Downloaded from www.TheOncologist.

com at Univ Pontificia/ Innatos on December 17, 2007

Making PubMed Searching Simple: Learning to Retrieve Medical Literature Through
Interactive Problem Solving
Beatriz Vincent, Maurice Vincent and Carlos Gil Ferreira
Oncologist 2006;11;243-251
DOI: 10.1634/theoncologist.11-3-243

This information is current as of December 17, 2007

The online version of this article, along with updated information and services, is located on
the World Wide Web at:
http://www.TheOncologist.com/cgi/content/full/11/3/243

The Oncologist® is devoted to medical and practice issues for medical, hematological, radiation,
gynecologic, and surgical oncologists and is designed specifically for the busy practitioner entrusted with
the care of adult or pediatric cancer patients.

The Oncologist® has been continuously published since 1995. The Journal is published 12 times
annually. The Oncologist® is owned, published, and trademarked by AlphaMed Press, 318 Blackwell
Street, Suite 260, Durham, North Carolina, 27701. © 2006 by AlphaMed Press, all rights reserved. Print
ISSN: 1083-7159. Online ISSN: 1549-490X.
 This material is protected by U.S. Copyright law.
Unauthorized reproduction is prohibited.
For reprints contact: Reprints@AlphaMedPress.com

The Community Oncologist

Making PubMed Searching Simple: Learning to Retrieve Medical
Literature Through Interactive Problem Solving

Downloaded from www.TheOncologist.com at Univ Pontificia/ Innatos on December 17, 2007

Beatriz Vincent,a Maurice Vincent,b Carlos Gil Ferreiraa

a
Clinical Research Department, Instituto Nacional do Câncer, Rio de Janeiro, Brazil;
b
Neurology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

Key Words. MEDLINE • PubMed • Medical subject headings • MeSH

Internet • Evidence-based medicine • Education, medical

Abstract
Searching the literature has a direct, beneficial influ-
ence on patient care. The amount of medical scientific
information has increased to a great extent, while the
development of networking technologies has broadened
access to online databases. Successful searches depend
upon understanding technical librarianship concepts
and the skills for mastering searching interfaces. From
a problem-oriented approach, concepts like MEDLINE
coverage, PubMed resources, Boolean logic, search
strategies, and Web sources for full-text articles are
introduced along seven online situations: locating a spe-
cific publication, answering a complex clinical question,
finding information on a general subject, finding publi-
cations by a particular author, finding publications in a
particular language, finding a specific publication type,
and locating the full-text document. Oncologists should
face the challenge of performing their own searches. Spe-
cific knowledge is mandatory to avoid frustrating, time-
consuming work. The objective of this work is to present
concepts, strategies, and skills required for medical lit-
erature retrieval, easing the incorporation of new and
welcomed practices. The Oncologist 2006;11:243–251

Introduction
Scientific journals are the primary publication media for librarian background on one hand and practical computer
professional communication. Once imprisoned in librar- experience for managing sophisticated Web interfaces on
ies, medical publications can now be accessed worldwide the other.
through the internet. More recently, Web-based resources The objective of this article is to present concepts, strat-
provide regular professional updates, evidence-based egies, and skills required for successful literature retrieval.
patient care information, and medical problem solving Database structure, MEDLINE coverage, PubMed
[1]. Therefore, oncologists should be able to perform their resources, Boolean logic, search strategies, and Web
own searches. sources for full-text articles are described. This publication
Specific training is needed because internet access and has been divided into three main topics: (a) how to start, (b)
the World Wide Web revolution have introduced a multi- how to search, and (c) finding the full-text article [2]. Origi-
tude of technologies and resources into the medical field. nal ideas from Greenhalgh [3] and Ebbert and colleagues
The necessary skills for performing a successful search [4] were adapted to create seven online examples using the
and locating full-text publications may include a technical same problem-oriented approach they presented.
Correspondence: Beatriz Vincent, M.D., M.Sc., Centro de Pesquisa do Instituto Nacional do Câncer, Rua André Cavalcanti 37, 2º andar,
Rio de Janeiro, Brazil, CEP 20.231-050. Telephone: 55-21-3233-1502; Fax: 55-21-3233-1411; e-mail: vincent@inca.gov.br Received
August 23, 2005; accepted for publication December 15, 2005. ©AlphaMed Press 1083-7159/2006/$20.00/0

