By Cindy Schmidt, M.D., M.L.S. and Teresa Hartman, M.L.S.

September 2024

 

Instructions:

  • Use the Arrow icons below the instruction screen to go forwards and backwards in the tutorial.
A screenshot of the forward and reverse arrows that appear under each instruction screen.
  • If you want to skip between distant parts of the tutorial, you can click the "Menu/Contents" button (the stack of three horizontal lines indicated by red arrow in screenshot below) and then click on the needed section of the tutorial. You may have to click away from the contents to see the instructions again.
A screenshot of the tutorial instruction header.
  • If this instruction panel or the "Contents" menu flickers or jerks, try right-clicking on the light grey bar in the screen header and selecting the "refresh" or "reload" option from the menu that appears. One or more refreshes will usually fix the problem.
  • Clicking the "single-page view" link (yellow arrow in the screenshot above) will produce a transcript of the entire tutorial.

Objectives

  • Students will practice using advanced Google search techniques to quickly identify practice guidelines that are relevant to a patient's care. Specifically, students will use the guidance provided to search for both 
    • 1) guidelines relevant to a tutorial-provided case and 
    • 2) guidelines relevant to their GI Block assignment 
  • Students will save the search strategy that must be included in their GI Block assignment.

Clinical Case

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For the purpose of this tutorial, pretend that you are a gastroenterologist seeing a new patient. The patient, Anna Sedlacek, is a 65 year-old woman (b. 1/20/1959) with celiac disease. The condition was diagnosed in 2010. She carefully follows the recommended gluten-free diet and is currently asymptomatic. She is just seeing you to establish a relationship with an Omaha-based gastroenterologist after moving to Omaha from Maryland two months ago. She prefers to be called Anna rather than Ms. or Miss Sedlacek.

Your clinic posts a "Hepatitis C screening" alert in the medical records of all patients over 18 years of age. Anna's electronic medical record contains this alert.

You notice that the review of systems form filled out by new patients shows that Anna had scoliosis surgery in 1979 and a second, spine surgery in 2009. You assume that these surgeries involved receipt of blood transfusions.

You raise the subject of hepatitis C testing with Anna. You mention that your clinic generally tests all adults for hepatitis C at least once. You ask if she knows whether she has been tested in the past.

She says that her previous physicians never suggested testing for hepatitis C. She also says that she did receive 7 units of blood during each of her two spine surgeries.  However, since her last spine surgery she has donated multiple units of blood. She believes the blood bank would have tested for HCV.

 

Clinical Case

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Step out of your pretend role as Anna's gastroenterologist. As a medical student, you may be asking yourself the following questions:

Is the clinic's practice testing everyone over 18 years-of-age supported by the evidence?

Would the transfusions in 1979 and/or 2009 have increased Anna's risk for hepatitis C?

Should Anna be tested for hepatitis C despite her self-reported history of recent blood donation?

It's possible that all of these questions might be addressed by a hepatitis C screening practice guideline.

Practice guidelines contain the best-practice recommendations generated by groups of experts. Ideally the recommendations in a guideline are based on careful review of all available evidence supplemented by expert opinion, but some guidelines depend more on professional opinion. Always assess the quality of a guideline before using it as a basis for changing your practice.

Finding a Relevant Guideline

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Practice guidelines published as journal articles (and a few published in other forms) are represented by PubMed records. However, many of the most authoritative guidelines are only published on the websites of major professional organizations or government websites.

You can search for guidelines that have been posted on websites as well as those published in journals using Google (not Google Scholar).   A few advanced search techniques can make these searches more effective. 

The first step in almost any search is listing the important search concepts. 

List the concepts that should be included in a search for guidelines that might answer the questions raised by Anna's case?

Finding a Relevant Guideline

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Did you say that the following three concepts should be included?

  • hepatitis C
  • screening
  • guidelines

If so, great job!

Finding a Relevant Guideline

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Perhaps you also listed:

  • recent publication dates
Adding a publication date concept to a Google search is reasonable. Add the "recent dates" concept to your initial search.
  • English-language
Google search "Settings" can be adjusted to 'ask' Google to display English-language results only. Google "Settings" will be addressed at the end of this tutorial.
  • blood transfusion/donation

Adding a blood transfusion/donation concept might help focus the search on relevant guidelines.  Alternatively, it might focus the search on testing of donated blood by blood banks. Keep the "blood transfusion/donation" concept in mind, but don't include it in your initial search.

Alternate terms for your concepts?

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Can you think of some of the important alternate terms  or synonyms for the initial search concepts?

Here's the list of initial search concepts:

  • hepatitis C
  • screening
  • guidelines
  • recent publication dates

 

Alternate terms for your concepts?

