Section 4: Biomedical Information on the Internet

Review of EBM searching

EBM theory ： best research evidence + clinical expertise + patient’s unique values + circumstances

Types of evidence: Systematic review,Meta-analysis,RCT,Practice guideline,Case report

5S levels of evidence: studies, synthesis, synopses, summaries, systems

Common sources of evidence for each S refer to the list in Practice III or the lecture PPTs

PICO – well built clinical questions

Common evidence resources:

ACP Journal Club

Cochrane Library

PubMed----Clinical Queries

ACP Journal Club ACP Journal Club, a publication of the American

College of Physicians, one of the two journals of ACP Journal Club Collection (The other is Evidence-Based Medicine)

Structured abstracts and commentary on recently published, methodologically sound, and clinically relevant research.

The editors of ACP Journal Club screen the top clinical journals on a regular basis and identify studies that are both methodologically sound and clinically relevant. They write an enhanced abstract of the chosen articles and provide a commentary on the value of the article for clinical practice. Using this source, clinicians can quickly understand and apply to their practice important changes in medical knowledge, without having to read and synthesize for themselves thousands of journal articles.

What is in The Cochrane Library?Cochrane Database of Systematic Reviews (Cochrane Reviews)

Represents the gold standard of high-quality, evidence-based medical information; Free for abstract

Database of Abstracts of Reviews of Effects (Other Reviews) Complements the Cochrane Reviews by quality-assessing and summarising reviews which have not been carried out by

The Cochrane Collaboration. DARE is unique in that it is the only database to contain abstracts of systematic reviews that have been quality assessed. Each abstract includes a summary of the review together with a critical commentary about the overall quality. Produced by the CRD in York.

Central Register of Controlled Trials (Clinical Trials) Includes details of published articles taken from bibliographic databases and other published resources. CENTRAL

records include the title of the article, information on where it was published and, in many cases, the abstract.

Cochrane Methodology Register (Methods Studies) Presents a bibliography of publications that report on methods used when conducting controlled trials. It includes

journals articles, books and conference proceedings. Articles are taken from MEDLINE and from hand searches.

Health Technology Assessment Database (Technology Assessments) Brings together details of completed and ongoing health technology assessments (studies of the medical, social, ethical

and economic implications of healthcare interventions) from around the world. The aim of the database is to improve the quality and cost effectiveness of health care. Produced by the CRD in York.

NHS Economic Evaluation Database (Economic Evaluations) As healthcare resources are finite, information about costs and effects are essential to making evidence-based decisions

about competing healthcare interventions. Information about cost-effectiveness can be difficult to identify, appraise and interpret. NHS EED assists decision-makers by systematically identifying economic evaluations from around the world, appraising their quality and highlighting their relative strengths and weaknesses. Produced by the CRD in York.

It also contains information about The Cochrane Collaboration and The Cochrane Collaborative Review Groups

“searching for all text schizo, drugs, atypical

and antipsychotic. in All Fields in The Cochrane

Database of Systematic Reviews"

An Advanced Search of The Cochrane Library…

… Returns the following results:

You can toggle between results listed for the different databases in The Cochrane Library here

Use these links to restrict your search results to Reviews only, or Protocols (reviews in progress) only.

Save or edit your search using these links.

MeSH (Medical Subjects Heading Search)

Let us look at an example MeSH search

Use the Thesaurus to search for MeSH descriptors

MeSH (Medical Subjects Heading Search)

Or use qualifiers.

MeSH (Medical Subjects Heading Search)

Search History

Select Search History to combine searches, enter their number together with Boolean operator of choice (AND, OR, NOT).

Combine searches by entering their number together with Boolean operator of choice (AND, OR, NOT).

Search History

Your combined search will then appear in your Search History.

Search History

PubMed - Clinical QueriesPubMed - Clinical QueriesAvailable on PubMed homepage; also available from the bottom of the Advanced Search screen

There are 3 search filters available from this page: Search by Clinical Study Category Find Systematic Reviews Medical Genetics Searches

Search by Clinical Study Category•This specialized search query is intended for clinicians and has built-in search "filters" based on research done by R. Brian Haynes, M.D., Ph.D. at McMaster University in Canada.

Five study categories or filters are provided:•etiology •diagnosis•therapy•prognosis•clinical prediction guidelines

Two emphasis categories or filters are provided:•narrow, specific search -- will get more precise, relevant citations but less retrieval•broad, sensitive search -- includes relevant citations but probably some less relevant; will get more retrieval

Medical Genetics Searches

•Finds citations related to various topics in medical genetics.

•Default is to All topics. Click on All check box to deselect; then click on topic(s) of interest.

•Developed in conjunction with the staff of GeneReviews: Genetic Disease Online Reviews at GeneTests, University of Washington, Seattle.

