Internal Medicine Portal: Searching

Primary Question Types

• Therapy: how to select treatments to offer our patients that do more good than harm and that are worth the efforts and costs of using them.
• Diagnostic tests: how to select and interpret diagnostic tests, in order to confirm or exclude a diagnosis, based on considering their precision, accuracy, acceptability, expense, safety, etc.
• Prognosis: how to estimate a patient's likely clinical course over time due to factors other than interventions
• Harm / Etiology: how to identify causes for disease (including its iatrogenic forms).

Other Question Types

• Clinical findings: how to properly gather and interpret findings from the history and physical examination.
• Clinical manifestations of disease: knowing how often and when a disease causes its clinical manifestations and how to use this knowledge in classifying our patients' illnesses.
• Differential diagnosis: when considering the possible causes of our patient’s clinical problem, how to select those that are likely, serious and responsive to treatment.
• Prevention: how to reduce the chance of disease by identifying and modifying risk factors and how to diagnose disease early by screening.
• Qualitative: how to empathize with our patients’ situations, appreciate the meaning they find in the experience and >understand how this meaning influences their healing.

From: Sackett, DL. Evidence-based medicine: how to practice and teach EBM.

General questions or background questions ask for basic knowledge about an illness, disease, condition, test, process or thing. These types of questions typically ask who, what, where, when, how & why about things like a disorder, test, or treatment, etc.

For example

• What is hairy cell leukemia?
• What are the adverse effects of Black Cohosh?
• What is the mechanism of action for dopamine agonists?
• What causes seizures?
• What are the diagnostic criteria for Deep Vein Thrombosis?

These types of questions are best answered by medical textbooks, point-of-care tools (e.g. DynaMed Plus, Essential Evidence Plus, Lexicomp, OvidMD), and narrative review articles.

A well-built clinical foreground question should have at least 4 components. The PICO model is a helpful tool that assists you in organizing and focusing your foreground question into a searchable query.

• P = Patient, Problem, Population (How would you describe a group of patients similar to you? What are the most important characteristics of the patient?)
• I = Intervention, Prognostic Factor, Test, Exposure (What main intervention are you considering? What do you want to do with this patient? What is the main alternative being considered?)
• C = Comparison (What is the main alternative to compare with the intervention? Are you trying to decide between two drugs, a drug and no medication,  placebo, or standard of care, or two diagnostic tests?)
• O= Outcome (What are you trying to accomplish, measure, improve or affect? Outcomes may be disease-oriented or patient-oriented.)

Example of a clearly focused question in PICO format:

Does CBT have a better effect than drug therapy on improving sleep in military members with PTSD experiencing insomnia?

• Patient - Military members with PTSD suffering from insomnia
  • could focus to active duty or also include veterans; remember to search synonyms for insomnia, sleep disturbances, etc. 
• Intervention - Cognitive behavioral therapy 
• Comparison - Pharmacologic therapy
• Outcome - better sleep

Example of a question that is too broad and not focused enough.

Do antibiotics help children with colds?  *It leaves us with a lot of questions and feels more like a topic.

• Patient/Population - Children with colds How old?
  • All children from 0 to 18 or 16 or 14. What do we mean by a ‘cold’? With a temperature or a runny nose? With a proven diagnosis of a bacterial infection?
• Intervention - Antibiotics
  • Which antibiotics? All of them? 
• Comparison
  • What comparator? A different type of antibiotic? A placebo? Nothing?
• Outcome
  • What does “help” mean? What are we trying to measure? Are we interested in symptoms/signs/quality of life/days off school? Or something else?

Ask for assistance with a literature search

​A lit search is searching a database for targeted results on your topic

• Contact us for a lit search for these types of questions:
  • Patient care questions (extremely quick turn-around, not as in-depth searching)
  • Questions with clinical implications (fast turn-around with some lee-way depending on the extent of research)
  • Questions related to grand rounds and presentations (we always try to meet your deadlines),
  • Research/QI project searching 

Results will typically be delivered as a list or link to citations

• We may attach some PDFs to give you a quick start
• We can send you results as an Endnote Library or word document of citation + abstract if that is your preferred format. 

Other related pieces to lit searching:

• We're happy to teach you to search literature efficiently on your own
• We can consult on best keywords, phrases, and controlled vocabulary for your searches if you want to work with us instead of have us conduct the search for you. 
• We can also work with you to see if there have been similar papers/projects done in the past, though rule-out searches are tricky based on database availability. 
• We offer assistance with extensive/long-term research projects such as systematic reviews/meta-analysis/scoping reviews, but we request that you meet with us so we can discuss library services and timeframes.

Request document delivery if you're looking for full-text PDFs for citations you've found

My NCBI allows you to save searches, save collections of citations, manage filters, and save site preferences for major NCBI databases in PubMed.

We recommend setting up a free account (you don't have to use your @health.mil address) so you can have personalized features, such as the links to full text results, highlighting of your search results, and the abstracts displayed when you search rather than just the summaries of articles.

Once you've created an account, go to the Filters box, click on "Manage Filters" and then select "Link Out". In the box, type in "Darnall" and check off both the boxes for filter and link icon. Next, in the search box, type in "Free Full Text," and check off the box for "filter."

Now you can go back to the top of the screen and click on "MyNCBI" again to customize your results display. Choose "NCBI Site Preferences" then, on the next page, change your highlighting preferences to a color of your choice (it is probably default to a non-color), and your "result display setting" to "abstract" and whichever number you choose instead of summary. You're all set and ready to search!

More information on NCBI accounts (there's a lot more to them, including saved searches)

Signing up for an account

MyNCBI Site Help

• Mon-Fri, 0900-1500, try our Live Chat Service
• Need help? Ask the Library
• Urgent Patient Care Query: Contact the Library
• Looking for a Book or Article? Contact the Library Technicians
• Literature Search / Reference Question? Contact the Librarians
• Conducting Research? Contact the Research Librarian
• Darnall Medical Library, Circulation Desk: 295-1184

• TRICARE Appointment Line: 855-227-6331
• Walter Reed NMMC Main Phone: 301-295-4611
• TRICARE Health Services (includes phone numbers)

Researching a Medical Condition?
Click the button below!

• MHS Medical Library (MML)
• USUHS Learning Resource Center
• Alexander T. Augusta Military Medical Center Library

To be linked to WRNMMC's journal article holdings (so you see the Locate@Darnall option), you should click on Settings in Google Scholar. Once you've clicked Settings, look to the left sidebar and click on Library Links. Look up Walter Reed National Military Medical Center - Locate@Darnall.