On Doctoring MEDLINE searches, with reference librarian comments, March 2000

The question was

What is the treatment plan for acute hypotension as a result of combining Viagra with organic nitrates?

1     exp Hypotension/ci [Chemically Induced]    results= 1043   
2     Drug interactions/ or "viagra".mp.    results= 15693   
3     1 and 2    results= 54   
4     Nitroglycerin/    results= 2626   
5     3 and 4    results= 2   
6     limit 3 to (human and english language)    results= 33   
7     "VIAGRA".mp.    results= 109   
8     1 and 4 and 7    results= 0   
9     1 and 7    results= 3   
10     exp Hypotension/    results= 4132   
11     10 and 7    results= 3   
12     "SILDENAFIL".mp.    results= 274   
13     12 and 10    results= 6   
14     4 and (7 or 12)    results= 4   
15     Angina pectoris/ or Coronary disease/ or Myocardial    results= 45448   
ischemia/ or Nitrates/ or Nitroglycerin/ or "nitrate
antianginal agents".mp.
16     15 and (12 or 7)    results= 18   
17     from 16 keep 3,5-6,10-12    results= 6   
18     from 14 keep 1-3    results= 3   

Reference Librarian comments

You were getting around MEDLINE nicely. You exploded subject headings, selected subheadings, used "limits," combine sets. You even did "parentheses" tricks. Great job.

I decided to try this search myself, in two different ways, and deliberately different from your approach, just to see what happened.

It looks like viagra is also called sildenafil and is part of the much larger piperazines family. It turns out that it's difficult to nail down "Viagra" in MEDLINE. It's just too new to have its own subject-heading.

Anyway, I did various tricks to get to set #4, (below), which I then "ANDed" to hypotension, and only got 6 references. Then i wondered: "Hey what about ANY old piperazine. Is there literature on hypotension and piperazines? Yes, but not much more. In set #8, I entertained myself for about 90 seconds looking at references which were about piperazines which were NOT viagra and which were involved somehow with hypotension. Great fun.

Then I thought I'd just "throw out" the whole Viagra concept. If you have hypotension in an elderly male, what do you do? That's in search °°B°°

°°A°°

#
Search History
Results
1
exp Piperazines/ae,pd,pk,po,to,ct [Adverse Effects, Pharmacology, Pharmacokinetics, Poisoning, Toxicity,
Contraindications]
8368
2
"SILDENAFIL".mp.
274
3
viagra.mp.
109
4
1 and (2 or 3)
128
5
exp Hypotension/
4132
6
4 and 5
6
7
1 and 5
15
8
7 not 6
9

°°B°°

Medline 1991 to January 2000

#
Search History
Results
1
exp *Hypotension/dt,th [Drug Therapy, Therapy]
259
2
limit 1 to (male and ("aged < 65 and over >" or "aged, 80 and over"))
63