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Appendix B Study Approach
Pages 409-442

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From page 409...
... The following sections detail the process by which the committee came to their conclusions about the weight of evidence regarding the association between cannabis and specific health endpoints. The steps include the literature search, the refinement of the specific health endpoints of medical and public health importance to be assessed, the identification and assessment of relevant literature (including published systematic reviews and primary literature)
From page 410...
... The results from searches 2 through 6 were combined to create a master library containing 10,759 unique articles, including 1,488 articles initially categorized as systematic reviews. These articles were then sorted into seven major health endpoint topic areas: injury and mortality; car
From page 411...
... After filtering the original search results for articles relevant to the health endpoints of interest, 6,540 primary literature articles and 288 systematic reviews were left to be reviewed by the committee. Given the large number of potentially relevant articles, the committee decided to begin by reviewing the identified systematic reviews.
From page 412...
... 2. Does the article describe a search involving appropriate search terms?
From page 413...
... . In their assessment of the quality of a systematic review, committee members considered the study eligibility criteria, how studies were identified and considered for inclusion, how data were collected and appraised by the authors, the methods by which study findings were selected and synthesized, and whether any conflict of interests were addressed.
From page 414...
... Conflict of interest • Was the conflict of interest for the systematic review stated? Overall quality • Rate the overall quality of the systematic review
From page 415...
... Only those systematic reviews rated as good or fair quality were used to inform the report's findings, conclusions, and recommendations. PRIMARY LITERATURE: IDENTIFICATION AND QUALITY REVIEW For those health endpoints addressed by more than one good- or fair-quality systematic review, the committee gave primacy to the most recently published systematic reviews (since 2011)
From page 416...
... Identify Health Topic-Relevant Articles Removed [Total: 2,292; SR: 247; PL: 2,048] Injury & Death Therapeutic Cancer & Immunity/ Psychosocial Mental Health Pregnancy Cardiovascular & Articles: 1,895 Articles: 2,825 Infection Articles: 1,896 Articles: 5,954 Articles: 460 Respiratory SR: 209 SR: 568 Articles: 1,418 SR: 146 SR: 653 SR: 58 Articles: 506 PL: 1,688 PL: 2,282 SR: 313 PL: 1,755 PL: 5,329 PL: 402 SR: 124 PL: 1,111 PL: 383 Identify Health Endpoint-Relevant Articles Removed [Total: 1,639; SR: 953; PL: 731]
From page 417...
... is an effective or ineffective treatment for the prioritized health endpoints of interest, or whether cannabis or cannabinoid use (primarily for recreational purposes) is statistically associated with the prioritized health endpoints of interest.
From page 418...
... Furthermore, very good research may not be reflected in this report because it did not directly address the health endpoint questions that the committee formulated.
From page 419...
... No conclusion can be made because of substantial uncertainty due to chance, bias, and confounding factors. SEARCH STRATEGIES Search 2 Date: June 27, 2016 Total citations: Systematic reviews: 541 Primary literature: 1,551 Total: 2,092
From page 420...
... . The fields searched by a .mp in Embase and Medline include title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, and unique identifier.
From page 421...
... 41 irritable bowel syndrome.mp. or Irritable Bowel Syndrome/ 42 28 and 41 43 limit 42 to (English language and humans and yr="1999–Current")
From page 422...
... or Brain Injuries/ 90 28 and 89 91 limit 90 to (English language and humans and yr="1999–Current") 92 34 or 37 or 40 or 43 or 48 or 51 or 55 or 58 or 61 or 66 or 69 or 72 or 77 or 83 or 88 or 91 93 limit 92 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
From page 423...
... 31 limit 30 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial) 32 limit 30 to (meta analysis or systematic reviews)
From page 424...
... 24 or/21–23 25 or/11–16 26 20 and 25 27 26 not 24 28 27 29 limit 28 to (English language and humans and yr="1999–Current") 30 limit 29 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
From page 425...
... 48 limit 23 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
From page 426...
... 54 limit 39 to (meta analysis or systematic reviews) 55 limit 47 to (meta analysis or systematic reviews)
From page 427...
