sources of literature in medical research

Evidence-based Medicine: Types of Literature

• Core EBM Databases
• Ask an Answerable Question (PICO)
• Acquire the Evidence
• Appraise the Evidence
• Apply the evidence in your clinical practice.
• Assess your performance
• Study Designs

Types of Literature

• Clinical Guidelines
• How to Find Books
• PubMed Guide This link opens in a new window
• EBM Resources
• Systematic Review Guide This link opens in a new window
• Literature Review Guide This link opens in a new window

Different types of publications have different characteristics.

Primary Literature Primary sources means original studies, based on direct observation, use of statistical records, interviews, or experimental methods, of actual practices or the actual impact of practices or policies. They are authored by researchers, contains original research data, and are usually published in a peer-reviewed journal. Primary literature may also include conference papers, pre-prints, or preliminary reports. Also called empirical research .

Secondary Literature Secondary literature consists of interpretations and evaluations that are derived from or refer to the primary source literature. Examples include review articles (such as meta-analysis and systematic reviews) and reference works. Professionals within each discipline take the primary literature and synthesize, generalize, and integrate new research.

Tertiary Literature Tertiary literature consists of a distillation and collection of primary and secondary sources such as textbooks, encyclopedia articles, and guidebooks or handbooks. The purpose of tertiary literature is to provide an overview of key research findings and an introduction to principles and practices within the discipline.

Adapted from the Information Services Department of the Library of the Health Sciences-Chicago , University of Illinois at Chicago.

Types of Scientific Publications

These examples and descriptions of publication types will give you an idea of how to use various works and why you would want to write a particular kind of paper.

• Scholarly article aka empirical article
• Review article
• Conference paper

Scholarly (aka empirical) article -- example

Empirical studies use data derived from observation or experiment. Original research papers (also called primary research articles) that describe empirical studies and their results are published in academic journals.  Articles that report empirical research contain different sections which relate to the steps of the scientific method.

      Abstract - The abstract provides a very brief summary of the research.

     Introduction - The introduction sets the research in a context, which provides a review of related research and develops the hypotheses for the research.

     Method - The method section describes how the research was conducted.

     Results - The results section describes the outcomes of the study.

     Discussion - The discussion section contains the interpretations and implications of the study.

     References - A references section lists the articles, books, and other material cited in the report.

Review article -- example

A review article summarizes a particular field of study and places the recent research in context. It provides an overview and is an excellent introduction to a subject area. The references used in a review article are helpful as they lead to more in-depth research.

Many databases have limits or filters to search for review articles. You can also search by keywords like review article, survey, overview, summary, etc.

Conference proceedings, abstracts and reports -- example

Conference proceedings, abstracts and reports are not usually peer-reviewed.  A conference article is similar to a scholarly article insofar as it is academic. Conference articles are published much more quickly than scholarly articles. You can find conference papers in many of the same places as scholarly articles.

How Do You Identify Empirical Articles?

To identify an article based on empirical research, look for the following characteristics:

     The article is published in a peer-reviewed journal .

     The article includes charts, graphs, or statistical analysis .

     The article is substantial in size , likely to be more than 5 pages long.

     The article contains the following parts (the exact terms may vary): abstract, introduction, method, results, discussion, references .

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• Getting Started
• Anatomy of a Citation
• PubMed Quick Guide
• Keyword or Subject?
• Clinical Queries
• How to Use MeSH
• Research Tips

Types of Medical Literature

Different kinds of information sources are useful depending on your topic and the type of information you need.

Books are good for general background and in-depth coverage of a topic. They are often not as current as journal articles because they take a long time to research, write, and publish.

Books may be useful when:

• You need a broad overview. There are times when you want someone to explain everything to you - beginning to end. Books are very appropriate for this.
• Your research topic is historical . Books lend themselves to topics in which the facts don't change much over time.
• You want several opinions from one place . Some books collect essays that give you several points of view in one source.

Books may not be useful when:

• The topic is very recent . Books take years to get researched, written, published, purchased, and put on library shelves. If the issue you are researching is constantly changing, a book may be outdated by the time it gets to the library.
• You have a fairly narrow topic . Sometimes books are too broad-based to address specific or narrow points.

Articles tend to be narrow in scope and are good for focused treatment of a topic. Scholarly journals contain high-quality articles usually written by experts and use data and statistics to back arguments. Popular magazines and newspapers (such as Newsweek, People , or the New York Times ) are good for current treatment of a topic and are good resources for editorials and opinions. Note that popular magazines are not peer-reviewed.

Articles may be useful when:

• Your topic is very recent . Articles are intended to keep people up-to-date on the latest developments in various issues.
• Your research topic is very narrow in scope . Some topics are so specific, whole books will not be written on them.

Articles may not be useful when:

• You need background or overview information . Articles tend to focus on a specific aspect of a topic.
• Your topic covers a long time span . When an issue has a long history, you may only find one aspect discussed in an article.

Web sites can be very good for finding quality information including primary sources, statistical information, educational sites on many levels, policy, opinion of all kinds, and much more. However, you have to take the responsibility to rigorously evaluate each site for quality; anyone can post a Web page, regardless of their expertise or intentions.

Adapted from the University of Connecticut Libraries

Different types of publications have different characteristics.

Primary Literature

Primary sources are original materials.  It is authored by researchers, contains original research data, and is usually published in a peer-reviewed journal. Primary literature may also include conference papers, pre-prints, or preliminary reports.

Secondary Literature

Secondary literature consists of interpretations and evaluations that are derived from or refer to the primary source literature. Examples include review articles (specifically meta-analysis and systematic reviews) and reference works. Professionals within each discipline take the primary literature and synthesize, generalize, and integrate new research.

Tertiary Literature

Tertiary literature consists of a distillation and collection of primary and secondary sources such as textbooks, encyclopedia articles, and guidebooks or handbooks. The purpose of tertiary literature is to provide an overview of key research findings and an introduction to principles and practices within the discipline.

Adapted from the Information Services Department of the  Library of the Health Sciences-Chicago , University of Illinois at Chicago.

Levels of Evidence

When searching for evidence-based information, one should select the highest level of evidence possible--systematic reviews or meta-analyses. Systematic reviews, meta-analyses, and critically-appraised topics/articles have all gone through an evaluation process: they have been "filtered". 

Information that has not been critically appraised is considered "unfiltered".

As you move up the pyramid, however, fewer studies are available; it's important to recognize that high levels of evidence may not exist for your clinical question.  If this is the case, you'll need to move down the pyramid if your quest for resources at the top of the pyramid is unsuccessful.

• Meta-Analysis  A systematic review that uses quantitative methods to summarize the results.
• Systematic Review     An article in which the authors have systematically searched for, appraised, and summarised all of the medical literature for a specific topic.
• Critically Appraised Topic      Authors of critically-appraised topics evaluate and synthesize multiple research studies.
• Critically Appraised Articles   Authors of critically-appraised individual articles evaluate and synopsize individual research studies.
• Randomized Controlled Trials   RCT's include a randomized group of patients in an experimental group and a control group. These groups are followed up for the variables/outcomes of interest.
• Cohort Study   Identifies two groups (cohorts) of patients, one which did receive the exposure of interest, and one which did not, and following these cohorts forward for the outcome of interest.
• Case-Control Study   Involves identifying patients who have the outcome of interest (cases) and control patients without the same outcome, and looking to see if they had the exposure of interest.
• Background Information / Expert Opinion   Handbooks, encyclopedias, and textbooks often provide a good foundation or introduction and often include generalized information about a condition.  While background information presents a convenient summary, often it takes about three years for this type of literature to be published.
• Animal Research / Lab Studies   Information begins at the bottom of the pyramid: this is where ideas and lab research takes place. Ideas turn into therapies and diagnostic tools, which then are tested with lab models and animals.

Sources: Greenhalgh, Trisha.  How to Read a Paper: the Basics of Evidence Based Medicine .  London: BMJ, 2000. Glover, Jan; Izzo, David; Odato, Karen & Lei Wang. EBM Pyramid.  Dartmouth University/Yale University. 2006.  

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Literature Searching

• First Online: 24 March 2020

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This chapter focuses on key aspects of literature searching including types of literature sources, rigour in searching for good quality information, useful databases used in health and social care research, and the process of conducting a search. In addition, tips and tactics to help you when undertaking the literature search are provided.

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Further Readings

Greenhalgh T. How to read a paper: the basics of evidence-based medicine and healthcare. 6th ed. London: Wiley-Blackwell; 2019.

Google Scholar  

Hart C. Doing a literature review: releasing the research imagination. 2nd ed. London: Sage; 2018.

Straus S, Richardson WS, Glasziou P, Haynes RB. Evidence - based medicine: how to practice and teach EBM. 5th ed. London: Elsevier; 2018.

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Vosper, M., Dimond, A. (2020). Literature Searching. In: Ramlaul, A. (eds) Medical Imaging and Radiotherapy Research: Skills and Strategies. Springer, Cham. https://doi.org/10.1007/978-3-030-37944-5_3

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MEDLINE Overview

MEDLINE is the National Library of Medicine’s (NLM) premier bibliographic database that contains more than 31 million references to journal articles in life sciences with a concentration on biomedicine.

MEDLINE is a primary component of PubMed , a literature database developed and maintained by the NLM National Center for Biotechnology Information (NCBI). MEDLINE is the online counterpart to the MEDical Literature Analysis and Retrieval System (MEDLARS) that originated in 1964 (see MEDLINE history ). A distinctive feature of MEDLINE is that the records are indexed with NLM Medical Subject Headings (MeSH).

Selection process:  The current procedure for adding new journals to MEDLINE is described on the page How to Include a Journal in MEDLINE . Time coverage:  MEDLINE includes literature published from 1966 to present, and selected coverage of literature prior to that period. For details about pre-1966 citations see OLDMEDLINE Data .

Source:  Currently, citations from more than 5,200 worldwide journals in about 40 languages.

Updates:  Citations are added to PubMed 7 days a week.

Subject coverage:  In line with the Collection and Preservation Policy of the NLM , the subject scope of MEDLINE is biomedicine and health, broadly defined to encompass those areas of the life sciences, behavioral sciences, chemical sciences, and bioengineering needed by health professionals and others engaged in basic research and clinical care, public health, health policy development, or related educational activities. MEDLINE also covers life sciences vital to biomedical practitioners, researchers, and educators, including aspects of biology, environmental science, marine biology, plant and animal science as well as biophysics and chemistry.

The majority of the publications in MEDLINE are scholarly journals; however, a small number of newspapers, magazines, and newsletters considered useful to particular segments of the NLM broad user community have historically been included.

Availability: Searching MEDLINE via PubMed results in a list of citations (including authors, title, source, and often an abstract) to journal articles and links to the electronic full-text, if available. Searching PubMed is free of charge and does not require registration.

A growing number of MEDLINE citations in PubMed contain a link to the free full-text of the article archived in PubMed Central . Some MEDLINE citations also have publisher-provided links to the full-text of the article at the journal website; exact details depend on the publisher's access requirements.

PubMed data, including MEDLINE, can be downloaded as described on the Download PubMed Data page.

Last Reviewed: February 5, 2024

Public Health Resources

Biomedical literature, legal and public policy literature, psychology and social sciences literature, interdisciplinary literature, internationally-produced literature, grey literature.

• Data Sources
• Data Resources for Health & Medical Research This link opens in a new window
• Global Health Resources & Services This link opens in a new window
• More Welch Guides

Advanced Searching in PubMed

This series of three videos produced by the National Library of Medicine provides essential tools for searching PubMed most effectively. 