Find Systematic Reviews

•This feature is provided to help clinicians locate systematic reviews and similar articles.

•It retrieves systematic reviews, meta-analyses, reviews of clinical trials, evidence-based medicine, consensus development conferences, and guidelines. Citations from journals specializing in clinical review studies are also included.

EBM databases: a summary

EBM Meta-Search engine

Search across multiple EBM resources

SUMSearch: http://sumsearch.uthscsa.edu

TRIP: http://www.tripdatabase.com

BioMedical Information BioMedical Information on the Interneton the Internet

Objective of this section

Learn how to use the internet for searching for medical resource, specific to your needs.

Guide you to some key Web sites for health and medicine.

Provide suggestions on ways to evaluate Internet sites and resources.

Help you start collecting your own list of useful Web sites to explore later.

The Internet for Health Professionals

What can the internet offer? Current and up-to-date information. Access to both traditional and new sources of

information. Access to all resources through one piece of

software. The opportunity to discuss medical issues with

colleagues and experts from around the world though email, discussion lists and newsgroups.

The opportunity to pursue your research interests and continuing medical education studies from your own desktop, at a time that is convenient to you.

Searching the Internet

Search Engines

Three major types.

How do they get content and

organize their information?

Each has its strengths and

weaknesses.

Search Engines Types

General search engines Free-text search tools

Web directories Subject-arranged resource lists

Evaluated medical directories Evaluated sources of information

General search engines

Aim to help you search as much of the Web as possible.

Search engines work by sending out a special computer program (eg. Spider or Crawler) to Web sites around the World to automatically create a huge index.

The best-known search engines are: GOOGLE http://www.google.com/ NORTHERN LIGHT http://nlresearch.com/

GOOGLE http://www.google.com/ With a reported index comprising two

billion pages, it is the biggest Web search engine currently available.

Demonstrate the power of the Google’s ranking technology. Although such a simple search generated many hits (about 79,500,000), highly relevant Web sites were at the top of this list, such as Am Diabetes Asso, NIDDK and CDC, etc. All types of information resources mixed up together.

GOOGLE: searching Simple search

Advanced search

1. Enter search terms in the query box;2. Click the ’Google search’ button.

you can search only for pages: that contain ALL the search terms, or the exact phrase, or at least one of the words, or NOT any of the words you type in written in a certain language created in a certain file format that have been updated within a certain period of time that contain numbers within a certain range within a certain domain, or website …….

Search resultGoogle ranks the results by a technique known as PageRank. Where ranking is determined by the frequency with which your search term(s) appears.

• Search syntax used at Google

search Example

Phrase searching “gulf war syndrome”

‘OR’ search ‘postpartum depression’ OR ‘baby blues’

Stop words hepatitis +c

Excluding terms osteoporosis -hrt

File-type searching anthrax filetype:pdf

Domain search site:stanford.edu

Locating pages that link to other sites

link: www.nih.gov

Services & tools

For more information, please visit Google Help Center http://www.google.com/intl/en/help/features.html

NORTHERN LIGHT http://nlresearch.com With special collection of full text journal and

newspaper articles, it provides a rich and unique source of information.

Include: journals, business web™ , news, white papers.

General search engines

Pros Useful if you want to find a very precise piece of

information Will find something on every subject imaginable Easy to search

Cons Can give you too many results –time consuming to sort

through Can return lots or irrelevant or inappropriate information

Web directories

Aim to help you look through (or browse) many thousands of Web sites under a series of subject headings.

Most are run commercially and use volunteers or hired-editors to select the Web sites and arrange them into subject lists.

Two well known examples are: YAHOO! HEALTH http://www.yahoo.com/Health/ OPEN DIRECTORY PROJECT http://dmoz.org/Health/

Yahoo!Health

Contain both directory categories and individual Web sites. Although the resources identified in this search do not represent the total of all diabetes resources (fewer results than Google), they nevertheless provide an excellent starting point.

Open directory project

Web directories

Pros The subject lists mean you don’t have to think up search

terms Cover a very wide range of subjects: so good if you want

popular sites as well as serious ones

Cons Relevant resources may be overlooked by inappropriate

use of directory headings. Significantly smaller and less up-to-date than their free-text

search engines equivalents. Can quickly become out of date.

Evaluated medical directories

Aim to help a particular audience find high quality Web sites for their particular needs.

They are often created by specialist organisations (eg. educational or professional organisations) who often employ qualified subject experts to select and organise Web sites under subject headings, and write descriptions of the sites.

Examples include: MEDICAL MATRIX http://www.medmatrix.org/ INTUTE: Health & Life Science http://www.intute.ac.

uk/healthandlifesciences/ HEALTH ON THE NET (HON) http://www.hon.ch/

Medical Matrix

Managed by the American Medical Informatics Association (AMIS)

Eight top-level headings, featured links, annotated description of the indexed resource.