The Oncologist 2006;11:243–251 www.TheOncologist.com

244
How to Start?
Choosing an evidence resource database must be the ini-
tial step. A database is a collection of data organized to
allow easy retrieval; MEDLINE, EMBASE, the Cochrane
Library, and Best Evidence are valuable sources of infor-
mation [5]. Because of its appropriateness, MEDLINE, the
world’s most commonly used biomedical database [6], was
selected for this work. MEDLINE is produced by the U.S.
National Library of Medicine (NLM) and contains cita-
tions for a vast number of journal articles. Its relevance is
described fully on the NLM Web site.
MEDLINE is readily available and free of charge
at http://www.pubmed.gov. PubMed is a Web-based
retrieval system developed by the National Center for
Biotechnology Information at the NLM. As a search
engine, it receives a search request, compares it with an
index, and returns the corresponding results. PubMed
queries match user submitted key words against MED-
LINE records. A record consists of a set of data elements;
fields required by MEDLINE include Title, Author(s),
Affiliation, Abstract, Language, Publication Date, Jour-
nal Title, and Medical Subject Heading (MeSH) terms
(Fig. 1). The MeSH field contains terms chosen from
among 22,568 descriptors defined by the NLM. The
MeSH vocabulary is continually updated. MeSH terms
are assigned according to the analysis of expert indexers
to best reflect article content [6].
Medical Literature Retrieval
How to Search?
Ebbert and colleagues [4] wrote a comprehensive review on
PubMed features and resources. The main advantages of
searching MEDLINE through PubMed are its user-friendly
interface, sophisticated search resources, and built-in links
to full-text documents [7]. Performing a PubMed search in
the same way that one performs an ordinary Web search
has a lot of appeal [6], since typing a word in a search box
and clicking on “Go” using the Google or Yahoo! search
engines has become a popular procedure. Techniques orig-
inally developed for internet search engines are adapted
Downloaded from www.TheOncologist.com at Univ Pontificia/ Innatos on December 17, 2007
here for PubMed searching.
Spell It Out: Define the Topic and Generate a List
of Search Terms
To search efficiently, users must first formulate the appro-
priate question [5] and then translate it into a database query
by choosing specific terms. Searchers may look, for exam-
ple, for specific authors, journals, generic words (free-text
search), and/or MeSH terms. In a free-text search, records
containing the given word anywhere in the title or abstract
are retrieved, even those not necessarily related to the sub-
ject [8]. On the other hand, searching through MeSH terms
allows retrievals limited to records on that specific subject,
regardless the words the authors may have used [6]. Although
MEDLINE contains publications from more than 5,000
journals published in many languages, MEDLINE field con-
Figure 1. Illustration of how
information is stored in the
MEDLINE database. MED-
LINE required fields for each
database record are indicated.
Abbreviation: MeSH, Medi-
cal subject headings.
OTncologist
he ®
Vincent, Vincent, Ferreira 245

tents are solely in English. Therefore, key words for a MED-
LINE search ought to be given in English. For non-native
speakers, using the “MeSH Database” link featured on the
PubMed home page on the blue side bar to confirm spelling is
recommended. The MeSH interface translates a search word
into the closest MeSH term [1]. It also shows which terms are
not included in the vocabulary. Suppose we search using the
words “breast cancer.” Because breast cancer does not belong
to the MeSH vocabulary, a more comprehensive search result
would be obtained using the phrase “breast neoplasm.”
Strategize: Choose the Tools and Resources That
Databases, in general, allow the use of Boolean
operators [1]. Boolean operators are used to combine
key words into a search expression. The connectors
AND, OR, and NOT improve search specificity [1, 8].
In PubMed, these operators must be typed using capital
letters [1, 4]. The AND operator retrieves a set of records
containing all given search terms, regardless of where
the terms are found (Fig. 2A). In contrast, the OR opera-
tor retrieves records in which any of the terms appear
(Fig. 2B). The NOT operator should be used with caution
because it may eliminate relevant citations. In free-text

Downloaded from www.TheOncologist.com at Univ Pontificia/ Innatos on December 17, 2007

