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Randomized trial for answers to clinical questions: evaluating a pre-appraised versus a MEDLINE search protocol.

OBJECTIVE: The paper compares the speed, validity, and applicability of two different protocols for searching the primary medical literature. DESIGN: A randomized trial involving medicine residents was performed. SETTING: An inpatient general medicine rotation was used. PARTICIPANTS: Thirty-two internal medicine residents were block randomized into four groups of eight. MAIN OUTCOME MEASURES: Success rate of each search protocol was measured by perceived search time, number of questions answered, and proportion of articles that were applicable and valid. RESULTS: Residents randomized to the MEDLINE-first (protocol A) group searched 120 questions, and residents randomized to the MEDLINE-last (protocol B) searched 133 questions. In protocol A, 104 answers (86.7%) and, in protocol B, 117 answers (88%) were found to clinical questions. In protocol A, residents reported that 26 (25.2%) of the answers were obtained quickly or rated as "fast" (<5 minutes) as opposed to 55 (51.9%) in protocol B, (P = 0.0004). A subset of questions and articles (n = 79) were reviewed by faculty who found that both protocols identified similar numbers of answer articles that addressed the questions and were felt to be valid using critical appraisal criteria. CONCLUSION: For resident-generated clinical questions, both protocols produced a similarly high percentage of applicable and valid articles. The MEDLINE-last search protocol was perceived to be faster. However, in the MEDLINE-last protocol, a significant portion of questions (23%) still required searching MEDLINE to find an answer.

Computer User Training↗

[Internet biomedical databases: the MEDLINE paradigm. Users' guide].

The Medline database is now available into a wide number of biomedical websites. Clinicians and scientists can now access the most important bibliographic file in medicine directly from their desktop. Medline availability on the Internet can enhance effectiveness and efficiency of medical activities. Real usefulness of Medline and other databases stands on the relevance and validity of the information content that can be obtained at the least work (and cost) for the user. In order to retrieve really useful information, knowledge of some methodological issues related to bibliographic searching is mandatory to the final user. The rising number of Medline providers on Internet occurring during 1996 and 1997 is a proof that the "ideal" world-wide-Medline has not arrived yet.

Information Storage and Retrieval↗

Perusing the literature: comparison of MEDLINE searching with a perinatal trials database.

The existence of a Register of Controlled Trials in Perinatal Medicine (National Perinatal Epidemiology Unit, Oxford, England) has offered an opportunity to assess the efficacy of online searching of MEDLINE, an example of a broad bibliographic database. Retrieval of all relevant randomized control trials (RCTs) in a given field is important in analyses in which results are pooled (meta-analyses). Reports of RCTs of prevention and treatment of neonatal hyperbilirubinemia and prevention of intraventricular hemorrhage (IVH) for the years 1966-1983 were sought in both the Register and MEDLINE files. Comparison of subject searches revealed a number of unlisted papers in each file that were then found to be present by an author search. In the MEDLINE searching an amateur was clearly less efficient than an expert, but the expert recovered only 29% of the relevant hyperbilirubinemia papers available in MEDLINE, and only 56% of the identified IVH RCTs. Some of the deficiencies in recovery have been corrected by indexing improvements, such as the capability of identifying text words in abstracts, and the addition of new medical subject heading terms (MeSH) such as RANDOM ALLOCATION. Efficiency will be best facilitated by authors and editors keeping the MeSH terms used by MEDLINE indexers in mind when they compose titles and abstracts.

Cerebral Hemorrhage↗

Medline for Medical Students? Searching for the Right Answer.

