Saeid SafariMD, Anesthesiologist
Editorial Manager of Anesthesiology and Pain Medicine
How to Conduct a Literature ReviewSearching references in medical journalism
ISRAPM 2014
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Objectives List four categories of information resources
Apply selection criteria to identify appropriate
information resource
List five databases to find primary studies
Strategize and execute a systematic, explicit and
reproducible search of the biomedical literature
Searching for scientific problemReview of literature
H y p o t h e s i sAims of research
M e t h o d s Plan of research
ResearchResults
Researchers work in graphic form
Aztec Pyramide
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What’s a Research Lit Review?
A research literature review is a systematic, explicit and
reproducible method for identifying, evaluating, and synthesizing
the existing body of completed and recorded work produced by
researchers, scholars, and practitioners.*
*Fink, A. (2005). Conducting Research Literature Reviews. London: Sage.
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Level of Evidence Pyramid
Qualitative Studies
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Criteria for Selecting a Resource1. Soundness of evidence-based approach
2. Comprehensiveness and specificity
3. Ease of use
4. Availability
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Questions to Ask Bias? Conflict of interest?
Evidence grading or ranking applied?
Links?
Discipline coverage?
Consistent and quick to search?
Cost?
Available in my location?
HOW TO SEARCH STUDIES
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A Comprehensive Search is... Systematic
Explicit
Reproducible
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7 tasks in the Research Lit Review
1. Selecting research questions
2. Selecting your sources
3. Choosing search terms
4. Running your search
5. Applying practical screening criteria
6. Applying methodological screening criteria
7. Synthesizing the results
SELECTING RESEARCH QUESTIONS
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Why do you need a research question?
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Scenario
You’re applying for a grant to support your research on
management of patients with atrial fibrillation.
Think of a question related to this topic...
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Possible questionsBroad:
What is the prevalence of atrial fibrillation?
Narrow:
What costs are associated with hospitalization for atrial fibrillation?
Very Narrow:
What strategies have been utilized in Iran to reduce length of stay for
patients with atrial fibrillation?
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How questions influence search results
Relevancy
Retrieval(# of search results)
Broad Questions
Narrow Questions
High = lots of articles
Low = very few articles
High = directly relevant articles
Low = mostly irrelevant articles
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Sample Search Statements I am looking for articles about osteoarthritis of the knee.
13,886 articles in PubMed
I am looking for RCTs on arthroscopic surgery for osteoarthritis
of the knee that include placebo surgery as a control. 9 articles in PubMed
I am looking for RCTs on arthroscopic surgery conducted in
latino females with type 1 diabetes mellitus. 0 articles in PubMed
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Stage In Searching1. Define search topics
2. Choose appropriate search terms/keywords that represent the
topic
3. Decide where to search/which sources to use (e.g. library
catalog, online databases)
4. Develop search strategy by optimizing search tools
5. Observe search results
6. Revise the search as necessary
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Turn your statement into a strategy
1. Break you question into concepts
2. Identify subject headings for each concept
3. Identify keywords for each concept
Tips: Use a “target article” to help identify search terms
Use a strategy worksheet to keep track of your terms:
http://www.lib.uwo.ca/files/taylor/grad/Search_Strategy_Worksheet.pdf
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Does hand washing prevent MRSA? in the ICU?
Hand washing MRSA ICU Prevention
Handwashing [MeSH]
Methicillin-Resistant Staphylococcus aureus [MeSH]
Intensive care units [MeSH] +
Handwash$.mp. Methicillin resistant staphylococcus aureus.mp.
Intensive care unit$.mp.
Prevent$.mp.
Hand wash.mp. MRSA.mp. ICU.mp.
Hand disinfect.mp. Critical care unit$.mp.
Surgical scrub$.mp.
Hand clean$.mp.
SELECTING YOUR SOURCES
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Lit reviews depend on data from seven sources
1. Online public bibliographic databases
2. Commercial bibliographic databases
3. Specialized bibliographic databases
4. Manual or “hand searches” of references lists
5. “Grey literature”
6. Web reports
7. Expert opinions
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Where to search Bibliographic Databases
Medicine PubMed (or Ovid MEDLINE), EMBASE, Cochrane Library, PsycINFO
Multidisciplinary Scopus
Web of Science
Nursing and Allied Health CINAHL
Websites
Associations, Organizations & Government World Health Organization, Health Canada, Canadian Medical Association, etc.