searches, the NOT operator eliminates every citation
Will Work Best for Your Search that contains the term following it somewhere in its title
A good strategy returns a manageable amount of relevant or abstract (Fig. 2C). PubMed processes Boolean con-
citations—an optimal balance between a too-specific and nectors in a left-to-right sequence; the expression “breast
a too-broad list of records. For a given subject, sensitivity
(or recall) is the proportion of high-quality articles that are
retrieved, while specificity (or precision) is the proportion
of low-quality articles that are not retrieved [9].
In a free-text search, synonyms (e.g., neoplasm and
cancer) and variants (e.g., tumour and tumor) of a term may
be entered to ensure comprehensive results [8]. In order to
increase recall, a recommended strategy is to type the trun-
cation function (*) to replace the last letters of a word to pick Figure 2A. Searching MEDLINE using the Boolean operator
up existing vocabulary variants [10]; for example, neoplas* AND between search terms returns only records that contain
[5]. If the search key is a multiword term, it is advisable to all of the search terms. In this example, records returned using
the search query “neoplasm AND breast” are indicated by the
enter the term in quotation marks (e.g., “tumor bank”) [11].
shaded overlapping area.
Searching for a term exclusively in the title field should be
tried [10]; however, complementary searching using a spe-
cific author’s name may improve both the sensitivity and spe-
cificity of free-text searches [10]. Free-text searching is par-
ticularly useful when there are no appropriate MeSH terms
for the subject [8]. Optimal results can be achieved when a
free-text search is combined with a MeSH search [10].
Literature searches performed using MeSH terms show Figure 2B. Searching MEDLINE using the Boolean operator
higher recall and precision than do single free-text searches; OR between search terms returns all records that contain any
important references may, nevertheless, be missed because of the search terms. In this example, records returned using
articles may have been indexed before a new term was the search query “neoplasm OR breast” are indicated by the
shaded area, which consists of all records for both terms.
included in the MeSH list [8]. An NLM indexer assigns
10–12 MeSH headings and 2–4 major MeSH headings in
the process of indexing an article [1, 6, 8]. Subheadings,
another related concept, further describe a particular
aspect of a MeSH term [1, 4, 6, 8] and are the fine-tuning
of MEDLINE [3]. The MeSH browser, accessed by the
MeSH Database link, displays MeSH subheadings that can
be applied to a search term, allowing users to focus their Figure 2C. Searching MEDLINE using the Boolean opera-
search more precisely to a diagnosis, drug therapy, surgery, tor NOT between search terms returns only records that con-
or other related subject [1, 8]. For narrowing a broad search, tain the first search term and not the second. In this example,
records returned using the search query “neoplasm NOT
users can just mark the check box “Restrict Search to Major
breast” are indicated by the shaded area, which excludes
Topic Headings Only” because major MeSH headings are records that contain both terms and those that contain only
designated as the main focus of each article [6, 8]. breast cancer.

www.TheOncologist.com
246
NOT neoplasm” would, therefore, lead to a different set
of references than “neoplasm NOT breast.” Complemen-
tary information on Boolean logic can be found else-
where [7, 11, 12]. The “Details” tab in the PubMed search
window shows the complete search expression employed
by PubMed [4].
Search: Get Online, Execute, Stay Focused,
Use Advanced Search Features
Search strategies depend on searcher objectives. In this
section, a problem-oriented approach [3, 4] and suggested
MEDLINE and PubMed strategies [4] have been incorpo-
rated to create online examples of: locating a specific publi-
cation, answering a specific clinical question, quickly find-
ing information on a general subject, finding publications
by a particular author, locating publications in a particular
language, and finding a particular publication type. To
master PubMed resources, we suggest conducting online
searches as you read this article.
Locating a Specific Publication
Search Strategy: Use the Single Citation Matcher Feature
of PubMed
The Single Citation Matcher featured on the PubMed home
page on the blue side bar is the best tool for locating a par-
ticular article. Citations may be found by journal (full name
or abbreviation), date, author, or title words, individually or
combined [1, 8].
Answering a Specific Clinical Question: “Does
Doxorubicin Reduce Breast Cancer Recurrence in
Postmenopausal Women?”
Search Strategy: Use the MeSH Database Feature
of PubMed (Option 1)
Clinical questions have four basic components: the type
of patient involved, the type of exposure the patient expe-
riences, the type of control with which the exposure is
being compared, and the outcomes to be addressed [1,
4, 5, 12, 13]. A well-formulated question would be: Does
“type of exposure” improve “type of outcome” in patients
with “type of patient” compared with “type of control”?
while a poorly formulated question would be: Is “type
of exposure” useful in “type of patient”? [1, 12, 13]. The
question is then divided into its components: disease/
population/procedure (postmenopausal women), ther-
apy/intervention (doxorubicin), comparison (not appli-
cable), and outcome (breast cancer recurrence) [1, 3, 5,
12, 13]. Following identification, search terms are trans-
lated into mapped MeSH terms and successively com-
bined using Boolean operators [1, 3, 5, 8, 12]. Using the
PubMed MeSH Database feature, the complete search
Medical Literature Retrieval
expression can be obtained by checking off the suggested
MeSH term(s) and selecting “Send to Search Box with
AND” from the drop-down menu. The search is exe-
cuted by clicking on the “Search PubMed” button after
the complete expression has been entered (Fig. 3). The
search query “Neoplasm Recurrence, Local” [MeSH]
AND “Doxorubicin” [MeSH] AND “Breast Neoplasms”
[MeSH] AND “Postmenopause” [MeSH] presented in
Figure 3, combining outcome, exposure, disease, and
population, led to three citations. Searchers should be
aware that combining (ANDing) MeSH terms may be too
restrictive. An alternative strategy is to map some of the
Downloaded from www.TheOncologist.com at Univ Pontificia/ Innatos on December 17, 2007
MeSH terms in order to retrieve major articles on the sub-
ject and further combine them with a free-text search.
The History tab featured on the PubMed home page
displays searches in the actual order they were run [4].
From this page, it is possible to create new expressions by
combining previous searches into new search strategies.
Table 1 shows that the first search led to 257 citations,
while ANDing it further to a free-text search led to 11
citations. The pound sign (#) must be used in the search
query to refer to a specific prior search.
Figure 3. Shown is the Medical Subject Headings (MeSH)
search window of PubMed displaying the search query “Neo-
plasm Recurrence, Local” [MeSH] AND “Doxorubicin”
[MeSH] AND “Breast Neoplasms” [MeSH] AND Postmeno-
pause” [MeSH].
Table 1. Answering a specific question
Search PubMed
No. Query recordsa
1 “Neoplasm Recurrence, Local” [MeSH] 257
AND “Doxorubicin” [MeSH] AND
“Breast Neoplasms” [MeSH]
2 postmenopause*; Limits: Female 26,501
3 Search #1 AND #2 11
a
Number of MEDLINE records retrieved by PubMed at the
time this article was submitted.
Abbreviation: MeSH, Medical subject heading.
OTncologist
he ®
Vincent, Vincent, Ferreira
Search Strategy: Use the Clinical Queries Feature of
PubMed (Option 2)
Clinical encounters may generate questions about diagno-
sis, etiology, prognosis, treatment, or prevention [13]. The
“Clinical Queries” link featured on the PubMed blue side
bar can be used for retrieving references that are scientifi-
cally sound and directly relevant to clinical practice [4, 5,
8, 9]. From the Clinical Queries window, users may choose
to either “Search by Clinical Study Category” or “Find Sys-
tematic Reviews.” The Search by Clinical Study Category
feature allows the user to select studies on therapy, diagno-
sis, etiology, or prognosis and to select whether the search
should be more sensitive (retrieving more relevant articles,
but probably including some that are less relevant) or more
specific (narrowly focused, but probably omitting a few)
[8]. The Find Systematic Reviews feature is used for locat-
ing systematic reviews, meta-analyses, reviews of clinical
trials, evidence-based medicine, and other types of cita-
tions, as stated on the Clinical Query web page.
Quickly Finding Information on a General Subject:
Doxorubicin Treatment in Postmenopausal Women with
Breast Cancer
Search Strategy: Use MeSH Subheadings in PubMed
Subheadings may be used to narrow searches that lead to an
unmanageable set of citations [3]. By mapping the search
word through the MeSH Database feature on the PubMed
blue side bar, users are led to a list of subheadings [4, 8]. For
example, after typing “breast neoplasm” in the MeSH win-
dow, the following two mapped terms are displayed: Breast
Neoplasms and Breast Neoplasms, Male. After selecting
the link Breast Neoplasm, “therapy” can be checked off
from a list of subheadings and added to the query box by
selecting “Send to Search Box with AND” from the drop-
Figure 4. Shown is the Medical Subject Headings (MeSH)
search window of PubMed displaying the search query “Breast
Neoplasms/therapy” [MeSH] AND “Doxorubicin” [MeSH]
AND “Postmenopause” [MeSH]. In this case, the MeSH term
“Breast Neoplasms” is limited to only records related to the
