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Plan in advance the methods to be used for identifying studies. Design searches to capture as many studies as possible that meet the eligibility criteria, ensuring that relevant time periods and sources are covered and not restricted by language or publication status. Searches should be motivated directly by the eligibility criteria for the review, and it is important that all types of eligible studies are considered when planning the search.
If searches are restricted by publication status or by language of publication, there is a possibility of publication bias, or language bias whereby the language of publication is selected in a way that depends on the findings of the study , or both. Removing language restrictions in English language databases is not a good substitute for searching non-English language journals and databases. Searches for studies should be as extensive as possible in order to reduce the risk of publication bias and to identify as much relevant evidence as possible.
Expertise may be required to avoid unnecessary duplication of effort. These databases are described in more detail in Sections 4. A key advantage of such databases is that they can be searched electronically both for words in the title or abstract and by using the standardized indexing terms, or controlled vocabulary, assigned to each record see Section 4. They may be available through national provisions, site-wide licences at institutions such as universities or hospitals, through professional organizations as part of their membership packages or free-of-charge on the internet.
Some international initiatives provide free or low-cost online access to databases and full-text journals over the internet. Electronic Information for Libraries EIFL is a similar initiative based on library consortia to support affordable licensing of journals and other sources in more than 50 low-income and transition countries in central, eastern and south-east Europe, the former Soviet Union, Africa, the Middle East and South-east Asia.
The online Technical Supplement provides more detailed information about how to search these sources and other databases. The accompanying Appendix provides a list of general healthcare databases by region and healthcare databases by subject area. Further evidence-based information about sources to search can be found on the SuRe Info portal , which is updated twice per year.
MEDLINE as of January contains approximately 30 million references to journal articles in biomedicine and health from onwards. When searching MEDLINE via service providers or interfaces other than Ovid or PubMed, we recommend verification of the exact coverage of the database in relation to PubMed, where no explicit information on this is readily available.
Embase as of January contains over 35 million records from onwards, including records from more than currently published journals from approximately countries Elsevier Further details on the implications of this for searching are available in the online Technical Supplement.
Embase Classic provides access to almost two million records digitized from the Excerpta Medica print journals the original print indexes from which Embase was created from to Elsevier Embase now also includes pre-print articles from multiple sources Elsevier Embase is only available by subscription, either directly via Elsevier as Embase. Note that Embase is searched regularly by Cochrane for reports of trials. The actual degree of reference overlap between MEDLINE and Embase varies widely according to the topic, but studies comparing searches of the two databases have generally concluded that a comprehensive search requires that both databases be searched Lefebvre et al , Bramer et al see MECIR Box 4.
Conversely, two studies examined different samples of Cochrane Reviews and identified the databases from which the included studies of these reviews originated Halladay et al , Hartling et al Both studies, one across all healthcare areas Halladay et al and the other on child health Hartling et al , report a minimal extent to which the inclusion of studies not indexed in PubMed altered the meta-analyses.
PubMed coverage across systematic review topics has been further evaluated in a recent study based on a comprehensive sample of Cochrane Reviews. Hence, the current recommendation of searching multiple databases needs to be evaluated further, so as to confirm under which circumstances comprehensive searches of multiple databases are warranted. CENTRAL, however, also includes citations to reports of randomized trials that are not indexed in MEDLINE, Embase or other bibliographic databases; citations published in many languages; and citations that are available only in conference proceedings or other sources that are difficult to access.
It also includes records from trials registers and trials results registers beyond ClinicalTrials. These additional records are, for the most part, identified by Cochrane Information Specialists, many of whom conduct comprehensive searches to populate CRG Specialized Registers, collecting records of trials eligible for Cochrane Reviews in their field.
In these cases, the search will be more precise, but an equivalent number of included studies will be identified with lower numbers of records to screen.
Many review authors have full access free-of-charge at the point-of-use through national provisions and other similar arrangements, or as part of a paid subscription to the Cochrane Library. Many countries and regions produce bibliographic databases that focus on the literature produced in those regions and which often include journals and other literature not indexed elsewhere. It is highly desirable that searches be conducted of appropriate national, regional and subject specific bibliographic databases see MECIR Box 4.
Further details are provided in the online Technical Supplement. Citation indexes are bibliographic databases that record instances where a particular reference is cited, in addition to the standard bibliographic content. Citation indexes can be used to identify studies that are similar to a study report of interest, as it is probable that other reports citing or cited by a study will contain similar or related content. Search appropriate national, regional and subject-specific bibliographic databases.