Other
“Grey Literature” Dissertations & Theses, SCOPUS (conference proceedings), Web search engines
CHOOSING SEARCH TERMS
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Different databases have different subject headings
Tips:
Select subject headings that are the closest match for your concept
Pay attention to “explode” commands – some databases will search related
headings by default, others will not
Database Subject HeadingsMedline MeSH
EMBASE EMTREE
CINAHL CINAHL Headings
Cochrane Library MeSH
PsycINFO Thesaurus of Psychological Index Terms
Scopus, Web of Science N/A
Which term explodes?
A. Bird Diseases B. Neutropenia
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Identifying concepts & MeSH headings
Which concepts are contained in the question:
Does hydration decrease incidence of delirium
at the end of life?
Find the MeSH heading(s) for each concept & add them to your worksheet
AND AND
OR exp Fluid Therapy/ Delirium/ exp Terminal Care/
OR Palliative Care/
exp Terminally Ill/
OR
OR
OR
Concept #1
Ovid MEDLINE strategy
Concept #2 Concept #3
Subject Headings
TextWords
Blank worksheets: http://muhclibraries.mcgill.ca/SearchStrategyWorksheet.doc
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Key Operators in OvidOperator Command Example
* Find alternate endings to this word
nurs* [will find nurse, nursing, nurses]
.tw. Search for this term in the Title and Abstract fields
anxiety.tw.
adj Search for one term within x number of terms from another
patient adj3 anxiety [will find patient within three words of anxiety]
AND Find articles where both terms appear
smoking AND cessation
OR Find articles where either term appears
smoking OR tobacco
AND AND
OR exp Fluid Therapy/ Delirium/ exp Terminal Care/
OR Palliative Care/
exp Terminally Ill/
OR
hydrat*.tw. deliri*.tw. (terminal* adj4 patient*).tw.
OR
fluid*.tw. palliative.tw.
ORwater.tw. end of life.tw.
Concept #1
Ovid MEDLINE strategy
Concept #2 Concept #3
Subject Headings
TextWords
RUNNING YOUR SEARCH
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Running your search(es) Start with your first concept
Search for the subject headings first
Then search text words
Combine these synonymous searches with OR using your
search history
Repeat for your second, third, and subsequent concepts
Finally, combine large search results set with AND
Running your search(es)
Search #2 =
Search #3 =
Search #4 =
Search #5 = #1 OR #2 OR #3 OR #4
Search #1 =
Concept 1
Search #6 =
Search #7 =
Search #8 =
Search #9 =
Concept 2
Search #10 = #6 OR #7 OR #8 OR #9
Search #11 = #5 AND #10
Results
Please complete the following search in Ovid Medline
AND AND
OR exp Fluid Therapy/ Delirium/ exp Terminal Care/
OR Palliative Care/
exp Terminally Ill/
OR
hydrat*.tw. deliri*.tw. (terminal* adj4 patient*).tw.
OR
fluid*.tw. palliative.tw.
ORwater.tw. end of life.tw.
Concept #1 Concept #2 Concept #3
Subject Headings
Text Words
APPLYING PRACTICAL SCREENING CRITERIA
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Screening Two kinds: practical and methodological
Use practical screening to identify a broad range of
potentially useful studies
Use methodological screening to identify the best available
studies
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Practical Screening Criteria –examples
1. Date of publication
only studies conducted between 2005 and 2010
2. Participants or subjects
only children 6 to 12 years of age
3. Publication language
only materials written in English or French
4. Research design
only clinical trials
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Apply Practical Screens Add the following screens (limits) to your combined search
result set:
English Language
Publication Year: 2001 – Current
Humans
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LIMITS/FILTERS• Most databases offer limit functions to help users limit
search results that are too broad or too many
• Limits are commonly specified according to:
- date of publication
- type of publications (books, journals, news, etc)
- age group
- language
- sex (male/female)
- type of files
NEXT STEPS
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Working with your results Save or export search results into a citation manager (i.e.,
Endnote)
Remove duplicates
Remove inappropriate studies by applying methodological
screens
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Methodological Screening Criteria - some questions to ask
Is the study’s research design internally & externally valid?