subheading “therapy.”
www.TheOncologist.com
247
down menu to narrow the search. We complete our search
by further searching for and checking off the MeSH terms
“doxorubicin” and “postmenopause” and successively
adding them to the query box by selecting “Send to Search
Box with AND” from the drop-down menu. The command
“Search PubMed” is then selected. The final search query,
“Breast Neoplasms/therapy” [MeSH] AND “Doxorubicin”
[MeSH] AND “Postmenopause” [MeSH], which is shown
in Figure 4, led to 26 citations.
Sift: Filter the Results
The Limits tab on the PubMed home page is the ideal tool for
Downloaded from www.TheOncologist.com at Univ Pontificia/ Innatos on December 17, 2007
refining searches [4]. Searches can be limited by language,
age, gender, and publication type, among others. An infinite
range of strategies can be created when the key words typed
into the query box are searched in combination with these
settings. To aid in comprehension, readers can refer to the
MEDLINE record structure displayed in Figure 1.
Finding Publications by a Particular Author
Search Strategy: Use the Limits Feature of PubMed
To retrieve citations by a particular author, the “All Fields”
drop-down menu is set to “Author” and the author infor-
mation is typed in the query box. Searchers may either use
the author’s complete name (e.g., DeVita-VT-Jr) or family
name (e.g., DeVita), or use the truncation function (*) (e.g.,
DeVita-V*).
Locating Publications in a Particular Language
Search Strategy: Use the Limits and History Features
of PubMed
By using the “Language” drop-down menu under the Lim-
its tab, PubMed can retrieve articles published in English,
Figure 5. Selecting “Language” from the “All Fields” drop-
down menu of the PubMed search page using the Limits fea-
ture and typing the desired language (in this example, Portu-
guese) into the search box returns all records published in that
language.
248
French, German, Italian, Japanese, Russian, or Spanish.
Since MEDLINE indexes publications from about 70 coun-
tries [11], citations related to articles published in languages
other than these seven may also be of interest. Succes-
sive steps using the History feature can lead to the desired
results. As shown in Figure 5, the chosen language (e.g.,
Portuguese) can be typed into the search box, while the
All Fields drop-down menu is set to Language. As shown
in Table 2, by using the History feature, a focused search
expression is built connecting two previous searches.
Locating Citations by Publication Type
Search Strategy: Use the Limits and History Features
of PubMed
Reviewing the literature is a necessary step for initiating
research. Review articles comprehensively cover a subject
and contain references that may serve as a source of use-
ful information. Selecting “Review” from the “Publication
Types” drop-down menu under the Limits tab retrieves only
review articles. As a recently introduced tool, the PubMed
results screen displays a Review tab under which only
review papers from the current search are listed. While
the PubMed Limits page only displays the options Clinical
Trial, Editorial, Letter, Meta-Analysis, Practice Guideline,
Randomized Control Trial, and Review in the Publication
Types drop-down menu, MEDLINE citations are classi-
fied into 54 categories. For retrieving case reports or patient
education handouts [14], users can take successive steps and
then refer to the History feature to achieve the appropriate
results (Table 3). As shown in Figure 6, a publication cat-
egory can be typed in the search box combined with the All
Table 2. Limiting your search to citations in Portuguese
Search PubMed
No. Query recordsa
1 Portuguese (Field: Language) 57,875
2 cisplatin (Field: Title) 10,359
3 Search #1 AND #2 3
a
Number of MEDLINE records retrieved by PubMed at the
time this article was submitted.
Table 3. Limiting your search to case reports
Search PubMed
No. Query recordsa
1 case reports (Field: Publication Type) 1,177,858
2 cisplatin (Field: Title) 10,359
3 Search #1 AND #2 738
a
Number of MEDLINE records retrieved by PubMed at the
time this article was submitted.
Medical Literature Retrieval
Fields drop-down menu set to Publication Type. As shown
in Table 3, by using the History feature, a focused search
expression is built connecting previous searches.
Save: Take Notes and Organize the Results
Building and keeping a list of selected MEDLINE citations
may save precious time for future searches. Understanding
the layout of the PubMed results screen and knowing how
to change the display format of the retrieved citations—to
adjust the number of citations displayed on a page, to move
between result pages, and to sort records—constitute basic
requirements for adequate management of MEDLINE cita-
Downloaded from www.TheOncologist.com at Univ Pontificia/ Innatos on December 17, 2007
tions. Useful information is found in a publication from
Ebbert and colleagues [4] and by following the PubMed
Tutorials link.
“Summary” is the default display option, showing the
author, title, source, and language, of the citation, among
other things. The display options “Brief,” “Abstract,”
and “Citation” may be selected through the “Display”
drop-down menu. By default, PubMed lists search results
in batches of 20 citations; a different range of citations
can be displayed by selecting a number from the “Show”
drop-down menu. As a large number of citations may
be presented, it may be necessary to access each article’s
quality. PubMed displays results by publication date, not
by descending relevance. An article from the New Eng-
land Journal of Medicine is more likely to be helpful than
another article published in a less relevant journal [6]. As
a general rule, journals with high impact factors are more
prestigious [15]. Considerations regarding the journal
impact factor and the relevance of the Institute for Scientific
Information (ISI) Web of Science portal are published else-
where [15, 16]. Further sorting citations by journal, publica-
tion date, or author may help select articles; the “Sort by”
Figure 6. Selecting “Publication Type” from the “All Fields”
drop-down menu of the PubMed search page using the Limits
feature and typing the desired publication type (in this exam-
ple, case reports) into the search box returns only records of
that particular publication type.
OTncologist
he ®
Vincent, Vincent, Ferreira 249

