Section 4: Biomedical Information on the Internet

1. Section 4: Biomedical Information on the Internet

2. 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

3. Common evidence resources: • ACP Journal Club • Cochrane Library • PubMed----Clinical Queries

4. 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.

5. 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

7. An Advanced Search of The Cochrane Library… “searching for all textschizo, drugs, atypical and antipsychotic. inAll FieldsinThe Cochrane Database of Systematic Reviews"

8. … 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.

9. MeSH (Medical Subjects Heading Search) Let us look at an example MeSH search

10. MeSH (Medical Subjects Heading Search) Use the Thesaurus to search for MeSH descriptors

11. MeSH (Medical Subjects Heading Search) Or use qualifiers.

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

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

15. Search History Your combined search will then appear in your Search History.

16. PubMed - Clinical Queries Available on PubMed homepage; also available from the bottom of the Advanced Search screen

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

18. 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

19. 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.

20. 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.

21. EBM databases: a summary

22. EBM Meta-Search engine Search across multiple EBM resources SUMSearch: http://sumsearch.uthscsa.edu TRIP: http://www.tripdatabase.com

23. BioMedical Information on the Internet

24. 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.

25. 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.

26. Searching the Internet Search Engines • Three major types. • How do they get content and organize their information? • Each has its strengths and weaknesses.

27. Search Engines Types • General search engines Free-text search tools • Web directories Subject-arranged resource lists • Evaluated medical directories Evaluated sources of information

28. 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/

29. GOOGLE http://www.google.com/ With a reported index comprising two billion pages, it is the biggest Web search engine currently available.

30. 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.

31. 1. Enter search terms in the query box; 2. Click the ’Google search’ button. GOOGLE: searching • Simple search • Advanced search 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 …….

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

33. Search syntax used at Google

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

35. 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.

37. 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

38. 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/

39. Yahoo!Health

40. 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.

42. Open directory project

44. 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.

45. 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/

46. 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.

47. 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.

49. Intute: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

50. 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