Objective: Does MEDLINE use, when added to more traditional sources of information, improve the accuracy of medical students' clinical decisions when compared to those obtained using traditional sources only? Design: Randomized control trial. Setting: McMaster University Faculty of Medicine, Undergraduate Program. Participants: The entire class of 101 medical students, class of 1998. Overall response rate on 9 items was 56% (510/909), with 35% (35/101) completing all 9 items. Intervention: All participants were randomized on each of the nine clincal scenarios for which the student could choose to apply, or refrain from applying, a proferred intervention. When randomized to the control arm, the student used traditional sources of information for decision-making. When randomized to the experimental arm, the student used MEDLINE searching in addition to more traditional sources of information, for decision-making. Main Outcome Measures: Prior to, and subsequent to the information search, the students indicated their comfort in using the proffered intervention on a seven point Likert scale. Results: Analyzed with one-way ANOVA, the mean rating post-search of the control non- MEDLINE arm was 2.94 (SD = 1.80) (where 1 = correct, 7 = incorrect) and of the experimental MEDLINE arm was 2.71 (SD = 1.81), (F(1,522) = 2.03, p = 0.15 n.s). The mean change of the control arm was 0.97 (SD = 2.04) and of the experimental arm was 1.008 (SD = 1.92), (F(1,511) = 0.04, p = 0.84n.s.). Conclusions: The addition of MEDLINE to more traditional answer-seeking behaviors by medical students does not translate into a beneficial impact on clinical decision-making.

Journal Article↗

CD Plus: MEDLINE on CD-ROM.

Developed by CD Plus (formerly Online Research Systems, Inc.), CD Plus MEDLINE is a welcome addition to the growing number of MEDLINE CD-ROM products. CD Plus MEDLINE offers monthly updates and coverage of the full MEDLINE database back to 1966. Some of its features include mapping to MeSH, explode capability, permuted term index, scope notes from the Annotated MeSH, and access to the tree structures. The system is designed for the novice as well as the professional searcher. The article takes a descriptive look at MEDLINE on CD Plus, its software, searching capabilities, limitations, special features, and system requirements.

Data Display↗

CD-ROM MEDLINE use and users: information transfer in the clinical setting.

Effective delivery of biomedical information to health professionals depends on the availability of systems that are compatible with the information-seeking patterns of health professionals. MEDLINE is a major source of biomedical information, but has been available primarily through libraries via telecommunications networks. The recent availability of MEDLINE on CD-ROM has made it possible to provide MEDLINE directly to clinicians without the associated problems of telecommunications and online use charges. The MEDLINE on CD-ROM Evaluation Forum sponsored by the National Library of Medicine reported on clinicians' use of CD-ROM MEDLINE at seven different clinical settings. This article summarizes the findings from these sites and places them in the context of current understanding of information-seeking behaviors of health professionals. Key issues in the design and development of information technologies in the clinical setting are also articulated.

Ambulatory Care Information Systems↗

Searching MEDLINE for randomized clinical trials involving care of the newborn.

Randomized clinical trials make up only a small fraction of published articles concerning care of the newborn infant and an even smaller fraction of articles about all human subjects. The busy pediatrician who wants to keep abreast of the medical literature requires strategies to detect such relevant studies promptly and reliably. Computer searching of MEDLINE is an attractive, potentially powerful but not sufficiently validated means of achieving this goal. Therefore, the sensitivity, specificity, and positive predictive value of two MEDLINE search strategies designed to detect randomized clinical trials for prevention and treatment of newborn diseases among all original articles about human subjects appearing in ten pediatric and general medical journals during 1985 were determined. The yield of both MEDLINE searches was compared to that of a manual search. Fifty-three randomized clinical trials of newborn care were identified by hand search among 233 articles concerning care of the newborn and 2,988 original articles about human subjects. The sensitivities of the MEDLINE searches were 53% and 34%, respectively, and the positive predictive values were 82% and 69%, respectively. Specificity of both computer searches was virtually 100%. Twenty-one randomized clinical trials were not identified by either MEDLINE search strategy, 17 of them for failure of the indexer to assign any methodologic terms at all or failure to assign sufficiently stringent methodologic terms. Consequently, sensitivities were higher, 77% and 68% respectively, when no methodologic terms were used during repeat searches. However, positive predictive values decreased concomitantly to 20% or less.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗

Evaluating CD-ROM versions of the MEDLINE database: a checklist.