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Did you think of any of the following:

hepatitis C: hepatitis C, HCV

screening: screening 

guidelines: guidelines, guideline, recommendations, position statement,  evidence-based 

recent dates: 2017, 2018, 2019, 2020, 2021

If you have access to a word processing program, copy the alternate term list above and paste it into a word processing document. 

Advanced Google Scholar Search Techniques

The following pages go through search operators and punctuation marks that are helpful in Google and Google Scholar searches.  Many of these will be familiar from PubMed searching, but there are some operators that are unique to Google.

As you go through the following pages,

  • use the operators and punctuation marks described to create a search strategy from the list of alternate terms in your Word processing document. 
  • If you don't have a Word processing program on your device, think about the ways you would apply the described punctuation marks and operators to the alternate terms list.

Use Quotes to Define Multi-Word Terms

"_______"

Enclose multi-word terms (e.g. any term that contains a space in quotes.  Example:

"hepatitis C"

The quotes ask the Google search engine to find only those items that contain the 'words' in the order shown and adjacent to each other.

Don't use search terms that combine a disease concept with a screening/treatment/diagnosis etc. in these guidelines searches.  In other words, do not use search terms like  "HCV screening" or "HCV treatment" in these guideline searches.  The treatment/management/screening/diagnosis/etc.  concept should be separate from the disease concept. 

Why?

You want to be able to find both

1) a guideline entitled "Guidelines regarding screening for HCV"

and a

2)  guideline entitled "Guidelines for HCV screening".

The search term "HCV screening" can only be counted on to find guideline #2.

Use OR to Join Alternate Terms

OR

 Join synonyms for a concept with OR

Results retrieved by OR'd  terms will be treated as a set. Retrieval of any one of the terms in the set meets the search requirements.  You can enclose the OR'd terms in parentheses, as you would in a PubMed search, but this is not essential in a Google search.

Use intitle: to Indicate That a Term Must be in the Title

intitle:

Add intitle: immediately in front of words you want to appear in the title of retrieved results.  Example:

intitle:guideline OR intitle:guidelines

Check to be sure there is no space between the colon and the search term that follows.

Which of the concepts in our tutorial case do you want to appear in the title?

 

Use site: to indicate website or type of site of interest.

site:

Add site: immediately in front of a partial web addresses to limit your search to webpages containing the partial address.   For example, if you only want to see results from U.S. government websites and non-profit organization websites add:

site:.gov OR site:.org

Check to be sure there is no space between the colon and the search term that follows.

Place the Most Important Terms at the Beginning of the Search

Put your most important concept at the beginning of your search.  Google treats the early terms as more important than terms listed later in your search.

Use Google Search Operators/Punctuation

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If you haven't already done so use the alternate terms for your search concepts (pasted below) and the Google search tips just discussed to create a Google search strategy.  It's often easier to create a search strategy in Word or another word processing program and then copy and paste the strategy into the Google search box.  However, you can type directly in the Google search box if you wish.

hepatitis C: hepatitis C, HCV

screening: screening

guidelines: guidelines, guideline, recommendations, position statement, algorithm, protocol, evidence-based____(blank = prevention, care, treatment management)

recent dates: 2017,2018,2019, 2020, 2021

Use Google Search Operators/Punctuation

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Did you produce a search strategy similar to the strategy below?

intitle:"hepatitis c" OR intitle:HCV screening intitle:guideline OR intitle:guidelines OR intitle:recommendations OR intitle:"position statement" OR intitle:evidence-based  2019 OR 2020 OR 2021 OR 2022 OR 2023 site:.gov OR site:.org

 Or does it look like the following strategy which includes the parentheses and ANDs that are important in PubMed but are not required by Google?

(intitle:"hepatitis c" OR intitle:HCV) AND screening AND (intitle:guideline OR intitle:guidelines OR intitle:recommendations OR intitle:"position statement" OR intitle:evidence-based) AND (2019 OR 2020 OR 2021 OR 2022 OR 2023) AND (site:.gov OR site:.org)

 Paste your search strategy in the Google Search box and hit the the "Enter" key on your keyboard or click the "Search" icon next to the Google search box.

 In the examples above, we've bold faced every-other search concept so that you can see where one concept ends and the next search concept starts.

Do the results appear relevant?

If there is an artificial intelligence summary or a group of advertisements, scroll down below these to find the actual search results.

If the actual search results don't appear relevant or are missing one of the important concepts, there are a few things you can try.