Databases relevant to the review topic should be covered e. Initiatives to provide access to ongoing studies and unpublished data constitute a fast-moving field Isojarvi et al It is important to identify ongoing studies, so that when a review is updated these can be assessed for possible inclusion.
Awareness of the existence of a possibly relevant ongoing study and its expected completion date might affect not only decisions with respect to when to update a specific review, but also when to aim to complete a review. Even when studies are completed, some are never published.
Finding out about unpublished studies, and including their results in a systematic review when eligible and appropriate Cook et al , is important for minimizing bias. Several studies and other articles addressing issues around identifying unpublished studies have been published Easterbrook et al , Weber et al , Manheimer and Anderson , MacLean et al , Lee et al , Chan , Bero , Schroll et al , Chapman et al , Kreis et al , Scherer et al , Hwang et al , Lampert et al There is no easy and reliable single way to obtain information about studies that have been completed but never published.
There have, however, been several important initiatives resulting in better access to studies and their results from sources other than the main bibliographic databases and journals. These include trials registers and trials results registers see Section 4.
A recent study Halfpenny et al assessed the value and usability for systematic reviews and network meta-analyses of data from trials registers, CSRs and regulatory authorities, and concluded that data from these sources have the potential to influence systematic review results. A Cochrane Methodology Review examined studies assessing methods for obtaining unpublished data and concluded that those carrying out systematic reviews should continue to contact authors for missing data and that email contact was more successful than other methods Young and Hopewell An annotated bibliography of published studies addressing searching for unpublished studies and obtaining access to unpublished data is also available Arber et al One particular study focused on the contribution of unpublished studies, including dissertations, and studies in languages other than English, to the results of meta-analyses in reviews relevant to children Hartling et al They found that, in their sample, unpublished studies and studies in languages other than English rarely had any impact on the results and conclusions of the review.
Correspondence can be an important source of information about unpublished studies. It is highly desirable for authors of Cochrane Reviews of interventions to contact relevant individuals and organizations for information about unpublished or ongoing studies see MECIR Box 4. Letters of request for information can be used to identify completed but unpublished studies.
One way of doing this is to send a comprehensive list of relevant articles along with the eligibility criteria for the review to the first author of reports of included studies, asking if they know of any additional studies ongoing or completed; published or unpublished that might be relevant.
This approach may be especially useful in areas where there are few trials or a limited number of active research groups. It may also be desirable to send the same letter to other experts and pharmaceutical companies or others with an interest in the area. Some review teams set up websites for systematic review projects, listing the studies identified to date and inviting submission of information on studies not already listed.
A recent study assessed the value of contacting trial authors and concluded that data supplied by authors modified the outcomes of some systematic reviews, but this was poorly reported in the reviews Meursinge Reynders et al Another case study of a Cochrane Methodology Review reported that making contact with clinical trials units and trial methodologists provided data for six of the 38 RCTs included in the review, which had not been identified through other search methods Brueton et al C31 : Searching by contacting relevant individuals and organizations Highly desirable.
Contact relevant individuals and organizations for information about unpublished or ongoing studies. It is important to identify ongoing studies, so that these can be assessed for possible inclusion when a review is updated. Asking researchers for information about completed but never published studies has not always been found to be fruitful Hetherington et al , Horton though some researchers have reported that this is an important method for retrieving studies for systematic reviews Royle and Milne , Greenhalgh and Peacock , Reveiz et al A recent study reported successful outcomes of a digital media strategy to obtain unpublished data from trial authors Godard-Sebillotte et al A study assessed the value of requesting information from drug manufacturers for systematic reviews and concluded that this helped to reduce reporting and publication bias and helped to fill important gaps, sometimes leading to new or altered conclusions, primarily where no other evidence existed McDonagh et al The RIAT Restoring Invisible and Abandoned Trials initiative Doshi et al aims to address the problems outlined above by offering a methodology that allows others to re-publish mis-reported and to publish unreported trials.
