Chapter 1: Finding the Answers

Overview

A comprehensive literature review is essential for understanding and applying evidence-based medicine. This chapter seeks to equip the busy surgeon with a core set of techniques to efficiently retrieve and manage clinical information, and to interpret such data within the context of the greater body of surgical literature. More specifically, this chapter will provide (1) succinct database and search engine descriptions with advice for best search strategies, (2) a guide to two popular reference management applications, and (3) descriptions of tools for remaining current with the latest clinical research. To understand the importance of the literature search, the chapter begins with some relevant clinical scenarios.

Scenario 1

A 42-year-old male is admitted to the intensive care unit with refractory septic shock secondary to perforated peptic ulcer. Treatment consists of antibiotics, intravenous fluid support, and norepinephrine. The intensivist wants to know whether evidence exists to support the addition of vasopressin, and asks you to locate articles on the topic, in particular articles that have significantly impacted clinical practice.

Locate High-Impact/Seminal Articles: One quick-and-easy method for identifying high-impact articles in a particular clinical domain is to rank papers by “times cited,” which is simply the number of times that an article was cited in other works (typically, other journal articles). Two tools for determining times cited are Google Scholar (free) and SCOPUS (subscription-only). Google Scholar ranks its results using a relevance weighting algorithm that, among other things, adds greater relevance to a search result that is frequently cited. SCOPUS, on the other hand, allows searchers to simply sort results from most to least cited (or vice versa).

Other tools such as Faculty of 1000 and NEJM Journal Watch use an actual cadre of subject experts rather than algorithms to identify noteworthy articles. However, both of these are subscription services.

Searching Google Scholar: As the name implies, Google Scholar is a resource for locating scholarly information, including academic articles, patents, books, court opinions, and theses. One of the key benefits of Google Scholar is the ability to search the full text of an item, not just the titles, abstracts, and supplemental keywords found in traditional literature databases such as PubMed, SCOPUS, and Web of Science. Search terms that might not appear in a standard reference (eg, an obscure lab method, a psychometric test, a health statistic) are potentially discoverable in the full text.

As mentioned previously, the number of times that an article is cited plays a significant role in ranking search results. Searchers can also view who is citing the work by clicking on the “Cited by” link.

Despite its utility, citation count as an indicator of relevance is imperfect. Inherent delays in reading and citing a particular work diminish the efficacy of citation count in detecting new articles that might become seminal.¹ Also, an article may be cited ...