Subheadings and explosions

In the Ovid Medline interface, subheadings are not autoexploded. You have to select subheadings from a list of checkboxes. Importantly, it looks like checkboxes are only provided for the subheadings associated with the MeSH term you're looking at - NOT for its narrower terms.

So, let's say that you're searching for statistics about corneal diseases. There exists a MeSH term Corneal Diseases, with narrower terms of course. You explode and go through to the subheadings page, and select epidemiology, ethnology, and mortality. You notice that "statistics and numerical data" is not available in the list.

You are, however, skeptical, so you try typing in exp Corneal Diseases/sn. Lo and behold, some results! A quick NOT shows that some of these were not found with the ep,eh,mo search.

Complete Reference view shows that the articles in this list are all narrower terms of Corneal Diseases, with subheading sn, such as Keratoconjunctivitis/sn.

So, if your search term has narrower terms and doesn't have a checkbox for a particular subheading, it's worth typing in the combination to see if any results from narrower terms are found.

Another example:

Searched Smoking and found three relevant subheadings: dt,pc,th

Searched "Tobacco Use" which is a broader term of Smoking. Only 2 subheadings found: pc,th

This meant that Smoking/dt returned 130 articles not found by the Tobacco Use search.

I was able to search exp "Tobacco Use"/dt,pc,th and retrieve the additional articles.

It may be helpful to search all subheadings related to your topic even if they are not listed.

MeSH 2017!

Yesterday was definitely brought to us by the mathematical concept "sine". One of the apices was the announcement of new MeSH for 2017. Of note:

Changes:

Three subheadings:  radiography (ra), radionuclide imaging (ri), and ultrasonography(us) will become diagnostic imaging (dg).

Brain Injuries is finally being split:

• Brain Contusion
• Brain Injuries, Diffuse
• Chronic Traumatic Encephalopathy
• Brain Injuries, Traumatic
• Brain Concussion

Brain Concussion already existed, of course, but this seems to be a list of all of the new narrower terms of Brain Injuries. TBI finally has its own MeSH!

I'm not quite sure if I understood correctly. It seems that Bisexuality, Homosexuality, and Homosexuality, Female, are being combined into one MeSH: Sexual Minorities. Or will they be narrower terms? I hope for the latter, for the specificity. However, if these three concepts are being combined, at least we won't have to apologise on NLM's behalf for the non-PC terms still in usage, when discussing with practitioners.

New Mesh:

Once again, I am only highlighting the MeSH which I am certain I would have used in the past year or so, if they had been available.

There are now more MeSH for Physician Specialists!

e.g. Cardiologists, Geriatricians, etc… (but not, as far as I could tell, Emergency Physicians! Which would have been very useful yesterday, sigh…)

In January, take a look at the explosion of "Physicians" to see what (or rather, whom) you can now search! 

There seemed to be a trend for MeSH related to shoulder injuries:

• Arthroplasty, Replacement, Shoulder
• Rotator Cuff Injuries
• Rotator Cuff Tear Arthropathy
• Shoulder Injuries
• Shoulder Prosthesis

 Other new MeSH of interest:

• Anterior Cruciate Ligament Injuries
• Attentional Bias
• Blood Culture
• Body Remains
• Cancer Pain
• Cardiac Rehabilitation
• Case Managers
• Closed Fracture Reduction
• Conservative Treatment
• Crush Injuries
• Diet, Carbohydrate Loading
• Emergence Delirium
• Hyperekplexia
• Intersectoral Collaboration
• Margins of Excision
• Medically Unexplained Symptoms
• Mentoring
• Multiple Chronic Conditions
• Patient Comfort
• Patient Reported Outcome Measures
• Positron Emission Tomography Computer Tomography
• Sexual Minorities
• Single Photon Emission Computed Tomography Computed Tomography
• Sleep Hygiene
• Small Fiber Neuropathy
• Spontaneous Perforation
• Stroke Rehabilitation
• Surgical Wound
• Sutureless Surgical Procedures
• Tardive Dyskinesia
• Transportation Facilities
• Work-Life Balance

Stuff that I probably wouldn't have used, but illustrate some current trends:

• Distracted Driving
• Healthy Diet
• Healthy Lifestyle
• Phage Therapy
• Pharmacogenomic Testing

PubMed's MeSH database does frequency search for mapping now?

