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OBJECTIVE: To determine the retrieval characteristics of methodologic textwords and MeSH terms in MEDLINE for identifying methodologically sound studies on the etiology, prognosis, diagnosis, and prevention and treatment of disorders in general adult medicine. DESIGN: Comparison of methodologic search terms and phrases for the retrieval of citations in MEDLINE with a manual hand search of the literature (the gold standard) for 10 internal and general medicine journals for 1986 and 1991. MEASURES: Sensitivity (proportion of methodologically sound and correct topic studies retrieved) and specificity (proportion of unsound or wrong topic articles not retrieved) of the search strategies. RESULTS: The individual terms yielding the best sensitivity for 1991 by purpose category were: risk (tw) for etiology; exp cohort studies for prognosis; sensitivity (tw) for diagnosis; and clinical trial (pt) for treatment. The corresponding terms for 1986 were: risk (tw) for etiology; prognosis: (tw) for prognosis; sensitivity (tw) for diagnosis; and random: (tw) for treatment. CONCLUSIONS: The performance of methodologic MeSH terms and textwords varied greatly in MEDLINE and changed from 1986 to 1991. More complex search strategies may be required to optimize retrieval.