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NLM Technical Bulletin

NLM Technical Bulletin 1997 Jan-Feb; 294

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Gold Standard Search

Thank you to everyone who mailed in search strategies in response to the "Gold Standard Search" article in the September-October 1996 issue of the Technical Bulletin. This feature offers searchers a chance to match wits with NLM staff on a search strategy formulation. The Gold Standard search strategies are developed here at NLM. The search request published in the September-October 1996 issue was:

The client is a layperson who wants information on alternative treatments for breast cancer.

The Winner

There was no winner for this search. However, honorable mentions go to Hazel Benson at the Biological Sciences/Pharmacy Library in Columbus, OH and Cheryl Banick of Warwick, RI. Their strategies showed careful thought and considerable attention to the selection of headings and Text Words that might be included in a search of this subject.

Choosing a File

The first step in this Gold Standard Search was to choose the correct file. For this search, it was necessary to select CANCERLIT. No other ELHILL file covers this subject area so completely. If you first ran your strategy in MEDLINE, you would still need to search CANCERLIT. This means running your strategy twice and incurring the extra step of eliminating the MEDLINE overlap. Most searchers did select CANCERLIT as their only database for searching. One searcher expressed the thought that perhaps non-traditional treatments for cancer would be more likely to be found in MEDLINE than in CANCERLIT - this is not true. Any and all citations to articles covering the subject of cancer that are published in journals indexed for MEDLINE will be pulled into the CANCERLIT file. After the CANCERLIT strategy is run in MEDLINE to create the updated file, there is no subjective layer of judgment used to reject articles that are written from any particular viewpoint. In addition, CANCERLIT also covers meeting abstracts which are not available in MEDLINE.

Analysis of the Search Strategies

The selection of the appropriate MeSH headings was important. In this search it was critical to look beyond the two obvious MeSH headings ALTERNATIVE MEDICINE and BREAST NEOPLASMS. These two headings when starred (*), EXPLODEd and ANDed together give only 28 English language citations, and half of them are more than five years old. So it's necessary to think about how to broaden the concept beyond the terms encompassed by these two MeSH headings. If the standard therapies for cancer are considered to be surgery, chemotherapy or radiation therapy, then almost all other treatments might be broadly considered as alternative or adjunctive therapies. And these other forms of treatment may and in fact do have applicable MeSH headings.The heading HOLISTIC HEALTH retrieves citations when combined with BREAST NEOPLASMS. Perhaps you remember an article by Norman Cousins on how the use of humor affected the course of his illness; the MeSH heading WIT AND HUMOR also retrieves relevant citations when combined with BREAST NEOPLASMS. DIET, DIET THERAPY and DIET THERAPY (SH) should also be considered. In the end, only the subheading DIET THERAPY produced useful retrieval, but initially all three possibilities needed to be looked at. The following terms post in CANCERLIT, but did not produce articles when combined with BREAST NEOPLASMS: PLAY THERAPY, MUSIC THERAPY, BIBLIOTHERAPY, and AROMATHERAPY (as a Text Word, not as an MH, because the MeSH heading is new for 1997 and no citations had been indexed with this heading at the time this search was run). So they are therapies used in combination with some kinds of cancer and again they might have at least been considered.

Searching with these additional terms will continue to yield about the same proportion of new and old materials that ALTERNATIVE MEDICINE found. That is, most of the citations will be more than five years old and it will be necessary to restrict your retrieval to the most recent five years, if only relatively current material is preferred. This is shown in in the Gold Standard Search in Figure 1 in Search Statements 9 and 10.

However, these are just suggestions. You really need to be guided by your own creativity and the particular interests of your client. You might want to look into vitamin therapy, balneology (bathing, mud baths, etc.), or whatever other ideas seem as though they might be fruitful. Ms. Banick was particularly good at considering all kinds of Text Word combinations such as juice therapy, megavitamins, sound therapy, etc. However, in any case, you do need to look outside the box contained by the words ALTERNATIVE MEDICINE.

The broadest category that was overlooked by everyone except Hazel Benson was PSYCHOTHERAPY. Included in the tree under this heading is the explodable category BEHAVIOR THERAPY and all the information on social support groups and their effect on the recovery and well-being of the patient. You definitely want to include this category.

