Robustness of empirical search strategies for clinical content in MEDLINE Impact of PubMed search filters on the retrieval of evidence by physicians Optimal search filters for detecting quality improvement studies in Medline Retrieval of diagnostic and treatment studies for clinical use through PubMed and PubMed's Clinical Queries filters The Medical Review Article Revisited: Has the Science Improved? Evaluating the impact of MEDLINE filters on evidence retrieval: study protocol The development of PubMed search strategies for patient preferences for treatment outcomes Retrieving randomized controlled trials from medline: a comparison of 38 published search filters. Quality assessment of reports on clinical trials in the Journal of Hepatology. Evaluating the quality of articles published in journal supplements compared with the quality of those published in the parent journal. Information management and reading habits of German diabetologists: a questionnaire survey Developing optimal search strategies for detecting clinically sound treatment studies in EMBASE. Gender bias in clinical trials: do double standards still apply? [Evidence-based clinical practice. Part II--Searching evidence databases]. Sources of evidence for systematic reviews of interventions in diabetes. Systematic review of interventions in the management of overweight and obese children which include a dietary component Systematic review of interventions in the management of overweight and obese children which include a dietary component.
BACKGROUND It is important for clinical end users of MEDLINE to be able to retrieve articles that are both scientifically sound and directly relevant to clinical practice . The use of method ologic search filters ( such as " r and om allocation " for sound studies of medical interventions ) has been advocated to improve the accuracy of search ing for such studies . Method ologic search filters have been tested in previous MEDLINE files but indexing continues to evolve and the operating characteristics of these search filters in current MEDLINE files are unknown . OBJECTIVE To determine the robustness of empirical search strategies developed in 1991 for detecting clinical content in MEDLINE in the year 2000 . DESIGN A survey based on a h and search of 171 core health care journals using predetermined quality indicators for scientific merit and clinical relevance . METHODS 6 trained , experienced research assistants read all issues of 171 journals for the publishing year 2000 . Each article was rated using purpose and quality indicators and categorized into clinical ly relevant original studies , review articles , general papers , or case reports . The original and review articles were then categorized as ' pass ' or ' fail ' for method ologic rigor in the areas of therapy/ quality improvement , diagnosis , prognosis , causation , economics , clinical prediction , and qualitative and review articles . Search strategies developed in 1991 were tested in the 2000 data base . MAIN OUTCOME MEASURES Sensitivity , specificity , precision , and accuracy of the search strategies . RESULTS Search strategies developed in 1991 generally performed at least as well in 2000 for both best single terms and combinations of terms for high-sensitivity MEDLINE search es for studies of treatment , prognosis , etiology and diagnosis . For example , the accuracy of " clinical trial ( pt ) " rose from 91.6 % to 94.4 % ( P<0.05 ) for retrieving high- quality studies of treatments . CONCLUSION Most MEDLINE search strategies developed in 1991 are robust when search ing in the publishing year 2000 Background : Physicians face challenges when search ing PubMed for research evidence , and they may miss relevant articles while retrieving too many nonrelevant articles . We investigated whether the use of search filters in PubMed improves search ing by physicians . Methods : We asked a r and om sample of Canadian nephrologists to answer unique clinical questions derived from 100 systematic review s of renal therapy . Physicians provided the search terms that they would type into PubMed to locate articles to answer these questions . We entered the physician-provided search terms into PubMed and applied two types of search filters alone or in combination : a methods -based filter design ed to identify high- quality studies about treatment ( clinical queries “ therapy ” ) and a topic-based filter design ed to identify studies with renal content . We evaluated the comprehensiveness ( proportion of relevant articles found ) and efficiency ( ratio of relevant to nonrelevant articles ) of the filtered and nonfiltered search es . Primary studies included in the systematic review s served as the reference st and ard for relevant articles . Results : The average physician-provided search terms retrieved 46 % of the relevant articles , while 6 % of the retrieved articles were nonrelevant ( the ratio of relevant to nonrelevant articles was 1:16 ) . The use of both filters together produced a marked improvement in efficiency , result ing in a ratio of relevant to nonrelevant articles of 1:5 ( 16 percentage point improvement ; 99 % confidence interval 9 % to 22 % ; p < 0.003 ) with no substantive change in comprehensiveness ( 44 % of relevant articles found ; p = 0.55 ) . Interpretation : The use of PubMed search filters improves the efficiency of physician search es . Improved search performance may enhance the transfer of research into practice and improve patient care