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PubMed1992

The MEDLINE Retriever.

Baylor College of Medicine has developed the MEDLINE Retriever, a tool to query MEDLINE, the data-base of medical literature at the National Library of Medicine. The MEDLINE Retriever communicates via the Internet to achieve excellent response time for MEDLINE queries. It uses the X Window System and the Motif toolkit, and employs the Knowbot Operating Environment developed by the Corporation for National Research Initiatives. We discuss the architecture of the MEDLINE Retriever, focusing on the graphical user interface that we have developed, as well as our experiences in developing and deploying the MEDLINE Retriever at Baylor. The MEDLINE Retriever is an extension of Baylor's IAIMS design concept that brought forth the Virtual Notebook System, and fits well with Baylor's aims with regard to the High Performance Computing Initiative.

Computer Communication Networks↗

PubMed1991

Evaluating the impact of MEDLINE using the Critical Incident Technique.

An adaptation of the Critical Incident Technique for the evaluation of an online information system is described. 552 users of the National Library of Medicine's MEDLINE database, interviewed by telephone and responding to a highly structured set of open-ended questions, reported 1,158 incidents in which the results of a MEDLINE search was especially helpful (or not helpful) in carrying out professional activities. Systematic analysis of these "critical incidents" produced three comprehensive and detailed views of the purposes and outcomes of MEDLINE searches: (1) why information is sought from MEDLINE; (2) the impact of MEDLINE-derived information on medical decision-making; and (3) the ultimate outcome of having (or not having) the desired information on medical situations prompting a MEDLINE search. Results revealed that MEDLINE is used to satisfy a diversity of medical needs concerning patient care, the progress of biomedical research, the quality of education received by health professionals in training, the safety and effectiveness of health care institutions, the operation of the system of third-party reimbursement, for legal decisions, and for the knowledge of the public.

Consumer Behavior↗

PubMed1991

MELVYL MEDLINE: a library services perspective.

The MELVYL MEDLINE project resulted in the addition of a full five-year subset of MEDLINE to the University of California's (UC) MELVYL online union catalog. As one of the nation's largest MEDLINE end-user searching systems, MELVYL MEDLINE provides online bibliographic access to the biomedical journal literature for all UC personnel at over seventy library sites or by remote access. This paper summarizes the project's accomplishments, reports MELVYL MEDLINE use and its impact on library services, and provides insights for other end-user search systems. The project serves as a model for adding databases to the MELVYL catalog and demonstrates the potential for use by other disciplines of a specialized database when readily accessible. Evaluation results report high user satisfaction and high usage. However, many advanced searching features of the interface are little used by searchers. Effects on library services include marked increases in reference transactions and interlibrary loans, with significant declines in mediated search services. Future MELVYL MEDLINE enhancements include matching search retrievals to journal locations, linkage to an online document delivery system, and consideration of building a superset of databases by combining MELVYL MEDLINE with citations from another database in the MELVYL catalog.

California↗

PubMed1992

The comprehensiveness of Medline and Embase computer searches. Searches for controlled trials of homoeopathy, ascorbic acid for common cold and ginkgo biloba for cerebral insufficiency and intermittent claudication.

OBJECTIVE: To assess the comprehensiveness of Medline and Embase computer searches for controlled trials. DESIGN: Comparison of articles found after an exhaustive search of the literature with the yield of a Medline or Embase search. This was performed for controlled clinical trials on the efficacy of three interventions: homoeopathy, ascorbic acid for common cold, and ginkgo biloba for intermittent claudication and cerebral insufficiency. The number of controlled trials found by exhaustive search of the literature was 107, 61 and 45, respectively. RESULTS: For homoeopathy, ascorbic acid and ginkgo the proportion of all trials found by Medline was 17%, 36% and 31% respectively and for Embase 13%, 25% and 58% respectively. After checking of the references in the Medline articles 44%, 79% and 76% of all trials were identified. After checking of the references in the Embase articles 42%, 72% and 93% of all trials were identified. About 20% of the articles was not correctly indexed. Of the best trials 68%, 91% and 83% could be found with Medline and 55%, 82% and 92% of the best trials were identified through Embase. CONCLUSIONS: For the topics mentioned, Medline and Embase searches are sufficient to get an impression of the evidence from controlled trials, but only if references in the articles are followed for further evidence. If one wants to get a more complete picture, additional search strategies make sense. Of course, this picture may be different for other topics.