Topics covered include using the MeSH database to find targeted search terms, using the advanced search feature to build complex searches, and narrowing results with filters.

Additional PubMed videos are available on the National Center for Biotechnology Information (NCBI) YouTube Channel .  

PubMed Search Strategies

Search strategies from the National Library of Medicine's Directory of Topic-Specific PubMed Queries .

• Health Disparities
• Health Services Research
• Healthy People 2030 Healthy People 2030 sets data-driven national objectives to improve health and well-being over the next decade. Healthy People 2030 includes 358 core — or measurable — objectives as well as developmental and research objectives.
• Population Health
• The Cochrane Library This link opens in a new window The Cochrane Library is a unique source of reliable and up-to-date information on the effects of interventions in health care. Published on a quarterly basis, The Cochrane Library is designed to provide information and evidence to support decisions taken in health care and to inform those receiving care. The Cochrane Library consists of a regularly updated collection of evidence-based medicine databases.
• Embase This link opens in a new window European database providing access to the biomedical literature.
• Evidence-Based Practice for Public Health This link opens in a new window Provides access to evidence-based public health resources. Created by the Lamar Soutter Library at the University of Massachusetts Medical School.
• Global Health This link opens in a new window Brings together the Public Health and Tropical Medicine (PHTM) database, previously produced by the Bureau of Hygiene and Tropical Diseases (BHTD), and the human health and diseases information extracted from CAB ABSTRACTS.
• PubMed This link opens in a new window Access to the biomedical literature provided by the National Library of Medicine (NLM).
• EVIPNet Virtual Health Library This link opens in a new window Focusing on low and middle-income countries, EVIPNet promotes partnerships at the country level between policy-makers, researchers, and civil society. The EVIPNet portal provides access to policy briefs, reports, and research syntheses to promote the systematic use of health research evidence in policy-making.
• Nexis Uni This link opens in a new window Nexis Uni provides access to a wide range of news, business, legal, medical and reference information.
• PAIS Index This link opens in a new window Chronicles global public policy and social issues. Provides access to periodicals, books, hearings, reports, grey literature, government publications, Internet resources, and other publications from 120 countries.
• Westlaw This link opens in a new window Searches a collection of primary and secondary legal research materials that includes federal and state case law, court rules, statutory and regulatory materials, reference publications, and full text legal periodicals.
• Mental Measurements Yearbook This link opens in a new window Produced by the Buros Institute of Mental Measurements at the University of Nebraska, the Mental Measurements Yearbook™ (MMY) provides users with a comprehensive guide to over 2,700 contemporary testing instruments. Designed for an audience ranging from novice test consumers to experienced professionals, the MMY series contains information essential for a complete evaluation of test products within such diverse areas as psychology, education, business, and leadership.
• PsycINFO This link opens in a new window PsycINFO covers behavioral sciences and mental health literature for psychiatry, psychology, management, business, education, sociology, neuroscience, law, medicine and social work.
• Sociological Abstracts This link opens in a new window Contains abstracts of the literature of sociology and related social sciences from domestic and international journals.
• Academic Search Ultimate This link opens in a new window Academic Search Ultimate is a comprehensive scholarly, multi-disciplinary full-text database. In addition to full text, this database offers indexing and abstracts for more than 11,000 journals and a total of more than 11,600 publications including monographs, reports, conference proceedings, and more.
• Scopus This link opens in a new window Scopus covers biomedical, social science, and arts and humanities literature. Complete coverage to 1966. Cited references only available to 1996.
• Web of Science This link opens in a new window Web of Science covers biomedical, social science, and arts & humanities literature. Supports citation searching and offers coverage back to the mid 1970s.
• WorldCat This link opens in a new window The largest worldwide union catalog covering all materials cataloged by more than 50,000 libraries in more than 90 countries.
• Africa-Wide Information This link opens in a new window An electronic information resource that is an aggregation of 40 bibliographic databases from around the world. Databases include the Index to South African Periodicals, IBISCUS, the database form the Africa Institute, African Journal Online, Media Africa, and NAMLIT (which is compiled from the National Library of Namibia).
• African Index Medicus (AIM) This link opens in a new window The World Health Organization, in collaboration with the Association for Health Information and Libraries in Africa (AHILA), has produced an international index to African health literature and information sources.
• China Academic Journals Medicine Database (CAJ-MED) This link opens in a new window Search the Chinese literature on medicine, hygiene, health care, and the medicine of biology.
• Eldis This link opens in a new window Browse more than 26,000 summarized documents from over 7,500 development organizations - all available free to download.
• Global Index Medicus This link opens in a new window Access to a variety of international sources including the WHO regional indexes (AIM, IMEMR, IMSEAR, LILACS, and WPRO).
• IMEMR This link opens in a new window A cumulative index, covering the period 1987-1990, to over 9000 articles in the health sciences published by journals within the WHO Eastern Mediterranean Region. By documenting key bibliographic data for these articles, the index aims to increase awareness of research being conducted in this region and thus improve knowledge about the region's health problems as depicted in its local health literature.
• LILACS This link opens in a new window Health science literature published by Latin American and Caribbean authors.
• SEARO This link opens in a new window The web site of the South-East Asia Regional Office (SEARO) of the World Health Organization. Covers information related to that region of the world.
• Virtual Health Library This link opens in a new window A tool developed by the Latin American and Caribbean Center on Health Sciences Information, also known by its original name, the Regional Library of Medicine (BIREME, the acronym in Portuguese). BIREME is a specialized center of the Pan American Health Organization/World Health Organization (PAHO/WHO).

Grey literature is information produced by government agencies, academic institutions, and the for-profit sector that is not made available by commercial publishers.

• Communication Initiative This link opens in a new window A resource for the communication and social change community. Includes a variety of documents (project evaluations, methodologies, planning models, etc.) relevant to specific countries and regions.
• Global Health Observatory (GHO) This link opens in a new window The Global Health Observatory theme pages provide data and analyses on global health priorities. Each theme page provides information on global situation and trends highlights, using core indicators, database views, major publications and links to relevant web pages on the theme. The WHO Statistical Information System (WHOSIS) has been incorporated into the Global Health Observatory (GHO) to provide you with more data, more tools, more analysis and more reports.
• Grey Literature Report This link opens in a new window The Grey Literature Report is a bimonthly publication of The New York Academy of Medicine Library alerting readers to new grey literature publications in health services research and selected public health topics.
• OAIster This link opens in a new window
• OpenGrey This link opens in a new window OpenGrey (Formerly known as OpenSIGLE) is a free database of bibliographical references of reports and other grey literature produced in Europe. Topics include environmental pollution, social sciences, and biological & medical sciences.
• UK Department for International Development (DFID) This link opens in a new window Publications of the UK Department of International Development.
• USAID DEC This link opens in a new window USAID's Development Experience Clearinghouse (DEC) is the largest online resource for USAID funded technical and program documentation, with over 150,000 documents available for electronic download. Search USAID's online database of agency-funded technical and program-related documents to download for free.
• WorldWideScience.org WorldWideScience.org is a global science gateway comprised of national and international scientific databases and portals, accelerates scientific discovery and progress by providing one-stop searching of databases from around the world, and provides real-time searching and translation of globally-dispersed multilingual scientific literature.
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Primary, Secondary, and Tertiary Sources in the Health Sciences.

Primary Sources

Primary sources (or primary research) presents the immediate results of original research activities and/or new scientific discoveries..  It often includes hypotheses, experiments, analysis of data collected in the field or laboratory and a conclusion.   Primary sources are original materials/information on which other research is based.

These include:

• Journals or Periodicals : main type of publication in which scientific research is reported. 
• Theses : detailed accounts of research conducted for the awarding of higher academic degrees.  In many cases, it will also be later reported in a condensed form as a journal article.
• Conferences : Papers presented at conferences may or may not be subject to editorial scrutiny. Conference papers may not published at all, published only in abstract form, published in advance of the conference as a preprint, published in book form, or as a special issue of a journal.
• Reports : individual publications reporting research. They may report internal research within an organization, or research done by an individual or organization under contract to a client. They may be freely available, available only to members of an organization, only available by purchase, or published in a journal article. 
• Patents : provides research information on new products or processes. Once published, patent information is freely available, but rarely republished in journal articles.

Secondary Sources

Secondary sources are those that discuss the original research of others. Secondary sources list, summarize, compare, analyses, interprets, re-packages, and evaluates primary information and studies so as to draw conclusions on or present current state of knowledge in a discipline or subject. Secondary sources will include a reference list to direct you to the primary research reported in the article.

They include:

• Review Journals  : These generally start with Annual Review of …, Advances in …, Current Opinion in …
•   Article Reviews  : Articles that summarize the current literature on a specific topic.
•   Textbooks  : These can be either specialized to a narrow topic or a more boarder overview.
•   Data Compilations  :  Statistical databases (SEERS), Vital & Health Statistics, etc.
• Article Indexes/Databases : These can be abstracting or citation (e.g. Biological Abstracts/MEDLINE).

They also include:

• Reviews, systematic reviews, meta-analysis
• Newsletters and professional news sources
• Practice guidelines & standards
• Clinical care notes
• Patient education Information
• Government & legal Information

Tertiary Sources

Tertiary sources consist of primary and secondary source information which has been collected and distilled. They present summaries of or an introduction to the current state of research on a topic, summarize or condense information from primary and secondary sources, or provide a list of primary and secondary sources. These include:

• Encyclopedias

Tutorial: Identifying Primary, Secondary & Tertiary Sources in the Sciences (CSB/SJU Libraries): (2021 September 3): 3:46 min.

Primary and Secondary Literature in the Sciences: An Introduction (Egan Library): (2021 February 4): 4:04 min.

Systematic Reviews: Where to Search

• Methods & Resources
• Protocol & Registration
• Search Strategy
• Where to Search
• Study selection and appraisal
• Data Extraction, Study Characteristics, Results
• Reporting the quality/risk of bias
• PRISMA Reporting Items
• Manage citations using RefWorks This link opens in a new window
• Covidence Guide This link opens in a new window

Document your search!

You should always document your searches so that you can report your methodology. Many journals will require you to add the full electronic search strategy for each database in an appendix.

In addition to the search strategy, PRISMA checklist Item 7 requires you to report information about your sources including:

• What databases/websites you searched, the name of the database search platform and the start/end dates the index covers if relevant e.g. OVID MEDLINE (1950-present), or just PubMed
• Who developed & conducted the searches
• Date each database/website was last searched
• Supplementary sources - what other websites did you search? What journal titles were hand searched, whether reference lists were checked, what trial registries or regulatory agency websites were searched, were manufacturers or other authors contacted to obtain unpublished or missing information on study methods or results.

Top 3 Databases

At a minimum you should search MEDLINE, EMBASE, and the Cochrane CENTRAL trials register. This is the recommendation of three medical and public health research organizations: the U.S. Agency for Healthcare Research and Quality (AHRQ), the U.K. Centre for Reviews and Dissemination (CRD), and the International Cochrane Collaboration (Source: Institute of Medicine (2011)  Finding What Works in Healthcare: Standards for Systematic Reviews  Table E-1, page 267).  Some databases have an alternate version that search the same records: the content of MEDLINE is in PubMed, while the content of EMBASE is in Scopus. You should reformat your search for each database as appropriate, contact your librarian if you want help on how to search each database.  

