Critical Appraisal of a Topic Essay: Indwelling Pleural Catheter versus Pleurodesis for Malignant Pleural Effusion
Description
See File Instructions. Additional material that may help: https://erj.ersjournals.com/content/52/1/1800349.figures-only#fig-data-supplementary-materials https://journal.chestnet.org/article/S0012-3692(13)60293-7/fulltext#seccestitle90 https://pubmed.ncbi.nlm.nih.gov/30272486/, https://www.atsjournals.org/doi/10.1513/AnnalsATS.201807-495OC?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
TF-2016-03V1.2 17/11/2017 Page 1 of 19Appendix A – The methodology checklist for the Taskforce statementYes No Panel assembly Experts from chest medicine and thoracic surgery xExperts vetted for conflict of interest xPatient representativex Expert methodologist xLiterature reviewPerformed in collaboration with librarianxSearched in multiple electronic databases (Medline/PUBMED, EMBASE, Cochrane Library)xReviewed reference list of retrieved articles xEvidence synthesisPre-specified inclusion and exclusion criteria x Evaluation of included studies for source of bias xExplicitly summarised benefits and harms xGrading system usedx Included studies evaluatedRecommendations for clinical practicex Summary/opinions xTF-2016-03V1.2 17/11/2017 Page 2 of 19Appendix B – PICO criteria for each question
What is the best definitive treatment for patients with symptomatic malignant pleural effusion (MPE)?P Patients with symptomatic malignant pleural effusionI Video-assisted Thoracoscopic Surgery (VATS), Local anaesthetic thoracoscopy (LAT), pleuroscopy, pleural endoscopyC Indwelling pleural catheter (IPC), pleurodesis (talc slurry, intra-pleural bleomycin, intra-pleural tetracycline)O Symptoms (breathlessness & CP), length of hospital stay
What is the optimal management for malignant pleural effusion with trapped lung?P Patients with symptomatic malignant pleural effusion and trapped lungI Indwelling pleural catheter, IPCC Surgical decortication, Video-assisted thoracic surgical partial pleurectomy, VATS PP, pleurectomy decortication, P/D, Extended pleurectomy decortication, EPDO Symptoms (breathlessness & CP), length of hospital stay, mortality
How should loculated malignant pleural effusion be managed?P Patients with loculated malignant pleural effusionI Video-assisted Thoracoscopic Surgery (VATS), Local anaesthetic thoracoscopy (LAT), pleuroscopy, pleural endoscopyC Fibrinolytics (alteplase, Tissue plasminogen activator, TPA, streptokinase, dornase alpha, DNAse), Indwelling pleural catheter, IPCO Symptoms, length of stay, resolution of effusion
What factors predict prognosis in malignant pleural effusion?Narrative synthesis to include literature review of prognostic scoring systems and prognostic factors.
Should patients with MPE and cancer that is sensitive to oncological treatment (e.g. chemotherapy, immunotherapy, targeted therapy) receive treatment prior to definitive management of their MPE? If so which cancers?P Patients with malignant pleural effusion due to treatment-sensitive cancers (lymphoma, small cell lung cancer, breast cancer, ovarian cancer, germ cell tumourI Oncological treatment (chemotherapy, radiotherapy, immunotherapy, hormone therapy, targeted therapy) prior to malignant pleural effusion managementC Definitive pleural intervention (pleurodesis, indwelling pleural catheter) prior to oncological treatmentO Control of pleural effusion, symptoms, complicationsTF-2016-03V1.2 17/11/2017 Page 3 of 19
In order to determine treatment in malignant pleural effusion, is a histological diagnosis always required or is cytology sufficient?P Patients with a cytological diagnosis of malignant pleural effusion without histological confirmation or molecular stagingI Biopsy for histologyC Cytological diagnosis (including liquid biopsy)O Number of procedures, time to diagnosis, personalised treatment planTF-2016-03V1.2 17/11/2017 Page 4 of 19Appendix C – Search strategies for each PICO question