Background As the knowledge translation and comparative effectiveness research agendas gain momentum , we can expect more evidence on which to base quality improvement ( QI ) programmes . Unaided search es for such content in the literature , however , are likely to be daunting , with search es missing key articles while mainly retrieving articles that are irrelevant to the question being asked . The objective of this study was to develop and vali date optimal Medline search filters for retrieving original and review articles about clinical QI . Methods Analytical survey in the McMaster Clinical Hedges data base and Health Knowledge Refinery ( HKR ) of 161 clinical journals to determine the operating characteristics of QI search filters  developed by computerised combinations of terms selected to detect original QI studies and systematic review s meeting basic method ological criteria for scientific merit . Results from a derivation r and om subset of articles were tested in a validation r and om subset . Results The Clinical Hedges QI data base contained 49 233 citations of which 471 ( 0.96 % ) were original or review QI studies ; of those , 282 ( 60 % ) were method ologically sound . Combinations of search terms reached peak sensitivities of 100 % at a specificity of 89.3 % for detecting method ologically sound original and review QI studies , and sensitivities of 97.6 % at a specificity of 53.0 % for detecting all original and review QI studies independent of rigour . Operating characteristics of the search filters derived in the development data base worked similarly in the validation data base , without statistical differences . Conclusion New empirically derived Medline search filters have been vali date d to optimise retrieval of original and review QI articles OBJECTIVE Clinical Queries filters were developed to improve the retrieval of high- quality studies in search es on clinical matters . The study objective was to determine the yield of relevant citations and physician satisfaction while search ing for diagnostic and treatment studies using the Clinical Queries page of PubMed compared with search ing PubMed without these filters . MATERIAL S AND METHODS Forty practicing physicians , presented with st and ardized treatment and diagnosis questions and one question of their choosing , entered search terms which were processed in a r and om , blinded fashion through PubMed alone and PubMed Clinical Queries . Participants rated search retrievals for applicability to the question at h and and satisfaction . RESULTS For treatment , the primary outcome of retrieval of relevant articles was not significantly different between the groups , but a higher proportion of articles from the Clinical Queries search es met method ologic criteria ( p=0.049 ) , and more articles were published in core internal medicine journals ( p=0.056 ) . For diagnosis , the filtered results returned more relevant articles ( p=0.031 ) and fewer irrelevant articles ( overall retrieval less , p=0.023 ) ; participants needed to screen fewer articles before arriving at the first relevant citation ( p<0.05 ) . Relevance was also influenced by content terms used by participants in search ing . Participants varied greatly in their search performance . DISCUSSION Clinical Queries filtered search es returned more high- quality studies , though the retrieval of relevant articles was only statistically different between the groups for diagnosis questions . CONCLUSION Retrieving clinical ly important research studies from Medline is a challenging task for physicians . Method ological search filters can improve search retrieval Review articles are an important element of most medical journals and a popular source of information for clinicians ( 1 ) . Given the increasing volume of medical literature and the limited time for reading that busy clinicians have , reliance on review articles is likely to increase . However , concerns have been raised that narrative , non systematic review articles may produce biased conclusions ( 2 , 3 ) . Mulrow ( 4 ) examined 50 review articles published in four major medical journals ( The New Engl and Journal of Medicine , Annals of Internal Medicine , JAMA , and Archives of Internal Medicine ) in 1985 - 1986 and found that none fulfilled 8 explicit criteria for scientifically sound summaries of the evidence . As a result , she and others ( 5 , 6 ) proposed criteria for conducting and evaluating review articles that would improve their quality ; these criteria are the first 10 listed in the Appendix Table . In a study of 36 review articles done by nine content experts and method ologists , these criteria were shown to yield reliable and valid estimates of the scientific quality of review s ( 7 , 8) . We sought to describe the methods used in recently published review articles and determine whether the attention paid to the method ologic shortcomings of review articles has led to improvements in their scientific quality . Methods By using the Science Citation Index ( 9 ) , we stratified the 12 general medicine journals that are considered core journals for ACP Journal Club ( 10 ) into those with high impact factors ( scores 5 ) and those with lower impact factors . We r and omly selected 3 ( The New Engl and Journal of Medicine , Annals of Internal Medicine , and JAMA ) of the 4 high-impact core journals and 3 ( British Medical Journal , American Journal of Medicine , and Journal of Internal Medicine ) of the 8 core journals