Embase search with PICO

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  • Systematic

    searching in

    Embase: Using

    PICO to identify

    relevant results

    Dr. Ivan Krsti Product Development Manager Embase

    18. XI 2015

  • 2

    In this webinar, we will discuss

    - Concepts that form the basis of a PICO search strategy

    - How to use information in Emtree to build effective searches

    - The best levels of evidence to include in systematic reviews

    - How upcoming Embase enhancements will make searching using

    PICO even easier

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    Why is Evidence-Based Medicine Important?

    EBM solutions have the potential to accelerate and improve clinical decision

    making and patient outcomes.

    To improve clinical efficiency/effectiveness

    To apply proven practices in medicine

    To standardize practices

    To reduce unnecessary care/costs

    "Evidence-based medicine is the thorough, explicit and cautious use of current

    best evidence in making decisions about the care of individual patients."

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    EBM is a Life-Long, Problem-Based Learning Process

    that Involves:

    1. Clearly defining a clinically relevant question

    2. Finding the best evidence

    3. Critically appraising the evidence

    4. Integrating the answer with clinical expertise and apply

    5. Evaluating the treatment

    Were doing our best every single day to connect the very latest research to clinical

    care so that our patients can benefit as much as possible. We use practice-based

    evidence to achieve the very best outcomes for our patients

    Steven E. Lipshultz, M.D., pediatrician-in-chief at the Childrens Hospital of Michigan and chair of Pediatrics for the Wayne State University School of Medicine

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    EBM is on the Rise

    By the year 2020, 90% of clinical decisions will be supported by accurate,

    timely, and current clinical information, and will reflect the best available


    Charter of the Institute of Medicine (IOM) Roundtable on Value & Science-Driven Health Care

    Physicians to guide treatment decisions

    Heathcare providers (insurers) to guide reimbursement policies

    Governments to set guidelines and policy

    Who uses EBM?

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    Finding the Best Evidence

    What are Systematic Reviews?

    High-level overviews of

    primary research on a

    particular research

    question that tries to

    identify, select, synthesize

    and appraise all high-

    quality research evidence

    relevant to that question in

    order to answer it.

    The systematic review provides a verdict on unsettled medical debates based on a painstaking

    reassessment of all the relevant researchthe impact can be enormous. Official guidelines and best

    practices are established or changed after systematic reviews. Legal standards defining malpractice

    may be set; insurers may decide which treatments to pay for and which to decline.

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    Systematic reviews sum up the best available research on a specific question. This

    is done by synthesizing the results of several studies.

    A systematic review uses transparent procedures (defined in advance) to find,

    evaluate and synthesize the results of relevant research. This practice is also

    designed to minimize bias.

    Peer review is a key part of the process; qualified independent researchers control

    the author's methods and results.

    A systematic review must have:

    Clear inclusion/ exclusion criteria

    An explicit search strategy

    Analysis of included studies

    Meta-analysis (where possible)

    What is a systematic review?

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    Preparing a Systematic Review

    The Cochrane Handbook outlines eight general steps for preparing a

    systematic review:

    1. Defining the review question(s) and developing criteria for including


    2. Searching for studies

    3. Selecting studies and collecting data

    4. Assessing risk of bias in included studies

    5. Analyzing data and undertaking meta-analyses

    6. Addressing reporting biases

    7. Presenting results and "summary of findings" tables

    8. Interpreting results and drawing conclusions

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    Using the PICO Framework to Structure a Question

    P = Patient

    I = Intervention

    C = Comparison/control

    O = Outcome

    PICO is a method used to structure the elements (concepts) of the review question

    into a search strategy and process.

    On the next few slides, well look at PICO to answer:

    What are the best empirical antibiotic treatment options for bacterial meningitis?

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    P (Patient, Problem or Population)

    A generic formula for this search strategy is:

    1. Disease Emtree preferred term

    name of the disease/de

    2. Disease term as free text search (Titles and Abstracts)

    name of the disease OR synonyms for the disease

    3. #1 OR #2


    'bacterial meningitis'/de OR

    'bacterial meningitis' OR 'e. coli meningitis' OR 'escherichia coli meningitis' OR

    'meningitis purulenta' OR 'purulent meningitis' OR 'pyogenic meningitis'

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    I (Intervention)

    A generic formula for this search strategy is:

    1. Drug Emtree preferred term

    name of the drug/de

    2. Drug term as free text search

    name of the drug OR synonyms for the drug

    3. Include the Drug trade name (:tn) field, when appropriate

    3. Drug CAS registry number Field search

    CAS number:rn

    4. #1 OR #2 OR #3


    'antibiotic agent'/exp OR antibiotic*

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    C (Comparison or Control)

    The aspects of this concept may include absence of risk or treatment,

    placebo or alternative therapy. This component may not apply to all

    review questions.

    It does not apply in our example: What are the best empirical antibiotic treatment options for bacterial


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    O (Outcome)

    The aspects of this concept may include risk, mortality, morbidity,

    quality of life and utilities.

    Sometimes this component is not searchable and/or it is advisable to

    ignore it in the search process.

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    Logical Operators

    Use the Boolean OR operator to search the relationship within each

    individual concept.

    The formula for using AND Boolean logical operators to search the

    relationship between the concepts is:








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    Poll When you build systematic reviews do you:

    Create long multi-line queries

    Create short one-line queries and combine

    I don't do Systematic Reviews

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    Conduct a Scoping Search (to start)

    Used to give an overview of previous work and to identify a Cochrane

    review or systematic review in particular

    Can be conducted quite quickly

    Can be based on a simple search strategy

    Limit topic search to Cochrane Review and/or Systematic Review

    Note Available on the Advanced, Drug and Disease search forms

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    Using Previous Work

    If a Cochrane review or

    systematic review is found, look

    for a search strategy published

    in the review.

    When a search strategy is


    Assess its relevance for


    Translate search syntax,

    when necessary

    Consider indexed terms

    (subject headings) and free-

    text terms used

    Convert subject terms, where


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    Hints and Tips for Searching

    Always start with Emtree to identify a preferred term (subject

    heading) for searching, when available

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    Reviewing an Emtree Record

    Take note of any Synonyms


    Read the entry provided from

    Dorlands dictionary

    e.g. Population:

    'bacterial meningitis'/de OR 'bacterial

    meningitis' OR 'e. coli meningitis' OR

    'escherichia coli meningitis' OR 'meningitis

    purulenta' OR 'purulent meningitis' OR

    'pyogenic meningitis'

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    Hints and Tips for Searching

    When performing an abstract and title search for any synonyms listed

    in an Emtree record, consider using truncation or wildcard characters

    (*, ?) as needed (e.g. antibiotic*)

    When conducting a search of Article title and Abstract for author free-

    text expressions consider using proximity operators (NEXT, NEAR)

    as appropriate (e.g. meningitis NEAR/2 purulent*)

    When performing free-text searches, remember to consider variant

    spellings including British and American spellings and terminology

    e.g., tumor vs tumour; diaper vs nappy; pediatric vs paediatric;

    otorhinolaryngology vs ear, nose and throat; overuse injury vs repetitive

    strain injury

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    The most common type of search filter is for specific study designs

    Other limits applied may include language, human or animal studies,

    sex and age, publication type, year(s) of publication

    When using date limits, remember also to add search strings for articles in press

    and records in process

    Some articles in press do not have publication dates and will be lost if not search

    for specifically!

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    Study Type Filters / Hedges

    Common study design filters for systematic reviews inc