Abstracting and Indexing↗

PubMed1992

Performance appraisal of online MEDLINE access routes.

OBJECTIVE: To compare the performance and cost of 11 online MEDLINE systems with MEDLINE at Elhill. DESIGN: Comparative study. SYSTEMS: Eleven online daytime systems commercially available in North America offering the MEDLINE database. MEASURES: Number of relevant citations, number of irrelevant citations, proportion of searches producing no relevant citations and cost per relevant citation were analyzed for each system. Relevance and cost for each system were compared with direct searching of MEDLINE through NLM for librarian and clinician search strategies for 18 clinical questions. The citations retrieved by both strategies were pooled and rated for relevance on a 7-point scale. RESULTS: Numbers of relevant and irrelevant citations and cost per relevant citation were higher for clinician searches than librarian searches, reflecting the higher total number of citations retrieved by the clinician approaches. A lower proportion of clinician searches produced no relevant citations than librarian searches. CONCLUSIONS: Eleven daytime MEDLINE systems performed similarly in terms of retrieval and cost within similar searching groups. Clinicians, however, tended to capture larger overall retrievals resulting in higher numbers of relevant and irrelevant citations than librarians.

CD-ROM↗

PubMed1990

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↗

PubMed1976

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↗

PubMed1990

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↗

PubMed1991

A study to enhance clinical end-user MEDLINE search skills: design and baseline findings.

OBJECTIVE: To determine if a preceptor and timely, individualized feedback improves the performance of physicians in searching MEDLINE using GRATEFUL MED in clinical settings. DESIGN: Randomized controlled trial. SETTING: A 300 bed primary to tertiary care teaching hospital. Computers were installed in wards and clinics of 6 major clinical services, and the emergency room, intensive care and neonatal intensive care units. SUBJECTS: All physicians and physicians-in-training from the departments of Medicine, Family Medicine, Surgery, Psychiatry, Pediatrics, and Obstetrics and Gynecology were included if they made patient care decisions for at least 8 weeks during the study period. INTERVENTION: All participants were given a 1-hour training class and 1 hour of individualized searching with 1 of the 2 study librarians. After training, participants were randomized to a control group who received no further intervention or to an intervention group in which each person chose a clinical preceptor experienced in MEDLINE searching and received individualized feedback by a study librarian on their first 10 searches, indicating search quality and providing suggestions for improvement. Feedback was mailed the first week day after the search was done. MAIN MEASURES: Baseline characteristics by study group, department and level of training, study participation rates, and searching rates. MAIN RESULTS: 308 of 392 eligible physicians joined the study. Participation was almost 80% with some variation by department and level of training. Excellent balance in the baseline characteristics was achieved for the 2 groups, as well as for the number who did first searches. Intervention group participants searched MEDLINE more often than did controls (3.5 searches per month vs 2.5 per month for controls, P = 0.046). The recall and precision for first searches for both groups was significantly less than that of librarians. The analysis of study data will be completed by September 1991. CONCLUSIONS: Clinicians are willing to do self-service searching of MEDLINE in clinical settings but their precision and recall are less than a trained librarian at baseline. Search skills enhancements are needed and the effect of feedback and preceptors is being tested. SOURCE OF FUNDING: U.S. National Library of Medicine and Ontario Ministry of Health.

Computer User Training↗

PubMed1991

Currency of full-text medical journals: CCML and MEDIS vs. MEDLINE.