with lower impact factors . The sampling frame included 3 of the 4 journals examined in Mulrow 's original study ( 4 ) . All 6 journals were h and - search ed by two of the investigators independently , and review articles published between January and December 1996 were retrieved . Review articles were defined as full-text articles published under the banner review that dealt with disease states ; had the words review , overview , or meta- analysis in the title or abstract ; or indicated in the text that the intention was to review or summarize the literature about a clinical topic . Editorials , correspondence , and conference summaries were excluded . Disagreements on article eligibility ( which occurred in five cases ) were resolved by consensus . After training with a test set of articles , five of the authors used explicit criteria ( Appendix Table ) to rate the identified review articles . So that the raters ' assessment s would be blinded , the articles ' authors , author affiliations , and sources of articles were masked . The first 10 criteria in the Appendix Table ( hereafter referred to as method ologic criteria ) have been previously vali date d ( 7 ) and assess method ologic rigor , whereas the last five criteria were developed for this study to evaluate the scientific basis of treatment recommendations . Because inter-rater agreement was excellent on the test set ( overall agreement , 94 % ) , each rater was assigned a r and om sample of 20 % of the articles . One rater independently evaluated a r and om sample of five articles from each rater to assess inter-rater reliability for the criteria . The mean value was 0.79 , indicating substantial agreement ; overall agreement was 95 % and ranged from 84 % for criteria 1 and 6 to 100 % for criteria 2 , 3 , and 5 . After we determined the number of criteria fulfilled by each article , the number of articles meeting each criterion was ascertained . The proportion of review s from high-impact journals and from lower-impact journals that met each criterion were compared . Only the subset of review s containing treatment recommendations were used for the comparisons for criteria 7 to 15 . The chi-square test was used and 95 % CIs for the observed differences were calculated for all comparisons . In addition , articles identified as meta-analyses , systematic review s , or overviews in their title , abstract , or text were compared with the remaining review articles for each criterion ( again by using the chi-square test and by limiting analysis to those that included treatment recommendations for criteria 7 to 15 ) . Logistic regression analysis was used to adjust for journal of publication . The funding organizations were not involved in the design , conduct , analysis , or reporting of this study . Results A total of 158 review articles were identified : 60 from The New Engl and Journal of Medicine , 33 from Annals of Internal Medicine , 24 from British Medical Journal , 18 from American Journal of Medicine , 13 from JAMA , and 10 from Journal of Internal Medicine . ( A full list of the included articles is available from Dr. McAlister on request . ) Most review s were written by more than one author ( median number of authors , 2 [ range , 1 to 10 authors ] ) , and 111 review s ( 70 % ) made treatment recommendations . Although most articles had sections review ing the relevant pathophysiology and pharmacodynamics , 19 articles ( 12 % ) were largely basic science review s. Only 2 review s met all 10 method ologic criteria ; the median number of criteria fulfilled was one ( Figure ) . Nineteen ( 12 % ) of the review articles were described as meta- analysis , systematic review , or overview in the title or abstract ; 12 of these 19 articles were published in high-impact journals . A higher proportion of these articles met the method ologic criteria ( Appendix Table ) ; the comparisons for all but criterion 6 were statistically significant , even after adjustment for journal of publication ( P<0.005 for all comparisons ) . Although there was significant heterogeneity among journals ( P<0.005 for criteria 1 to 5 , 7 , and 8) , review articles published in high-impact journals did not meet method ologic criteria more frequently than those published in other journals ( Table ) . Exclusion of the review s from one journal with method ologic scores that were significantly lower than the rest ( P<0.001 for all comparisons ) resolved much of the interjournal heterogeneity and revealed that review s published in the remaining high-impact journals more often met some ( but not all ) of the method ologic criteria ( Table ) . Figure . Percentage of 158 review articles published in 1996 that fulfilled specific method ologic criteria . Table . Comparison of Methods Used in 1996 Review Articles , by Journal Impact Factor The 44 articles that described how evidence was located used the following sources ( which were not mutually exclusive ) : MEDLINE ( 42 articles ) , h and search of reference lists from published studies or review articles ( 30 articles ) , other electronic data bases ( 14 articles ) , contact with experts in the field ( 10 articles ) , h and search of relevant journals ( 7 articles ) , and contact with the pharmaceutical industry ( 5 articles ) . Of the 22 review s that included a description of the electronic search strategy , the search was restricted to English- language publications in 11 . Of the 111 review s in which treatment recommendations were made , a