Begin by searching:

• MEDLINE Complete Health sciences articles including clinical, basic sciences, and public health information. Coverage: 1946 - Present. Produced by the U.S. National Library of Medicine. Note that all the content indexed in MEDLINE is also indexed in PubMed.
• Scopus Interdisciplinary database covering more than 25,000 journals, tracking cited and citing literature. Cochrane recommends searching EMBASE, which Himmelfarb does not subscribe to. The content indexed in EMBASE is also indexed in Scopus, but it is not possible to perform an EMTREE thesaurus search in Scopus.
• Cochrane Central Register of Controlled Trials (CENTRAL) Database of randomized and quasi-randomized controlled trials in health care.

Search Tools

• Polyglot Search Translator A very useful tool for translating search strings from PubMed or Medline via Ovid across multiple databases, developed by the Institute for Evidence-Based Healthcare at Bond University. But please note Polyglot does not automatically map subject terms across databases (e.g. MeSH terms to Emtree terms) so you will need to manually edit the search syntax in a text editor to change to the actual subject terms used by another database.
• Yale MeSH Analyzer You can enter a list of up to 20 PMID numbers for records in the PubMed database, the Yale Mesh Analyzer will then display the Mesh Medical Subject Headings for those 20 articles as a table so you can identify and compare what Mesh headings they have in common, this can suggest additional search terms for your PubMed search.
• MedSyntax A useful tool for parsing out very long searches with many levels of brackets. This would be especially useful if you are trying to edit a pre-existing search strategy with many levels of parentheses.

Finding Pre-Existing Search Filters

Some sources for pre-existing database search filters or "hedges" include:

• CADTH Search Filters Database
• Hedges Project from McMaster University
• ISSG Search Filter Resource (York University)
• CareSearch PubMed filters For topics related to palliative care

You can also try searching PubMed for another validated search filter using some variation of a search like this, possibly adding your discipline or search topic keywords: ("Databases, Bibliographic"[Mesh] OR "Search Engine"[Mesh]) AND ("Reproducibility of Results"[Mesh] OR "Sensitivity and Specificity"[Mesh] OR validat*) AND (filter OR hedge)

Supplementary Resources

Searching the databases, websites, and journals listed here is not required to perform a systematic review, but may be beneficial. Note that you may need to reformat your search. You can also check our subject research guides for suggestions.

You may wish to search one or more of the following resources.

• Google Scholar
• Cochrane Database of Systematic Reviews To search for a pre-existing systematic review on your topic
• BASE Academic Search Engine Useful for searching in University Institutional Repositories
• Epistemonikos This database has a matrix of evidence table so you can see what citations are shared in common across existing systematic reviews of the same topic. This feature might help identify sentinel or 'don't miss' articles.

Clinical Trial Registers. The Cochrane Collaboration recommends for a systematic review to search both clinicaltrials.gov and the WHO ICTRP (See The Cochrane Handbook , section 4.3 for more information):

• ClinicalTrials.gov
• WHO International Clinical Trials Registry Platform (ICTRP)
• TRIP Database Searchable index of clinical trials, guidelines, and regulatory guidance
• ISRCTN registry
• EU Clinical Trials Register

Guidelines:

• ECRI Guidelines Trust

Grey Literature / Datasets:

• Science.gov "Authoritative scientific research results from U.S. federal agencies"
• NIH RePORTER
• re3data Registry of research data repositories
• Open Access Data Repositories (list from Simmons University)
• OpenDOAR Directory of open access repositories
• RAND Health Reports
• National Academy of Medicine Publications
• Health & Medical Care Archive (Robert Wood Johnson Foundation)
• Milbank Memorial Fund Population health. "The Fund currently publishes reports, issue briefs (shorter papers), case studies, and Milbank-supported reports"
• CADTH Grey Matters

Dissertations and Theses:

• Dissertations & Theses Dissertations and theses via Proquest Dissertations & Theses Global
• Open Access Theses and Dissertations
• You may choose to "hand search" select journals where the research team reads the Table of Contents of each issue for a chosen period of time.  You can look for the names of high impact journal titles in a particular field indexed in Journal Citation Reports (JCR) .
• See our guide to Preprints
• See our guide to Grey Literature
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Where to find medical and anatomical research

Author: Molly Smith, DipCNM, mBANT • Last reviewed: September 22, 2022 Reading time: 12 minutes

Today, thanks to platforms like Google and Wikipedia, we have quick and easy access to a wealth of medical and anatomical information with just the click of a mouse.

Such platforms are useful for getting an overview of a subject. However, the aim when looking for medical and anatomical information should always be to use accurate and reliable sources, like those found in academic research articles. 

This is a tricky area to navigate, though. You may be wondering where to find research articles, and how to tell a high quality one from a poorer quality one. There are plenty more confusing elements to consider, too, like the different types of academic research, and how this can influence the results of a given study. 

Don't stress. In this article, we’re going to cover:

• where to look
• how to look
• tips and tricks to get the most out of your research
• and common mistakes to avoid along the way

when searching for medical and anatomy research. Let's get started!

Refining your results

Primary and secondary sources, non-database sources, keeping up to date with new research, determine your search criteria .

Finding medical research and literature boils down to one crucial starting point: before you begin any search, you should have a good idea of what exactly you are searching for. It’s important that you are very clear on what your medical or anatomy research topic is, what answer you are trying to find and what types of research will be best placed to provide you with relevant information.

So, how do you determine your search criteria? Well, first you will need to analyse your research topic . What are the key component parts? Think about keywords within your topic that you could use as search terms as well as synonyms and variations of the term you search for. Outside of textbooks, the literature search engines found in medical databases and archives (discussed below) provide lots of options for refining your search criteria, for example limiting the results to human studies only, or studies conducted withing the last 10 years, and so on. 

The information you gain from doing this can help to provide you with a clearer focus by filtering out irrelevant details. This is important, as there is a lot of information out there, and it can be easy to get sidetracked!

Try to avoid using general search terms as this may result in too many hits - a large fraction of which are often useless. On the other hand, if you use terms that are too specific, this may also lead to missing out on important information that may be related to your search. If you're struggling to find something specific, a lot of larger academic libraries provide consulting services from subject librarians that can help you find subject-specific information.

As you carry out your search and analyse your results, you may find new keywords, terms or aspects of your search that you were not previously aware of. Refine and repeat your search to include these new aspects of information. Research is a cyclical process!

Need some support with your studies? Check out our guide on how and where to find anatomy study tools.

Here are some common search limits provided by literature search engines that you can use to specify the type of research your search delivers.

Publication date

Usually, if you are using scientific research to answer your medical or anatomy research topic or back up your claim, more recently published research is more highly regarded as it reflects up to date findings in the particular area of research. However, a historical perspective may be useful if you are, for example, looking to find the initial research in which a particular theory or protocol originated. Both types of research can be found on medical research databases and archives. Perhaps you will use a mixture of old and new research. Your personal research aims will inform the publication dates you will focus on finding research within.

Patient characteristics

Another important factor is patient characteristics. These refer to variables such as age , sex , environment and type of condition .

Filtering your search depending on any one of these variables will have a huge influence on the type of research you consequently find, and most importantly, the implications of the research. For example, if a study was conducted using exclusively male subjects, how might the results differ if the same experiment was conducted on female subjects? 

Additionally, the geography of the research is important as the findings may be location specific, and therefore not applicable or useful for your particular research. For example, was the research conducted in a UK population only? Or was it done on Southeast Asians? How might this affect the research results?

Lastly, the study type can provide clues to the reliability and validity of the study’s findings. The type of studies most appropriate to your research depends, once again, on the question you are looking to answer.

Randomised controlled trials , or RCT’s for short, are considered the gold standard in scientific research because they are thought to have a low risk of false causality claims and experimental bias.

Meta-analyses are great for delivering an overview of all of the research conducted into a specific subject area.

Case studies can provide interesting information about unusual cases within a population. Case studies are interesting but not especially useful, as they do not tell us about the population as a whole. 

Before we take a look at the best places to find medical information and literature, let us first look at the different sources you will likely come across in your search. Primary and secondary sources refer to two classes of information that differ in the degree to which the author is removed from the findings they describe.

Primary sources: provide direct or first hand evidence about a topic by the person who investigated it. It is a raw material of the research process. For example, a scientific paper documenting a researcher’s experiment.

Secondary sources: interpret, assign value to and draw conclusions about the information presented within primary sources of information. This would include mediums such as books, newspaper articles and article reviews.

When you are looking for medical research and literature, make sure that primary sources of information account for the majority of your notes.

Now let’s take a look at the different platforms you can use to find medical research and literature.

The best medical research databases

In terms of how to find medical and anatomical articles, research databases and archives are the best and most commonly used resources. Oftentimes, access to certain medical information and literature may not be obtainable through regular search engines. Some important databases may only be available locally within the intranets of respective universities. Check with your university or learning institution what is available.

Aside from intranet databases, there exist publically available medical research databases that can be accessed for free, such as:

• Cochrane Library
• and Google Scholar . Note: Google Scholar cross references research articles found on sites like PubMed with Google’s own regular web pages. Sometimes the cross referencing causes the database to return irrelevant websites, books or legal articles. However, generally speaking, Google Scholar makes it easier to access good quality, free full text articles. Just be careful to check the quality of the research before using it to inform your research topic.

In some cases, you may be asked for login information or credit card information to access journal articles on certain medical research databases. However, you can usually read the abstract of the article on whichever medical search enginge you're using, which will help you decide whether or not you want to learn more. In other cases, the journal you are looking for may only be available in printed form in the library holdings. In this case, the use of linking services or a link resolver may be used to find the full text.

If you are unable to find what you’re looking for from the research papers found within science research databases alone, other forms of respected evidence include:

• Publications on clinical guidelines e.g. those from the organisation NICE.
• Monographs from organisations like the World Health Organisation or the British National Formulary.
• Online learning platforms like Kenhub  - great for learning about established anatomical facts, as opposed to new research findings 
• and Evidence based textbooks

Confused about how to use anatomy resources? Read our effective guide!

However, just because information is printed in a book, does not necessarily mean that it is reliable. Always use textbooks that are used to teach accredited courses or degrees, or that are written by respected authors who work in the field that their book relates to, for instance as a university professor or clinical specialist. If you are using books as an information source, always be mindful to check that the author is qualified to write on this subject and that the information within it is up to date and supported by valid, scientific references.

New information, new discoveries and new research articles are published everyday. It is therefore important that you be open to change as well as differing opinions on a subject matter, practice patience with regards to your literature search and your findings, and also be aware that the information you find has often been created by somebody with a certain purpose or even agenda in mind.

A great way to keep your finger on the pulse with new anatomy news and current events is by browsing the contents of journals , reading subject-specific mailing lists , following other researchers on Twitter, browsing the highlighted articles on medical database homepages or even reading subject-specific weblogs . For example, a good English language weblog to keep an eye on is Plos Blogs.

These pointers are just the tip of the iceberg, but we hope you’ve finished reading this article feeling more confident about where and how to find medical and anatomical research articles and literature. Happy researching!

When it comes to medical knowledge and information, the question is: how do we find more accurate, reliable and relevant sources?! The truth is, if you want to know how to find medical research and literature, the most important thing is to have a system, such as the one given below:

• Know what you search for by being clear on your research topic, the answer you are trying to find, and what information will provide that answer.
• Become familiar with a topic by using general and broad resources, like databases, encycopledias and similar reference works.
• Limit and filter your research using aspects like publication date, patient characteristics, geography, study types (randomised controlled trials, meta-analyses, case studies)
• Focus your search mainly from primary sources of information, such as online research databases like PubMed, Cochrane Library and Google Scholar. Alternatively, monographs, clinical guidelines and evidence based textbooks are also reliable sources of information.
• Stay up-to-date with the newest research by browsing journals, following researchers on social media, or reading sub-specific weblogs.

