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Informing a medical subject heading (MeSH) request: The 'Prescribing cascades' case study.

Fernando Fernandez-Llimos1, Fernanda S Tonin2

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Summary

A dedicated Medical Subject Headings (MeSH) term for "prescribing cascades" is not currently needed. Existing MeSH terms adequately capture the concept, suggesting focus should shift to improving indexing strategies for better retrieval.

Keywords:
Bibliographic databasesControlled vocabularyInformation storage and retrievalTerminology as topic

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Area of Science:

  • Pharmacovigilance and Drug Safety
  • Medical Informatics and Controlled Vocabularies
  • Health Services Research

Background:

  • Prescribing cascades, where new treatments are initiated for adverse drug effects mistaken as new conditions, pose a challenge for accurate medical indexing.
  • Currently, no specific Medical Subject Headings (MeSH) term exists for this phenomenon, hindering precise literature retrieval.
  • This study investigated the necessity of a dedicated MeSH term for prescribing cascades and its potential influence on indexing consistency.

Purpose of the Study:

  • To evaluate the need for a new MeSH term to represent 'prescribing cascades'.
  • To assess whether existing MeSH terms are sufficient for indexing and retrieving literature on prescribing cascades.
  • To analyze the impact of a potential new MeSH term on indexing consistency and retrieval accuracy.

Main Methods:

  • A cross-sectional analysis of 139 articles from a scoping review was performed.
  • PubMed and MEDLINE metadata were utilized to examine MeSH term attribution for the selected articles.
  • Statistical analysis, including odds ratios (OR) with 95% confidence intervals (CI), quantified associations between keywords (e.g., 'inapprop-', 'adverse', 'cascade') and assigned MeSH terms.

Main Results:

  • Analysis of 106 MEDLINE-indexed articles revealed prevalent MeSH terms including 'Drug-Related Side Effects and Adverse Reactions' (32.1%), 'Polypharmacy' (30.2%), and 'Inappropriate Prescribing' (26.4%).
  • Keyword analysis showed significant associations: 'inapprop-' in titles predicted 'Potentially Inappropriate Medication List' (OR=204), and 'adverse' in abstracts predicted 'Drug-Related Side Effects and Adverse Reactions' (OR=2.8).
  • The term 'cascade' in titles was associated with 'Drug-Related Side Effects and Adverse Reactions' (OR=3.6), indicating some existing terms capture aspects of prescribing cascades.

Conclusions:

  • The findings suggest that current MeSH descriptors are adequate for capturing the main dimensions of prescribing cascades.
  • Evidence does not currently support the creation of a dedicated MeSH term for 'prescribing cascades'.
  • Future research should focus on achieving definitional consensus and developing compositional indexing strategies to improve retrieval accuracy for this concept.