Are the data sources used in the study reliable & valid?
Are the analytic methods appropriate?
Are the results meaningful in practical & statistical terms?*
*Fink, A. (2005). Conducting Research Literature Reviews. London: Sage.
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Moving to another source Retain as much of your original strategy as possible
Recognize that subject headings will be different (or non-
existent)
Keep track of your search terms using new worksheets
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Hand searching and final steps Locate the reference lists for selected articles*
Identify new articles that have cited your articles*
Identify key journals and “hand search” their issues
Test your search strategy by checking to see if a few “target
articles” appear in the results
* Use Web of Science or Scopus
SYNTHESIZING THE RESULTS
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Use your results to...1. Describe current knowledge about your research topic
2. Support the need for and significance of new research
3. Explain research findings
4. Describe the quality of a body of research*
*Fink, A. (2005). Conducting Research Literature Reviews. London: Sage.
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Tips For Effective Searches1. Plan your search – identify the words that represent the topic of
your search
2. Avoid using too broad or general terms, use specific terms instead
to get limited but relevant results.
3. Use limit/filter functions as necessary
4. Create an account. Most online databases allow you to sign up for
an account/personal folder in their database that helps you manage
searches, search results or references, set up preferences, alerts,
and many others.
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Research strategy guide for finding quality, credible sources
1. Get organized
2. Articulate your topic
3. Locate background information
4. Identify your information needs
5. List keywords and concepts for search engines and databases
6. Consider the scope of your topic
7. Conduct your searches
8. Evaluate the information sources you found
9. Analyze and adjust your research strategy
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• Basic computer skill: More than
• Windows
• Word
• PowerPoint
• Excel
• SPSS
• Adobe photoshop
• Medline search
• Endnote
Basic skills for a scientist
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• Paper reading
• Critically and actively
• Ability to recognize problems in the
experimental design
• Ability to recognize key sentences
Basic skills for a scientist
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• Understanding and use of the literature
• Ability to evaluate a paper critically and accurately
• Familiarity to a broad-based, relevant and current literature
• Ability to generate useful notes while reading the literature
• Ability to generate interesting and important questions
• Ability to generate original ideas on the literature
Basic skills for a scientist
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• Experimental design
• Ability to get techniques to work predictably and reproducibly
• Ability to generate high quality data with both positive and negative controls that
can give clear cut answer to a question
• Ability to find the best available information from the best sources
• Ability to interpret fully your data, generate next question or hypothesis and
design the next experiment
• Ability to troubleshoot and solve a technical problem
• Resistance to doing an incomplete experiment using whatever reagents or cells
that happen to be available ”to see what happens”
Basic skills for a scientist
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• Paper writing
• Ability to group data in a logical fashion into good figures
• Ability to make a good-looking figure
• Ability to interpret data in relation to existing literature and
come up with new ideas
• Ability to write a good and useful first draft
• Ability to use key sentence
Basic skills for a scientist
Scholar Google
Results in scholar Google
Google Scholar Profile
TUMS Digital Library
Databases
All EBM Reviews (OVID) MD Consult
Biological Abstract Nursing Consult
CINAHL with Full text Nursing Index
Cochrane Library OVID Databases
Drug Information Full Text OVID Medline
EndNote Web Scopus
Essential Science Indicators (ESI) UpToDate
Journal Citation Reports (JCR) Ulrichsweb
Library, Information Science & Technology Abstracts (LISTA)
Web of Science
All EBM Reviews (OVID)
Cochrane Library
Drug Information Full Text
Scopus
UpToDate
ULRICHS WEB
MD Consult
Journals Collection
Ebsco MD Consult
Elsevier (Sciencedirect) MEDLIB
Emerald Oxford journals
Iran Medex OVID Journals
JAMA Journals Proquest
Wiley Springer
Magiran Thieme Medical Journals
ScienceDirect
Emerald Insight
Iran Medex
JAMA
Wiley Online Library
MagIran
MEDLIB
Springer Link
Theime
PubMed
MeSH (Medical Subject Headings)
MeSH Subheadings
MeSH
Result, PMID, Related Articles!