Note: Users can browse Medical Matrix free of charge. Searching the database, however, is restricted to subscribers.

All the sites listed look as though they have serious educational content with a description written by a subject expert. Can be an excellent way of finding relevant and authoritative documents in a very short space of time.

Intute:Health and Life SciencesIntute:Health and Life Sciences

Health and Life Sciences Gateway

Medicine (formerly OMNI) Nursing, Midwifery and

Allied Health Veterinary Bioresearch Natural History Agriculture, Food and

Forestry BioethicsWeb -

biomedical ethics MedHist - history of

medicine resources Psci-com – public

engagement with science and technology

Intute:Medicine Searching

Over 31,000 records, each one hand selected and described by a subject specialist.

Simple or advanced searches, keyword or “phrase searching”.

Refine your search results Browsing

using NLM classification and MeSH headings far more precise and focused

Browse by MeSH

Harvester to broaden your searchesOther subject groupsA- Arts and HumanitiesS- Science, Engineering and TechnologySo- Social Sciences

Health on the Net (HON) Special features are two widely-used medical search

tools (HONselect and MedHunt) and the HON Code of Conduct (HONcode).

•HONSelect Search integrator Use MeSH, a database of

33,000 medical terms. Combine six

information types into one service-- web sites, medical images, news, scientific articles, clinical trials, conferences/ events.

Four popular categories

•HONSelect Search Example

Full text search engine. Web documents is

organized in four categories: All, Hospitals, Support, Events.

* HONselect is suitable for users who have identified their needs with some precision in advance.

* MedHunt search is not restricted to medical terms but ranges far more widely.

•MedHunt- Medical Document Hunter

•MedHunt Search Example

Evaluated medical directories

Pros Good if you need trustworthy results for serious work or

research You get fewer, but more relevant results, as the subject

specialists have filtered out a lot of the inappropriate sites

Cons As individuals compile the directories, potentially useful

resources are over looked. Most evaluated subject directories are still very much in

their infancy, and consequently the number of resources identified thus far is quite small.

The biomedical Web

Professional Organizations BioMedical Journals BioMedical Portals Interactive Learning BioMedical Images Consumer Health Information

Professional Organizations Government organizations World Health Organization (WHO) National Institutes of Health (NIH) American Centers for Disease Control and Prevention (CDC) US food and drug administration (FDA) Professional societies/Professional

associations Federation of American Societies for Experimental Biology (FASEB) American College of Physicians (ACP)

medical schools, hospitals, research centers

……

National Institutes of Health (NIH)

The NIH, a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research. http://www.nih.gov/

Helpful resources ABOUT NIH

NIH Institutes, Centers & Offices http://www.nih.gov/icd/

News and Events - the lastest research advances, NIH-sponsored conferences and events… http://www.nih.gov/news/index.html

Health Topic A to Z http://health.nih.gov/see_all_topics.asp

Clinicaltrials.gov - offers information for locating federally and privately supported clinical trials for a wide range of diseases and conditions in the U.S and around the world. http://www.clinicaltrials.gov/

Computer Retrieval of Information on Scientific Projects (CRISP) - Research funded by NIH -Search many ways. http://crisp.cit.nih.gov/

PubMed MedlinePlus

ClinicalTrials.gov

Practice: Using the Clinicaltrials.gov, find the clinical trails data for diabetes for persons over 66?

CRISP

PRACTISE: search for NIH-funded projects about diabetes in FY2008.

American Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/

Practice: Using CDC Wonder, find prevention guidelines of SARS.

US food and drug administration (FDA) http://www.fda.gov/

World Health Organization http://www.who.int/

Medical Journals Three models of scholarly publishing1. E-print archives: Everything is free and available to all via the Web. In the

biomedical sciences, however, this model has not been widely accepted.

2. New publishers – economic alternatives: Subscription journals still exist but are published by not-for-

profic organizations. BioMed Central (BMC) represents the biggest single alternative to the traditional medical publishers.

3. Free back-files archives: All research should be free on the Web after a period of time,

say 6 months or 12 months and so on. Current issues would only be available to subscribers.

Medical Journals

Acess to journals on the Web1. Publisher siteScienceDirect, HighWire Press, Springerlink,etc.2. Aggregator Services ProQuest, OVID, EBSCO,etc.

Note: Check with our library for access to full-text e-journals. http://www.cmu.edu.cn/library/showpage.asp?pageid=351

Medical JournalsOpen Access Journal Sites http://highwire.stanford.edu/lists/free

art.dtl

http://www.pubmedcentral.com/ http://www.biomedcentral.com/ http://www.freemedicaljournals.com/

Further resources: http://www.healthnet.org/essential-links/fulltext-e-

journals.html

This the HireWire Press free article database. Users have access to over 2,009,596 full text articles.

PubMed Central is a free archive of articles that have been deposited in this free repository.

