By Cindy Schmidt, M.D., M.L.S.
published 06/01/2015
updated 07/26/2018
Complete episode 1, episode 2, and episode 3 before beginning this episode.
Warning:
If you are using Internet Explorer, please STOP now! Open another internet browser (we recommend Firefox) and go to --
http://list.unmc.edu/gots/tutorial/com-sb-4
-- and continue working on the tutorial in the new browser.
During this afternoon's PBL session and during your work on this tutorial miniseries, you've collected a list of diagnoses that often present with epigastric pain (a differential diagnosis list).
However, it's possible that you haven't yet considered the implications, if any, of John's past medical and social histories (PMH and SH). Specifically:
Learning issue #8. Does surgery for pyloric stenosis during infancy have any longterm implications in adulthood?
Learning issue #9. Do medical students experience increased rates of gastrointestinal problems?
Both of these learning issues include multiple search concepts. Not all search engines can handle more than one concept.
1) AccessMedicine's Advanced Search (lower search box on "Advanced Search" page)
2) UpToDate
3) PubMed and other literature databases that index the journal literature.
4) Google or Google Scholar
You used the AccessMedicine ebook collection during episode 1, and UpToDate for learning issues 8 and 9. So, for these learning issues, start with a PubMed search for relevant journal articles.
These two learning issues are the types of very specific issues that are best addressed by the journal literature in any case.
Each student is expected to bring at least one journal article to one of the three sessions for each of your PBL cases.
It's worth taking some time to practice PubMed search techniques and methods for obtaining full-text articles now.
PubMed is the U.S. government's means for providing access to:
A reminder: During episode 3, you used MedlinePlus. Remember, MEDLINE contains records for professional-level, journal articles. It is part of PubMed. MedlinePlus contains links to authoritative, lay-level information on the internet. It is not part of PubMed.
To reach the version of PubMed that contains UNMC's full-text buttons:
In the future, you can reach the library's homepage by going to any unmc.edu page and clicking the "Library" link at the bottom of the "Quick Links" in the lower right-hand corner of the page.)
Open a Word document. In the document type terms for the important concepts in the two searches:
Search 1. Does surgery for pyloric stenosis during infancy have any longterm implications in adulthood?
Search 2. Do medical students experience increased rates of gastrointestinal problems?
Did you say that the important concepts were:
____________
search 1:
Surgery
pyloric stenosis
infancy
longterm
adult
_____________
search 2:
medical students
gastrointestinal, dyspepsia
______________
If so, great job!
It's possible that you included the phrase --
gastrointestinal problems
-- rather than the word -- gastrointestinal. This is totally reasonable. You'll understand the reason for avoiding the phrase -- gastrointestinal problems -- after completing the next step in search construction.
Today, you'll conduct a keyword search. A keyword search is a search in which you try to guess which words an author would have used in an article's title or abstract to indicate a discussion of your search concepts. Later this year, you'll be asked to conduct the other type of PubMed search ( a medical subject heading search).
The next step in a keyword search is listing important synonyms or alternate terms for your search concepts.
List important synonyms and alternate terms next to the concept terms in your Word document.
Did you list any of the alternate terms shown below?
Search 1
Surgery, surgeries, surgical, operative, operation, operations, post-operative, postoperative
infancy, infantile, infant, infants, newborn, newborns, neonate, neonates, neonatal, baby, babies
longterm, long-term, long term
adult, adulthood, adults
Search 2
medical students, medical student
gastrointestinal, gastric, intestinal, stomach, bowel, bowels, dyspepsia, pyloric, pylorus, duodenum, duodenal, ulcer, ulcers, gastritis, reflux, gerd, gastroesophageal, esophageal, Crohn's, ibs
If so, good job!
Add any terms you missed to your word document.
There are actually many more relevant terms, especially for the "gastrointestinal" concept.
Imagine how much worse the "gastrointestinal" term list would be if you had to include all the synonyms for "gastrointestinal problems", in both singular and plural form. Plural versions alone include:
gastrointestinal problems, gastrointestinal conditions, gastrointestinal diseases, gastric problems, intestinal problems, gut problems, bowel problems, etc., etc.
It's easier to just deal with the synonyms for the word "gastrointestinal." If the search with the word gastrointestinal and its synonyms retrieve too many irrelevant results, the search can be revised.
For example, the search term --
infan*
-- will retrieve PubMed records containing any of the following terms --
Warnings:
Multi-word phrases should not be truncated in PubMed.
Avoid using one syllable word trunks. For example, it would be unwise to use --
bab*
-- as a substitute for baby and babies. Bab* will retrieve records containing
--but will also retrieve many irrelevant words, e.g. --
Do your term lists look something like the following?
Surger*, surgical*, operat*, post-operative, postoperative
infan*, newborn*, neonat*, baby, babies
adult*
gastrointestinal, gastric, intestinal, stomach, bowel*, dyspepsia, pyloric, pylorus, duoden*, ulcer*, gastritis,reflux, gerd, gastroesophageal, esophageal, Crohn*, ibs
"medical students"
The quotes tells the PubMed search engine that you only want to retrieve records in which the enclosed words are adjacent and in the order shown.
Surger* OR surgical* OR operat* OR post-operative OR postoperative
The OR's tell the search engine that you don't care which of the terms is present.
Does your work look something like the following?
"pyloric stenosis"
infan* OR newborn* OR neonat* OR baby OR babies
longterm OR long-term OR "long term"
"medical students" OR "medical student"
gastrointestinal OR gastric OR intestinal OR stomach OR bowel* OR dyspepsia OR pyloric OR pylorus OR duoden* OR ulcer* OR gastritis OR reflux OR gerd OR gastroesophageal OR esophageal OR Crohn* OR ibs
If so, great job! Fix any quotes or OR's you missed.
The next step in a search depends on whether you use the single PubMed search box on the PubMed homepage or use the multi-box search builder on the "Advanced" search page.
Perform the following steps on the first search only (the "longterm effects of pyloric stenosis surgery" search)
Does your work on the first search now look like the following:
(Surger* OR surgical* OR operat* OR post-operative OR postoperative) AND "pyloric stenosis" AND (infan* OR newborn* OR neonat* OR baby OR babies) AND (longterm OR long-term OR "long term") AND adult*
The "Order item through Interlibrary Loan" button is immediately under this message. Before you order an interlibrary loan,
You will continue searching PubMed in the next tutorial episode so the PubMed questions are at the end of that episode. Here's a single question on some of the other content of this tutorial and tutorial 3.
Which of the following (a,b, or both a and b(c) ) is true concerning UpToDate?
Tutorial episode 5 will guide you as you use the "Advanced" search feature in PubMed to complete the search for articles about gastrointestinal problems in medical students.