median of 3 therapies ( range , 1 to 23 therapies ) were discussed . The 16 meta-analyses that included treatment recommendations were more focused , examining a median of 1 therapy ( range , 1 to 6 therapies ) . The scientific basis of these recommendations is outlined in the last five criteria of the Appendix Table . Discussion In summary , only a minority of the review articles published in six widely read general medical journals specified rigorous , systematic methods of identifying , evaluating , and synthesizing the evidence , thereby raising concerns about the validity of their conclusions and recommendations ( 11 ) . Furthermore , although most review articles made recommendations for therapeutic options , their clinical relevance may be limited : Only one third discussed benefits and harms of the treatment options , only 6 % mentioned the relative or absolute costs of the various options , less than half provided an estimate of the anticipated treatment effect , and very few presented the results in clinical ly relevant formats that would be easily understood by clinicians . Although there is still substantial room for improvement , these results do represent progress from the situation in 1985 - 1986 ( Appendix Table ) . A higher proportion of recently published review s specify how the evidence was identified and synthesized . This same pattern was observed in a recent study of oncology review articles published in a single journal between 1983 and 1995 ( 12 ) . Similarly , our findings for meta-analyses published in these journals in 1996 are consistent with contemporaneous investigations in other fields and represent substantial improvement over the state of affairs in the mid-1980s ( 13 , 14 ) . Our study had several potential limitations . First , the authors of articles in which systematic methods were not specified may have used such methods but not reported them ( or the journal may have removed the details of the methods in prepublication ) . However , preliminary evidence suggests that there is little difference between the conduct of studies and their published methods ( 7 , 15 ) . In other words , if what was done is not reported , there is a good chance that it was not done rigorously ( 7 ) . Second , our finding that meta-analyses are more scientifically rigorous than other review s may be seen as tautological because the criteria used in this study may be used by meta-analysts in performing their studies . However , meta-analysts disagree over some issues of methodology , and published meta-analyses often vary in the quality of their reports ( 13 ) . Third , the practical importance of the method ologic flaws identified in these review s is difficult to ascertain . We lack empirical evidence that review s with explicit , systematic methods yield results closer to the truth , but it is known that non systematic review s are more prone to r and om and Background Rather than search ing the entire MEDLINE data base , clinicians can perform search es on a filtered set of articles where relevant information is more likely to be found . Members of our team previously developed two types of MEDLINE filters . The ' methods ' filters help identify clinical research of high method ological merit . The ' content ' filters help identify articles in the discipline of renal medicine . We will now test the utility of these filters for physician MEDLINE search ing . HypothesisWhen a physician search es MEDLINE , we hypothesize the use of filters will increase the number of relevant articles retrieved ( increase ' recall , ' also called sensitivity ) and decrease the number of non-relevant articles retrieved ( increase ' precision , ' also called positive predictive value ) , compared to the performance of a physician 's search unaided by filters . Methods We will survey a r and om sample of 100 nephrologists in Canada to obtain the  MEDLINE search  that they would first perform themselves for a focused clinical question . Each question we provide to a nephrologist will be based on the topic of a recently published , well-conducted systematic review . We will examine the performance of a physician 's unaided MEDLINE search . We will then apply a total of eight filter combinations to the search ( filters used in isolation or in combination ) . We will calculate the recall and precision of each search . The filter combinations that most improve on unaided physician search es will be identified and characterized . Discussion If these filters improve search performance , physicians will be able to search MEDLINE for renal evidence more effectively , in less time , and with less frustration . Additionally , our methodology can be used as a proof of concept for the evaluation of search filters in other disciplines Background The importance of respecting patients ’ preferences when making treatment decisions is increasingly recognized . Efficiently retrieving papers from the scientific literature reporting on the presence and nature of such preferences can help to achieve this goal . The objective of this study was to create a search filter for PubMed to help retrieve evidence on  patient preferences for treatment outcomes  . Methods A total of 27 journals were h and - search ed for articles on patient preferences for treatment outcomes published in 2011 . Selected articles served as a reference set . To develop optimal search strategies to retrieve this set , all articles in the reference set were r and omly split into a