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Dental Medicine and Oral Health Sciences

Foreground questions

Foreground questions are specific and relevant to the clinical issue. Foreground questions must be asked in order to determine which of two interventions is the most effective in improving patient outcomes. For example, "In adult patients undergoing surgery, how does guided imagery compared with music therapy affect analgesia use within the first 24 hours post-op?" is a specific, well-defined question that can only be answered by searching the current literature for studies comparing these two interventions.

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-Based Practice, Step by Step: Asking the Clinical Question: A Key Step in Evidence-Based Practice. AJN, American Journal of Nursing, 110(3), 58-61.

Growing Pearls

An easy way to start your search is the find one or two relevant articles and use these to see what keywords you might use to find others like them.

You can also look to see how these articles are indexed. To do this, search for one of the articles by title in the database you wish to search. View the full record to see what subject headings have been assigned and add these subject headings to your search.

Librarians call this "pearl growing".

Google Scholar or Scopus are good places to start growing pearls, but you can do this in any database that uses subject headings.

Tip for building your Medline search:

In Google Scholar, view all versions of the relevant article you have found and view the version that has the link "". This will bring you to Pubmed, where you can click on "MeSH terms" to see what subject headings were used in Medline.

Refining and Improving your Search

Remember that the search process is iterative. If your search results are not relevant, revise your search! Most searches will require revision.


If your results are off topic:

  • Try growing pearls: f you found one or two relevant articles, see what subject headings and keywords are being used and add these.

If you have too many results:

  • Add additional concepts or subject headings (also called controlled vocabulary or controlled terms) and combine with AND (the more concepts you have the more specific your search)
    e.g. minor depression AND self care AND written materials.
  • Use narrower subject headings

To get new ideas for subject headings in Ovid-Medline and Cinahl, type in your keywords and make sure the "suggest subject headings" box is ticked. Select from the list of suggested terms (add these one at a time onto a separate line of your search).

  • Select one or more of the database's limit types
    e.g. publication type, language, publication date
  • Search for words only in a particular field
    e.g. self care in title only 

If you have too few results

  • Remove a less important concept (the fewer concepts you have the more sensitive your search)
    e.g. minor depression AND self care (remove written materials)
  • Use a broader subject heading
    e.g. depression instead of minor depression
  • Use truncation to allow the terms to end in various ways
    e.g. written material* (this will find both written material AND written materials)
  • Add synonyms or similar concepts, combining them with OR to generate more results
    e.g. minor depression AND self care AND (written materials OR patient education)

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