Ethics information retrieval in HTA: state of current practice.

OBJECTIVES: Though there have been longstanding discussions on the value of ethics in health technology assessment (HTA), less awareness exists on ethics information retrieval methods. This study aimed to scope available evidence and determine current practices for ethics information retrieval in HTA. METHODS: Literature searches were conducted in Ovid MEDLINE, LISTA, Scopus, and Google Scholar. Once a list of relevant articles was determined, citation tracking was conducted via Scopus. HTA agency websites were searched for published guidance on ethics searching, and for reports which included ethical analyses. Methods sections of each report were analyzed to determine the databases, subject headings, and keywords used in search strategies. The team also reached out to information specialists for insight into current search practices. RESULTS: Findings from this study indicate that there is still little published guidance from HTA agencies, few HTAs that contain substantial ethical analysis, and even less information on the methodology for ethics information retrieval. The researchers identified twenty-five relevant HTAs. Ten of these reports did not utilize subject-specific databases outside health sciences. Eight reports published ethics searches, with significant overlap in subject headings and text words. CONCLUSIONS: This scoping study of current practice in HTA ethics information retrieval highlights findings of previous studies-while ethics analysis plays a crucial role in HTA, methods for literature searching remain relatively unclear. These findings provide insight into the current state of ethics searching, and will inform continued work on filter development, database selection, and grey literature searching.

Updated generic search filters for finding studies of adverse drug effects in Ovid medline and Embase may retrieve up to 90% of relevant studies.

BACKGROUND: The most current objectively derived search filters for adverse drug effects are 15 years old and other strategies have not been developed and tested empirically. OBJECTIVE: To develop and validate search filters to retrieve evidence on adverse drug effects from Ovid medline and Ovid Embase. METHODS: We identified systematic reviews of adverse drug effects in Epistemonikos. From these reviews, we collated their included studies which we then randomly divided into three tests and one validation set of records. We constructed a search strategy to maximise relative recall using word frequency analysis with test set one. This search strategy was then refined using test sets two and three and validated on the final set of records. RESULTS: Of 107 systematic reviews which met our inclusion criteria, 1948 unique included studies were available from medline and 1980 from Embase. Generic adverse drug effects searches in medline and Embase achieved 90% and 89% relative recall, respectively. When specific adverse effects terms were added recall was improved. CONCLUSION: We have derived and validated search filters that retrieve around 90% of records with adverse drug effects data in medline and Embase. The addition of specific adverse effects terms is required to achieve higher recall.

Sepsis-Associated Mortality, Resource Use, and Healthcare Costs: A Propensity-Matched Cohort Study.

OBJECTIVES: To examine long-term mortality, resource utilization, and healthcare costs in sepsis patients compared to hospitalized nonsepsis controls. DESIGN: Propensity-matched population-based cohort study using administrative data. SETTING: Ontario, Canada. PATIENTS: We identified a cohort of adults (≥ 18) admitted to hospitals in Ontario between April 1, 2012, and March 31, 2016, with follow-up to March 31, 2017. Sepsis patients were flagged using a validated International Classification of Diseases, 10th Revision-coded algorithm (Sepsis-2 definition), including cases with organ dysfunction (severe sepsis) and without (nonsevere). Remaining hospitalized patients were potential controls. Cases and controls were matched 1:1 on propensity score, age, sex, admission type, and admission date. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Differences in mortality, rehospitalization, hospital length of stay, and healthcare costs were estimated, adjusting for remaining confounders using Cox regression and generalized estimating equations. Of 270,669 sepsis cases, 196,922 (73%) were successfully matched: 64,204 had severe and 132,718 nonsevere sepsis (infection without organ dysfunction). Over follow-up (median 2.0 yr), severe sepsis patients had higher mortality rates than controls (hazard ratio, 1.66; 95% CI, 1.63-1.68). Both severe and nonsevere sepsis patients had higher rehospitalization rates than controls (hazard ratio, 1.53; 95% CI, 1.50-1.55 and hazard ratio, 1.41; 95% CI, 1.40-1.43, respectively). Incremental costs (Canadian dollar 2018) in sepsis cases versus controls at 1-year were: $29,238 (95% CI, $28,568-$29,913) for severe and $9,475 (95% CI, $9,150-$9,727) for nonsevere sepsis. CONCLUSIONS: Severe sepsis was associated with substantially higher long-term risk of death, rehospitalization, and healthcare costs, highlighting the need for effective postdischarge care for sepsis survivors.

A collaborative pilot on current awareness alerts for disinvestment and horizon scanning.

