Full text of DOI:10.1046/j.1365-2532.2000.00280.x

Blackwell Science, Ltd
A Hungarian example for handsearching specialized
national healthcare journals of small countries for
controlled trials. Is it worth the trouble?
Dániel Bereczki* & Gyöngyi Gesztelyi†, *Department of Neurology, University of Debrecen Medical
School, Hungary, †Department of Neurology, Kenézy Gyula Hospital, Debrecen, Hungary
Abstract
The objective of this study was to determine whether a Hungarian language
journal of clinical neuroscience, which is not indexed in , contains any
reports of randomized or quasi-randomized clinical trials that are not also
reported in -indexed publications. A cover-to-cover handsearch was
performed of the journal Clinical Neuroscience/Ideggyógyászati Szemle, the
official journal of Hungarian societies of neurology, neurosurgery, psychiatry
and related clinical neurosciences, from its first volume in 1950 to the end
of 1998; and a search of  for other reports of the trials identified.
Clinical trials in which patients were allocated to interventions by randomized,
quasi-randomized or possibly randomized means were identified. Controlled
trials were tabulated and coded as randomized controlled trials or controlled
clinical trials according to the definitions of the Handsearch Manual of the
Cochrane Collaboration. We identified three randomized and eight quasi-
randomized trials. Six of the 11 trials were not reported in  indexed
publications.
In conclusion, to obtain a comprehensive controlled trials register, specialized
healthcare journals printed in small numbers in the national languages of small
countries should be searched.
In order to identify the largest possible number of
controlled trials a systematic cover-to-cover hand-
Introduction
Systematic reviews of the effects of health care
interventions should include all available evidence.
Because randomized controlled trials (RCT) provide
the most reliable evidence, the Cochrane Collabora-
tion collects randomized, quasi-randomized and
possibly randomized clinical trials, which are referred
to as controlled clinical trials (CCT). These are made
available in the Cochrane Controlled Trials Register.1
search of healthcare journals is recommended by
the Collaboration to be performed back to the
first volume of the journals, or to 1948 or before.2
Excluding non-English language publications
from systematic reviews might result in neglecting
a considerable amount of evidence.3 It may also
lead to a bias in favour of including more studies
with positive results, because authors have been
shown to be more likely to publish RCTs in English
language journals if the results are statistically
significant.4 Therefore, it is important to try to
include trials published in non-English languages
Correspondence: Dr Dániel Bereczki, Department of Neurology,
University of Debrecen, Medical School, Nagyerdei krt. 98., H-4012
Debrecen, Hungary. E-mail: bereczki@jaguar.dote.hu
144
© Blackwell Science Ltd 2000 Health Libraries Review, 17, pp.144–147

