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Flash videos. Partial [52] Insert online videos Youtube, Vimeo, Slideshare. Insert online pictures in Word, Excel, Powerpoint. No possible via third party services. Yes [54]. No tdf , only support for import of existing ink annotations from MS Word file format.

Lasso Select free-form tool for selecting ink. Ink replay feature. Yes macOS only. Stable layout. Layout problems. No, but complicated workaround. Master documents and Master document templates supported. Supported but deprecated because it causes file corruption. Yes release notes. Yes [57]. Complex calculations. Only basic arithmetic.

Supported, image formats:. Support for Pages v [58]. Some layout problems [59]. Extended label creation features release notes. Yes generic database access, synchronise content. DTP-like features like text in multiple columns and text-wrap around graphics. Concept of "horizontal frames" is more limited.

DirectCursor allows to enter text anywhere on a page. Supported, under the name Click and type advanced option. Partial release notes 5.

Export only as comments inside margin. Grammar checker LanguageTool available as remote grammar checker or as extension: Languagetool for 30 languages plus 13 language variants level of language support varies; 11 languages with more than rules. Grammar check on macOS version limited to few languages. Templates provide this functionality, but more difficult to handle.

Helpful extension: Template Changer tdf Experimental design themes: tdf , tdf Supported "document themes". Extension: TexMaths. No tdf , but effects are preserved on import and export. Glow effect and soft edges supported. Implementation misses some features, see: tdf tdf Available as experimental feature [60]. Yes [61]. Option to track one's own changes without forcing others to track theirs [62]. Extension Read Text. Yes [63]. Better recovery mode [64] , [65]. More frequently denies opening those files.

Supported requires Java. Import of eBook formats: FictionBook 2. Yes [66]. How to switch on the feature. See also tdf Links between anchors and footnotes or endnotes even if not on the same page are available in both direction.

Yes [67] , [68] PDF [69]. Partial [70] , [71]. Manual creation of replacement lists. Unlimited columns. Limited to 63 columns. Multi-line headings for chapters by allowing a line break as separator between a chapter number and its name in Chapter Numbering dialog. Only via work-around [72]. Basic inbuilt support. Excellent free extensions: e. Zotero , JabRef as well as proprietary extensions. Inbuilt support. Zotero as well as proprietary extensions. Partial tdf See List of Regular Expressions.

Different numerically equivalent format not supported tdf Less default shortcuts [73]. More default shortcuts [74]. Support for text watermarks. Partial text and picture watermarks. This is not possible on Chromebooks as there is no app, Word for the web cannot do watermarks.

Some formatting features are supported, e. No tdf , extension: TradutorLibreText. Yes [76]. No, extension: Sun Weblog Publisher outdated. Yes [77]. Line Focus removes removes distractions feature in MS Word. Yes [78]. No [79] [80]. No [81]. Yes [82].

OpenFormula standard. Largely supported. Copy of cells is kept for pasting, even if the user does other tasks like typing or inserting cells. No [83]. Support for Numbers v [84] , see also this comparison. Jumbo spreadsheets supported since LO 7. Limited support [86]. Inserted image cannot be resized nor cropped, usability issues. Add-on, not activated by default. Additional features: Histogram, Random number generation, Rank and percentiles, and some more detailed options. No tdf , tdf , tdf Selection of some pre-set chart styles and layouts.

No tdf regarding DAX functions. No tdf , tdf , tdf , tdf , tdf Yes [87]. Data types from online sources: geography, stocks, organization, location, zip code, university, space, satellite, element, chemistry, food, exercise, movie, characters, medical, body, media, nature, activities, other Not available in MS Office sales versions [89] , [90]. Extended set of forecast functions based on exponential smoothing algorithm.

Forecast functions and forecast charts based on exponential smoothing algorithm not supported in macOS version. Multi-threaded calculation [91]. Multi-threaded import of XLSX documents. Parallel formula compiling on the CPU.

Multithreading is work in progress: tdf , [94] , Presentation "Making Calc Calculate in Parallel". Starting in Excel , the following features use multi-core processors: saving a file, opening a file, refreshing a PivotTable for external data sources, except OLAP and SharePoint , sorting a cell table, sorting a PivotTable, and auto-sizing a column.

