How to Conduct Literature
Searches
COLLEEN KENEFICK, MLS, AHIP
H E A LT H S C I E N C E S L I B R A RY
S TO N Y B R O O K U N I V E R S I T Y
It All Starts Here
 Health Sciences Library Website
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Provides access to all electronic and print resources
available from the library
 Medicine Subject Guide
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Provides electronic and print resources for all subject areas
of medicine
 My students are dismayed when I say to them,
“Half of what you are taught as medical students
will in 10 years have been shown to be wrong. And
the trouble is, none of your teachers knows which
half.”
Dr. Sydney Burwell
Dean of the Harvard Medical School, 1956
Annual Addition of Articles to MEDLINE
(PubMed)
Types of Clinical Questions
 Background questions ask for general
knowledge about a topic, and generally involves
who, what, when, why, where, or how
 To answer, use electronic textbooks or other
print reference sources:
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AccessMedicine textbooks such as Harrison’s Online
First Consult
MDConsult textbooks such as Rosen’s Emergency
Medicine
UpToDate
Types of Clinical Questions
 Foreground questions apply to a specific
patient or problem
 To answer, search for peer-reviewed journal articles
and other EBM literature
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The Cochrane Library
Ovid MEDLINE or PubMed
TRIP Database
Web of Science
Four Step Program for Finding the Evidence
 Focus your question by using the PICO model
 Select appropriate information sources to answer your
question
 Choose databases or other sources with best coverage of
the topic
 Devise search strategy using subject terms, thesaurus, or
index entries
What is a Well-Built Question?
A well-built question is:
 Directly relevant to the problem
 Focused and clearly formulated
 Sufficiently specific to ensure a clear answer
 Articulated to facilitate searching for an answer
The PICO Model
 A well framed question addresses a relationship
between these four components:
 P = the patient or problem being addressed
 I = the intervention or exposure under
consideration
 C = a comparison intervention or exposure
 O = clinical outcome(s) of interest
Four Basic Categories of Clinical Questions
 Therapy
 Diagnosis
 Prognosis
 Harm/Exposure or Prevention
Therapy
Cochrane
Library
TRIP Database
PubMed Clinical
Queries+
PubMed MeSH
1
2
3
4
2
1*
Diagnosis
Prognosis
Harm/Exposure or
Prevention
1**
1
2***
1=the most high yield place to start
+Use Systematic Reviews (click on Clinical Queries under PubMed
Tools) to locate systematic reviews, meta-analyses, reviews of clinical
trials, evidence-based medicine, consensus development conferences,
and guidelines
*Use diagnosis category
**Use prognosis category
***Use MeSH headings and subheadings
Translating a Question into a Database Search
 You will need to modify your answerable question
(PICO) to formulate a database strategy
 Your PICO question may be either too specific or too
broad to easily search on MEDLINE (PubMed) or
one of the other available medicine databases
Finding a Therapy Answer
 Systematic review or randomized controlled study is
best feasible study design
 First place to look for answer:
 Cochrane Library
 TRIP Database
 PubMed Clinical Queries
 PubMed MeSH
Finding a Diagnosis Answer
 Cross-sectional study is best feasible study design
 First place to look for answer:
 PubMed Clinical Queries (use diagnosis category and
Broad Scope)
 TRIP Database
Finding a Prognosis Answer
 Cohort study is best feasible study design
 First place to look for answer:
 PubMed Clinical Queries (use prognosis category
and Broad Scope)
 These questions share three elements: a qualitative
aspect, a quantitative aspect, and a temporal aspect
Finding a Harm/Exposure or Prevention Answer
 Cohort study is best feasible study design
 First place to look for answer:
 Cochrane Database of Systematic Reviews
 Next best place is PubMed MeSH
The Evidence Pyramid
MA
SR
RCT
Cohort Studies
Case Control Studies
Case Series / Case Reports
Expert Opinion
Animal Research / In Vitro
Studies
MA=Meta-Analysis, SR=Systematic Review,
RCT=Randomized Controlled Trial
Synonyms and Controlled Vocabulary
 The main point to remember is that if a database
offers a controlled vocabulary, use it in addition to
textwords or keywords.
 In PubMed (MEDLINE) the controlled vocabulary is
called MeSH (Medical Subject Headings)
Using PubMed Clinical Queries
Use the built-in filters for:
 etiology
 diagnosis
 therapy
 prognosis
 clinical prediction guides
You must indicate your preference for either:
narrow, specific search – will miss a few relevant articles
broad, sensitive search – will include irrelevant articles
PubMed Clinical Queries
The Top Seven Databases
 Cochrane Library
 Faculty of 1000
 Health & Psychosocial Instruments (HaPI)
 Journal Citation Reports (JCR)
 PubMed
 TRIP Database
 Web of Science
Five Steps to Conducting a Systematic Review
 Step 1. Frame the questions for your research project
Should be in the form of clear, unambiguous and
structured questions before starting
 Modify your question only if alternative ways of defining
the populations, interventions, outcomes or study designs
become apparent

Journal of the Royal Society of Medicine 2003 Mar;96(3):118-21.
Five steps to conducting a systematic review.
Khan KS, Kunz R, Kleijnen J, Antes G
Five Steps to Conducting a Systematic Review
 Step 2. Identifying relevant work
Multiple databases should be searched using study
selection criteria already decided upon by the research
question
 Reasons for inclusion or exclusion is documented
 Keep your search strategy (in addition to citations) from
each database

Journal of the Royal Society of Medicine 2003 Mar;96(3):118-21.
Five steps to conducting a systematic review.
Khan KS, Kunz R, Kleijnen J, Antes G
Five Steps to Conducting a Systematic Review
 Step 3. Assessing the quality of studies
 Quality is relevant to each step
 Use general critical appraisal guides or design-based
quality checklists
 These will make it easier to decide what to include or
exclude
Journal of the Royal Society of Medicine 2003 Mar;96(3):118-21.
Five steps to conducting a systematic review.
Khan KS, Kunz R, Kleijnen J, Antes G
Five Steps to Conducting a Systematic Review
 Step 4. Summarizing the evidence
 Tabulate study characteristics
 If you are not doing a meta-analysis, then analyze the
sub-groups separately
Journal of the Royal Society of Medicine 2003 Mar;96(3):118-21.
Five steps to conducting a systematic review.
Khan KS, Kunz R, Kleijnen J, Antes G
Five Steps to Conducting a Systematic Review
 Step 5. Interpreting the findings
Publication or other bias is explored
 Can the overall summary be trusted?
 Any recommendations should be graded by strengths and
weaknesses of the evidence

Journal of the Royal Society of Medicine 2003 Mar;96(3):118-21.
Five steps to conducting a systematic review.
Khan KS, Kunz R, Kleijnen J, Antes G
Save Citations in Electronic Form
 In almost every database, there are four options for
saving references once you have found relevant
material.
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Print
Email
Save to file
Export to bibliographic management software such as
EndNote or Zotero (http://www.zotero.org)
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