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User Guide


1. helsebiblioteket | McMaster PLUS

a. About helsebiblioteket | McMaster PLUS


helsebiblioteket | McMaster PLUS is a service designed to help clinicians and researchers find and keep up to date on the current best evidence for clinical decisions.

helsebiblioteket has two components: a search service and an email alert service.



Search Service

With just one search, helsebiblioteket searches many information sources at once, and returns results from all sources on one page. This saves significant time because only one site and one search are required, and users can view results from many sources at one time.

Resources currently included in helsebiblioteket searches:
  • UpToDate
  • Best Practice
  • DARE
  • McMaster Premium Literature Service (PLUS)
  • ACP Journal Club
  • PubMed Clinical Queries
  • PubMed


Email Alert Service

The McMaster Premium Literature Service (PLUS) is a division of the McMaster Health Knowledge Refinery. For articles to be included in PLUS, first they must pass a Critical Appraisal Process (CAP) to identify those that are methodologically sound. Articles that pass the CAP are then rated by clinicians for their relevance and newsworthiness. End users of PLUS select their disciplines and patient populations of interest, and helsebiblioteket will send email alerts when there are new relevant and newsworthy articles of potential interest to the user.

More than 120 journals are rated each year (25,000+ articles). By filtering the articles based on methodology, relevance, and newsworthiness, PLUS gives a 90% ‘noise reduction’, enabling clinicians to easily keep up to date with the best, most relevant research in their areas of practice and interest.

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b. The Pyramid of Evidence


To facilitate the use of medical resources, Brian Haynes, MD, Chief of the McMaster Health Information Research Unit, proposed a 5S model (later refined to a 6S model) to describe the kinds of resources that are available. These are organized into a pyramid/hierarchy of evidence.



  • Systems: Computerized Decision Support

  • Summaries: Evidence-based clinical practice textbooks and guidelines

  • Synopses of Syntheses: Evidence-based journal abstracts of selected systematic reviews

  • Syntheses: Systematic reviews

  • Synopses of Studies: Evidence-based abstracts of selected individual studies

  • Studies: Original pre-appraised individual studies



helsebiblioteket | McMaster PLUS searches resources at all levels of the pyramid, and organizes the results into a hierarchy of evidence. Always look first at the content available at the highest level of the hierarchy, as it is most likely to be useful for clinical purposes.

The hierarchy is based on principles of evidence-based decision-making:
• Systems provide patient-specific computerized decision support. These are not currently included in helsebiblioteket | McMaster PLUS (or almost anywhere else)
• Summaries provide the best summarization of evidence for entire clinical topics (e.g. asthma, diabetes)
• Synopses are brief abstracts of high quality original studies and systematic reviews
• Syntheses are systematic reviews of original studies
• Studies are original studies

For further information about the pyramid and the 6S model, please consult: Explanation of the 6S model (PDF file).
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c. McMaster Premium LiteratUre Service (PLUS)


The McMaster Premium LiteratUre Service (PLUS) provides the content for the email alerting side of helsebiblioteket | McMaster PLUS.

Research associates trained in health research methodology read all original and review articles in approximately 120 high quality journals. Articles are rated on the quality of the methodology. Approximately 15% of articles pass this review. Articles are also tagged with appropriate disciplines (ie obstetrics, surgery). See inclusion criteria.

Articles that pass methodological review are passed to volunteer reviewer clinicians (MDs, Nurses, and Rehab specialists) who have indicated interest in the disciplines assigned to each article. These reviewers rate the articles for relevance and newsworthiness. Every article is sent to at least 4 volunteer reviewers in each appropriate discipline. Reviewers may also provide comments.

When at least 3 ratings are received for an article within one discipline, the total scores are averaged and articles scoring at least 3 (out of 7) for both relevance and newsworthiness are transferred to the PLUS database. Users who have registered to receive email alerts in that discipline will then be sent an email indicating there is a new article they may wish to review. Users can also view the ratings and comments made by the clinician raters.

Click here for an in-depth look at the PLUS process.
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2. Using Search

a. Introduction to searching

To search, type your query into the search box and click Søk (Search). Simple terms are best (e.g. finasteride and cancer). You can also use many abbreviations (e.g. MI, ALS). Your search will simultaneously be run through all the covered databases, and results for each will be displayed in an organized hierarchy. Please note that all databases are indexed in English.



Your previous searches can be accessed via the Historikk link. They will be listed in reverse chronological order, the most recent search at the top.



Results are limited to the first 100 hits for each service/database searched.
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b. Searching summary level resources

Search strings (the search terms you entered) are sent, as entered, to the summary resources. These resources handle the search string in their own way, and then return the search results for display. For information on the conventions used to process search strings by the summary level services, please consult the appropriate help guides:




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c. Searching DARE


The search string you enter is sent to DARE as entered; Dare processes the search and the results are returned for display.
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d. Selecting a PLUS database


The default database for PLUS searches is Lege (Physician), as all articles are included in that database. You can choose a different database - Sykepleier (Nursing) or Fysioterapeut (Rehab/OTPT) - from the drop down. This setting only affects the search results returned from PLUS databases.



When you access a PLUS record at the Syntheses or Studies level, you can view comments and ratings from the other databases by clicking on the tabs across the top of the record. Please note that not all articles are rated by all three groups, so you may not see three tabs on every record.



If you want to see all possible PLUS results, use the Lege (Physician) database. All PLUS articles are in the Physician database.
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e. Search string conventions used in PLUS

Please note the PLUS database is indexed in English.