What is the best definitive treatment for patients with symptomatic malignant pleural effusion?Summary – the following databases were searched:MEDLINE 172 records identifiedEmbase 341 records identifiedCochrane Library 27 recordsCochrane Database of Systematic Reviews (CDSR) 0 recordsDatabase of Abstracts of reviews of effectiveness (DARE) 1 record Cochrane Central Register of Controlled Trials (CENTRAL) 23 records Health Technology Assessment Database 1 record NHS Economic Evaluation Database 2 recordsMEDLINE via OVID 4th January 2017Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) <1946 to Present>1 Pleural Effusion, Malignant/ (3488)2 malignant pleura$ effusion$.mp. (2458)3 1 or 2 (4641)4 exp Thoracoscopy/ (12483)5 Thoracic Surgery, Video-Assisted/ (5714)6 VATS.mp. (3786)7 video assisted thoracic surgery.mp. (2104)8 video-assisted thoracic surgery.mp. (2104)9 video assisted thoracoscopic surgery.mp. (2596)10 video-assisted thoracoscopic surgery.mp. (2596)11 local anaesthetic thoracoscop$.mp. (13)12 local anesthetic thoracoscop$.mp. (4)13 LAT.mp. (4972)14 pleuroscopy.mp. (204)15 pleural endoscopy.mp. (3)16 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 (19814)17 indwelling pleural catheter$.mp. (145)18 in-dwelling pleural catheter$.mp. (1)19 IPC.mp. (3509)20 Catheters, Indwelling/ (18293)21 pleurodesis/ (1319)22 pleurodesis.mp. (2597)23 talc slurry.mp. (117)24 intra-pleural bleomycin.mp. (0)25 intra pleural bleomycin.mp. (0)26 intrapleural bleomycin.mp. (12)27 intra-pleural tetracycline.mp. (0)28 intra pleural tetracycline.mp. (0)29 intrapleural tetracycline.mp. (38)30 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 (24298)31 3 and 16 and 30 (224)32 limit 31 to english language (172)TF-2016-03V1.2 17/11/2017 Page 5 of 19Embase via OVID 4th JanuaryDatabase: Embase <1974 to 2017 January 03>1 Malignant Pleura Effusion/ (1488)2 malignant pleura$ effusion$.mp. (3889)3 1 or 2 (3889)4 Thoracoscopy/ (12862)5 Video Assisted Thoracoscopic Surgery/ (7661)6 VATS.mp. (5935)7 video assisted thoracic surgery.mp. (2736)8 video-assisted thoracic surgery.mp. (2736)9 video assisted thoracoscopic surgery.mp. (8854)10 video-assisted thoracoscopic surgery.mp. (8854)11 local anaesthetic thoracoscop$.mp. (28)12 local anesthetic thoracoscop$.mp. (10)13 LAT.mp. (5461)14 pleuroscopy.mp. (316)15 pleural endoscopy.mp. (6)16 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 (27253)17 indwelling pleural catheter$.mp. (285)18 in-dwelling pleural catheter$.mp. (7)19 IPC.mp. (4283)20 Indwelling Catheter/ (10226)21 pleurodesis/ (4218)22 pleurodesis.mp. (4694)23 talc slurry.mp. (168)24 intra-pleural bleomycin.mp. (1)25 intra pleural bleomycin.mp. (1)26 intrapleural bleomycin.mp. (13)27 intra-pleural tetracycline.mp. (0)28 intra pleural tetracycline.mp. (0)29 intrapleural tetracycline.mp. (40)30 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 (19049)31 3 and 16 and 30 (400)32 limit 31 to english language (341)The Cochrane Library 4th January 2017
1 MeSH descriptor: [Pleural Effusion, Malignant] explode all trees
2 malignant pleura* effusion*:ti,ab,kw (Word variations have been searched)
3 #1 or #2
4 MeSH descriptor: [Thoracoscopy] explode all trees
5 MeSH descriptor: [Thoracic Surgery, Video-Assisted] explode all trees
6 VATS:ti,ab,kw (Word variations have been searched)
7 video assisted thoracic surgery:ti,ab,kw (Word variations have been searched)
8 video-assisted thoracic surgery:ti,ab,kw (Word variations have been searched)
9 video assisted thoracoscopic surgery:ti,ab,kw (Word variations have been searched)
10 video-assisted thoracoscopic surgery:ti,ab,kw (Word variations have been searched)
11 local anaesthetic thoracoscop*:ti,ab,kw (Word variations have been searched)
12 local anesthetic thoracoscop*:ti,ab,kw (Word variations have been searched)
13 LAT:ti,ab,kw (Word variations have been searched)
14 pleuroscopy:ti,ab,kw (Word variations have been searched)
15 pleural endoscopy:ti,ab,kw (Word variations have been searched)
16 #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15
TF-2016-03V1.2 17/11/2017 Page 6 of 19
17 indwelling pleural catheter*:ti,ab,kw (Word variations have been searched)
18 in-dwelling pleural catheter*:ti,ab,kw (Word variations have been searched)
