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to identify and locate relevant sources&#44; know how to access them&#44; how to appraise the information and how to organize it&#46; Biomedical literature tells us what is already known and helps prepare future work&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Furthermore&#44; it is an essential component of the clinical decision&#44; along with clinical experience and the values and preferences of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> There is evidence that immediately available online information can change and improve clinical decisions&#46; Searching MEDLINE when inpatients are admitted significantly reduces costs and length of stay&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In a study by Crowley et al&#44; 77&#37; of 625 clinical questions of Internal Medicine residents were answered using MEDLINE&#44; which led to 47&#37; of changes in clinical management&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this paper is to address some topics on searching and managing biomedical information&#46; We will discuss the construction of a search query and the development of a search strategy&#46; We will use PubMed as an example&#44; and demonstrate some of the tools that are provided&#46; Hopefully&#44; you will find some of the topics discussed useful when trying to find a specific answer to a question arising in your practice or engaging on a systematic search of data and information to access the current knowledge or ignorance in your medical field&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Searching Biomedical Information</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">What to search&#63;</span><p id="par0020" class="elsevierStylePara elsevierViewall">You are searching for scientific publications&#44; usually called the &#8220;literature&#8221;&#44; which are reports of empirical or theoretical scientific work&#46; They can be very varied&#44; such as journals&#44; conference proceedings&#44; books&#44; technical reports&#44; leaflets or patents&#46; You will most frequently tend to be searching for scientific articles in journals&#44; which are indexed in different online databases &#40;based on various criterions&#44; such as the existence of peer review&#44; the scientific field and the periodicity of publications&#44; amongst others&#41;&#46; The first medical journal was the New England Journal of Medicine&#44; with its first article published in 1812&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Nowadays&#44; MEDLINE alone indexes more than 5500 journals&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">It is possible to understand the influence of biomedical journals with the help of citation analysis&#46; There are many techniques and indexes&#44; but perhaps the most famous is the Impact Factor&#46; The Impact Factor is the number of citations in the current year of items published in the previous 2 years divided by the number of substantive articles and reviews published in the same 2 years&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> For example&#44; if a journal has an Impact Factor of 5 in 2008&#44; it means that the papers published in 2006 and 2007 had an average of 5 citations in 2008&#46; The analysis of the Impact Factor should be made with caution&#44; since there are several factors that can influence this index&#44; such as the citation distribution of journals&#44; the publication lag and the online availability of publications&#46; These issues are further discussed by Dong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Furthermore&#44; you should not compare Impact Factors of different medical fields&#44; because of different citation properties&#44; such as citation density and half-life&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">You can find the annual reports of the Impact Factor and other indexes in the Journal Citation Report&#44; provided by Thomson Reuters &#40;more info at <a href="http://go.thomsonreuters.com/jcr">http&#58;&#47;&#47;go&#46;thomsonreuters&#46;com&#47;jcr</a>&#41;&#46; The top ten journals of the General and Internal Medicine&#44; as of 2009&#44; are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Search strategy</span><p id="par0035" class="elsevierStylePara elsevierViewall">Before you begin your search&#44; you should define a strategy&#46; A search strategy is a set of simple actions that maximize the effectiveness of your search&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The first step is to frame a focused and consistent question to ask&#46; A technique that aids the construction of the question is to use a structured framework&#46; There are many frameworks&#44; but the most referred is PICO&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> PICO stands for Patient&#47;Population&#47;Problem&#44; Intervention&#47;Exposure&#44; Comparison and Outcome&#44; and can be extended to include the Type of question being asked &#40;therapy&#44; diagnosis&#44; prognosis&#44; etc&#46;&#41; and the Type of study design&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> For example&#44; you may ask if a shot of a steroid could work as well as five days of oral steroids in a young child after an asthma exacerbation&#46; The question&#44; based on the PICO framework&#44; would be &#8220;Among young children with acute asthma exacerbation &#40;Population&#41;&#44; is a single dose of IM dexamethasone &#40;Intervention&#41; comparable to five days of oral prednisolone &#40;Comparison&#41; for resolution of asthma symptoms &#40;Outcome&#41;&#63;&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In this case&#44; you could also consider searching for Therapy studies&#44; usually Randomized Controlled Trials&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Next&#44; using the components outlined with PICO&#44; define the concepts you want to include in your query&#44; followed by synonyms and alternative terms&#46; Delineate the specifics of your search&#58; temporal interval &#40;last 5 years&#44; last decade&#44; etc&#46;&#41;&#44; type of study &#40;systematic reviews&#44; randomized controlled trials&#44; cohort studies&#44; etc&#46;&#41; and participants characteristics &#40;age&#44; gender&#44; etc&#46;&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The best search strategies for a particular question are often achieved through trial and error&#44; so keep on practising&#46; The efficacy of your query will improve with time and experience&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Where to search&#63;</span><p id="par0055" class="elsevierStylePara elsevierViewall">There are many databases and search engines you can use&#46; There are databases of specific types of studies&#44; or specific diseases or conditions&#46; You can find some examples in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; adapted from Pai et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and Hull et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">PubMed has gained a high profile and authority in the biomedical field throughout the years&#46; Because it is easy and quick to use and providing free access&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> we will use it as an example&#46; We believe that satisfactory