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Guide on Searching Healthcare databases using Dialog ilit home page vaccine jab


Guide on Searching Healthcare databases using Dialog ilit home page vaccine jab

More Info
									Searching Healthcare
databases using Dialog

April 2007

Claire Jones
Information Skills Trainer
Farnborough Education Centre
Princess Royal University Hospital
Tel: 01689 864105 or 864306


1.    Aims of the training                                  3
      Learning objectives                                   3
2.    Background information                                3
      What are healthcare databases?                        3
      What are the different databases?                     3
      Which database should you use for what?               4
      What is Dialog?                                       4
      What is KA24?                                         4
      The Cochrane Library                                  4
3.    Planning your search                                  5
4.    Accessing the databases                               6
5.    Searching for your first term                         7
6.    Searching for your next term                          9
7.    Combining your searches                               10
8.    Displaying, saving and printing your search results   13
9.    Deleting your search                                  15
10.   More comprehensive searching                          16
      Medline Record                                        17
      Explode or Major                                      19
11.   Limiting your search                                  22
12.   Changing databases and logging off                    27
      Appendix                                              28
      Exercises                                             29

1.     Aims of the training

To give you an understanding of the most common healthcare databases, what they
contain and when to use them.
To help you search the databases and find relevant information.

Learning objectives

By the end of the session, participants will have learnt:
     how to select the most appropriate database for their needs
     how to devise and execute a simple search strategy using both subject headings
       and keyword searches
     how to broaden or refine searches by combining or limiting results
     how to display, select, save and print results.

2.     Background information

What are healthcare databases?
These are collections of abstracts and references for journal articles. You can search the
databases to find journal articles that have been published on specific subjects.

What are the different databases available?
The Allied and Complementary Medicine Database (AMED) covers a selection of journals
in complementary medicine, palliative care, and several professions allied to medicine.

The British Nursing Index (BNI) contains articles from English language nursing journals
published primarily in the UK. It covers over 220 nursing and allied health journals from
1994 to the present.

The Cumulative Index of Nursing & Allied Health (CINAHL) database provides coverage of
the literature related to nursing and allied health from 1982 - present. In total, more than
1200 journals are regularly indexed and there are more than 600,000 records.

EMBASE, the Excerpta Medica database, is a major biomedical and pharmaceutical
database. It is strong on drug research, pharmacology and pharmaceutics. Approximately
375,000 records are added yearly and over 3,500 international journals are indexed.

Healthcare Management Information Consortium. This is useful for information on
healthcare management and administration. It also covers medical toxicology and
environmental health.

King’s Fund
This database contains over 75,000 bibliographic records of official UK health policy
documents and informally published - 'grey' - literature from health and social care
organisations. It covers policy and management of health and social care services in the

MEDLINE is the main source of information on biomedical literature and is very strong on
clinical medicine. PREMEDLINE covers recent articles that have not yet been processed
into the MEDLINE database. The database currently contains more than 3,900 journal
titles and over 12 million records. The whole database covers 1951 – present.

The PsycInfo database is produced by the American Psychological Association, and
contains references in the field of psychology and the psychological aspects of related
fields, such as medicine, psychiatry, nursing, sociology and education. Journal coverage,
spanning 1887 to present, includes material from more than 1,500 journals.

Which database should you use for what?
Whatever the subject of your search, you should consider using Medline in addition to any
other database, as it is so comprehensive and covers most health topics. If you are
searching for information on an area of clinical medicine then Medline is your main source.
EMBASE can also be useful, especially for drug research.
CINAHL is useful for nursing and allied health staff, as it is the largest database on these
subject areas. The British Nursing Index is a useful source for nurses, especially if the
results in CINAHL have too much of a North American focus. AMED is a useful alternative
for allied health topics.

What is Dialog?
Dialog is the name of the publisher that produces a software package to enable users to
access different databases online, through a single search interface. Dialog provides
access to the databases listed above for NHS staff and links to more than 1000 full-text
journals via these databases. (For a complete list of full text journals, please visit This enables you to search across databases, and use a common
search screen and commands for different databases, rather than remembering different
passwords, instructions, layouts etc.

