rapid searching - knowledge.scot.nhs.uk · searching/review –standardisation may not be...
TRANSCRIPT
RAPID SEARCHING Prepared by: Jenny Harbour and Suzanne Wilson
WEBEX GOOD PRACTISE
• Webex interface:
• If you have a question use the chat box or the “raise
hand” button
• If you’re having technical difficulties message the
host via the Webex chat function
• Tele-conference:
• Remember to introduce yourself before speaking
• Remember to speak into the telephone speaker
• Don’t have side conversations with colleagues
• Mute your phone if you are in a noisy environment
• Search and synthesis
element of Knowledge Into
Action programme
• Need to develop skills within
K&IS to support search and
synthesis
• Expressed desire for rapid
searching support/training
• Part of an ongoing
programme of seminars to
support K2A implementation
KNOWLEDGE INTO ACTION
• What are rapid reviews?
• Rapid searching: the literature base
• Survey of rapid review bodies
• IHE rapid searching
• The CADTH method
• Just In Time study
• Knowledge into Action: rapid searching tests of change
• Rapid searching at Healthcare Improvement Scotland
• Resources to support rapid searching
• References and resources
OUTLINE
“A literature review carried out (often systematically) but within a limited time (sometimes weeks or a couple of months) and with restrictions on the scope of the search (for example, restricted by year, or country).” Evidence Database on Age Caring. Glossary of Terms. Available from: http://www.searchedac.org/glossary.php?q=R
“Rapid reviews are literature reviews that use methods to
accelerate or streamline traditional systematic review
processes.”
Gannan R, Ciliska D, Thomas H. Expediting systematic reviews: methods and implications of rapid
reviews. Implementation Science. 2010;5:56. Available from:
http://www.implementationscience.com/content/5/1/56
DEFINITIONS
• General agreement on three features of rapid reviews:
– Audience
– Timescale
– Involves some form of methodological shortcut
• No standardised method for rapid searching/review
– Standardisation may not be appropriate
– Course designed to give overview of methods
RAPID REVIEWS
“Target audiences for
rapid reviews include
government
policymakers, healthcare
institutions, health
professionals, and
patient associations to
inform health system
planning and policy
development” (Gannan
et al. 2010)
RAPID SEARCHING: THE LITERATURE BASE
• Limited literature on methods
• Lack of transparency in reporting
• Generalisability of conclusions
• Variety of rapid review methods:
– Coverage limits
– Fewer details
– No grey literature
– No quality assessment
– Search limits
SURVEY OF RAPID REVIEW BODIES: METHOD
• Institute of Health Economics (Canada)
• 2011
• Online survey via mailing list
• International HTA bodies
• Identify trends in RR methods
• Definition of rapid HTA:
“An HTA report where methodological compromises are
made in order to meet shorter timelines”
• 16 respondents
• Geographical spread: Canada,
England, Scotland, Germany,
Sweden, Norway, Netherlands,
Malaysia, Spain, Argentina,
Poland
• 13 producing rapid reviews
(+/- HTA)
• 32 rapid review products
• Timescales 1 day to 9 months
SURVEY OF RAPID REVIEW BODIES: RESULTS
SURVEY OF RAPID REVIEW BODIES: LIMITS
• 83% limited number of databases searched for RR
• 100% included some grey literature searching
– 75% reduced number of grey literature sources
– 97% searched other HTA body websites
• 64% used a pre-existing strategy
• 58% created more precise strategy
• 42% used a more specific filter
RAPID REVIEW AT IHE
• Institute of Health Economics, Canada
• 4 types of rapid review product
• Methods linked to timescale
• Checklist of databases and grey literature
• Strategies to limit the literature:
– Use existing search strategies
– Title searching
– Restricted date, publication type, language
– Geographical limit (Canada)
THE CADTH METHOD
• Canadian Agency for Drugs and Technologies in Health
Report Type Description Turnaround Time
Reference list List with abstracts and links to fulltext 5-10 days
Summary of abstracts Summary based on abstracts and including links
15 days
Summary with critical appraisal
Summary of evidence, with critical appraisal and policy implications
30 days
Peer-reviewed summary with critical appraisal
Summary with critical appraisal (as above) plus external peer review by clinical expert
4 months
SR and meta-analysis Basic HTA report with more refined questions and limited scope
5-6 months
THE CADTH METHOD
• Process driven limits:
– Firm deadlines
– Focused questions (negotiated with customer)
– Guidelines for max. number of results per product
– Guidelines for max. number articles ordered per product
– Shortened grey literature checklist (still 30 compulsory!)