19 IPC:ti,ab,kw (Word variations have been searched)
20 MeSH descriptor: [Catheters, Indwelling] explode all trees
21 MeSH descriptor: [Pleurodesis] explode all trees
22 pleurodesis:ti,ab,kw (Word variations have been searched)
23 talc slurry:ti,ab,kw (Word variations have been searched)
24 intra-pleural bleomycin:ti,ab,kw (Word variations have been searched)
25 intra pleural bleomycin:ti,ab,kw (Word variations have been searched)
26 intrapleural bleomycin:ti,ab,kw (Word variations have been searched)
27 intra-pleural tetracycline:ti,ab,kw (Word variations have been searched)
28 intra pleural tetracycline:ti,ab,kw (Word variations have been searched)
29 intrapleural tetracycline:ti,ab,kw (Word variations have been searched)
30 #17 or #18 or #19 or #20 or #21 or #22 or #23 or #24 or #25 or #26 or #27 or #28 or #29
31 #3 and #16 and #30
What is the optimal management for malignant pleural effusion with trapped lung?Summary – the following databases were searched:MEDLINE 27 records identifiedEmbase 53 records identifiedCochrane Library 8 recordsCochrane Database of Systematic Reviews (CDSR) 0 recordsDatabase of Abstracts of reviews of effectiveness (DARE) 1 record Cochrane Central Register of Controlled Trials (CENTRAL) 7 records Health Technology Assessment Database 0 records NHS Economic Evaluation Database 0 recordsMEDLINEVia Ovid 6th January 2017Database: Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) <1946 to Present>1 Pleural Effusion, Malignant/ (3489)2 malignant pleur$ effusion$.mp. (2466)3 1 or 2 (4648)4 trapped lung$.mp. (149)5 (lung adj (trap$ or entrap$)).mp. (41)6 4 or 5 (185)7 3 and 6 (61)8 Catheters, Indwelling/ (18298)9 IPC.mp. (3513)10 indwelling pleural catheter$.mp. (145)11 in-dwelling pleural catheter$.mp. (1)12 8 or 9 or 10 or 11 (21809)13 7 and 12 (19)14 Pleural Effusion, Malignant/ (3489)15 malignant pleur$ effusion$.mp. (2466)16 14 or 15 (4648)17 trapped lung$.mp. (149)TF-2016-03V1.2 17/11/2017 Page 7 of 1918 (lung adj (trap$ or entrap$)).mp. (41)19 17 or 18 (185)20 16 and 19 (61)21 Thoracic Surgery, Video-Assisted/ (5718)22 VATS.mp. (3789)23 video assisted thoracic surgery.mp. (2104)24 video-assisted thoracic surgery.mp. (2104)25 video assisted thoracoscopic surgery.mp. (2597)26 video-assisted thoracoscopic surgery.mp. (2597)27 (VATS adj PP).mp. (0)28 partial pleurectomy.mp. (43)29 (video$ adj4 partial pleurectomy).ti,ab. (4)30 pleurectomy decortication.mp. (161)31 EPD.mp. (901)32 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 (9606)33 20 and 32 (13)34 13 or 33 (27)35 from 34 keep 1-27 (27)EmbaseVia Ovid 6th January 2017Database: Embase <1974 to 2017 January 05>1 Malignant Pleura Effusion/ (1492)2 malignant pleur$ effusion$.mp. (3899)3 1 or 2 (3899)4 trapped lung$.mp. (278)5 (lung adj (trap$ or entrap$)).mp. (88)6 4 or 5 (347)7 3 and 6 (116)8 Indwelling Catheter/ (10233)9 IPC.mp. (4285)10 indwelling pleural catheter$.mp. (285)11 in-dwelling pleural catheter$.mp. (7)12 8 or 9 or 10 or 11 (14583)13 7 and 12 (44)14 Malignant Pleura Effusion/ (1492)15 malignant pleur$ effusion$.mp. (3899)16 14 or 15 (3899)17 trapped lung$.mp. (278)18 (lung adj (trap$ or entrap$)).mp. (88)19 17 or 18 (347)20 16 and 19 (116)21 Video Assisted Thoracoscopic Surgery/ (7669)22 VATS.mp. (5940)23 video assisted thoracic surgery.mp. (2741)24 video-assisted thoracic surgery.mp. (2741)25 video assisted thoracoscopic surgery.mp. (8862)26 video-assisted thoracoscopic surgery.mp. (8862)27 (VATS adj PP).mp. (0)28 partial pleurectomy.mp. (66)TF-2016-03V1.2 17/11/2017 Page 8 of 1929 (video$ adj4 partial pleurectomy).ti,ab. (7)30 pleurectomy decortication.mp. (280)31 EPD.mp. (1154)32 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 (12636)33 20 and 32 (18)34 13 or 33 (53)Cochrane Library 6th January 2017
1 MeSH descriptor: [Pleural Effusion, Malignant] explode all trees
2 malignant pleur* effusion*:ti,ab,kw (Word variations have been searched)
3 #1 or #2
4 trapped lung*:ti,ab,kw (Word variations have been searched)
5 (lung near (trap* or entrap*)):ti,ab,kw (Word variations have been searched)