What is KA24?
Knowledge Access to health care information, 24 hours a day, 7 days a week. KA24
gives anyone working for or with the NHS in London and the South-East access to full text
journals and major biomedical databases from any Internet or NHSnet terminal, whether at
home, clinic, workplace, library or Internet cafe. To access the resources provided by
KA24, an Athens username and password is required. This can be acquired by
completing a registration form online at .

The Cochrane Library.
The Cochrane Library is an important database of systematic reviews that is also available
to everyone (not via Dialog). The use of this database is not described here. You should
consider using this database for information on the effectiveness of particular treatments or
interventions. It is not useful for general information on healthcare topics. It is available via or via

3.     Planning your search.

Before starting a search it is important to decide exactly what information you are
searching for, and try to select some „keywords‟ or concepts that describe this as
specifically as possible.


 You are interested in finding recent research on heart attack and aspirin.

 You break your topic down into keywords or concepts and you decide to search for:
     Heart attack
     Aspirin

 You also need to decide upon a database. You decide to search on Medline.

You will first need to search for each of your concepts separately, finding as much
information as possible on each topic, before you combine the concepts together to find
out where the overlap is. (See page 10 for further information on combining).

4. Accessing the databases.

Go to the Health Information for London Online site:

                                                                          Click on databases

                                                                          Now click on Search

Enter your Athens username and password in the appropriate boxes. Click on Login.

You will then be presented with a screen offering you a choice of databases.
This handout uses examples from Medline 1996 to date, but the other databases from
Dialog can be searched in the same way.

 To access a
 database, click on
 the Advanced
 Search button

                                                                For more information
                                                                about a database, click
                                                                on the i in the blue circle
                                                                to the right of it

Always use Advanced Search, not Easy Search as it is not possible to create a search
strategy using Easy Search. Also Advanced Search provides you with the facility of
searching using the thesaurus enabling searching using Medical Subject Headings
(MeSH) or descriptors (see page 15).
It is possible to search more than one database at a time but this is not recommended as it
restricts your searching if you want to do a thesaurus/subject heading search.

5. Searching for your first term.

Enter the Medline database (1996 to date) by clicking on the blue Advanced Search button
to the left. We will look for articles on heart attack and aspirin.
Type your first search term – heart attack – into the search box as shown on the next

    Type your
    search term –
    heart attack –
    into the search

                                                         Then click on

                      After entering the first
                      term, more buttons
Set number

                                                 1075 references have
                                                 been found that have
                                                 these words in the

 6. Searching for your next term.

 As soon as you have entered your first term the search history appears with set numbers
 and extra blue buttons appear above the search history box.
 At present we have found everything that mentions heart attack, but the articles will not
 necessarily be to do with aspirin. We need to do another search to narrow down to articles
 on this topic.
 Repeat the steps you followed to search for heart attack, but this time look for aspirin.

Set number

                                                                                 Then click
                                                                                 on Search

      Enter the
      search term
      in the box

                                                                  There are 12276
                                                                  containing the
                                                                  search term aspirin.

If you wanted to, you could now search for as many other concepts as you wish. We will
stop at two for this example.

7. Combining your searches.
In the example above, we have carried out a search for heart attack and then a search for
aspirin. At the moment, these two searches are not related. There are two different ways to
combine searches using Boolean logic - OR or AND, and they will each give you different

            OR – Used to combine                  AND – Used to find the
            similar subjects into one             overlap between two
            big group.                            different subjects.
            Heart attack OR                       Heart attack AND aspirin
            myocardial infarction

                                        - 10 -
Using OR will broaden your search. For example, searching for heart attack OR
myocardial infarction will give you results with references containing either of these terms.
Using AND will give you results containing references for both of your search terms eg
heart attack AND aspirin. This makes your search more specific.
You can also use NOT. Using NOT will find soap NOT detergent or HIV NOT AIDS.

We have found many articles on all aspects of heart attack and many articles on all
aspects of aspirin. We need to combine the two searches to find the articles that are about
both of these subjects. In this case we want to combine our topics using AND (heart attack
AND aspirin) in order to find articles that cover BOTH subjects. To do this, type the set
numbers you want to combine linked with AND. The word AND can be in upper or lower

                                                  Type 1 and 2 in the box to
                                                  combine these two
                                                  searches. Then Click

                                         - 11 -
                                                            There are 62 results.
                                                            Click on Show Titles to
                                                            view them.

