Systematic Review Processes, Teams,& Experiences

Methods: Searching & Systematic Reviews Mark MacEachern & PF Anderson; October 31, 2017

For Dentistry 610; University of Michigan

Introduction

Objectives

◻ Understand the importance of literature searches

◻ Learn how to construct effective searches for clinical

and research projects

◻ Learn reporting and citation management strategies

and resources

Why is it important to search well?

◻ Support evidence-based decision-making◻ Avoid biases in research projects and clinical decisions◻ Missed studies can undermine clinical decisions and

research findings◻ Save yourself time by leveraging resource features◻ Keep current on new trends, developments

Evidence Pyramid

Source: Sackett DL. Evidence-based medicine: how to practice and teach EBM.

Search Construction

What to expect?

◻ Expect the search to be iterative

◻ Expect 1000s of results

◻ Expect to search multiple databases

◻ EMBASE, PubMed, ERIC, PsycINFO, etc.

◻ Expect the search process to take awhile

◻ Expect to publish search strategy and search methodology

◻ Expect to consult someone with appropriate search expertise

Search construction

1. Identify search terms

2. Use Boolean

3. Use combination of keywords and controlled terms

4. Supplemental strategies

1. Identifying search terms Question/hypothesis:

◻ Real time ultrasonography and in implant and oral surgery

What are the major concepts?

◻ Ultrasonography (ultrasound, ultrasonic imaging, echography, etc.)◻ Dental implants (types of implants, implant names, etc.)◻ Oral surgery (surgery, surgeries, surgical, specific procedures

and types of surgery, etc.)

2. Boolean

2. Boolean Concept 1

Ultrasonography

OR

Ultrasound

OR

Echography

Concept 2

Dental implants

OR

Tooth implants

OR

Dental implantation

2. Boolean Concept 1

Ultrasonography

OR

Ultrasound

OR

Echography

Concept 2

Dental implants

OR

Tooth implants

OR

Dental implantation

(ultrasonography or ultrasound or echography) AND (dental implants or dental implant or tooth

implant or dental implantation)

2. Boolean (What a final search can look like)

3. Keywords vs controlled vocabulary Keywords

Controlled vocabulary

3. Keywords vs controlled vocabulary Keywords

Controlled vocabulary

What are they?

◻ Literal search

◻ Looks for occurrences of words

When to use?

◻ Always

◻ Current topics

◻ No vocabulary exists in database

Examples

◻ Google, PubMed

3. Keywords vs controlled vocabulary Keywords

Controlled vocabulary

What are they?

◻ Set of words or phrases used to describe concepts

◻ Dictionary of accepted terms for a database

When to use?

◻ Searching a database that has one

Examples

◻ MeSH (Medical Subject Headings)

◻ EMTREE (Embase)

3. Keywords vs controlled vocabulary Keywords

Controlled vocabulary

4. Supplemental strategies ◻ Examine the references of key studies and reviews◻ Examine studies that have cited your key studies (Web of Science,

Google Scholar)◻ Contact authors, companies, orgs, societies, etc. ◻ Note journals that frequently publish relevant articles◻ Search for ongoing trials (Clinicaltrials.gov)◻ Search conference proceedings, abstracts (Scopus, Web of Science,

Embase)

MeSH & MeSH Database

Finding MeSH Method Example

MeSH Database

Individual Article

Search Builder

Finding MeSH Method Example

MeSH Database

Individual Article

Search Builder

Finding MeSH Method Example

MeSH Database https://www.ncbi.nlm.nih.gov/pubmed/17936128

Individual Article

Search Builder

Finding MeSH Method Example

MeSH Database

Individual Article

Search Builder

Activity: MeSH

Team A vs. Team B: Searching Articaine+

TEAM A:

Enter terms found into your team’s Google Doc: http://bit.ly/Dent610TeamA

Search MeSH database for:

● Most important term● MeSH headings ● Related terms● MeSH Tree Structure:

○ Go up a level○ Go down a level

TEAM B:

Enter terms found into your team’s Google Doc: http://bit.ly/Dent610TeamB

Search for freetext keywords:

● Brainstorming● Textbooks or articles● Search Google or similar ● Search Google Scholar

Team A vs. Team B: Searching Articaine+ — FLIP!

TEAM B:

Enter terms found into your team’s Google Doc: http://bit.ly/Dent610TeamB

Search MeSH database for:

● Most important term● MeSH headings ● Related terms● MeSH Tree Structure:

○ Go up a level○ Go down a level

TEAM A:

Enter terms found into your team’s Google Doc: http://bit.ly/Dent610TeamA

Search for freetext keywords:

● Brainstorming● Textbooks or articles● Search Google or similar ● Search Google Scholar

Debrief

1. How is what your team found similar or different from what the other team found? Why do you think that is?

2. Which would you rather do first: Keyword searching, or MeSH term searching? Why?

3. Do you think you need lots of terms for EVERY topic you research? Why or why not?

Want to know what they did in the original?

