Recording Database Searches for Systematic Reviews - What is the Value of Adding a Narrative to Peer-Review Checklists? A Case Study of NICE Interventional Procedures Guidance

This paper discusses the value of open and transparent methods for recording systematic database search strategies, showing how they have been applied at the National Institute for Health and Clinical Excellence (NICE) in the United Kingdom (UK). Objective – The objectives are to: 1) Discuss the value of search strategy recording methods. 2) Assess any limitations to the practical application of a checklist approach. 3) Make recommendations for recording systematic database searches. Methods – The procedures for recording searches for Interventional Procedures Guidance at NICE were examined. A sample of current methods for recording systematic searches identified in the literature was compared to the NICE processes. The case study analyses the search conducted for evidence about an interventional procedure and shows the practical issues involved in recording the database strategies. The case study explores why relevant papers were not retrieved by a search strategy meeting all of the criteria on the checklist used to peer review it. The evidence was required for guidance on non-rigid stabilisation techniques for the treatment of low back pain. Results – The analysis shows that amending the MEDLINE strategy to make it more sensitive would have increased its yield by 6614 articles. Examination of the search records together with correspondence between the analyst and the searcher reveals the peer reviewer had approved the search because its sensitivity was appropriate for the purpose of producing Interventional Procedures Guidance. The case study demonstrates the limitations of relying on a checklist to ensure the quality of a database search without having any contextual information. Conclusion – It is difficult for the peer reviewer to assess the subjective elements of a search without knowing why it has a particular structure or what the searcher intended. There is a risk that the peer reviewer will concentrate on the technical details, such as spelling mistakes, without having the contextual information. It is beneficial if the searcher records correspondence on key decisions and reports a summary alongside the search strategy. The narrative describes the major decisions that shaped the strategy and gives the peer reviewer an insight into the rationale for the search approach.

External skeletal fixation of femoral shaft fractures in polytrauma patients

Introduction. Polytrauma remains a major social, economic and medicine affliction. A successful surgical treatment of polytrauma patients requires an approach predicated on prioritizing injuries. An isolated femur fractures rarely poses any threat but in association with multiple injuries, this fracture assumes greater significance. The proper management of femur fractures in polytrauma can greatly reduce the mortality and morbidity. Material and methods. We present our results in the treatment of 24 femur shaft fracture in 22 polytrauma patients treated by Mitkovic external fixator in 5 year period (2000-2004) on Orthopeadic and Traumatology Clinic - Clinical Center Nis. The average of patients age was 32.8 years (ranging from 17 to 62). There were 11 (46%) closed and 13 (54%) open fractures. Results. Eighteen fractures were treated by external fixation until union. The remaining six fractures were treated by conversion of the external fixation to internal fixation. Sixteen fractures (88.88%), in which the external fixation was the definitive method of treatment, healed completely. The average healing time was 6.29 (4-9) months. There were three pin-track infections (16.66%), one nonunion (5.55%) and only one deep infection (5.55%). Conclusion. The external fixation by the use of Mitkovic external fixator in the treatment of femur fractures is a safe procedure to achieve temporary rigid stabilisation in polytrauma patients before the subsequent internal fixation (damage control orthopaedics). The external fixation using Mitkovic external fixator can be definitive method of choice in treatment of open and comminutiwe femur fractures in polytrauma patients until union.