title: Efficiency of pragmatic search strategies to update clinical guidelines recommendations.
abstract: BACKGROUND
  A major challenge in updating clinical guidelines is to efficiently identify new, relevant evidence. We evaluated the efficiency and feasibility of two new approaches: the development of restrictive search strategies using PubMed Clinical Queries for MEDLINE and the use of the PLUS (McMaster Premium Literature Service) database.
  
  
  METHODS
  We evaluated a random sample of recommendations from a national guideline development program and identified the references that would potentially trigger an update (key references) using an exhaustive approach. We designed restrictive search strategies using the minimum number of Medical Subject Headings (MeSH) terms and text words required from the original exhaustive search strategies and applying broad and narrow filters. We developed PLUS search strategies, matching Medical Subject Headings (MeSH) and Systematized Nomenclature of Medicine (SNOMED) terms with guideline topics. We compared the number of key references retrieved by these approaches with those retrieved by the exhaustive approach.
  
  
  RESULTS
  The restrictive approach retrieved 68.1 % fewer references than the exhaustive approach (12,486 versus 39,136), and identified 89.9 % (62/69) of key references and 88 % (22/25) of recommendation updates. The use of PLUS retrieved 88.5 % fewer references than the exhaustive approach (4,486 versus 39,136) and identified substantially fewer key references (18/69, 26.1 %) and fewer recommendation updates (10/25, 40 %).
  
  
  CONCLUSIONS
  The proposed restrictive approach is a highly efficient and feasible method to identify new evidence that triggers a recommendation update. Searching only in the PLUS database proved to be a suboptimal approach and suggests the need for topic-specific tailoring.
authors.affiliation: Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain. laura.martinez.garcia@cochrane.es.
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authors.affiliation: Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain. akotzeva@gencat.cat.|CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain. akotzeva@gencat.cat.
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authors.affiliation: Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain. DRigau@santpau.cat.
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authors.forename: J
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authors.affiliation: GuíaSalud-Aragon Institute of Health Sciences, Zaragoza, Spain. fsalcedo.iacs@aragon.es.
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authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. bhaynes@mcmaster.ca.
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authors.affiliation: Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain. PAlonso@santpau.cat.|CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain. PAlonso@santpau.cat.
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mesh_terms: D005240:Feasibility Studies; D006801:Humans; D016247:Information Storage and Retrieval / Q000379:methods*; D016239:MEDLINE; D046650:Medical Subject Headings; D017410:Practice Guidelines as Topic / Q000592:standards*; D039781:PubMed; D015203:Reproducibility of Results