OK, so here's a weird thing.

I searched induction therapy in the MeSH database (Pubmed) and it returned the MeSH term Neoadjuvant Therapy. Which is pretty close to what I was looking for, but the weird thing is, I can't figure out how it knew that. Induction therapy is not an entry term for Neoadjuvant Therapy, nor does the word induction appear anywhere in the scope note. The only thing that I can guess is that PubMed is now doing some kind of frequency search, the way that Ovid is so famous for, in order to return a MeSH result.

Psychiatric Manifestations of...

this one comes up a lot!


"Neurologic Manifestations"[Mesh] OR "Mental Disorders/etiology"[Mesh] OR "Mental Disorders/epidemiology"[Mesh] OR "Behavioral Symptoms"[Mesh] OR "Cognition"[Mesh]

Other things to try:
"Learning"[Mesh]
"Anxiety"[Mesh]
"Affect"[Mesh]
"Intelligence"[Mesh]
"Personality Development"[Mesh]
"Educational Status"[Mesh]

Behavioral Symptoms comes from a whole pile of stuff under Behavior. It's a good idea to look at the narrower terms of Behavior to see which ones apply to your particular search. There are some which are almost certain to be irrelevant, though, for example, Behavior,Animal.

some examples of potentially useful MeSH: "Compulsive Behavior"[Mesh:NoExp] OR "Stereotyped Behavior"[Mesh]

Other terms to check out for relevant narrower terms would be Emotions (NT=Anxiety) and Personality (NT=Intelligence)

Adjacency (proximity) searching

Adjacency (proximity) searching

When people can't agree on their terms, adjacency searching is your best friend. Before Chronic Pain was a MeSH term (and even after), you could do some awesome things with proximity.

For example, a search for: chronic adj3 pain.mp. (Ovid Medline) would find all of the following for you:
chronic pain
chronic noncancer pain
chronic non-cancer pain
chronic nonmalignant pain
chronic non-malignant pain
chronic neuropathic pain

and probably even more!

It also does phrase inversions. A search for disease adj3 progression.mp. would find both of the following:
disease progression
progression of the disease

And, it can save you in the case of greek letters, unsearchable characters, and stop words.
oral adj3 estradiol (oral beta estradiol)
accident adj2 emergency.mp. (accident & emergency)
tobacco adj2 disorder*.mp. (tobacco use disorder)

One tricky thing about adjacency is: how do you choose the number that goes after the adj?
How it works is: write out the longest phrase that you want to find. Let's use the example of "progression of the disease"
Put your finger (or your cursor) on the first word. Actually it is the zeroth word, as we will see shortly.
Now count forward over your phrase until you reach the last word.
Progression = 0; of = 1; the = 2; disease = 3.
Therefore, you should put the number 3 after your adj.
disease adj3 progression.mp.

Not sure of all the phrases that might be relevant? Heuristically, adj3 is usually a good default. It's broad enough to catch most of the relevant stuff, but narrow enough that your search won't be hopelessly plagued by false drops. However, if you're not sure, just try an adj4 for the same words, and use NOT to remove the adj3 results. Did you find anything useful?

EBSCO interface allows you to decide whether your want phrase inversions or not. It's nice to have the control, but the downside is you need a cheat sheet to remember which is which.
patient N3 position*
Finds words in any order (patient positioning, positioning of the patient)

patient W3 position*
Find words only in that order (patient positioning*, the patient was in position)

Sadly, adjacency searching is not available in PubMed.

Drug Combinations - don't become enmeshed

Watch out for this tricky one:

MeSH term "Drug Combinations" refers to single preparations containing 2 or more active ingredients (e.g. 1 pill with two drugs in it)

MeSH term "Drug Therapy, Combination" refers to therapy with two or more separate preparations given for a combined effect (e.g. taking 2 pills at the same time)

You might also be interested in:

Drug Interactions
Drug-Related Side Effects and Adverse Reactions (YI=2014)

Major Depression

For some reason, there is inconsistency in the way that the MesH Depressive Disorder and Depressive Disorder, Major are used.