search techniques are easily replicated in all search engines and databases&#46; However&#44; be warned that if you are conducting a systematic review&#44; where search methods are fundamental to the validity of the study&#44; using PubMed alone may not be sufficient&#44; and you should include other databases and search engines&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Pubmed was created in 1997 by the National Library of Medicine of USA&#44; with the aim of providing free access to MEDLINE&#44; a large biomedical database&#46; It has over 20 million citations&#44; 6000 journals&#44; and 57 languages and is known for covering a large spectrum of clinical&#44; biomedicine&#44; bioethics and life sciences journals&#44; covering publications since 1950&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> You will not find the full text of the paper you are searching in PubMed&#44; but instead&#44; you will have external links to the full-text and also the possibility of navigating through related articles&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Searching Pubmed</span><p id="par0070" class="elsevierStylePara elsevierViewall">PubMed has been recently updated&#44; and now has a cleaner and more user-friendly interface&#46; The search-box is available everywhere in the site&#44; and you can use it whenever you want&#46; Just fill in your query in the search box and click &#8220;Go&#8221;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">You will most probably have several terms in your query&#44; and you may combine them using special words&#46; They are the Boolean operators&#44; created by George Boole in the XIX century&#46; You can use <span class="elsevierStyleBold">AND</span>&#44; <span class="elsevierStyleBold">OR</span> and <span class="elsevierStyleBold">NOT</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Using <span class="elsevierStyleBold">AND</span> will narrow the results of your search&#44; selecting only articles that contain all the terms linked with the operator&#44; whereas <span class="elsevierStyleBold">OR</span> will &#8220;explode&#8221; the search&#44; increasing the number of results&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> You can see some examples in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The terms of your query can also be truncated&#44; using a wildcard character&#44; &#8220;&#42;&#8221;&#46; For instance&#44; if you search for &#8220;Alerg&#42;&#8221;&#44; your output will include references with the terms &#8220;Allergy&#8221;&#44; &#8220;Allergen&#8221; and &#8220;Allergic&#8221;&#46; Moreover&#44; there is a list of common words in the English language that are ignored when searching PubMed&#46; They are known as &#8220;Stopwords&#8221;&#44; and the output generated when searching with these words would probably include all references available&#33; They should not be included in your query&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Another useful feature of PubMed is that it is possible to specify a field in which a term should be applied&#46; All references in PubMed are defined with several descriptors&#44; such as Author&#44; Journal&#44; Publication Date&#44; Title&#44; etc&#46; You can mark a term in your query with square brackets&#44; so that it only applies to the specific descriptor&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows examples of some descriptors and how to use them&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">And of course&#44; you can combine all these possibilities&#58;</p><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Wyatt J &#91;au&#93; AND BMJ &#91;ta&#93; AND last 5 years &#91;dp&#93;</span> &#8211; Outputs all references with an author called Wyatt J&#44; that have been published in the British Medical Journal in the last 5 years&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Asthma AND 2007 &#91;dp&#93; AND treatment &#91;tiab&#93;</span> &#8211; Outputs all references with the term &#8220;Asthma&#8221;&#44; published in 2007 and which contain the term &#8220;treatment&#8221; in both the title and the abstract&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">PubMed also offers some useful tools&#44; of which we describe the most relevant ones&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">MeSH Terms</span><p id="par0115" class="elsevierStylePara elsevierViewall">You can search PubMed using only keywords&#44; but this method has some limitations&#46; Using thesaurus-based searching may be more appropriate&#46; Indexers assign descriptors to each reference&#44; from a controlled list of subject terms&#46; The terms used in PubMed are called MeSH Terms&#44; acronym for Medical Subject Headings&#46; There are over 23000 terms&#44; updated weekly and reviewed annually&#46; They have a hierarchical division&#44; with narrower terms under broader terms&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> For example&#44; the term for Chronic Obstructive Pulmonary Disease is &#8220;Pulmonary Disease&#44; Chronic Obstructive&#8221;&#44; and is organized under Lung Diseases&#44; Obstructive<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Lung Diseases<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Respiratory Tract Diseases<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Diseases&#46; You can learn more about MeSH terms in a specific section of the website of the National Library of Medicine&#44; available at <a href="http://www.nlm.nih.gov/mesh">http&#58;&#47;&#47;www&#46;nlm&#46;nih&#46;gov&#47;mesh</a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">There are advantages when you use MeSH terms in your query&#46; They link synonyms&#44; grammatical and spelling alternatives together and represent unique meanings for homonyms words&#46; Moreover&#44; they should ensure more relevant references in the output of your search&#46; MeSH terms facilitate the design of your query by allowing broader &#40;&#8220;exploding&#8221;&#41; or narrower searches &#40;using &#8220;subheadings&#8221;&#41;&#46; The disadvantages are that the indexer attribution of a term may be wrong&#44; leading to false positive results and also that recent concepts may not yet have a MeSH term&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> There is no &#8220;right&#8221; way to use MeSH Terms or keywords&#44; so try different combinations to see which one works best with your question&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Limits</span><p id="par0125" class="elsevierStylePara elsevierViewall">With this tool&#44; you can apply limits to your search&#44; as you may have defined in your search strategy&#46; You can state&#44; amongst other things&#44; the range of the date of publication&#44; types of articles to be included&#44; species &#40;humans or animals&#41;&#44; languages&#44; study participant&#39;s gender and age group&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical queries</span><p id="par0130" class="elsevierStylePara elsevierViewall">Clinical queries are a set of instruments that add detailed components to your query&#44; with the aim of improving your results&#46; You can define if you only want to search systematic reviews or genetic studies&#46; You can also include particular study types&#44; such as etiology&#44; diagnostic&#44; therapeutics &#40;default choice&#41; or prognostic studies&#46; Furthermore&#44; you can say if you want your search to be more narrow and specific &#40;fewer results but more accurate&#41; or to be more broad and sensitive &#40;more results but less accurate&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Journal Database</span><p id="par0135" class="elsevierStylePara elsevierViewall">You can use this database to search for a particular journal&#46; It is very useful if you want&#44; for instance&#44; to only retrieve articles from a given journal or analyze the publications of a journal in a specific medical field&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Single Citation Matcher</span><p id="par0140" class="elsevierStylePara elsevierViewall">If you want to search for an individual article&#44; it may be easier to use the single citation matcher&#46; Just fill in the details of the reference you are interested in &#40;journal&#44; date&#44; author name and title words&#41;&#46; The more details you enter&#44; the more accurate the search&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">What to do with too many &#47; too few results&#63;</span><p id="par0145" class="elsevierStylePara elsevierViewall">If you have too many results&#44; it is probably best to refine the search terms&#46; Use fewer synonyms or try to search only in the title of the references&#46; Also&#44; try to use Limits to restrict your search&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">When you have too few or no results&#44; search for errors in your query&#46; Use broader terms and increase the timespan of your search&#46; Try to use more concepts and terms&#44; while removing terms that are very specific&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Getting the full-text</span><p id="par0155" class="elsevierStylePara elsevierViewall">When you open a reference in PubMed&#44; we will most probably find links to external sites where you can download the full-text of the article&#46; They can refer to libraries&#44; the website of the journal&#44; or to online open-access repositories&#44; such as PubMed Central &#40;<a href="http://www.ncbi.nlm.nih.gov/pmc">www&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;pmc</a>&#41;&#46; Some journals or repositories will require a subscription or a single &#8220;pay-per-view&#8221; to give you access to the full-text of the article&#46; However&#44; most academic and research institutions have access to relevant databases and journals&#44; and you can try getting the full-text through them&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Managing results</span><p id="par0160" class="elsevierStylePara elsevierViewall">There are many methods that you can use to store the results of your search&#46; You can write them in your notebook &#40;not advisable&#33;&#41;&#44; save them in a text file or a spreadsheet&#44; or use specific software called &#8220;Bibliographic Managers&#8221;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Bibliographic Managers offer many features to save and use bibliographical references&#44; and are usually very flexible and versatile&#46; They can be used to store references to items in many different formats and material types&#44; search and output references in many citation styles&#44; import references directly from online databases&#44; insert references in a document and generate bibliographies&#44; and also store links to documents related to the references&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Bibliographic managers are available in many formats and have a long list of features&#44; so you should try them &#40;most are free and easy to install&#41; to see which applies best to your workflow&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> There are commercial&#44; free&#44; open-source and web-based options&#46; Probably the best known commercial software is Endnote &#40;<a href="http://www.endnote.com/">http&#58;&#47;&#47;www&#46;endnote&#46;com</a>&#41; or Reference Manager &#40;<a href="http://www.refman.com/">http&#58;&#47;&#47;www&#46;refman&#46;com</a>&#41;&#46; Other options include Mendeley &#40;<a href="http://www.mendeley.com/">http&#58;&#47;&#47;www&#46;mendeley&#46;com</a>&#41; and Zotero &#40;<a href="http://www.zotero.org/">http&#58;&#47;&#47;www&#46;zotero&#46;org</a>&#41;&#44; both free&#46; For web-based bibliographic managers&#44; you can try CiteULike &#40;<a href="http://citeulike.org/">http&#58;&#47;&#47;citeulike&#46;org</a>&#41; or Connotea &#40;<a href="http://www.connotea.org/">http&#58;&#47;&#47;www&#46;connotea&#46;org</a>&#41;&#46;</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0175" class="elsevierStylePara elsevierViewall">Being able to search and identify relevant data and information is essential for the clinical decision and for clinical research&#46; There are a number of rules and concepts&#44; that are easy to apprehend and to use&#44; and which considerably improve the outputs of your search&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">As Isaac Newton said&#44; &#8220;If I have seen further it is by standing on the shoulders of giants&#8221;&#46; In the Internet era&#44; there are many &#8220;giants&#8221; of information available for you to use&#46; Carefully define your aims and design your question&#44; and with some practice and experience&#44; you will find your &#8220;needle in a haystack&#8221;&#46;</p></span></span>"
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          "titulo" => "Searching Biomedical Information"
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              "titulo" => "Searching Pubmed"
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              "titulo" => "MeSH Terms"
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              "identificador" => "sec0040"
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              "identificador" => "sec0055"
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              "identificador" => "sec0060"
              "titulo" => "What to do with too many &#47; too few results&#63;"
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            10 => array:2 [
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              "titulo" => "Getting the full-text"
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        2 => array:2 [
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Boolean Operators</span></p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dark grey area represent the output of your search&#44; which is the result of the combination of the terms and the operators&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Impact Factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total Cites&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Articles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">New England Journal Of Medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">216752&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">352&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">The Lancet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;758&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">152843&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">280&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Journal Of The American Medical Association&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;899&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">117090&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">234&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Annals Of Internal Medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45184&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">174&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">British Medical Journal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71175&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">345&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PLOS Medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8425&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Annual Review Of Medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4257&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Archives Of Internal Medicine&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35977&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">203&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Canadian Medical Association Journal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;271&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Journal Of Internal Medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;942&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7470&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">105&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Database&#47;Search Engine&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Size &#40;&#35; references&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Pubmed &#40;Medline&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62; 20&#46;000&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Free <span class="elsevierStyleInterRef" href="http://www.pubmed.gov/">http&#58;&#47;&#47;www&#46;pubmed&#46;gov</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">SciVerse SCOPUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Broad scientific coverage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62; 33&#46;000&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Requires Subscription &#40;Elsevier&#41; <span class="elsevierStyleInterRef" href="http://www.info.sciverse.com/scopus">http&#58;&#47;&#47;www&#46;info&#46;sciverse&#46;com&#47;scopus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ISI Web of Knowledge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Broad scientific coverage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62; 15&#46;000&#46;000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Broad coverage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not published&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Free <span class="elsevierStyleInterRef" href="http://scholar.google.com/">http&#58;&#47;&#47;scholar&#46;google&#46;com</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Embase&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62; 24&#46;000&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Requires subscription &#40;Elsevier&#41; <span class="elsevierStyleInterRef" href="http://www.embase.com/">http&#58;&#47;&#47;www&#46;embase&#46;com</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Cochrane Database of Systematic Reviews&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Systematic reviews in health care&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62; 6600&nbsp;\t\t\t\t\t\t\n
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                    0 => array:2 [
                      "titulo" => "As we may search&#58; Comparison of major features of the Web of Science&#44; Scopus&#44; and Google Scholar citation-based and citation-enhanced databases"
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                          "etal" => false
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                      "Revista" => array:5 [
                        "tituloSerie" => "Current science"
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                        "paginaInicial" => "1537"
                        "paginaFinal" => "1547"
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              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Healthcare Research&#58; A Textbook for Students and"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46; Roberts"
                            1 => "H&#46; Priest"
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                    ]
                  ]
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                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2010"
                        "editorial" => "Wiley"
                        "editorialLocalizacion" => "Practitioners"
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                ]
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            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Integrating evidence into clinical practice&#58; an alternative to evidence based approaches"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;R&#46; Tonelli"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2753.2004.00551.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Journal of evaluation in clinical practice"
                        "fecha" => "2006"
                        "volumen" => "12"
                        "paginaInicial" => "248"
                        "paginaFinal" => "256"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16722902"
                            "web" => "Medline"
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                ]
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              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of online literature searching on length of stay and patient care costs"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;S&#46; Klein"
                            1 => "F&#46;V&#46; Ross"
                            2 => "D&#46;L&#46; Adams"
                            3 => "C&#46;M&#46; Gilbert"
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                    ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Academic Medicine"
                        "fecha" => "1994"
                        "volumen" => "69"
                        "paginaInicial" => "489"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8003169"
                            "web" => "Medline"
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              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A Web-based compendium of clinical questions and medical evidence to educate internal medicine residents"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;D&#46; Crowley"
                            1 => "T&#46;A&#46; Owens"
                            2 => "C&#46;M&#46; Schardt"
                            3 => "S&#46;I&#46; Wardell"
                            4 => "J&#46; Peterson"
                            5 => "S&#46; Garrison"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12634206"
                            "web" => "Medline"
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            5 => array:3 [
