Internal Medicine Residents & Students: Search Optimization Tips

1. Only read this if you want to be "smarter than your average bear!"
2. Use a word document to develop your search strings so that you can edit it easily.
3. Search by both MeSH and Keywords. MeSH will bring you the indexed literature, which is important because you cannot think of all the possible terms used for a concept. Keywords will bring you the un-indexed literature, which includes the most current publications (awaiting indexing) and literature that will never be indexed.
4. Keywords are a way to capture articles which must be identified by new jargon or emerging concept language that has not yet been assimilated into the MeSH vocabulary. Keywords help you capture the cutting edge or latest study.
5. As you find relevant articles, look to see how they are indexed and include any new MeSH terms in your ongoing search string development.    Include new jargon and keywords as well. Look at the related citations in the right hand column of any good article in PubMed. Then, look at how the article was indexed to enrich your citation string. This is called “harvesting” search terms.
6. Look at the entry date of a MeSH term to the database. Patient Safety did not become a MeSH term until 2012. If you search for patient safety articles using only the MeSH term, you will not retrieve decades of prior research that was not indexed with the MeSH term.
7. Look at the search details box and decide if a phrase is being split and does not need to be. It may be better to search for “Patient Safety”[all fields] by itself rather than allow the search translator add into the string the split phrase (patient AND safety). But, reconsider the effects of making this change to the translation if you are in a comprehensive review search.
8. Use the minimum number of concepts needed to identify your intended literature.  If you are using more than 2 concept searches together, consider whether you are missing anything by including the third, fourth, or other concept search terms in your string. Try different combinations of search terms. Consider whether a search concept is likely to be in the indexing or abstract of all the articles you are seeking -- could the concept exist inside the title/article, perhaps in a table or sub-group analysis. Many things can exist inside a full-text article, but not be accounted for in the title/abstract or indexing. Just because an indexing term exists does not mean the indexer used it. Often, less is more - so put your strategic thinking cap on!  
9. Search each concept separately and then join them together on the Advanced page since you may want to amplify overly simple concept searches as you discover additional keywords. Join synonyms for the same concept together with OR to create a concept set
10. Use the subheadings or MeSH Major focus selections judiciously. These selections are available inside a terms MeSH record. Sometimes the indexer does not apply the emphatic Major indexing. In a comprehensive review, you seldom want to insist on a Major indexing term. Similarly, the indexer may not have addressed the subheadings rigorously and if you insist on them in the search, you will lose articles that may be valuable.
11. Before you create a complex string, see if there is a good systematic review available in your topic area. Look at the review’s search method (often in an appendix) and borrow the search strategy. You might even improve on it. If the review search is fairly recent, you can pick up your search at the point the authors stopped theirs (this is not the same as the article’s publication date but the end date mentioned in the methods section). It is always easier to update a good review and look for more current high level evidence than to recreate the historical record.
12. Use the Clinical Queries filters, limit by dates, ..add filters to reduce the research results. Clinical Queries utilizes special filters developed by Dr. Haynes that allow you to maximize specificity or sensitivity by question type. Remember, unless a filter is critical, specifying it may reduce results in unanticipated ways - e.g., if the indexer neglected to add "Human" as a MeSH term.
13. You can also look at the articles cited by or citing your prize article. This puts you in touch with the researchers who may be on the same investigative thread.

Go to PubMed > Use the pulldown menu to select NLM Catalog instead of PubMed > Search Internal Medicine > Under Journal Subset (left sidebar) Select Filter for Current Medline Index (look for the blue checkmark) > Select Customize and when the menu appears, select Core Clinical Journals and select it when it appears as an option on the filter bar > Select JAMA and BMJ Clinical Evidence > Add to the Search Builder and press Search PubMed.

Go to MeSH using the database pulldown menu > Enter Patient Readmission > select the MeSH term and Add to the Search Builder and Search PubMed > Go to the Advanced Page > Enter additional keywords for the readmissions concept (e.g., re-admi* OR readmi* OR rehospi* OR re-hospi*) - join them with OR to the MeSH term for Patient Readmission > On the Advanced Search page, join the journal search with AND to the concept search for readmission > Save the Search using "Create Alert" (just below the search box)

Important! Try this out at least onece! This is the go-to resource after you can't find the evidence in UptoDate, Dynamed, ACP Smart Medicine, the guidelines. Check this source for the latest high-quality research that has not been integrated into the point-of-care tools.

Clinical Queries - CQ is a valuable PubMed search interface that brings specialized filters to aid you in getting the highest levels of evidence for your patient oriented questions. An efficient way to search for answers to clinical questions is to identify when a key point of care resource such as DynaMed or UpToDate last reviewed a topic (and the age of the most central studies on which recommendations are based) and then customize your Clinical Queries search in relationship to that timeframe. 

You can reach Clinical Queries from the PubMed entry page menu. You can simply enter a search string in natural language if you know that your terms will map to MeSH headings as well as keyword terms. If you are in the area of an evolving topic that has not been established in the MeSH vocabulary for a significant period of time, then you may want to make your search string more comprehensive. Once the search results are back, select the type of question (e.g., therapy, diagnosis, etiology, prognosis, clinical prediction guidelines), and whether you want a broad or narrow filter. Note the link to the Haynes search filters at the bottom of the first column results to understand the sensitivity and specificity associated with each of the search filters broad/narrow dimensions. Select the link to the search results at the bottom of the first column to have your search registered in the MYNCBI home recent searches table.

TUTORIAL: https://www.youtube.com/watch?v=yWy0ssLC-ME

Important! This page might help you with a Quality Improvement, Patient Safety, or other special topic search.

PubMed has developed topic and subject filters that can enable robust searches in specific topics. These filters are helpful because it is difficult to identify all of the relevant terminology for a search each and every time. Although these filters are a great starting point, please don't assume that you cannot improve them. You can! You can also edit and customize them - adding and subtracting terms strategically for your particular search.

If you run the search using the subset field tag (e.g., survivors AND cancer[sb]), you will not see real underlying search string. To see the pre-fabricated search, select the link for the topic and drill down. The cancer search sting is several pages long!

On the PubMed Special Queries page, take a look at the Healthy People 2020 link. On the Healthy People 2020 Structured Evidence Queries page, select the link for Maternal, Infant, and Child Health.  There are 33 searches on a variety of topics of interest to Pediatricians and Neonatalists.

Important for the practice homework.

PUBMED (via the UIC LHS Chicago Gateway so that you are connected to all the proxy server identifications needed to access full text)

• Enter into the PUBMED search box: sepsis AND encephalopathy
• From the left-column, in the filters section, select "more" under Article Types - when the menu selection popup box appears, deselect everything except Case Reports and press Show
• Once the menu selection box disappears, click on Case Reports so that a check mark appears next to the term (indicating the activation of this Case Reports filter)
• Your search results are automatically filtered for those documents that are Case Reports (this is indicated by a reduction in the Results number)