The Literature Search
In the previous module, we learned how to construct a well-built clinical question. Using that question, we will move on to the literature search.
Constructing a well-built clinical question can lead directly to a well-built search strategy. Note that you may not use all the pieces of the well-built clinical question in your MEDLINE strategy. In the following example we did not use the term "ejection fraction 40%" or "elderly." We also did not include the word therapy. Instead we used the publication type, randomized controlled trial, to get at the concept of treatment. However, you may consider the issue of ejection fraction or age later when you review the articles for applicability to your patient.
Select a resource
The practice of Evidence-Based Practice advocates that clinicians search the primary literature to find answers to their clinical questions. There are literally millions of published reports, journal articles, correspondence and studies available to clinicians. Choosing the best resource to search is an important decision. Large databases such as PubMed/MEDLINE will give you access to the primary literature. Secondary resources such as ACP Journal Club, Essential Evidence, FPIN Clinical Inquiries, and Clinical Evidence, will provide you with an assessment of the original study. These are often called "pre-appraised" or EBP resources. The Cochrane Library provides access to systematic reviews which help summarize the results from a number of studies.
To quickly find an answer, we might first look at an appraised resource, such as ACP Journal Club. ACP Journal Club's general purpose is to select from the biomedical literature articles that report original studies and systematic reviews that warrant immediate attention by physicians attempting to keep pace with important advances in internal medicine. These articles are summarized in value-added abstracts and commented on by clinical experts. Studies included in this small database are relevant, newsworthy and critically appraised for study methodology.
Conduct the search in PubMed:
Step 1: Use PICO to formulate the search strategy; start with the Patient problem and Intervention
Enter the term for the patient problem and the intervention: heart failure AND irbesartan. PubMed attempts to map your terms to appropriate Medical Subject Headings (MeSH). MeSH is the standard terminology used by the indexer and helps find articles on the topic, regardless of the exact wording used by the authors.
Step 2. Look at Details to verify MeSH terms
Click on Details (from the Advanced search page) to see the terms that PubMed actually used in its search. You want to be sure PubMed found the appropriate MeSH terms. PubMed will automatically also search for your terms as words in the title and abstract. Heart failure is a MeSH term and irbesartan is a Substance Name.
Step 3. Limit to appropriate study design
You can also use the Clinical Queries function to limit the results to study methodologies relevant to therapy questions. Copy your last search strategy heart failure AND irbesartan. Click on Advanced search; near the end of the page under More Resources there will be a link to the Clinical Queries. Paste the search strategy in the Clinical Query search box and select the type of question (Therapy) and the default narrow, specific search. Click on GO. You may get more results using the Clinical Queries.
Step 4. Review the results
Both methods limit your results to RCTs. The second citation is the Massie article that we found in ACP Journal Club.
We have a short video demonstrating this search.
If you are not familiar with searching PubMed, you may want to review the PubMed tutorials at http://www.nlm.nih.gov/bsd/disted/pubmedtutorial
Revised July 2010