The emergence of CD-ROM (compact disc/read-only memory) versions of the MEDLINE database requires experienced MEDLINE searchers to examine assumptions about searching MEDLINE, since some expectations may not be fulfilled by this new technology. When applied to a particular CD-ROM MEDLINE product, the evaluation procedure involves testing assumptions concerning database contents; mechanics of searching; display, print, and download capabilities; and user-friendly features. The extent to which a CD-ROM product preserves and exploits important MEDLINE strengths should be assessed, e.g., the MeSH controlled vocabulary, the designation of major and minor MeSH emphasis, and the use of subheadings. Search software characteristics that affect ease of searching and quality of results also need to be examined, e.g., the ability to truncate search terms and the order of precedence in which Boolean operators are evaluated. A checklist to assist in the evaluation process is presented, including search examples for use in testing search functions.

Abstracting and Indexing↗

Nonmediated use of MEDLINE and TOXLINE by pathologists and pharmacists.

Pathologists and pharmacists have used terminals in their departmental areas successfully to perform searches on MEDLINE and TOXLINE, during the period from fall 1974 through August 1975; MEDLINE has been used more than TOXLINE. In the Department of Pathology at the University of Maryland Health Sciences Center, the annual rate of combined mediated and nonmediated use of MEDLINE increased from 142 search sessions to 432, over half of the identified use being by three individuals. About half of the total potential users from each group tried MEDLINE or TOXLINE at least once. Nine pathologists and seven pharmacists used MEDLINE five or more times. Five of the individuals in each group were "intensive" users, who concentrated more than half of their sessions within two months. Vocabulary experience and systems problems are touched on. Most individuals learned to use the systems from one another or in individual sessions with the authors, although a twenty-five page "minimanual" has also been used by a limited group.

Information Systems↗

Articles on complementary medicine in the mainstream medical literature: an investigation of MEDLINE, 1966 through 1996.

OBJECTIVE: To investigate the growth of interest, if any, in complementary or alternative medicine by the professional scientific community from the number of MEDLINE-listed and clinical trial-type articles for January 1, 1966, through December 31, 1996. METHODS: Systematic literature searches of the MEDLINE database, using the expanded terms "alternative medicine," "traditional medicine," "acupuncture," "homeopathy," and "chiropractic," were conducted in January 1998 to evaluate the number of all articles. The number of clinical trial-type articles on the above was obtained by conducting searches for those indexed as 1 or more of the following publication types: clinical trial; clinical trial phase 1, 2, 3, or 4; controlled clinical trial; metaanalysis; randomized controlled trial; and limited to "human" trials only. RESULTS: Articles indexed as alternative medicine formed a small proportion (0.4%) of the total number of MEDLINE-listed articles throughout the period studied. From 1966 through 1996, the total number of articles listed in MEDLINE rose significantly to a peak of 400000 additions per annum in 1996 (r = 0.97; P<.001). By contrast, the number of articles indexed under alternative medicine rose progressively only from 1972 through 1986 and since then has been relatively stable at around 1500 additions per annum. For this period, the proportion of clinical trial-type alternative medicine articles was low (mean, 2.1% per annum) but increased significantly from 1987 through 1996, reaching around 10% of the total in 1996 (r = 0.79; P<.001). Patterns of growth in the number of publications for individual therapies have varied during the period studied, and clinical trial-type articles form only a small part of any increase. CONCLUSIONS: Interest in and awareness of complementary medicine among orthodox health care professionals has increased in the past 30 years. The increase in the number and proportion of reports of clinical trials indicates an increasing level of original research activity in complementary medicine and suggests a trend toward an evidence-based approach in this discipline. The cumulative number of clinical trial-type articles is small, however, and more high-quality original research in complementary medicine is required.

Complementary Therapies↗

Presence of pharmacoepidemiology in three bibliographic databases: Medline, IPA and SCI.

