline:
– 90 randomised placebo-controlled trials
– 10 head-to-head comparative trials
– 4 combination therapy trials
Search filters and limits
When required IS staff use validated search filters to limit results by study design
These filters include:
• Systematic reviews• RCTs• Economic evaluations and quality of life
• Where possible, search results are usually limited by English language and human studies
What happens next?• We pass all search results on to the Analysts in the ICG team
• The evidence is presented at the Guideline Development Group meetings (GDGs) and the group make recommendations based on the evidence and its quality
• NICE issues a draft version of the guideline for consultation on the website for stakeholders to comment on
• The GDG then considers the comments from the consultation, and produces final recommendations
• The final recommendations are then submitted to NICE for approval
• Once NICE formally approves the final guideline, consultees are notified
• NICE issues the guidance to the NHS
CG 96 Neuropathic pain (March 2010)
Referred by DH 19th wave
August 2008: Scoping
Searches conducted October
2008
Development phase Feb-Oct
2009: Development literature
searches completed April 2009
Guideline published: March
2010
Published NICE Internal Clinical GuidelinesCG96 Neuropathic
pain
CG125 Peritoneal dialysis
CG135 Organ donation
CG86 Coeliac disease
CG69 Antibiotics for respiratory tract infection
CG117 Tuberculosis (update)
CG93 Donor breast milk
CG50 Acutely ill patients in hospital
CG64 Antimicrobial prophylaxis for infective endocarditis
CG130 Hyperglycaemia
CG83 Rehab after critical illness
CG105 Motor neurone disease
CG134 Anaphylaxis
CG106 Barrett's oesophagus
CG116 Food allergy in children
CG118 Colonoscopic surveillance CG119 Diabetic
foot care
CG60 Surgical Mgt of OME
In-development NICE Internal Clinical Guidelines
Dyspepsia (update)
Falls in a care setting (update)Hyperphosphataemia
Neuropathic pain in adults (update)
Sickle Cell Crisis
Type 2 Diabetes (update)
To summarise...
• Overview of NICE and Information Services team
• Similarities between searching for both IP and ICG guidance
• Searching for a “needle in a haystack”, the process involved in searching for Interventional Procedure Guidance
• Role of the Information Specialist in the development of Internal Clinical Guidelines
Thank You
Any Questions?
Contact details:
