Presentation of the Sunrise Seminar at Medical Library Association #mlanet15 in Austin Texas. In one and a half hour I gave a demonstration of my search methods, creating live a systematic search on a research question from the audience. The demonstration parts have been replaced with similar slides that show the building of the search stategy.

1. A unique method for fast, high-
quality systematic searching
Wichor M. Bramer
Erasmus MC
Rotterdam the Netherlands
MLA - Austin TX –May 18th 2015
handouts: bit.ly/mlabramer1

2. Research Question
Is exercise therapy an effective
treatment for hip osteoarthritis
Simple search strategy:
exercise therapy effectiveness hip osteoarthritis
PubMed 69 hits

3. Embase.com 1916
('hip osteoarthritis'/exp OR ((arthritis/de OR
osteoarthritis/de) AND (hip/de OR 'hip pain'/exp)) OR
(coxarth* OR ((hip OR cox) NEAR/6 (arthrit* OR arthrosis*
OR arthroses* OR osteoarth* OR oa)) OR 'malum coxae
senilis'):ab,ti) AND ('kinesiotherapy'/exp OR exercise/exp
OR physiotherapy/exp OR 'conservative treatment'/de OR
(kinesiotherap* OR kinesitherap* OR exercis* OR
physiotherap* OR gymnastic* OR ((movement* OR
motion OR manual OR phys* OR conservative* OR
nonoperat* OR nonsurg* OR non-operative OR non-
surgical OR paramedic* OR para-medical) NEAR/3
(technique* OR therap* OR treat* OR isokinet* OR
isomet* OR water OR management* )) OR ((muscle* OR
muscul*) NEAR/3 (train*))):ab,ti)

5. Research question  exhaustive search
Systematic searching
1. Examining the research question
2. Identifying key terms
a. Thesaurus terms
b. Free text terms
3. Creating a basic search strategy
4. Optimizing the basic strategy
5. Translating the strategy between databases

6. The Research Question
Clear and focused

7. 7
Clear and focused research question
How can gist knowledge of patients be measured
Is scopic stabilisation better than Bristow Latarjet for treating
an Anterior glenohumeral luxation with labrum injury (no
ossale disorder) in a 20 YO rugby player for recurrent luxation
or other Patient Related Outcome Measures
Dietary intake and cardiovascular disease
TOO VAGUE
TOO SPECIFIC
TOO BROAD

8. The Research Question
Clear and focused
Which articles can answer the question?

9. Which articles can answer the question?
Facilitators and barriers in preconception care
 evaluation studies of preconception care
Predictive factors for oronasal fistulas in children
treated for clef lip
 follow up studies of children treated for clef
lip

10. The Research Question
Clear and focused
Which articles can answer the question?
Elements (Key Concepts):
- Watch our for Bias and Duplicates
- Which elements to use in search?

11. Elements : Bias
Very specific characteristics
Duration of breastfeeding and intelligence
Judgements
Poor family functioning, harsh parenting and
bullying behavior

12. Elements : Duplicates
Pre-eclampsia AND pregnant AND women
Lichtenstein therapy AND inguinal hernias

13. Which elements to use:
Exercise therapy effective for hip osteoarthritis??
generalspecific
important
unimportant
Exercise
therapy
Hip
osteoarthritis
Treatment
effectiveness
Exercise
therapy
Hip
osteoarthritis
Treatment
effectiveness

14. Identifying thesaurus terms
One element  One emtree term

16. Identifying thesaurus terms
One element  One emtree term
exercise therapy  kinesiotherapy
One element  More thesaurus terms (OR)

25. Identifying thesaurus terms
One element  One emtree term
One element  Multiple MeSH terms (OR)
prevention and control (Subheading) OR
Preventive Medicine OR Preventive Health Services
Multiple elements  One emtree term

31. Identifying thesaurus terms
One element  One emtree term
One element  Multiple MeSH terms (OR)
Multiple elements  One emtree term
('cancer mortality' OR (neoplasm AND mortality))
(neoplasm OR 'cancer mortality') AND (mortality OR 'cancer
mortality')
One element  Multiple MeSH terms (AND)
Bennett Fracture: (Fracture, Bone AND metacarpal bones AND
thumb)
Alcohol metabolites: alcohols/metabolism

