Library Services
Healthcare databases for NHS
staff (HDAS)
An introductory guide
Alan Fricker
Library Liaison Manager
[email protected]
October 2014
1. Aims of the training ....................................................................................................... 3
Learning objectives .......................................................................................................... 3
2. Background information ............................................................................................... 3
What are healthcare databases? .................................................................................. 3
Databases available for NHS staff ................................................................................ 3
Electronic journals and ebooks available for NHS staff ................................................ 5
The Cochrane Library and additional eresources ......................................................... 5
3. How to register ............................................................................................................... 6
4. Planning your search. ................................................................................................... 6
Choosing a database ....................................................................................................... 7
5. Getting into the databases ............................................................................................ 8
6. Keyword searching ........................................................................................................ 8
7. Combining your searches. .......................................................................................... 10
8. Displaying, saving, printing and emailing your search results. .............................. 11
9. Deleting your search. .................................................................................................. 12
10. Changing databases, repeating and removing duplicates ..................................... 12
11. Searching for an author ............................................................................................ 12
12. Subject heading searching. ...................................................................................... 13
Combining keyword and subject heading searches ....................................................... 16
13. Limiting your search.................................................................................................. 18
14. Saving and re-running search strategies and creating alerts. ............................... 19
15. Logging off ................................................................................................................. 20
16. Further information and support .............................................................................. 20
Obtaining full-text articles and King’s College London email accounts .......................... 20
Exercises. ......................................................................................................................... 20
Appendix .......................................................................................................................... 23
Search tips ..................................................................................................................... 23
Too many results ........................................................................................................ 23
Too few results ........................................................................................................... 24
1. Aims of the training
The aim of the course is to introduce the most important features of the key databases
available to NHS staff. This guide covers the NHS interface for accessing databases
(HDAS). NHS staff can also access most of the databases via Ovid (see separate guide).
Learning objectives
By the end of the session, participants will have learnt:

how to select the most appropriate database for their needs

how to devise and execute a simple search strategy using both subject headings and
keyword searches

how to broaden or refine searches by combining or limiting results

how to display, select, save and print results.
2. Background information
What are healthcare databases?
The databases are known as bibliographic databases. They provide references of the
printed health care journal literature. You will find a range of types of journal articles
describing everything from systematic reviews to case reports. Most records contain
abstracts. Some of the databases also reference other publication types, including book
chapters, theses and reports.
Databases available for NHS staff
AMED
An allied and complementary medicine database. Its main strengths lie in the fields of
physiotherapy, occupational therapy, rehabilitation, podiatry, palliative care and speech
and language therapy. Although international in coverage, it has a strong emphasis on
European information. 1985 to date.
British Nursing Index
A valuable resource for nurses, midwives and health visitors, encompassing references
and abstracts from over 220 British and English language nursing journals primarily
published in the UK. 1992 to date.
3
CINAHL
The Cumulative Index to Nursing and Allied Health Literature (CINAHL). A major literature
resource in the field of nursing and allied health, providing references to research from
over 1,600 current international journals. Subject coverage includes primary journals from
allied health disciplines such as physiotherapy, occupational therapy and rehabilitation,
health education, nutrition and medical technology. 1981 to date.
EMBASE
A major literature resource in the field of biomedicine and drug research, providing
references from over 3,500 international journals with extensive coverage of the European
literature. Its comprehensive coverage includes pharmacy and pharmacology, toxicology,
public and environmental health, psychiatry and forensic science. 1980 to date.
HMIC
Comprises DH Data and Kings Fund databases both of which cover UK NHS health
services management, policy and standards and social care. DH Data includes planning financial, building and equipment; public health; toxicity studies on specific chemicals.
Kings Fund’s focus is on improvements in health and health care, covering health
inequalities, partnership working and workforce development. 1979 to date
Medline
The most widely used database for information retrieval in biomedicine and health,
providing access to over 22 million references to research papers from some 5,600
international journals. It has extensive subject coverage with an emphasis on clinical
medicine and biomedical research, but also including dentistry, pharmacology,
microbiology, nutrition, health care delivery, psychiatry, psychology . 1946 to date.
PsycINFO
A major database in the field of psychology. It provides references from over 1,900
journals. While its main focus is psychology its coverage is multidisciplinary, including
psychiatry, education, medicine, nursing, law and social work. In addition to journal
literature, other information is drawn from alternative sources such as books, book
chapters, theses and reports. 1806 to date.
4
Electronic journals available for NHS staff
In addition to databases, thousands of electronic full text journals are accessible. A variety
of different companies provide access to the full text journals sometimes familiar
publishers (like Wiley) but also companies that sell collections like Proquest.
An A-Z journals list is available via www.library.nhs.uk/booksandjournals/journals/
(NB you need to login with NHS OpenAthens to see the full list) You can access full-text
journals directly from this list. Alternatively, when you do a search on one of the databases
above and view your search results you will see which articles are available to you in full
text.
Additional ejournals are available via King’s College London. See ejournals link at:
www.kcl.ac.uk/library/
For further information see our website: www.kcl.ac.uk/library/nhs or the ‘accessing fulltext journal articles’ guide.
The Cochrane Library
The Cochrane Library is a key source of information on the effects of interventions in
health care. It is designed to provide information and evidence to support decisions taken
in health care. It is also available to all NHS staff (not via the NHS interface covered in this
guide). The use of this database is covered in a separate course and user guide and
is not described here. You should consider using this database for information on the
effectiveness of particular treatments or interventions. It is not useful for general
information on healthcare topics. It is available via www.thecochranelibrary.com
Additional electronic resources
NHS staff have access to a range of evidence based eresources, including Clinical
Evidence, BMJ Case Reports, BMJ Learning, Drug and Therapeutics Bulletin, Anatomy
TV.
These can be accessed by logging into the MyAthens website via www.athens.nhs.uk
which lists all the resources to which you are entitled using your NHS OpenAthens
password,
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3. How to register
The NHS username and passwords are authenticated by a system called OpenAthens
which administers access to eresources for some organisations in health and academic
sectors.
All of the databases, ejournals and additional eresources require a personal NHS
OpenAthens username and password.
You need to self-register online at www.athens.nhs.uk via the NHS network or using your
NHS email address.
4. Planning your search.
Before you start searching for information, it is a good idea to plan your search.
Things to think about include:

why you need the information (research, patient care, strategy planning);