development and a validation set . MeSH-terms and keywords retrieved using PubReMiner were tested individually and as combinations in PubMed and evaluated for retrieval performance ( e.g. sensitivity ( Se ) and specificity ( Sp ) ) . Results Of 8238 articles , 22 were considered to report empirical evidence on patient preferences for specific treatment outcomes . The best search filters reached Se of 100 % [ 95 % CI 100 - 100 ] with Sp of 95 % [ 94–95 % ] and Sp of 97 % [ 97–98 % ] with 75 % Se [ 74–76 % ] . In the validation set these queries reached values of Se of 90 % [ 89–91 % ] with Sp 94 % [ 93–95 % ] and Se of 80 % [ 79–81 % ] with Sp of 97 % [ 96–96 % ] , respectively . Conclusions Narrow and broad search queries were developed which can help in retrieving literature on patient preferences for treatment outcomes . Identifying such evidence may in turn enhance the incorporation of patient preferences in clinical decision making and health technology assessment BACKGROUND People search medline for trials of healthcare interventions for clinical decisions , or to produce systematic review s , practice guidelines , or technology assessment s. Finding all relevant r and omized controlled trials ( RCTs ) with little extraneous material is challenging . OBJECTIVE To provide comparative data on the operating characteristics of search filters design ed to retrieve RCTs from medline . METHODS We identified 38 filters . The testing data base comprises h and search ing data from 161 clinical journals indexed in medline .  Sensitivity , specificity and precision were calculated . RESULTS The number of terms and operating characteristics varied considerably . Comparing the retrieval against the single term ' r and omized controlled trials.pt . ' ( sensitivity for retrieving RCTs , 93.7 % ) , 24 of 38 filters had statistically higher sensitivity ; 6 had a sensitivity of at least 99.0 % . Four other filters had specificities ( non retrieval of non- RCTs ) that were statistically not different or better than the single term ( 97.6 % ) . Precision was poor : only two filters had precision ( proportion of retrieved articles that were RCTs ) statistically similar to that of the single term (56.4%)-all others were lower . Filters with more search terms often had lower specificity , especially at high sensitivities . CONCLUSION Many RCT filters exist ( n = 38 ) . These comparative data can direct the choice of an RCT filter BACKGROUND / AIMS Electronic search es on data bases for r and omised clinical trials and controlled clinical trials do not identify as many trials as h and search es , and trial reporting may be flawed . The aims were to identify all fully reported r and omised clinical trials in the Journal of Hepatology and to make a qualitative assessment of the reporting . METHODS The publications were identified by systematic ally h and search ing the full text of the journal and search ing MEDLINE . Central dimensions of trial quality were used to assess the reporting quality of the trials . RESULTS R and omised clinical trials represented 8.4 % of the original articles ( 171/2028 ) . Ten original articles ( 0.5 % ) could not be classified . A search on MEDLINE identified 81.3 % of the r and omised clinical trials , i.e. , 139 out of the 171 identified by the h and search . A total of 166 r and omised clinical trials could be quality assessed . Forty-seven ( 28.3 % ) of them reported adequate generation of allocation sequence ; 22 ( 13.3 % ) adequate allocation concealment ; 95 ( 57.2 % ) allowed intention-to-treat analysis with only a few losses to follow-up ; 50 ( 30.1 % ) were double-blind ; 33 ( 19.9 % ) reported sample -size calculations ; 13 trials ( 7.8 % ) employed the crossover design ; and the median number of subjects per intervention arm in parallel group trials was 19 subjects ( interquartile range : 11 - 31 ; range : 5 - 519 ) . The quality of reporting was significantly better in regular issue articles than in supplement articles . CONCLUSIONS Many important r and omised clinical trials are published in the Journal of Hepatology , but there seems to be ample room for improvement of quality of reporting OBJECTIVES To determine the relationship between the quality of articles and whether they were published in a supplement or in the parent journal . DATA SOURCES AND STUDY SELECTION All r and omized control trials of drug therapies in adults published in the American Journal of Cardiology , the American Journal of Medicine and the American Heart Journal from January 1990 and obtained in November 1992 by means of a MEDLINE search . A total of 318 abstract s appeared to meet our inclusion criteria , and these articles were obtained and review ed in further detail . An additional 76 were excluded . DATA EXTRACTION Three review ers who were " blinded " and thus unaware of supplement status independently assessed the quality of each of the remaining 242 articles according to a st and ard quality scoring system . DATA SYNTHESIS Overall , 67 ( 27.7 % ) of the articles were published in journal supplements . Article quality scores ranged from 4.2 % to 87.5 % , with a mean ( + /- SD ) score of 37.2 % + /- 13.1 % . Quality scores were lower in articles published in journal supplements than in those published in the parent journal ( t[240 ] = 2.61 , P = .01 ) . The mean quality score for articles published in journal supplements was 33.6 % + /- 12.8 % compared with a score of 38.5 % + /- 13.1 % for articles published in the