Anyone who can access the trial data and document trial abandonment can use this methodology. The RIAT Support Centre offers free-of-charge support and competitive funding to researchers interested in this approach. It has also been suggested that legislation such as Freedom of Information Acts in various countries might be used to gain access to information about unpublished trials Bennett and Jull , MacLean et al A recent study suggested that trials registers are an important source for identifying additional randomized trials Baudard et al A recent audit by Cochrane investigators showed that the majority of Cochrane Reviews do comply with this standard Berber et al Although there are many other trials registers, ClinicalTrials.
Research has shown that even though ClinicalTrials. The extent to which this might still be the case with the new ICTRP interface released in its final version in June see online Technical Supplement remains to be ascertained.
Therefore, the current guidance that it is not sufficient to search the ICTRP alone still stands, pending further research. Guidance for searching these and other trials registers is provided in the online Technical Supplement. In addition to Cochrane, other organizations also advocate searching trials registers. There has been an increasing acceptance by investigators of the importance of registering trials at inception and providing access to their trials results.
Despite perceptions and even assertions to the contrary, however, there is no global, universal legal requirement to register clinical trials at inception or at any other stage in the process, although some countries are beginning to introduce such legislation Viergever and Li Efforts have been made by a number of organizations, including organizations representing the pharmaceutical industry and individual pharmaceutical companies, to begin to provide central access to ongoing trials and in some cases trial results on completion, either on a national or international basis.
Increasingly, as already noted, trials registers such as ClinicalTrials. Search trials registers and repositories of results, where relevant to the topic, through ClinicalTrials.
Although ClinicalTrials. A number of organizations, including Cochrane, recommend searching regulatory agency sources and clinical study reports.
Details of these are provided in the online Technical Supplement. Clinical study reports CSRs are the reports of clinical trials providing detailed information on the methods and results of clinical trials submitted in support of marketing authorization applications.
Specifically, guidance on how to use data from regulatory sources is needed. The online Technical Supplement describes several other important sources of reports of studies. Review authors may also consider searching the internet, handsearching journals and searching full texts of journals electronically where available see online Technical Supplement for details.
They should examine previous reviews on the same topic and check reference lists of included studies and relevant systematic reviews see MECIR Box 4. Search relevant grey literature sources such as reports, dissertations, theses and conference abstracts.
Check reference lists in included studies and any relevant systematic reviews identified. This section highlights some of the issues to consider when designing search strategies. Designing search strategies can be complex and the section does not fully address the many complexities in this area. Many of the issues highlighted relate to both the subject aspects of the search e. For a search to be robust, both aspects require attention to be sure that relevant records are not missed.
Further evidence-based information about designing search strategies can be found on the SuRe Info portal , which is updated twice per year. If the review has specific eligibility criteria around study design to address adverse effects, economic issues or qualitative research questions, undertake searches to address them.
Sometimes a review will address questions about adverse effects, economic issues or qualitative research using a different set of eligibility criteria from the main effectiveness component.
In such situations, the searches for evidence must be suitable to identify relevant study designs for these questions. Different searches may need to be conducted for different types of evidence. The starting point for developing a search strategy is to consider the main concepts being examined in a review. For a Cochrane Review, the review objective should provide the PICO concepts, and the eligibility criteria for studies to be included will further assist in the selection of appropriate subject headings and text words for the search strategy.
The structure of search strategies in bibliographic databases should be informed by the main concepts of the review see Chapter 3 , using appropriate elements from PICO and study design see MECIR Box 4. Although a research question may specify particular comparators or outcomes, these concepts may not be well described in the title or abstract of an article and are often not well indexed with controlled vocabulary terms. Therefore, in general databases, such as MEDLINE, a search strategy will typically have three sets of terms: i terms to search for the health condition of interest, i.
Typically, a broad set of search terms will be gathered for each concept and combined with the OR Boolean operator to achieve sensitivity within concepts. The results for each concept are then combined using the AND Boolean operator, to ensure each concept is represented in the final search results. It is important to consider the structure of the search strategy on a question-by-question basis. In some cases it is possible and reasonable to search for the comparator, for example if the comparator is explicitly placebo; in other cases the outcomes may be particularly well defined and consistently reported in abstracts.
The advice on whether or not to search for outcomes for adverse effects differs from the advice given above see Chapter Inform the structure of search strategies in bibliographic databases around the main concepts of the review, using appropriate elements from PICO and study design.
In structuring the search, maximize sensitivity whilst striving for reasonable precision. Inappropriate or inadequate search strategies may fail to identify records that are included in bibliographic databases. The structure of a search strategy should be based on the main concepts being examined in a review. In general databases, such as MEDLINE, a search strategy to identify studies for a Cochrane Review will typically have three sets of terms: i terms to search for the health condition of interest, i.
