On the -16th day of Xmas, NLM gave to me

- new and welcome changes to the MeSH tree

Triple Negative Breast Neoplasms
Prostatic Neoplasms, Castration-Resistant
Medical Marijuana
Mindfulness
Mobile Applications
Pediatric Obesity :(
Dandruff (really? I had no idea this wasn't in there)
Non-Nutritive Sweeteners
Nutritive Sweeteners

And lots of other good ones, too! However, these are the most likely to make an impact on daily searching.

But hey! Still no ptyps for Systematic Reviews and Protocols? Come on, the sooner you add it, the sooner it'll be useful!

Searching Steroids in Medline

Here's a real pain in the wazoo.

You search in the MeSH database and get the MeSH Steroids. So far, so good. But you get only a few articles on the topic and you have a sneaking suspicion that there should be more.

So, you try some other combinations of MeSH, or some keywords, and lo and behold, there is another MeSH term, Adrenal Cortex Hormones! It's in a completely different part of the tree than Steroids.

Grr. It particularly burns me that articles with the word Steroid in the title are indexed Adrenal Cortex Hormones rather than Steroids. If you're gonna be like that, why not use both?

The same thing happens with corticosteroids and glucocorticoids, which are narrower terms of each, so y'know, be warned.

Google Scholar sort by date removes results

OK, here's a weird one:

Doing a search in Google Scholar. Of course the default is Sort by Relevance.

Whoa! Way too many results, so I selected only articles from the past year (Since 2013)

OK, so now I have 662 results. OK, but I'd like to look through them by date...

I clicked on Sort by Date.

Now I've only got 3 results.

What gives?

Now, it turns out that whether or not you've limitted your results by year, when you click on Sort by Date, it always gives you just the past year. How ridiculous and annoying that is would take up a blog post in itself. But what I don't understand is why even when I'd limitted the results to just the past year, there were more than when I sorted by date. And it wasn't just one or two. It lost over 600 results!

This is not a one-time glitch either - it persists over time and with different browsers. Guess it's supposed to be like that? Man! Google Scholar has its good points, but it is damn useless when it comes to result manipulation.

They keep changing PICO...

...but it never gets better.

PICO was a good first step in trying to describe the process of turning a clinical question into a search strategy. However, it is fundamentally flawed. The problem with PICO cannot be solved by adding more letters onto the end. The problem can only be addressed by understanding what is wrong with PICO, and why so many clinicians find it confusing.

The fundamental problem with PICO is that it de-emphasises the most important question that a person can ask when starting work on their search strategy. That question, as explained to me on the first day of my practicum by my mentor, is: what is the disease or disorder in question?

Medline and other biomedical databases are set up so that the best search results are gained by searching first for the disease or disorder in question. Searching first for the disease or disorder was unquestionably the best advice I ever received for framing a search strategy.

However, every question that I've received from a clinician who had used PICO was missing that fundamentally important piece of information. These omissions resulted in hours of wasted time. In each case, once I finally realised what information I was missing, or queried the clinician and received a clarification, I had to completely revise my search strategy, and immediately began receiving much more relevant results.

A second problem with PICO, or perhaps an extension of the first problem, is that although it is intended as a tool for use by healthcare professionals, it is not written in their language. The very fact that we have to define the word "population" as something other than what a healthcare professional usually means by this term means that PICO fails to communicate with the target audience.

Another problem with PICO is that it assumes that most questions are about interventions, when many are about risk factors, statistics, cost-effectiveness, and other non-intervention topics. Many others do not have a specific intervention in mind, such as the perennial "best practices" request.

The fourth problem with PICO is that the organisation of the components does not correspond well to the order in which the search should be entered into a database. For instance, some of the information falling under population, such as age, species, and setting, are listed first in PICO, but entered last in most search strategies.

On several occasions, when I have mentioned the flaws of PICO to my colleagues who work in various health libraries, many immediately spoke up with great relief, agreeing that it causes more problems than it fixes. Yet it seems that no one wants to be the first to say that the Emperor has no clothes.

The Emperor has no clothes.

But it's not enough to say that there's a problem - that is futile unless it comes with a proposed solution. Let's develop a search frame that emphasises the disease or disorder, uses the target audience's language, and recognises that many questions are not about interventions. Even better, let's develop a search frame that is based on the structure of health databases, so that the clinician using the frame fits their keywords into a structure that readily translates into a database search. Clinicians know what they want to know - what they struggle with is how to tell a database what they want to find. We, as health librarians, are the people with the expertise to develop that translation.

I myself am not yet experienced enough to develop such a frame on my own. However, by pointing out the need for it, and giving a suggestion of what it might look like, I hope to spark the idea for the next tool in the minds of more experienced librarians. Here are some of the elements I think would be worth considering:

1. The first element could be the letter D standing for disease or disorder.
2. An I for specific interventions could be included although optional
3. The next element, also optional, could bring in the idea of risk factors, statistics, etc... unfortunately, the only words I can think of to describe this idea are Information and Demographics, both of which start with letters already taken
4. At this point there could be a P for population, including such concepts as age, gender, species, setting, type of patient (inpatient, outpatient, postop, etc...), chronic vs acute, etc..
5. An L for limits could be next - this would refer to publication limits (year, type, and language of publication, methodology, peer reviewed, etc...)

If the healthcare professional is going to submit that information to a librarian to do the search, then they can use that framework to create a sentence or paragraph explaining what they want.

However, if they're going to do their own search, the search frame has to indicate what to do with all this data.

1. Separate the search terms and search each one individually
2. Modify search terms with subheadings
3. combine synonyms with OR
4. combine concepts with AND
5. Refine with limits
6. Evaluate current search results
7. Look for new search strategies
8.  Iterate

Unfortunately that spells SMOARELI which is not exactly memorable!

I looked through my literature search requests from the past 6 months, and couldn't find much to add there, but I'm sure there are other and better suggestions out there in the minds of my fellow librarians!

My purpose in creating this post is not to downplay the value of PICO as a starting point. Like the Lamarck's theory or the Bohr atom, it was the first step in describing something very complex. What I'm saying is that PICO is not the end point. Let us not, by adhering too closely to the offering of our Lamarck, fail to inspire our Darwin.

Antibiotics

When searching for Antibiotics in Medline, the correct MeSH is:

Antibiotic Prophylaxis

not

Anti-infective Agents/therapeutic use

(Apparently).

Cone Rod Dystrophies, or a rare epic failure of MeSH

If you search Cone Rod Dystrophy in MeSH, you'll find that it is an entry term for Retinitis Pigmentosa, and (at least in the PubMed Mesh database), it maps only to that one term. I stupidly assumed that this meant it was the same thing. (Bad librarian, no cookie!)

My search was: "Retinitis Pigmentosa/therapy"[Majr]

Luckily, one of the articles on the topic set me straight. The abstract clearly stated that cone rod dystrophy was different from retinitis pigmentosa. I immediately stopped collecting articles on RP, and investigated.

It turns out that some people consider cone rod dystrophy to be a sub-type of retinitis pigmentosa. The more prevalent form of RP is rod cone dystrophy, where the rods are affected before the cones, resulting in night blindness. In Cone Rod Dystrophy, the cones are affected before the rods, resulting in a loss of central vision and sometimes in colour blindness. The causes of Cone Rod Dystrophy are mostly genetic, unlike with standard RP.

Armed with this new data, my new search was: ("cone rod dystrophy"[all fields] OR "cone rod dystrophies"[all fields] OR "cone rod degeneration"[all fields]) AND "Retinitis Pigmentosa/therapy"[Mesh]

However, I noticed that combining with the RP term reduced the number of articles to less than half of the results found with the keywords. It seemed odd - surely if CRD was a subtype of RP, most of the articles should have been included?

Experimental search: ("cone rod dystrophy"[all fields] OR "cone rod dystrophies"[all fields] OR "cone rod degeneration"[all fields]) NOT "Retinitis Pigmentosa/therapy"[Mesh]

Whoo-ey! It turns out that many articles about Cone Rod Dystrophy are indexed under "Retinal Diseases"[Mesh], or even more obscure terms. I noticed that the MeSH "Retinal Dystrophies" was hardly used at all, when I would have guessed that it would be the closest MeSH to Cone Rod Dystrophies. It's strange, because Cone Rod Dystrophies is so clearly an entry term for Retinitis Pigmentosa, and yet the indexers do not seem to be treating it as such.