32. Identifying free text words
Optimal sensitivity only by additionally searching
in title / abstract:
• Relevant, non-inverted terms from synonyms/
entry terms

37. Identifying free text words
Optimal sensitivity only by additionally searching in
title / abstract:
• Relevant, non-inverted terms from synonyms /
entry terms
Shoulder: glenohumeral joint- humeroscapular joint- scapulo
humeral joint- scapulohumeral joint- articulatio humeri
• Relevant words / phrases from narrower terms

40. Identifying free text words
Optimal sensitivity only by additionally searching in
title / abstract:
• Relevant, non-inverted terms from synonyms /
entry terms
Shoulder: glenohumeral joint- humeroscapular joint- scapulo
humeral joint- scapulohumeral joint- articulatio humeri
• Relevant words / phrases from narrower terms
Colorectal Neoplasms: Colonic cancer- Cancer of Sigmoid-
Rectum tumor- Anal Neoplasms…etc…

41. Creating a basic search strategy
Build your query in Word
Copy the query to the database to test it
Make changes and translations in Word
The word document is simultaneously:
- Supplementary file or the resulting article
- Storage of search strategies for customers

42. Embase.com OvidSP PubMed
Boolean AND, OR, NOT
Thesaurus /exp exp …/ [mh]
---- Unexploded /de …/ [mh:noexp]
Title / abstract ():ab,ti ().ab,ti. [tiab]
Phrases ‘single quotes’ No quotes
needed
“Double quotes”
or *
Proximity NEAR/n ADJn Not possible: use
AND or phrases
Standard syntax
Extended version (20 syntaxes in 7 databases) available upon request

43. Example
Research Question:
Is exercise therapy an effective treatment for hip
osteoarthritis
Elements:
1. Hip osteoarthritis
2. Exercise therapy
3. (Treatment effectiveness)
DEMO

44. Example
Research Question:
Is exercise therapy an effective treatment for hip
osteoarthritis
Elements:
1. Hip osteoarthritis
2. Exercise therapy
3. (Treatment effectiveness)

45. Hip osteoarthritis
()

47. Hip osteoarthritis
(''/exp)
('hip osteoarthritis'/exp)

49. Hip osteoarthritis
('hip osteoarthritis'/exp OR ():ab,ti)
('hip osteoarthritis'/exp OR
(coxarth*):ab,ti)
('hip osteoarthritis'/exp OR (coxarth* OR
(() NEAR/3 ())):ab,ti)

50. Hip osteoarthritis
('hip osteoarthritis'/exp OR (coxarth* OR
((hip OR cox) NEAR/3 (arth* OR
osteoarth*))):ab,ti)
('hip osteoarthritis'/exp OR (coxarth* OR
((hip OR cox) NEAR/3 (arth* OR
osteoarth*)) OR 'malum coxae
senilis'):ab,ti)

51. Exercise therapy

54. Exercise therapy
('kinesiotherapy'/exp OR (kinesiotherap*
OR kinesitherap* OR ((exercis*) NEAR/3
(technique* OR therap* OR
treat*))):ab,ti)

56. Exercise therapy
('kinesiotherapy'/exp OR (kinesiotherap*
OR kinesitherap* OR ((exercis* OR
movement*) NEAR/3 (technique* OR
therap* OR treat* OR isokinet* OR
isomet*)) OR ((muscle*) NEAR/3
(train*))):ab,ti)

57. Treatment effectiveness

60. Treatment effectiveness
('clinical effectiveness'/exp OR
'comparative effectiveness'/exp OR 'cost
effectiveness analysis '/exp OR 'program
cost effectiveness'/exp OR 'program
effectiveness'/exp)

61. Treatment effectiveness
('clinical effectiveness'/exp OR
'comparative effectiveness'/exp OR 'cost
effectiveness analysis '/exp OR 'program
cost effectiveness'/exp OR 'program
effectiveness'/exp OR ():ab,ti)

62. Treatment effectiveness
('clinical effectiveness'/exp OR
'comparative effectiveness'/exp OR 'cost
effectiveness analysis '/exp OR 'program
cost effectiveness'/exp OR 'program
effectiveness'/exp OR (effectiv*):ab,ti)

63. Concept query
('hip osteoarthritis'/exp OR (coxarth* OR ((hip OR
cox) NEAR/3 (arth* OR osteoarth*)) OR 'malum coxae
senilis'):ab,ti) AND ('kinesiotherapy'/exp OR
(kinesiotherap* OR kinesitherap* OR ((exercis* OR
movement*) NEAR/3 (technique* OR therap* OR
treat* OR isokinet* OR isomet*)) OR ((muscle*)
NEAR/3 (train*))):ab,ti) AND ('clinical
effectiveness'/exp OR 'comparative
effectiveness'/exp OR 'cost effectiveness analysis
'/exp OR 'program cost effectiveness'/exp OR
'program effectiveness'/exp OR (effectiv*):ab,ti)
152 hits

64. Creating a basic search strategy (summary)
• Type code in Word
• Open an element with ()
• For emtree terms type ''/exp and paste term
• After pasting all emtree terms, type OR ():ab,ti
within that element once for free text words
• Type single word synonyms first
• Type (() NEAR/3 ()) somewhere in the document
to reuse
• Copy (() NEAR/3 ()) into the ():ab,ti part search for
phrase variants, and add the words

65. Optimizing your strategy
Sort by relevance and check title / abstract and
thesaurus
Add new relevant words to the search in Word
Temporarily change the syntax and check words:
Per element, keeping the rest unchanged
• (emtree) NOT (free text)
• (free text) NOT (emtree)
DEMO

66. Step 3: optimizing your strategy
1. Check retrieved articles for relevant words

68. ('hip osteoarthritis'/exp OR (coxarth* OR ((hip OR
cox) NEAR/3 (arth* OR osteoarth*)) OR 'malum coxae
senilis'):ab,ti) AND ('kinesiotherapy'/exp OR
(kinesiotherap* OR kinesitherap* OR ((exercis* OR
movement* OR motion OR manual) NEAR/3
(technique* OR therap* OR treat* OR isokinet* OR
isomet* OR water)) OR ((muscle*) NEAR/3
(train*))):ab,ti) AND ('clinical effectiveness'/exp OR
'comparative effectiveness'/exp OR 'cost
effectiveness analysis '/exp OR 'program cost
effectiveness'/exp OR 'program effectiveness'/exp OR
(effectiv*):ab,ti)
160 hits

69. Step 3: optimizing your strategy
1. Check retrieved articles for relevant words
2. Temporarily change the syntax for one of the
elements into (emtree) NOT (free text)
while keeping the rest unchanged

70. ('hip osteoarthritis'/exp …) AND
('kinesiotherapy'/exp OR (kinesiotherap* OR
kinesitherap* OR ((exercis* OR movement*
OR motion OR manual) NEAR/3 (technique*
OR therap* OR treat* OR isokinet* OR
isomet* OR water)) OR ((muscle*) NEAR/3
(train*))):ab,ti) AND ('clinical
effectiveness'/exp …)

71. ('hip osteoarthritis'/exp …) AND
('kinesiotherapy'/exp NOT (kinesiotherap*
OR kinesitherap* OR ((exercis* OR
movement* OR motion OR manual) NEAR/3
(technique* OR therap* OR treat* OR
isokinet* OR isomet* OR water)) OR
((muscle*) NEAR/3 (train*))):ab,ti) AND
('clinical effectiveness'/exp …)

73. ('hip osteoarthritis'/exp …) AND
('kinesiotherapy'/exp OR (kinesiotherap* OR
kinesitherap* OR exercis* OR physiotherap*
OR ((movement* OR motion OR manual)
NEAR/3 (technique* OR therap* OR treat*
OR isokinet* OR isomet* OR water)) OR
((muscle*) NEAR/3 (train*))):ab,ti) AND
('clinical effectiveness'/exp …)
267 hits

74. Step 3: optimizing your strategy
1. Check retrieved articles for relevant words
2. Temporarily change the syntax for one of the
elements into (emtree) NOT (free text)
3. Temporarily change the syntax for one of the
elements into (free text) NOT (emtree)
while keeping the rest unchanged

75. ('hip osteoarthritis'/exp …) AND
('kinesiotherapy'/exp OR (kinesiotherap* OR
kinesitherap* OR exercis* OR physiotherap*
OR ((movement* OR motion OR manual)
NEAR/3 (technique* OR therap* OR treat*
OR isokinet* OR isomet* OR water)) OR
((muscle*) NEAR/3 (train*))):ab,ti) AND
('clinical effectiveness'/exp …)

76. ('hip osteoarthritis'/exp …) AND
((kinesiotherap* OR kinesitherap* OR
exercis* OR physiotherap* OR ((movement*
OR motion OR manual) NEAR/3 (technique*
OR therap* OR treat* OR isokinet* OR
isomet* OR water)) OR ((muscle*) NEAR/3
(train*))):ab,ti) AND ('clinical
effectiveness'/exp …) NOT
'kinesiotherapy'/exp

78. ('hip osteoarthritis'/exp …) AND
('kinesiotherapy'/exp OR exercise/exp OR
physiotherapy/exp OR (kinesiotherap* OR
kinesitherap* OR exercis* OR physiotherap*
OR ((movement* OR motion OR manual)
NEAR/3 (technique* OR therap* OR treat*
OR isokinet* OR isomet* OR water)) OR
((muscle*) NEAR/3 (train*))):ab,ti) AND
('clinical effectiveness'/exp …)
355 hits

79. End Result – Systematic Review
('hip osteoarthritis'/exp OR ((arthritis/de OR osteoarthritis/de)
AND (hip/de OR 'hip pain'/exp)) OR (coxarth* OR ((hip OR cox)
NEAR/6 (arthrit* OR arthrosis* OR arthroses* OR osteoarth* OR
oa)) OR 'malum coxae senilis'):ab,ti) AND ('kinesiotherapy'/exp
OR exercise/exp OR physiotherapy/exp OR 'conservative
treatment'/de OR (kinesiotherap* OR kinesitherap* OR exercis*
OR physiotherap* OR gymnastic* OR ((movement* OR motion
OR manual OR phys* OR conservative* OR nonoperat* OR
nonsurg* OR non-operative OR non-surgical OR paramedic* OR
para-medical) NEAR/3 (technique* OR therap* OR treat* OR
isokinet* OR isomet* OR water OR management* )) OR
((muscle* OR muscul*) NEAR/3 (train*))):ab,ti)
1916 hits

80. Considerations
Explode a broad term or not?
Start exploded, when many irrelevant
results appear, be more specific
Truncate a term or not?
Truncate as much as possible, hardly noise
Phrases or proximity?
Always proximity, easier and more sensitive
How broad should proximity be?
Start with 3, increase with 3 and
evaluate newly retrieved articles

81. Step 5: Translating the strategy
between databases
Embase.com (Embase and Medline)
Thorough optimization of thesaurus terms and title / abstract terms in search strategy
Macro and edit thesaurus
Medline (OvidSP)
MeSH terms in PubMed / Optimization
Add extra terms Remove thesaurus
Cochrane library
Macro
Web-of-science
Macro
Scopus
Macro
PubMed
publisher
[sb]
Macro and
edit
thesaurus
CINAHL
(EBSCO)
edit
thesaurus
PsycINFO
(OvidSP)
Macro and edit
Google Scholar
Macro and edit
Lilacs / Scielo / Eric /
Clinical trials etc etc
DEMO

82. Success factors
• Optimization techniques
• Macros for database translation
• Single-line search strategies
• Database choice and order
• Direct feedback by researcher
• Creating queries in Word
• Computer literaracy
• Experience (be pro active)

83. Contact details
E-mail: w.bramer@erasmusmc.nl
Twitter: @wichor
LinkedIn: nl.linkedin.com/in/wichor
Slideshare: www.slideshare.net/wichor
Upcoming international workshops:
June 2015 Edinburgh (UK) – EAHIL Workshop
September 2015 Basel (CH) – AGMB Workshop