The main search page now shows 62 articles that are about both heart attack AND aspirin
(search result correct for October 2004).

                                      - 12 -
8. Displaying, saving and printing your search results.

Clicking on „show titles‟ in the right hand column of your search results will display a list of
the article references produced by the search in short format on the Titles page. This
displays 20 references per page. Click on next titles to view the next 20.
You can access articles that are available fulltext by clicking on the “Fulltext available at
…” link above the reference.

Titles page - displays references in short format (below).

                                                                               To view the full
                                                                               text, click on the
                                                                               fulltext link

                                                                             To view the full
                                                                             reference, click
                                                                             on the blue link.

References can be displayed in three different formats, short, medium and full.
      Short format (above) displays just the article title, authors and source (journal title,
       volume, issue, page numbers). This is the format displayed on the Titles page.
      Medium format (this is the most useful format to view references) displays the
       reference details and an abstract if there is one - see method 2 for viewing
       references on page 14 .
      Full format displays all the fields including the reference details, the abstract,
       author‟s address and a list of descriptors or MeSH terms (see page 17 onwards).
       You can access this by clicking on the blue “Link to abstract/database record”
       above the references on the Titles page.

                                          - 13 -
There are two different methods of viewing and selecting references to print or save
depending on whether you want to view your references in 1) short format (title only) or 2)
medium format (most useful) where you are able to see an abstract if there is one:

           1. This method is useful if you want to view your search results by title only.
              On the titles page (short format), tick the boxes next to the references that
              you want to save. If there are more that 20 references, click on next titles
              when you reach the bottom of the page. When you have selected all the
              references that you want to save, scroll to the bottom of the page to the
              display and save manager box. You can select the format you wish to
              display your saved results but is best to leave it at the default setting and
              your results will be displayed in medium format with an abstract. Click on
              display in the Action box. Your selected references will then be displayed
              ready to save or print (see page 15).
           2. Use this method to view your references with an abstract. At the top of the
              list of titles, tick Select All. Then click on next titles to go to the next 20
              references. Repeat this until all the references in you search have been
              selected. Scroll to the bottom of the page and click on display in the
              Action box. Your references will now all be displayed by title first and then
              lower down the page in medium format with an abstract if there is one.
              Remove the tick from the Select All box and then view the references,
              ticking the ones you wish to keep. Your selected references will then be
              ready to save or print (see page 15).
Display & Save Manager box (this is at the bottom of every titles page)

   View ticked results            Leave at Medium                   Click Display to view
   from this page only            format to display the             your selected
   or from all your               basic reference and               references.
   results pages.                 abstract.

It is also possible to email your selected results from the titles page by clicking on the blue
email button.

                                          - 14 -
Printing & Saving

Beware - Clicking on the Print screen button will just print your all the references on the
If you wish to save or print your selected references and your search strategy as well, click
on the drop down arrow and select “include all search steps” or “include relevant search
steps only” and then click on save (locally as: PDF document) button. Either Open the
document to print it or save it to disc.

     To print all the
     references, click                                      To print the search strategy and
     on the blue print                                      your references, click on the drop
     screen button.                                         down arrow and select include all
                                                            search steps or include relevant
                                                            search steps only and then click
                                                            on save.

9. Deleting your search.

To return to the main search page, click on the blue Search Page button at the top of the
screen. Once you have finished looking at the results of a search, you may find it easier to
delete the search before you start on a new one. Click on Delete all search steps under
your search history box. You will be asked if you really want to delete your search. Click on
Delete individual search steps to delete individual lines from your search, but not the whole
search. Tick the boxes for the lines you want to delete and click on Delete button.

Now try Exercise 1 on page 29.

                                         - 15 -
10. More comprehensive searching.

There are ways to make your searching more comprehensive or more precise.
When we typed in a search term for the search above, we only looked for the exact
phrases that we typed in the search box. If someone had written about myocardial
infarction, rather than about heart attack, we will not have found their article. If someone
had written about aspirin, but this phrase did not appear in the reference of their article, we
would not have found that article either. So we have not done a very thorough search so

In order to do a really comprehensive search for our topic, we should search for articles
using medical subject headings (MeSH), or descriptors, that have been assigned to the
articles. Each article is read by indexers and they will assign subject headings to describe
the main subjects of the article as thoroughly as possible. These descriptors are selected
from a Thesaurus and several are assigned to each article. Searching for a subject
heading will pick up all articles on that subject without having to search for every possible
word or phrase that an author may have used to describe that subject. For example, the
subject heading for heart attack is myocardial infarction and a search for that subject
heading will bring up articles that mention either heart attack or myocardial infarction or MI.