6 #4 or #5
7 #3 and #6
8 MeSH descriptor: [Catheters, Indwelling] explode all trees
9 IPC:ti,ab,kw or indwelling pleural catheter:ti,ab,kw or in-dwelling pleural catheter:ti,ab,kw (Word variations have been searched)
10 #8 or #9
11 #7 and #10
12 MeSH descriptor: [Thoracic Surgery, Video-Assisted] explode all trees
13 VATS:ti,ab,kw or “video assisted thoracic surgery”:ti,ab,kw or “video-assisted thoracic surgery”:ti,ab,kw or “video assisted thoracoscopic surgery”:ti,ab,kw or ” video-assisted thoracoscopic surgery”:ti,ab,kw (Word variations have been searched)
14 VATS near/1 PP:ti,ab,kw or partial pleurectomy:ti,ab,kw or video* near/4 partial pleurectomy:ti,ab,kw or pleurectomy decortication:ti,ab,kw or EPD:ti,ab,kw (Word variations have been searched)
15 #12 or #13 or #14
16 #7 and #15
17 #11 or #16
How should septated & loculated malignant pleural effusion be managed?Summary – the following databases were searched:MEDLINE 103 records identifiedEmbase 52 records identifiedCochrane Library 2 recordsCochrane Database of Systematic Reviews (CDSR) 0 recordsDatabase of Abstracts of reviews of effectiveness (DARE) 0 records Cochrane Central Register of Controlled Trials (CENTRAL) 2 records Health Technology Assessment Database 0 records NHS Economic Evaluation Database 0 recordsMEDLINEVia Ovid 9th January 2017Database: Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) <1946 to Present>1 pleural effusion, malignant/ (3489)2 (loculat$ or complex or septat$).ti,ab. (1144868)TF-2016-03V1.2 17/11/2017 Page 9 of 193 1 and 2 (111)4 (malignant pleural effusion adj5 (loculat$ or complex or septat$)).ti,ab. (4)5 3 or 4 (113)6 limit 5 to english language (103)EmbaseVia Ovid 9th January 2017Database: Embase <1974 to 2017 January 05>1 Malignant pleura effusion/ (1486)2 (loculat$ or complex or septat$).ti,ab. (1141646)3 1 and 2 (49)4 (malignant pleural effusion adj5 (loculat$ or complex or septat$)).ti,ab. (9)5 3 or 4 (56)6 limit 5 to english language (52)Cochrane Library 9th January 2017
1 MeSH descriptor: [Pleural Effusion, Malignant] explode all trees
2 (loculat* or complex or septat*):ti,ab,kw (Word variations have been searched)
3 #1 and #2
4 (malignant pleural effusion) near/5 (loculat* or complex or septat*):ti,ab,kw (Word variations have been searched)
5 #3 or #4
What factors predict prognosis in malignant pleural effusion?Summary – the following databases were searched:MEDLINE 676 records identifiedEmbase 1045 records identifiedCochrane Library 141 recordsCochrane Database of Systematic Reviews (CDSR) 3 recordsDatabase of Abstracts of reviews of effectiveness (DARE) 0 records Cochrane Central Register of Controlled Trials (CENTRAL) 1382 records Health Technology Assessment Database 0 records NHS Economic Evaluation Database 0 recordsMEDLINEVia Ovid 11th January 2017Database: Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) <1946 to Present>1 ((prognosis or prognostic or survival or outcome$) adj3 (score$ or scoring or predict$)).ti,ab. (142406)2 Pleural Effusion, Malignant/ (3491)3 malignant pleura$ effusion.mp. (1652)4 malignant pleural mesothelioma.mp. (3238)5 (EORTC or LENT or CALGB).mp. (9757)6 2 or 3 or 4 or 5 (17048)7 1 and 6 (690)8 limit 7 to english language (676)EmbaseTF-2016-03V1.2 17/11/2017 Page 10 of 19Via Ovid 11th January 2017Database: Embase <1974 to 2017 January 10>1 ((prognosis or prognostic or survival or outcome$) adj3 (score$ or scoring or predict$)).ti,ab. (188427)2 Malignant Pleura Effusion/ (1488)3 malignant pleura$ effusion.mp. (3113)4 malignant pleural mesothelioma.mp. (4433)5 (EORTC or LENT or CALGB).mp. (15323)6 2 or 3 or 4 or 5 (22660)7 1 and 6 (1070)8 limit 7 to english language (1045)Cochrane Library 9th January 2017
1 MeSH descriptor: [Pleural Effusion, Malignant] explode all trees
2 malignant pleura* effusion:ti,ab,kw (Word variations have been searched)
3 malignant pleural mesothelioma:ti,ab,kw (Word variations have been searched)
4 (EORTC or LENT or CALGB):ti,ab,kw (Word variations have been searched)
5 #1 or #2 or #3 or #4