drop-down menu can be used to order results according to
these criteria. To select articles, users check off the corre-
sponding checkbox. When the Send to drop-down menu is
set to “Text,” citations are displayed in plain text format.
The following application of the well-known command
sequence “Select All,” “Copy,” “Paste” from the browser’s
“Edit” menu, transfers the set of citations to a text file to be
saved and kept for later use.
Finding Full-Text Articles
Having the list of references, the final step is to obtain the
full-text articles. Online access to full-text electronic arti-
As a new and powerful resource, Google has introduced
Google Scholar (http://scholar.google.com), a user-friendly
tool designed for both searching and locating scholarly
literature. The advanced scholar search interface (http://
scholar.google.com/advanced_scholar_search) makes it
easier to search by author, publication, and date, while the
results screen provides users with useful complementary
information by ranking search results by relevance and
displaying the number of citations for each occurrence. As
with PubMed, Google Scholar may grant access to full-text
articles for individual or institutional subscriptions. Fur-
ther, it may locate a library that has the book you need.

Downloaded from www.TheOncologist.com at Univ Pontificia/ Innatos on December 17, 2007

cles emerged in the mid-1990s and has become more and
more available over the Web. Basically, there are two main
models of full-text availability [7]. In the distributed full-
text model, each journal has its own site, and users create
an account for each journal they address. In the aggregated
full-text model, journals are licensed from publishers and
placed in collections with other journals. Journal collec-
tions can then be searched through a single interface.
The PubMed results screen links citations to individual
articles [4]. The free full-text icons displayed in the PubMed
result window may grant access to electronic articles from
PubMed Central and other online sources. E-mailing the
author and asking for a copy of the article is, in general, very
well received. An author’s e-mail address may be avail-
able either on the PubMed results page or be searched using
Google (http://www.google.com). Quite often, the full ver-
sion of an article is saved somewhere on an internet server.
It is, therefore, worthwhile to search for articles through the
Google “Advanced Search” feature by typing the full title
in quotes combined with the search field “File Format” set
to Adobe Acrobat PDF (.pdf).
Chasing the Full-Text Document
Search Strategy: Try Online Services One by One
Worldwide and continental/local online sources for full-
text documents are presented in Table 4. Some of the men-
tioned Web services require entering the journal’s com-
plete name. The “Journals Database” link featured on the
PubMed home page on the blue side bar translates abbrevia-
tions into complete journal names.
PubMed Central (http://www.pubmedcentral.gov) is
the U.S. National Institutes of Health (NIH) free digital
archive of biomedical and life sciences journal litera-
ture. Content availability varies from immediate access
to 6, 12, or 24 months. PubMed Loansome Doc (http://
www.nlm.nih.gov/loansomedoc/loansome_home.html)
enables PubMed users in the U.S. and abroad to order full-
text copies [1, 11]. A list of servicing centers worldwide
is provided. The Free Medical Journals (http://www.free-
medicaljournals.com) Web site is a top reference for locat-
ing journal addresses online. Created to promote the free
availability of full-text medical journals on the internet,

Table 4. Relevant Web addresses for finding full text-documents

Resource URL
PubMed Central http://www.pubmedcentral.gov
Loansome Doc Ordering System http://www.nlm.nih.gov/loansomedoc/loansome_home.html
FreeMedicalJournals.com http://www.freemedicaljournals.com
Medscape http://www.medscape.com
MDConsult http://www.mdconsult.com
HINARI http://www.healthinternetwork.org
SciELO http://www.scielo.org
BIREME BVS Virtual Health Library http://www.bireme.br
Portal of Journals on Health Sciences http://portal.revistas.bvs.br
CAPES portal http://www.periodicos.capes.gov.br
Abbreviations: CAPES, Coordenação de Aperfeiçoamento de Pessoal de Nivel Superior; HINARI, Health InterNetwork Access to
Research Initiative; SciELO, Scientific Electronic Library Online.

