Tuesday, April 29, 2008

Search challenge 7: strategies

Last week's search challenge explored whether there is evidence in the literature to support the use of nutritional therapy in patients with pressure ulcers.

A PubMed search strategy that seems to work well:
(pressure ulcer[mh] OR pressure ulcer*[tiab] OR decubitus ulcer*[tiab]) AND (nutrition[tiab] OR nutritional[tiab] OR nutrition therapy[mh] OR diet therapy[sh] OR vitamins[mh] OR vitamin[tiab] OR vitamins[tiab]) AND eng[la] AND humans[mh]

I also tried the MeSH term "nutritional support," since I was seeing some articles that looked at feeding regimens which are often indexed in this broad MeSH category, but didn't find that it added anything to the retrieval, probably because of the text words I'd included.

In reviewing the results, there's a meta-analysis that includes the literature through 2004: Stratton RJ, Ek AC, Engfer M, Moore Z, Rigby P, Wolfe R, Elia M. Enteral nutritional support in prevention and treatment of pressure ulcers: a systematic review and meta-analysis. Ageing Res Rev. 2005 Aug;4(3):422-50 (PubMed abstract) -- this meta-analysis included studies that focused on either enteral nutrition formulas or other oral supplements (e.g. vitamin C). The meta-analysis seemed well-executed and had clear inclusion/exclusion criteria; it also provided a good overview of the previous literature on this topic.

For this kind of question, I think I'd be comfortable providing a good meta-analysis accompanied by any high-quality references (e.g. trials or cohorts) published since the time it was executed; I'd also want to look at the kinds of things that they excluded and consider whether any of those need to be mentioned. For example, there might be therapies represented in small experimental studies that wouldn't make it into a meta-analysis but still would be useful to mention to the requester as a potential option, so that I'd feel like I was thoroughly representing all of the possible "options" that are in the literature.

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