6 (prognosis or prognostic or survival or outcome) near/3 (score or scoring or predict*):ti,ab,kw (Word variations have been searched)
7 #5 and #6
Should patients with malignant pleural effusion and cancer that is sensitive to oncological treatment (e.g. chemotherapy, immunotherapy, targeted therapy) receive treatment prior to definitive management of their MPE? If so which cancers?Summary – the following databases were searched:MEDLINE 257 records identifiedEmbase 286 records identifiedCochrane Library 44 recordsCochrane Database of Systematic Reviews (CDSR) 0 recordsDatabase of Abstracts of reviews of effectiveness (DARE) 0 records Cochrane Central Register of Controlled Trials (CENTRAL) 44 records Health Technology Assessment Database 0 records NHS Economic Evaluation Database 0 recordsMEDLINEVia Ovid 13th January 2017Database: Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) <1946 to Present>1 Pleural Effusion, Malignant/ (3491)2 Malignant pleura$ effusion.mp. (1652)3 1 or 2 (4275)4 Lymphoma/ (54779)5 Small Cell Lung Carcinoma/ (3085)6 Breast Neoplasms/ (283396)7 Ovarian Neoplasms/ (79995)8 “Neoplasms, Germ Cell and Embryonal”/ (8957)TF-2016-03V1.2 17/11/2017 Page 11 of 199 Germinoma/ (3121)10 4 or 5 or 6 or 7 or 8 or 9 (421445)11 lymphoma.ti,ab. (151057)12 (small cell lung adj (cancer$ or neoplasm$)).ti,ab. (56193)13 (breast adj (cancer$ or neoplasm$)).ti,ab. (256513)14 (ovarian adj (cancer$ or neoplasm$)).ti,ab. (52724)15 (germ cell tumour$ or germ cell tumor$).ti,ab. (11064)16 11 or 12 or 13 or 14 or 15 (513676)17 10 or 16 (673735)18 3 and 17 (1114)19 Drug Therapy/ (31435)20 drug therapy/ or chemoradiotherapy/ or chemotherapy, adjuvant/ (76526)21 exp Radiotherapy/ (174182)22 exp Immunotherapy/ (270920)23 Hormone Replacement Therapy/ (9807)24 Molecular Targeted Therapy/ (22333)25 19 or 20 or 21 or 22 or 23 or 24 (526207)26 (chemotherap$ or radiotherap$ or immunotherap$ or hormone replacement therap$ or targeted therap$).ti,ab. (577344)27 25 or 26 (964203)28 18 and 27 (305)29 limit 28 to english language (257)EmbaseVia Ovid 13th January 2017Database: Embase <1974 to 2017 January 10>1 Malignant Pleura Effusion/ (1488)2 Malignant pleura$ effusion.mp. (3113)3 1 or 2 (3113)4 Lymphoma/ (110307)5 Small Cell Lung Carcinoma/ (212)6 Small Cell Lung Cancer/ (4086)7 Lung Small Cell Cancer/ (19297)8 Breast Cancer/ (320895)9 Ovary Tumor/ (30520)10 Germ cell tumor/ (15504)11 4 or 5 or 6 or 7 or 8 or 9 or 10 (488491)12 lymphoma.ti,ab. (182097)13 (small cell lung adj (cancer$ or neoplasm$)).ti,ab. (72722)14 (breast adj (cancer$ or neoplasm$)).ti,ab. (306059)15 (ovarian adj (cancer$ or neoplasm$)).ti,ab. (62684)16 (germ cell tumour$ or germ cell tumor$).ti,ab. (13336)17 12 or 13 or 14 or 15 or 16 (618693)18 11 or 17 (767259)19 3 and 18 (889)20 Chemotherapy/ (234955)21 chemoradiotherapy/ or chemotherapy, adjuvant/ (70602)22 exp Radiotherapy/ (449000)23 exp Immunotherapy/ (172040)24 Hormone Substitution/ (35337)25 Molecularly Targeted Therapy/ (19537)26 20 or 21 or 22 or 23 or 24 or 25 (846757)TF-2016-03V1.2 17/11/2017 Page 12 of 1927 (chemotherap$ or radiotherap$ or immunotherap$ or hormone replacement therap$ or targeted therap$).ti,ab. (744222)28 26 or 27 (1130917)29 19 and 28 (320)30 limit 29 to english language (286)Cochrane Library 13h January 2017
1 MeSH descriptor: [Pleural Effusion, Malignant] explode all trees
2 Malignant pleura* effusion:ti,ab,kw (Word variations have been searched)
3 #1 or #2
4 MeSH descriptor: [Lymphoma] explode all trees
5 MeSH descriptor: [Small Cell Lung Carcinoma] explode all trees
6 MeSH descriptor: [Breast Neoplasms] explode all trees
7 MeSH descriptor: [Ovarian Neoplasms] explode all trees
8 MeSH descriptor: [Neoplasms, Germ Cell and Embryonal] explode all trees
9 MeSH descriptor: [Germinoma] explode all trees
10 #4 or #5 or #6 or #7 or #8 or #9
11 lymphoma:ti,ab,kw (Word variations have been searched)
12 small cell lung near/1 (cancer* or neoplasm*):ti,ab,kw (Word variations have been searched)
13 breast near/1 (cancer* or neoplasm*):ti,ab,kw (Word variations have been searched)
14 ovarian near/1 (cancer* or neoplasm*):ti,ab,kw (Word variations have been searched)