Brandt RG, Anderson PF, McDonald NJ, Sohn W, Peters MC.

The pulpal anesthetic efficacy of articaine versus lidocaine in dentistry: a meta-analysis.

J Am Dent Assoc. 2011 May;142(5):493-504.

Sentinel Articles (vs. Seminal)

What is a Seminal Article?

Highly significant

Influential

Important

By a leader in defining the research in the field

“Key studies”

What is a Sentinel Article? (VALIDATION)

● Remember – purpose is for validating search, NOT proving you know the best articles on the topic (that would be seminal articles)

● On topic, not broader or narrower● Well-indexed with appropriate terms● Representative of citations that would be retrieved by a

well-done search● Each sentinel article must represent ALL desired concepts

in the search● Articles selected must meet ALL inclusion and exclusion

criteria.

Choosing Sentinel Articles

How many articles? 3-5. No more than ten.

Verify appropriateness of selected sentinels.

Neither very recent (current year) or old (before 1985)

● Articles old enough to have MeSH assigned. ● New enough to have complete indexing

MeSH Tips (What to do if there is NO HEADING)Earlier term mappings prior to assignment of a MeSH term are often:

● presenting symptom or diagnosis● anatomical area

TMJD Example:

TMJD = temporomandibular joint disorder

= (Temporomandibular joint [anatomical area] + ("myofacial pain" OR "Bone Diseases") [presenting symptom OR diagnosis]

Image: Frank Gaillard. Normal anatomy of the Temporomandibular joint. 14 Jan 2009. http://commons.wikimedia.org/wiki/File:Temporomandibular_joint.png

MeSH & Sentinels

Verify sentinel citations in MEDLINE

Save file with full citations (abstract, MeSH headings, everything)

Make duplicate file to process

Analyse MeSH Terms

● retain topical terms● retain methodology terms● retain non-MeSH terms

such as publication type and registry numbers (but separate from core concept terms)

Activity: Terms

Extra Ideas for Finding Terms

⃞ Plural forms⃞ Alternate and variant terms mentioned in MeSH Browser⃞ Abstract & title mining for equivalent terms ⃞ Other forms of main term (eg. Diabetes and diabetic)⃞ British and American spellings (eg. Hematology and haematology)⃞ Concepts of which this is a part⃞ Concepts which create this concept when combined

Extra Ideas for Finding Terms⃞ If clinical: Anatomical site (or region) + presenting symptom (eg: TMJD = Temporomandibular joint + Myofascial pain)⃞ If clinical: Anatomical site (or region) + disease category (eg: TMJD = Temporomandibular joint + Bone diseases)⃞ If clinical: Diagnostic criteria (eg. Diabetes and fasting plasma glucose or oral glucose tolerance test) ⃞ If clinical: Disease precursors, related conditions, or sequelae (eg: Dental caries and tooth demineralization.)

Extra Ideas for Finding Terms

⃞ If treatment: Anatomical site or system + specific modality⃞ If pharmaceutical or chemical: chemical formula/symbols, registry numbers⃞ If microorganisms: historical names, taxonomic groups ⃞ If materials: relevant ISO/ANSI standards and product identification numbers

What Do You Think?

1. Did you find anything different from the first time?

2. Was it useful or not? How do you know?

3. Do you have ideas for other ways you might find terms?

Process, Methods, Teams

Example Process

Team meets: Define topic, overview literature base, suggest inclusion/exclusion criteria, discuss methodology & timeline.

Librarian: Generates data for the team; FRIAR/MEMORABLE/SECT

Topic experts: Review data at 3-4 levels (title, abstract, article, [request additional information]), achieve consensus

Handsearching (librarian generates list, experts implement)

Determine level of evidence for remaining research

Generate review tables

Share findings (Publication)

Strength of evidence available (strong, weak, inadequate); suggest directions for future research to fill gaps in research base

Example: Cochrane Review Teams

Clinical expert(s) [2+]: Initiates, defines, selects topic. Partner and collaborate in review to prevent bias.

Statistician: Provides methodological oversight, ensures process quality for entire project.

Librarian: Provides methodological oversight, ensues process quality for information search process.

Healthcare Consumer: Provides insight into the priorities for research, information conduit for relating priorities and findings between consumers and clinicians.

Expectations of the Librarian Role

● Search strategy○ Background research of already published similar search strategies, systematic

reviews on related topics○ Suggest appropriate terms & concepts for review by clinical experts ○ Sensitivity / specificity ○ Validated, revised, adhering to standards / guidelines / best practices○ Publication-ready copy of strategy○ Variant strategies for other databases

● Data set○ In appropriate format

● Data set management support● Methodology oversight● Write / revise methodology & results as appropriate● Assure replicability of methods

Standard Team Process vs. Reality

Most common?