The example of a Medline record on the following page illustrates the difference between a
keyword search (as we did above) and a subject heading search. A keyword search will
search the complete reference for the record. A subject heading search will search the
Descriptors section of the record. When searching for a topic, you want to be as thorough
as possible and collect all potentially relevant references. You can selectively reduce your
results later, we will look at how to Limit searches on page 22.

                                          - 16 -

Title Effect of fixed low-dose warfarin added to aspirin in the long term after acute
myocardial infarction; the LoWASA Study.
Source European heart journal {Eur-Heart-J} 2004 Feb, VOL: 25 (3), P: 232-9, ISSN:
Author(s) Herlitz-Johan, Holm-Johan, Peterson-Magnus
Author affiliation Division of Cardiology, Sahlgrenska University Hospital, Göteborg,

      AIM: To evaluate whether long-term treatment with a fixed low dose of warfarin in
      combination with aspirin improves the prognosis compared with aspirin treatment
      alone after an acute myocardial infarction (AMI). METHODS: Patients who were
      hospitalized for AMI were randomized to either 1.25mg of warfarin plus 75mg of
      aspirin (n=1659) daily or 75mg of aspirin alone (n=1641). The study was performed
      according to the PROBE (Prospective Open Treatment and Blinded End Point
      Evaluation) design and was conducted at 31 hospitals in Sweden. The median
      follow-up time was 5.0 years. In the aspirin+warfarin group, 30.2% were
      permanently withdrawn as opposed to 14.0% in the aspirin group (P<0.0001).
      Analyses were performed on an intention-to-treat basis. RESULTS: The
      combination of cardiovascular death, reinfarction or stroke was registered in 28.1%
      in the aspirin+warfarin group versus 28.8% in the aspirin group (NS).
      Cardiovascular deaths occurred in 14.2% in the aspirin+warfarin group vs 15.7% in
      the aspirin group (NS) . Whereas no difference was found with regard to total
      mortality or reinfarction, those randomized to aspirin+warfarin had a reduced
      occurrence of stroke (4.7% vs 7.1%; P=0.004). The percentage of patients who
      suffered a serious bleed was 1.0% in the aspirin group vs 2.2% in the combination
      group (P=0.0006). CONCLUSION: A fixed low dose of warfarin added to aspirin in
      the long term after AMI did not reduce the combined risk of cardiovascular death,
      reinfarction or stroke. The results did, however, indicate that a fixed low dose of
      warfarin added to aspirin reduced the risk of stroke, but this was a secondary end
      point. The combination of aspirin and warfarin was associated with an increased
      risk of bleeding.
MeSH headings

       ANTICOAGULANTS / *AD (administration & dosage) AE (adverse effects)
       ASPIRIN / *AD (administration & dosage) AE (adverse effects)
       MYOCARDIAL-INFARCTION / *DT (drug therapy)
       PLATELET-AGGREGATION-INHIBITORS / *AD (administration & dosage)
       AE(adverse effects)
       WARFARIN / *AD (administration & dosage) AE (adverse effects)
       HEMORRHAGE / CI (chemically induced)

                                       - 17 -
                                   Tick the
 Enter your first                  Thesaurus
 term: heart                       mapping box.

                                                  Finally, click on

Clicking on the yellow
symbol displays a scope
note defining the term.

                                        Do not select more
                                        than ONE subject
                                        heading at a time.

                                   The correct subject heading is
                                   myocardial infarction. Tick the
                                   box on the left of this and tick
                                   Explode on the right. Then click
                                   the Search button.

                          - 18 -
Explode or Major.

Ticking the Explode box means that you will find all the articles indexed under
your subject heading and also under any more specific terms to do with your
chosen heading. Ticking the Major box will limit your search results just to articles
in which your subject heading is considered to be the main point of the article. When
combining two or more terms, it is usually best to tick the Explode box, to make sure that
you find all relevant articles for your subject.