15 (germ cell tumour) or (germ cell tumor):ti,ab,kw (Word variations have been searched)
16 #11 or #12 or #13 or #14 or #15
17 #3 and (#10 or #16)
18 MeSH descriptor: [Drug Therapy] explode all trees
19 MeSH descriptor: [Chemoradiotherapy] explode all trees
20 MeSH descriptor: [Chemotherapy, Adjuvant] explode all trees
21 MeSH descriptor: [Radiotherapy] explode all trees
22 MeSH descriptor: [Immunotherapy] explode all trees
23 MeSH descriptor: [Hormone Replacement Therapy] explode all trees
24 MeSH descriptor: [Molecular Targeted Therapy] explode all trees
25 #18 or #19 or #20 or #21 or #22
26 (chemotherap* or radiotherap* or immunotherap* or hormone replacement therap* or targeted therap*):ti,ab,kw (Word variations have been searched)
27 #25 or #26
28 #17 and #27
Question 6 – In order to determine treatment in malignant pleural effusion, is a histological diagnosis always required or is cytology sufficient?Summary – the following databases were searched:MEDLINE 987 records identifiedEmbase 650 records identifiedDatabase: Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) <1946 to Present>Via Ovid 14th February 20171 Pleural Effusion, Malignant/ (3262)2 Malignant pleura$ effusion.ti,ab. (1525)TF-2016-03V1.2 17/11/2017 Page 13 of 193 1 or 2 (3977)4 exp Biopsy/ (251622)5 biops$.ti,ab. (339380)6 exp histological techniques/ (706358)7 exp histocytochemistry/ (449080)8 exp fluorescent antibody technique/ (116898)9 exp histocytological preparation techniques/ (236867)10 exp microdissection/ (3079)11 exp microtomy/ (8911)12 exp replica techniques/ (8586)13 exp “staining and labeling”/ (169591)14 exp tissue embedding/ (7844)15 exp tissue preservation/ (66122)16 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 (1147659)17 3 and 16 (811)18 exp cytological techniques/ (1366851)19 cell count/ (60797)20 cell culture techniques/ (40931)21 cell migration assays/ (401)22 cell separation/ (38995)23 cell tracking/ (1494)24 cytodiagnosis/ (15162)25 karyometry/ (1516)26 cytogenetic analysis/ (5423)27 cytophotometry/ (1045)28 enzyme-linked immunospot assay/ (905)29 histocytochemistry/ (72568)30 histocytological preparation techniques/ (1436)31 Biomarkers, Tumor/an Analysis32 Neoplastic Cells, Circulating/ (8364)33 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 (1390594)34 3 and 33 (929)35 17 or 34 (1147)36 limit 35 to english language (987)EmbaseVia Ovid 14th February 2017Database: Embase <1974 to 2017 Week 06>1 Pleural Effusion, Malignant/ (197)2 Malignant pleura$ effusion.ti,ab. (2335)3 1 or 2 (2401)4 exp Biopsy/ (618468)5 biops$.ti,ab. (492133)6 exp histology/ (1168556)7 exp histocytochemistry/ (116963)8 exp fluorescent antibody technique/ (30029)9 exp microdissection/ (10231)10 exp microtomy/ (2492)11 exp staining/ (248558)12 exp tissue embedding/ (1168556)13 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 (2035078)14 3 and 13 (548)TF-2016-03V1.2 17/11/2017 Page 14 of 1915 exp cytology/ (755612)16 exp cell count/ (348483)17 cell culture technique/ (640)18 cell migration assay/ (1800)19 cell separation/ (13927)20 cell tracking/ (2752)21 exp cytodiagnosis/ (62461)22 karyometry/ (1198)23 cytophotometry/ (1370)24 enzyme linked immunospot assay/ (9229)25 Tumor Marker/an (7049)26 Circulating Tumor Cell/ (6831)27 15 or 6 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 (1835767)28 3 and 27 (550)29 14 or 28 (756)30 limit 29 to english language (650)TF-2016-03V1.2 17/11/2017 Page 15 of 19Appendix D – Eligibility criteria for each PICO questionPICOInclusion criteriaExclusion criteria1Systematic reviewsMeta-analysesRandomised controlled trialsLarge observational studies (n>100)Smaller observational studies (n<100) if novel data, or if only report of a certain intervention Opinion pieces & editorials Letters Non-formal review articles Case reports Conference abstracts Laboratory studies Animal studies Trials comparing pleurodesis agents Papers relating to trapped lung or loculated effusion (PICO 2 & 3) 2 Systematic reviews Meta-analyses Randomised controlled trials, Observational studies where n>1Opinion