OBJECTIVE: The objective of this study is to make a comparative description of the evolution and distribution of international research into pharmacoepidemiology, using three bibliographic databases, in order to select the most appropriate for future bibliometric studies. METHODS: Bibliographic searches were performed using the following databases: Medline (1966-99), IPA (1970-99) and SCI (1990-99), using the term 'pharmacoepidemiology'. On the basis of these searches, the number of original articles per year and per journal title were noted. The growth of the output of scientific writing was found to fit Price's law. RESULTS: A total of 845 original articles were recovered: 467 from IPA, 219 from Medline and 159 from SCI. The highest mean number of original articles per year (33.4) was obtained with the IPA database. Price's exponential growth pattern was observed among all three databases. The total numbers of journals in which the original articles were published were 102 in Medline, 65 in IPA and 60 in SCI. The journals providing a single original article comprised 65% of the Medline titles and 61% of those in IPA and SCI. CONCLUSIONS: International research into pharmacoepidemiology presents an exponential growth pattern, in accordance with Price's law. There is a large degree of publishing dispersion. IPA was found to be the bibliographic database that recovered the greatest number of original articles, nearly half of which were published in Pharmacoepidemiology and Drug Safety. We therefore consider the latter database appropriate for bibliometric studies in the field of pharmacoepidemiology.

Bibliometrics↗

How good are clinical MEDLINE searches? A comparative study of clinical end-user and librarian searches.

The objective of this study was to determine the quality of MEDLINE searches done by physicians, physician trainees, and expert searchers (clinicians and librarians). Its design was an analytic survey with independent replication in a setting of self-service online searching from medical wards, an intensive care unit, a coronary care unit, an emergency room, and an ambulatory clinic in a 300-bed teaching hospital. Participating were all M.D. clinical clerks, house, and attending staff responsible for patients in the above settings. Intervention for all participants consisted of a 2-h small group class and 1-h practice session on MEDLINE searching (GRATEFUL MED) before free access to MEDLINE. Search questions from 104 randomly selected novice searches were given to 1 of 13 clinicians with prior search experience and 1 of 3 librarians to run independent searches (triplicated searches). Measurements and main results from these unique citations of the triplicated searches were sent to expert clinicians to rate for relevance (7-point scale). Recall (number of relevant citations retrieved from an individual search divided by the total number of relevant citations from all searches on the same topic) and precision (proportion of relevant citations retrieved in each search) were calculated. Librarians were significantly better than novices for both. Librarians had equivalent recall to, and better precision than, experienced end-users. Unexpectedly, only 20% of relevant citations were retrieved by more than one search of the set of three, with the conclusion that novice searchers on MEDLINE via GRATEFUL MED after brief training have relatively low recall and precision. Recall improves with experience but precision remains suboptimal. Further research is needed to determine the "learning curve," evaluate training interventions, and explore the non-overlapping retrieval of relevant citations by different searchers.

Evaluation Studies as Topic↗

Information content in Medline record fields.