who do you need it for (manager, patient, your own studies etc.);
This will help you choose an appropriate resource and decide how comprehensive your
search needs to be.
You also need to be as specific as possible with your question.
Broad question: what treatments are effective for epilepsy?
Focused question: is a ketogenic diet effective for children with epilepsy
If it isn’t possible to narrow it down then you may need to look in a textbook or for
summaries of evidence rather than for original research articles.
Don’t try to search using whole sentences. The more words you use at once the fewer
results you will find!
Instead, think of the most important keywords you need to use and search for these
separately. You should also try to think about any other synonyms or alternative spellings
to describe your subject.
6
You may find it helpful to think of PICO to help you pick out the keywords. Using these
questions can help you to pick out the most important concepts:
P
Patient
(Who is the patient? What part of the population are you
interested in?)
I
Intervention
(What treatment, health promotion intervention or therapy
do you want to investigate?)
C
Comparison
(What do you want to compare this treatment to? This is
optional, you may not have a comparison.)
O
Outcome
(What is the expected or desired outcome of the
intervention? What do you want to achieve?)
Example:
You are interested in finding good quality recent research into whether compression
bandages are effective for venous ulcers in older people
P
older people; elderly; venous ulcers; varicose ulcers
I
compression bandages; compression stockings
C
-
O
morbidity; function; quality of life
You can use Limits to find articles on a specific age group. You may not need to enter
search terms for the “outcomes” element, but use this as a criteria to screen your results.
Choosing a database
Your search topic will dictate which database or database(s) you choose. The coverage of
each database is described above.
As a general rule a thorough search should include Medline and at least one other
database. Medline has such a broad coverage you will always find something of
relevance but you will probably also want to search another database which focuses on
your particular specialty. For example EMBASE is good for drug information; CINAHL and
BNI are the two key nursing databases, and CINAHL and AMED cover allied health.
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You should also consider searching the Cochrane Library if you are looking at the
effectiveness of healthcare interventions.
An Advanced search in a single database is the recommended way of searching if
you are looking for articles on a particular topic and is the method of searching
covered by this guide.
5. Getting into the databases
We are now going to carry out the search we planned in the section above.
Go to: www.evidence.nhs.uk/ click the Journals and Database tab and select Healthcare
Databases Advanced Search then log in with your NHS OpenAthens username and
password.
Click on the Database name you wish to search, e.g. MEDLINE.
This handout uses examples from Medline, but the other databases can be searched
in the same way. Whichever database you use the search screens will look very similar.
You can navigate around the system by using the links below, e.g. go back to the search
page by clicking on Search and Limits, or to the original list of databases by clicking
Databases select.
The name of the database you are currently in is above the search box.
The
buttons show you where help is available for a particular action. Click on one of
the buttons and a Help screen will appear.
6. Keyword searching
There is a single search box. Next to this there is a box which allows you to apply your
search term to a particular field of the database, eg author. The fields available will differ
from database to database.
8
We will look for articles on venous ulcers and compression bandages.
Type your first search term – venous ulcers – into the search box as below, ensuring title
and abstract is selected. Click on Search.
The NHS interface automatically combines words together using AND, e.g. the search
above would look for venous leg ulcers as well as venous ulcers. You need to use
inverted commas if you wish to look for a phrase, e.g. “venous ulcers”. Plurals will
not be found automatically for you. Use truncation to find plurals or alternative word
endings, e.g. ulcer* will find ulcers and ulceration as well as ulcer. You also need to
consider UK and US spellings.
We have found articles whose title or abstract mention venous ulcers, but the articles will
not necessarily also mention compression bandages. We need to do another search to
narrow down to articles on this topic.
Repeat the steps you followed to search for venous ulcers, but this time look for
compression bandages.
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7. Combining your searches.
In the example above, we have carried out a search for venous ulcers and then a search
for compression bandages. At the moment, these two searches are not related. There
are two different ways to combine searches and they will each give you different results.
Search statement
Shaded areas indicate
Types of records retrieved
retrieval of records
stress OR anxiety
stress AND anxiety
Documents that discuss
either stress or anxiety
Documents that discuss
both stress and anxiety
We have found articles on all aspects of venous ulcers and articles on all aspects of
compression bandages. We have to combine the two searches to find articles that are
about both of these subjects. Therefore we want to combine our topics using AND
(venous ulcers AND compression bandages) to find articles that cover BOTH subjects.
Tick the boxes of the searches you wish to combine and click on Combine selected as
below:
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8. Displaying, saving, printing and emailing your search results.
Clicking on the number under View Results in the right hand column will bring up a list of
references produced by the search
They will not all be available in full text, but most should have an abstract available.

You can display the abstract by clicking on the blue title link at the top of each
reference. There is also a tick box ‘display abstracts’ above the first result to show
all abstracts.

Click on the Available in full text at link to access the full-text article

If you have more than ten results you can scroll through them, page by page, using
the buttons at the top and bottom.

You can also sort results, e.g. by Publication date, and choose to display more than
ten at a time by selecting from the drop down menus above the first result.

You can tick those that you are interested in, using the boxes on the left hand side
of each reference.