– Simultaneous website searching
– Peer review of strategies not always required
THE CADTH METHOD
• Search strategy limits:
– Filters to limit by study design e.g. RCT
– CADTH strategy archive for reference and re-use
– FluffFilter®
– Database selection
– Limits e.g. language, publication date, human
– Avoid using broad subject headings or keywords
– Add additional concepts e.g. outcomes, care setting
– Focused subject headings*
– Title only for some keywords*
– Frequency of terms in abstract*
• RCT in primary care (librarian versus no librarian to respond to clinicians questions)
• 1,889 questions asked by 88 participants during 6 months
• Average time for librarian to respond = 13.68 minutes
• Average time for participants to respond = 20.29 minutes
• Without the service 40% of participants questions went unanswered
• Less costly for librarians to locate relevant information than primary care clinicians
• 62.9% of clinicians reported highly positive impact on decision making
• Time spent by participants responding to own questions was not productive or effective for decision making
JUST-IN-TIME STUDY- MCGOWAN
JUST-IN-TIME - PROCESS
Question received
Categorise question Search
Appraisal Summarize
Send Tag & document
THERAPY
Cochrane
Clinical evidence
TRIP
DIAGNOSIS
Guidelines
Harrison’s online
TRIP
PROGNOSIS
EB Journals
TRIP
PREVENTION
Cochrane
Guidelines
TRIP
Clinical evidence
ETIOLOGY/ RISK
TRIP
Harrison’s online
OTHER
ATTRACT
TRIP
Medline
JUST-IN-TIME - RESOURCES
• NHS Greater Glasgow & Clyde rapid search & synthesis for
patient specific clinical enquiries developed specifically for ICU
(part of wider literature search service)
• Turnaround within 48 hours, most request less than 4 hours,
average time taken is 1.5 hours (across 80 searches)
• Simple form to capture questions (suitable for use at bedside)
• Pre-defined search protocol – tested and updated frequently
• Search until find answer. If no answer found, report that and
option to refer to another service
Documentation available at:
http://www.knowledge.scot.nhs.uk/together/knowledge-into-
action/search-and-synthesis.aspx
KNOWLEDGE INTO ACTION EXAMPLES (1):
• CLEAR: clinical enquiry and answer service
– 24 hour, 3 day and 5 day turnaround
– Structured, staged protocol based on 4S system of evidence: search guidelines, summaries, reviews, studies
– Stop when the answer is found
– Provide short summary of recommendations and key references used to answer question with links to full text where available, or abstracts for primary studies
– QA process for search and digest to ensure consistency and clarity
Method available at: http://www.knowledge.scot.nhs.uk/clear/about-us.aspx
KNOWLEDGE INTO ACTION EXAMPLES (2):
RAPID SEARCHING AT HEALTHCARE
IMPROVEMENT SCOTLAND
• Rapid review products:
– Scoping Reports
– Evidence Notes
• 3 month timescale
• Focus on Scottish context
• Checklist of grey literature and databases
• Limited to English language, secondary literature, and publication date
• Ongoing research and conference proceedings optional
Scottish context
Reviews, HTAs &
guidelines
Databases
Other e.g. economics,
EQIA, ongoing research
RAPID SEARCHING AT HEALTHCARE
IMPROVEMENT SCOTLAND
• Scottish context:
– Scottish Government
publications
– SHOW
– Chief Scientists Office
– HSRU (Aberdeen)
– National Procurement
– ISD
• If relevant:
– Health Scotland
– Health Protection
Scotland
– Health Facilities
Scotland
– SMC
SCOTTISH CONTEXT
• Guidelines:
– SIGN