If you want Major Depression:

"Depressive Disorder, Major"[Majr] AND ("major depression"[tiab] OR "major depressive"[tiab])
OR
"Depressive Disorder"[Majr:NoExp] AND ("major depression"[title] OR "major depressive"[title])

That should capture the relevant stuff - you can change Majr to MeSH and/or add subheadings depending on your question.

Long term outcomes

Man, searching for outcomes is so annoying! Like "interventions", it's such a logical thing for someone to ask for, and yet so completely unsearchable.

"Long Term Adverse Effects"[Mesh] OR "Prognosis"[Mesh] OR "Disease Progression"[Mesh] OR "Follow Up Studies"[Mesh]

(Two things to note: Prognosis includes Treatment Outcomes as a narrower term, and Long Term Adverse Effects was added to the MeSH database in 2016.)

or

"long term"[tiab]

or

"Time Factors"[Mesh]
(technically this is what articles about anything "long term" were supposed to be indexed under pre-2016. And anything long term other than long term adverse effects should still be indexed here post-2016. However, there are two problems - one, indexers forget to use it, and two, they index other time-related stuff here, so you may want to combine it with "long term"[tiab] (rather than using OR between these two) if the rest of your search strategy is rather broad.

EMBASE:

exp follow up/ or prognosis/ or exp treatment outcome/ or disease course/ or exp illness trajectory/ or "long term".ti,ab.

Home management of ....

"Home Care Services"[Mesh]

also
"Home Care Agencies"[Mesh] OR "Home Health Aides"[Mesh] OR "Homebound Persons"[Mesh] OR "House Calls"[Mesh]

This is for home management by healthcare professionals. It's not for searches about unpaid home care, usually by family members.

Tapering drugs

Do this in Ovid to use the adjacency searching:

(taper* or wean* or deprescri* or de-prescri*).ti,ab.
(reduc* adj1 dos*).ti,ab.
(decreas* adj1 dos*).ti,ab.
(lower adj1 dos*).ti,ab.
exp Drug Administration Schedule/
exp Withholding Treatment/


If no access to adjacency searching, can try
taper*[tiab] OR reduc*[tiab] OR wean*[tiab] OR deprescri*[tiab] OR de-prescri*[tiab] 

Some of the following may also be useful
discontinu*[tiab] OR withdraw[tiab] OR withdrawing[tiab] OR terminat*[tiab] OR de-induc*[tiab] OR deinduc*[tiab] OR detox*[tiab]
Withdraw is not truncated because you don't want articles about withdrawal (as a symptom)!

It can help to use administration & dosage subheading on the substance(s) being tapered.
e.g. Benzodiazepines/ad

It can also help to say what you're trying to prevent:
Substance Withdrawal Syndrome/pc

EMBASE has Drug Withdrawal/

Switching from one drug to another

You can try:

"Drug Substitution"[Mesh] OR switch*[tiab] OR transfer*[tiab] OR transition*[tiab]

I also tried convert*[tiab] OR conversion*[tiab] OR swap*[tiab] for my search, but they didn't return any results after being combined with the drugs of interest.

taper*[tiab] OR induction*[tiab] OR initiat&[tiab] may be of use. The taper part applies to the drug which is being discontinued, and the induction/initiation part applies to the drug being started, of course - but this language is used in drug switching as well as monodrug therapy.

If the drugs are not drugs of abuse, then you could also try:
substitut*[tiab]

However, this search is NO GOOD if you're switching from, say, methadone to suboxone, because then you get all this stuff about opioid substitution, which is not helpful.

Physical or built environment or environment design in the hospital

Physical or built environment or environment design in the hospital

"Health Facility Environment"[Mesh] OR "Environment"[Mesh:NoExp] OR "Environment Design"[Mesh] OR "Facility Design and Construction"[Mesh]

combine the above with the relevant MeSH for the department/unit or facility in your question (e.g. "Psychiatric Department, Hospital"[Mesh] OR "Hospitals, Psychiatric"[Mesh])

You can also try keywords such as:
"physical environment"[tiab] OR "built environment"[tiab] OR architectur*[tiab] OR "interior design"[tiab]
however, for my question these only resulted in 1 additional article, so not especially helpful.