You can then choose to save (to display, save or export to bibliographic software,
e.g. Endnote) or email your selection. You can also click on ‘copy to clipboard’.
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Saving at this point will simply save the search results. See section 14 for saving and rerunning search strategies. To get back to the main search page, click on the Search
and Limits link towards the top of the screen.
9. Deleting your search.
Once you have finished looking at the results of a search, you may find it easier to delete
the search before you start on a new one. Tick the boxes for the lines you want to delete
and click on Delete button. You can select all searches by ticking the box in the top row.
10. Changing databases, repeating and removing duplicates
To change to a different database and start a new search, click on Databases select
link towards the top of the main screen and then select the next database you want to
search (remember to untick the box for the database you have just searched).
If you wish to repeat your search in another database, this can now be performed from
the main search page, by changing the database listed underneath the search history, and
clicking on re-run as below:
You can remove duplicates from searches across databases by selecting the relevant
lines and clicking on the Remove duplicates button above the search history (NB there is
a limit of 500 total articles across databases).
11. Searching for an author
Author searching: use the format "smith j*" , "smith je" or "smith*" (include the quotes)
Enter “Smith J*” in the search box. Tick author next to the search box. Click Search
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12. Subject heading searching.
When we typed in a search term for the search above, we only looked at the titles and
abstracts of articles and we only looked for the exact words that we typed in the search
box. If someone had written about varicose ulcers, rather than about venous ulcers,
we will not have found their article.
Each reference in a database will have a number of subject headings assigned to it. In
Medline they are specifically known as MeSH (Medical Subject Headings).
Searching for a subject heading will pick up all articles on that subject without you
having to search for every possible word or phrase that an author may have used to
describe that subject. For example, the subject heading for venous ulcers is Varicose
Ulcers and a search for that subject heading will bring up articles that mention venous
ulcers or varicose ulcers or venous leg ulceration or varicose ulceration etc. Using these
terms is the recommended way of doing a reliable search on a particular topic.
You don't need to know all the headings in the thesaurus because a function called Map
to Thesaurus will tell the system to look for likely subject headings matching your search
term.
The example of an (edited) Medline record below illustrates the difference between a
keyword search (as we did above) and a subject heading search. A keyword search will
search the Title and Abstract section of the record. A subject heading search will search
the Subject Headings section of the record.
The article below is relevant to our search, but we would not have picked it up so
far, as it doesn’t mention bandages in the title or abstract. However, it does have the
Subject Headings Compression Bandages, so it would be picked up by a Subject
Heading search.
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MEDLINE RECORD
Successful treatment of venous stasis ulcers with combination compression therapy and
pulsed radio frequency energy in a patient scheduled for amputation.
Citation: Journal of Wound, Ostomy, & Continence Nursing, 01-02 2011, vol./is. 38/1(914), 1071-5754;1528-3976 (2011 Jan-Feb)
Author(s): Fletcher S
Abstract: BACKGROUND: Venous ulcers are a frequent complication of chronic venous
insufficiency. Compression therapy remains the mainstay of conservative treatment, as
many patients are not candidates for surgical intervention.CASE:. Mr A underwent
treatment with a combination of compression therapy and pulsed radio frequency
energy.CONCLUSION: Compression therapy plus pulsed radio frequency energy led to
healing of his venous leg ulcers and avoided amputation of the affected limb. This
treatment is currently being evaluated in other patients with chronic venous insufficiency
and ulceration.
Subject Heading(s):
*Amputation
*Catheter Ablation/mt [Methods]
*Compression Bandages/ut [Utilization]
*Varicose Ulcer/th [Therapy]
*Wound Healing
Combined Modality Therapy
Limb Salvage/mt [Methods]
Nursing Assessment
Preoperative Care
Referral and Consultation
Treatment Outcome
Varicose Ulcer/us [Ultrasonography]
We will now continue our search, this time using subject headings.
14
Re-enter your first term: venous ulcers, but this time tick the Map to Thesaurus box as
below, and click on Search (do NOT click on Browse)
This will bring up the page below:
Select Varicose Ulcer by ticking the box on the right as above.
If you aren’t sure which subject heading to select, you can:

click on the [scope] link beside the heading. This will tell you about the meaning and
use of the heading.

click on the subject heading itself. This will take you to a ‘tree’ structure (with your
subject heading in bold) which shows you how the subject heading relates to other
subject headings. At the top of the structure is a summary of broader headings.