Search Strategy Suggestions

The most common errors were attaching subheadings to BREAST NEOPLASMS which unnecessarily restricted an already small retrieval set. When running a search as broadly defined as this Gold Standard search was, the following very general guidelines might be used to progressively narrow down your results.

  • Run your search using all possible explosions but without starring (*) any of the headings.
  • Run your search as above, but use the * to limit retrieval to citations where the starred MeSH headings are the main points of the article.
  • Run your search using EXPLODEd starred MeSH headings with subheadings (e.g. EXP *BREAST NEOPLASMS /dh).

After each of these steps you should carefully examine the retrieval; you need to consider not just the number of citations retrieved, but also look at some of the citations you are losing with each restriction to make sure you are not eliminating relevant material. You can compare retrieval online by using a search statement in the form of 1 and not 2, where 1 is the broader search statement with the larger retrieval set and 2 is the more restricted search statement retrieving the smaller set. Too many people were satisfied with extremely small retrieval sets (under 5) that were obtained by searching with MeSH headings/subheading combinations.

The Next Gold Standard Search

The search request is:

Is zinc effective in treating the common cold?

Results will be published in the May-June 1997 Technical Bulletin. Entries must be received by April 15, 1996 to be considered.

Mail us a copy of your search strategy and include a printout of citations. Please note that in the interest of saving time, money, and paper we are no longer asking for abstracts. If your strategy is selected for publication you will win one hour of free search time. In cases of multiple submissions of identical winning strategies, the prize winner will be either the person who is a first time winner or the first winning strategy received.

Search Hints for Direct Searchers

Select your database carefully. Limit your retrieval to English-language citations.

Search Hints for Grateful Med Searchers

Select your database carefully. Remember to use MeSH headings. Limit your retrieval to English-language citations.


There are no exact answers or absolutely correct strategies, only best approximations, just like real life. Good luck!

Please send a copy of your search strategy with the retrieval, including which database was searched and whether you searched directly or used Grateful Med to:

Gold Standard Search
MEDLARS Management Section
National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
--prepared by Toby Port
MEDLARS Management Section

Figure 1 - Gold Standard Search

     SS 1 /C?


     file cancer





     SS 1 /C?


     exp *breast neoplasms



     SS (1) PSTG (52351)


     SS 2 /C?


     exp *alternative medicine



     SS (2) PSTG (986)


     SS 3 /C?


     1 and 2



     SS (3) PSTG (38)


     SS 4 /C?


     *holistic health or *wit a#d humor or exp *psychotherapy



     SS (4) PSTG (712)


     SS 5 /C?


     1 and 4



     SS (5) PSTG (58)


     SS 6 /C?


     exp *breast neoplasms/dh



     SS (6) PSTG (27)


     SS 7 /C?


     3 or 5 or 6



     SS (7) PSTG (114)


     SS 8 /C?


     7 contains eng (la) and 7 contains human (mh)     

			* Contains may be 

			  used efficiently to                     

			  replace "and not for 

			  and human" because 

			  the retrieved set is 




     SS (8) PSTG (87)


     SS 9 /C?

     8 and 96 (yr) or 8 and 95 (yr) or 8 and 94 (yr)   

			* The 1997 data were 

			  not in CANCERLIT at 

			  the time this search 

			  was run.



     SS (9) PSTG (25)


     SS 10 /C?

     8 and 93 (yr) or 8 and 92 (yr) or 8 and 91 (yr)



     SS (10) PSTG (19)


     SS 11 /C?


     9 or 10



     SS (11) PSTG (44)                                 

			 * Five sample titles 

			   from the retrieval 

			   are shown below.


     TI     -    The impact of a psychological intervention 

		 on quality of life in non-metastatic breast 



     TI     -    Adherence to a dietary fat intake reduction 

		 program in postmenopausal women receiving 

		 therapy for early breast cancer. The 

		 Women's Intervention Nutrition Study [see 



     TI     -    Womanspirit: a journey into healing through 

		 art in breast cancer.

     TI     -    Humor, health, and happiness: the use of 

		 humor in coping with cancer.


     TI     -    The use of herbal remedies and alternative 

		 therapies by breast cancer patients 

		 (Meeting abstract).


     TI     -    Suppression of growth by dietary fish oil 

		 of human breast carcinomas maintained in 

		 three different strains of immune-deficient 


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Last updated: 11 April 2012