OBJECTIVE: In 2019, members of the Health Technology Assessment international (HTAi) Interest Group for Disinvestment and Early Awareness (DEA-IG) and the HTAi Interest Group for Information Retrieval (IR-IG) agreed to produce quarterly current awareness alerts for members of the DEA-IG. The purpose was to pilot a predefined strategy for sharing new publications on methods and topical issues in this area. METHODS: Literature search strategies for PubMed and Google were developed. Retrieved citations were posted on the DEA-IG Web site. Members of the DEA-IG received an email notification when new alerts were available. An informal survey of the DEA-IG members was used to provide feedback after the pilot. RESULTS: Six alerts were issued during the pilot (June 2019-September 2020) with a total of 170 citations. The bulk of the information were 124 PubMed indexed citations, and of these, 96 were retrieved by the PubMed search strategies. Google searches were not found to be useful, but ongoing horizon scanning work at the Canadian Agency for Drugs and Technologies in Health (CADTH) provided additional information. Based on retrospective sorting, we considered thirty-five PubMed citations to be highly relevant for health technology assessment (HTA). The response rate to the survey was limited (seventeen respondents), but most respondents found the alerts useful for their work. CONCLUSIONS: The results of this pilot project can be used to revise search strategies and information sources, improve the relevance of the alerts, and plan for expanded dissemination strategies.

Almost half of references in reports on new and emerging nondrug health technologies are grey literature.

OBJECTIVE: The research investigated how frequently grey literature is used in reports on new and emerging nondrug health technologies, which sources are most cited, and how grey literature searching is reported. METHODS: A retrospective review of references cited in horizon scanning reports on nondrug health technologies-including medical devices, laboratory tests, and procedures-was conducted. A quasi-random sample of up to three reports per agency was selected from a compilation of reports published in 2014 by international horizon scanning services and health organizations. RESULTS: Twenty-two reports from 8 agencies were included in the analysis. On average, 47% (288/617) of references listed in the bibliographies of the horizon scanning reports were grey literature. The most frequently cited type of grey literature was information from manufacturers (30% of all grey literature references), regulatory agencies (10%), clinical trial registries (9%), and other horizon scans or evidence synthesis reports (9%). The US Food and Drug Administration (FDA) and ClincalTrials.gov were the most frequently cited specific sources, constituting 7% and 8% of grey literature references, respectively. Over two-thirds (15/22) of the analyzed reports provided some details on search methodology; all 15 of these reported searching some grey literature. CONCLUSIONS: In this sample, grey literature represented almost half of the references cited in reports on new and emerging nondrug health technologies. Of these grey literature references, almost half came from three sources: the manufacturers, ClincalTrials.gov, and the FDA. There was wide variation in the other sources cited. Literature search methodology was often insufficiently reported for analysis.

Errata for trial publications are not uncommon, are frequently not trivial, and can be challenging to access: a retrospective review.

Objective: The research sought to determine the prevalence of errata for drug trial publications that are included in systematic reviews, their potential value to reviews, and their accessibility via standard information retrieval methods. Methods: The authors conducted a retrospective review of included studies from forty systematic reviews of drugs evaluated by the Canadian Agency for Drugs and Technologies in Health (CADTH) Common Drug Review (CDR) in 2015. For each article that was included in the systematic reviews, we conducted searches for associated errata using the CDR review report, PubMed, and the journal publishers' websites. The severity of errors described in errata was evaluated using a three-category scale: trivial, minor, or major. The accessibility of errata was determined by examining inclusion in bibliographic databases, costs of obtaining errata, time lag between article and erratum publication, and correction of online articles. Results: The 40 systematic reviews included 127 articles in total, for which 26 errata were identified. These errata described 38 errors. When classified by severity, 6 errors were major; 20 errors were minor; and 12 errors were trivial. No one database contained all the errata. On average, errata were published 211 days after the original article (range: 15-1,036 days). All were freely available. Over one-third (9/24) of online articles were uncorrected after errata publication. Conclusion: Errata frequently described non-trivial errors that would either impact the interpretation of data in the article or, in fewer cases, impact the conclusions of the study. As such, it seems useful for reviewers to identify errata associated with included studies. However, publication time lag and inconsistent database indexing impair errata accessibility.

The development of search filters for adverse effects of medical devices in medline and embase.