It turned out that the best search was: "cone rod dystrophy"[all fields] OR "cone rod dystrophies"[all fields] OR "cone rod degeneration"[all fields]

I ended up going through all of the results, which was good because there was very little on therapy, and fortunately a couple of articles mentioned that fact (but of course it wasn't reflected in the indexing since the article wasn't about that). But that's a problem that had nothing to do with the indexing.

Normally MeSH terms are truly awesome, and too often taken for granted by those lucky enough to work in health librarianship. We only remember how brilliant they are when we end up searching some other subject and see how inaccurate and inconsistent the use of controlled vocabulary can truly be. However, sometimes there is a term within our own literature that shows us how messy things can be if indexing is not up to Medline's usual high standards.

Home birth

I searched home birth in the MeSH database and got no results.

I searched home birth in PubMed Reminer and found Home Childbirth.

MeSH database, can I get an "oops"?

D'as right.

Transplant or immunocompromised patients

PubMed:


"Immunocompromised Host"[Mesh] OR "Immunocompetence"[Mesh]  OR "Immunosuppression"[Mesh] OR "Immunosuppressive Agents"[Mesh] OR "Transplantation"[Mesh] OR "Transplants"[Mesh]

EMBASE:


exp immunocompromised patient/ OR exp immunocompetence/ OR exp immunosuppressive treatment/ OR exp immunosuppressive agent/ OR exp transplantation/ OR exp graft recipient/

Visual impairments

Visual impairments in PubMed:

"Vision Disorders"[Mesh] OR "Eye Diseases"[Mesh]

and, depending on your search, you may also wish to search for:

"Visual Acuity"[Mesh]

Replacement for Highlight All in Office 2010

When we first got Office 2010 at work, I quickly discovered that "Highlight All" was no longer available with Ctrl-F.

The Find option would find all of the instances of a particular word within the text, but as soon as one clicked on the text itself or attempted to make a change (say, change the text colour), all the Found words were lost. It wasn't possible to Find, and then make a change to all those instances of the found word.

Tragedy! Highlight All was supremely useful for finding important words in long bibliographies, especially where there were synonyms. For instance, if I were looking for articles related to the geriatric population, I might search for geriatric, gerontol, elder, older, oldest, senior, and so forth. I could highlight each synonym in the text, and turn each a different colour: red, orange, blue, etc... and then go through the list, finding my chosen words at a mere glance. I could take a closer look at words with other possible meanings (older, senior) when I saw their colours, and identify articles of high relevance due to the prevalence of certain colours in the title and abstract.

All this functionality disappeared when my workplace switched to Office 2010, and no one on the internet had a solution - everyone just said that it was no longer possible. I emailed Microsoft Office's support people, but they didn't have any solutions, either.

However, my colleague has just shown me how to get the same functionality with a different procedure!

1. In your document, go to Ctrl-H, or Replace in the Edit menu.
2. In the Find field, type in the word that you want to highlight, e.g. geriatric.
3. Click in the Replace With field to place your cursor there. This step is very important!
4. Click the More button
5. Under the Replace section, click on the Format button and choose Font.
6. Make any selections that you like, e.g., Font Colour: Red or Font Style: Bold.
7. Click the OK button to save your selections and go back to the "Find and Replace" dialogue box.
8. Click the Replace All button to apply your changes to the text.
9. Repeat steps 2-8 for each word that you want to highlight.
10. Click the Cancel button when you are done.

Now all of your words will be highlighted in the colours and/or styles that you chose!

Even better, this also works when composing emails in Outlook, so you can highlight words in bibliographies that you send to patrons.

I hope this streamlines your workload as much as it will mine.

(Colossal thanks to my colleague, Karen, for showing me how to do this! I've been without this functionality for a year and a half and it is brilliant to get it back again.)

PS: If you mess up and accidentally make the Find what field red and bold rather than the Replace with field, you can click on the No Formatting button to reset yourself.

