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. jenny.harbour@nhs.net

Suzanne Wilson

Health Information Scientist

Healthcare Improvement Scotland

Tel. 0141 241 6317

E-mail. suzannewilson@nhs.net

CONTACT DETAILS