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cleo_md
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Searching The Medical Literature On The Internet
« on: /November/ 06, 2005, 12:28:30 PM »

The use of computers has revolutionized the act of searching the medical literature, and the number of physicians performing their own searches continues to increase significantly.[2][3] This is the result of several converging trends:
The compendium of published medical literature is enormous and thus is not immediately accessible to most clinicians.
The volume of new information added to the literature is expanding quickly.
Practicing physicians are becoming more computer literate, and medical schools and residency-training programs are teaching students and residents how to integrate computers into their everyday practice.
There are now few, if any, medical offices that do not have computers.
The older, cumbersome access to searching medical databases has evolved into easier "point-and-click" or menu-driven interfaces.
Evidence-based medicine continues to grow in importance.[4]

In the past, literature searches were used primarily for research and manuscript preparation. The continuing importance of this type of literature search was emphasized during the recent controversy over the death of a research subject, in which an inadequate literature search was cited as a contributing factor.[5] Today, however, computer-assisted literature searches are being used to assist in patient care and clinical problem solving,[6][7][8] and many computer-assisted systematic literature reviews have been published in the contemporary literature.[9][10] Literature searches are reported to be extremely useful in several aspects of patient care, including choosing the most appropriate diagnostic tests, properly diagnosing medical conditions, and developing and implementing suitable treatment plans.[7][8] Users also have reported that findings from literature searches have resulted in improved patient outcomes overall and, in some cases, have contributed to the implementation of life- or organ-saving treatments.[8] In fact, in one study, the use of online literature searches early in the course of hospitalization resulted in significantly lower hospital costs and charges and in shorter lengths of stay than when literature searches were not performed in matched control patients with the same diagnoses.[6] Even more impressive, the patients in the literature-search group had a higher average level of illness severity than did the patients in the control group, which normally results in higher costs and longer length of stay.

Literature searches are reported to be extremely useful in several aspects of patient care, including choosing the most appropriate diagnostic tests, properly diagnosing medical conditions, and developing and implementing suitable treatment plans.?


Quality Of Literature Searches


The quality of literature searches is traditionally assessed with two variables: recall and precision.[11] Recall refers to the ratio of relevant citations retrieved by a search to the actual number of relevant citations present in the literature. Precision refers to the ratio of relevant citations retrieved by a search to the number of total citations retrieved by a search. In the past, searches often were mediated by medical librarians, who were knowledgeable and trained in search techniques; these were considered the "gold standard" of literature searches. Studies have shown, however, that clinician searches can approach the quality of librarian searches after a relatively short period of training and practice.[3]


Available Sources Of Literature Searches

Databases maintained through the National Library of Medicine
MEDLINE is a database of journal citations that covers general medicine, nursing, dentistry, veterinary medicine, health care systems, and preclinical sciences. As of early 2002, MEDLINE contained citations to over 11 million articles from over 4600 biomedical journals from the United States and 70 other countries dating back as far as 1966. Approximately 460,000 references were added in 2001.

In 1997, the National Library of Medicine (NLM) began providing free, unlimited access to MEDLINE on the Internet through a search interface called PubMed, which was developed in association with the National Center for Biotechnology Information at the NLM. Its search engine, called Entrez, is flexible and powerful, allowing users to perform both simple and complex searches. PubMed can be accessed through links at the NLM Web site (www.nlm.nih.gov ) or directly (www.ncbi.nlm.nih.gov/entrez/query.fcgi ).

Changes and improvements continue to be made to PubMed. Most aim to synthesize and "add value" to the information. For example, links from PubMed articles refer users to gene sequences in public databases such as Genbank or to the National Institutes of Health (NIH)-maintained Online Mendelian Inheritance in Man database. Plans are underway to hyperlink phrases in PubMed abstracts to relevant sections of major textbooks.[12] The LinkOut feature is designed to point to additional Web-accessible resources (e.g., databases, consumer health information, research tools) and to offer direct access to the citation's full-text article. The NLM's goal -- to provide free access to full-text articles -- has met with some resistance, mainly from the publishers of journals; however, there is increasing support for providing the full text of at least the older articles free of charge. Many newer articles probably will remain embargoed for some time.

