Systematic Review Processes, Teams,&
Experiences
Methods: Searching & Systematic Reviews
Mark MacEachern & PF Anderson; October 31, 2017
For Dentistry 610; University of Michigan

Objectives
◻ Understand the importance of literature searches
◻ Learn how to construct effective searches for clinical
and research projects
◻ Learn reporting and citation management strategies
and resources

Why is it important to search well?
◻ Support evidence-based decision-making
◻ Avoid biases in research projects and clinical decisions
◻ Missed studies can undermine clinical decisions and
research findings
◻ Save yourself time by leveraging resource features
◻ Keep current on new trends, developments

Evidence Pyramid
Source: Sackett DL. Evidence-based medicine: how to practice and teach EBM.

What to expect?
◻ Expect the search to be iterative
◻ Expect 1000s of results
◻ Expect to search multiple databases
◻ EMBASE, PubMed, ERIC, PsycINFO, etc.
◻ Expect the search process to take awhile
◻ Expect to publish search strategy and search methodology
◻ Expect to consult someone with appropriate search expertise

Search construction
1. Identify search terms
2. Use Boolean
3. Use combination of keywords and controlled terms
4. Supplemental strategies

1. Identifying search terms
Question/hypothesis:
◻ Real time ultrasonography and in implant and oral surgery
What are the major concepts?
◻ Ultrasonography (ultrasound, ultrasonic imaging, echography, etc.)
◻ Dental implants (types of implants, implant names, etc.)
◻ Oral surgery (surgery, surgeries, surgical, specific procedures
and types of surgery, etc.)

2. Boolean
Concept 1
Ultrasonography
OR
Ultrasound
OR
Echography
Concept 2
Dental implants
OR
Tooth implants
OR
Dental implantation

2. Boolean
Concept 1
Ultrasonography
OR
Ultrasound
OR
Echography
Concept 2
Dental implants
OR
Tooth implants
OR
Dental implantation
(ultrasonography or ultrasound or echography)
AND (dental implants or dental implant or tooth
implant or dental implantation)

2. Boolean (What a final search can look like)

3. Keywords vs controlled vocabulary
Keywords
Controlled
vocabulary

Keywords
Controlled
vocabulary
What are they?
◻ Literal search
◻ Looks for occurrences of words
When to use?
◻ Always
◻ Current topics
◻ No vocabulary exists in database
Examples
◻ Google, PubMed

Keywords
Controlled
vocabulary
What are they?
◻ Set of words or phrases used to
describe concepts
◻ Dictionary of accepted terms for a
database
When to use?
◻ Searching a database that has one
Examples
◻ MeSH (Medical Subject Headings)
◻ EMTREE (Embase)

4. Supplemental strategies
◻ Examine the references of key studies and reviews
◻ Examine studies that have cited your key studies (Web of Science,
Google Scholar)
◻ Contact authors, companies, orgs, societies, etc.
◻ Note journals that frequently publish relevant articles
◻ Search for ongoing trials (Clinicaltrials.gov)
◻ Search conference proceedings, abstracts (Scopus, Web of Science,
Embase)

Finding MeSH
Method Example
MeSH Database
Individual Article
Search Builder

Finding MeSH
Method Example
MeSH Database https://www.ncbi.nlm.nih.gov/pubmed/17936128
Individual Article
Search Builder

Team A vs. Team B: Searching Articaine+
TEAM A:
Enter terms found into your team’s
Google Doc:
http://bit.ly/Dent610TeamA
Search MeSH database for:
● Most important term
● MeSH headings
● Related terms
● MeSH Tree Structure:
○ Go up a level
○ Go down a level
TEAM B:
Google Doc:
http://bit.ly/Dent610TeamB
Search for freetext keywords:
● Brainstorming
● Textbooks or articles
● Search Google or similar
● Search Google Scholar

Team A vs. Team B: Searching Articaine+ — FLIP!
TEAM B:
Google Doc:
http://bit.ly/Dent610TeamB
Search MeSH database for:
● Most important term
● MeSH headings
● Related terms
● MeSH Tree Structure:
○ Go up a level
○ Go down a level
TEAM A:
Google Doc:
http://bit.ly/Dent610TeamA
Search for freetext keywords:
● Brainstorming
● Textbooks or articles
● Search Google or similar
● Search Google Scholar

Debrief
1. How is what your team found similar or different from
what the other team found? Why do you think that is?
2. Which would you rather do first: Keyword searching, or
MeSH term searching? Why?
3. Do you think you need lots of terms for EVERY topic you
research? Why or why not?

Want to know what they did in the original?
Brandt RG, Anderson PF, McDonald NJ, Sohn W, Peters MC.
The pulpal anesthetic efficacy of articaine versus lidocaine
in dentistry: a meta-analysis.
J Am Dent Assoc. 2011 May;142(5):493-504.