   Enter the next              Tick the Thesaurus                  Then click on
   search term:                mapping box.                        Search

                                        - 19 -
         Select aspirin and tick the
         Explode box. Then click
         on the Search button

- 20 -
We now need to combine our two topics together. In order to do this we need to combine
them with AND. (See page 10 for more information on combining). The first search we
carried out was for heart attack and we found 1075 papers on this. But, by searching for
heart attack indexed under the subject heading myocardial infarction we found 30516

                                                                   Combine myocardial
                                                                   infarction and aspirin
                                                                   Mesh results with

We have ended up with 966 references (see next page) to articles that are about both
heart attack and stroke: this is rather too many to search through. (Compare this to the 62
we found by just searching the words in the references and not using subject headings,
(see page 12).) Once you have entered your main subjects, and combined them, you can
reduce your final results further and make them more specific by using Limits.

                                        - 21 -
11. Limiting your search.
Once you have combined your subjects and obtained your search results, you may still
find that you have too many references. You can use the Limit facilities to focus your
search further and reduce your results. It is better to keep your search as inclusive as
possible whilst you are carrying it out, so as not to exclude potentially relevant references
at an early stage. Once you have your search results you can use Limits to exclude
articles that are not useful to you.
For example, you can limit to a particular language, publication date, population/patient
age group, or publication type (e.g. randomized controlled trials). You can choose as many
limits as you wish in order to limit your search results. There are three different Limit
1.     The limit button: This is really only useful for limiting to publication year.
2.     Quick limit tick boxes: These limits are the tick boxes under the “enter your search
       term” box. Enter the number of the set you want to limit in the “enter your search term
       box” and tick as many of the boxes as you like. Click on Search. See the picture

     Enter the search step
     number that you want
     to limit in the search

                                        Tick as many of the boxes as you
                                        want. In this example we will look
                                        for documents in English, relating
                                        to humans and relating to adults.
                                        Then click on Search.

Please Note: “The information added since “ box is not particularly useful as this will only
give you articles added to the databases since a certain year which will not necessarily be
the publication year of the article.

                                           - 22 -
We end up with 443 results, which is still far too many. To focus our search results even
more we can use the look up lists at the bottom of the main search page.

3.   Look up lists or further limits: These lists are at the bottom of the screen and can
     be accessed by clicking on the blue arrow next to the list that you wish to open eg
     publication year.

                                                      These more detailed menus will
                                                      allow you to focus your search
                                                      even more. We will look at
                                                      publication year. Click on the
                                                      arrow next to publication year.

 When you click on the blue arrow next to publication year, a list will appear and you can
select the publication years you require by holding down the control key and clicking on the
years that you require (see over).

                                        - 23 -
                                                    You can select more than one
                                                    publication year by holding down the
                                                    Control key on your keyboard and
                                                    clicking on the years that you want.
                                                    We will look at articles published for
                                                    2000-2004. Then click on Search.

Note: This searches the whole of Medline for ALL articles published in the selected years
and you will need to combine this with your search.

                                                   You have searched the whole of
                                                   Medline for all articles published
                                                   between 2000 and 2004

                                       - 24 -
Finally, we will limit our search to randomized controlled trials in order to obtain the best
quality evidence. This will also search for ALL the RCTs on Medline.

                                                   Choose Publication Types.

                                                           Choose RCTs from the list
                                                           of publication types.

                                          - 25 -
Now combine all your search results with AND

                                               Combine the three
                                               searches using

                                               There are now
                                               only 80 search
                                               results to view.

                                     - 26 -
12. Repeating a search in another Database
A search can be repeated in another database. Click on Repeat. Choose the search that
you wish to run and select the Database that you wish to run it in. Click on Repeat.
Beware when doing this as it will not always produce results if the Subject headings or
limits that you have used are different in the new database that you have selected.

13. Changing databases
Once your have done a search in a particular database, you can switch to another
database by clicking on the blue Databases button at the top of any search or results
page. Clicking on this button brings you back to the Select Databases page, and you can
select a new database.

14. Logging off
Once you have finished all your searches, log off. To log out of the databases, go
to the main search page and click on the word Logoff in the black bar at the top
of every screen. Make sure you always log off at the end of a session, or you
may be preventing someone else from getting into the databases (only a certain
number of people can use them at any one time).