Because indexing articles often takes time, MEDLINE had published a separate PREMEDLINE database, which contained information supplied during the prepublication period by publishers of medical and scientific journals. This information now has been incorporated into MEDLINE, so delay is no longer an issue. Notably, this prepublication material does not include medical subject headings (MeSH) and must be searched with free text. Additionally, the NLM is gradually adding citations for material published before the mid-1960s through a database called OLDMEDLINE (available through the NLM gateway at gateway.nlm.nih.gov/gw/Cmd ), which currently contains citations from 1958 to 1965. Approximately 2 additional years of citations are being added during each calendar year.

Although there are other search engines available and some libraries and medical centers may have their own search interfaces, the free access and expanded features of PubMed have made it the most frequently used medical search engine. Thus, this article focuses primarily on techniques that help the user search efficiently using PubMed. These techniques, however, can be applied and used with other databases.


MEDLINE interfaces other than PubMed

In addition to PubMed, there are several commercially available interfaces to MEDLINE; however, because they are fairly expensive for an individual user, most are accessed through medical or hospital libraries or educational institutions. The ones most commonly used are maintained by Ovid Technologies (http://www.ovid.com/sales/medical.cfm ) and Silver Platter (www.silverplatter.com/catalog/meds.htm ).


Other important medical databases

In addition to MEDLINE, conscientious searchers should check other information sources. The Cochrane Library (www.update-software.com/cochrane ) is an excellent collection of research reviews on the effect of health care interventions. Because it has been indexed by MEDLINE since only 2000, physicians should make it a practice to search the Cochrane Library directly. It also includes the Database of Abstracts of Reviews of Effectiveness (DARE), and the Cochrane CENTRAL register of controlled trials, which indexes them back to the 1948 streptomycin-for-pulmonary-tuberculosis trial, which is generally regarded as the first modern controlled clinical trial.[13] A current individual subscription to the Cochrane Library is $285 per year, but it is often available through local medical or hospital libraries.

For clinical trials, the NIH maintains its own Web site (www.clinicaltrials.gov ), and the National Cancer Institute' site (www.cancer.gov/cancer_information ) includes information on clinical trials, research initiatives, and clinical practice guidelines. The British equivalent of the NIH's clinical trials registry is the metaRegister of controlled trials (www.controlled-trials.com ), which can be a fruitful source of information.

Exerpta Medica's EMBASE (www.embase.com ), which is available free through many medical and hospital libraries or through individual subscriptions, is a bibliographic database of 3500 journals and concentrates on drug information; therefore, it is especially useful for identifying articles on controlled clinical trials. Recent research has shown the importance of searching both MEDLINE and EMBASE to ensure comprehensive coverage.[14]

Citation indexing, such as with the Institute for Scientific Information's Science Citation Index (www.isinet.com/isi/products/citation/sci/ ) also can add another dimension to medical literature searching. By following chains of citations, the benefits of old-fashioned browsing can be achieved.

For the clinician who is interested in evidence-based medicine, the American College of Physicians-American Society of Internal Medicine sponsors ACP Journal Club (www.acpjc.org ) and Best Evidence (www.acponline.org/catalog/electronic/best_evidence.htm ), which are useful sites for finding summaries of high-quality studies and are available to nonmembers for $85 per year.

For guidelines and consensus statements, the Agency for Healthcare Research and Quality in partnership with the American Medical Association and the American Association of Health Plans sponsors the National Guideline Clearinghouse (www.guidelines.gov ), which is a good start. Other useful sites include InfoPOEMS Database from the Journal of Family Practitioners (www.infopoems.com/index.cfm ), the CDC Recommends Prevention Guidelines System (www.phppo.cdc.gov/cdcRecommends/AdvSearchV.asp ), and NIH Consensus Statements (text.nlm.nih.gov/nih/upload-v3/CDC_Statements/cdc.html#list ).

 
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 MDConsult from Elsevier Science provides full-text access to approximately 40 medical textbooks, 50 medical journals, comprehensive drug information, and more than 600 clinical practice guidelines.? ?
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MDConsult (www.mdconsult.com ) from Elsevier Science provides full-text access to approximately 40 medical textbooks, 50 medical journals, comprehensive drug information, and more than 600 clinical practice guidelines. The service is subscription based, but many medical schools and health care systems license the service and make it available to physicians in their systems.