LET function. Yes Flow charts and organizational charts supported in rental version, not supported in MS Office sales versions. Yes [97]. Supported [98] , [99]. Yes List of Regular Expressions. Independent window. Cannot be moved outside the application window. Yes tdf No []. Possibility to switch between function names in local language and English. Export of comments according to PDF specification. No Only available: Inverting colors for negative values.

Yes not available on Windows, see tdf More detailed: Number formats: more flexible use of "Format Code" for custom adjustments, leading zeroes, language setting, percentages without percentage sign, thousands separator for percentages; Font: overligning of text, relief embossed, engraved , outline, shadow, underline of individual words, spacing settings, kerning; Borders: shadow, spacing to contents; Protection: hide cells when printing.

Less features. Number format "Boolean value". Engineering notation. Natural language number format spelling out numbers in various languages. Easy work around for missing US zip code and US phone number formats. Partial Engineering notation via custom formats. Partial Using work-arounds. No reverse icon order tdf Customization of icon sets, e. Partial Styles supported, Cell Format not supported. Partial tdf , tdf , tdf Less default shortcuts [] , tdf , tdf , tdf More default shortcuts [] , [] , [].

Searches for studies should be as extensive as possible in order to reduce the risk of publication bias and to identify as much relevant evidence as possible. Expertise may be required to avoid unnecessary duplication of effort. These databases are described in more detail in Sections 4. A key advantage of such databases is that they can be searched electronically both for words in the title or abstract and by using the standardized indexing terms, or controlled vocabulary, assigned to each record see Section 4.

They may be available through national provisions, site-wide licences at institutions such as universities or hospitals, through professional organizations as part of their membership packages or free-of-charge on the internet. Some international initiatives provide free or low-cost online access to databases and full-text journals over the internet. Electronic Information for Libraries EIFL is a similar initiative based on library consortia to support affordable licensing of journals and other sources in more than 50 low-income and transition countries in central, eastern and south-east Europe, the former Soviet Union, Africa, the Middle East and South-east Asia.

The online Technical Supplement provides more detailed information about how to search these sources and other databases. The accompanying Appendix provides a list of general healthcare databases by region and healthcare databases by subject area. Further evidence-based information about sources to search can be found on the SuRe Info portal , which is updated twice per year. MEDLINE as of January contains approximately 30 million references to journal articles in biomedicine and health from onwards.

When searching MEDLINE via service providers or interfaces other than Ovid or PubMed, we recommend verification of the exact coverage of the database in relation to PubMed, where no explicit information on this is readily available.

Embase as of January contains over 35 million records from onwards, including records from more than currently published journals from approximately countries Elsevier Further details on the implications of this for searching are available in the online Technical Supplement. Embase Classic provides access to almost two million records digitized from the Excerpta Medica print journals the original print indexes from which Embase was created from to Elsevier Embase now also includes pre-print articles from multiple sources Elsevier Embase is only available by subscription, either directly via Elsevier as Embase.

Note that Embase is searched regularly by Cochrane for reports of trials. The actual degree of reference overlap between MEDLINE and Embase varies widely according to the topic, but studies comparing searches of the two databases have generally concluded that a comprehensive search requires that both databases be searched Lefebvre et al , Bramer et al see MECIR Box 4.

Conversely, two studies examined different samples of Cochrane Reviews and identified the databases from which the included studies of these reviews originated Halladay et al , Hartling et al Both studies, one across all healthcare areas Halladay et al and the other on child health Hartling et al , report a minimal extent to which the inclusion of studies not indexed in PubMed altered the meta-analyses.

PubMed coverage across systematic review topics has been further evaluated in a recent study based on a comprehensive sample of Cochrane Reviews. Hence, the current recommendation of searching multiple databases needs to be evaluated further, so as to confirm under which circumstances comprehensive searches of multiple databases are warranted.