BACKGROUND: Objectively derived search filters for adverse drug effects and complications in surgery have been developed but not for medical device adverse effects. OBJECTIVE: To develop and validate search filters to retrieve evidence on medical device adverse effects from ovid medline and embase. METHODS: We identified systematic reviews from Epistemonikos and the Health Technology Assessment (hta) database. Included studies within these reviews that reported on medical device adverse effects were randomly divided into three test sets and one validation set of records. Using word frequency analysis from one test set, we constructed a sensitivity maximising search strategy. This strategy was refined using two other test sets, then validated. RESULTS: From 186 systematic reviews which met our inclusion criteria, 1984 unique included studies were available from medline and 1986 from embase. Generic adverse effects searches in medline and embase achieved 84% and 83% sensitivity. Recall was improved to over 90%, however, when specific adverse effects terms were added. CONCLUSION: We have derived and validated novel search filters that retrieve over 80% of records with medical device adverse effects data in medline and embase. The addition of specific adverse effects terms is required to achieve higher levels of sensitivity.

Women's preferences and experiences of cervical cancer screening in rural and remote areas: a systematic review and qualitative meta-synthesis.

INTRODUCTION: Cervical cancer is one of the leading causes of mortality in women. Population-based cervical cancer screening programs have been highly effective in reducing the incidence and mortality of cervical cancer worldwide. However, disparities remain in women's cervical cancer screening participation rates, especially in rural and remote areas, where access to health care may be circumscribed due to logistical barriers. Until now, there has been no effort to review and synthesize the perspectives and experiences of women accessing cervical cancer screening in rural and remote areas. This systematic review and qualitative meta-synthesis of 14 studies aimed to describe and elaborate the issues women face when accessing cervical cancer screening in rural and remote areas. METHODS: This study used the qualitative meta-synthesis approach to review 14 studies on rural women's participation in cervical cancer screening. This research approach synthesized findings from multiple, primary qualitative studies to produce a new interpretation of the phenomenon while retaining the original meaning of each qualitative study. RESULTS: After 4937 citations were screened by database searching, 117 were retrieved for full-text review, of which 14 studies were included. This study identified two themes that modulate rural women's access to cervical cancer screening: interactions with healthcare providers and healthcare system access. Furthermore, this study found that women frequently expressed issues around patient-centered care in their interactions with healthcare providers. The implications of these findings for program design and delivery efforts in rural and remote areas are discussed. CONCLUSION: This article provides the foundation for tailoring interventions and programming to increase cervical cancer screening rates in women who reside in rural and remote areas. This review also clarifies the factors of patient-centered care that may be adopted to enhance the quality of care for women in rural and remote areas. In summary, this systematic review and qualitative meta-synthesis provide information about women's perspectives and experiences accessing cervical cancer screening in rural and remote areas. The review has strong implications for this population and can be used to inform future research and program design initiatives.

Effectiveness of adverse effects search filters: drugs versus medical devices.

OBJECTIVE: The study tested the performance of adverse effects search filters when searching for safety information on medical devices, procedures, and diagnostic tests in MEDLINE and Embase. METHODS: The sensitivity of 3 filters was determined using a sample of 631 references from 131 rapid reviews related to the safety of health technologies. The references were divided into 2 sets by type of intervention: drugs and nondrug health technologies. Keyword and indexing analysis were performed on references from the nondrug testing set that 1 or more of the filters did not retrieve. RESULTS: For all 3 filters, sensitivity was lower for nondrug health technologies (ranging from 53%-87%) than for drugs (88%-93%) in both databases. When tested on the nondrug health technologies set, sensitivity was lower in Embase (ranging from 53%-81%) than in MEDLINE (67%-87%) for all filters. Of the nondrug records that 1 or more of the filters missed, 39% of the missed MEDLINE records and 18% of the missed Embase records did not contain any indexing terms related to adverse events. Analyzing the titles and abstracts of nondrug records that were missed by any 1 filter, the most commonly used keywords related to adverse effects were: risk, complications, mortality, contamination, hemorrhage, and failure. CONCLUSIONS: In this study, adverse effects filters were less effective at finding information about the safety of medical devices, procedures, and tests compared to information about the safety of drugs.

Rapid review: an emerging approach to evidence synthesis in health technology assessment.

BACKGROUND: Increasingly, healthcare decision makers demand quality evidence in a short timeframe to support urgent and emergent decisions related to procurement, clinical practice, and policy. Health technology assessment (HTA) producers are responding by developing innovative approaches to evidence synthesis that can be executed more quickly than traditional systematic review. These approaches, and the broader implications they bring to bear on health decision making and policy development, however, are generally neither well-understood nor well-described. This study intends to contribute to an emerging literature around methodological approaches to rapid review in HTA by outlining those developed and implemented by the Canadian Agency for Drugs and Technologies in Health (CADTH). METHODS: Since 2005, CADTH has developed and implemented a rapid review approach that synthesizes evidence to support informed healthcare decisions and policy. Rapid Response reports are tailored to the identified needs of Canadian health decision makers, representing a range of options with regard to depth, breadth, and time-to-delivery. RESULTS: Preliminary observations indicate that CADTH's approach to rapid evidence review is generally well-received by Canadian health decision makers; real-world case studies provide pragmatic examples of how health decision makers have used Rapid Response reports to support evidence-informed health decisions across Canada. CONCLUSIONS: Rapid review is becoming an increasingly important approach to evidence synthesis, both within and external to the field of HTA. Transparent reporting of the methods used to develop rapid review products will be critical to the assessment of their relevance, utility and effects in a range of contexts.