Controlled trials in a Hungarian journal of clinical neurosciences, D. Bereczki & G. Gesztelyi 145
in systematic reviews.5 In addition to finding reports
step the family names without initials of all authors
for each identified randomized or quasi-randomized
trial was combined with OR, and the disease and
the intervention was added to the query using AND
after the authors’ names and using OR between
the disease condition and the intervention. This
search was run separately for each publication. If
this search identified a -indexed correspond-
ing publication for any of the reports identified by
handsearch, then no further search was done for
that study. For those reports where the above search
yielded no result, in the second step we combined
the family names without initials of all authors
by OR, and ran the search separately for each
report. The results were then checked against the
original report identified by handsearch.
of trials in the languages of large nations, hand-
searching of -indexed journals from smaller
countries has also identified a number of controlled
trials.6 It has not been reported whether hand-
searching non--indexed specialized journals
printed in small numbers in national languages of
small countries does or does not yield a reasonable
number of reports of RCTs and CCTs not published
in -indexed journals also. In the present
study we performed a cover-to-cover handsearch
for RCTs and CCTs of all volumes of a Hungarian
language journal Clinical Neuroscience/Ideggyó-
gyászati Szemle, which is the official journal of
Hungarian societies of neurology, neurosurgery,
psychiatry and related clinical neurosciences.
Methods
Results
Handsearch
Handsearch
A cover-to-cover handsearch was performed of the
Hungarian journal Clinical Neuroscience/Ideggyó-
gyászati Szemle from its first volume in 1950 to
the end of 1998. Because it was a cover-to-cover
search, not only full-length papers, but letters,
society reports, abstracts of meetings, etc. were
also checked. Trials were identified and coded as
randomized controlled trials (RCT), or controlled
clinical trials, according to the definitions of the
Cochrane Handsearch Manual.
The handsearch results of all pages from the
first issue in 1950 to the last one in 1998 of the
Hungarian-language journal of clinical neuroscience
Clinical Neuroscience/Ideggyógyászati Szemle is
summarized in Table 1. There were more than 2400
full length articles plus numerous abstracts and
other reports. We found three definitely randomized
trials,8–10 eight trials in which a method of quasi-
randomization was described,11–18 and a further 16
trials that were possibly randomized or quasi-
randomized. Bibliographic data of these trials are
now available in the Cochrane Controlled Trials
Register.1 The 11 trials where patient allocation
was explicitly stated to be random or quasi-random
ranged in size from seven to 120 participants (median:
33). Two of the three RCTs were published as full
length papers.8,9 The other was a conference
abstract.10
Electronic search
To check whether the definitely randomized or
quasi-randomized trials identified by handsearch
were also reported in -indexed articles, we
searched  for the names of all authors on
the trials using the ‘Advanced  search’
option of PubMed.7 The search was performed
twice. The first search was run in July 1999 using
the family name and the first initial of all authors
of each publication. Separate searches were per-
formed one-by-one for each author. Not only the
titles but also the text of all abstracts was read,
because it is not always possible to decide the
content of the paper only from the titles. The
second search was run in February 2000. This
search was performed in two steps. In the first
Table 1 The number of various types of controlled trials in
Clinical Neuroscience/Ideggyógyászati Szemle.
Definite
RCT
Definite
CCT
PossibleRCT
or CCT
Years
1950–61
1962–73
1974–85
1986–98
0
1
0
2
0
0
3
5
7
1
4
4
© Blackwell Science Ltd 2000 Health Libraries Review, 17, pp.144–147

146 Controlled trials in a Hungarian journal of clinical neurosciences, D. Bereczki & G. Gesztelyi
Grant from the Ministry of Education, Republic
Electronic search
of Hungary. The handsearch activity was partly
supported by the Soros Foundation, Hungary.
The authors thank Dr Mike Clarke (UK Cochrane
Centre, Oxford) for his comments on a previous
version of this manuscript.
Two  searches were performed to investigate
whether the 11 definitely randomized or quasi-
randomized trials (three RCTs and eight CCTs)
had been published in  indexed journals.
Two of the three randomized trials9,10 also appeared
in .19,20 The only RCT not found elsewhere
was a small, Latin square cross-over trial in seven
healthy volunteers.8 In the first search (July 1999)
one of the eight quasi-randomized trials12 could
be identified in  as a part of a more com-
plex paper,21 and another one with 22 patients16
was a pilot study for a large multicentre trial involv-
ing 255 patients.22 The second search (February
2000) yielded one more result,23 which was a paper
published in 1999 and could not be identified by
the first search because at that time the report
was not indexed on . The handsearch-
identified version of that report was an abstract,17 a
preliminary report with 20 patients, whereas the
final -indexed report involved 40 cases.
References
1 The Cochrane Controlled Trials Register. In: The
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Discussion
The number of RCTs and CCTs compared to
the total number of papers published in Clinical
Neuroscience/Ideggyógyászati Szemle was relatively
small, but this is comparable to the proportion
of RCTs and CCTs found in at least one speci-
alized English language journal that is indexed in
.24 The Hungarian trials were usually small.
Two of the three RCTs and one quasi-randomized
trial could also be identified in English language
papers published in -indexed journals. In
addition, two more quasi-randomized trials found
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trials, reports of which appeared in  1
and 4 years later. Because five of the eight quasi-
randomized trials and one of the RCTs could not
have been identified by  search, we suggest
that to obtain a comprehensive controlled trials
register, specialized medical journals printed in
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Acknowledgements
D. Bereczki was supported by the Széchenyi
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