CENTRAL, however, also includes citations to reports of randomized trials that are not indexed in MEDLINE, Embase or other bibliographic databases; citations published in many languages; and citations that are available only in conference proceedings or other sources that are difficult to access.

It also includes records from trials registers and trials results registers beyond ClinicalTrials. These additional records are, for the most part, identified by Cochrane Information Specialists, many of whom conduct comprehensive searches to populate CRG Specialized Registers, collecting records of trials eligible for Cochrane Reviews in their field. In these cases, the search will be more precise, but an equivalent number of included studies will be identified with lower numbers of records to screen.

Many review authors have full access free-of-charge at the point-of-use through national provisions and other similar arrangements, or as part of a paid subscription to the Cochrane Library.

Many countries and regions produce bibliographic databases that focus on the literature produced in those regions and which often include journals and other literature not indexed elsewhere. It is highly desirable that searches be conducted of appropriate national, regional and subject specific bibliographic databases see MECIR Box 4.

Further details are provided in the online Technical Supplement. Citation indexes are bibliographic databases that record instances where a particular reference is cited, in addition to the standard bibliographic content.

Citation indexes can be used to identify studies that are similar to a study report of interest, as it is probable that other reports citing or cited by a study will contain similar or related content.

Search appropriate national, regional and subject-specific bibliographic databases. Databases relevant to the review topic should be covered e. Initiatives to provide access to ongoing studies and unpublished data constitute a fast-moving field Isojarvi et al It is important to identify ongoing studies, so that when a review is updated these can be assessed for possible inclusion.

Awareness of the existence of a possibly relevant ongoing study and its expected completion date might affect not only decisions with respect to when to update a specific review, but also when to aim to complete a review. Even when studies are completed, some are never published. Finding out about unpublished studies, and including their results in a systematic review when eligible and appropriate Cook et al , is important for minimizing bias.

Several studies and other articles addressing issues around identifying unpublished studies have been published Easterbrook et al , Weber et al , Manheimer and Anderson , MacLean et al , Lee et al , Chan , Bero , Schroll et al , Chapman et al , Kreis et al , Scherer et al , Hwang et al , Lampert et al There is no easy and reliable single way to obtain information about studies that have been completed but never published.

There have, however, been several important initiatives resulting in better access to studies and their results from sources other than the main bibliographic databases and journals. These include trials registers and trials results registers see Section 4. A recent study Halfpenny et al assessed the value and usability for systematic reviews and network meta-analyses of data from trials registers, CSRs and regulatory authorities, and concluded that data from these sources have the potential to influence systematic review results.

A Cochrane Methodology Review examined studies assessing methods for obtaining unpublished data and concluded that those carrying out systematic reviews should continue to contact authors for missing data and that email contact was more successful than other methods Young and Hopewell An annotated bibliography of published studies addressing searching for unpublished studies and obtaining access to unpublished data is also available Arber et al One particular study focused on the contribution of unpublished studies, including dissertations, and studies in languages other than English, to the results of meta-analyses in reviews relevant to children Hartling et al They found that, in their sample, unpublished studies and studies in languages other than English rarely had any impact on the results and conclusions of the review.

Correspondence can be an important source of information about unpublished studies. It is highly desirable for authors of Cochrane Reviews of interventions to contact relevant individuals and organizations for information about unpublished or ongoing studies see MECIR Box 4.

Letters of request for information can be used to identify completed but unpublished studies. One way of doing this is to send a comprehensive list of relevant articles along with the eligibility criteria for the review to the first author of reports of included studies, asking if they know of any additional studies ongoing or completed; published or unpublished that might be relevant.

This approach may be especially useful in areas where there are few trials or a limited number of active research groups. It may also be desirable to send the same letter to other experts and pharmaceutical companies or others with an interest in the area.

Some review teams set up websites for systematic review projects, listing the studies identified to date and inviting submission of information on studies not already listed. A recent study assessed the value of contacting trial authors and concluded that data supplied by authors modified the outcomes of some systematic reviews, but this was poorly reported in the reviews Meursinge Reynders et al Another case study of a Cochrane Methodology Review reported that making contact with clinical trials units and trial methodologists provided data for six of the 38 RCTs included in the review, which had not been identified through other search methods Brueton et al C31 : Searching by contacting relevant individuals and organizations Highly desirable.