There are exceptions, however. For instance, for reviews of complex interventions, it may be necessary to search only for the population or the intervention. Some search strategies may not easily divide into the structure suggested, particularly for reviews addressing complex or unknown interventions, or diagnostic tests Huang et al , Irvin and Hayden , Petticrew and Roberts , de Vet et al , Booth or using specific approaches such as realist reviews which may require iterative searches and multiple search strategies Booth et al Cochrane Reviews of public health interventions and of qualitative data may adopt very different search approaches to those described here Lorenc et al , Booth see Chapter 17 on intervention complexity, and Chapter 21 on qualitative evidence.
Some options to explore for such situations include:. Searches for systematic reviews aim to be as extensive as possible in order to ensure that as many of the relevant studies as possible are included in the review. It is, however, necessary to strike a balance between striving for comprehensiveness and maintaining relevance when developing a search strategy.
Sensitivity is defined as the number of relevant reports identified divided by the total number of relevant reports in the resource. Precision is defined as the number of relevant reports identified divided by the total number of reports identified.
Increasing the comprehensiveness or sensitivity of a search will reduce its precision and will usually retrieve more non-relevant reports. Article abstracts identified through a database search can usually be screened very quickly to ascertain potential relevance.
At a conservatively estimated reading rate of one or two abstracts per minute, the results of a database search can be screened at the rate of 60— per hour or approximately — over an 8-hour period , so the high yield and low precision associated with systematic review searching may not be as daunting as it might at first appear in comparison with the total time to be invested in the review. Table 4. This section should be read in conjunction with Section 3.
One is based on text words, that is terms occurring in the title, abstract or other relevant fields available in the database. The other is based on standardized subject terms assigned to the references either by indexers specialists who appraise the articles and describe their topics by assigning terms from a specific thesaurus or controlled vocabulary or automatically using automated indexing approaches.
Searches for Cochrane Reviews should use an appropriate combination of these two approaches, i. Approaches for identifying text words and controlled vocabulary to combine appropriately within a search strategy, including text mining approaches, are presented in the online Technical Supplement. C33 : Developing search strategies for bibliographic databases Mandatory.
Identify appropriate controlled vocabulary e. MeSH, Emtree, including ‘exploded’ terms and free-text terms considering, for example, spelling variants, synonyms, acronyms, truncation and proximity operators. Search strategies need to be customized for each database. The same principle applies to Emtree when searching Embase and also to a number of other databases. In order to be as comprehensive as possible, it is necessary to include a wide range of free-text terms for each of the concepts selected.
This might include the use of truncation and wildcards. Developing a search strategy is an iterative process in which the terms that are used are modified, based on what has already been retrieved.
Searches should capture as many studies as possible that meet the eligibility criteria, ensuring that relevant time periods and sources are covered and not restricted by language or publication status see MECIR Box 4. Review authors should justify the use of any restrictions in the search strategy on publication date and publication format see MECIR Box 4. To reduce the risk of introducing bias, searches should not be restricted by language.
Recommendations for rapid reviews searches to limit publication language to English and add other languages only when justified Garritty et al are supported by evidence that excluding non-English studies does not change the conclusions of most systematic reviews Morrison et al , Jiao et al , Hartling et al , Nussbaumer-Streit et al However, exceptions that non-English studies do influence review findings have been observed for complementary and alternative medicine Moher et al , Pham et al , Wu et al , psychiatry, rheumatology and orthopaedics Egger et al Additionally, when searches are limited to English or to databases containing only English-language articles, there is a risk that eligible studies may be missed from countries where a particular intervention of interest is more common e.
For further discussion of these issues see Chapter Particularly when resources and time are available, the inclusion of non-English studies in systematic reviews is recommended to minimize the risk of language bias Egger et al , Pilkington et al , Morrison et al It has also been argued that, when language restrictions are justified, these should not be imposed by limiting the search but by including language as an eligibility criterion during study selection Pieper and Puljak Further use of a supportive narrative may help explain why a particular date restriction was applied Craven and Levay , Cooper et al b.
For example, a database date restriction of current for a review of nurse-led community training of epinephrine autoinjectors is justified because this is the approval date of the first device Center for Drug Evaluation and Research Conversely, arbitrary date restrictions intended to reduce search yield e.