Sentinel Articles (vs. Seminal)

What is a Seminal Article?
Highly significant
Influential
Important
By a leader in defining the research in the field
“Key studies”

What is a Sentinel Article? (VALIDATION)
● Remember – purpose is for validating search, NOT proving
you know the best articles on the topic (that would be
seminal articles)
● On topic, not broader or narrower
● Well-indexed with appropriate terms
● Representative of citations that would be retrieved by a
well-done search
● Each sentinel article must represent ALL desired concepts
in the search
● Articles selected must meet ALL inclusion and exclusion
criteria.

Choosing Sentinel Articles
How many articles? 3-5. No more than ten.
Verify appropriateness of selected sentinels.
Neither very recent (current year) or old (before 1985)
● Articles old enough to have MeSH assigned.
● New enough to have complete indexing

MeSH Tips (What to do if there is NO HEADING)
Earlier term mappings prior to assignment of
a MeSH term are often:
● presenting symptom or diagnosis
● anatomical area
TMJD Example:
TMJD = temporomandibular joint disorder
= (Temporomandibular joint [anatomical area]
+ ("myofacial pain" OR "Bone Diseases")
[presenting symptom OR diagnosis]
Image: Frank Gaillard. Normal anatomy of the Temporomandibular joint. 14 Jan
2009. http://commons.wikimedia.org/wiki/File:Temporomandibular_joint.png

MeSH & Sentinels
Verify sentinel citations
in MEDLINE
Save file with full
citations (abstract, MeSH
headings, everything)
Make duplicate file to
process
Analyse MeSH Terms
● retain topical terms
● retain methodology terms
● retain non-MeSH terms
such as publication type
and registry numbers
(but separate from core
concept terms)

Extra Ideas for Finding Terms
⃞ Plural forms
⃞ Alternate and variant terms mentioned in MeSH Browser
⃞ Abstract & title mining for equivalent terms
⃞ Other forms of main term (eg. Diabetes and diabetic)
⃞ British and American spellings (eg. Hematology and
haematology)
⃞ Concepts of which this is a part
⃞ Concepts which create this concept when combined

⃞ If clinical: Anatomical site (or region) + presenting
symptom (eg: TMJD = Temporomandibular joint + Myofascial
pain)
⃞ If clinical: Anatomical site (or region) + disease
category (eg: TMJD = Temporomandibular joint + Bone
diseases)
⃞ If clinical: Diagnostic criteria (eg. Diabetes and
fasting plasma glucose or oral glucose tolerance test)
⃞ If clinical: Disease precursors, related conditions, or
sequelae (eg: Dental caries and tooth demineralization.)

⃞ If treatment: Anatomical site or system + specific
modality
⃞ If pharmaceutical or chemical: chemical formula/symbols,
registry numbers
⃞ If microorganisms: historical names, taxonomic groups
⃞ If materials: relevant ISO/ANSI standards and product
identification numbers

What Do You Think?
1. Did you find anything different from the first time?
2. Was it useful or not? How do you know?
3. Do you have ideas for other ways you might find terms?

Example Process
Team meets: Define topic, overview
literature base, suggest
inclusion/exclusion criteria,
discuss methodology & timeline.
Librarian: Generates data for the
team; FRIAR/MEMORABLE/SECT
Topic experts: Review data at 3-4
levels (title, abstract, article,
[request additional information]),
achieve consensus
Handsearching (librarian generates
list, experts implement)
Determine level of evidence for
remaining research
Generate review tables
Share findings (Publication)
Strength of evidence available
(strong, weak, inadequate); suggest
directions for future research to
fill gaps in research base

Example: Cochrane Review Teams
Clinical expert(s) [2+]: Initiates, defines, selects topic.
Partner and collaborate in review to prevent bias.
Statistician: Provides methodological oversight, ensures
process quality for entire project.
Librarian: Provides methodological oversight, ensues process
quality for information search process.
Healthcare Consumer: Provides insight into the priorities
for research, information conduit for relating priorities
and findings between consumers and clinicians.