Indigenous women's experiences of cervical cancer screening: Incorporating Indigenous ways of knowing into a systematic review and meta-synthesis of qualitative research.

Due to historical and contextual factors, cervical cancer is typically detected at a later stage in Indigenous women, and so has higher morbidity and mortality. Increasing participation in cervical cancer screening (CCS) could ameliorate this health inequity by detecting cancer when it is more easily treatable. To understand the perspectives, preferences, and experiences of Indigenous women related to participation in CCS, we conducted a systematic review and meta-synthesis of nine qualitative research studies. To advance decolonised qualitative evidence synthesis approaches, we use a modified version of the Two Row Wampum-Covenant Chain Tradition, a Haudenosaunee two-eyed seeing analytic approach that integrates Western approaches with Indigenous worldviews. Using the metaphor of a network of forest plants, we illustrate the systemic and topical barriers and facilitators to CCS, as reported by Indigenous women. We use this metaphor to reiterate the importance of all levels of change to improve CCS experiences for Indigenous women.

Understanding Black Women's Perspectives and Experiences of Cervical Cancer Screening: A Systematic Review and Qualitative Meta-synthesis.

Cervical cancer is the third most common gynecological cancer. Effective population-based cervical cancer screening programs exist, but improvements in morbidity and mortality continue to demonstrate racial disparities. For example, Black women are 41% more likely to develop cervical cancer than White women and are 75% more likely to die from it. It is therefore important to understand whether these inequities in cervical cancer outcomes are related to differential access and uptake of screening programs. In this systematic review and qualitative meta-synthesis, we used an intersectional lens to understand Black women's experiences and perspectives of cervical cancer screening (CCS). We identified 12 factors related to the perspectives and experiences of Black women participating in CCS. Understanding Black women's experiences and perspectives of CCS can help individual clinicians and policymakers implement CCS in a way that is culturally appropriate and cognizant of structural oppression.

Risk of bias tools in systematic reviews of health interventions: an analysis of PROSPERO-registered protocols.

BACKGROUND: Systematic reviews of health interventions are increasingly incorporating evidence outside of randomized controlled trials (RCT). While non-randomized study (NRS) types may be more prone to bias compared to RCT, the tools used to evaluate risk of bias (RoB) in NRS are less straightforward and no gold standard tool exists. The objective of this study was to evaluate the planned use of RoB tools in systematic reviews of health interventions, specifically for reviews that planned to incorporate evidence from RCT and/or NRS. METHODS: We evaluated a random sample of non-Cochrane protocols for systematic reviews of interventions registered in PROSPERO between January 1 and October 12, 2018. For each protocol, we extracted data on the types of studies to be included (RCT and/or NRS) as well as the name and number of RoB tools planned to be used according to study design. We then conducted a longitudinal analysis of the most commonly reported tools in the random sample. Using keywords and name variants for each tool, we searched PROSPERO records by year since the inception of the database (2011 to December 7, 2018), restricting the keyword search to the "Risk of bias (quality) assessment" field. RESULTS: In total, 471 randomly sampled PROSPERO protocols from 2018 were included in the analysis. About two-thirds (63%) of these planned to include NRS, while 37% restricted study design to RCT or quasi-RCT. Over half of the protocols that planned to include NRS listed only a single RoB tool, most frequently the Cochrane RoB Tool. The Newcastle-Ottawa Scale and ROBINS-I were the most commonly reported tools for NRS (39% and 33% respectively) for systematic reviews that planned to use multiple RoB tools. Looking at trends over time, the planned use of the Cochrane RoB Tool and ROBINS-I seems to be increasing. CONCLUSIONS: While RoB tool selection for RCT was consistent, with the Cochrane RoB Tool being the most frequently reported in PROSPERO protocols, RoB tools for NRS varied widely. Results suggest a need for more education and awareness on the appropriate use of RoB tools for NRS. Given the heterogeneity of study designs comprising NRS, multiple RoB tools tailored to specific designs may be required.