Contact relevant individuals and organizations for information about unpublished or ongoing studies. It is important to identify ongoing studies, so that these can be assessed for possible inclusion when a review is updated. Asking researchers for information about completed but never published studies has not always been found to be fruitful Hetherington et al , Horton though some researchers have reported that this is an important method for retrieving studies for systematic reviews Royle and Milne , Greenhalgh and Peacock , Reveiz et al A recent study reported successful outcomes of a digital media strategy to obtain unpublished data from trial authors Godard-Sebillotte et al A study assessed the value of requesting information from drug manufacturers for systematic reviews and concluded that this helped to reduce reporting and publication bias and helped to fill important gaps, sometimes leading to new or altered conclusions, primarily where no other evidence existed McDonagh et al The RIAT Restoring Invisible and Abandoned Trials initiative Doshi et al aims to address the problems outlined above by offering a methodology that allows others to re-publish mis-reported and to publish unreported trials.

Anyone who can access the trial data and document trial abandonment can use this methodology. The RIAT Support Centre offers free-of-charge support and competitive funding to researchers interested in this approach. It has also been suggested that legislation such as Freedom of Information Acts in various countries might be used to gain access to information about unpublished trials Bennett and Jull , MacLean et al A recent study suggested that trials registers are an important source for identifying additional randomized trials Baudard et al A recent audit by Cochrane investigators showed that the majority of Cochrane Reviews do comply with this standard Berber et al Although there are many other trials registers, ClinicalTrials.

Research has shown that even though ClinicalTrials. The extent to which this might still be the case with the new ICTRP interface released in its final version in June see online Technical Supplement remains to be ascertained.

Therefore, the current guidance that it is not sufficient to search the ICTRP alone still stands, pending further research. Guidance for searching these and other trials registers is provided in the online Technical Supplement. In addition to Cochrane, other organizations also advocate searching trials registers.

There has been an increasing acceptance by investigators of the importance of registering trials at inception and providing access to their trials results. Despite perceptions and even assertions to the contrary, however, there is no global, universal legal requirement to register clinical trials at inception or at any other stage in the process, although some countries are beginning to introduce such legislation Viergever and Li Efforts have been made by a number of organizations, including organizations representing the pharmaceutical industry and individual pharmaceutical companies, to begin to provide central access to ongoing trials and in some cases trial results on completion, either on a national or international basis.

Increasingly, as already noted, trials registers such as ClinicalTrials. Search trials registers and repositories of results, where relevant to the topic, through ClinicalTrials. Although ClinicalTrials. A number of organizations, including Cochrane, recommend searching regulatory agency sources and clinical study reports.

Details of these are provided in the online Technical Supplement. Clinical study reports CSRs are the reports of clinical trials providing detailed information on the methods and results of clinical trials submitted in support of marketing authorization applications.

The policy applies only to documents received since 1 January The terms of use for access are based on the purposes to which the clinical data will be put.

Further details of this and other resources are available in the online Technical Supplement. A recent study by Jefferson and colleagues Jefferson et al that looked at use of regulatory documents in Cochrane Reviews, found that understanding within the Cochrane community was limited and guidance and support would be required if review authors were to engage with regulatory documents as a source of evidence. Specifically, guidance on how to use data from regulatory sources is needed.

The online Technical Supplement describes several other important sources of reports of studies. Review authors may also consider searching the internet, handsearching journals and searching full texts of journals electronically where available see online Technical Supplement for details. They should examine previous reviews on the same topic and check reference lists of included studies and relevant systematic reviews see MECIR Box 4. Search relevant grey literature sources such as reports, dissertations, theses and conference abstracts.

Check reference lists in included studies and any relevant systematic reviews identified. This section highlights some of the issues to consider when designing search strategies. Designing search strategies can be complex and the section does not fully address the many complexities in this area. Many of the issues highlighted relate to both the subject aspects of the search e.

