The Anesthesiology Department has been developing Enhanced Recovery After Surgery (ERAS) Clinical Pathways for specific surgeries. The pathways provide an evidence based perioperative care plan to guide a consistent approach to each aspect of patient management. The goal is to reduce complications and maximize recovery.
The research evidence for each element of patient care during the preoperative, intraoperative and postoperative period needs to be identified and assessed. Since the evidence base is constantly changing, the evidence will need to be reviewed on a regular basis. Therefore, a "best search" for each topic should be identified and saved so that it can be repeated as needed.
A demonstration search for the following clinical question will be explored in this example:
What effect does preoperative carbohydrate treatment, compared with placebo or preoperative fasting, have on postoperative recovery in adult patients undergoing surgery?
|Patient / Problem||Adult patient undergoing surgery|
|Comparison||Placebo OR preoperative fasting|
|Type of Question||Therapy|
|Type of Study||Systematic Review of RCTs > individual RCTs > cohort studies|
Select words from the PICOTT concepts to guide the development of a PubMed search. Remember:
|Adult patient undergoing surgery||No search terms. The intervention includes the word preoperative and we do not need to duplicate this concept by also searching surgery.|
(Preoperative OR Pre-operative) AND (Carbohydrate OR Carbohydrates)
|Placebo OR preoperative fasting||
No search terms. We are open to no comparison.
|Postoperative recovery||(Postoperative OR Post-operative)|
|Study design filters||Systematic Review of RCTs > individual RCTs > cohort studies|
(Preoperative OR Pre-operative) AND (Carbohydrate OR Carbohydrates) AND (Postoperative OR Post-operative)
Run the search in PubMed:
Check the Search Details (scroll down the right hand side, click See More):
(Preoperative[All Fields] OR Pre-operative[All Fields]) AND (("carbohydrates"[MeSH Terms] OR "carbohydrates"[All Fields] OR "carbohydrate"[All Fields]) OR ("carbohydrates"[MeSH Terms] OR "carbohydrates"[All Fields])) AND (("postoperative period"[MeSH Terms] OR ("postoperative"[All Fields] AND "period"[All Fields]) OR "postoperative period"[All Fields] OR "postoperative"[All Fields]) OR ("postoperative period"[MeSH Terms] OR ("postoperative"[All Fields] AND "period"[All Fields]) OR "postoperative period"[All Fields] OR ("post"[All Fields] AND "operative"[All Fields]) OR "post operative"[All Fields]))
Revise the Search
Filter Results to Systematic Reviews
The systematic review filter applies a broad search for results that may be true systematic reviews. You need to read the abstracts to identify articles that are about your clinical question and are true systematic reviews. It may be possible to identify higher quality systematic reviews from the abstracts.
The most recent directly relevant high quality systematic reviews in this result set are:
Filter for more recent RCTs
When you find a high quality systematic review you should still look for more recent RCTs. The Amer meta-analysis reports that the last search was conducted in June 2016, so filter the search for RCTs and select any that were published after May 2016. Remember, the default order to display results in PubMed is by publication date.
The next step in the EBM process, Appraise, is beyond the scope of this module. Here are some tools that will help you with that step.