pieces & editorialsLettersNon-formal review articlesCase studiesConference abstractsLaboratory studiesAnimal studiesPleurodesis papersPapers reporting trapped lung incidence or trapped lung as an outcome3Systematic reviewsMeta-analysesRandomised controlled trials,Observational studiesNon-formal review articlesCase reportsOpinion pieces & editorialsLettersConference abstractsLaboratory studiesAnimal studiesPapers reporting incidence of loculated effusions or loculations as an outcome4Systematic reviewsMeta-analysesRandomised controlled trials,Observational studies n>100Prognostic biomarkers or biomarkers that affect clinical decision makingOpinion pieces & editorialsLettersNon-formal review articlesCase reportsConference abstractsLaboratory studiesAnimal studiesPapers describing prognostic factors for a specific tumour type that may include malignant pleural effusions, but do not relate specifically to people with effusionsPredictors of pleurodesis successDiagnostic & disease specific biomarkersMolecular markers and histochemistry5Systematic reviewsMeta-analysesRandomised controlled trials,Observational studiesCase reportsOpinion pieces & editorialsLettersNon-formal review articlesConference abstractsLaboratory studiesAnimal studiesTF-2016-03V1.2 17/11/2017 Page 16 of 196Systematic reviewsMeta-analysesRandomised controlled trials,Observational studiesBlood biomarkersCirculating tumour cellsLiquid biopsyOpinion pieces & editorialsLettersNon-formal review articlesCase reportsConference abstractsLaboratory studiesAnimal studiesPapers comparing cytokines/cell populations in benign vs malignant effusionsPapers comparing specific biopsy techniquesPaediatric tumoursPapers describing molecular pathways/mechanistic processesPapers focussing on specific cell receptors or markersTF-2016-03V1.2 17/11/2017 Page 17 of 19Appendix E – PRISMA diagram for each PICO questionPRISMA diagram for PICO question 1PRISMA diagram for PICO question 2Identified by snowballing30Studies included94Records screened447Records excluded311Full texts assessed136Records excluded42N<100 = 28Review article = 4Not relevant to PICO = 10Identified by search517Records once duplicates removed447Identified by snowballing8Studies included17Records screened77Records excluded50Full texts assessed27Records excluded10Review article = 4Not relevant to PICO = 6Identified by search86Records once duplicates removed77TF-2016-03V1.2 17/11/2017 Page 18 of 19PRISMA diagram for PICO question 3PRISMA diagram for PICO question 4Identified by snowballing13Studies included18Records screened164Records excluded137Full texts assessed27Records excluded9Review article = 3Not relevant to PICO = 4Research letter = 2Identified by search146Records once duplicates removed164Identified by snowballing13Studies included66Records screened1130Records excluded1021Full texts assessed109Records excluded43N<100 = 20Not relevant to PICO = 18Conference abstract = 2Review article = 2Duplicate data = 1Identified by search1726Records once duplicates removed1130TF-2016-03V1.2 17/11/2017 Page 19 of 19PRISMA diagram for PICO question 5PRISMA diagram for PICO question 6Identified by snowballing0Studies included15Records screened479Records excluded430Full texts assessed49Records excluded34Not relevant to PICO = 22In vitro studies = 6Review article = 5Not in English = 1Identified by search557Records once duplicates removed479Identified by snowballing40Studies included62Records screened1527Records excluded1352Full texts assessed175Records excluded113Not relevant to PICO = 109Review article = 4Identified by search1637Records once duplicates removed1527
Introduction
In the essay in M1, the student should write a systematic, coherent and critical report in English as a result of a systematic review, related to a concrete clinical scenario and a clinical question. The essay follows the steps of the CAT. An extra step in the essay is the search for guidelines and protocols.
Learning goals The student can:
-To describe a clinical scenario
-To formulate a question
-To formulate a question according to the PICO method
