Step 1-4. Outline Your Search

Step 1 – Define the Clinical or Research Question

It’s best to have a clear idea of the question you want to answer before you begin a MEDLINE search. Read over the clinical situation described below and then write down or mentally state the question you need to answer.

Clinical Situation

A liver transplant patient has been given cyclosporine to prevent transplant rejection and is beginning to show signs of renal failure. The patient’s physicians asked you to recommend an immunosuppressive regimen that has been proven to work in prevention of liver transplant rejection and is less likely to cause renal toxicity.  You found some studies documenting less renal toxicity when sirolimus is used as the primary immunosuppressive agent.

After reviewing the results of your first search, the clinical team is considering the use of sirolimus immunosuppression. First, however, they would like to see all reports concerning kidney diseases caused by sirolimus.

Step 2 — Outline Search Concepts

In the list below, click on the concepts that should be represented in the search strategy.

• Open a Word document.
• Type the search concepts in the document.

Step 3–Filter Concepts

After listing the search concepts, determine which of the listed concepts would be best represented by filters/limits.

Limits are things like:

• subject species, age and gender,
• publication type, language and date.

Does your concept list include any limit concepts? If so, type “Limit” next to these concepts.

You won’t apply the limits until much later, after your initial PubMed search results have been obtained.

Step 4 — Which Concepts are Headings and subheadings

4a — Which concepts do you think should be represented by MeSH headings?

• Type the word  “heading” next to the search concepts that should be represented by subject headings?

Concepts represented by subject headings are “stand-alone” concepts. Heading concepts are things like:

1. names of diseases or names of categories of diseases,
2. names of drugs/therapies or names of categories of drugs/therapies
3. names of organs or body parts or “wounds and injuries” of named body parts
4. names of agents responsible for communicable diseases, names of organisms, or names of animals
5. names of infections (Infections caused by a communicable agent and the communicable agent itself are represented by separate headings)
6. names of procedures or tests or the names of categories of procedures or tests,
7. names of specialties or professions,
8. names of specific study designs,
9. names of types of programs

Step 4b–Which Concepts do you Think Should be Represented by Subheadings ?

• Type the word  “subheading” next to the search concepts that should be represented by subheadings.

Subheading concepts are aspects of the stand-alone heading concepts.   They can usually be linked to these prepositions by a preposition like “of”.

Can you link the heading and subheading concepts correctly?

• Using whatever method you prefer, record the correct linking of heading and subheading concepts in your Word document.

Step 4c — Which Concepts do Search Templates Suggest Should be Represented by Headings or Subheadings.

As the most common journal article topics are indexed in a predictable manner, standard templates can be used to guide searches on these topics.

The three templates listed below are especially important for drug information searches

1. Drug A (Procedure A) causes Disease B
(“Drug A/adverse effects”[mesh] ) AND (“Disease B/etiology”[mesh])

2. Drug A used to treat Disease B
( “Drug A/therapeutic use”[mesh]) AND (“Disease B/therapy”[mesh] )

3. Drug A used to prevent Disease B
“Drug A”[mesh] AND “Disease B/prevention and control”[mesh]

Additional concepts can, of course, be added to the types of searches above.  The templates are just intended to guide the applicable part of your search.

Notes:

In the templates above, “Drug Class A” can replace “Drug A”

The templates above are optimized for PubMed.  PubMed explodes subheadings.  Broad subheadings retrieve narrower subheadings in the same subheading tree.  The “etiology” subheading is in the same tree and broader than the “chemically-induced” subheading.  The “adverse effects” subheading is in the same tree and broader than the “poisoning” and “toxicity” subheadings.   The “therapeutic use” subheading is in the same tree and broader than the “administration and dosage” subheading.  The “therapy” subheading is in the same tree and broader than the “drug therapy” subheading.  Not all MEDLINE search interfaces explode subheadings.  For instance, the EBSCOhost MEDLINE interface doesnt explode subheadings.   When using the EBSCOhost interface you would have to include the important narrower subheadings in your search strategy as well as the subheading indicated in the template..  

Time to Look up Real Headings

Congratulations! You have outlined your search strategy. You can now begin to look up the real MeSH terms for the heading-concept/subheading pairs you’ve listed.