Critical Care

PubMed:

"Critical Care"[Mesh] OR "Intensive Care Units"[Mesh] OR "Critical Illness"[Mesh] OR "Life Support Care"[Mesh]

If you are looking for absolutely everything, or want In Process articles, you can also add:
"critical care"[tiab] OR "intensive care"[tiab] OR "life support"[tiab] OR "close support"[tiab] OR "critically ill"[tiab] OR "critical illness"[tiab] OR icu[tiab] OR "critical unit"[tiab] OR "critical units"[tiab] OR "intensive unit"[tiab] OR "intensive units"[tiab]

EMBASE:

exp intensive care/ OR exp intensive care unit/ OR exp critical illness/ OR exp critically ill patient/

CINAHL:

MH "Critical Care+" OR MH "Critical Care Nursing+" OR MH "Critical Illness+" OR MH "Critically Ill Patients+"

Thanks to my colleague, Karen, for the suggestion of "close support"[tiab].

Palliative Care Patients and End of Life

Often there's a question about a particular disease or therapy and it ends with the phrase "in palliative care patients"

PubMed:

"Palliative Care"[Mesh] OR "Terminal Care"[Mesh] OR "Terminally Ill"[Mesh] OR "end of life"[tiab] OR palliati*[tiab] OR hospice[tiab]

You can also OR the following:
terminal*[tiab] NOT ("n terminal"[tiab] OR "c terminal"[tiab] OR "amino terminal"[tiab] OR "carboxy terminal"[tiab] OR "carboxyl terminal"[tiab] OR "cooh terminal"[tiab])


N-terminal and C-terminal are something completely different, and if you leave them in, you'll get zillions of irrelevant results.

EMBASE:

exp palliative therapy/ OR exp terminal care/ OR exp terminally ill patient/ OR exp hospice patient/ OR exp hospice/ OR ("end of life" OR palliati* OR hospice).ti,ab.
OR
terminal*.ti,ab. NOT (n terminal OR c terminal OR amino terminal OR carboxy* terminal OR cooh terminal).ti,ab.

CINAHL:

MH "Terminal Care+" OR MH "Hospice and Palliative Care Nursing" OR MH "Terminally Ill Patients+" OR MH "Hospice Patients" OR MH "Hospices" OR palliati* OR hospice OR "end of life" OR (terminal* NOT ("n terminal" OR "c terminal" OR "amino terminal" OR carboxy* terminal OR "cooh terminal")

A keyword search for "end stage" may or may not be useful depending on your question.

Recurrence

Recurrence is a Mesh, but you'll get more results if you search for keywords as well.

"Recurrence"[Mesh] OR recurren*[tiab] OR intractabl*[tiab] OR refractor*[tiab] OR persisten*[tiab] OR relaps*[tiab] OR incessan*[tiab] OR reinfection*[tiab]

EMBASE has exp recurrent disease/

These can also be useful:
recurren*[title] OR repetiti*[title] OR frequen*[title] OR cumulati*[title] OR repeat*[title] OR second*[title] OR multiple*[title] OR accumulat*[title] OR additive[title] OR additional[title] OR subsequent[title]

Two searches for elderly

When searching for information about elderly patients, there are two main possibilities.

The first possibility is that the requestor wants some articles about such-and-such disease in the elderly - a broad search. If you use "Aged" limit or MeSH to search this, you'll get masses of articles which look irrelevant, because the "Aged" MeSH in Medline is sometimes applied even if the study population only included one or two older patients. Therefore, I like to avoid the "Aged" MeSH altogether, and use keywords.

Here is my favourite search for cases like that:

elder*[tiab] OR geriatr*[tiab] OR gerontol*[tiab] OR "older adult"[tiab] OR "older adults"[tiab] OR "older person"[tiab] OR "older people"[tiab] OR "older patient"[tiab] OR "older patients"[tiab] OR "oldest old"[tiab] OR "late life"[tiab] OR "later life"[tiab] OR aging[tiab] OR ageing[tiab] OR octagenarian*[tiab] OR nonagenarian*[tiab]

The second possibility is that you have quite a specific topic, and have a relatively small set of search results to work with. You want a search that will find everything it can possibly find on elderly people, to combine with your already narrowed search.