The authors ask whether full-text versions of medical journals are available for searching sooner than their biblographic counterparts. The journals in question are those found in the Comprehensive Core Medical Library (CCML) from BRS Information Technologies and in Mead Data Central's MEDIS Current Journal Files. All journals in these two files are full-text, and neither file contains any indexing features. Update schedules for the full-text version of the MEDLINE journals in each of these files were compared with the most recent issue available in the National Library of Medicine's (NLM) MEDLINE on five different dates. The data revealed substantial fluctuation in comparative currency for MEDIS/MEDLINE over the period of the test. On the date of the last snapshot, June 8, 1990, MEDLINE and MEDIS were offering the same currency for 43% of the journals, and MEDIS was providing first access to 29% of the titles. The CCML/MEDLINE comparison showed less variation. In the last snapshot MEDLINE and CCML were providing access to the same issue for 36% of the journals, and CCML was offering first access to 14%. Prior to publication, this paper was submitted to all three vendors for comment. Significant portions of their responses are quoted.

MEDLINE↗

PubMed1991

Biomedical database inter-connectivity: an experiment linking MIM, GENBANK, and META-1 via MEDLINE.

The linkage of disparate biomedical databases is an important goal of the Unified Medical Language (UMLS) Project. We conducted an experiment to investigate the feasibility of using UMLS resources to link databases in clinical genetics and molecular biology. References from MIM ("Mendelian Inheritance in Man") were lexically mapped to the equivalent citations in MEDLINE. The MeSH major subject headings by which the citations in a particular MIM entry had been indexed were used to develop a "genetic-disorder-centered view of the world" in Meta-1 (the first official version of the UMLS Metathesaurus). Our hypothesis was that these MeSH subject headings could provide access to a "semantic neighborhood" in Meta-1 that would be relevant to a particular genetic disorder. By browsing in this "semantic neighborhood," a user could select various combinations of terms with which to search MEDLINE through an interface between Meta-1 and Grateful Med. Such searches might retrieve citations that were more recent than those in MIM or that provided useful supplementary information. Since some MEDLINE records contain pointers to entries in GENBANK, information about genetic sequences related to a particular clinical genetic disorder could also be retrieved. This scenario was implemented for a small number of MIM entries, providing a concrete demonstration that linking disparate electronic databases in an important subdomain of biomedicine is relatively straightforward.

Databases, Factual↗

PubMed1977

MEDLINE demand profiles: an analysis of requests for clinical and research information.

When a medical library serves both research scientists and practicing physicians, it may be predicted from the results of previous studies that computerized bibliographic search services will show more research and less clinical activity. The present paper reports the results of a statistical analysis of professional use of the National Library of Medicine's bibliographic retrieval system. MEDLINE (Medical Literature Analysis and Retrieval System on-Line), at a large medical school library. Results indicate that (1) demand for MEDLINE service is primarily research oriented; (2) frequency of use bears a relationship to rank and departmental affiliation; (3) broad and comprehensive searches are requested more frequently than searches for specific information; (4) usage shows an interesting curvilinear relationship with age and status of the user; and (5) grant funds and support correlate with the number of searches requested. Implication of these findings are that since clinicians' use of MEDLINE was found to be minimal, information services should be reevaluated in order to assist in meeting their information needs more effectively.

Connecticut↗

PubMed1991

Comparison of search strategies for recalling double-blind trials from MEDLINE.

To minimise the effect of reference bias in literature retrieval, it is important to use computerised search strategies that give a high yield of relevant reports. In a MEDLINE search that included the Medical Subject Heading (MeSH) "Comparative study," the recall of double-blind trials of NSAIDs in rheumatoid arthritis was 93.1% (122/131) and the precision was 19.0% (122/641). When "Double-blind method" was used, either as MeSH or text words, the recall was only 72.5% (95/131) with a precision of 22.7% (95/419). A combined search strategy increased the recall to 97.7% (128/131) with a precision of 17.3% (128/738). With the MeSH term "Random allocation" only eight relevant reports were retrieved, and none was new. By using "Clinical trials" alone, we would have missed eleven reports. We conclude that "Comparative study" is preferable to "Double-blind method" when searching double-blind trials on MEDLINE.

Abstracting and Indexing↗

PubMed1991

Online access to MEDLINE in clinical settings: impact of user fees.

