In our Embase webinar, Ian Crowlesmith searched for evidence in 4 case studies: Drugs & diseases; Diagnostic tests; Medical devices and Process of care He also focused on: Goals and methods; Levels of evidence and Other search tips

1. Searching for Evidence-Based
Medicine in Embase
Your host: Ann-Marie Roche Your presenter: Ian Crowlesmith
Welcome to our Embase webinar!

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Need to know

4. • Searching for evidence: 4 case studies
Drugs & diseases
Diagnostic tests
Medical devices
Process of care
• Focus on:
Goals and methods
Levels of evidence
Other search tips
Agenda

5.  Goal
To locate the highest quality of evidence available,
with the best balance of sensitivity and specificity.
Goals & methods
 Methods
Systematic search of the literature using predefined
inclusion / exclusion criteria (PICO)
 Not included
• Comparison with multiple data sources (e.g. MEDLINE)
• Analytical methods for evaluating evidence (e.g. GRADE)

6. PICO (a reminder)
P = Patient
I = Intervention
C = Comparison / Control
O = Outcome

7. Therapy vs Diagnosis
Therapy
Diseased patient
↓
Intervention
↓
Has the patient improved?
Diagnosis
Suspicion of disease
↓
Diagnostic test
↓
Is the patient diseased?

8. Therapeutic trials / Diagnostic tests
Series of patients
Index group Control group
Intervention Control
Outcome Outcome
Index test Reference standard
Cross classification
Single patient group

9. Levels of evidence
Source: Robin Harbour & Juliet Miller (SIGN), BMJ 2001;323:334.1
Parachutes reduce the risk of injury
after gravitational challenge, but their
effectiveness has not been proved
with randomised controlled trials
Source: Gordon Smith & Jill Pell, BMJ 2003;327:1459
Ref: Nursetopia.netOxford Centre for Evidence-based Medicine - Levels of Evidence (Mar 2009)

10. Levels of evidence in Embase
 check tags
 study types
 topic terms
 reviews of the evidence
See also: Embase Indexing Guide 2012 (via Embase.com/info)

11. Levels of evidence: check tags
Check tag Year Scope note (Used for …)
randomized
controlled
trial
1993 … original reports of clinical trials using a control group (e.g. placebo, sham or
no treatment, standard intervention) for comparison with the experimental
intervention, with random allocation of subjects to experimental and control
groups
controlled
clinical trial
2007 … original studies with a control group, i.e. in which previously defined groups
are compared with each other. Also used for studies with control material or
control procedures. Retrospective studies may also be included
multicenter
study
1993 … original reports of clinical trials performed at two or more medical centers
clinical trial * 1974 ... original reports of prospective clinical studies in which the (comparative)
efficacy of one or more medical interventions in humans is evaluated; also
used for prospective clinical veterinary trials in which the (comparative)
efficacy of one or more medical interventions in animals is evaluated
major clinical
study
1974 … original items reporting clinical work on greater than 50 patients
clinical article 1974 … original items reporting clinical work on 5-50 patients
case report 1974 … original items reporting clinical work on not more than 4 individual cases
* check tags for phases 1-4 clinical trials are also available

12. Levels of evidence: study types
 case control study
 cohort analysis
 comparative study
 controlled study
 longitudinal study
 prospective study
 retrospective study
Emtree examples

13. Levels of evidence: study types

14. Levels of evidence: topic terms
Topic terms were introduced in Emtree in 2011
Emtree (from two hierarchical views)

15. Reviewing the evidence
Check tag Year Scope note
systematic
review
2004 Used for studies that systematically summarize all relevant
evidence pertaining to a defined health question, and
including items identified as such by the author
meta
analysis
1987 Used for original reports evaluating medical interventions by
the statistical analysis of a large collection of analysis results
from individual studies, for the purpose of integrating the
findings; not limited to clinical trials
Related topic terms (2011)
systematic review (topic)
meta analysis (topic)
Practice guidelines

16. Case studies
Type Search question
Drugs & diseases Evaluate the evidence for suicide risk in children
treated for depression with SSRIs
Diagnostic tests How accurately does HPV testing predict cervical
cancer in adult women?
Medical devices What are the pro’s and con’s for metal-on-metal hip
implants vs other types of hip prosthesis?
Process of care Since the last Cochrane review in 2007, have there
been any significant updates regarding the application
of telemedicine for diabetes?

17. Case study (1): Drugs & diseases
Aim: Evaluate the evidence that children treated for
depression using serotonin reuptake inhibitors are at
increased risk of suicide
P = depression (treatment) in children
I = serotonin (re)uptake inhibitors / SSRIs
C = controlled studies vs alternative/no treatment
O = (risk of) suicide
(review levels of evidence)

18. 1. Emtree to disease search => depression/exp/dm_dt (= drug therapy)
2. Limits => [child]/lim OR [adolescent]/lim
3. Emtree to drug search => serotonin-uptake-inhibitor/exp/dd_dt
(via synonym search for SSRI)
4. 1 AND 2 AND 3
5. Emtree => suicide/exp
6. 4 AND 5
7. Filter => view & select levels of evidence
Case study (1): Drugs & diseases

19. Case study (1): Drugs & diseases

20. Case study (2): Diagnostic tests
Aim: How accurately does HPV testing predict
cervical cancer in adult women?
P = cervical cancer (diagnosis), women (adult)
I = human papilloma virus
C = biopsy (or other reference standard)
O = diagnostic test accuracy (study)
(review levels of evidence)

21. 1. Disease search => uterine-cervix-cancer/dm_di (= diagnosis)
2. Limits => female/de AND adult/de
3. Emtree => human-papilloma-virus (or papilloma-virus)
4. 1 AND 2 AND 3
5. Filter => “diagnostic test accuracy study’
6. Filter => view & select levels of evidence
Case study (2): Diagnostic tests

22. Case study (2): Diagnostic tests

23. Case study (3): Medical devices
Aim: What are the pro’s and con’s for metal-on-metal
hip implants vs other types in different patient groups?
P = human (unspecified)
I = metal-on-metal hip prostheses
C = comparison (studies)
O = treatment outcome
(review levels of evidence)

24. 1. Emtree => hip-prosthesis/exp
2. Metal-on-metal (after reviewing Quick search / autocomplete)
Avoid relying on metal-on-metal joint prosthesis, introduced 2013
3. 1 AND 2
4. Filter => select comparative-study, intermethod-comparison
5. Edit => replace by compar* (compare free text vs Emtree results)
6. Emtree => treatment outcome
7. Filter => view & select levels of evidence
Case study (3): Medical devices

25. Case study (3): Medical devices

26. Case study (4): Process of care
Aim: How does the application of telemedicine for
diabetes compare with implementation for other
diseases? Have there been any significant updates
since the last Cochrane review in 2007?
P = diabetes
I = telemedicine
C = other delivery mechanisms
O = systematic reviews, meta analyses, RCTs
(review levels of evidence)

27. 1. Emtree => telemedicine (identify telehealth)
2. Filter => diseases to compare areas of application; select diabetes
3. Edit => convert diabetes-mellitus to major term
4. Limit => Cochrane reviews (via copy to Advanced Search / EBM limit)
5. Limit => Systematic Review, RCTs
6. Filter set #3 to view levels of evidence directly
Case study (4): Process of care

28. Case study (4): Process of care

29. Searching for EBM: summary
When searching for evidence on
Embase, the results can always
be summarized according to the
levels of evidence available

30. Thank you
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