1. Searching Medline Helen Rowlandson Principal Medicines Information Pharmacist London Medicines Information (Northwick Park) London

2. Jan 2008 course - participants responses 21 questionnaires returned More than half have had formal training (during pre-reg, at university, during diploma/certificate, or by NHS library service) Informal training in-house in MI service Most participants use Dialog and a few use Ovid Of the Dialog users most use Advanced search option

3. Main issues/problems Searches produce too many hits - how do you narrow your search down? Searches produce irrelevant hits – how to you find relevant hits for your topic? Searches produce no hits – why is this? Finding/deciding which are the relevant search terms to use –use of the MeSH browser/ MESH descriptors/MESH headings/thesaurus What to do if a drug name isn’t a MESH heading Using search terms across both Embase and Medline Use of explode function, major descriptors and subheadings

4. Session aims To understand the concepts of a basic search strategy in Medline To describe the MeSH thesaurus in detail so that you will be able to apply MeSH to use Medline efficiently To carry out advanced Medline searches

5. Plan Searching basics – a refresher What is Medline? Medical Subject Headings (MeSH) NLM’s MeSH browser Searching tools Dialog software – the basics Worked examples

6. Searching basics – a refresher Large databases – electronic searching is essential A controlled vocabulary or a thesaurus is necessary A means of combining terms is also required e.g. BOOLEAN operators

7. A AND B AB A OR B AB A NOT B A B Boolean operators

8. What is Medline? Vast source of medical information Medicine, Dentistry, Veterinary, Psychology Covers Clinical medicine, anatomy, pharmacology, toxicology, genetics, microbiology, pathology, environmental health, occupational medicine, psychology, biomedical technology 5,000 journals indexed, 70 countries

9. Searching Medline Use indexing system - MeSH thesaurus – Controlled vocabulary with ~23,000 descriptors – Each represents a single concept – Tree structure - hierarchal – Constantly changing – 600+ added per year

10. Medical Subject Headings Articles indexed by 3 tier system – MeSH descriptor (MeSH heading) – MeSH qualifier (MeSH subheading) – Items mentioned (check tags) – Articles are indexed & then double checked by another indexer  must agree

11. MeSH Browser Open the Internet and type: http://www.nlm.nih.gov/mesh/MBrowser.html Right click & then click on “create a shortcut” Now click on “Navigate from tree top” NLM MeSH Browser

12. MeSH Examples Kidney Failure Depression Chronic Fatigue Syndrome PTSD Fluoxetine NLM MeSH Browser

13. Searching Tools Explode – Includes everything below in the tree structure Focus (Major) – Only includes articles where the MeSH heading (descriptor) is the main focus of the article NLM MeSH Browser

14. Quick questions… What is the correct MeSH term to use for angina? And if you exploded this term, what term(s) would you be also including in your search? NLM MeSH Browser

15. Subheadings (qualifiers) Subheadings (qualifiers) refine your search – What aspect of the main heading is the author writing about or discussing? – Look at the definitions of the subheading e.g.: Administration and Dosage Adverse Effects Analysis Chemistry Diagnostic use Economics History NLM MeSH Browser

16. Check Tags All relevant tags are attached to the article These are essentially used as “limit” functions – Human – Child – Adult – Aged – Male – Female – etc.. Type in “female” and look at annotation

17. Check tags Limits – publication types If you want to search for papers that are meta analyses use the publication type limit function. Articles will then be meta-analyses If you use the MeSH heading ‘meta-analysis as a topic’ from tree E the articles you will get will be about meta-analysis as a study design(methods etc..) Look at the MESH browser for definitions

18. Supplementary Concepts Searches for substances that are not defined in MeSH (ie don’t have MeSH terms) Supplementary chemical record >30,000 substances undergoing clinical development – but not all will become commercially available medicines Depending on software - search by CAS registry number and combine with text word search using OR (not necessary in Dialog)

19. Quick question… What is directly above olanzapine in the MeSH tree? What is its CAS registry number?

20. Medline & MeSH Recap Successful searching is finding correct indexing term MeSH headings Scope Notes Focus/Explode Subheadings/Check Tags Supplementary concepts

21. Accessing Medline? MEDLINE OVID MEDSCAPE SILVER PLATTER PUBMED DIALOG NHS

22. Dialog software Open Internet and type: http://www.datastarweb.com/NHS/ Click “Athens users click here” Right click & then click on “create a shortcut” Enter Athens password

23. Dialog software Use advanced search (avoid ‘easy search’) Medline 1951 to date or 1996 to date 3 options to search for terms: – Thesaurus mapping – Browse headings – Enter a term Dialog NHS

24. Dialog software Don’t use punctuation e.g. – Fatigue syndrome, chronic in NLM MeSH – Fatigue syndrome chronic in Dialog Subheadings Tree structure Limits Show titles Dialog NHS

25. Worked example 1 Are there any recent papers about SSRIs or SNRIs being used in the treatment of Huntington disease?

27. Worked example 2 Are there any recent RCTs of the UK- available acetylcholinesterase inhibitors (galantamine, rivastigmine, donepezil) for Lewy Body Dementia?

28. Worked example 3 Are there any articles which discuss using high dose vitamin supplementation to treat autistic disorders ? NB – remember that your enquirer’s way of describing what he is asking for may not necessarily be exactly how MeSH describes it….

31. ANY QUESTIONS?