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              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How to read a paper&#58; The basics of evidence-based medicine"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "T&#46; Greenhalgh"
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                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "2010"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Remarks on angina pectoris"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Warren"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "The New England Journal of Medicine&#44; Surgery and Collateral Branches of Science"
                        "fecha" => "1812"
                        "volumen" => "1"
                        "paginaInicial" => "1"
                        "paginaFinal" => "11"
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            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "MEDLINE Fact Sheet&#46; National Library of Medicine&#59; 2011 &#91;24&#47;04&#47;2011&#93;&#59; Available from&#58; <a href="http://www.nlm.nih.gov/pubs/factsheets/medline.html">http&#58;&#47;&#47;www&#46;nlm&#46;nih&#46;gov&#47;pubs&#47;factsheets&#47;medline&#46;html</a>&#46;"
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              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "The history and meaning of the journal impact factor"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46; Garfield"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.295.1.90"
                      "Revista" => array:5 [
                        "tituloSerie" => "JAMA&#58; the journal of the American Medical Association"
                        "fecha" => "2006"
                        "volumen" => "295"
                        "paginaInicial" => "90"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16391221"
                            "web" => "Medline"
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The &#8220;impact factor&#8221; revisited"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Dong"
                            1 => "M&#46; Loh"
                            2 => "A&#46; Mondry"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1742-5581-2-7"
                      "Revista" => array:5 [
                        "tituloSerie" => "Biomedical digital libraries"
                        "fecha" => "2005"
                        "volumen" => "2"
                        "paginaInicial" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16324222"
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              "identificador" => "bib0055"
              "etiqueta" => "11"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Weighing the Evidence&#58; PICO Questions&#58; What Are They&#44; and Why Bother&#63;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "V&#46; Moyer"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "AAP Grand Rounds"
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                        "paginaInicial" => "2"
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            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Utilization of the PICO framework to improve searching PubMed for clinical questions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Schardt"
                            1 => "M&#46;B&#46; Adams"
                            2 => "T&#46; Owens"
                            3 => "S&#46; Keitz"
                            4 => "P&#46; Fontelo"
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1472-6947-7-16"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC medical informatics and decision making"
                        "fecha" => "2007"
                        "volumen" => "7"
                        "paginaInicial" => "16"
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Thematic series
How to write a scientific paper - Searching and Managing Biomedical information
Como escrever um artigo científico - Pesquisa e gestão da informação biomédica
T. Jacintoa,
Corresponding author
tiagojacinto@med.up.pt

Corresponding author.
, A. Moraisb, J.A. Fonsecaa
a Biostatistics and Medical Informatics Department & CINTESIS, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
b Pulmonology Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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to identify and locate relevant sources&#44; know how to access them&#44; how to appraise the information and how to organize it&#46; Biomedical literature tells us what is already known and helps prepare future work&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Furthermore&#44; it is an essential component of the clinical decision&#44; along with clinical experience and the values and preferences of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> There is evidence that immediately available online information can change and improve clinical decisions&#46; Searching MEDLINE when inpatients are admitted significantly reduces costs and length of stay&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In a study by Crowley et al&#44; 77&#37; of 625 clinical questions of Internal Medicine residents were answered using MEDLINE&#44; which led to 47&#37; of changes in clinical management&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this paper is to address some topics on searching and managing biomedical information&#46; We will discuss the construction of a search query and the development of a search strategy&#46; We will use PubMed as an example&#44; and demonstrate some of the tools that are provided&#46; Hopefully&#44; you will find some of the topics discussed useful when trying to find a specific answer to a question arising in your practice or engaging on a systematic search of data and information to access the current knowledge or ignorance in your medical field&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Searching Biomedical Information</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">What to search&#63;</span><p id="par0020" class="elsevierStylePara elsevierViewall">You are searching for scientific publications&#44; usually called the &#8220;literature&#8221;&#44; which are reports of empirical or theoretical scientific work&#46; They can be very varied&#44; such as journals&#44; conference proceedings&#44; books&#44; technical reports&#44; leaflets or patents&#46; You will most frequently tend to be searching for scientific articles in journals&#44; which are indexed in different online databases &#40;based on various criterions&#44; such as the existence of peer review&#44; the scientific field and the periodicity of publications&#44; amongst others&#41;&#46; The first medical journal was the New England Journal of Medicine&#44; with its first article published in 1812&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Nowadays&#44; MEDLINE alone indexes more than 5500 journals&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">It is possible to understand the influence of biomedical journals with the help of citation analysis&#46; There are many techniques and indexes&#44; but perhaps the most famous is the Impact Factor&#46; The Impact Factor is the number of citations in the current year of items published in the previous 2 years divided by the number of substantive articles and reviews published in the same 2 years&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> For example&#44; if a journal