Here's the one I use:

elder*[all fields] OR geriatr*[all fields] OR gerontol*[all fields] OR "older adult"[all fields] OR "older adults"[all fields] OR "older person"[all fields] OR "older people"[all fields] OR "older patient"[all fields] OR "older patients"[all fields] OR "oldest old"[all fields] OR "late life"[all fields] OR "later life"[all fields] OR aging[all fields] OR ageing[all fields] OR octagenarian*[all fields] OR nonagenarian*[all fields] OR "Aged"[Mesh] OR "Nursing Homes"[Mesh] OR "Homes for the Aged"[Mesh] OR "Assisted Living Facilities"[Mesh]

You'll note that I didn't search "aged" as a keyword, nor did I search senior*. If you search "aged" as a keyword, you get a lot of irrelevant results, such as "our study population included children aged 5-12". While the word "seniors" is used a lot in consumer health literature, it is hardly ever used in the biomedical literature. Instead, if you search senior* as a keyword, most of the results will be a quick mention of a senior attending physician or senior staff. I don't know if that is also true in a humanities database such as PsycInfo, so you may wish to experiment with the senior* keyword if you are using other databases.

Acute Alcohol Poisoning

You'd really think there would be more in the literature on this topic.

If you search "alcohol poisoning" in the MeSH database, you end up with no results. If you search it in Ovid Medline, the top result is Alcoholic Intoxication, which is not the same thing.

Here is the search which is most helpful:

"Ethanol/poisoning"[Mesh]

Emergency Kit (for doctors' offices)

Second time I've gotten this question - it's impossible to search with keywords (well, you can try, but you won't get anything), but as James Herriot says, it's all in knowing how to do it.

"Equipment and Supplies"[Mesh]
AND
"Physician's Offices"[Mesh] OR "Ambulatory Care Facilities"[Mesh]
AND
emergenc*[all fields]

You do have to sort through some irrelevant stuff, but not too much.

Life Span

To search for life span in Medline (PubMed syntax)

"Longevity"[Mesh] OR "Life Expectancy"[Mesh]

High Cholesterol

The problem with high cholesterol is that it's not a disease. It's kind of a symptom, kind of a blood chemical, kind of a chronic disease - kind of a pain!

"Cholesterol/blood"[Mesh] OR "Hypercholesterolemia"[Mesh]

or depending on your search, you might use:

"Cholesterol"[Mesh] OR "Hypercholesterolemia"[Mesh]

Postoperative Care

Here is what you find if you search Postoperative in the MeSH database:

Postoperative Care
Postoperative Period
Postoperative Complications (with narrower terms)

But when you search the same in CINAHL, it also suggests:
Aftercare

And when I searched it in the MeSH database, it exists!

So you can do this search:

Medline (PubMed)
"Postoperative Care"[Mesh] OR "Postoperative Period"[Mesh] OR "Postoperative Complications"[Mesh] OR "Aftercare"[Mesh]

CINAHL:
MH "Postoperative Period" OR MH "Postoperative Care+" OR MH "Postoperative Complications+" OR MH "Aftercare"

Yay...

EMBASE:

exp postoperative period/ OR exp postoperative complication/ OR exp aftercare/


postoperative period includes postoperative care as well as other narrower terms. Postoperative complication has many narrower terms.

Look who's evil now!

Erm, your secret thoughts are showing...

Graft Restenosis

OK, now I swear yesterday, when I typed "graft restenosis" into the MeSH database, I got no results. Today, I typed it in, and I got one of the two relevant MeSH terms (Graft Occlusion, Vascular). Grr! Well, I've started this post anyway, so here goes.

I was asked to do a search for "coronary artery bypass graft re-stenosis". Here is my final search strategy:

"Coronary Artery Bypass"[MeSH]
AND
"Graft Occlusion, Vascular"[Mesh] OR "Coronary Restenosis"[Mesh]

plus some other stuff unique to this question. The point of posting this is that "Coronary Restenosis" is a synonym of "Graft Occlusion, Vascular", at least for the purposes of this search, but is not as readily found in the MeSH database.