Underestimating time/labor requirements

First time findings: "insufficient evidence"

Build-A-Search

FRIAR/SECT

F – Frame

R - Rank by Relevance

I - Irrelevant Search Concepts

A - Alternates/Aliases (Term Generation)

R - Review, Revise, Repeat

MEMORABLE, A Medline Search Strategy Development Tool

Data Extraction

Cochrane Data Extraction

Evidence Table Example

● Levels of evidence● Participant

characteristics● Study

characteristics● Intervention and

outcome measurements

● Results● Study limitations● Inclusion/Exclusion

criteria

http://www.aota.org/DocumentVault/AJOT/Template.aspx?FT=.pdf

Data abstraction / extraction samplesCochrane:

● Forms: http://endoc.cochrane.org/data-extraction-sheets

● Elements: http://www.cochrane.org/handbook/table-73a-checklist-items-consider-data-collection-or-data-extraction

● Cochrane CFGD November 2004 * (DOC): http://cfgd.cochrane.org/sites/cfgd.cochrane.org/files/uploads/Study%20selection%20and%20%20extraction%20form.doc

More Cochrane:

● Data Extraction Template, 2011 (XLS): http://www.latrobe.edu.au/chcp/assets/downloads/DET_2011.xls

● Overview: http://www.cochrane-pro-mg.org/Documents/Reviewsheet-1-4-08.pdf

Other:

● CDC Data Abstraction Form: http://www.nccmt.ca/uploads/registry/CDC%20Tool.pdf

● Social science example (suicide) http://www.cmaj.ca/content/suppl/2009/01/29/180.3.291.DC2/ssri-barbui-3-at.pdf

Other Resources

Other sources

Core Secondary Others

● Medline● Embase● Cochrane Central

Register of Controlled Trials

● CINAHL● Dentistry & Oral

Sciences Source● Scopus● Web of Science● Google Scholar● ClinicalTrials.gov

● PsycINFO● Sociological Abstracts● ERIC● ABI Inform

• Cochrane Handbook (10.3.1)

– Search multiple sources

– Search unpublished studies

– Search trial registries

Links to resources

◻ PubMed (http://www.lib.umich.edu/database/link/9817)

◻ Google Scholar (http://www.lib.umich.edu/database/link/9825)

◻ EMBASE (http://www.lib.umich.edu/database/link/9173)

◻ ERIC (http://www.lib.umich.edu/database/link/10069)

◻ Web of Science (http://www.lib.umich.edu/database/link/29137)

◻ CINAHL (http://www.lib.umich.edu/database/link/28883)

◻ PsycINFO (http://www.lib.umich.edu/database/link/8375)

◻ Clinical Key (http://www.lib.umich.edu/database/link/29221)

Documenting / Reporting

Reporting

Guidelines and standards

PRISMACochrane HandbookNational Academies of the Sciences

Reporting - PRISMA

Reporting - Cochrane Handbook

◻ See Cochrane Handbook

■ http://handbook-5-1.cochrane.org/

■ Section 6.6

◻ “It should be borne in mind at the outset that the full search strategies for each database will need to be included in an Appendix of the review.”

Reporting - Cochrane Handbook

◻ See Cochrane Handbook

■ http://handbook-5-1.cochrane.org/

■ Section 6.6

◻ In abstract:

■ List all databases searched.

■ Note the dates of the last search for each database or the period searched.

■ Note any language or publication status restrictions

■ List individuals or organizations contacted.

Reporting - Cochrane Handbook

◻ See Cochrane Handbook

■ http://handbook-5-1.cochrane.org/

■ Section 6.6

◻ In methods:

■ List all databases searched.

■ Note the dates of the last search for each database AND the period searched.

■ Note any language or publication status restrictions

■ List grey literature sources.

■ List individuals or organizations contacted.

Reporting - Cochrane Handbook

◻ See Cochrane Handbook

■ http://handbook-5-1.cochrane.org/

■ Section 6.6

◻ In study flow diagram:

■ number of unique records identified by the searches;

■ number of records excluded after preliminary screening (e.g. of titles and abstracts); and

■ number of records retrieved in full text

Reporting - Cochrane Handbook

PRISMA Checklist http://prisma-statement.org/documents/PRISMA%202009%20checklist.pdf

Systematic Review Search Strategy ExampleTorabinejad M, Anderson P, Bader J, Brown LJ, Chen LH, Goodacre CJ, Kattadiyil MT, Kutsenko D, Lozada J, Patel R, Petersen F, Puterman I, White SN. Outcomes of root canal treatment and restoration, implant-supported single crowns, fixed partial dentures, and extraction without replacement: a systematic review. J Prosthet Dent. 2007 Oct;98(4):285-311. PMID: 17936128

FAQ - Find Full-Text

FAQ - Save searches

◻ PubMed emails you new citations as they enter the database

◻ Click ‘Create alert’

◻ Use cases:

■ Table of contents

■ Research and clinical topic of interest

■ Keep track of colleague papers

Slides at: http://slideshare.net/umhealthscienceslibraries/

Session guide: http://guides.lib.umich.edu/dent610

Contact:

Mark MacEachern: markmac@umich.edu

Patricia F. Anderson: pfa@umich.edu

Tyler Nix: tnix@umich.edu