Expectations of the Librarian Role
● Search strategy
○ Background research of already published similar search strategies, systematic
reviews on related topics
○ Suggest appropriate terms & concepts for review by clinical experts
○ Sensitivity / specificity
○ Validated, revised, adhering to standards / guidelines / best practices
○ Publication-ready copy of strategy
○ Variant strategies for other databases
● Data set
○ In appropriate format
● Data set management support
● Methodology oversight
● Write / revise methodology & results as appropriate
● Assure replicability of methods

Standard Team Process vs. Reality
Most common?
Underestimating time/labor
requirements
First time findings: "insufficient
evidence"

FRIAR/SECT
F – Frame
R - Rank by Relevance
I - Irrelevant Search Concepts
A - Alternates/Aliases (Term Generation)
R - Review, Revise, Repeat

MEMORABLE, A Medline Search Strategy Development Tool

Evidence Table Example
● Levels of evidence
● Participant
characteristics
● Study
characteristics
● Intervention and
outcome
measurements
● Results
● Study limitations
● Inclusion/Exclusion
criteria
http://www.aota.org/DocumentVault/AJOT/Template.aspx?FT=.pdf

Data abstraction / extraction samples
Cochrane:
● Forms:
http://endoc.cochrane.org/data-extract
ion-sheets
● Elements:
http://www.cochrane.org/handbook/table
-73a-checklist-items-consider-data-col
lection-or-data-extraction
● Cochrane CFGD November 2004 * (DOC):
http://cfgd.cochrane.org/sites/cfgd.co
chrane.org/files/uploads/Study%20selec
tion%20and%20%20extraction%20form.doc
More Cochrane:
● Data Extraction Template, 2011 (XLS):
http://www.latrobe.edu.au/chcp/assets/
downloads/DET_2011.xls
● Overview:
http://www.cochrane-pro-mg.org/Documen
ts/Reviewsheet-1-4-08.pdf
Other:
● CDC Data Abstraction Form:
http://www.nccmt.ca/uploads/registry/C
DC%20Tool.pdf
● Social science example (suicide)
http://www.cmaj.ca/content/suppl/2009/
01/29/180.3.291.DC2/ssri-barbui-3-at.p
df

Other sources
Core Secondary Others
● Medline
● Embase
● Cochrane Central
Register of Controlled
Trials
● CINAHL
● Dentistry & Oral
Sciences Source
● Scopus
● Web of Science
● Google Scholar
● ClinicalTrials.gov
● PsycINFO
● Sociological Abstracts
● ERIC
● ABI Inform
• Cochrane Handbook (10.3.1)
– Search multiple sources
– Search unpublished studies
– Search trial registries

Links to resources
◻ PubMed (http://www.lib.umich.edu/database/link/9817)
◻ Google Scholar (http://www.lib.umich.edu/database/link/9825)
◻ EMBASE (http://www.lib.umich.edu/database/link/9173)
◻ ERIC (http://www.lib.umich.edu/database/link/10069)
◻ Web of Science (http://www.lib.umich.edu/database/link/29137)
◻ CINAHL (http://www.lib.umich.edu/database/link/28883)
◻ PsycINFO (http://www.lib.umich.edu/database/link/8375)
◻ Clinical Key (http://www.lib.umich.edu/database/link/29221)

Reporting
Guidelines and standards
PRISMA
Cochrane Handbook
National Academies of the Sciences

Reporting - Cochrane Handbook
◻ See Cochrane Handbook
■ http://handbook-5-1.cochrane.org/
■ Section 6.6
◻ “It should be borne in mind at the outset that the full search strategies
for each database will need to be included in an Appendix of the
review.”

■ Section 6.6
◻ In abstract:
■ List all databases searched.
■ Note the dates of the last search for each database or the period
searched.
■ Note any language or publication status restrictions
■ List individuals or organizations contacted.

■ Section 6.6
◻ In methods:
■ List all databases searched.
■ Note the dates of the last search for each database AND the
period searched.
■ Note any language or publication status restrictions
■ List grey literature sources.
■ List individuals or organizations contacted.

■ Section 6.6
◻ In study flow diagram:
■ number of unique records identified by the searches;
■ number of records excluded after preliminary screening (e.g. of
titles and abstracts); and
■ number of records retrieved in full text

PRISMA Checklist http://prisma-statement.org/documents/PRISMA%202009%20checklist.pdf

Systematic Review Search Strategy Example
Torabinejad M, Anderson
P, Bader J, Brown LJ,
Chen LH, Goodacre CJ,
Kattadiyil MT, Kutsenko
D, Lozada J, Patel R,
Petersen F, Puterman I,
White SN. Outcomes of
root canal treatment and
restoration,
implant-supported single
crowns, fixed partial
dentures, and extraction
without replacement: a
systematic review. J
Prosthet Dent. 2007
Oct;98(4):285-311. PMID:
17936128

FAQ - Save searches
◻ PubMed emails you new citations as they enter the database
◻ Click ‘Create alert’
◻ Use cases:
■ Table of contents
■ Research and clinical topic of interest
■ Keep track of colleague papers

Slides at: http://slideshare.net/umhealthscienceslibraries/
Session guide: http://guides.lib.umich.edu/dent610
Contact:
Mark MacEachern: markmac@umich.edu
Patricia F. Anderson: pfa@umich.edu
Tyler Nix: tnix@umich.edu

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