Caution should be exercised when designing database search strategies with date restrictions. Information specialists should be aware of the various date fields available from database providers e.
It may be necessary to search additional sources or datafiles to ensure adequate coverage of the date period of interest for the review. To account for inconsistent publication dates in database records e. As any information about an eligible study may contain valuable details for analysis, document format restrictions should not be applied to systematic review searches.
For example, excluding letters is not recommended because letters may contain important additional information relating to an earlier trial report or new information about a trial not reported elsewhere Iansavichene et al As with comments and letters, preprints versions of scientific articles that precede formal peer review and publication in a journal should also be considered a potentially relevant source of study evidence.
Recent and widespread availability of preprints has resulted from an urgent demand for emerging evidence during the COVID pandemic Gianola et al , Kirkham et al , Callaway , Fraser et al As study data are often reported in multiple publications and may be reported differently in each Oikonomidi et al , efforts to identify all reports for eligible studies, regardless of publication format, are necessary to support subsequent stages of the review process to select, assess and analyse complete study data.
Justify the use of any restrictions in the search strategy on publication date and publication format. Date restrictions in the search should only be used when there are date restrictions in the eligibility criteria for studies.
They should be applied only if it is known that relevant studies could only have been reported during a specific time period, for example if the intervention was only available after a certain time point. Searches for updates to reviews might naturally be restricted by date of entry into the database rather than date of publication to avoid duplication of effort.
Publication format restrictions e. When considering the eligibility of studies for inclusion in a Cochrane Review, it is important to be aware that some studies may have been found to contain errors or to be fraudulent or may, for other reasons, have been corrected or retracted since publication.
For review updates, it is important to search MEDLINE and Embase for the latest version of the citations to the records for the previously included studies, in case they have since been corrected or retracted. Errata are published to correct unintended errors accepted as errors by the author s that do not invalidate the conclusions of the article. Including data from studies that are fraudulent or studies that include errors can have an impact on the overall estimates in systematic reviews.
There is an increasing awareness of the importance of not including retracted studies or those with significant errata in systematic reviews and how best to avoid this Royle and Waugh , Wright and McDaid , Decullier et al A recent study, however, showed that even when review authors suspect research misconduct, including data falsification, in the trials that they are considering including in their systematic reviews, they do not always report it Elia et al Details of how to identify fraudulent studies, other retracted publications, errata and comments are described in the online Technical Supplement.
Some studies may have been found to be fraudulent or may have been retracted since publication for other reasons. Errata can reveal important limitations, or even fatal flaws, in included studies. All of these may lead to the potential exclusion of a study from a review or meta-analysis. Care should be taken to ensure that this information is retrieved in all database searches by downloading the appropriate fields, together with the citation data.
Search filters are search strategies that are designed to retrieve specific types of records, such as those of a particular methodological design. Make easy corrections, enhancements, and adjustments to one or thousands of photos at once with batch processing tools.
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Toggle navigation. Upgrade Eligibility Shipping Policy. Toggle navigation WordPerfect All-in-one office suite. Quattro Pro. WordPerfect Lightning. Paradox Database Management. Also includes. What’s new in WordPerfect ? Oxford Concise Dictionary. Now standard in WordPerfect Office , the Oxford Concise Dictionary contains tens of thousands of definitions, phrases, phonetic spellings from every variety of English around the world, as well as scientific and specialist words.
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The exception to this rule occurs when a sentence contains a dash, in which case the superscript would precede it. Historians are known to use Chicago style citations. Associate Justice Stephen Breyer of the Supreme Court of the United States is famous in the American legal community for his writing style, in which he never uses notes. He prefers to keep all citations within the text which is permitted in American legal citation.
Posner has also written against the use of notes in judicial opinions. Garner , however, advocates using notes instead of inline citations. HTML , the predominant markup language for web pages, has no mechanism for adding notes. Despite a number of different proposals over the years, and repeated pleas from the user base, the working group has been unable to reach a consensus on it.
It might be argued that the hyperlink partially eliminates the need for notes, being the web’s way to refer to another document. However, it does not allow citing to offline sources and if the destination of the link changes, the link can become dead or irrelevant. The London printer Richard Jugge is generally credited as the inventor of the footnote, first used in the Bishops’ Bible of From Wikipedia, the free encyclopedia.
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