For instance for Varicose Ulcers the broader heading structure is as below:
15
It is best NOT to select more than one subject heading at a time, even if more than
one looks relevant. Instead search for each subject heading separately by using Map to
Thesaurus on the main search screen.
You can choose to tick any, all, some or none of the other boxes on the right:
Explode – this will search for your selected term plus any narrower, more specific terms
(these will be listed in the structure underneath your heading and indented to the right –
see compression bandages example below)
Major – this means that the term you have selected will be one of the key concepts of
articles retrieved (this is a subjective decision made by the indexer so use with care)
Subheadings – this allows you to assign a number of headings to refine your search, e.g.
therapy, diagnosis, prevention
We will then repeat the same process as above for compression bandages.
In this case if we click on the heading Compression Bandages in the structure we see
there is a more specific term – Stockings, Compression – so to include this we need to
ensure we tick Select and Explode before clicking on Search.
Combining keyword and subject heading searches
We now need to combine our two topics together. We could just combine the two subject
heading searches. However, not all articles will have the correct headings, and recent
articles may not have any headings. So, to be thorough, we should combine a keyword
search for a topic, with the subject heading for that topic, using OR.
16
The original search we carried out was for articles containing venous ulcers in the title or
abstract. We have now searched for articles indexed under the subject heading Varicose
Ulcer. Since these are both the same topic, we should add them together into one set
using OR.
We also need to do the same for the two searches on compression bandages. Finally we
need to combine our two different topics using AND, to find articles that are about both of
these topics.
Line 6 = articles which either mention venous AND ulcers in the title and abstract OR
have Varicose Ulcers as a subject heading
Line 7 = articles which either mention compression AND bandages in the title and
abstract OR have Compression Bandages as a subject heading
Line 8 = articles which are about both of the above
You can see that combining the keyword and subject heading searches together for each
topic gave over twice as many results than the keyword search on its own.
We have ended up with over 300 references to articles that are about both venous ulcers
and bandaging: this is rather too many to search through. Once you have entered your
main subjects in and combined them, you can reduce your final results further and make
them more specific by using Limits.
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13. Limiting your search.
You can use the Limit facility to focus your search further and reduce your results. It is
better to keep your search as inclusive as possible whilst you are carrying it out, so as not
to exclude potentially relevant references at an early stage.
For example, you can limit to a particular language, publication date, population/patient
age group, or publication type (e.g. randomized controlled trials). You can choose as many
limits as you wish in order to limit your search results. However, use some Limits (e.g.
Human, Age Groups, Gender) with caution, as they rely on the article being indexed
with that heading, and can miss relevant articles if they have not been correctly indexed.
The different Limit options can be seen by clicking on the Limits tab (next to the Search
tab).
The limits available will vary depending upon which database you are searching.
You can click on apply limits against individual search lines in the search history, and
then select limits as below
The above screen shows the impact of limiting to the Publication Year 2007-current. You
can also select the Age Groups limit to limit results to older people.
Remember to Clear all Limits before performing a new search.
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14. Saving and re-running search strategies and creating
alerts.
If you wish to, you can save your search strategies for future use. They will be saved as
permanent strategies, which will remain in your account until you delete them. Your
searches can also be saved as alerts - which means that the system will re-run your
search for you on a regular basis and then email you with any new articles.
Click on Save All to save all the search, or Save selected lines if you have selected
specific lines to save
Give the search a name, and then choose to either Save, or Save and Create an alert. If
you choose to save and create an alert, you will be asked to enter the email address to
send the alerts to, and what format and frequency you would like to receive the alert.
To access your saved searches and alerts, click on the Saved Searches or Alerts links at
the top of the screen:
To re-run a saved search, click on Saved Searches, select the search you wish to run
and then Click on the appropriate button, e.g. Run Search (this will run the search in the
database(s) you originally saved the search in). Run in Current database will run the
search in the database you are currently searching.
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The search will then appear on the Main Search Page.
15. Logging off
Once you have finished all your searches, log off. To log out of the databases, click on
your name in the top right:
This link also goes to My Account where you can access searches and alerts and also
change your email address, password or organisation.
16. Further information and support
Obtaining full-text articles
NHS staff who are members of King’s College London Libraries can request delivery of
items from other King’s sites, or from other libraries.
Please complete an inter-library loan request online via the Library catalogue (please
note: you will need your library card details and PIN) where you can also check to see if
we hold a journal.
For further information see our website: www.kcl.ac.uk/library/nhs or the ‘accessing fulltext journal articles’ guide.
King’s College London email accounts
King’s College London no longer uses OpenAthens to access eresources. NHS staff
involved in teaching, research or administration on behalf of the College may be entitled to
register for an affiliate KCL email account, which in turn will generate remote access to
significant additional electronic resources. For details please contact a Library enquiry
desk or contact [email protected]
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Exercises.
Exercise 1
Select one (or more) of the following scenarios.
Your patient is suffering from depression and would like information on whether
taking St John’s Wort might be helpful for her.
What are the main keywords that you would search for?
What database(s) would you use?
You would like to find recent research on the MMR vaccination and autism.
What are the main keywords that you would search for?
What database(s) would you use?
Are there any advantages to health care workers being given the flu jab?
What are the main keywords that you would search for?
What database(s) would you use?
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Exercise 2
Try carrying out one (or more) of the searches from Exercise 1, or a topic of your own*,
including the following steps (tick them off):

