1. Handsearching: an old strategy in the era of the information Garcia JM, Pardo J, Bonfill X Iberoamerican Cochrane Centre Hospital de la Santa Creu i Sant Pau Barcelona-SPAIN EAHIL/9 - 2004 Santander, SPAIN

2. Handsearching project Major activity of The Cochrane Collaboration

3. The Cochrane Collaboration? An international non-profit and independent organisation, dedicated to making up-to-date, accurate information about the effects of healthcare readily available worldwide.

4. Main Activities of CC Preparing, maintaining and promoting the accessibility to systematic reviews of the effects of health care The major product of the Collaboration is the Cochrane Database of Systematic Reviews published quarterly in The Cochrane Library

5. Cochrane Systematic review? A Cochrane Review is a systematic, up- to-date summary of reliable evidence of the benefits and risks of healthcare. Cochrane Reviews are intended to help people make practical decisions.

6. Background (1) Systematic reviews (SR) need to be based on all the available evidence. SR of effectiveness of interventions are typically based on reports of RCTs Electronic databases do not always allow to identify them due to: –inadequate indexing of this type of study –Not all journals are indexed in the main databases

7. Background (2) Iberoamerican Cochrane Centre register of clinical trials published in Spanish.

8. Objectives To identify randomised controlled trials in Spanish journals To register randomised controlled trials in CENTRAL in The Cochrane Library To increase the accessibility of randomised controlled trials published in Spanish journals

9. Methods (1) Identification of all health care journals published in Spain (Catálogo C-17) Selection of journals to be handsearched Registration of journals on Cochrane Collaborations Master List Training handsearchers Handsearch journal issues to identify possible randomised controlled trials All reports identified verified by Trial Search Coordinator, and rejected if necessary

10. Methods (2) All controlled trials entered in a Procite ® database Electronic records generated and submitted for inclusion in the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library Journals handsearched from 1948 to 2001

11. Characteristics of Randomised Controlled Trials The study compares interventions in humans The study is prospective Two or more interventions are compared Random assignment of participants to interventions

12. Handsearcher Copies of originals Organise handsearching Trials Search Co-ordinator IbCC Evaluation by TSC Accepted Rejected US Cochrane Center Sending reference database containing electronic citations of identified trials Register journal searches on Master List Flow chart C LIB

13. Trials Search Coordinator God TSC

14. My office... In heaven - Yes, is a Trial - No, is not a Trial

15. All you need is trials - Oh my god, I need a trial

16. Difficult access Please, all my reports should be trials

17. The new generation My god, I need found trials in my stories

18. …exhausted TSC

19. Results (I) Identified 643 Spanish health care journals 41 indexed in Medline 432 (67%) journals handsearched

20. Results (II) 3,548 randomised controlled trials identified 2,028 (57.2%) randomised controlled trials from journals not indexed in Medline More trials identified between 1992-1996

21. Number of trial reports in each publication year

22. Total number of trials in indexed in Medline journals Versus journals not indexed in Medline 1,520 2,028

23. Global Results of database and handsearches 415,918 Reports of Trials

24. CENTRAL The Cochrane Central Register of Controlled Trials Likely to be the best single source of published trials for inclusion in systematic reviews and meta-analyses Egger M, Smith GD. Bias in location and selection of studies. BMJ 1998;316:61-6.

26. Conclusions The handsearch has made available controlled trials from a greater number of journals Handsearching has added significant results to the information from controlled trials published in Spanish journals Handsearching contributes to increase the available knowledge to everyone involved in evidence-based health care

27. Acknowledgements - Sources of support: BIOMED-1 Program [BMH1-CT94-1289] BIOMED-2 Program [BMH4-CT98-3803] FIS Project [96/1802E] FIS Project [99/1333] SEOM Marató TV3 FIPSE - The authors thank all the handsearchers who participated in this project.

28. Contact Address Josep Mª Garcia Jgarciaa@santpau.es