Long term use of a drug

In 2016, the term "Long Term Adverse Effects" was added to MeSH! Hooray!

However, we still need to be able to find articles pre-2016 indexing. Here are some strategies:

"Time Factors"[Mesh] (previous indexing for the concept of long term)

"Prescription Drug Overuse"[Mesh]


Keywords:
"long term"[tiab] OR "chronic use"[tiab] OR "chronic usage"[tiab] OR "prolonged use"[tiab] OR "prolonged usage"[tiab] OR longterm[tiab] OR long-time[tiab] OR longtime[tiab] OR longstanding[tiab] OR long-standing[tiab] OR "prolonged utilization"[tiab] OR "prolonged utilisation"[tiab] OR "chronic use"[tiab] OR "chronic usage"[tiab] OR "chronic utilization"[tiab] OR "chronic utilisation"[tiab] OR "chronic effect"[tiab] OR "chronic effects"[tiab]

You can also add the name of the drug in question, e.g.:
"chronic benzodiazepine"[tiab] OR "chronic benzodiazepines"[tiab] OR "prolonged benzodiazepine"[tiab] OR "prolonged benzodiazepines"[tiab]
or
"chronic melatonin"[tiab] OR "prolonged melatonin"[tiab]

Preoperative Period

To find or exclude preoperative period from your results:

"Preoperative Period"[Mesh] OR "Preoperative Care"[Mesh]
OR
"preoperative"[tiab] OR "pre-operative"[tiab] OR "preadmission"[tiab] OR "pre-admission"[tiab] OR presurg*[tiab] OR pre-surg*[tiab] OR preprocedur*[tiab] OR pre-procedur*[tiab] OR premedicat*[tiab] OR pre-medicat*[tiab]

CINAHL:
MH "Preoperative Period+" OR MH "Preoperative Care+"

EMBASE:
exp preoperative period/

High dose

high adj3 dos*
extreme adj3 dos*
maximum adj3 dos*
megadose
mega adj1 dos*
supratherapeutic dos*
large adj3 dos*
increas* adj3 dos*
dose escalation

Hydration (Fluid therapy)

PubMed:
"Water-Electrolyte Imbalance"[Mesh] OR "Water-Electrolyte Balance"[Mesh] OR "Body Fluids"[Mesh:NoExp] OR "Body Water"[Mesh] OR "Thirst"[Mesh] OR "Drinking"[Mesh] OR "Drinking Behavior"[Mesh] OR "Water/therapeutic use"[Mesh] OR "Water/deficiency"[Mesh] OR "Fluid Therapy"[Mesh] OR "Rehydration Solutions"[Mesh]

EMBASE:
exp hydration/ or exp dehydration/ or exp water/ae,ad,dt,to,th or exp body water/ or exp total body water/ or exp water absorption/ or exp water deprivation/ or exp water metabolism/ or exp skin water loss/ or body fluid/

CINAHL:
MH "Fluid Therapy+" OR MH "Dehydration" OR MH "Body Fluids" OR MH "Body Water" OR MH "Thirst" OR MH "Drinking Behavior" OR MH "Water+"AD/AE/DF/DU/ME/PO/TU" OR MH "Rehydration Solutions+"

Journals in "my discipline"

Over the weekend, the question came up: what if I want to limit my search to only articles from journals in my discipline?

There isn't an easy way to do this in Medline and the other medical databases. There are, however, some hacks which can be used. If you use these, keep in mind that you may be inadvertently losing articles of value, either by missing a journal in the discipline of interest, or by removing a relevant article because it was in a journal for another discipline.

The strategies available to you depend on the database and interface which you choose to search.

In PubMed, you have two options.

The first is to use PubMed Reminer to analyse your results and pull out journal titles.