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Useful Sites CADTH. Grey Matters: a practical search tool for
evidence-based medicine -
http://cadth.ca/en/resources/grey-matters
Cochrane Handbook for Systematic Reviews and
Interventions - http://www.cochrane-handbook.org/
IOM (Institute of Medicine). Finding what works in health
care: standards for systematic reviews -
http://www.iom.edu/Reports/2011/Finding-What-Works-in-Health-Care-Standards-for-Systematic-Reviews.aspx
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Recap
How would you describe a quality literature review?
Synonymous searches are combined with ___
Can you apply methodological screens with a database?
Finally, please make your librarian happy by filling out your
EFFECTIVE MEDICAL LITERATURE SEARCHING
Objectives
1. Formulate your question2. Understand basic database structure3. Use of Boolean Logic4. Use Field Searching5. Use of Controlled Vocabulary6. Specialty techniques (truncation, etc.)7. Building your search strategy
Reasons for Searching the Medical Literature
To answer a specific patient case-related question (clinical practice)
To learn more about a medical topic (education)
To determine current best practice (guideline)
To give the best possible care to patients using evidence-based medicine
Information OverloadPubMed
(Medline) contains over 18 million journal citations going back to ~1950
Year # new citations added*
2005 606,0002006 623,089 2007 670,943 2008 671,904
*statistics from http://www.nlm.nih.gov/bsd/bsd_key.html
Asking the Question: PICO Patient, Population or Problem
What are the characteristics of the patient or population?
What is the condition or disease you are interested in? Intervention or exposure
What do you want to do with this patient (e.g. treat, diagnose, observe)?
Comparison What is the alternative to the intervention (e.g.
placebo, different drug, surgery)? Outcome
What are the relevant outcomes (e.g. morbidity, death, complications)?
http://healthlinks.washington.edu/ebp/pico.html
Parsing the Question What are the main concepts in your
question?Sample question:
Does nutrition therapy improve decubitus (pressure) ulcer healing in an elderly patient?
Concepts:
Nutrition therapy
Decubitus/pressure ulcers
Ulcer healing Elderly patientsTreatment efficacy
A database is an organized collection of data.
Bibliographic databases are searched through many of the same techniques as any other database
Focus will be on PubMed, but these techniques apply to ANY literature database
Examples of Records and FieldsRecord #
Author Title Publisher Date of Publication
1 Jones KM Infectious Diseases
Wiley 2001
2 Smith BR Medicine Cambridge Univ. Press
2004
3 Johnson AS
Cancer Elsevier 2005
4 Bradley PL
Asthma Synergy 2003
Examples of Records and FieldsRecord #
Author Title Publisher Date of Publication
1 Jones KM Infectious Diseases
Wiley 2001
2 Smith BR Medicine Cambridge Univ. Press
2004
3 Johnson AS
Cancer Elsevier 2005
4 Bradley PL
Asthma Synergy 2003
RED=RECORD BLUE=FIELD PURPLE = ONE PIECE OF DATA
Searching a DatabaseDifferent search interfaces do the same things in slightly different
ways
Good search interfaces should provide Ability to search for a specific item Ability to search for related items to a
known item Ability to search in a specific field or fields Ability to combine search terms using
Boolean Logic Ability to retrieve search results in a useful
way
Boolean LogicA British mathematician named George
Boole (1815-1864) developed an algebraic system of logic that is now widely used in computer and electronic systems including database searching.
While Boole’s algebraic system can be complex, a very simple form of Boolean Logic is used for searching most bibliographic databases.
Boolean OperatorsStandard Boolean Logic for database
searching uses 3 relationships among search terms.
ANDOR NOT
It is both simple and powerful.
AND
BOTH terms included in any results.
If a record has only one of the two terms, it will not be retrieved.
If the record has neither term, it will not be retrieved.
What does this do to the amount of records retrieved?
OROnly one (NOT both)
of the terms are in the results
‘OR’ will retrieve the record if both are included.
What does OR do to the amount of records retrieved?
NOTExcludes any
results containing the term
Records containing both will not be retrieved.
What does NOT do to the amount of records retrieved?