has an Impact Factor of 5 in 2008&#44; it means that the papers published in 2006 and 2007 had an average of 5 citations in 2008&#46; The analysis of the Impact Factor should be made with caution&#44; since there are several factors that can influence this index&#44; such as the citation distribution of journals&#44; the publication lag and the online availability of publications&#46; These issues are further discussed by Dong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Furthermore&#44; you should not compare Impact Factors of different medical fields&#44; because of different citation properties&#44; such as citation density and half-life&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">You can find the annual reports of the Impact Factor and other indexes in the Journal Citation Report&#44; provided by Thomson Reuters &#40;more info at <a href="http://go.thomsonreuters.com/jcr">http&#58;&#47;&#47;go&#46;thomsonreuters&#46;com&#47;jcr</a>&#41;&#46; The top ten journals of the General and Internal Medicine&#44; as of 2009&#44; are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Search strategy</span><p id="par0035" class="elsevierStylePara elsevierViewall">Before you begin your search&#44; you should define a strategy&#46; A search strategy is a set of simple actions that maximize the effectiveness of your search&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The first step is to frame a focused and consistent question to ask&#46; A technique that aids the construction of the question is to use a structured framework&#46; There are many frameworks&#44; but the most referred is PICO&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> PICO stands for Patient&#47;Population&#47;Problem&#44; Intervention&#47;Exposure&#44; Comparison and Outcome&#44; and can be extended to include the Type of question being asked &#40;therapy&#44; diagnosis&#44; prognosis&#44; etc&#46;&#41; and the Type of study design&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> For example&#44; you may ask if a shot of a steroid could work as well as five days of oral steroids in a young child after an asthma exacerbation&#46; The question&#44; based on the PICO framework&#44; would be &#8220;Among young children with acute asthma exacerbation &#40;Population&#41;&#44; is a single dose of IM dexamethasone &#40;Intervention&#41; comparable to five days of oral prednisolone &#40;Comparison&#41; for resolution of asthma symptoms &#40;Outcome&#41;&#63;&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In this case&#44; you could also consider searching for Therapy studies&#44; usually Randomized Controlled Trials&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Next&#44; using the components outlined with PICO&#44; define the concepts you want to include in your query&#44; followed by synonyms and alternative terms&#46; Delineate the specifics of your search&#58; temporal interval &#40;last 5 years&#44; last decade&#44; etc&#46;&#41;&#44; type of study &#40;systematic reviews&#44; randomized controlled trials&#44; cohort studies&#44; etc&#46;&#41; and participants characteristics &#40;age&#44; gender&#44; etc&#46;&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The best search strategies for a particular question are often achieved through trial and error&#44; so keep on practising&#46; The efficacy of your query will improve with time and experience&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Where to search&#63;</span><p id="par0055" class="elsevierStylePara elsevierViewall">There are many databases and search engines you can use&#46; There are databases of specific types of studies&#44; or specific diseases or conditions&#46; You can find some examples in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; adapted from Pai et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and Hull et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">PubMed has gained a high profile and authority in the biomedical field throughout the years&#46; Because it is easy and quick to use and providing free access&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> we will use it as an example&#46; We believe that satisfactory search techniques are easily replicated in all search engines and databases&#46; However&#44; be warned that if you are conducting a systematic review&#44; where search methods are fundamental to the validity of the study&#44; using PubMed alone may not be sufficient&#44; and you should include other databases and search engines&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Pubmed was created in 1997 by the National Library of Medicine of USA&#44; with the aim of providing free access to MEDLINE&#44; a large biomedical database&#46; It has over 20 million citations&#44; 6000 journals&#44; and 57 languages and is known for covering a large spectrum of clinical&#44; biomedicine&#44; bioethics and life sciences journals&#44; covering publications since 1950&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> You will not find the full text of the paper you are searching in PubMed&#44; but instead&#44; you will have external links to the full-text and also the possibility of navigating through related articles&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Searching Pubmed</span><p id="par0070" class="elsevierStylePara elsevierViewall">PubMed has been recently updated&#44; and now has a cleaner and more user-friendly interface&#46; The search-box is available everywhere in the site&#44; and you can use it whenever you want&#46; Just fill in your query in the search box and click &#8220;Go&#8221;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">You will most probably have several terms in your query&#44; and you may combine them using special words&#46; They are the Boolean operators&#44; created by George Boole in the XIX century&#46; You can use <span class="elsevierStyleBold">AND</span>&#44; <span class="elsevierStyleBold">OR</span> and <span class="elsevierStyleBold">NOT</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Using <span class="elsevierStyleBold">AND</span> will narrow the results of your search&#44; selecting only articles that contain all the terms linked with the operator&#44; whereas <span class="elsevierStyleBold">OR</span> will &#8220;explode&#8221; the search&#44; increasing the number of results&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> You can see some examples in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The terms of your query can also be truncated&#44; using a wildcard character&#44; &#8220;&#42;&#8221;&#46; For instance&#44; if you search for &#8220;Alerg&#42;&#8221;&#44; your output will include references with the terms &#8220;Allergy&#8221;&#44; &#8220;Allergen&#8221; and &#8220;Allergic&#8221;&#46; Moreover&#44; there is a list of common words in the English language that are ignored when searching PubMed&#46; They are known as &#8220;Stopwords&#8221;&#44; and the output generated when searching with these words would probably include all references available&#33; They should not be included in your query&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Another useful feature of PubMed is that it is possible to specify a field in which a term should be applied&#46; All references in PubMed are defined with several