Article, review and layout:

• Molly Smith

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Methodology

• How to Write a Literature Review | Guide, Examples, & Templates

How to Write a Literature Review | Guide, Examples, & Templates

Published on January 2, 2023 by Shona McCombes . Revised on September 11, 2023.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research that you can later apply to your paper, thesis, or dissertation topic .

There are five key steps to writing a literature review:

• Search for relevant literature
• Evaluate sources
• Identify themes, debates, and gaps
• Outline the structure
• Write your literature review

A good literature review doesn’t just summarize sources—it analyzes, synthesizes , and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

What is the purpose of a literature review, examples of literature reviews, step 1 – search for relevant literature, step 2 – evaluate and select sources, step 3 – identify themes, debates, and gaps, step 4 – outline your literature review’s structure, step 5 – write your literature review, free lecture slides, other interesting articles, frequently asked questions, introduction.

• Quick Run-through
• Step 1 & 2

When you write a thesis , dissertation , or research paper , you will likely have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and its scholarly context
• Develop a theoretical framework and methodology for your research
• Position your work in relation to other researchers and theorists
• Show how your research addresses a gap or contributes to a debate
• Evaluate the current state of research and demonstrate your knowledge of the scholarly debates around your topic.

Writing literature reviews is a particularly important skill if you want to apply for graduate school or pursue a career in research. We’ve written a step-by-step guide that you can follow below.

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See an example

Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

• Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
• Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
• Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
• Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research problem and questions .

Make a list of keywords

Start by creating a list of keywords related to your research question. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list as you discover new keywords in the process of your literature search.

• Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
• Body image, self-perception, self-esteem, mental health
• Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some useful databases to search for journals and articles include:

• Your university’s library catalogue
• Google Scholar
• Project Muse (humanities and social sciences)
• Medline (life sciences and biomedicine)
• EconLit (economics)
• Inspec (physics, engineering and computer science)

You can also use boolean operators to help narrow down your search.

Make sure to read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

You likely won’t be able to read absolutely everything that has been written on your topic, so it will be necessary to evaluate which sources are most relevant to your research question.

For each publication, ask yourself:

• What question or problem is the author addressing?
• What are the key concepts and how are they defined?
• What are the key theories, models, and methods?
• Does the research use established frameworks or take an innovative approach?
• What are the results and conclusions of the study?
• How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
• What are the strengths and weaknesses of the research?

Make sure the sources you use are credible , and make sure you read any landmark studies and major theories in your field of research.

You can use our template to summarize and evaluate sources you’re thinking about using. Click on either button below to download.

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It is important to keep track of your sources with citations to avoid plagiarism . It can be helpful to make an annotated bibliography , where you compile full citation information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

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To begin organizing your literature review’s argument and structure, be sure you understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly visual platforms like Instagram and Snapchat—this is a gap that you could address in your own research.

There are various approaches to organizing the body of a literature review. Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarizing sources in order.

Try to analyze patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organize your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text , your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, you can follow these tips:

• Summarize and synthesize: give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: don’t just paraphrase other researchers — add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically evaluate: mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: use transition words and topic sentences to draw connections, comparisons and contrasts

In the conclusion, you should summarize the key findings you have taken from the literature and emphasize their significance.

When you’ve finished writing and revising your literature review, don’t forget to proofread thoroughly before submitting. Not a language expert? Check out Scribbr’s professional proofreading services !

This article has been adapted into lecture slides that you can use to teach your students about writing a literature review.

Scribbr slides are free to use, customize, and distribute for educational purposes.

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If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

• Sampling methods
• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarize yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your thesis or dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

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• Defining the Research Question(s)
• Reference Resources
• Evidence Summaries & Clinical Guidelines
• Health Data & Statistics
• Patient & Consumer Facing Materials
• Images/Streaming Video
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• Crafting a Search
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• Save Your Searches
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• Critical Appraisal
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• Conducting & Reporting Systematic Reviews
• Finding Systematic Reviews
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Sources of OT Literature

Biomedical and health sciences.

• Medline via PubMed This link opens in a new window PubMed comprises over 30 million citations for biomedical literature from MEDLINE, life science journals, and online books. PubMed citations and abstracts include the fields of biomedicine and health, covering portions of the life sciences, behavioral sciences, chemical sciences, and bioengineering. PubMed also provides access to additional relevant web sites and links to the other NCBI molecular biology resources.
• EMBASE: Excerpta Medica 1974 – present (updated daily) This link opens in a new window EMBASE is a biomedical and pharmaceutical database indexing over 3,500 international journals in the following fields: drug research, pharmacology, pharmaceutics, toxicology, clinical and experimental human medicine, health policy and management, public health, occupational health, environmental health, drug dependence and abuse, psychiatry, forensic medicine, and biomedical engineering/instrumentation. There is selective coverage for nursing, dentistry, veterinary medicine, psychology, and alternative medicine. Dates of coverage: 1974 to present (updated daily)

Allied Health and Nursing

• CINAHL Complete This link opens in a new window CINAHL indexes over 3,800 journals from the fields of nursing and allied health, with indexing for selected journals back to 1937. Topics covered are related to nursing, physical therapy, health education, social service/healthcare, occupational therapy, and related disciplines. CINAHL also provides access to healthcare books, nursing dissertations, selected conference proceedings, standards of professional practice, educational software and audiovisual materials in nursing. Dates of coverage: 1937 to present.

Occupational Therapy

• OTseeker (Occupational Therapy Systematic Evaluation of Evidence) This link opens in a new window OTseeker is a database that contains abstracts of systematic reviews, randomised controlled trials and other resources relevant to occupational therapy interventions. Most trials have been critically appraised for their validity and interpretability.

Sports and Exercise

• SPORTDiscus This link opens in a new window SPORTDiscus covers many related sports medicine subjects, including nutrition, physical therapy, occupational health and therapy, exercise physiology, kinesiology and more. In addition to journals and monographs, the database includes references to tens of thousands of dissertations and theses. International references are included from journal and magazine articles, books, book chapters, conference proceedings and more.

Psychosocial

• PsycNET (with PsycINFO) This link opens in a new window APA PsycNET is an integrated collection of databases from the American Psychological Association (APA), including the following: PsycINFO, PsycBOOKS, PsycTESTS, PsycTHERAPY, PsycARTICLES, and PsycEXTRA. PsycINFO, the most popular database in PsycNET, is a bibliographic index covering core literature in the psychological and behavioral sciences and their related disciplines. PsycBOOKS includes online versions of the APA Handbooks in Psychology Series, as well as other ebooks and online encyclopedias published by APA. PsycTESTS is a source of structured information about psychological tests and measures as well as a repository for the full text of select instruments. PsycTHERAPY provides access to streaming psychotherapy demonstration videos. Altogether, PsycNET provides information about and access to journal articles, books and ebooks, dissertations, conference presentations, tests and measures, videos, gray literature, and many other other publication types in the psychological, social, behavioral, and health sciences. More information less... To search only a specific database (e.g., PsycINFO) within the PsycNET interface, use the "Select Databases" features at the top of the PsycNET landing page and check (or uncheck) the database(s) that apply.
• PsycINFO via Ovid This link opens in a new window PsycINFO via Ovid indexes core academic and professional literature in the psychological and behavioral sciences and their related disciplines. Coverage is from 1806 to the present. **Note that the database PsycINFO is also searchable on APA PsycNET platform.

Multidisciplinary Sources with OT Coverage

• Web of Science Core Collection This link opens in a new window Web of Science Core Collection is a multidisciplinary citation index that includes scholarly articles, conference proceedings, and books in the biomedical, psychosocial, and arts and humanities. The collections contain Science Citation, Social Sciences Citation Index, Arts and Humanities Citation Index , Conference Proceedings Citation Index, Book Citation Index, Emerging Sources Citation Index and Current Chemical Reactions index.
• Scopus This link opens in a new window Scopus is a multidisciplinary index of peer-reviewed journals and conference proceedings.
• ProQuest Central This link opens in a new window ProQuest Central is a large, multidisciplinary database with over 11,000 titles, with over 8,000 titles in full-text. It serves as the central resource for researchers at all levels in all markets. Over 160 subjects areas are covered extensively in this product including business and economics, health and medical, news and world affairs, technology, social sciences and more.
• Dissertations & Theses Global This link opens in a new window Dissertations and Theses Global contains indexes, dissertations and some theses. Full-text is available for many dissertations and theses, including those from NYU.

Education and Social Sciences

• Education Source with ERIC This link opens in a new window Education Source with ERIC provides access to research on all levels of education from early childhood to adult education. The content includes peer reviewed journal articles, ebooks, book reviews, dissertations, conference papers and policy reports on all topics in the realm of education.
• SocINDEX with Full Text This link opens in a new window SocINDEX covers the sociology literature, encompassing all sub-disciplines and closely related areas of study. It indexes scholarly journals, books, monographs, and conference papers.
• Sociological Abstracts This link opens in a new window Sociological Abstracts represents the core database for sociological scholarship, covering literature in sociology and related disciplines in the social and behavioral sciences. It indexes scholarly journals, dissertations and theses, books, and conference papers and proceedings, and is international in scope.

What is Google Scholar? How should I use it?

Google Scholar is a time-saving, scholarly search interface. With Google Scholar, you can locate scholarly journal articles, books and book sections.  For literature searching, specialized databases have more functionality and access more comprehensive results, but Google Scholar is a good tool to use for a search for a known item .

You can configure Google Scholar to:

• Display a link to NYU options for the full-text of an article
• Export your citations to RefWorks or EndNote

Here's how to display NYU links in Google Scholar:

• Open scholar.google.com
• Go to the left screen, 3 bars, "Settings" 
• Click on menu item, "Library Links"
• Type in: NYU
• From the results, put a check mark next to "New York University Libraries-GetIt at NYU"
• Click on Save to save preferences.

The next time you search scholar.google.com , the GetIt at NYU option will be available next to accessible article citations.

Here's how to change settings for Bibliography manager:

• In the Search Results, go to Bibliography Manager
• Select Show Links  to import citation into: (your choice of bibliography manager, BibTex, Refworks, Endnote, etc.)
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• Last Updated: Sep 6, 2024 1:50 PM
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Integrity of Databases for Literature Searches in Nursing

The quality of literature used as the foundation to any research or scholarly project is critical. The purpose of this study was to analyze the extent to which predatory nursing journals were included in credible databases, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus, commonly used by nurse scholars when searching for information. Findings indicated that no predatory nursing journals were currently indexed in MEDLINE or CINAHL, and only one journal was in Scopus. Citations to articles published in predatory nursing journals are not likely found in a search using these curated databases but rather through Google or Google Scholar search engines.

Research, evidence-based practice, quality improvement studies, and other scholarly projects typically begin with a literature review. In research, the review of the literature describes existing knowledge about the topic, reveals gaps and further research questions to be answered, and provides a rationale for engaging in a new study. In evidence-based practice, the literature review provides evidence to answer clinical questions and make informed decisions. Quality improvement studies also begin with a search of the literature to gather available knowledge about a problem and explore interventions used in other settings. The appearance of journals that are published by predatory publishers has introduced the danger that reviews of the literature include inadequate, poorly designed, and low-quality information being used as “evidence”—raising the possibility of risky and harmful practice. Researchers and authors should be confident in the literature they cite; readers should have assurance that the literature review is based on sound, authoritative sources. When predatory journals are cited, that trust is eroded. No matter what type of study or project is being done, the quality of literature is critical for the development of nursing knowledge and for providing up-to-date information, concepts, theories, and approaches to care. 1

An effective literature review requires searching various reliable and credible databases such as MEDLINE (through PubMed or Ovid) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), among others that are relevant to the topic. The ease of searching using a web browser (now commonly referred to as “googling”) has increased the risk of finding sources published in predatory and low-quality journals that have not met the standards of research and scholarship that can be trusted as credible and reliable evidence.