84. Further reading:
• Bramer WM, Giustini D, Kramer BM, Anderson PF. The comparative recall of
Google Scholar versus PubMed in identical searches for biomedical
systematic reviews: a review of searches used in systematic reviews. Syst
Rev. 2013 Dec 23;2:115.
• Bramer WM, Holland L, Mollema J, Hannon T, Bekhuis T. Removing duplicates
in retrieval sets from electronic databases: comparing the efficiency and
accuracy of the Bramer-method with other methods and software packages
(Eahil conference, Rome)
• Embase webinar : Systematic searching with Wichor Bramer (25 feb 2015)
• Bramer WM, Pols DHJ, Bindels PJE, Bohnen AM. A fast, reliable and objective
method for creating thematic search filters in bibliographic databases [in
process]
• Work in progress on coverage, retrieval and relevance ranking of the major
databases for systematic reviews
(>450 review searches; >100 finished; >4500 included references)
• Two articles in progress about this methodology (how to, and how well)

85. Single line approach or set numbers?
Well structured?
#1 brassica/exp
#2 brassica*:ab,ti
#3 broccoli:ab,ti
#4 #1 OR #2 OR #3
#5 neoplasm/exp
#6 neoplas*:ab,ti
#7 cancer*:ab,ti
#8 tumor*:ab,ti
#9 #5 OR #6 OR #7 OR #8
#10 #4 AND #9
#11 [animals]/lim
#12 [humans]/lim
#13 #11 AND #12
#14 #11 NOT #13
#15 #10 NOT #14
Unstructured?
(brassica/exp OR (brassica* OR
broccoli):ab,ti) AND (neoplasm/exp
OR (neoplas* OR cancer* OR
tumor*):ab,ti) NOT ([animals]/lim
NOT [humans]/lim)

86. What to do with subheadings
Separate element
(broccoli/de OR (broccoli* OR
bassica*):ab,ti) AND (neoplasm/exp
OR (cancer* OR neoplas*):ab,ti) AND
(prevention:lnk OR prevention/exp
OR (prevent*):ab,ti)
Combined element
(broccoli/de OR (broccoli* OR
bassica*):ab,ti) AND
(neoplasms/exp/dm_pc OR ‘cancer
prevention’/de OR ((cancer OR
neoplasm) NEAR/3 (prevent*)):ab,ti)
Sensitive
 More hits : 345 (101 unique)
 Less chance of missing relevant
articles
 Recommended for start
 For SRs highly recommended
Specific
 Less hits : 257 (13 unique)
 Higher chance of missing relevant
articles
 To reduce the number of hits
 Use proximity in free text

87. Why start in embase?
Source: Unpublished research Bramer (5048 included references from 111 reviews)

88. Relevance ranking

89. Interface choice
Embase.com
Pros
- Very good relevance ranking
Cons
- Translating between embase
and medline more
complicated
- No wildcard (?) in truncation
- Special characters not
normalized ( VO2max )
OvidSP
Pros
- Equal syntax to medline
(OvidSP)
Cons
- No relevance ranking on
complicated queries
- Complex thesaurus interface
My advice: relevance ranking is
very helpful during
optimization. Problems are only
minor. Start in embase.com and
translate with macros

90. The databases I use:
Database Used in % of SR
Embase.com 100%
Medline (OvidSP) 99%
(PubMed the other 1%)
Cochrane central 98%
Web-of-Science 95%
Google Scholar 92%
PubMed (publisher) 91%
Scopus 36%
Cinahl 25%
PsycINFO 19%
Others (proquest, sportdiscus,
lilacs, scielo, eric, amed etc)
7%