parent journal . Supplement articles included in their final analysis a smaller proportion of the patients initially r and omized ( t[75 ] = 2.8 , P = .007 ) . CONCLUSION Our findings suggest that r and omized control trials published in journal supplements are generally of inferior quality compared with articles published in the parent journal . The review process surrounding the publication of journal supplements should be consistent with that of the parent journal Abstract Aims /hypothesis . Journals play an important part in continuing medical education and in influencing the prescription of drugs . Because little is known about reading habits and information management of specialists a question naire survey among German diabetologists was conducted . Subjects and methods . A non-r and omised sample of 461 German diabetologists was selected from a data base of German diabetologists ( n=1585 ) . A question naire was developed ( 92 items ) which consisted of eight sections : continuing education in general , decision making and problem solving , use of data bases , reading habits , knowledge of technical terms and critical appraisal skills , personal data . Results . The adjusted response rate was 57 % ( crude 52 % ) . Most influential factors for therapeutic decision making were due to own experience , continuing education events , published material , and colleagues . The influence of industry related factors was perceived low . A relatively high rate of respondents ( 39 % ) perceived the influence by patients as rather low . Overall 90 % had convenient access to the internet , MedLine or EMBASE but only 45 % search ed data bases regularly ( three search es per month ) . Median time for reading journals was 3 h a week . Five journals were read regularly , 25 % of which were diabetological journals and 47 % of the respondents did not read English written journals regularly . The methods section of an article was seldom read whereas the abstract and the discussion were almost always read . Most respondents had some underst and ing of technical terms but reported practice s of appraising articles were inadequate . Conclusion /interpretation . It could be shown that reading expenditures and critical appraisal skills of diabetologists are slightly higher compared with non-specialists . But the concept of evidence -based medicine still does not seem to be incorporated in clinical practice OBJECTIVE The ability to accurately identify articles about therapy in large bibliographic data bases such as EMBASE is important for research ers and clinicians . Our study aim ed to develop optimal search strategies for detecting sound treatment studies in EMBASE in the year 2000 . METHODS H and search es of journals were compared with retrievals from EMBASE for c and i date search strategies . Six trained research assistants review ed fifty-five journals indexed in EMBASE and rated articles using purpose and quality indicators . C and i date search strategies were developed for identifying treatment articles and then tested , and the retrievals were compared with the h and - search data . The operating characteristics of the strategies were calculated . RESULTS Three thous and eight hundred fifty articles were original studies on treatment , of which 1,256 ( 32.6 % ) were method ologically sound . Combining search terms revealed a top performing strategy ( r and om:.tw . OR clinical trial:.mp . OR exp health care quality ) with sensitivity of 98.9 % and specificity of 72.0 % . Maximizing specificity , a top performing strategy ( double-blind:.mp . OR placebo:.tw . OR blind : .tw . ) achieved a value over 96.0 % , but with compromised sensitivity at 51.7 % . A 3-term strategy achieved the best optimization of sensitivity and specificity ( r and om:.tw . OR placebo:.mp . OR double-blind:.tw . ) , with both these values over 92.0 % . CONCLUSION Search strategies can achieve high performance for retrieving sound treatment studies in EMBASE Differential enrollment into clinical trials by gender has been described previously . In 1993 , the National Institutes of Health ( NIH ) Revitalization Act was enacted to promote the inclusion of women in clinical trials . The purpose of this study was to review patterns in clinical trial enrollment among studies published in a major medical journal to determine the effects of this policy . A systematic search was conducted of all articles published in the Original Articles section of The New Engl and Journal of Medicine from 1994 to 1999 . Two independent observers abstract ed information from the r and omized clinical trials using st and ardized forms . All r and omized clinical trials in which the primary end point was total mortality or included mortality in a composite end point were considered for review . Trials were analyzed for enrollment of women with respect to disease state , funding source , site of trial performance , and use of gender-specific data analysis . From 1994 to 1999 , 1322 original articles were published in The New Engl and Journal of Medicine , including 442 r and omized , controlled trials of which 120 met our inclusion criteria . On average , 24.6 % women were enrolled .  