www.TheOncologist.com
250
it sorts 1,380 journals by specialty and language. Access
is free of charge. Medscape (http://www.medscape.com)
lists more than 100 full-text publications. It is also possi-
ble to order full-text articles through the Medscape Docu-
ment Ordering Center. Access is free of charge for regis-
tered members. MDConsult (http://www.mdconsult.com)
is a service of Elsevier Science. The MDConsult core col-
lection offers 71 full-text medical journals, plus medical
reference books. More than 1,700 health care organiza-
tions and 280,000 professionals are licensed MDConsult
users. The individual membership rate for the annual plan
is currently US$ 219.95.
The main objective of the Health InterNetwork
Access to Research Initiative (HINARI), launched by the
United Nations and World Health Organization (WHO),
is to reduce the health information gap between rich and
poor countries [17]. WHO administers HINARI and pro-
vides user IDs and passwords to eligible participating
institutions from low-income countries. From PubMed,
registered HINARI (http://www.healthinternetwork.
org) users can search and access full-text articles directly.
There are more than 2,000 journals from six major pub-
lishers including Blackwell, Elsevier Science, and
Springer Verlag. The list of eligible countries, the com-
plete list of publications, and information on institutional
registration, among others, can be obtained online from
the HINARI Web site. Also sponsored by WHO and the
Pan American Health Organization (PAHO), the Scien-
tific Electronic Library Online (SciELO) (http://www.
scielo.org) covers a selected collection of scientific jour-
nals from Brazil, Chile, Cuba, and Spain. Access is free
of charge. BIREME (BVS Virtual Health Library) (http://
www.bireme.br) is a PAHO specialized center estab-
lished in Brazil. The Cooperative Service for Accessing
(SCAD) (http://scad.bus.br/html/en/home.html) from
BIREME provides document delivery between Latin
American and Caribbean medical libraries. The service
Portal of Journals on Health Sciences (http://portal.
revistas.bvs.br) may be used when locating printed jour-
nals (Serials on Health Sciences) across the BIREME
network. At the Brazilian National Cancer Institute
and 150 other research centers, institutional users have
access to the portal (http://www.periodicos.capes.gov.
br), sponsored by the Brazilian Ministry of Education.
Users logged in at institutional networks performing their
search on PubMed are further linked to full-text articles.
In the oncology field, the European Journal of Cancer,
Lancet Oncology, and the Journal of Clinical Oncology
stand among 116 relevant publications covered by the
CAPES portal. Titles are sorted in alphabetical order and
the impact factor is shown when applicable.
Medical Literature Retrieval
Final Comments
This work delivers both theoretical and practical knowl-
edge for searching and retrieving quality full-text articles
online. We believe that a successful search depends, on one
hand, upon understanding technical concepts and the rea-
soning behind the search itself and, on the other hand, upon
the skills needed to actively implement the search through a
specific interface.
Database structure and contents, subheadings use,
Boolean logic, and key word selection constitute users’
greatest difficulties for conceptually understanding online
searching [18]. Publications are available describing MED-
Downloaded from www.TheOncologist.com at Univ Pontificia/ Innatos on December 17, 2007
LINE structure, relevance, and coverage [1, 3, 5–10, 18];
detailing PubMed searching [1, 4, 11]; explaining Bool-
ean logic [1, 4, 7, 8, 11, 12]; explaining how to formulate a
well-built clinical question [1, 4, 5, 12, 13]; and describing
general searching strategies [1, 3–5, 7–12, 19] in contrast to
searching by data elements as, for example, MeSH terms [1,
3–8, 10], author [11], or publication type [4, 7, 8, 11]. Some
publications mention the PubMed Loansome Doc service
for ordering copies [1, 11]; others give advice on local insti-
tutions and libraries for finding medical publications [11]
or list resources on the Web where full-text articles may be
found [5, 12, 17, 19].
The scope and approach constitute the strongest aspects
of the present work. When it comes to scope, we were able to
collapse all the above-mentioned concepts and merge them
into a sequence of practical situations. We value the impor-
tance of exploring the PubMed interface in a wider perspec-
tive, for example, by searching for less commonly used
languages or for less common publication types. These two
examples, in particular, illustrate the potential of PubMed