For a search to be robust, both aspects require attention to be sure that relevant records are not missed. Further evidence-based information about designing search strategies can be found on the SuRe Info portal , which is updated twice per year. If the review has specific eligibility criteria around study design to address adverse effects, economic issues or qualitative research questions, undertake searches to address them.

Sometimes a review will address questions about adverse effects, economic issues or qualitative research using a different set of eligibility criteria from the main effectiveness component. In such situations, the searches for evidence must be suitable to identify relevant study designs for these questions. Different searches may need to be conducted for different types of evidence. The starting point for developing a search strategy is to consider the main concepts being examined in a review.

For a Cochrane Review, the review objective should provide the PICO concepts, and the eligibility criteria for studies to be included will further assist in the selection of appropriate subject headings and text words for the search strategy. The structure of search strategies in bibliographic databases should be informed by the main concepts of the review see Chapter 3 , using appropriate elements from PICO and study design see MECIR Box 4. Although a research question may specify particular comparators or outcomes, these concepts may not be well described in the title or abstract of an article and are often not well indexed with controlled vocabulary terms.

Therefore, in general databases, such as MEDLINE, a search strategy will typically have three sets of terms: i terms to search for the health condition of interest, i. Typically, a broad set of search terms will be gathered for each concept and combined with the OR Boolean operator to achieve sensitivity within concepts. The results for each concept are then combined using the AND Boolean operator, to ensure each concept is represented in the final search results.

It is important to consider the structure of the search strategy on a question-by-question basis. In some cases it is possible and reasonable to search for the comparator, for example if the comparator is explicitly placebo; in other cases the outcomes may be particularly well defined and consistently reported in abstracts.

The advice on whether or not to search for outcomes for adverse effects differs from the advice given above see Chapter Inform the structure of search strategies in bibliographic databases around the main concepts of the review, using appropriate elements from PICO and study design.

In structuring the search, maximize sensitivity whilst striving for reasonable precision. Inappropriate or inadequate search strategies may fail to identify records that are included in bibliographic databases.

The structure of a search strategy should be based on the main concepts being examined in a review. In general databases, such as MEDLINE, a search strategy to identify studies for a Cochrane Review will typically have three sets of terms: i terms to search for the health condition of interest, i. There are exceptions, however. For instance, for reviews of complex interventions, it may be necessary to search only for the population or the intervention.

Some search strategies may not easily divide into the structure suggested, particularly for reviews addressing complex or unknown interventions, or diagnostic tests Huang et al , Irvin and Hayden , Petticrew and Roberts , de Vet et al , Booth or using specific approaches such as realist reviews which may require iterative searches and multiple search strategies Booth et al Cochrane Reviews of public health interventions and of qualitative data may adopt very different search approaches to those described here Lorenc et al , Booth see Chapter 17 on intervention complexity, and Chapter 21 on qualitative evidence.

Some options to explore for such situations include:. Searches for systematic reviews aim to be as extensive as possible in order to ensure that as many of the relevant studies as possible are included in the review.

It is, however, necessary to strike a balance between striving for comprehensiveness and maintaining relevance when developing a search strategy. Sensitivity is defined as the number of relevant reports identified divided by the total number of relevant reports in the resource.

Precision is defined as the number of relevant reports identified divided by the total number of reports identified. Increasing the comprehensiveness or sensitivity of a search will reduce its precision and will usually retrieve more non-relevant reports. Article abstracts identified through a database search can usually be screened very quickly to ascertain potential relevance.

At a conservatively estimated reading rate of one or two abstracts per minute, the results of a database search can be screened at the rate of 60— per hour or approximately — over an 8-hour period , so the high yield and low precision associated with systematic review searching may not be as daunting as it might at first appear in comparison with the total time to be invested in the review.

Table 4. This section should be read in conjunction with Section 3. One is based on text words, that is terms occurring in the title, abstract or other relevant fields available in the database. The other is based on standardized subject terms assigned to the references either by indexers specialists who appraise the articles and describe their topics by assigning terms from a specific thesaurus or controlled vocabulary or automatically using automated indexing approaches.