Gender-specific data analysis was performed in 14 % of the trials . The NIH Revitalization Act does not appear to have improved gender-balanced enrollment or promoted the use of gender-specific analyses in clinical trials published in an influential medical journal . Overcoming this trend will require rigorous efforts on the part of funding entities , trial investigators , and journals disseminating study results The inadequacy of most of traditional sources for medical information , like textbook and review article , do not sustained the clinical decision based on the best evidence current available , exposing the patient to a unnecessary risk . Although not integrated around clinical problem areas in the convenient way of textbooks , current best evidence from specific studies of clinical problems can be found in an increasing number of Internet and electronic data bases . The sources that have already undergone rigorous critical appraisal are classified as secondary information sources , others that provide access to original article or abstract , as primary information source , where the quality assessment of the article rely on the clinician oneself . The most useful primary information source are SciELO , the online collection of Brazilian scientific journals , and Medline , the most comprehensive data base of the USA National Library of Medicine , where the search may start with use of keywords , that were obtained at the structured answer construction ( P.I.C.O. ) , with the addition of boolean operators " AND " , " OR " , " NOT " . Between the secondary information sources , some of them provide critically appraised articles , like ACP Journal Club , Evidence Based Medicine and InfoPOEMs , others provide evidence s organized as online texts , such as " Clinical Evidence " and " UpTo Date " , and finally , Cochrane Library are composed by systematic review s of r and omized controlled trials . To get studies that could answer the clinical question is part of a mindful practice , that is , becoming quicker and quicker and dynamic with the use of PDAs , Palmtops and Notebooks AIMS To analyse the effect on systematic review s in diabetes interventions of including only trials that are indexed in medline , and to assess the impact of adding trials from other data bases and the grey literature . METHODS All systematic review s of diabetes interventions which included a meta- analysis of r and omized controlled trials , and were published since 1996 , were selected . The impact on the meta- analysis of including only those trials indexed in medline , and the effect of then adding trials from other sources , was assessed . Where possible this was measured quantitatively , by redoing the meta- analysis , otherwise a qualitative estimate was made . RESULTS Forty-four systematic review s met our inclusion criteria . There were 120 articles reporting trial data which were not indexed in medline . These came from 52 % of the review s. In 34 % of the review s , basing a meta- analysis on a search of only medline would miss trials that could affect the result . Sources of non- medline data which had the biggest effect on the meta-analyses were journal articles from central and embase ( mainly in Diabetes , Nutrition and Metabolism ) and unpublished data ( mainly from industry ) . The exceptions were journal articles on herbal medicine , mostly indexed in Chinese language data bases . CONCLUSIONS A search of only the medline data base is insufficient for systematic review s of diabetes , because in about 34 % of review s the missed trials could affect the results of the meta- analysis . It is recommended that central ( on the Cochrane Library ) also be search ed . Scanning meeting abstract s , and seeking unpublished data are also recommended if the intervention has only recently been introduced Background The prevalence of overweight and obesity in children and adolescents is increasing at an alarming rate around the world and prevention has become a key public health objective . Treatment and management of those already overweight and obese must be aligned with the best available evidence on effectiveness , if the risk of obesity‐related morbidity and mortality is yet be reduced . Diet plays a pivotal role in successful treatment of obesity but to date , there is limited evidence on which to base practice . Objectives To identify and present the best available evidence on the optimal dietetic treatment and management of children and adolescent who are overweight or obese . Search strategy Published English language literature was search ed using the electronic data bases CINAHL , MEDLINE , PRE‐ MEDLINE , DARE , COCHRANE , EMBASE , AUSTROM , Current Concepts and Dissertation Abstract s. The data bases were limited to English Language from 1975 until 2003 . Government reports from the UK , USA and Australian were also search ed and a h and search performed for the Journal of the Dietitians Association of Australia , International Journal of Obesity and the Journal of Human Nutrition and Dietetics and the bibliographies of retrieved articles . Selection criteria ( i ) Interventions that evaluated the effectiveness of nutrition or dietary interventions to treat or manage overweight and obesity ; ( ii ) Children aged less than 18 years ; and ( iii ) Participants were defined as overweight or obese by relative weight or a measure of body weight status , studies that reported body weight per se were excluded . Data collection and analysis An experienced professional librarian search ed the data bases , and two trained research assistants independently identified studies for retrieval and assessed each article for inclusion . The included studies were critically appraised for method ological quality by two people independently . Data were