The purpose of this article is to present an analysis of the extent to which predatory nursing journals are included in MEDLINE, CINAHL, and Scopus databases, used by nurse researchers and other nurses when searching for information, and in the Directory of Open Access Journals. This directory indexes “high-quality, open access, peer-reviewed journals” and should not include any predatory journals. 2

Statement of Significance

What is known or assumed to be true about this topic?

The quality of nursing literature used is vital for the development of research studies, application of evidence in clinical settings, and other scholarly projects. Nurse scholars need to be confident as they search the literature that they are accessing sound information sources and not articles from predatory nursing journals, which do not adhere to quality and ethical publishing standards. Citations of articles in predatory nursing journals may be found when searching Google and Google Scholar, making these citations easy to access but potentially resulting in the integration of poor quality research into the nursing literature. On the other hand, searches through credible databases—MEDLINE, CINAHL, and Scopus—are less likely to yield citations from predatory publications.

What this article adds:

This study helps validate the trustworthiness of these databases for conducting searches in nursing.

PREDATORY JOURNALS

Many studies have documented the problem of predatory journals. These journals do not adhere to quality and ethical publishing standards, often use deceptive language in emails to encourage authors to submit their manuscripts to them, are open access but may not be transparent with the article processing charge, may have quick but questionable peer review, and may publish inaccurate information on their Web sites such as impact factor and indexing. 3 – 6 Predatory publishing is an issue in many fields including nursing. In a recent study, 127 predatory journals were identified in nursing. 7

Citations acknowledge the ideas of others and give credit to the authors of the original work. When articles are cited in a subsequent publication, those citations disseminate the information beyond the original source, and the article in which it is cited might in turn be referenced again, transferring knowledge from one source to yet another. When articles in predatory journals are cited, the same process occurs. Those citations transfer knowledge from the predatory publication beyond that source. Studies have found that authors are citing articles published in predatory journals in nursing as well as other fields. 7 – 10 Nurse scholars need to be confident as they search the literature that they are accessing sound information sources and not articles from predatory journals.

NATIONAL LIBRARY OF MEDICINE INFORMATION RESOURCES

The National Library of Medicine (NLM) supports researchers and clinicians through its multiple health information resources including PubMed, MEDLINE, and PubMed Central (PMC). PubMed serves as the search engine to access the MEDLINE database, PMC, and books, chapters, and other documents that are indexed by the NLM. PubMed is free and publicly available: by using PubMed, researchers can search more than 30 million citations to the biomedical literature. 11 The majority of records in PubMed are from MEDLINE, which has citations from more than 5200 scholarly journals. For inclusion in MEDLINE, journals are assessed for their quality by the Literature Selection Technical Review Committee. 12 Five areas are included in this assessment: scope of the journal (ie, in a biomedical subject); quality of the content (validity, importance of the content, originality, and contribution of the journal to the coverage of the field); editorial standards and practices; production quality (eg, layout and graphics); and audience (content addresses health care professionals).

PMC includes journal citations and full-text articles that are selected by the NLM for digital archiving. To be included in PMC, journals are evaluated for their scope and scientific, editorial, and technical quality. 13 Journals considered for inclusion are evaluated by independent individuals both inside and outside PMC. 14 PMC serves as the repository for articles to meet the compliance requirements of the National Institutes of Health (NIH) and other funding agencies for public access to funded research. About 12% of the articles in PMC are deposited by individual authors to be in compliance with funders and 64% by publishers, scholarly societies, and other groups. 15 Beginning in June 2020, as a pilot program, preprints reporting research funded by the NIH also can be deposited in PMC. 16

CINAHL AND SCOPUS

The journal assessment and indexing processes for CINAHL and Scopus are similar to those used by the NLM. However, as private corporations, EBSCO (CINAHL) and Elsevier (Scopus) are not required to make journal selection processes publicly available or explicit. CINAHL has an advisory board for journal selection. A CINAHL representative provided the following criteria for indexing of journals in CINAHL: high impact factor; usage in reputable subject indexes (eg, the NLM catalog); peer-reviewed journals covered by other databases (eg, Web of Science and Scopus); top-ranked journals by industry studies; and article quality (avoiding low-quality journals) (personal communication, October 19, 2020).

Elsevier's Scopus provides a webpage referring to the journal selection and assessment processes. Journals being considered for indexing in Scopus are evaluated by the Content Selection and Advisory Board and must meet the following criteria: peer-reviewed with a publicly available description of the peer review process; published on a regular basis; has a registered International Standard Serial Number (ISSN); includes references in Roman (Latin) script; has English language titles and abstracts; and has publicly available publication ethics and publication malpractice statements. 17

LITERATURE REVIEW

Studies have shown that in health care fields, researchers, clinicians, faculty, and students regularly search MEDLINE for their research and other scholarly and clinical information. 18 – 21 De Groote et al 18 found that 81% of health science faculty used MEDLINE to locate articles for their research. MEDLINE was used by the majority of faculty in each individual health care field including nursing (75%) and medicine (87.5%) for searching the literature and finding articles. In another study of 15 different resources, medical faculty and residents reported that PubMed was used most frequently for searching the databases of the NLM, primarily MEDLINE. 20 Few studies have focused on the search practices of nurses. In a review of the literature, Alving et al 22 found that hospital nurses primarily searched Google for information on evidence-based nursing. They used Google more than bibliographic databases.

The quality of content that is retrieved when using PubMed as a search engine is important considering its widespread use for accessing scholarly and clinical information in nursing and other fields. Manca et al 23 reported that articles published in predatory journals were being retrieved when conducting searches using PubMed and were a concern for researchers. Based on their studies of predatory journals in neurology 24 and rehabilitation, 25 they concluded that predatory journals “leaked into PubMed” through PMC because of less stringent criteria for inclusion of journals. 23 Citations to articles from predatory journals then could be found using the PubMed search engine. However, in a letter to the editor, Topper et al 26 from the NLM clarified that individual articles published in predatory journals might be deposited in PMC to meet the requirements of research funding and be searchable in PubMed. Topper and colleagues make a clear distinction between journals indexed in MEDLINE or PMC and citations of individual articles that were deposited in PMC to meet funder requirements.

The aim of this study was to determine whether predatory nursing journals were included in databases used by nurse researchers and other nurses when searching for information. These databases included MEDLINE (searched via PubMed), CINAHL (EBSCO), and Scopus (Elsevier) and in the Directory of Open Access Journals.

In an earlier study, 127 predatory nursing journals were identified and assessed for characteristics of predatory publications. That dataset was used for the current study. For each predatory nursing journal, information was retrieved from the NLM Catalog, Ulrichsweb, and journal and publisher Web sites. Ulrichsweb 27 provides bibliographic and publisher information on academic and scholarly journals, open access journals, peer-reviewed titles, magazines, newspapers, and other publications. Journal titles of the predatory journals were often similar to nonpredatory journals and could be easily mistaken. To ensure accuracy, the information for each journal was checked for consistency between these sources using the ISSN, exact journal title, and publisher name. The purpose of an ISSN is to identify a publication and distinguish it from other publications with similar names. An ISSN is mandatory for all publications in many countries and having one assigned is considered a journal best practice. 28 For each predatory journal, the following data were collected if available: complete journal title; abbreviated journal title; acronym; ISSN (electronic and/or print); DOI prefix; publisher name and Web site URL; NLM index status; number of predatory journal articles cited in MEDLINE and PMC (when searching using PubMed), in CINAHL, and in Scopus; if the journal was indexed in the Directory of Open Access Journals; status in Ulrichsweb; and Google Scholar profile URL.

Counts of articles cited were checked individually by journal title, publisher, and/or ISSN. Once ISSNs (both electronic and print where available) were assembled, a search algorithm was created, which included all retrieved journal ISSNs. MEDLINE was searched via PubMed using a combination of NLM journal title abbreviations and ISSNs. CINAHL, Scopus, and the Directory of Open Access Journals were searched using a combination of ISSN, journal title abbreviation, full title, and publisher. Results were visually inspected for accuracy and alignment with dataset fields.

Data analysis

Data were collected between January and April 2020. Data were entered into an Excel spreadsheet and organized by predatory journal name; abbreviated journal title; acronym; ISSN (electronic, print); DOI prefix; Web site URL; entry in NLM Catalog (yes/no); index status; number of articles cited in PubMed, CINAHL, and Scopus; Directory of Open Access Journals (included/not included); Ulrichsweb status (active/ceased); publisher; and Google Scholar profile URL. Frequencies and medians are reported.

Of the 127 predatory nursing journals in the dataset, only 102 had ISSNs to use for the search. Eighteen of the journals had records in the NLM Catalog, but only 2 of those had ever been indexed in MEDLINE, and neither are currently indexed. These 2 journals had been published earlier by a reputable publisher but then were sold to one of the large predatory publishers. The NLM Catalog record for these journals indicates that citations of articles from them appeared in MEDLINE through 2014 for one of the journals and 2018 for other, but following their transition to the new publisher are no longer included. Consistent with the MEDLINE results, these same 2 journals had been indexed in Scopus as well. Citations of articles from one of these journals were added to Scopus up to 2014, with no articles cited thereafter. Articles from the second journal continue to be added through 2020. One additional journal from the predatory journal dataset is currently in Scopus, however, only through 2014. None of the predatory nursing journals were indexed in CINAHL based on full journal title, title abbreviation, ISSN, or publisher. Two journals in the dataset were found in the Directory of Open Access Journals.

When searching PubMed, we found citations of articles from 16 predatory nursing journals. The number of citations ranged from 1 to 372 citations (from one of the journals indexed earlier in MEDLINE but sold to a predatory publisher). The second highest number of citations (n = 168) was of articles from a predatory nursing journal that had been depositing articles in PMC (and thus were retrievable when searching PubMed) but is no longer adding new material to PMC. The other citations were of articles deposited in PMC to meet requirements of NIH and other research funding. The predatory journals in which these articles were published, however, are not indexed in MEDLINE or PMC.

There were no articles from predatory nursing journals cited in CINAHL. Scopus has citations from the 2 predatory nursing journals that are no longer indexed there: 616 that were published in one of the journals and 120 from the other. Articles from a third predatory nursing journal in the study dataset, which is currently indexed in Scopus, totaled 173 (see Table).

Abbreviation: CINAHL, Cumulative Index to Nursing and Allied Health Literature.

a Predatory nursing journals with 3 or more citations to articles.

b Search using PubMed.

This analysis documented that none of the predatory nursing journals in the study dataset were currently indexed in MEDLINE or CINAHL, and only one journal is still in Scopus. Most of the citations of articles from predatory journals found in a search of these databases are from earlier years before the journals were sold to one of the large predatory publishers. Other citations are to articles deposited in PMC in compliance with research funder requirements.

By using PubMed as a search engine and entry point to the databases of the NLM, researchers can search millions of records included in MEDLINE, or in process for inclusion, and articles from PMC deposited by publishers or authors for compliance with funders. Six million records, and about 5500 journals, can be searched in CINAHL Complete, 29 and Scopus, the largest of the proprietary databases, provides access to 24000 journals and 60 million records. 30 Results from this study show that very few articles published in predatory nursing journals find their way into a search done using PubMed and Scopus and none into CINAHL.