91. Do you need to fully understand the research question?
What is the Cell contribution to chondroid / endochondreal /
intramembranous bone formation
((('bone development'/de OR 'bone mineralization'/de OR 'bone
maturation'/de OR ossification/de OR 'bone conduction'/de OR 'bone
transplantation'/exp OR 'bone matrix'/exp OR 'bone growth'/exp OR
'bone remodeling'/de OR ((bone NEAR/6 (minerali* OR develop* OR
format* OR synthesis* OR growth* OR graft* OR transplant* OR
engineer* OR defect* OR matri* OR remodel* OR conduct* OR
maturat*)) OR osteogen* OR ossificat*):ab,ti) AND (chondroid* OR
transchondroid* OR enchondr* OR endochondr* OR intermembran*
OR cartilagin* OR (inter NEXT/1 membran*)):ab,ti) OR 'enchondral
ossification'/de) AND ('cell death'/de OR 'cell survival'/de OR
apoptosis/de OR 'cell differentiation'/de OR 'cell fate'/de OR 'host
cell'/de OR 'cell lineage'/de OR (((cell* OR msc OR osteoblast* OR
osteocyte* OR osteoclast* OR preosteoblast*) NEAR/3 (death OR
senescen* OR contribut* OR differentiat* OR fate OR plasticit* OR
reprogram* OR donor* OR host* OR recruit* OR surviv* OR viabilit*
OR lineage*)) OR apoptosis):ab,ti)

92. PICO?
P 67 73%
I 51 55%
C 2 2%
O 37 40%
S 24 26%
? 29 32%
PI 14
PO 8
PIS 7
IO 6
P? 6
PIO 4
P 4
I? 4
PS? 4
PI? 3
IOS 3
I 3
? 2
PO? 2
IO? 2

93. Embase.com syntax
()
(''/exp)
('hip osteoarthritis'/exp)
('hip osteoarthritis'/exp OR ():ab,ti)
('hip osteoarthritis'/exp OR (coxarth*):ab,ti)
('hip osteoarthritis'/exp OR (coxarth* OR (() NEAR/3
())):ab,ti)
('hip osteoarthritis'/exp OR (coxarth* OR ((hip OR cox)
NEAR/3 (arthrit* OR arthros* OR osteoarth*))):ab,ti)

94. Ovid (Medline) syntax
()
(exp ""/)
(exp "osteoarthritis, hip"/)
(exp "osteoarthritis, hip"/ OR ().ab,ti.)
(exp "osteoarthritis, hip"/ OR (coxarth*).ab,ti.)
(exp "osteoarthritis, hip"/ OR (coxarth* OR (() ADJ3
())).ab,ti.)
(exp "osteoarthritis, hip"/ OR (coxarth* OR ((hip OR cox)
ADJ3 (arthrit* OR arthros* OR osteoarth*))).ab,ti.)

95. PubMed syntax (not optimal)
()
(""[mh])
("osteoarthritis, hip"[mh])
(exp "osteoarthritis, hip"/ OR coxarth*[tiab])
(exp "osteoarthritis,
hip"/ OR coxarth*[tiab]
OR ((hip[tiab] OR
cox[tiab]) AND
(arthrit*[tiab] OR
arthros*[tiab] OR …)))
(exp "osteoarthritis, hip"/ OR
coxarth*[tiab] OR hip arthrit*[tiab]
OR cox arthrit*[tiab]
OR hip arthros*[tiab]
OR cox arthros*[tiab]
OR hip osteoarthrit*[tiab] OR …)

96. How well do the searches perform?
Benchmark This study
# terms 46 54
# databases 3 7
# hits 1399 2224
# includes 19 25
precision 1.2% 2.0%
Benckmark: 93 systematic reviews from 2014 with an acknowledgement or co-authorship
of a medical information specialist from another Dutch academic hospital.

97. Hausner, 2015 (13); Saleh, 2014 (17); Allen, 1999 (19); Gann, 2013 (47); Lyon, 2014 (9) [1-5] and unpublished
data from London Health Sciences Centre in Canada (43)
0%
25%
50%
75%
100%
0 10 20 30 40 50
PercentageofSystematicReviews
Hours needed to create search strategy
Meta-analysis (N=148)
And the speed?

98. 0%
25%
50%
75%
100%
0 10 20 30 40 50
PercentageofSystematicReviews
Hours needed to create search strategy
Meta-analysis (N=148)
Bramer (N=258)
Hausner, 2015 (13); Saleh, 2014 (17); Allen, 1999 (19); Gann, 2013 (47); Lyon, 2014 (9) [1-5] and unpublished
data from London Health Sciences Centre in Canada (43)
And the speed?