Literature Search Strategy: Source Hierarchy and Query Templates
This reference gives the exact search queries, source-by-source rationale, and warning conditions for the structured search mode described in the informed-patient skill's Phase 2. Use it when running the source hierarchy; refer back to the skill for when to use open search instead, and for how to present results (transparency, tagging, the Evidence Snapshot).
Source hierarchy: query templates by source type
Use web search to find evidence across these source types, in priority order.
1. Systematic reviews — cast a wide net, not just Cochrane
Cochrane is the gold standard for systematic reviews because of its standardized methodology, but it has a meaningful blind spot: it tends to cover high-burden conditions with ample RCT evidence. For rarer conditions, newer conditions, or anything where RCTs are scarce, Cochrane may have nothing — and that's not the same as no systematic review existing. Search all of these:
Cochrane review [condition]— Cochrane first. If this returns no results, do not silently skip it. Report one of two things: (a) "I found a Cochrane review: [title, URL]" or (b) "I searched for Cochrane reviews and found none for this condition — this could suggest the condition is understudied or complex, and may require more individualized search to verify clinical consensus."[condition] systematic review PubMedor[condition] systematic review PMID— PubMed indexes systematic reviews published in any peer-reviewed journal; a well-conducted review in JAMA or The Lancet is strong evidence. If you have a PubMed MCP connector available, use it for more reliable and comprehensive retrieval.[condition] NICE guideline— NICE (UK) produces high-quality evidence reviews as part of guideline development, often covering conditions Cochrane hasn't addressed.[condition] AHRQ evidence review— AHRQ (US) commissions systematic reviews via Evidence-Based Practice Centers. Do not silently skip this (see SKILL.md's Phase 2 for why). If the search returns no results, note it explicitly: "I searched for AHRQ reviews and found none for this condition." If strong Cochrane coverage already exists and you're stopping early, still note the skip: "AHRQ not searched — Cochrane and guideline coverage was sufficient."
Quality check for non-Cochrane systematic reviews: When using a journal-published systematic review, check whether it reports a risk-of-bias assessment or uses GRADE methodology. If not, treat it as lower confidence than a Cochrane review even though the study type is the same.
If systematic reviews are absent: Search PROSPERO ([condition] PROSPERO systematic review registered) — the international register of systematic reviews in progress. Finding a registered in-progress review is itself useful information: tell the user that research is underway but not yet published.
2. Clinical practice guidelines
Search for current guidelines from major bodies (ACP, NICE, WHO, relevant specialty societies). Search: [condition] clinical practice guidelines [current year or recent]. Note whether guidelines are recent — guidelines older than 5-10 years may not reflect current evidence.
3. Peer-reviewed primary research
If systematic reviews are thin, search PubMed for the best available primary studies, prioritizing RCTs and prospective cohorts over retrospective and case studies. Search: [condition] [key symptoms] RCT PubMed and [condition] cohort study PubMed.
4. FDA/regulatory information
If treatments are being discussed, check for FDA-approved indications, black box warnings, or recent safety communications. This applies to drug classes as well as specific drug names. Search: FDA [drug class or drug name] [condition] (e.g., FDA ACE inhibitors hypertension or FDA lisinopril approval).
5. Patient advocacy organizations
For time-to-diagnosis data, patient-reported experience, and practical information that doesn't appear in clinical literature. Search: [condition] patient advocacy or [condition] foundation. These are context, not clinical evidence.
Source-level warning conditions (flag with ⚠️ inline)
When a source has a nuanced issue that affects how much weight to give it, flag it directly in the source entry with a ⚠️ and a one-sentence explanation. Do not bury these caveats in prose — make them impossible to miss.
- Guidelines older than 5-10 years: ⚠️ Published [year] — check the link to see if an update has been issued.
- Abstract-only access: ⚠️ Only the abstract was available — full methodology not reviewed.
- No risk-of-bias assessment in a non-Cochrane systematic review: ⚠️ This review does not report a risk-of-bias assessment — treat as lower confidence than a Cochrane review.
- Small sample size relative to the claim being made: ⚠️ [N] participants — findings may not generalize.
- Population mismatch with the user: ⚠️ Study population was [X] — relevance to your situation is uncertain.