Using OR“OR” groupings contain terms for the same
idea/concept and are usually put in parenthesis
(term OR term OR term) where all terms are difference ways of
representing the same concept
(faculty OR teachers OR professors)
(students OR learners OR pupils)
Using AND“AND” groupings contain terms for different
ideas/concepts and can combine OR groupings
Term AND (Term OR Term) where each represents a different concept
heart attack AND smoking
Diabetes AND exercise
Cancer AND (treatment OR therapy)
Using NOT“NOT” statements are usually put last and
can contain an “OR” grouping; they are often used to get rid of a common subgroup
Students NOT dental
Diabetes NOT juvenile
Putting Them Together1. Identify the concepts (Parse the
question)2. List specific terms for each concept3. Put the terms for each concept in an
OR statements within parentheses4. Combine OR statements with AND5. Add any NOT statements to the end
Creating a Boolean Search
Concept 1Influenza
Concept 2Vitamin C
Concept 3Treatment
Concept 4helpfulness
Influenza Vitamin C Treatment OutcomeFlu Ascorbic acid Therapy Recovery
Orange Juice Management Success
QUESTION: Is Vitamin C helpful in treating the flu?1. Identify concepts and list terms
Step 22. Make your OR statements, one per
concept (influenza OR flu OR orthomyxovirus) (vitamin C OR ascorbic acid OR
ascorbate) (treatment OR therapy OR management) (outcome OR recovery OR success)
Steps 3 and 4 3. Put “AND” between each of the OR
statements(influenza OR flu) AND (vitamin C OR
ascorbic acid OR orange juice) AND (treatment OR therapy OR management) AND (outcome OR recovery OR success)
4. Consider any NOT statements you might want to add.
Note: NOT isn’t used very often
Parsing a Boolean Search(emergency OR acute OR critical) AND
(treatment OR therapy OR management OR care) AND (motor vehicle accident OR car crash) NOT (pedestrian OR walking)
What are the four concepts?What terms are used for each concept?Which three concepts must be included in all
records found?Which concept must not be included in any record
found?
Beyond Basic Boolean Field Searching Controlled Vocabulary
Subject vs. Keyword Searching Specialty Features
Truncation Phrase searching
Field SearchingAlmost all databases will provide you with
some ability to search a specific field or fields.
Allows faster searching Allows more accurate searching
Not all databases may make all fields searchable.
Each search system will require a specific format.
All Field vs. Specific Field Searches
I would like to find articles by John Smith.
Search all fields: John Smith Search Author Field only: John Smith
I would like to find an article published in 1997.
Search all fields: 1997 Search Publication Date Field: 1997
Why waste time searching for a date in the author field or an author in the volume field?
Formats for Field SearchingDifferent databases provide different
formats for specifying fields.
Most use field names or nicknames Field ‘tags’ OR ‘labels’which may follow a period or be placed in
brackets or parentheses.
Some databases offer forms or drop-down menus.
PubMedField tags go in [] and follow termField tags can be used within Boolean
queries
PubMed Field Tagshttp://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=helppubmed.section.pubmedhelp.Search_Field_Descrip
[au] = author[ti] = title[tw] = textword[tiab] = title and abstract[mh] = medical subject heading
[dp] = date of publication[la] = language[gr] = grant number[ta] = journal name[ad] = affiliation
OVID databases require field tags to follow the term separated by a period.
Meharry.in and 2005.yr
Some databases, such as the ISI’s Web of Science (Science Citation Index Expanded) provide forms to fill out.
Select Field from drop-down menu
Select Boolean Operator
Combining Field SearchesMultiple field searches can be combined
using Boolean logic.
Find a 2005 article by an author named Hubble about ankle fractures.
Combine with AND: 2005 in date/year field Hubble in author field Ankle fractures in title field
2005[dp] AND Hubble[au] AND ankle fractures[ti]
Final Notes on Fields Each database provides its own specific
fields Each database requires a specific format
to designate field searching When searching a new database, take a
moment to read the help documentation; most will provide a list of fields and how to search them.
Controlled VocabularyA controlled vocabulary is a set of
established terms where every term represents a single concept only one term is used for that concept
Another example How many words could you think of for
the idea of “cancer”? Cancer, tumor, malignancy, neoplasm,
sarcoma…
Articles in a database Article one: “Breast tumors in young women” Article two: “Surgery for prostrate cancer.” Article three: “Diagnosing Melanoma.”