Step 1: Put your entire search strategy into one blurb. Copy the search strategy.
Step 2: Go to PubMed Reminer: http://hgserver2.amc.nl/cgi-bin/miner/miner2.cgi
Step 3: Paste your search strategy into PubMed Reminer.
Step 4: If you've already done a search in PubMed Reminer, you can select the Columns to Display on the right-hand side. Uncheck all except Journal.
Step 5: Click the Search button (search with manual adjustment)
Step 6: Above the list(s) of results, click n the link: Save the results as a txt-file.
Step 7: Use the Find feature on your browser to find the text: #T:Journal. (If you selected just the Journal column, this should appear at the top)
Step 8: Copy the list of journals.
Step 9: Paste the list of journals into Word.
Step 10: Starting at the bottom of the list, delete irrelevant journals. Journals with only 1 or 2 in the left-hand column will likely be irrelevant, but watch out for unusual cases such as new journals or quarterlies.
Step 11: Do a Find-and-Replace - In the Find field, type: ^p^#^t and in the Replace field, type: "[Jour] OR " - be sure to include the quotation marks.
Step 12: In the Find field, add another ^# for the two-digit numbers, i.e. ^p^#^#^t and repeat with three ^p^#^#^#^t if you have any three-digit numbers in the left column.
Step 13: Clean up the first and last entry on your list.
Step 14: Copy and paste your new search string into PubMed, and use AND to combine it with your existing search strategy.

The second option is to use the Journals search in PubMed.

Step 1: Make a list of MeSH for your discipline of interest. For example, for palliative care I did: "Terminally Ill"[Mesh] OR "Palliative Care"[Mesh] OR "Terminal Care"[Mesh] OR "Advance Care Planning"[Mesh]
Step 2: Go to the PubMed home page, and click on Journals in NCBI Databases in the right-hand column.
Step 3: Copy and paste your search strategy into the search field.
Step 4: On the left-hand side, click on Currently indexed in Medline
Step 5: On the left-hand side, click on Referenced in the NCBI DBs to deselect it.
Step 6: On the left-hand side, click on English
Step 7: At the top of the page, click on the link that says 20 per page, and set it to show all results at once.
Step 8: Go through the list and check the box next to each journal of interest*
Step 9: When all the journals of interest are selected, at the top right-hand side of the page, click the Add to search builder button.
Step 10: Click the Search PubMed button.
Step 11: Use AND to combine this search with your existing search strategy.

* I'm working on a way to make this step easier. Stay tuned...


Ovid Medline:
Step 1: Make a list of all of the keywords which might appear in the title of a relevant journal. For example, for palliative care, I did: palliat* or support* or end or death or symptom* or hospice or terminal*
Step 2: Enter your list of keywords into the search field, inside parentheses: e.g. (palliat* or support* or end or death or symptom* or hospice or terminal*)
Step 3: After the close parenthesis, add .jw.
Step 4: Click the search button.
Step 5: Combine the results of this search with the rest of your search strategy.

Ovid Embase:
Step 1: Make a list of all of the keywords which might appear in the title of a relevant journal. For example, for palliative care, I did: palliat* or support* or end or death or symptom* or hospice or terminal*
Step 2: Enter your list of keywords into the search field, inside parentheses: e.g. (palliat* or support* or end or death or symptom* or hospice or terminal*)
Step 3: After the close parenthesis, add .jx.
Step 4: Click the search button.
Step 5: Combine the results of this search with the rest of your search strategy.

EBSCO CINAHL:
Step 1: Make a list of all of the keywords which might appear in the title of a relevant journal. For example, for palliative care, I did: palliat* OR support* OR end OR death OR symptom* OR hospice OR terminal*
Step 2: Paste this list into the top search field in the EBSCO interface
Step 3: Change the drop-down menu from Select a Field to SO Publication Name
Step 4: Click the search button.
Step 5: Combine the results of this search with the rest of your search strategy.

Please note: the search history will show text such as the following:
SO palliat* OR support* OR end OR death OR symptom* OR hospice* OR terminal 
You might be tempted to copy and paste this somewhere and use it again at a later date. It will not work. For some reason you must use the drop-down menu to search the SO field, you can't copy and paste the search line from the search history.