descriptors&#44; such as Author&#44; Journal&#44; Publication Date&#44; Title&#44; etc&#46; You can mark a term in your query with square brackets&#44; so that it only applies to the specific descriptor&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows examples of some descriptors and how to use them&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">And of course&#44; you can combine all these possibilities&#58;</p><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Wyatt J &#91;au&#93; AND BMJ &#91;ta&#93; AND last 5 years &#91;dp&#93;</span> &#8211; Outputs all references with an author called Wyatt J&#44; that have been published in the British Medical Journal in the last 5 years&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Asthma AND 2007 &#91;dp&#93; AND treatment &#91;tiab&#93;</span> &#8211; Outputs all references with the term &#8220;Asthma&#8221;&#44; published in 2007 and which contain the term &#8220;treatment&#8221; in both the title and the abstract&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">PubMed also offers some useful tools&#44; of which we describe the most relevant ones&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">MeSH Terms</span><p id="par0115" class="elsevierStylePara elsevierViewall">You can search PubMed using only keywords&#44; but this method has some limitations&#46; Using thesaurus-based searching may be more appropriate&#46; Indexers assign descriptors to each reference&#44; from a controlled list of subject terms&#46; The terms used in PubMed are called MeSH Terms&#44; acronym for Medical Subject Headings&#46; There are over 23000 terms&#44; updated weekly and reviewed annually&#46; They have a hierarchical division&#44; with narrower terms under broader terms&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> For example&#44; the term for Chronic Obstructive Pulmonary Disease is &#8220;Pulmonary Disease&#44; Chronic Obstructive&#8221;&#44; and is organized under Lung Diseases&#44; Obstructive<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Lung Diseases<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Respiratory Tract Diseases<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Diseases&#46; You can learn more about MeSH terms in a specific section of the website of the National Library of Medicine&#44; available at <a href="http://www.nlm.nih.gov/mesh">http&#58;&#47;&#47;www&#46;nlm&#46;nih&#46;gov&#47;mesh</a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">There are advantages when you use MeSH terms in your query&#46; They link synonyms&#44; grammatical and spelling alternatives together and represent unique meanings for homonyms words&#46; Moreover&#44; they should ensure more relevant references in the output of your search&#46; MeSH terms facilitate the design of your query by allowing broader &#40;&#8220;exploding&#8221;&#41; or narrower searches &#40;using &#8220;subheadings&#8221;&#41;&#46; The disadvantages are that the indexer attribution of a term may be wrong&#44; leading to false positive results and also that recent concepts may not yet have a MeSH term&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> There is no &#8220;right&#8221; way to use MeSH Terms or keywords&#44; so try different combinations to see which one works best with your question&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Limits</span><p id="par0125" class="elsevierStylePara elsevierViewall">With this tool&#44; you can apply limits to your search&#44; as you may have defined in your search strategy&#46; You can state&#44; amongst other things&#44; the range of the date of publication&#44; types of articles to be included&#44; species &#40;humans or animals&#41;&#44; languages&#44; study participant&#39;s gender and age group&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical queries</span><p id="par0130" class="elsevierStylePara elsevierViewall">Clinical queries are a set of instruments that add detailed components to your query&#44; with the aim of improving your results&#46; You can define if you only want to search systematic reviews or genetic studies&#46; You can also include particular study types&#44; such as etiology&#44; diagnostic&#44; therapeutics &#40;default choice&#41; or prognostic studies&#46; Furthermore&#44; you can say if you want your search to be more narrow and specific &#40;fewer results but more accurate&#41; or to be more broad and sensitive &#40;more results but less accurate&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Journal Database</span><p id="par0135" class="elsevierStylePara elsevierViewall">You can use this database to search for a particular journal&#46; It is very useful if you want&#44; for instance&#44; to only retrieve articles from a given journal or analyze the publications of a journal in a specific medical field&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Single Citation Matcher</span><p id="par0140" class="elsevierStylePara elsevierViewall">If you want to search for an individual article&#44; it may be easier to use the single citation matcher&#46; Just fill in the details of the reference you are interested in &#40;journal&#44; date&#44; author name and title words&#41;&#46; The more details you enter&#44; the more accurate the search&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">What to do with too many &#47; too few results&#63;</span><p id="par0145" class="elsevierStylePara elsevierViewall">If you have too many results&#44; it is probably best to refine the search terms&#46; Use fewer synonyms or try to search only in the title of the references&#46; Also&#44; try to use Limits to restrict your search&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">When you have too few or no results&#44; search for errors in your query&#46; Use broader terms and increase the timespan of your search&#46; Try to use more concepts and terms&#44; while removing terms that are very specific&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Getting the full-text</span><p id="par0155" class="elsevierStylePara elsevierViewall">When you open a reference in PubMed&#44; we will most probably find links to external sites where you can download the full-text of the article&#46; They can refer to libraries&#44; the website of the journal&#44; or to online open-access repositories&#44; such as PubMed Central &#40;<a href="http://www.ncbi.nlm.nih.gov/pmc">www&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;pmc</a>&#41;&#46; Some journals or repositories will require a subscription or a single &#8220;pay-per-view&#8221; to give you access to the full-text of the article&#46; However&#44; most academic and research institutions have access to relevant databases and journals&#44; and you can try getting the full-text through them&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Managing results</span><p id="par0160" class="elsevierStylePara elsevierViewall">There are many methods that you can use to store the results of your search&#46; You can write them in your notebook &#40;not advisable&#33;&#41;&#44; save them in a text file or a spreadsheet&#44; or use specific software called &#8220;Bibliographic Managers&#8221;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Bibliographic Managers offer many features to save and use bibliographical references&#44; and are usually very flexible