Transcript Interventional Procedures

Searching for a “needle in a haystack”
Sarah Glover and Jenny Kendrick
Information Specialists
Information Services, NICE
Outline of presentation
• What is NICE?
• Introduction to the Information Services Team
• Brief overview of the Interventional Procedures
Programme
• Searching for a “needle in a haystack” - the role of the
Information specialist in the development of NICE
Interventional Procedure guidance
Who are we?
• The National Institute for Health and Clinical Excellence
(NICE) is an independent NHS organisation.
• Set up 1 April 1999 to ensure everyone has equal access
to medical treatments and high quality care from the NHS
• A world leader in setting standards for high quality
healthcare
• The most prolific producer of clinical guidelines in the
world
• We have offices in London and Manchester
What we do
• NICE is responsible for
– providing national guidance on the promotion of good health
and the prevention and treatment of ill health
– setting quality standards
– managing NHS Evidence
• NICE makes recommendations to the NHS on:
– new and existing medicines, treatments and procedures
– treatment and care for people with specific diseases and
conditions
• NICE makes recommendations to the NHS, local authorities
and other organisations on:
– how to improve people’s health and prevent illness and
disease.
The Information Services team at NICE
• Associate Director, 22 Information Professionals and an
Administrator.
• We offer tailored support to the different Centres and
Directorates.
• We also offer Institute-wide corporate information
services.
Interventional Procedures (IP)
• New interventional procedures are notified directly to NICE –
usually by clinicians.
• The potential output of the topic is defined during the topic
selection process at NICE
• NICE Interventional Procedures guidance advises the NHS
on when and how new procedures can be used in clinical
practice.
• NICE makes recommendations about whether interventional
procedures used for diagnosis or treatment are safe enough
and work well enough for routine use.
What is an Interventional Procedure?
An interventional procedure is a procedure used for diagnosis
or treatment that involves one of the following:
• Making a cut or a hole to gain access to the inside of a
patient's body
• Gaining access to a body cavity (such as the digestive
system, lungs, womb or bladder) without cutting into the
body
• Using electromagnetic radiation (which includes X-rays,
lasers, gamma-rays and ultraviolet light)
Information Services support
• We carrying out literature searches to support the
development of the Interventional Procedure Guidelines
• The literature search findings are an essential component
to the IP overview document development process.
• The basis of the overview is then discussed at the
Interventional Procedures Advisory Committee (IPAC)
The literature search
• Aims to identify as much evidence on the procedure as
possible
• Is a comprehensive and structured search strategy
• We use a limited number of resources
• Within a limited timeframe – 2 weeks are allocated for
all searching to be completed
• It’s an unusual and tricky process!
Interventional Procedures
search request
• The IP search request is sent to us via a literature
search request form
• This contains the title, a brief description of the
procedure, and sometimes key words
• Also lists key papers that the Analyst is aware of
• Core databases/websites to be searched
Interventional Procedures
search request
For example:
Endoscopic mastectomy and endoscopic wide local
excision for breast cancer
(Keyhole surgery to treat breast cancer)
Brief description:
Treatment for early breast cancer usually involves surgery to remove all or
part of the breast. In this keyhole procedure, part or all of the breast tissue is
removed using special instruments inserted through small skin incisions. The
skin envelope of the breast and nipple are left intact, ready for an implant that
can be inserted during the same operation.
So what are we looking for?
• We know that there are other mastectomy procedures
available in the NHS
• But we are searching for information on this new
procedure only – (Endoscopic or key hole surgery to
remove all or part of the breast)
• So we are looking for a subset of results focused on this
procedure only, within a vast amount of information that
is already out there on other mastectomy procedures
Searching for a “needle in a haystack”
Background information:
A number of sources are used to find out as much
information on the procedure as possible. These include:
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Literature search request form
Medical dictionaries
Cochrane reviews
Google search
Discussion with the Analysts
Use of PICO
Structure is a key component to consider when searching for IPs:
• Normal rules of PICO do not apply
• P and I are mainly used but represent Procedure and Indication
• Sometimes a three-concept search strategy is used to combine two
different concepts in the procedure part of the strategy, this ensures we
find information on the exact procedure we are looking for.