... 31 or/28–30 32 18 and 31 33 32 not 17 34 33 35 limit 34 to (human and english language and yr="1999–Current") 36 limit 35 to (clinical trial or randomized controlled trial or controlled clinical trial or multicenter study or phase 1 clinical trial or phase 2 clinical trial or phase 3 clinical trial or phase 4 clinical trial)
From page 428...
... 80 limit 78 to (clinical trial or randomized controlled trial or controlled clinical trial or multicenter study or phase 1 clinical trial or phase 2 clinical trial or phase 3 clinical trial or phase 4 clinical trial) 81 limit 80 to (journal and article)
From page 429...
... or newborn mortality/ 26 physical growth.mp. or growth/ 27 18 and 19 28 27 not 17 29 28 30 limit 29 to (human and english language)
From page 430...
... 62 limit 49 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial) 63 limit 49 to (meta analysis or systematic reviews)
From page 431...
... 78 limit 70 to (meta analysis or systematic reviews) 80 limit 75 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
From page 432...
... 52 24 or 32 or 36 or 42 or 47 or 51 53 limit 52 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial) 54 24 or 32 or 36 or 42 or 47 or 51 55 limit 54 to (meta analysis or systematic reviews)
From page 433...
... 26 limit 25 to (meta analysis or systematic reviews) 27 limit 25 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
From page 434...
... 16 or/14–15 17 13 not 16 18 17 19 limit 18 to (English language and humans) 20 limit 19 to (classical article or clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or comparative study or controlled clinical trial or evaluation studies or guideline or journal article or multicenter study or observational study or practice guideline or pragmatic clinical trial or randomized controlled trial or validation studies)
From page 435...
... 22 20 not 21 23 limit 22 to yr=1999-current 24 limit 19 to (meta analysis or "review" or systematic reviews) 25 limit 19 to (addresses or autobiography or bibliography or biography or case reports or clinical conference or comment or congresses or consensus development conference or consensus development conference, NIH or "corrected and republished article" or dataset or dictionary or directory or duplicate publication or editorial or english abstract or festschrift or government publications or historical article or in vitro or interactive tutorial or interview or introductory journal article or lectures or legal cases or legislation or letter or news or newspaper article or overall or patient education handout or periodical index or personal narratives or portraits or published erratum or research support, non us gov't or retracted publication or "retraction of publication" or "scientific integrity review" or technical report or video-audio media or webcasts)
From page 436...
... AND pd(19990101 20160601) Search 5 Date: July 15, 2016 Total citations: Systematic Reviews: 10 Primary Literature: 23 Total: 33 Database (search engine)
From page 437...
...  9 or/6–8 10 5 not 9 11 limit 10 to (English language and yr="1999-Current") 12 limit 11 to (clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or observational study or randomized controlled trial)
From page 438...
... 16 or/14–15 17 13 not 16 18 17 19 limit 18 to (English language and humans) 20 limit 19 to (classical article or clinical study or clinical trial, all or clinical trial, phase I or clinical trial, phase II or clinical trial, phase III or clinical trial, phase IV or clinical trial or comparative study or controlled clinical trial or evaluation studies or guideline or journal article or multicenter study or observational study or practice guideline or pragmatic clinical trial or randomized controlled trial or validation studies)
From page 439...
... Search No. Search Syntax  1 major clinical study/  2 clinical article/  3 case report/  4 clinical trial/  5 controlled clinical trial/  6 phase 1 clinical trial/  7 phase 2 clinical trial/  8 phase 3 clinical trial/  9 phase 4 clinical trial/ 10 randomized controlled trial/ 11 double blind procedure/ 12 single blind procedure/ 13 crossover procedure/ 14 multicenter study/ 15 controlled study/ 16 "clinical trial (topic)
From page 440...
... 43 41 not 42 44 case report/ 45 43 not 44 46 45 47 limit 46 to (human and English language) 48 limit 47 to yr="2016–Current" 49 limit 48 to dd=20160630-20161231 50 meta analysis/ 51 "meta analysis (topic)
From page 441...
... APPENDIX B 441 REFERENCES Higgins, J


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