search for the first topic using a keyword or phrase

(tick thesaurus mapping to find the relevant subject heading, and search for this too)

combine the keyword and subject heading search

(using OR)
repeat steps 1-2 for each topic in your search (combine the resulting sets using AND)

limit the results, e.g. to a particular date range or language

email some abstracts to yourself

access a full-text article (if available)

search the King’s library catalogue / ejournals list to find an article not available full-text
from your search

save the search

delete the search

change databases
*if you choose a topic of your own, you will also need to select an appropriate database,
and keywords
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Appendix
Search tips
Too many results
If you have too many results, you should consider the following options:

Is there is a narrower (more precise) keyword or phrase that you can use (‘smoking
cessation’ rather than ‘smoking’; ‘MMR vaccine’ rather than ‘vaccinations’)?

When carrying out a subject heading search, click on the Subject Heading itself and
see if there is a narrower subject heading (e.g. Myocardial Infarction rather than
Heart Diseases).

Can you focus in on a more specific aspect of a subject? For example ‘physiotherapy
AND rehabilitation’ rather than ‘rehabilitation’; diet AND health promotion rather than
just ‘diet’.

Is there a further topic that you could add into your search? The more subjects you
search for and combine with AND the fewer results you will have.

Choose fewer similar subject headings and keywords for each topic. The fewer words
you search for and combine with OR the fewer results you will have for that concept.

Consider using more Limits: the more you use, the fewer results you will have.

Consider limiting to Randomized Controlled Trials, if appropriate. This will reduce your
results considerably, even without the use of any other limits. Furthermore this will pick
out the most effective research.

Consider removing keyword searches for very common words (e.g. risk)

Consider ticking the Major box when searching for subject headings which will only find
articles where your subject is the main focus. Use with care as you may end up
excluding articles that are useful.

Could you use specific sub-headings for your Subject Headings? You can tick as
many or as few sub-heading boxes as you like, to home in on specific aspect(s) of your
subject.
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Too few results
If you have too few results, you should consider the following options:

Is there a broader term that you could use (‘eating disorders’ rather than ‘anorexia’;
‘lung’ rather than ‘bronchi’)?

When carrying out a subject heading search, click on the Subject Heading itself and
see if there is a narrower subject heading (e.g. Heart Diseases rather than
Myocardial Infarction).

Are there any synonyms, alternative terms and alternative spellings for your term?

Choose additional similar subject headings and keywords for each topic. The more
words you search for and combine with OR the more results you will have for that
concept.

Could you exclude the least important part of your search? The fewer subjects you
search for and combine with AND the more results you will have.

Check the subject headings of relevant articles by looking at the abstract. This may
give you some more ideas of terms to search for.

Don’t Limit your search at all until you see how many results you have at the end.
Only Limit if you have too many results to manage.

Make sure you tick the Explode box for all your Subject Headings.

Check the definition [scope] for the subject heading you have chosen. Some
alternative terms may be suggested. It will also indicate whether a different subject
heading was used for this term in the past – in which case you may need to search for
this heading too, especially if you are looking for older articles.
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