In a prior study, 814 citations of articles in predatory nursing journals were found in articles published in nonpredatory nursing journals. 7 Based on this current study, the conclusion can be made that these citations are not coming from searches in MEDLINE/PubMed, CINAHL, or Scopus and are likely from searches done using Google or Google Scholar as the search engine. The databases examined in this study are curated by organizations with a vested interest in maintaining and improving the quality of the research literature in those databases.

Searching multiple databases using different search engines can be frustrating and time consuming. There is overlap among MEDLINE, CINAHL, and Scopus. However, these are curated databases and, as this study found, are unlikely to return many, if any, predatory citations as part of the search results. Still, it falls on the searcher to eliminate duplicates and redundant citations. Further, certain types of literature, such as theses, dissertations, and fugitive (or “gray” literature), 31 are unlikely to be found in any of these databases, even though those citations may be important or relevant sources. Given this, it is easy to understand the intuitive appeal of Google Scholar, which provides “one stop shopping”: “From one place, you can search across many disciplines and sources: articles, theses, books, abstracts and court opinions, from academic publishers, professional societies, online repositories, universities and other web sites. Google Scholar helps you find relevant work across the world of scholarly research.” 32 Google and Google Scholar were founded with a mission to become the most comprehensive search engines in the world. While this allows someone to scour the World Wide Web and Internet for some of the most obscure facts available, at the same time, little is done to verify or validate the results that are returned. Thus, it falls on the searcher to be diligent and evaluate the results of a Google or Google Scholar search, which will include citations of articles in predatory journals. This is easily confirmed by the fact that many predatory journal Web sites promote the Google Scholar logo as a sign of indexing or a badge of legitimacy.

Another vexing issue that was revealed in this study is that of reputable journals that have been bought by predatory publishers. This study found 2 journals in this category. Brown 33 reported on 16 medical specialty journals that were purchased from 2 Canadian commercial publishers by a predatory publisher. In all these cases, it is the same predatory publisher, although some of the purchases were made under a different business imprint, adding further confusion to an already muddied situation. Jeffrey Beall, who coined the term “predatory publisher” and maintained the blog “Scholarly Open Access” for almost a decade, was quoted by Brown 33 : “[The company] is not only buying journals, it is buying metrics and indexing, such as the journals' impact factors and listing in Scopus and PubMed, in order to look legitimate.” One positive finding from this study was that the 2 purchased journals that were identified were quickly de-accessioned by the NLM and are no longer indexed in MEDLINE, although citations from their pre-predatory era remain intact.

Recommendations

All of this presents a confusing picture, but it is possible to make some specific recommendations to aid researchers, clinicians, faculty, and students in their literature searches. First, become familiar with the journals and publications in your field. This is a basic foundation of scholarship. As you read articles, remember where they were published, learn journal titles, and focus on sources as well as the content. As you come across predatory journals in nursing and health care, make note of them and learn their titles too. Remember that many predatory journals adopt names that are intended to be confusing and may differ from a legitimate journal by only one letter, such as “Africa” and “African.”

Second, consider carefully how to approach your search from the outset. If you choose to start with MEDLINE (searched via PubMed), CINAHL, or Scopus, then you can have some assurance that the results will not return citations from predatory journals—although you should still verify every citation that you receive. On the other hand, Google and Google Scholar can be a “quick and easy” way to get started but will require that you carefully review and evaluate the results. If you need to venture to other more specialized databases, such as PsycInfo or ERIC (Education Resources Information Center), it is important to carefully inspect the results that you receive. To reduce the risk of including a predatory journal article in research, nursing scholars should use reputable bibliographic databases, which have clear criteria for journal indexing, for their searches.

Third, when you come across a journal title that is not familiar, take time to research it, visit the journal Web site and evaluate the information at the Web site, and determine whether it is a credible source to include in your results. If something seems irregular, then it is worth your time to do more investigating—either on your own or by enlisting the help of a knowledgeable colleague or librarian. Journals change publishers all the time, and while most of these business transfers are benign and probably will not impact you as an end consumer of the literature, that is not always the case. Likewise, the major publishers in the world today are large, multinational conglomerates that regularly spin off or purchase other companies. While this probably will not impact you on a day-to-day basis, it is important to investigate any irregularities when conducting a search of the literature.

Last, because these issues are complex and multifaceted, it is always wise to consult with a librarian who can assist you in every step of the search process. Their knowledge and expertise in information literacy, data sources, and searching techniques can help to ensure that you find the information you need from sources that are reliable and credible.

Researchers, clinicians, faculty, and students need to be careful not to include citations from predatory sources in their literature searches and articles. Predatory journals publish low-quality studies and citing this work erodes the scholarly literature in nursing. The findings of this study offer some reassurance to those who search the professional nursing literature: if you begin a search in a database such as MEDLINE, CINAHL, or Scopus, then the results will probably not include citations to predatory publications. Google and Google Scholar searches, however, may very well include predatory citations, and in that case, it is the searcher's responsibility to carefully evaluate the output and discard findings from nonlegitimate sources. Enlisting the help of a librarian is always beneficial and highly recommended.

Peggy L. Chinn, PhD, RN, FAAN, Editor, Advances in Nursing Science , is a member of our research team and contributed to the study and preparation of the manuscript.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Here’s how you know

• U.S. Department of Health and Human Services
• National Institutes of Health

Acupuncture: Effectiveness and Safety

.header_greentext{color:green!important;font-size:24px!important;font-weight:500!important;}.header_bluetext{color:blue!important;font-size:18px!important;font-weight:500!important;}.header_redtext{color:red!important;font-size:28px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;font-size:28px!important;font-weight:500!important;}.header_purpletext{color:purple!important;font-size:31px!important;font-weight:500!important;}.header_yellowtext{color:yellow!important;font-size:20px!important;font-weight:500!important;}.header_blacktext{color:black!important;font-size:22px!important;font-weight:500!important;}.header_whitetext{color:white!important;font-size:22px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;}.Green_Header{color:green!important;font-size:24px!important;font-weight:500!important;}.Blue_Header{color:blue!important;font-size:18px!important;font-weight:500!important;}.Red_Header{color:red!important;font-size:28px!important;font-weight:500!important;}.Purple_Header{color:purple!important;font-size:31px!important;font-weight:500!important;}.Yellow_Header{color:yellow!important;font-size:20px!important;font-weight:500!important;}.Black_Header{color:black!important;font-size:22px!important;font-weight:500!important;}.White_Header{color:white!important;font-size:22px!important;font-weight:500!important;} What is acupuncture?

Acupuncture is a technique in which practitioners insert fine needles into the skin to treat health problems. The needles may be manipulated manually or stimulated with small electrical currents (electroacupuncture). Acupuncture has been in use in some form for at least 2,500 years. It originated from  traditional Chinese medicine but has gained popularity worldwide since the 1970s.

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According to the World Health Organization, acupuncture is used in 103 of 129 countries that reported data.

In the United States, data from the National Health Interview Survey show that the use of acupuncture by U.S. adults more than doubled between 2002 and 2022. In 2002, 1.0 percent of U.S. adults used acupuncture; in 2022, 2.2 percent used it. 

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National survey data indicate that in the United States, acupuncture is most commonly used for pain, such as back, joint, or neck pain.

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How acupuncture works is not fully understood. However, there’s evidence that acupuncture may have effects on the nervous system, effects on other body tissues, and nonspecific (placebo) effects. 

• Studies in animals and people, including studies that used imaging methods to see what’s happening in the brain, have shown that acupuncture may affect nervous system function.
• Acupuncture may have direct effects on the tissues where the needles are inserted. This type of effect has been seen in connective tissue.
• Acupuncture has nonspecific effects (effects due to incidental aspects of a treatment rather than its main mechanism of action). Nonspecific effects may be due to the patient’s belief in the treatment, the relationship between the practitioner and the patient, or other factors not directly caused by the insertion of needles. In many studies, the benefit of acupuncture has been greater when it was compared with no treatment than when it was compared with sham (simulated or fake) acupuncture procedures, such as the use of a device that pokes the skin but does not penetrate it. These findings suggest that nonspecific effects contribute to the beneficial effect of acupuncture on pain or other symptoms. 
• In recent research, a nonspecific effect was demonstrated in a unique way: Patients who had experienced pain relief during a previous acupuncture session were shown a video of that session and asked to imagine the treatment happening again. This video-guided imagery technique had a significant pain-relieving effect.

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Research has shown that acupuncture may be helpful for several pain conditions, including back or neck pain, knee pain associated with osteoarthritis, and postoperative pain. It may also help relieve joint pain associated with the use of aromatase inhibitors, which are drugs used in people with breast cancer. 

An analysis of data from 20 studies (6,376 participants) of people with painful conditions (back pain, osteoarthritis, neck pain, or headaches) showed that the beneficial effects of acupuncture continued for a year after the end of treatment for all conditions except neck pain.

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• In a 2018 review, data from 12 studies (8,003 participants) showed acupuncture was more effective than no treatment for back or neck pain, and data from 10 studies (1,963 participants) showed acupuncture was more effective than sham acupuncture. The difference between acupuncture and no treatment was greater than the difference between acupuncture and sham acupuncture. The pain-relieving effect of acupuncture was comparable to that of nonsteroidal anti-inflammatory drugs (NSAIDs).
• A 2017 clinical practice guideline from the American College of Physicians included acupuncture among the nondrug options recommended as first-line treatment for chronic low-back pain. Acupuncture is also one of the treatment options recommended for acute low-back pain. The evidence favoring acupuncture for acute low-back pain was judged to be of low quality, and the evidence for chronic low-back pain was judged to be of moderate quality.

For more information, see the  NCCIH webpage on low-back pain .

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• In a 2018 review, data from 10 studies (2,413 participants) showed acupuncture was more effective than no treatment for osteoarthritis pain, and data from 9 studies (2,376 participants) showed acupuncture was more effective than sham acupuncture. The difference between acupuncture and no treatment was greater than the difference between acupuncture and sham acupuncture. Most of the participants in these studies had knee osteoarthritis, but some had hip osteoarthritis. The pain-relieving effect of acupuncture was comparable to that of NSAIDs.
• A 2018 review evaluated 6 studies (413 participants) of acupuncture for hip osteoarthritis. Two of the studies compared acupuncture with sham acupuncture and found little or no difference between them in terms of effects on pain. The other four studies compared acupuncture with a variety of other treatments and could not easily be compared with one another. However, one of the trials indicated that the addition of acupuncture to routine care by a physician may improve pain and function in patients with hip osteoarthritis.
• A 2019 clinical practice guideline from the American College of Rheumatology and the Arthritis Foundation conditionally recommends acupuncture for osteoarthritis of the knee, hip, or hand. The guideline states that the greatest number of studies showing benefits have been for knee osteoarthritis.

For more information, see the  NCCIH webpage on osteoarthritis .

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• A 2020   review of nine studies that compared acupuncture with various drugs for preventing migraine found that acupuncture was slightly more effective, and study participants who received acupuncture were much less likely than those receiving drugs to drop out of studies because of side effects.
• There’s moderate-quality evidence that acupuncture may reduce the frequency of migraines (from a 2016 evaluation of 22 studies with almost 5,000 people). The evidence from these studies also suggests that acupuncture may be better than sham acupuncture, but the difference is small. There is moderate- to low-quality evidence that acupuncture may reduce the frequency of tension headaches (from a 2016 evaluation of 12 studies with about 2,350 people).

For more information, see the  NCCIH webpage on headache .