Searches for Cochrane Reviews should use an appropriate combination of these two approaches, i. Approaches for identifying text words and controlled vocabulary to combine appropriately within a search strategy, including text mining approaches, are presented in the online Technical Supplement. C33 : Developing search strategies for bibliographic databases Mandatory. Identify appropriate controlled vocabulary e. MeSH, Emtree, including 'exploded' terms and free-text terms considering, for example, spelling variants, synonyms, acronyms, truncation and proximity operators.

Search strategies need to be customized for each database. The same principle applies to Emtree when searching Embase and also to a number of other databases. In order to be as comprehensive as possible, it is necessary to include a wide range of free-text terms for each of the concepts selected. This might include the use of truncation and wildcards. Developing a search strategy is an iterative process in which the terms that are used are modified, based on what has already been retrieved.

Searches should capture as many studies as possible that meet the eligibility criteria, ensuring that relevant time periods and sources are covered and not restricted by language or publication status see MECIR Box 4. Review authors should justify the use of any restrictions in the search strategy on publication date and publication format see MECIR Box 4.

To reduce the risk of introducing bias, searches should not be restricted by language. Recommendations for rapid reviews searches to limit publication language to English and add other languages only when justified Garritty et al are supported by evidence that excluding non-English studies does not change the conclusions of most systematic reviews Morrison et al , Jiao et al , Hartling et al , Nussbaumer-Streit et al However, exceptions that non-English studies do influence review findings have been observed for complementary and alternative medicine Moher et al , Pham et al , Wu et al , psychiatry, rheumatology and orthopaedics Egger et al Additionally, when searches are limited to English or to databases containing only English-language articles, there is a risk that eligible studies may be missed from countries where a particular intervention of interest is more common e.

For further discussion of these issues see Chapter Particularly when resources and time are available, the inclusion of non-English studies in systematic reviews is recommended to minimize the risk of language bias Egger et al , Pilkington et al , Morrison et al It has also been argued that, when language restrictions are justified, these should not be imposed by limiting the search but by including language as an eligibility criterion during study selection Pieper and Puljak Further use of a supportive narrative may help explain why a particular date restriction was applied Craven and Levay , Cooper et al b.

For example, a database date restriction of current for a review of nurse-led community training of epinephrine autoinjectors is justified because this is the approval date of the first device Center for Drug Evaluation and Research Conversely, arbitrary date restrictions intended to reduce search yield e. Caution should be exercised when designing database search strategies with date restrictions.

Information specialists should be aware of the various date fields available from database providers e. It may be necessary to search additional sources or datafiles to ensure adequate coverage of the date period of interest for the review. To account for inconsistent publication dates in database records e.

As any information about an eligible study may contain valuable details for analysis, document format restrictions should not be applied to systematic review searches. For example, excluding letters is not recommended because letters may contain important additional information relating to an earlier trial report or new information about a trial not reported elsewhere Iansavichene et al As with comments and letters, preprints versions of scientific articles that precede formal peer review and publication in a journal should also be considered a potentially relevant source of study evidence.

Recent and widespread availability of preprints has resulted from an urgent demand for emerging evidence during the COVID pandemic Gianola et al , Kirkham et al , Callaway , Fraser et al As study data are often reported in multiple publications and may be reported differently in each Oikonomidi et al , efforts to identify all reports for eligible studies, regardless of publication format, are necessary to support subsequent stages of the review process to select, assess and analyse complete study data.

Justify the use of any restrictions in the search strategy on publication date and publication format. Date restrictions in the search should only be used when there are date restrictions in the eligibility criteria for studies.

They should be applied only if it is known that relevant studies could only have been reported during a specific time period, for example if the intervention was only available after a certain time point. Searches for updates to reviews might naturally be restricted by date of entry into the database rather than date of publication to avoid duplication of effort.

Publication format restrictions e. When considering the eligibility of studies for inclusion in a Cochrane Review, it is important to be aware that some studies may have been found to contain errors or to be fraudulent or may, for other reasons, have been corrected or retracted since publication. For review updates, it is important to search MEDLINE and Embase for the latest version of the citations to the records for the previously included studies, in case they have since been corrected or retracted.