and provide users with ideas for future searches. Knowing
that access to online resources for relevant medical publi-
cations may be expensive or difficult, we suggested alterna-
tive paths and reminded searchers of important initiatives in
their institutions, countries, or continents. The publications
of Coimbra [20] and Monteiro and colleagues [19] are par-
ticularly interesting for Brazilian oncologists, while indi-
viduals from African, Asian, and some European countries
may benefit from a recent article published in the New Eng-
land Journal of Medicine [17]. The “How to Search” section
is structured according to common Web search techniques.
Since general web search engines are popular, our approach
may help in the learning process. Hence, online exercises
based on questions and answers [3, 4] were explored and
detailed because this may help to familiarize the reader with
both simple and complex searching strategies
PubMed and HINARI, produced by the U.S. NLM and
the WHO, respectively, constitute examples of valuable
initiatives for improving information availability world-
OTncologist
he ®
Vincent, Vincent, Ferreira
wide. The incorporation of internet technology and related
resources into physicians’ practices around the world
depends not only on adequate infrastructure and local
resources, but also on specific training.
References
1 Stewart MG, Kuppersmith RB, Moore AS. Searching the medical litera-
ture on the Internet. Otolaryngol Clin North Am 2002;35:1163–1174.
2 Vincent B. Pesquisa bibliográfica na web. In: Vincent B, ed. Internet -
Guia para Profissionais de Saúde. Rio de Janeiro: Atheneu, 2003:97–128.
3 Greenhalgh T. How to read a paper. The Medline database. BMJ
1997;315:180–183.
4 Ebbert JO, Dupras DM, Erwin PJ. Searching the medical literature using
PubMed: a tutorial. Mayo Clin Proc 2003;78:87–91.
5 Hunt DL, Haynes RB, Browman GP. Searching the medical literature for
the best evidence to solve clinical questions. Ann Oncol 1998;9:377–383.
6 Coletti MH, Bleich HL. Medical subject headings used to search the bio-
medical literature. J Am Med Inform Assoc 2001;8:317–323.
7 Detmer WM. Medline on the web: ten questions to ask when evaluating a
web based service. Internet Working Group Newsletter 1997;3:11–13.
8 Pappas DE, Owen Hendley J. Otitis media. A scholarly review of the evi-
dence. Minerva Pediatr 2003;55:407–414.
9 Wilczynski NL, Haynes RB. Developing optimal search strategies for
detecting clinically sound prognostic studies in MEDLINE: an analytic
survey. BMC Med 2004;2:23.
10 Harrison J. Designing a search strategy to identify and retrieve articles
on evidence-based health care using MEDLINE. Health Libr Rev
1997;14:33–42.
www.TheOncologist.com
251
Disclosure of Potential Conflicts
of Interest
The authors indicate no potential conflicts of interest.
11 Rau JL. Searching the literature and selecting the right references. Respir
Care 2004;49:1242–1245.
12 Levy J. Searching for evidence. Cinahl News 2004;23:2–12.
13 Counsell C. Formulating questions and locating primary studies for inclu-
sion in systematic reviews. Ann Intern Med 1997;127:380–387.
Downloaded from www.TheOncologist.com at Univ Pontificia/ Innatos on December 17, 2007
14 PubMed Help. Table 6. PubMed Publication Types. Available at http://
www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=helppubmed.table.pubmed-
help.T41. Accessed July 2, 2005.
15 Garfield E. Journal impact factor: a brief review. CMAJ 1999;161:
979–980.
16 Sevinc A. Web of science: a unique method of cited reference searching.
J Natl Med Assoc 2004;96:980–983.
17 Aronson B. Improving online access to medical information for low-
income countries. N Engl J Med 2004;350:966–968.
18 Walker CJ, McKibbon KA, Haynes RB et al. Problems encountered by
clinical end users of MEDLINE and GRATEFUL MED. Bull Med Libr
Assoc 1991;79:67–69.
19 Monteiro R, Jatene FB, Bernardo WM et al. Ways of searching for scien-
tific information. Rev bras cir cardiovasc 2003;18:9–12.
20 Coimbra CE Jr. [Scientific production in public health and the interna-
tional bibliographic data bases]. Cad Saude Publica 1999;15:883–888.
Portuguese.
Making PubMed Searching Simple: Learning to Retrieve Medical Literature Through
Interactive Problem Solving
Beatriz Vincent, Maurice Vincent and Carlos Gil Ferreira
Oncologist 2006;11;243-251
DOI: 10.1634/theoncologist.11-3-243
This information is current as of December 17, 2007

Updated Information including high-resolution figures, can be found at:

& Services http://www.TheOncologist.com/cgi/content/full/11/3/243

Downloaded from www.TheOncologist.com at Univ Pontificia/ Innatos on December 17, 2007