BACKGROUND: The authors have been conducting text mining analyses (extraction of useful information from text) of Medline records, using Abstracts as the main data source. For literature-based discovery, and other text mining applications as well, all records in a discipline need to be evaluated for determining prior art. Many Medline records do not contain Abstracts, but typically contain Titles and Mesh terms. Substitution of these fields for Abstracts in the non-Abstract records would restore the missing literature to some degree. OBJECTIVES: Determine how well the information content of Title and Mesh fields approximates that of Abstracts in Medline records. APPROACH: Select historical Medline records related to Raynaud's Phenomenon that contain Abstracts. Determine the information content in the Abstract fields through text mining. Then, determine the information content in the Title fields, the Mesh fields, and the combined Title-Mesh fields, and compare with the information content in the Abstracts. RESULTS: Four metrics were used to compare the information content related to Raynaud's Phenomenon in the different fields: total number of phrases; number of unique phrases; content of factors from factor analyses; content of clusters from multi-link clustering. The Abstract field contains almost an order of magnitude more phrases than the other fields, and slightly more than an order of magnitude more unique phrases than the other fields. Each field used a factor matrix with 14 factors, and the combination of all 56 factors for the four fields represented 27 separate, but not unique, themes. These themes could be placed in two major categories, with two sub-categories per major category: Auto-immunity (antibodies, inflammation) and circulation (peripheral vessel circulation, coronary vessel circulation). All four sub-categories included representation from each field. Thus, while the focus of the representation of each field in each sub-category was moderately different, the four sub-category structure could be identified by analyzing the total factors in each field. In the cluster comparison phase of the study, the phrases used to create the clusters were the most important phrases identified for each factor. Thus, the factor matrix served as a filter for words used for clustering. While clusters were generated for all four fields, the Title hierarchy tended to be fragmented due to sparsity of the co-occurrence matrix that underlies the clusters. Therefore, the Title clusters were examined at only the lower levels of aggregation. The Abstract, Mesh, and Mesh + Title fields had the same first level taxonomy categories, auto-immunity and circulation. At the second level, the Abstract, Mesh, and Mesh + Title fields had the autoimmune diseases and antibodies sub-category in common. The Abstract and Mesh fields shared fascia inflammation as the other auto-immunity sub-category, while the other Mesh + Title sub-category focuses on vinyl chloride poisoning from industrial contact, and consequences of antineoplastic agents. However, in both cases, even though the words may be different, inflammation may be the common theme. CONCLUSIONS: For taxonomy generation, especially at the higher levels, each of the four fields has a similar thematic structure. At very detailed levels, the Mesh and Title fields run out of phrases relative to the Abstract field. Therefore, selection of field (s) to be employed for taxonomy generation depends on the objectives of the study, particularly the level of categorization required for the taxonomy. For information retrieval, or literature-based discovery, selection of the appropriate field again depends on the study objectives. If large queries, or large numbers of concepts or themes are desired, then the field with the largest number of technical phrases would be desirable. If queries or concepts represented by the more accepted popular terminology is adequate, then the smaller fields may be sufficient. Because of its established and controlled vocabulary, the Mesh field lags the Title or Abss the Title or Abstract fields in currency. Thus, the Title or Abstract fields would retrieve records with the most explicitly stated current concepts, but the Mesh field would capture a larger swath of fields that contained a concept of interest but perhaps had a wider range of specific terminology in the Abstract or Title text. In addition, this study provides the first validated estimate of the disparity in information retrieved through text mining limited to Titles and Mesh terms relative to entire Abstracts. As much of the older biomedical literature was entered into electronic databases without associated Abstracts, literature-based discovery exercises that search the older medical literature may miss a substantial proportion of relevant information. On the basis of this study, it may be estimated that up to a log order more information may be retrieved when complete Abstracts are searched.

Abstracting and Indexing↗

Analysis of current nuclear cardiology literature in MEDLINE database: a study of gated SPECT imaging using PubMed.

BACKGROUND: Easy access to relevant clinical information is necessary for physicians to make the best decisions for patient management. The increasing amount of information available has made it difficult for physicians to retrieve up-to-date information efficiently. We sought to determine the accessibility and accuracy of indexing in the nuclear cardiology literature by conducting sample searches in the MEDLINE database on the topic of gated single photon emission computed tomography (SPECT) imaging. METHODS AND RESULTS: The MEDLINE database was initially searched by use of both a primary and a comprehensive search strategy on PubMed for publications in English from 1994 to 2000. A total of 260 papers were retrieved from the primary search and 306 additional papers from the comprehensive search. Only 204 of the 566 citations from the combined electronic searches were truly relevant to gated SPECT. The resulting specificity index (precision) was 36%. A hand search was conducted in 11 top journals from 1994 to 2000. It yielded 81 additional citations that were missed by the PubMed search. The sensitivity index (recall) was calculated for all 11 journals. The Journal of Nuclear Cardiology had the highest rate of publication but the lowest rate of recall (44%). The clinical nuclear cardiology terminology and classifications were compared with the available Medical Subject Headings (MeSH) and MeSH Trees used for indexing in MEDLINE. CONCLUSIONS: There are 6 nuclear cardiology techniques, including gated SPECT and myocardial perfusion imaging, that are not specifically indexed in the current MEDLINE database. The lack of specific MeSH headings and indexing structure results in low recall and precision for retrieval of nuclear cardiology literature. We recommend 2 additions to the MeSH Tree Structure and 6 new MeSH headings.

Cardiology↗

Searching for rehabilitation articles on MEDLINE and EMBASE. An example with cross-over design.