-To conduct an adequate literature search
-To make a considered and reasoned choice for the systematic review to be analyzed
-To critically evaluate a systematic review
-To describe the results in a good way
-To weigh the results found and translate them to the individual patient.
-The student writes an essay on a CAT in English and uses the following parts:
Clinical scenario
A description of the patient is given in which the clinical relevance is made clear.
2.Clinical question
A clinical question is described: “what do I want to know for this patient? The clinical question includes the 4 PICO elements.
3.Guidelines and protocols
A description is given of the guidelines and protocols available for the clinical scenario. Attention is paid to both the national guidelines and the guidelines/protocols within the institution. If there are no guidelines and/or protocols for the clinical question, in step 6 (comments) attention is given to the description of important aspects of a possible future guideline.
4.Searching for a Systematic review
A good and recent systematic review is searched for, using the web course ‘literature search’. The search strategy is described in the essay.
5.Critical appraisal of a systematic review
We are looking for a good recent systematic review. The quality of the review is evaluated critically based on the following questions:
-is the question adequately formulated?
-has the search been carried out adequately?
-has the selection procedure been carried out adequately?
-has the clinical and statistical heterogeneity of the studies been adequately dealt with?
-was the quality assessment adequately carried out?
-have the main characteristics of the original studies been described?
-Is there a transparent presentation of the results?
6.Evidence
A clear description and interpretation of the results of the systematic review is provided.
7.Weighing of evidence, experience and patient preferences
The results found are weighed and combined with the knowledge of the physician and the applicability to the patient. Where possible, you ask the physician about his/her experience with the problem and you ask the patient about his/her preferences and wishes.
The following points are described:
-What is the meaning of the found evidence for the diagnosis/treatment of the patient in question?
-Does the evidence comply with the guidelines? If not, why and what should/can be changed in the guideline on the basis of the current evidence?
-If no guidelines were available, a description is given of the important aspects in the future guideline.
-The role of the doctor’s experience: how does the doctor interpret the situation in the light of the evidence and his or her previous experiences?
-The role of the patient’s preferences: to what extent do the patient’s preferences differ from the evidence and do they influence the choice of diagnosis or treatment?
The essay concludes with the final answer to the clinical question. Here it is indicated what the appropriate course of action is, given the information about the guidelines, the evidence, the doctor’s experience and the patient’s preferences.
Conditions In addition to the above substantive conditions, the essay must meet the following technical conditions: -Writing language: English -Number of words: 2000 (minimum) – 2500 (maximum) words -Scientific language use -Logical and clear structure -Correct source listing (in accordance with APA)
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Our essay writers are graduates with diplomas, bachelor’s, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college diploma. When assigning your order, we match the paper subject with the area of specialization of the writer.
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Get superb grades consistently
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You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.
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Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.
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