Clinical Paper Appraisal

• Evidence-based practice

  Finding the right information in the most efficient manner is key to success
• Well conducted literature search

  • Important to identify all relevant research that has been carried out on a particular question
  • Thorough search to identify relevant studies is a key factor in minimising bias in the review process
• Balance sensitivity with precision

  In searching to minimize bias
• Publication bias

  Positive results are more likely to be published
• Language bias

  Positive results are more likely to be published in English language publications
• Systematic search

  • Transparent reporting of the search process (reproducible)
  • Where to search - How to search
  • Adequately comprehensive - depend on research/clinical question or topic, time frame of the work & resources available
• Steps in systematic research

  1. Formulate search/clinical question

  2. Choose relevant databases/sources for the research question

  3. Develop individual search strategies for the selected sources

  4. Review search results and possibly revise the search strategy

  5. Document and report search process
• Focused question

  Helps determine appropriate keywords and limitations for your topic
• PICO model

  • P - Who is the patient or what problem is being addressed
  • I - What is the intervention or exposure?
  • C - What is the comparison group?
  • O - What is the outcome or endpoint?
• Example PICO question

  • Is Bevacizumab effective compared to Ranizumab in the treatment of Age Related Macular Degeneration
• Additional elements of well-built clinical question

  • Type of question
  • Type of study
• Developing search strategy - Search terms

  • Identify key concepts in topic
  • Find synonym terms to describe these key concepts
  • Use text words & subject headings in search
  • Where to find search terms: Colleagues & experts, Journal articles or books, Scope notes of database subject headings, Dictionaries
• Text words

  Words in title and/or abstract
• Subject headings

  Standardised subject terms assigned by indexers that describe the content of a document
• Developing search strategy - Search techniques

  • Truncation/wildcards
  • Phrase searching
  • Boolean operators
  • Proximity operators
• Truncation/wildcards

  Used to search for variant forms of words
• Phrase searching

  Placing entire phrase in quotation marks
• Boolean operators

  Method for combining search terms: AND, OR, NOT
• Proximity operators

  • ADJ = two search terms next to each other, in the given order
  • ADJ1 = two search terms next to each other in any order
  • ADJ2 = two search terms within one word from each other, in any order
• Where to search

  • Avoid duplication of work; identify relevant systematic reviews or HTAs
  • Sources: Cochrane Database of Systematic Review, Database of Abstracts of Reviews of Effects (DARE), NHS Evidence, Canadian Agency for Drugs and Technologies in Health (CADTH)
  • General health related databases: PubMED/MEDLINE, EMBASE
  • Subject specific databases: MANTIS, AMED, The PILOTS
• Review search

  1. How many 'hits' obtained?

  2. If too wide --> focus the search

  3. If too narrow --> expand the search
• Review titles & abstracts

  1. Vet titles listed to see relevance

  2. Select relevant titles (no bias)

  3. Obtain their related abstracts

  4. Read abstract

  5. Retrieve full articles of relevant abstract
• Key messages

  • Effective searching requires training & practice
  • Each database/platform may be different
  • Planning is key (be as precise as possible)
  • Balance sensitivity with precision
  • Record what has been done