All three articles are about types of cancer but different terms are used in titles.
In a controlled vocabulary ONE word (i.e., cancer) is chosen and placed in a special field, usually called a subject field.
For all three articles Article one: “Breast tumors in young women” Article two: “Surgery for prostrate cancer.” Article three: “Diagnosing Melanoma.”
The subject term (concept term) “cancer” is placed in the subject field by database indexers.
Now, Searching the database for cancer in the subject field will identify all records about the concept of cancer even if a different word for cancer is used.
Search ‘cancer-in-subject-field’ finds all three articles
How many articles would the search ‘cancer-in-title-field’ find?
Structure of Controlled Vocabulary
Broader Concepts
Narrower Concepts
More on Controlled Vocabulary “Expanding” = Search includes all
narrower terms beneath the searched term Some databases do it automatically, others
don’t “Focusing” or “Majoring” = For a given
item, some subject terms are considered the major focus; you can select to return only those articles. Hip fracture[majr] = only give me articles
where hip fracture is an important concept
Subject vs. Keyword Searching
Controlled vocabulary searching
Matches terms against a
specific field in the record.
You need to consult a thesaurus (paper or online) to find out what the controlled vocabulary term is for each concept.
Free-text (keyword) searching
Some concepts have many synonyms. A free-text search statement would mean "OR"ing all those terms together
Matches terms against words anywhere in record (abstract, title, etc.).
Advantages to Controlled Vocabularies Using the controlled vocabulary can make your
search more precise and easier. Increases the relevancy of results (fewer false
drops) The indexers have already done much of the
work for you. Searchable tree structures of terms can help you
find new terms to use.
Problems with Controlled Vocabularies
NOT all databases use a controlled vocabulary
New concepts take time to be added There is often a lag phase during which the
newest articles aren’t indexed Controlled vocabularies can contain some
very strange things and some concepts may not be handled well
The controlled vocabulary must be easily searchable
Trying to understand what is and isn’t in a particular controlled vocabulary can give you a big headache!
Combining Subject and Keyword Searching
To be comprehensive, it is often helpful to combine subject and keyword searching
(diabetes mellitus[mh] OR diabetes[tw])
(sickle cell anemia[mh] OR sickle cell anaemia[ti])
Don’t forget… Boolean logic to combine terms Use of other search fields in combination
with subject terms
A Complex Search:(head[mh] OR head[tw]) AND (wound and
injuries[mh] OR trauma[ti] OR injury[ti]) AND 2005[dp] AND English[la]
Some Specialty Features Truncation Phrase searching Neighboring and other rarer Boolean
operators
TruncationWhat about including the singular and plural versions
of words as well as other word variations?For example: therapy, therapies, therapeutics,
You could combine them all in an OR relationship:
(therapy OR therapies OR therapeutics OR therapeutic)
But an easier way is by the use of truncation. therap*
Each database handles truncation in a unique way. The ‘*’ and ‘$’ are the most common wildcard symbols.
More on TruncationSome examples:
Bacter$Proc*Vir?Staph?
Be cautious when truncating!
If the word stem is too short, there may be too many possible variations and you might pick up unrelated terms.
For example, using proc* for finding procaine-like drugs will also include words like proceedings and process.
Phrase Searching Sometimes you want to force the
database to search for a set of words in exact order
“fever of unknown origin”
Most databases will accept a phrase in quotes.
BUT…some do not handle phrases well and will automatically break them up – usually ‘AND’-ing the terms
Check how the database handles phrase searching before doing it!
Limits Options Many databases provide “limits” pages
that make it easier for you to select common options such as language, article type, publication dates, human or animal, gender, age groups, etc.
Each database’s limits options are unique
Most limits can be done ‘by hand’ using field tags, but sometimes limit pages save time
PubMed Limits Page
Step-By-Step Search Construction1. State the question 2. Identify the concepts in the question3. For each concept, determine keywords and
subject terms4. Specify field tags after terms if needed5. Combine terms for the same concept with “OR”
in parenthesis6. Combine “OR” statements with AND7. Put any NOT terms at the end
Keep track of your searches, how many articles were found total, and how many you selected as relevant
Example Question: What is the appropriate ED
medical management of adult patients with intracranial hemorrhage (either trauma or spontaneous)?
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