In the hospital setting

Don'tcha just love those "settings" questions?

In the hospital setting:

"Hospital Administration"[Mesh] OR "Hospital Units"[Mesh] OR "Hospitalization"[Mesh]
with
hospital*[tiab]

EMBASE:
exp hospital/ or exp hospital management/ or exp hospital care/

Workaround for EBSCO's NOT operator glitch

When searching in EBSCO, you may have noticed that the NOT operator doesn't play nice with the Limits.

That is, let's say you've done a search. You limit to the Full Text articles and export them. Then, you want to select all of the not-full-text articles and export them. However, if you do so, you get zero results, despite the fact that there are definitely not-full-text articles in the list.

The only workaround for that is to export all of the results into your bibliographic manager and then use the FT set which you previously exported to recognise and remove the FT articles from the list. By hand.

However, if you have a limit other than Full Text, you may be able to force the EBSCO database to perform a NOT correctly. You can do this by using the Indexes at the top of the page. Here's how:

 At the top of the page, in the blue bar, click on More and select Indexes

Where it says Browse an index, click the drop-down menu and make a selection. For instance, you could select Language and then browse for English.

Add your search to the Search field by clicking its checkbox and then clicking the Add button.

Now you can combine this limit with other searches and use the NOT operator.

Sometimes it's difficult to figure out what Index to use. To find out, first use the limit that you're interested in using the normal limits system.

Select any article in the list and click its title.

On the right-hand side, click the Export option.

Choose Generic Bibliographic Management Software and click the Save button.

Use your browser's Find option to find the text of the limit. In this example, I found the word peer (as in peer reviewed).

Now we can see that the two-letter code is PT.

So, we can use the search PT peer review* to find peer reviewed articles. We can then use NOT to find the articles which are not peer reviewed.

Behavioural and psychological symptoms of dementia

Getting a lot of questions these days on the behavioural and psychological symptoms of dementia

exp * Dementia/
AND
exp Neurobehavioural Manifestations/ or exp Behavioral Symptoms/ or (psych* symptoms or behavio* symptoms or neurobehavio* symptoms or neuropsych* symptoms or BPSD or behavio* disturbance*).mp.

You may also wish to try:
exp * Dementia/
AND
exp Apathy/ or exp Sleep Wake Disorders/ or exp Psychotic Disorders/ or exp Psychomotor Agitation/ or exp Aggression/ or exp Violence/ or exp Anxiety/ or Compulsive Behavior/ or exp Stereotyped Behavior/

PsycInfo:
DE "Behavior Problems" OR DE "Stereotyped Behavior" OR DE "Compulsions" OR DE "Repetition Compulsion"

EMBASE:
exp problem behavior/ or exp stereotypy/

New Mesh for 2016!

There were so many great new MeSH this year that I've only highlighted the ones that I would definitely have used in a search in the past year.

• Adult Survivors of Child Adverse Events 
• Autism Spectrum Disorder
• Behavior Rating Scale
• Child Protective Services
• Clinical Decision-Making
• Cognitive Aging
• Criminal Behavior
• Deprescriptions
• Dermal Fillers
• Diet, Vegan
• Distance Counseling
• Exposure to Violence
• Fecal Microbiota Transplantation
• Gender Dysphoria
• Help-Seeking Behavior
• Hoarding Disorder
• Late Onset Disorders
• Long Term Adverse Effects
• Physical Abuse
• Potentially Inappropriate Medication List 
• Problem Behavior
• Professionalism
• Psychological Trauma
• Radiation Exposure
• Serotonin and Noradrenaline Reuptake Inhibitors
• Social Workers
• Transitional Care
• Vegans
• Vegetarian

Hooray!

One weird thing: diagnostic use is no longer available as a subheading. Not sure why, but I know I've used that one before, so that's too bad.

However, Buprenorphine, Naloxone Drug Combination is now a MeSH rather than a Supplementary Concept, so that is useful. So far that's the only SC that I've come across which was promoted - there may be others too.