Errata are published to correct unintended errors accepted as errors by the author s that do not invalidate the conclusions of the article.

Including data from studies that are fraudulent or studies that include errors can have an impact on the overall estimates in systematic reviews. There is an increasing awareness of the importance of not including retracted studies or those with significant errata in systematic reviews and how best to avoid this Royle and Waugh , Wright and McDaid , Decullier et al A recent study, however, showed that even when review authors suspect research misconduct, including data falsification, in the trials that they are considering including in their systematic reviews, they do not always report it Elia et al Details of how to identify fraudulent studies, other retracted publications, errata and comments are described in the online Technical Supplement.

Some studies may have been found to be fraudulent or may have been retracted since publication for other reasons. Errata can reveal important limitations, or even fatal flaws, in included studies. All of these may lead to the potential exclusion of a study from a review or meta-analysis. Care should be taken to ensure that this information is retrieved in all database searches by downloading the appropriate fields, together with the citation data.

Search filters are search strategies that are designed to retrieve specific types of records, such as those of a particular methodological design. When searching for randomized trials in humans, a validated filter should be used to identify studies with the appropriate design see MECIR Box 4.

The site includes, amongst others, filters for identifying systematic reviews, randomized and non-randomized studies and qualitative research in a range of databases and across a range of service providers Glanville et al For further discussion around the design and use of search filters, see the online Technical Supplement. Use specially designed and tested search filters where appropriate including the Cochrane Highly Sensitive Search Strategies for identifying randomized trials in MEDLINE, but do not use filters in pre-filtered databases e.

Search filters should be used with caution. They should be assessed not only for the reliability of their development and reported performance, but also for their current accuracy, relevance and effectiveness given the frequent interface and indexing changes affecting databases.

It is strongly recommended that search strategies should be peer reviewed before the searches are run. Peer review of search strategies is increasingly recognized as a necessary step in designing and executing high-quality search strategies to identify studies for possible inclusion in systematic reviews. Studies have shown that errors occur in the search strategies underpinning systematic reviews and that search strategies are not always conducted or reported to a high standard Mullins et al , Layton , Salvador-Olivan et al This has also been shown to be the case within some Cochrane Reviews Franco et al Research has shown that peer review using a specially designed checklist can improve the quality of searches both in systematic reviews Relevo and Paynter , Spry et al and in rapid reviews Spry et al , Spry and Mierzwinski-Urban The PRESS checklist covers not only the technical accuracy of the strategy line numbers, spellings, etc.

It is recommended that authors provide information on the search strategy development and peer review processes. For Cochrane Reviews, the names, credentials, and institutions of the peer reviewers of the search strategies should be noted in the review with their permission in the Acknowledgments section. In practice, alerts are based on a previously developed search strategy, which is saved in a personal account on the database platform e.

These saved strategies filter the content as the database is being updated with new information. The account owner is notified usually via email when new publications meeting their specified search parameters are added to the database. In the case of PubMed, the alert can be set up to be delivered weekly or monthly, or in real-time and can comprise email or RSS feeds.

For review authors, alerts are a useful tool to help monitor what is being published in their review topic after the original search has been conducted. Authors should consider setting up alerts so that the review can be as current as possible at the time of publication.

Another way of attempting to stay current with the literature as it emerges is by using alerts based on journal tables of contents TOCs. These usually cannot be specifically tailored to the information needs in the same way as search strategies developed to cover a specific topic. They can, however, be a good way of trying to keep up to date on a more general level by monitoring what is currently being published in journals of interest.

Many journals, even those that are available by subscription only, offer TOC alert services free of charge.

In addition, a number of publishers and organizations offer TOC services see online Technical Supplement. Use of TOCs is not proposed as a single alternative to the various other methods of study identification necessary for undertaking systematic reviews, rather as a supplementary method.

See also Chapter 22, Section Alerts should also be considered for sources beyond databases and journal TOCs, such as trials register resources and regulatory information. The published review should be as up to date as possible. Searches for all the relevant databases should be rerun prior to publication, if the initial search date is more than 12 months preferably six months from the intended publication date see MECIR Box 4.