Traditional PICO
Patient
Intervention
Comparator
Outcome
Interventional procedure PICO
Procedure
Indication
Comparator
Outcome
PICO example for
Interventional Procedures
For example:
Endoscopic mastectomy and endoscopic wide local
excision for breast cancer
Procedure
Endoscopic mastectomy
Indication
Breast cancer
Searching for a “needle in a haystack”
• Before we being searching, we try to identify all the
possible search terms that we can use in PICO
• Use a combination of MeSH and free text searching
• Use truncation to find alternative spellings and word
endings
• Use Boolean to combine concepts
• Adj3 operator is often used to help focus the search
Search process
• The first search strategy is composed in Medline
• Each IP is assigned an Information Specialist (IS) who
provides support to the Assistant Information Specialist (AIS)
• The Information Specialist quality assures the Medline
strategy – checking the search terms, the structure of the
search, spellings and correct use of boolean
• Once a Medline strategy has been agreed between the AIS
and IS it is then translated into other medical databases
• These translations are quality assured by the other AISs in
the Information Services team
• Checking searches in this way helps to maintain standards
and reduce errors
Concept 1 – Procedure
The search terms for each concept are explored in Medline
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Endoscopy/
Endoscop*.tw
Surgical Procedures, Minimally Invasive/
(minimal* adj3 invasive* adj3 (surg* or procedure* or
technique* or excisi*)).tw
(Key*hole* adj3 (surg* or procedure* or technique* or
excisi*)).tw
(video* adj3 assist* adj3 (surg* or procedure* or
technique*)).tw
Transareolar*.tw
((Skin* or Nipple* or Areola*) adj3 Spar*).tw.
Concept 1 – Procedure
Three concept search strategy:
• Exp Mastectomy/
• Mastect*.tw
• Endoscopic mastectomy is a new procedure
• There are no relevant thesaurus heading
• So we need to combine the MeSH headings and free
text terms for Endoscopic AND Mastectomy in the
Procedure part of the strategy in order to focus the
search on this new procedure
Concept 2 – Indication
• Breast Neoplasms/
• (Breast* adj3 (Neoplasm* or Cancer* or Metastas* or
Carcinoma* or Adenocarcinom* or Tumour* or Tumor*
or Malignan* or Lump* or Masses* or Sarcoma*)).tw
Combining
• As with usual searching OR is used to combine the
similar search terms in each concept
• AND is used to combine the Procedure and Indication
terms
• Some IP’s require AND to be used within one concept
usually the Procedure section.
• In this example AND is also used to combine the
different Endoscopy and Mastectomy terms in concept
1 to focus the search.
Limiting
• The only limit used for every IP search is to exclude Animal
studies.
• We don’t tend to use any other limits as it is better to keep the
search as inclusive as possible so potential relevant references
are not excluded
• If we get quite a large number of results and after discussions
with the Analyst we sometimes limit strategies to:
– Randomised Controlled Trails
– Systematic Reviews
– English Language
• Date limits are also sometimes used
Final search strategy
1
2
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Endoscopy/
Surgical Procedures, Minimally Invasive/
Endoscop*.tw.
(Minimall* adj3 Invasive* adj3 (Surg* or Procedure* or Technique* or excisi*)).tw.
(Key*hole* adj3 (Surg* or Procedure* or Technique* excisi*)).tw.
(Video* adj3 Assist* adj3 (Surg* or Procedure* or Technique*)).tw.
Transareolar*.tw.
((Skin* or Nipple* or Areola*) adj3 Spar*).tw
or/1-8
exp Mastectomy/
Mastect*.tw.
or/10-11
exp Breast Neoplasms/
(Breast* adj3 (Neoplasm* or Cancer* or Metastas* or Carcinoma* or
Adenocarcinom* or Tumour* or Tumor* or Malignan* or Lump* or Masses* or
Sarcoma*)).tw
15 or/13-14
16 9 and 12 and 15
Sources to search
Databases:
• Medline, Medline in Process, EMBASE, CDSR, CENTRAL, HTA &
DARE (via CRD), CINAHL and BLIC
Websites:
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NICE website – for related guidance
FDA - (MAUDE database)
ASERNIP
ANZHSN
Clinical Trials:
• Clinicaltrials.gov
• metaRegister of Controlled Trials – mRCT
• UK Clinical Research Network (UKCRN) Portfolio Database
What happens next?
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We pass all search results on to the Analysts in the IP team
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An overview is prepared, and is then discussed at the Interventional
Procedures Advisory Committee (IPAC)
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NICE issues a consultation document on the safety and efficacy of the
procedure
•
IPAC then considers the comments from the consultation, and
produces final recommendations for the procedure
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The final recommendations are then submitted to NICE for approval
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Once NICE formally approves the final guideline, consultees are
notified
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NICE issues the guidance to the NHS
IPG296: Endoscopic mastectomy and endoscopic
wide local excision for breast cancer
Date notified to NICE:
25 January 2008
IS searches complete:
05 August 2008
Consultation date:
Winter 2008/9
Guidance issued:
22 April 2009
Thank You
Any Questions?
Contact details:
[email protected]
[email protected]