Now try Exercises 2 on page 29.

                                        - 27 -

A few useful tips for searching:
      UK and US spelling differences are taken into account
       eg behaviour will also find behaviour.
      Plurals are found automatically eg nurse will find nurse or nurses.
      Dialog is not case sensitive, so using upper or lower case makes no difference.
      To truncate a word, use a $ sign ie: ethic$ will find ethic, ethics, ethical.
      When searching for a journal, type the journal name ie: New England Journal of
       Medicine, and select Source or journal from the drop down menu to the right.
      For an author search, type the author‟s surname and initials with hyphens ie:
       Borg-A-S or Borg-A$, select Author from the drop down menus to the right. Using
       just the initial will find an author even if they use their full first name.
      Using ? will enables you to search by a root command. Searching for lund-v? will
       open up a list of all authors with the name lund, v and any other initial. The root
       command can also be used to search for journals ie asthma? will search for all
       journals with the word asthma in.
      When searching for a term with number in it, insert single quotation marks
       around the number ie: type ‘1’ diabetes.
      If a term eg: growth does not map to a subject heading, in the look up lists at the
       bottom of the screen, click on MeSH – enter a term. Enter the term growth in the
       box and click on OK. If the term is a subject heading (descriptor), it will appear in
       the list.
      Do not use punctuation in your search term
       eg self harm not self-harm
       St Johns wort not St John’s wort
      Typing a word or words in the search term box and selecting Title from the drop
       down menu in the right-hand box will find references for the word(s) in the title.
      Ranking - this analyses statistical trends found in your search results by counting
       occurrences of unique terms within a specific field such as the author, journal or
       descriptor fields. Clicking on Rank next to your search results and selecting
       Author will show how many publications each author has in that particular search.
      You can save your search strategy and run it at a later date by clicking on Save
      You can also Create Alerts so that you will receive new article references by email
       weekly, biweekly or monthly.

                                          - 28 -
Exercise 1.

Try to find articles in Medline 1996 to date on each of the following subjects.
Don’t worry for the moment if you have too many results, just practice following the search
steps and viewing the articles.

A. Heart attack and aspirin.
B. Acupuncture and smoking cessation.
C. Whiplash and physiotherapy.
D. Asthma and pollution.
E. Occupational therapy and stroke.
F. Aphasia and speech and language therapy.
G. Health visiting and accident prevention.

Exercise 2.

Select one (or more) of the following scenarios.

H. Your patient is suffering from depression and would like information on whether
taking St John’s Wort might be helpful for her.

What are the main keywords that you would search for?
What database(s) would you use?
Now try carrying out the search.

I. You would like to find recent research on the MMR vaccination and autism.

What are the main keywords that you would search for?
What database(s) would you use?
Now try carrying out the search.

J. Are there any advantages to health care workers being given the flu jab?

What are the main keywords that you would search for?
What database(s) would you use?
Now try carrying out the search

K. You would like to find information on the effectiveness of falls prevention and
rehabilitation strategies in the elderly.

What are the main keywords that you would search for?
What database(s) would you use?
Now try carrying out the search.

L. You are treating two children who suffer from glue ear. Will antibiotics help
alleviate their symptoms?

What are the main keywords that you would search for?
What database (s) would you use?
Now try carrying out the search.

                                        - 29 -
Exercise 2.

H.     Keywords:    Depression
                    St John‟s Wort

       Databases: Medline

Suggested results for Medline (correct for July 2004):

                                        - 30 -
I.     Keywords:    MMR vaccine

       Databases: Medline

Suggested results for Medline (correct for July 2004):

                                        - 31 -
J.      Keywords: Health staff
                  Flu vaccine

       Databases: Medline

Suggested results for Medline (correct for July 2004):

                                        - 32 -
K.     Keywords:    Fall prevention

       Databases: CINAHL

Suggested results for CINAHL (correct for July 2004):

Note: rather than limiting to review articles, you might want to add another
search category in order to make the search more specific (physiotherapy, health
promotion, nursing etc.).

                                       - 33 -
L.     Keywords:    Glue ear
                    Otitis media

       Databases: Medline

Suggested results for Medline (correct for July 2004):

                                        - 34 -

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