This is also good practice for searches of non-database sources. The results should also be screened to identify potentially eligible studies. Ideally, the studies should be incorporated fully in the review. Rerun or update searches for all relevant sources within 12 months before publication of the review or review update, and screen the results for potentially eligible studies. The search must be rerun close to publication, if the initial search date is more than 12 months preferably six months from the intended publication date, and the results screened for potentially eligible studies.

Fully incorporate any studies identified in the rerun or update of the search within 12 months before publication of the review or review update. After the rerun of the search, the decision whether to incorporate any new studies fully into the review will need to be balanced against the delay in publication. Developing a search is often an iterative and exploratory process. It involves exploring trade-offs between search terms and assessing their overall impact on the sensitivity and precision of the search.

It is often difficult to decide in a scientific or objective way when a search is complete and search strategy development can stop. The ability to decide when to stop typically develops through experience of developing many strategies. Suggestions for stopping rules have been made around the retrieval of new records, for example to stop if adding in a series of new terms to a database search strategy yields no new relevant records, or if precision falls below a particular cut-off point Chilcott et al Stopping might also be appropriate when the removal of terms or concepts results in missing relevant records.

Another consideration is the amount of evidence that has already accrued: in topics where evidence is scarce, authors might need to be more cautious about deciding when to stop searching. Although many methods have been described to assist with deciding when to stop developing the search, there has been little formal evaluation of the approaches Booth , Arber and Wood At a basic level, investigation is needed as to whether a strategy is performing adequately.

It is not enough, however, for the strategy to find only those records, otherwise this might be a sign that the strategy is biased towards known studies and other relevant records might be being missed. In addition, citation searches see online Technical Supplement Section 1. If those additional methods are finding documents that the searches have already retrieved, but that the team did not necessarily know about in advance, then this is one sign that the strategy might be performing adequately.

If some of the PRESS dimensions seem to be missing without adequate explanation or arouse concerns, then the search may not yet be complete. Statistical techniques can be used to assess performance, such as capture-recapture Spoor et al , Ferrante di Ruffano et al also known as capture-mark-recapture; Kastner et al , Lane et al , or the relative recall technique Sampson et al , Sampson and McGowan Kastner suggests the capture-mark-recapture technique merits further investigation since it could be used to estimate the number of studies in a literature prospectively and to determine where to stop searches once suitable cut-off levels have been identified.

This would entail potentially an iterative search and selection process. Capture-recapture needs results from at least two searches to estimate the number of missed studies. Further investigation of published prospective techniques seems warranted to learn more about the potential benefits. Relative recall Sampson et al , Sampson and McGowan requires a range of searches to have been conducted so that the relevant studies have been built up by a set of sensitive searches. The performance of the individual searches can then be assessed in each individual database by determining how many of the studies that were deemed eligible for the evidence synthesis and were indexed within a database, can be found by the database search used to populate the synthesis.

If a search in a database did not perform well and missed many studies, then that search strategy is likely to have been suboptimal. If the search strategy found most of the studies that were available to be found in the database, then it was likely to have been a sensitive strategy.

Assessments of precision could also be made, but these mostly inform future search approaches since they cannot affect the searches and record assessment already undertaken. Relative recall may be most useful at the end of the search process since it relies on the achievement of several searches to make judgements about the overall performance of strategies. In evidence synthesis involving qualitative data, searching is often more organic and intertwined with the analysis such that the searching stops when new information ceases to be identified Booth The reasons for stopping need to be documented and it is suggested that explanations or justifications for stopping may centre around saturation Booth Further information on searches for qualitative evidence can be found in Chapter Review authors should document the search process in enough detail to ensure that it can be reported correctly in the review see MECIR Box 4.

The searches of all the databases should be reproducible to the extent that this is possible. By documenting the search process, we refer to internal record-keeping, which is distinct from reporting the search process in the review discussed in online Chapter III. Document the search process in enough detail to ensure that it can be reported correctly in the review.

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