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• Myofascial pain syndrome is a common form of pain derived from muscles and their related connective tissue (fascia). It involves tender nodules called “trigger points.” Pressing on these nodules reproduces the patient’s pattern of pain.
• A combined analysis of a small number of studies of acupuncture for myofascial pain syndrome showed that acupuncture applied to trigger points had a favorable effect on pain intensity (5 studies, 215 participants), but acupuncture applied to traditional acupuncture points did not (4 studies, 80 participants).  

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• Sciatica involves pain, weakness, numbness, or tingling in the leg, usually on one side of the body, caused by damage to or pressure on the sciatic nerve—a nerve that starts in the lower back and runs down the back of each leg.
• Two 2015 evaluations of the evidence, one including 12 studies with 1,842 total participants and the other including 11 studies with 962 total participants, concluded that acupuncture may be helpful for sciatica pain, but the quality of the research is not good enough to allow definite conclusions to be reached.

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• A 2016 evaluation of 11 studies of pain after surgery (with a total of 682 participants) found that patients treated with acupuncture or related techniques 1 day after surgery had less pain and used less opioid pain medicine after the operation.

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• A 2016 review of 20 studies (1,639 participants) indicated that acupuncture was not more effective in relieving cancer pain than conventional drug therapy. However, there was some evidence that acupuncture plus drug therapy might be better than drug therapy alone.
• A 2017 review of 5 studies (181 participants) of acupuncture for aromatase inhibitor-induced joint pain in breast cancer patients concluded that 6 to 8 weeks of acupuncture treatment may help reduce the pain. However, the individual studies only included small numbers of women and used a variety of acupuncture techniques and measurement methods, so they were difficult to compare.
• A larger 2018 study included 226 women with early-stage breast cancer who were taking aromatase inhibitors. The study found that the women who received 6 weeks of acupuncture treatment, given twice each week, reported less joint pain than the participants who received sham or no acupuncture.

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• Chronic prostatitis/chronic pelvic pain syndrome is a condition in men that involves inflammation of or near the prostate gland; its cause is uncertain.
• A review of 3 studies (204 total participants) suggested that acupuncture may reduce prostatitis symptoms, compared with a sham procedure. Because follow-up of the study participants was relatively brief and the numbers of studies and participants were small, a definite conclusion cannot be reached about acupuncture’s effects.

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• A 2019 review of 41 studies (3,440 participants) showed that acupuncture was no more effective than sham acupuncture for symptoms of irritable bowel syndrome, but there was some evidence that acupuncture could be helpful when used in addition to other forms of treatment.

For more information, see the  NCCIH webpage on irritable bowel syndrome .

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• A 2019 review of 12 studies (824 participants) of people with fibromyalgia indicated that acupuncture was significantly better than sham acupuncture for relieving pain, but the evidence was of low-to-moderate quality.

For more information, see the  NCCIH webpage on fibromyalgia . 

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In addition to pain conditions, acupuncture has also been studied for at least 50 other health problems. There is evidence that acupuncture may help relieve seasonal allergy symptoms, stress incontinence in women, and nausea and vomiting associated with cancer treatment. It may also help relieve symptoms and improve the quality of life in people with asthma, but it has not been shown to improve lung function.

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• A 2015 evaluation of 13 studies of acupuncture for allergic rhinitis, involving a total of 2,365 participants, found evidence that acupuncture may help relieve nasal symptoms. The study participants who received acupuncture also had lower medication scores (meaning that they used less medication to treat their symptoms) and lower blood levels of immunoglobulin E (IgE), a type of antibody associated with allergies.
• A 2014 clinical practice guideline from the American Academy of Otolaryngology–Head and Neck Surgery included acupuncture among the options health care providers may offer to patients with allergic rhinitis.

For more information, see the  NCCIH webpage on seasonal allergies .

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• Stress incontinence is a bladder control problem in which movement—coughing, sneezing, laughing, or physical activity—puts pressure on the bladder and causes urine to leak.
• In a 2017 study of about 500 women with stress incontinence, participants who received electroacupuncture treatment (18 sessions over 6 weeks) had reduced urine leakage, with about two-thirds of the women having a decrease in leakage of 50 percent or more. This was a rigorous study that met current standards for avoiding bias.

.header_greentext{color:green!important;font-size:24px!important;font-weight:500!important;}.header_bluetext{color:blue!important;font-size:18px!important;font-weight:500!important;}.header_redtext{color:red!important;font-size:28px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;font-size:28px!important;font-weight:500!important;}.header_purpletext{color:purple!important;font-size:31px!important;font-weight:500!important;}.header_yellowtext{color:yellow!important;font-size:20px!important;font-weight:500!important;}.header_blacktext{color:black!important;font-size:22px!important;font-weight:500!important;}.header_whitetext{color:white!important;font-size:22px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;}.Green_Header{color:green!important;font-size:24px!important;font-weight:500!important;}.Blue_Header{color:blue!important;font-size:18px!important;font-weight:500!important;}.Red_Header{color:red!important;font-size:28px!important;font-weight:500!important;}.Purple_Header{color:purple!important;font-size:31px!important;font-weight:500!important;}.Yellow_Header{color:yellow!important;font-size:20px!important;font-weight:500!important;}.Black_Header{color:black!important;font-size:22px!important;font-weight:500!important;}.White_Header{color:white!important;font-size:22px!important;font-weight:500!important;} Treatment-Related Nausea and Vomiting in Cancer Patients

• Experts generally agree that acupuncture is helpful for treatment-related nausea and vomiting in cancer patients, but this conclusion is based primarily on research conducted before current guidelines for treating these symptoms were adopted. It’s uncertain whether acupuncture is beneficial when used in combination with current standard treatments for nausea and vomiting.

For more information, see the  NCCIH webpage on cancer .

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• In a study conducted in Germany in 2017, 357 participants receiving routine asthma care were randomly assigned to receive or not receive acupuncture, and an additional 1,088 people who received acupuncture for asthma were also studied. Adding acupuncture to routine care was associated with better quality of life compared to routine care alone.
• A review of 9 earlier studies (777 participants) showed that adding acupuncture to conventional asthma treatment improved symptoms but not lung function.

For more information, see the  NCCIH webpage on asthma .

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• A 2018 review of 64 studies (7,104 participants) of acupuncture for depression indicated that acupuncture may result in a moderate reduction in the severity of depression when compared with treatment as usual or no treatment. However, these findings should be interpreted with caution because most of the studies were of low or very low quality.

For more information, see the  NCCIH webpage on depression .

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• In recommendations on smoking cessation treatment issued in 2021, the U.S. Preventive Services Task Force, a panel of experts that makes evidence-based recommendations about disease prevention, did not make a recommendation about the use of acupuncture as a stop-smoking treatment because only limited evidence was available. This decision was based on a 2014 review of 9 studies (1,892 participants) that looked at the effect of acupuncture on smoking cessation results for 6 months or more and found no significant benefit. Some studies included in that review showed evidence of a possible small benefit of acupuncture on quitting smoking for shorter periods of time.

For more information, see the  NCCIH webpage on quitting smoking .

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• A 2021 review evaluated 6 studies (2,507 participants) that compared the effects of acupuncture versus sham acupuncture on the success of in vitro fertilization as a treatment for infertility. No difference was found between the acupuncture and sham acupuncture groups in rates of pregnancy or live birth.
• A 2020 review evaluated 12 studies (1,088 participants) on the use of acupuncture to improve sperm quality in men who had low sperm numbers and low sperm motility. The reviewers concluded that the evidence was inadequate for firm conclusions to be drawn because of the varied design of the studies and the poor quality of some of them. 

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• A 2018 review of 12 studies with 869 participants concluded that acupuncture and laser acupuncture (a treatment that uses lasers instead of needles) may have little or no effect on carpal tunnel syndrome symptoms in comparison with sham acupuncture. It’s uncertain how the effects of acupuncture compare with those of other treatments for this condition.    
• In a 2017 study not included in the review described above, 80 participants with carpal tunnel syndrome were randomly assigned to one of three interventions: (1) electroacupuncture to the more affected hand; (2) electroacupuncture at “distal” body sites, near the ankle opposite to the more affected hand; and (3) local sham electroacupuncture using nonpenetrating placebo needles. All three interventions reduced symptom severity, but local and distal acupuncture were better than sham acupuncture at producing desirable changes in the wrist and the brain.

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• A 2018 review of studies of acupuncture for vasomotor symptoms associated with menopause (hot flashes and related symptoms such as night sweats) analyzed combined evidence from an earlier review of 15 studies (1,127 participants) and 4 newer studies (696 additional participants). The analysis showed that acupuncture was better than no acupuncture at reducing the frequency and severity of symptoms. However, acupuncture was not shown to be better than sham acupuncture.

For more information, see the  NCCIH webpage on menopause .

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• Auricular acupuncture is a type of acupuncture that involves stimulating specific areas of the ear. 
• In a 2019 review of 15 studies (930 participants) of auricular acupuncture or auricular acupressure (a form of auricular therapy that does not involve penetration with needles), the treatment significantly reduced pain intensity, and 80 percent of the individual studies showed favorable effects on various measures related to pain.
• A 2020 review of 9 studies (783 participants) of auricular acupuncture for cancer pain showed that auricular acupuncture produced better pain relief than sham auricular acupuncture. Also, pain relief was better with a combination of auricular acupuncture and drug therapy than with drug therapy alone.
• An inexpensive, easily learned form of auricular acupuncture called “battlefield acupuncture” has been used by the U.S. Department of Defense and Department of Veterans Affairs to treat pain. However, a 2021 review of 9 studies (692 participants) of battlefield acupuncture for pain in adults did not find any significant improvement in pain when this technique was compared with no treatment, usual care, delayed treatment, or sham battlefield acupuncture.

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• Relatively few complications from using acupuncture have been reported. However, complications have resulted from use of nonsterile needles and improper delivery of treatments.
• When not delivered properly, acupuncture can cause serious adverse effects, including infections, punctured organs, and injury to the central nervous system.
• The U.S. Food and Drug Administration (FDA) regulates acupuncture needles as medical devices and requires that they be sterile and labeled for single use only.

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• Some health insurance policies cover acupuncture, but others don’t. Coverage is often limited based on the condition being treated.
• An analysis of data from the Medical Expenditure Panel Survey, a nationally representative U.S. survey, showed that the share of adult acupuncturist visits with any insurance coverage increased from 41.1 percent in 2010–2011 to 50.2 percent in 2018–2019.
• Medicare covers acupuncture only for the treatment of chronic low-back pain. Coverage began in 2020. Up to 12 acupuncture visits are covered, with an additional 8 visits available if the first 12 result in improvement. Medicaid coverage of acupuncture varies from state to state.

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• Most states license acupuncturists, but the requirements for licensing vary from state to state. To find out more about licensing of acupuncturists and other complementary health practitioners, visit the NCCIH webpage  Credentialing, Licensing, and Education . 

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NCCIH funds research to evaluate acupuncture’s effectiveness for various kinds of pain and other conditions and to further understand how the body responds to acupuncture and how acupuncture might work. Some recent NCCIH-supported studies involve:

• Evaluating the feasibility of using acupuncture in hospital emergency departments.
• Testing whether the effect of acupuncture on chronic low-back pain can be enhanced by combining it with transcranial direct current stimulation.
• Evaluating a portable acupuncture-based nerve stimulation treatment for anxiety disorders.

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• Don’t use acupuncture to postpone seeing a health care provider about a health problem.
• Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions.

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Nccih clearinghouse.

The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

Toll-free in the U.S.: 1-888-644-6226

Telecommunications relay service (TRS): 7-1-1

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Know the Science

NCCIH and the National Institutes of Health (NIH) provide tools to help you understand the basics and terminology of scientific research so you can make well-informed decisions about your health. Know the Science features a variety of materials, including interactive modules, quizzes, and videos, as well as links to informative content from Federal resources designed to help consumers make sense of health information.