OBJECTIVE: To analyze the usefulness of MEDLINE and EMBASE biomedical databases in rehabilitation and to identify descriptors and text words necessary to do a comprehensive search. METHODS: We looked for articles published since 1990 relating to neurologic, orthopedic, respiratory, urologic, and rheumatologic rehabilitation. We looked for all descriptors and text words pertinent to rehabilitation and linked them with "cross-over." RESULTS: We found 165 articles in MEDLINE and 159 in EMBASE with an overlap of only 17% of articles. Only 32% of the articles in MEDLINE and 35% in EMBASE were relevant. Of the 214 nonoverlapping articles, 84% were published in journals present in both databases, but were indexed differently. CONCLUSION: At least two databases must be used to ensure a comprehensive literature search. Searching in EMBASE after MEDLINE we gained 25 articles (32%). Bibliographic search in rehabilitation is particularly complex because of the heterogeneity of the subject matter. Cooperation between an information professional and a clinician is essential to ensure a comprehensive search.

Cross-Over Studies↗

The accuracy of MEDLINE and Journal contents pages for papers published in Clinical Otolaryngology.

MEDLINE is widely used as a source for identifying and reviewing medical journal literature. Its accuracy is generally taken for granted, as is that of the contents pages published by the journals themselves. In this study of citation accuracy we examined the articles published in Clinical Otolaryngology and Allied Sciences from 1976 to 1998. The entries in MEDLINE were compared with the entries in the Journal's contents pages, and with the actual articles. Of 1651 articles published in the journal, one was omitted from MEDLINE and 25 (1.5%) were incorrectly cited, while 88 (5.3%) were incorrectly cited in the contents pages. Twenty-one (84%) of the errors in MEDLINE involved names of authors. Apart from incomplete retrieval of information for practice and research, errors could result in an author not getting credit for publications.

Abstracting and Indexing↗

The impact of an individual tutorial session on MEDLINE use among obstetrics and gynaecology residents in an academic training programme: a randomized trial.

Over the past decade, on-line databases have become increasingly popular among health care professionals. As a group, these 'end-users' report utilizing databases to keep abreast of medical progress, to conduct research and to address specific patient care issues. Throughout the literature, medical professionals ('content experts') have proved to be less effective searchers than librarians ('search experts'). The potential implications of this discrepancy are worrysome. For any given clinical scenario, for example, published reports may reach contradictory conclusions. A poorly skilled searcher may not retrieve enough articles to appreciate this fact. Optimizing searching skills is therefore a worthwhile goal. As a first step, many medical schools introduce students to on-line databases, most notably MEDLINE. Residency is an ideal time to continue this training. A recognized obstacle to provide residents with formal MEDLINE instruction is time constraint. We therefore conducted this study to ascertain the impact an individual 1-hour tutorial session would have on MEDLINE utilization among obstetrics and gynecology residents training at an academic medical centre. Outcome measures included MEDLINE search frequency, duration, recall, precision and searcher satisfaction. Search recall measures the searcher's ability to retrieve articles deemed relevant to the question at hand. Search precision gauges the searchers' ability to eliminate irrelevant articles. Although the sessions were well received, we were unable to demonstrate an improvement in the outcome measures analysed. Further research is therefore indicated so that cost-effective educational strategies can be recommended for wide-scale use.

Double-Blind Method↗

Contribution of medical student research to the Medline-indexed publications of a German medical faculty.

Medical students in Germany have to write a research thesis to acquire the title of medical doctor. This study evaluates the contribution of student research to the Medline-indexed publications of a German medical faculty. A 1993-1995 Medline-publication list, on which medical students among authors should be marked, was sent to medical faculty staff of the University of Würzburg, Germany (n = 238). Faculty members responded (106, 45%), 66 were working at a clinic, 26 at a clinic-associated institute and 14 at a basic science institute. Between 1993 and 1995, 1128 Medline-indexed papers were published by these faculty members, who on average supervised 4.5 medical students (n = 477). Medical students were among the authors of 316 (28%) and were the first authors of 88 papers (7.8%). For 66% of medical students their research resulted in a Medline-indexed publication. Medical student research activity can significantly influence the published output of a medical faculty.

Faculty↗