Additionally, the following otolaryngology journals all provide free full-text access to current subscribers and have many value-added features over the actual journals: Archives of Otolaryngology-Head and Neck Surgery (www.archotol.ama-assn.org ), Annals of Otology, Rhinology, and Laryngology (www.annals.com ), Laryngoscope (www.laryngoscope.com ), and Otolaryngology-Head and Neck Surgery (www.elsevierhealth.com/oto ).

Finally, Lexis-Nexis (www.lexisnexis.com ) is potentially an extremely valuable research resource. Although not focused on health care, it is a comprehensive database of legal, public record, business, and news information. Because Lexis-Nexis frequently is licensed to academic institutions, it is usually available to affiliated personnel. Additionally, access to specific documents can be purchased on a pay-per-view basis.


Search Techniques


Whatever database or search interface is used, the searcher should take advantage of all provided training materials to obtain the best possible search results. Most systems provide either a user manual or online help features. For achieving maximal effectiveness, the importance of reviewing the help information cannot be overemphasized and applies to any database interface (including Internet search engines). Fortunately, PubMed provides a helpful online tutorial, a list of frequently asked questions, and a comprehensive help file.

Regardless of the search interface used, the key factors for the success of any computer-based search are the search strategy and the search technique. The two most important methods of achieving these are (1) planning a strategy for searching before going on-line, and (2) monitoring the results of the search as it progresses. Similarly, understanding the techniques of efficient searching leads to higher-quality search results. In the following subsections, the authors summarize the basic concepts needed for successful literature searches.


Formulating the question


To search efficiently, one must formulate an answerable question, which can then be transformed into a set of searchable concepts. One commonly used technique is to visualize the title of the article that would answer your question exactly. Then analyze that title, break it down into its component concepts, and perform a search on those concepts, first individually and then combined. For example, "Are tubes beneficial for otitis media?" is not a focused clinical question that lends itself to a literature search, because it does not follow the mnemonic PICO (patient, intervention, comparison, outcome).[15] [Table 1] shows how the PICO categories can focus a clinical question on otitis media. Depending on the intent of the question, however, the PICO categories may change. For example, if the question concerns a prognosis, then the "Comparison" category might remain blank.

Table 1. An example of formulating a searchable clinical question using the PICO system.

Heading Example
Patient or population Children with recurrent otitis media
Intervention Antibiotics
Comparison Watchful waiting
Outcome Reduced recurrences


MeSH terms
The entire search process relies on an accurate formulation of the search question, which then is translated into a search query by breaking it down into concepts. MEDLINE uses concepts to index articles. To standardize this indexing, the NLM created a special list of terms called MeSH terms, which are used in MEDLINE and other MeSH-based databases. MeSH terms constitute a thesaurus that contains all the concepts that appear in the literature. New MeSH terms are created and added to the thesaurus as significant new or modified concepts appear in the literature. Today, there are approximately 19,000 main MeSH terms. All scientific articles are indexed accurately, hierarchically, and uniformly into MEDLINE using an average of 10 to 12 MeSH terms that describe each article's content. Using MeSH terms, therefore, contributes to the precision and completeness of any search.

Users should be aware of the MeSH vocabulary and know what terms are not included. This requires reviewing the MeSH vocabulary itself, because MeSH terms are not always intuitive. By default, PubMed attempts to "map" the search queries to the closest MeSH term, but if this is not possible, the system performs only a free-text search. Furthermore, users should not rely on the expectation that commonly used terms will map to the correct MeSH term. For example, although nosebleed and its alternate spelling nose bleed both map to the MeSH term epistaxis, the term bloody nose does not. This is more often a problem for the nonprofessional searcher, but it illustrates the importance of using precise terminology.

Another example of the importance of using MeSH terms is trying to search using laryngeal cancer, which is not a MeSH term, instead of laryngeal neoplasms, which is. Using the latter ensures a more comprehensive search result.

There is a MeSH browser available from the main PubMed search page that should help users find the appropriate MeSH terms. Additionally, check the subheadings that can be applied to the MeSH term for which you plan to search by clicking on "Display Details" for the term. These MeSH subheadings allow users to focus the search more precisely to a diagnosis, drug therapy, surgery and so forth.

Choosing a MeSH term as a "major heading" also can focus a search. Although articles usually are indexed using 10 to 12 MeSH terms, only a few are defined as the major focus of an article. Searching a MeSH term as a major heading can be useful for narrowing a large search result into a more manageable number of citations.