The effect of introducing user fees on the frequency and quality of MEDLINE searching with GRATEFUL MED by physicians in clinical settings was tested. After training and free use (prior study), consenting participants were randomly allocated to pay searching costs (pay group) or continue without fees (no pay group). Fifty-nine physicians participated. Among the prior study's frequent searchers, the pay group searched at less than one third of the rate of those assigned to no pay. For less frequent searchers in the prior study, only 48% of those assigned to pay did any searches, compared with 85% for the no pay group (P = 0.006), and for those who did search, their frequency was almost half. However, there was no significant difference in the quality of searches; both groups demonstrated about equivalent recall (P = 0.77), but significantly lower precision (P = 0.03) than for the librarian's independent searches. Similarly, there was no difference in the proportion of searches affecting clinical decisions for the two groups. Thus, imposing user charges for online searching in clinical settings after a period of free use adversely affects searching quantity, but not quality. MEDLINE providers should consider whether user fees will undermine its benefits.

Fees and Charges↗

PubMed1990

An evaluation of CD-ROM MEDLINE use in Thailand.

An analysis of requests for CD-ROM MEDLINE* searches from June to December 1987 at the Medical Library, Chulalongkorn University, was performed. Requests were received from eighty-two places, in Bangkok and the provinces; 97.8% were from government organizations. MEDLINE on CD-ROM was available from 1982 to date. Most users requested searches covering the previous five or six years. Users were surveyed regarding the service: just over 87% found the service user-friendly. In addition, users suggested that the library conduct search training programs, and more than half of the users noted that a single work station could not meet the search load.

Information Services↗

PubMed1978

MEDLINE searching and retrieval.

The development of MEDLINE searching philosophy and methodology is described. Searcher requirements and capabilities in moving from a batch-mode linear operation to the iterative searching and retrieval provided by the random access mode of MEDLARS II are discussed. A detailed tutorial on searching methodology for individual queries is covered. Elements of search formulation include requestor interview, query analysis, presearching, technics of selecting terminology, formulation logic, adapting indexing protocol in the search, on-line man-machine interface, and retrieval analysis. Similar searching technics are utilized in producing the two basic types of MEDLINE publications, recurring bibliographies (RBs) and literature searches (LSs). RBs are co-operative ventures between the NLM and professional organizations or other government agencies. LSs are NLM sponsored non-recurring bibliographies on a topic of current but also general interest to the medical community. All publications are produced through the retrieval and publication systems of MEDLARS II and graphic arts composing equipment. At the beginning of the 1978 publication year there were 27 RBs in routine production including Index Medicus. Through 1977, over 375 LSs had been produced.

MEDLARS↗

PubMed1978

Selection of MEDLINE contents, the development of its thesaurus, and the indexing process.

The operation of MEDLINE requires three ongoing activities by persons having subject matter knowledge. These are literature selection, thesaurus maintenance and indexing. MEDLINE is intended to give access to the most generally useful biomedical literature rather than to provide indiscriminate comprehensive coverage. Literature is selected with the guidance of a group of health-science educators, editors and librarians who review periodicals under consideration for inclusion and re-evaluate those that are already regularly indexed. The MeSH thesaurus provides the descriptors that are used for subject indexing. Its hierarchical structure facilitates both general and specific searching. The appearance of new concepts and terminology in the literature requires a dynamic MeSH, but MeSH changes may complicate the process of searching backward in time. Maintaining MeSH requires finding a balance between the need for adaptability and the need for stability. Quality indexing requires accuracy and consistency in the assignment of subject headings. To this end, indexers receive didactic training plus practice under supervision. Precedents for indexers are detailed in an extensive Indexer's Manual and in MeSH annotations. Work of all indexers is reviewed on at least a sampling basis, and special sessions are held each year to familiarize indexers with MeSH changes.

Abstracting and Indexing↗

PubMed1975

Mechanization of library procedures in the medium-sized medical library: XV. A study of the interaction of nonlibrarian searchers with the MEDLINE retrieval system.

The MEDLINE searchhes of sixteen nonlibrarian searchers at the School of Medicine Library, Washington University, were examined to determine the amount of utilization of the interactive capabilities of the system. The searchers made an average of 5.7 search statement modifications of their original searc statements and it was concluded that they did indeed use the interactive capabilities of MEDLINE.

Information Systems↗