extracted from the appropriate articles and when a discrepancy arose , a third party would arbitrate . Main results There were 116 articles that met the inclusion criteria . While 49 articles described r and omised controlled trials , they arose from 37 separate studies . There were 67 non‐r and omised trials . Meta‐analyses were performed on eight studies that included both a dietary intervention component and an adequate control group and on four studies that had follow‐up data . There was a high degree of heterogeneity between studies and this made comparisons between studies problematic . Interventions that include diet therapy generally result in significant weight loss , at least in the short term . Many studies were poorly design ed and had no or only minimal follow up . The details of the dietary intervention were often inadequately described and dietary outcomes rarely reported , making repetition of the studies difficult . Review ers ' conclusions There is an urgent need for high quality studies investigating the optimal dietary approach to management of paediatric  overweight and obesity . These studies require adequate follow up to ascertain if weight loss can be sustained in the long term . Details of the dietary prescription , adherence to the dietary intervention and diet‐specific outcomes need to be reported in order to inform best practice Background The prevalence of overweight and obesity in children and adolescents is increasing at an alarming rate around the world and prevention has become a key public health objective . Treatment and management of those already overweight and obese must be aligned with the best available evidence on effectiveness , if the risk of obesity-related morbidity and mortality is yet be reduced . Diet plays a pivotal role in successful treatment of obesity but to date , there is limited evidence on which to base practice . Objectives To identify and present the best available evidence on the optimal dietetic treatment and management of children and adolescent who are overweight or obese . Search strategy Published English language literature was search ed using the electronic data bases CINAHL , MEDLINE , PRE- MEDLINE , DARE , COCHRANE , EMBASE , AUSTROM , Current Concepts and Dissertation Abstract s. The data bases were limited to English Language from 1975 until 2003 . Government reports from the UK , USA and Australian were also search ed and a h and search performed for the Journal of the Dietitians Association of Australia , International Journal of Obesity and the Journal of Human Nutrition and Dietetics and the bibliographies of retrieved articles . Selection criteria ( i ) Interventions that evaluated the effectiveness of nutrition or dietary interventions to treat or manage overweight and obesity ; ( ii ) Children aged less than 18 years ; and ( iii ) Participants were defined as overweight or obese by relative weight or a measure of body weight status , studies that reported body weight per se were excluded . Data collection and analysis An experienced professional librarian search ed the data bases , and two trained research assistants independently identified studies for retrieval and assessed each article for inclusion . The included studies were critically appraised for method ological quality by two people independently . Data were extracted from the appropriate articles and when a discrepancy arose , a third party would arbitrate . Main results There were 116 articles that met the inclusion criteria . While 49 articles described r and omised controlled trials , they arose from 37 separate studies . There were 67 non-r and omised trials . Meta-analyses were performed on eight studies that included both a dietary intervention component and an adequate control group and on four studies that had follow-up data . There was a high degree of heterogeneity between studies and this made comparisons between studies problematic . Interventions that include diet therapy generally result in significant weight loss , at least in the short term . Many studies were poorly design ed and had no or only minimal follow up . The details of the dietary intervention were often inadequately described and dietary outcomes rarely reported , making repetition of the studies difficult . Review ers ' conclusions There is an urgent need for high quality studies investigating the optimal dietary approach to management of paediatric overweight and obesity . These studies require adequate follow up to ascertain if weight loss can be sustained in the long term . Details of the dietary prescription , adherence to the dietary intervention and diet-specific outcomes need to be reported in order to inform best practice
Specifically , the research er studied whether ( a ) there was a significant difference in physiological measures , ( b ) there was a significant difference in quality of life , ( c ) there was a significant difference in satisfaction levels , ( d ) there was a significant difference in pain reduction , ( e ) there was a significant difference in procedural length , ( f ) there was a significant difference in length of stay , and ( g ) whether the overall effect size and 95 % confidence level support the recommendation of music therapy in the health care setting .
The purpose of the activity reported in this article was to conduct an exhaustive search of the Journal of  Music Therapy  , filter the articles on the desired parameters , and organize data for analysis and interpretation .