Explaining How Research Works (NIH)

Know the Science: How To Make Sense of a Scientific Journal Article

Understanding Clinical Studies (NIH)

A service of the National Library of Medicine, PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. For guidance from NCCIH on using PubMed, see How To Find Information About Complementary Health Approaches on PubMed .

Website: https://pubmed.ncbi.nlm.nih.gov/

NIH Clinical Research Trials and You

The National Institutes of Health (NIH) has created a website, NIH Clinical Research Trials and You, to help people learn about clinical trials, why they matter, and how to participate. The site includes questions and answers about clinical trials, guidance on how to find clinical trials through ClinicalTrials.gov and other resources, and stories about the personal experiences of clinical trial participants. Clinical trials are necessary to find better ways to prevent, diagnose, and treat diseases.

Website: https://www.nih.gov/health-information/nih-clinical-research-trials-you

Research Portfolio Online Reporting Tools Expenditures & Results (RePORTER)

RePORTER is a database of information on federally funded scientific and medical research projects being conducted at research institutions.

Website: https://reporter.nih.gov

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• Befus D, Coeytaux RR, Goldstein KM, et al.  Management of menopause symptoms with acupuncture: an umbrella systematic review and meta-analysis . Journal of Alternative and Complementary Medicine. 2018;24(4):314-323.
• Bleck   R, Marquez E, Gold MA, et al.  A scoping review of acupuncture insurance coverage in the United States . Acupuncture in Medicine. 2020;964528420964214.
• Briggs JP, Shurtleff D.  Acupuncture and the complex connections between the mind and the body. JAMA. 2017;317(24):2489-2490.
• Brinkhaus B, Roll S, Jena S, et al.  Acupuncture in patients with allergic asthma: a randomized pragmatic trial. Journal of Alternative and Complementary Medicine. 2017;23(4):268-277.
• Chan MWC, Wu XY, Wu JCY, et al.  Safety of acupuncture: overview of systematic reviews. Scientific Reports. 2017;7(1):3369.
• Coyle ME, Stupans I, Abdel-Nour K, et al.  Acupuncture versus placebo acupuncture for in vitro fertilisation: a systematic review and meta-analysis. Acupuncture in Medicine. 2021;39(1):20-29.
• Hershman DL, Unger JM, Greenlee H, et al.  Effect of acupuncture vs sham acupuncture or waitlist control on joint pain related to aromatase inhibitors among women with early-stage breast cancer: a randomized clinical trial. JAMA. 2018;320(2):167-176.
• Linde K, Allais G, Brinkhaus B, et al.  Acupuncture for the prevention of episodic migraine. Cochrane Database of Systematic Reviews. 2016;(6):CD001218. Accessed at  cochranelibrary.com on February 12, 2021.
• Linde K, Allais G, Brinkhaus B, et al.  Acupuncture for the prevention of tension-type headache. Cochrane Database of Systematic Reviews. 2016;(4):CD007587. Accessed at  cochranelibrary.com on February 12, 2021.
• MacPherson H, Vertosick EA, Foster NE, et al. The persistence of the effects of acupuncture after a course of treatment: a meta-analysis of patients with chronic pain . Pain. 2017;158(5):784-793.
• Qaseem A, Wilt TJ, McLean RM, et al.  Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2017;166(7):514-530.
• Seidman MD, Gurgel RK, Lin SY, et al.  Clinical practice guideline: allergic rhinitis. Otolaryngology—Head and Neck Surgery. 2015;152(suppl 1):S1-S43.
• Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for chronic pain: update of an individual patient data meta-analysis . The Journal of Pain. 2018;19(5):455-474.
• White AR, Rampes H, Liu JP, et al.  Acupuncture and related interventions for smoking cessation. Cochrane Database of Systematic Reviews. 2014;(1):CD000009. Accessed at  cochranelibrary.com on February 17, 2021.
• Zia FZ, Olaku O, Bao T, et al.  The National Cancer Institute’s conference on acupuncture for symptom management in oncology: state of the science, evidence, and research gaps. Journal of the National Cancer Institute. Monographs. 2017;2017(52):lgx005.

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• Adams D, Cheng F, Jou H, et al. The safety of pediatric acupuncture: a systematic review. Pediatrics. 2011;128(6):e1575-1587.
• Candon M, Nielsen A, Dusek JA. Trends in insurance coverage for acupuncture, 2010-2019. JAMA Network Open. 2022;5(1):e2142509.
• Cao J, Tu Y, Orr SP, et al. Analgesic effects evoked by real and imagined acupuncture: a neuroimaging study. Cerebral Cortex. 2019;29(8):3220-3231.
• Centers for Medicare & Medicaid Services. Decision Memo for Acupuncture for Chronic Low Back Pain (CAG-00452N). Accessed at https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=295 on June 25, 2021.
• Chen L, Lin C-C, Huang T-W, et al. Effect of acupuncture on aromatase inhibitor-induced arthralgia in patients with breast cancer: a meta-analysis of randomized controlled trials . The Breast. 2017;33:132-138. 
• Choi G-H, Wieland LS, Lee H, et al. Acupuncture and related interventions for the treatment of symptoms associated with carpal tunnel syndrome. Cochrane Database of Systematic Reviews. 2018;(12):CD011215. Accessed at cochranelibrary.com on January 28, 2021.
• Cui J, Wang S, Ren J, et al. Use of acupuncture in the USA: changes over a decade (2002–2012). Acupuncture in Medicine. 2017;35(3):200-207.
• Federman DG, Zeliadt SB, Thomas ER, et al. Battlefield acupuncture in the Veterans Health Administration: effectiveness in individual and group settings for pain and pain comorbidities. Medical Acupuncture. 2018;30(5):273-278.
• Feng S, Han M, Fan Y, et al. Acupuncture for the treatment of allergic rhinitis: a systematic review and meta-analysis. American Journal of Rhinology & Allergy. 2015;29(1):57-62.
• Franco JV, Turk T, Jung JH, et al. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database of Systematic Reviews. 2018;(5):CD012551. Accessed at cochranelibrary.com on January 28, 2021.
• Freeman MP, Fava M, Lake J, et al. Complementary and alternative medicine in major depressive disorder: the American Psychiatric Association task force report. The Journal of Clinical Psychiatry . 2010;71(6):669-681.
• Giovanardi CM, Cinquini M, Aguggia M, et al. Acupuncture vs. pharmacological prophylaxis of migraine: a systematic review of randomized controlled trials. Frontiers in Neurology. 2020;11:576272.
• Hu C, Zhang H, Wu W, et al. Acupuncture for pain management in cancer: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine. 2016;2016;1720239.
• Jiang C, Jiang L, Qin Q. Conventional treatments plus acupuncture for asthma in adults and adolescent: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine . 2019;2019:9580670.
• Ji M, Wang X, Chen M, et al. The efficacy of acupuncture for the treatment of sciatica: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine.  2015;2015:192808.
• Kaptchuk TJ. Acupuncture: theory, efficacy, and practice. Annals of Internal Medicine . 2002;136(5):374-383.
• Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care & Research. 2020;72(2):149-162. 
• Langevin H. Fascia mobility, proprioception, and myofascial pain. Life. 2021;11(7):668. 
• Liu Z, Liu Y, Xu H, et al. Effect of electroacupuncture on urinary leakage among women with stress urinary incontinence: a randomized clinical trial. JAMA. 2017;317(24):2493-2501.
• MacPherson H, Hammerschlag R, Coeytaux RR, et al. Unanticipated insights into biomedicine from the study of acupuncture. Journal of Alternative and Complementary Medicine. 2016;22(2):101-107.
• Maeda Y, Kim H, Kettner N, et al. Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture. Brain. 2017;140(4):914-927.
• Manheimer E, Cheng K, Wieland LS, et al. Acupuncture for hip osteoarthritis. Cochrane Database of Systematic Reviews. 2018;(5):CD013010. Accessed at cochranelibrary.com on February 17, 2021. 
• Moura CC, Chaves ECL, Cardoso ACLR, et al. Auricular acupuncture for chronic back pain in adults: a systematic review and metanalysis. Revista da Escola de Enfermagem da U S P. 2019;53:e03461.
• Nahin RL, Rhee A, Stussman B. Use of complementary health approaches overall and for pain management by US adults. JAMA. 2024;331(7):613-615.
• Napadow V. Neuroimaging somatosensory and therapeutic alliance mechanisms supporting acupuncture. Medical Acupuncture. 2020;32(6):400-402.
• Patnode CD, Henderson JT, Coppola EL, et al. Interventions for tobacco cessation in adults, including pregnant persons: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2021;325(3):280-298.
• Qin Z, Liu X, Wu J, et al. Effectiveness of acupuncture for treating sciatica: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine. 2015;2015;425108.
• Smith CA, Armour M, Lee MS, et al. Acupuncture for depression. Cochrane Database of Systematic Reviews. 2018;(3):CD004046. Accessed at cochranelibrary.com on January 20, 2021.
• US Preventive Services Task Force. Interventions for tobacco smoking cessation in adults, including pregnant persons. US Preventive Services Task Force recommendation statement. JAMA. 2021;325(3):265-279.
• Vase L, Baram S, Takakura N, et al. Specifying the nonspecific components of acupuncture analgesia. Pain. 2013;154(9):1659-1667.
• Wang R, Li X, Zhou S, et al. Manual acupuncture for myofascial pain syndrome: a systematic review and meta-analysis. Acupuncture in Medicine. 2017;35(4):241-250.
• World Health Organization. WHO Traditional Medicine Strategy: 2014–2023. Geneva, Switzerland: World Health Organization, 2013. Accessed at https://www.who.int/publications/i/item/9789241506096 on February 2, 2021.
• Wu M-S, Chen K-H, Chen I-F, et al. The efficacy of acupuncture in post-operative pain management: a systematic review and meta-analysis. PLoS One. 2016;11(3):e0150367.
• Xu S, Wang L, Cooper E, et al. Adverse events of acupuncture: a systematic review of case reports. Evidence-Based Complementary and Alternative Medicine. 2013;2013:581203.
• Yang J, Ganesh R, Wu Q, et al. Battlefield acupuncture for adult pain: a systematic review and meta-analysis of randomized controlled trials. The American Journal of Chinese Medicine. 2021;49(1):25-40.
• Yang Y, Wen J, Hong J. The effects of auricular therapy for cancer pain: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine. 2020;2020:1618767.  
• Yeh CH, Morone NE, Chien L-C, et al. Auricular point acupressure to manage chronic low back pain in older adults: a randomized controlled pilot study. Evidence-Based Complementary and Alternative Medicine. 2014;2014;375173.
• You F, Ruan L, Zeng L, et al. Efficacy and safety of acupuncture for the treatment of oligoasthenozoospermia: a systematic review. Andrologia. 2020;52(1):e13415.
• Zhang X-C, Chen H, Xu W-T, et al. Acupuncture therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials. Journal of Pain Research. 2019;12:527-542.
• Zheng H, Chen R, Zhao X, et al. Comparison between the effects of acupuncture relative to other controls on irritable bowel syndrome: a meta-analysis. Pain Research and Management. 2019;2019:2871505.

Acknowledgments

NCCIH thanks Pete Murray, Ph.D., David Shurtleff, Ph.D., and Helene M. Langevin, M.D., NCCIH for their review of the 2022 update of this fact sheet. 

This publication is not copyrighted and is in the public domain. Duplication is encouraged.

NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCIH.

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