– NICE
– Guidelines
International Network
– NHS evidence
• Other secondary evidence:
– HTA bodies e.g. NHS HTA
programme, CADTH
– Cochrane Library (Cochrane,
DARE & HTA)
– Pubmed clinical queries
– Subscription resources e.g. ECRI
– Joanna Briggs
– Dynamed
– TRIP database
– Commissioning body summaries
REVIEWS, HTAS AND GUIDELINES
• Medline
• Medline in Process
• Embase
• Cinahl (or other topic related
database e.g. Psychinfo)
• Web of Knowledge
DATABASES
• Select the most appropriate database for topic
– CINAHL, HMIC, ERIC, PsycInfo, MIDIRS
• Use subject headings – focus if necessary
• Select an appropriate filter
– Methodological
– Subject
– Specific or optimised
RAPID SEARCH RESOURCES - DATABASES
OTHER GREY LITERATURE
• Economics
– NHSEED
– HEED
• EQIA
• Ongoing research
– e.g. current controlled trials, DUETs
• Conference proceedings (ZETOC)
• Dynamed
• UpToDate
• Prodigy
• Mobile applications such as SIGN Apps
– Guidelines and quick reference guides available for
iPhone, iPad, iPod Touch and Android
RAPID SEARCH RESOURCES - POINT OF CARE
DYNAMED
PRODIGY
http://prodigy.clarity.co.uk/clinical_topics
KEY POINTS
• Be clear about the question and scope
from the outset
• Get to know the resources
• Have a process
• Document what you do
• There is no right answer
REFERENCES AND RESOURCES
TRIP. Liberating the literature: rapid versus systematic reviews. 2012; Available
from: http://blog.tripdatabase.com/2012/04/rapid-versus-systematic-
reviews.html
Khangura S, Konnyu K, Cushman R, Grimshaw J, Moher D. Evidence
summaries: the evolution of a rapid review approach. Systematic Reviews.
2012;1:10. Available from:
http://www.systematicreviewsjournal.com/content/pdf/2046-4053-1-10.pdf
Related webex session available at:
https://kponline.webex.com/kponline/lsr.php?AT=pb&SP=MC&rID=66680517&r
Key=72ad0d36d7a1031f
Ganann R, Ciliska D, Thomas H. Expediting systematic reviews: methods and
implications of rapid reviews. Implementation Science. 2010;5:56. Available
from: http://www.implementationscience.com/content/pdf/1748-5908-5-56.pdf
Canadian Agency for Drugs and Technologies in Health. Grey matters. 2011
[cited 2012 Aug 03]; Available from: http://cadth.ca/resources/grey-matters
REFERENCES AND RESOURCES
Watt A, Cameron A, Sturm L, Lathlean T, Babidge W, Blamey S, et al. Rapid
reviews versus full systematic reviews: an inventory of current methods and
practice in health technology assessment. International Journal of Technology
Assessment in Health Care. 2008;24(2):133-9.
Haynes RB. Of studies, syntheses, synopses and systems: the “4s” evolution of
services for finding current best evidence. EBM. 2001;6:36-8. Available at:
http://ebm.bmj.com/content/6/2/36.full.pdf+html
McGowan J, Hogg W, Campbell C, Rowan M. Just-in-time information improved
decision-making in primary care: a randomized controlled trial. PLoS ONE.
2008. 3(11):e3785. Available at:
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.000378
5
McGowan, Hogg W, Rader T, Salzwedel D, Worster D, Cogo E, et al. A rapid
evidence-based service by librarians provided information to answer primary
care clinical questions. Health Information & Libraries Journal. 2010:27(1):11-21.
Jenny Harbour
Health Information Scientist
Healthcare Improvement Scotland
Tel. 0141 227 3259
E-mail. [email protected]
Suzanne Wilson
Health Information Scientist
Healthcare Improvement Scotland
Tel. 0141 241 6317
E-mail. [email protected]
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