  • Using a single word

    • The search term and any of its synonyms will be searched

    • If you want results that contain only a specific term, enclose that term in quote marks (synonyms and alternative spellings will not be searched).

    • Examples:

      • typing gallstone into the search box will retrieve any articles with the term gall stone; gallstone; cholelithiasis; cholecystolithiasis; biliary calculi; or biliary stone, among others.

      • typing “gallstone” into the search box will only retrieve articles with the found term gallstone.

  • Using multiple words

    • All available synonyms for terms entered consecutively or separated by AND or OR will be used in the search strategy.

    • Example:

      • Typing either anorexient sibutramine or anorexient AND sibutramine into the search box retrieves all of the articles that contain both search terms or any combination of synonyms to each of the terms: anorexient /sibutramine; anorexient / Meridia; appetite depressant / sibutramine; appetite depressant /Meridia; anorectic / sibutramine; and anorectic / Meridia.


    • Example:
      • complex searches will follow the Boolean syntax. If you’re looking for bronchopulmonary dysplasia OR chronic lung disease then the search will re-format the string as following: (bronchopulmonary AND dysplasia) OR (chronic AND lung AND disease).

  • Using a phrase

    • A concept represented by a phrase can be searched by entering its composite terms into the search box. The search phrase and any of its synonyms that we have implemented will be searched.

    • If you want results that contain only a specific phrase, enclose that phrase in quote marks (synonyms and alternative spellings will not be searched).

    • Examples:

      • Typing body mass index into the search box will retrieve all articles containing the phrases body mass index; BMI; Quetelet’s Index; Quetelet Index; and Quetelets Index.

      • Typing “body mass index” into the search box will only retrieve articles that contain the exact phrase body mass index. Synonyms will not be searched.

  • Using truncation

    • When an asterisk (*) is used at the end of a word or partially completed word, alternative word endings are used in the search strategy

    • Example:

      • Typing cardio* will retrieve articles that contain the terms cardiovascular, cardiogenic, cardiopulmonary, cardiorespiratory, and cardioversion, among others.

  • Using a title

    • Enclose the exact title (or portion of it) in quote marks. Note that no synonyms will be searched when quote marks are used.

    • Example:

      • Typing “Being big or growing fast” will retrieve the following article: Being big or growing fast: systematic review of size and growth in infancy and later obesity.

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f. Using Avansert søk options in PLUS

  • Advanced search options apply only to the PLUS databases (levels 3-5 of the pyramid)

  • A search strategy can be refined to reduce the number of hits and better target your information needs. Click the 'Avansert søk' (advanced search) option to restrict PLUS results to articles in specific disciplines, categories, populations, and/or settings. Please note that the PLUS database in indexed in English.


  • Hold down Ctrl to make multiple selections within a category

  • PLUS search results can also be ordered by date, relevance, and most accessed.



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g. Searching PubMED and PubMED CQ


  • PubMED: The search string is sent to PubMED. Results will be restricted to studies with human subjects only, and limited to only those published in the last five years. Further information about PubMED’s search conventions can be found on PubMED's information page.

  • PubMED CQ: The search string is sent to PubMED CQ. Results are limited to the last five years. PubMED CQ uses search strategies developed by HIRU. More information can be found on PubMED CQ's information page.




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3. Email Alerts

a. Alert set up


Email alerts are set up on your profile page. Your profile can always be accessed via the link in the menu bar at the top of the page:



On your profile, under ‘alert settings’, you can choose patient populations and disciplines of interest. You also select how frequently you would like to receive alerts, and cut off scores for frequency and relevance. The graph at the bottom indicates how many articles you would have received with the current settings, allowing you to fine tune your settings to receive more or fewer articles.



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b. Alerts via RSS feed


You can receive your alerts via RSS feed. The link can be found under My Profile, at the bottom of the Alert Settings section. Copy the link into your feed reader.


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c. My Alerts


Recent alerts that meet your personalized settings can be found on the website, under ‘My Alerts’.



You can access several categories of alerts via the menu on the left-hand side of the page.



  • New Articles: All articles that meet your criteria from the last 30 days.

  • Saved Articles: Articles you have saved

  • Most Accessed: Articles that have been the most read by other users during the last 30 days

  • Highest Rated: Articles with the highest Relevance and Newsworthiness ratings

  • Alert Setup: links to your profile alert settings



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d. Saving and deleting articles


You can save articles to your saved articles list for future reference. Click the checkbox next to the article(s) you would like to save, and click Save Selected.

You delete articles from the list by clicking Delete Selected.


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e. Downloading references

You can download references in EndNote, Reference Manager, RefWorks, or HTML format. Click the checkbox next to the article(s) you would like to download, and click Download Selected. Then select the format you would like to use.



For more information about downloading references, see the FAQ:

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f. Hit Parade


The most frequently read articles can be accessed via the Hit Parade link in the top menu bar.



You can access several categories of popular articles on the menu on the left side of the screen:

  • Reviews: Most frequency read review articles that meet your personalized settings

  • Original Studies: Most frequently read original studies that meet your personalized settings

  • Clinical Predictions: Most frequently read clinical prediction articles that meet your personalized settings

  • Prognosis: Most frequently read prognosis articles that meet your personalized settings

  • Most Read: The most frequently read articles by all users (does not use your personalized settings)


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Further Help

Contact information


If you have further questions, comments, or feedback about helsebiblioteket | McMaster PLUS, please use the Contact form.

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