BioMed Central is an open access publisher that makes access to published articles freely available to the public. The journals are funded by an author pays model.

FreeMedicalJournals.com lists journals sites that make their content free to all users.

Journals are listed by A-Z, speciality, and language.

This is the AED/SATELLIFE Essential Health Links gateway that links to relevant WWW sites for the health community in developing and transitional countries.

Medical Portals

Aim to address all the information and educational needs from a single site. Examples include:

Medscape http://www.medscape.com/ Free access, 300 000 doctors and 1.2 million other user subscribed; around 30 specialty sites, provide access to MEDLINE, DrugInfo and various image database; CME programme; ……

MD Consult http://www.mdconsult.com/ Access fees, over 250 000 subscribers, owned by Elsevier Science; over 600 peer-reviewed clinical guidelines,……

Medcape’s Specialty homepage contain: Featured CME highlighted educational activities for the week

(generally updated twice a week); In Focus the top articles of the week (generally updated twice

week); Today's News the top news stories of the day (updated daily); CME Center recent professional educational activities by

specialty; Resource Centers sections on specific conditions or topics of

interest; Expert Corner Ask the Experts based on topics of concern

according to specialty; Conference Center reports and highlights from key medical

meetings; Discussions a forum for discussions with your peers; Library Journals, textbooks, and reference tools.

Interactive Learning Virtual interactive patient simulations Tuarma Moulage

http://www.trauma.org/resus/moulage/moulage.html Lecture notes,tutorials and multimedia textbooks Lectures: Supercourse - epidemiology, the internet and global

health http://www.pitt.edu/~super1/ Tutorials: the Internet Pathology Laboratory http://www-

medlib.med.utah.edu/WebPath/TUTORIAL/TUTORIAL.html Textbooks: Merck Manual of Diagnosis and Therapy

http://www.merck.com/ubs/mmanual Online CME courses Online CME http://www.cmelist.com/list.htm Examinations MCQs http://www.mcqs.com/ Virtual conferencing Medscape Conference Center, Videocasting

Medical Images

Medical image databases Images.MD http://www.images.md/users/index.asp Bristol Biomedical Image Archive http://www.brisbio.ac.uk/ Images from the History of Medicine

http://www.ihm.nlm.nih.gov/

Search Engines: Image Retrieval Google Image Finder http://images.google.com/ AltaVista Image Search http://uk.altavista.com/ Karolinska Institute page of image-related links

http://www.mic.ki.se/Medimages.html

Consumer health information

Patient questions Where can I find information about a particular illness?

Where can I find out more information about a drug I have been prescribed? How can I prepare for a consultation? How does the performance of one hospital compare with another?......

Key sites MEDLINEplus http://www.medlineplus.gov/ US Pharmacopoeia http://www.intelihealth.com/IH/ Pocket Doctor http://www.pocketdoctor.co.uk/ Ask the Doc http://www.intelihealth.com/

MEDLINEplus A patient-centered resource

developed by the National Library of Medicine

MEDLINEplus Health Topics

MEDLINEplus Health Topics Example

Evaluating Internet Resources

The Web is full of information and data from all over the world.

Excellent resources reside alongside dubious.

Anyone can publish anything!

Evaluating Internet Resources

Evaluate using Criteria for Evaluating Web Resources

Determine the type of site by analyzing Web Site Addresses

Helpful Evaluation AMA Guidelines for medical and health information sites

on the Internet (2000) http://jama.ama-assn.org/cgi/content/full/283/12/1600

A User's Guide to finding and evaluating health information on the web http://www.mlanet.org/resources/userguide.html

HON: Published code of conduct for web publishing of health information (HONcode)

Criteria for Evaluating Web Resources

Accuracy Authority Objectivity Currency Coverage, intended audience

FROM: Kapoun, Jim. "Teaching undergrads WEB evaluation: A guide for library instruction." C&RL News (July/August 1998): 522-523. http://www.library.cornell.edu/olinuris/ref/webcrit.html

Analyze the Website Address

edu org com gov mil

http://www.cdc.gov/nip/child.htm

sub directory

Domain name

Hypertext transfer protocol

filename

Top level domain

Learning More To find out more about using the

Internet to find reliable information, I would strongly recommend that you take one of the tutorials (whichever best fits your subject) from the menu of Health & Life Sciences topics:

www.vts.intute.ac.uk This will introduce you to some useful

starting points in your Internet searching and will look in more detail at how you can assess the quality and reliability of the sites that you find

Notes

Change of the 4th /the last practice date to: Nov 27, 10:00-12:00am

To review this course, please download the lecture PPTs from the folder “pub-medical information retrieval” on ftp.cmu.edu.cn

The review synopsis will be issued together with the Practice Exercises IV on the teacher’s QQ space: http://151437680.qzone.qq.com