Objective 4b: Keyword Search for Recent Meta-analyses, Observational and Economic Studies, and Practice Guidelines (search 4)

The search for meta-analyses, observation and economic studies, and guidelines must retrieve indexed and unindexed articles.

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Why run this search?

1. A meta-analysis analyzes the combined data from a group of studies.  If done correctly, this provides stronger findings based on a higher number of participants.
2. Observational studies provide a better look at real-world outcomes and have a better chance of detecting rare adverse events than trials do.
3. Cost benefit/utility and other pharmacoeconomic studies will affect the decisions you and your institution make concerning the value of a drug.
4. Guidelines are ideally based on systematic reviews and/or meta-analyses.  Some are just based on expert consensus.  In either case, they give the reader a sense of current practice recommendations.
5. The formulary monograph assignment asks you to consider findings of a couple articles that are either meta-analyses, observational studies or pharmacoeconomic/cost-related studies.  You should be able to report on  guideline recommendations during your oral monograph presentation if a practice guideline exists which speaks to the place of your drug in treating the condition of interest.

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Prepare and Run the search

This next search is a search for indexed and unindexed records.

• If you are not already looking at the search history table on the “advanced” search page, click the “Advanced” link under the search box to go to the “advanced” search page.
• Click on the  …  in the “Actions” column to add your most recent search (the search containing NOT MEDLINE[sb]) to the query box.  Then, because you want to be able to retrieve indexed and unindexed records,  REMOVE the –

NOT MEDLINE[sb]

— from the search strategy

Now it’s time to focus  the search on meta-analyses, observational and economic studies, and guidelines. 

Because you want to retrieve unindexed records and indexed records, you can’t use the meta-analysis, observational study, pharmacoeconomic/cost study, and guideline-related “Article Type” filters and/or subject headings alone (Article Type filters and subject headings are indexing-dependent).  You will either need to use keywords alone to focus on the desired publication types or use a combination of OR’d together publication type filters, subject headings, and keywords.

Fortunately, meta-analyses usually contain the word —

meta-analysis

— in the article title, and practice guidelines most often contain one of the following keywords —

guideline* OR consensus OR “position statement”

— in their titles.  The [ti] tag can be added to these terms to specify that they should be used to search the title only.

Observational studies and pharmacoeconomic/cost studies are not always distinguished by title words, but most will contain —

observational OR case-control* OR cohort* OR pharmacoeconomic* OR cost-benefit* OR cost-utility OR cost-effectiveness

— in either their article title or abstract.    The [tiab] tag can be added to these terms.

Search-strategy-ready’ , meta-analysis- and guideline-related filter terms  can be OR’d with the title tagged keywords.  Search strategy ready filter terms are created by adding the relevant filters to a search and using the “Add Query” feature in the search history table.  I’ve done this for you.

• Copy the “guideline, meta-analysis, observational, economic”  search segment shown below.

(consensusdevelopmentconference[Filter] OR consensusdevelopmentconferencenih[Filter] OR guideline[Filter] OR meta-analysis[Filter] OR practiceguideline[Filter] OR observationalstudy[Filter] “Cost-Benefit Analysis”[Mesh] OR “Cost-Effectiveness Analysis”[Mesh] OR “Economics, Pharmaceutical”[Mesh]  OR  guideline*[ti] OR consensus[ti] OR “position statement*”[ti] OR meta-analysis[ti] OR  observational[tiab] OR case-control*[tiab] OR cohort*[tiab] OR pharmacoeconomic*[tiab] OR cost-benefit*[tiab] OR cost-utility[tiab] OR cost-effectiveness[tiab] )

• Type an — AND — surrounded by a space on either side after the search in the Query box.
• Paste in the “guideline, meta-analysis, observational, economic” search segment.
• Click the “Search” button or hit the “Enter”/”Return” key on your keyboard.

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Document Your Search

Copy  the search strategy from the “Advanced” page as for search 1 and 2 and paste it under the search 4 heading.

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Using the search results

Almost all keyword searches retrieve both relevant and irrelevant results.  It’s the readers responsibility to determine which articles are the publication types of interest.  Fortunately, this can usually be determined by reading the title alone.

• You may select two articles that are either cost-utility, cost-effectiveness, pharmaco-economic or observational studies or meta-analyses to discuss in your formulary monograph.
• You should not include guidelines (guidelines, “position statements”, or consensus articles) as evidence in the formulary monograph.  However, you will want to be able to discuss the role or lack of role for your drug in guideline recommended care.
• Some of the articles retrieved by the search will not fit into any of the desired study types.   You can ignore these after screening their titles and abstracts.