You can:

  • edit your search terms
  • add or remove intitle: operators
  • change the order of your search concepts
  • remove the date concept (sometimes date limits exclude the only published guidelines on the topic of interest)

You can also consider:

  • removing all results that contain an unwanted term

Thus last approach is usually only worth considering after you've tried a search and have seen a bunch of results that are focused on a totally irrelevant topic.

Use a Minus Sign in Front of a Term That Must Not be Present

- 

(the above is a hyphen, or minus/negative sign)

If your search is retrieving items about an irrelevant topic, you can add a hyphen (negative sign) immediately followed by a term for the irrelevant topic to your search.  For example, if your search for HCV screening guidelines retrieved a lot of guidelines that mentioned HCV but focused on HIV, you could include

-intitle:HIV

as a segment of your search. As shown below:

(intitle:"hepatitis c" OR intitle:HCV) AND screening AND (intitle:guideline OR intitle:guidelines OR intitle:recommendations OR intitle:"position statement" OR intitle:evidence-based) AND (2019 OR 2020 OR 2021 OR 2022 OR 2023) AND (site:.gov OR site:.org) -intitle:HIV

 

Save Your Search Strategy

Hopefully, you're pretty happy with the search you've constructed. If you were working on this search for an assignment or research project, you would copy the search strategy you've created and save it in a Word document or paste it into an e-mail and send it to yourself.  Having a record of your search strategy can save you time later, and is an essential part of your GI block inquiry coil assignment.  

Google Settings

If you're seeing foreign language results, and want to ask Google to limit to English language results. 

To ask Google to list only English language results:

  • Click "Tools"
  • Click "Advanced Search"
  • Click "Any language"
  • Select "English" from the drop-down menu.
  • Click the "Advanced Search" button below all the search option choices.

Critically Evaluate the Guidelines You Find

We would like you to:

1) Find link/s to the guideline "Recommendations for Testing, Managing, and Treating ..."
https://www.hcvguidelines.org/

 among your search results. A screenshot showing the desired search result.

 

2) Please, note the full title of the guideline and the name/s of the organizations responsible for the guideline at the top of the webpage.  Hopefully, our reason for having you look at this guideline is obvious.

In the future, when you look for guidelines:

  • Look for guidelines from reputable sources. 
    • Click on results that appear relevant
    • Find the names of the organization that are authoring or taking responsibility for the recommendations/guidelines.

If the responsible organization is a government agency, or an important national or international organization, there's a good chance that the guideline carries some authority. 

  • Scan guidelines from government organizations and national or international organizations quickly to see if they address your questions.

The guideline you pick should address some of your questions, but it's possible that no guideline will address all your questions.  When working on your assignment, don't spend too much time trying to find a guideline that addresses all questions.

3) Click here to download the "Critical Review Form for Practice Guidelines"  (https://unmc.libguides.com/ld.php?content_id=37346055). You will use this form to guide you as you critically evaluate the guideline "HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C" available at https://www.hcvguidelines.org/ .  You will use the form again, to guide your evaluation of the guideline you locate for your take-home assignment.   

The remaining pages in this tutorial provide:

  • tips for your GI Block Inquiry Coil assignment, 
  • a sample assignment, 
  • a reminder of the methods you can use to contact a librarian for help with this take- home assignment, or other, assignments, and 
  • a link to a form you can use to submit comments on this tutorial.

Your take-home assignment

Tips for your GI Block Inquiry Coil assignment:

  • You may want to use the preceding portions of this tutorial as a guide when you search for guidelines for your GI block assignment.
  • Remember, it's often best to focus on the major topic (e.g. hepatitis C , guidelines, and screening) and hope that the minor aspects of the topic (e.g. blood transfusion) will be covered in the guidelines retrieved by your search. You can always add terms for the minor topics later.
  • Please, remember that "screening" is not an important part of all your topics.   
  • Google search results will include guidelines and articles that discuss or critique guidelines.  Be sure that the item you select for evaluation is a guideline and not an article discussing a guideline. 

Here is a link to a sample assignment .  This sample assignment is focused on an older guideline for HCV screening. Your assignment will not be focused on HCV screening, but it may help you to see how someone else addresses the various requirements for this writing assignment.. 

Librarians will be happy to provide help if you find yourself struggling to find relevant guidelines or determine whether an item you have selected is a guideline.  If you want help creating a search strategy, you will need to send us or show us the search strategy you've tried.

To contact a librarian:

e-mail:  askus@unmc.edu

phone:  leave a message at 402-559-6221 and we'll return your call

Schedule an appointment with a librarian to meet via Zoom:  Use the appointment scheduling page or contact a liaison directly using their contacts on this webpage at https://www.unmc.edu/library/contact/liaisons/index.html.  

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