and versatile&#46; They can be used to store references to items in many different formats and material types&#44; search and output references in many citation styles&#44; import references directly from online databases&#44; insert references in a document and generate bibliographies&#44; and also store links to documents related to the references&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Bibliographic managers are available in many formats and have a long list of features&#44; so you should try them &#40;most are free and easy to install&#41; to see which applies best to your workflow&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> There are commercial&#44; free&#44; open-source and web-based options&#46; Probably the best known commercial software is Endnote &#40;<a href="http://www.endnote.com/">http&#58;&#47;&#47;www&#46;endnote&#46;com</a>&#41; or Reference Manager &#40;<a href="http://www.refman.com/">http&#58;&#47;&#47;www&#46;refman&#46;com</a>&#41;&#46; Other options include Mendeley &#40;<a href="http://www.mendeley.com/">http&#58;&#47;&#47;www&#46;mendeley&#46;com</a>&#41; and Zotero &#40;<a href="http://www.zotero.org/">http&#58;&#47;&#47;www&#46;zotero&#46;org</a>&#41;&#44; both free&#46; For web-based bibliographic managers&#44; you can try CiteULike &#40;<a href="http://citeulike.org/">http&#58;&#47;&#47;citeulike&#46;org</a>&#41; or Connotea &#40;<a href="http://www.connotea.org/">http&#58;&#47;&#47;www&#46;connotea&#46;org</a>&#41;&#46;</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0175" class="elsevierStylePara elsevierViewall">Being able to search and identify relevant data and information is essential for the clinical decision and for clinical research&#46; There are a number of rules and concepts&#44; that are easy to apprehend and to use&#44; and which considerably improve the outputs of your search&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">As Isaac Newton said&#44; &#8220;If I have seen further it is by standing on the shoulders of giants&#8221;&#46; In the Internet era&#44; there are many &#8220;giants&#8221; of information available for you to use&#46; Carefully define your aims and design your question&#44; and with some practice and experience&#44; you will find your &#8220;needle in a haystack&#8221;&#46;</p></span></span>"
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              "titulo" => "Searching Pubmed"
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              "titulo" => "Limits"
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              "titulo" => "Single Citation Matcher"
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              "titulo" => "What to do with too many &#47; too few results&#63;"
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            10 => array:2 [
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              "titulo" => "Getting the full-text"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Boolean Operators</span></p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dark grey area represent the output of your search&#44; which is the result of the combination of the terms and the operators&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Impact Factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total Cites&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Articles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">New England Journal Of Medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">216752&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">352&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">The Lancet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;758&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">152843&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">280&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Journal Of The American Medical Association&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;899&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">117090&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">234&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Annals Of Internal Medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45184&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">174&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">British Medical Journal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71175&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">345&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PLOS Medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8425&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Annual Review Of Medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4257&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Archives Of Internal Medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;813&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35977&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">203&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Canadian Medical Association Journal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;271&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Journal Of Internal Medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;942&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7470&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Size &#40;&#35; references&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Requires subscription &#40;Elsevier&#41; <span class="elsevierStyleInterRef" href="http://www.embase.com/">http&#58;&#47;&#47;www&#46;embase&#46;com</span>&nbsp;\t\t\t\t\t\t\n
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                        0 => array:2 [
                          "etal" => false
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                        0 => array:2 [
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                          "autores" => array:2 [
                            0 => "P&#46; Roberts"
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                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2010"
                        "editorial" => "Wiley"
                        "editorialLocalizacion" => "Practitioners"
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                ]
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              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Integrating evidence into clinical practice&#58; an alternative to evidence based approaches"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;R&#46; Tonelli"
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                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2753.2004.00551.x"
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                        "tituloSerie" => "Journal of evaluation in clinical practice"
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                        "volumen" => "12"
                        "paginaInicial" => "248"
                        "paginaFinal" => "256"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16722902"
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ISSN: 08732159
Original language: English
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Pulmonology

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