 
? ?
 Using the MeSH vocabulary requires some learning; however, the effort one puts into becoming familiar with the MeSH vocabulary pays off in improved search quality.? ?
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Searches also may be limited by language, geographic area, age group, gender, and a variety of other terms called check tags. Limiting searches in PubMed is simply done by using the "Limits" link immediately under the box in which the search terms are entered. There are also MeSH terms for publication type, which indicate the type of article rather than its concept (e.g., review, clinical trial, meta-analysis). The publication types also can be added through the "Limits" link or by entering the publication type followed by "[pt]" as a separate search term (e.g., "review[pt]").

Using the MeSH vocabulary requires some learning; however, the effort one puts into becoming familiar with the MeSH vocabulary pays off in improved search quality. Authors have compared literature searches performed using both free text and MeSH terms, and MeSH-based searches have higher recall and precision than do free-text searches.[11]


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cleo_md
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Re: Searching The Medical Literature On The Internet
« Reply #1 on: /November/ 06, 2005, 12:28:48 PM »

Free-text searches

In a free-text search, the computer looks for those particular words in either the title or the abstract of a citation. The obvious weakness of a free-text search is that all possible synonyms and variants of a term (e.g., caustic ingestion, corrosive burns, caustic stenosis, esophageal burn, and so forth) must be entered to ensure a comprehensive result (i.e., one with high recall). Additionally, PubMed and most systems also require the user to enter both singular and plural forms and variant spellings of each word. Another problem is that all of the articles that contain those words anywhere in the abstract or title are retrieved -- even articles that are not pertinent to the search topic.

Free-text searching can be useful when there are no appropriate MeSH terms for the search in question; however, even under those circumstances, free-text searching is used mostly in conjunction with the MeSH vocabulary.

Advanced free-text searching techniques that use "word stemming" (i.e., the expansion of synonyms) exist but are beyond the scope of this article.


Boolean search techniques

After you have identified your search concepts or terms, MEDLINE and most other databases allow the use of Boolean logic to improve search specificity. To use Boolean logic in searches, first dissect the search query into concepts (usually MeSH terms) and search each of these separately. Then combine them using the following Boolean operators: AND, OR, or NOT. These operators must be entered in the search window using capital letters. The operator AND between two terms retrieves only those articles in which both concepts appear. The operator OR retrieves any article in which either of the two terms appear. By using NOT before a term, one eliminates any article that contains the concept. For example, if a clinician is searching for clinical trials in sinusitis, an appropriate starting point for the search would be "sinusitis AND clinical trial" (both of which are MeSH terms); however, if the clinician is searching for articles on "sarcoidosis AND sinusitis," perhaps not all potentially relevant articles for sarcoidosis would be retrieved; some might be indexed under granulomatous disease. In this case, the following strategy can be used:

Search 1: "sinusitis"
Search 2: "sarcoidosis OR granulomatous disease"
Search 3: "sinusitis AND sarcoidosis OR granulomatous disease"

This sample search illustrates an important point: one should always check the MeSH vocabulary. It turns out that granulomatous disease is not a MeSH term and that its nearest match -- granulomatous disease, chronic -- refers to a rare immunodeficiency syndrome. On further searching of the MeSH browser, one discovers that sarcoidosis is indexed under the heading lymphoproliferative disorders. A review of other diagnoses under that heading demonstrates that it is a more appropriate MeSH term for this search. Thus, a more appropriate search would be as follows:

Search 1: "sinusitis"
Search 2: "sarcoidosis OR lymphoproliferative disorders"
Search 3: "sinusitis AND sarcoidosis OR lymphoproliferative disorders"

Although this search might result in the retrieval of many nonrelevant articles (e.g., sinusitis and lymphoma) -- a low search precision -- it may yield some articles of interest that would not have been identified using only "sarcoidosis AND sinusitis." If the clinician did not want those articles on lymphoma, he or she could do a fourth search:

Search 4: "sinusitis AND sarcoidosis OR lymphoproliferative disorders NOT lymphoma"

The searcher, however, should be cautious about using the Boolean operator NOT, especially in free-text searches. In the last search, using "NOT lymphoma" would rule out every article that contains the term lymphoma in its title or abstract, even if the article itself focused on sarcoidosis.


Other PubMed features
Related articles

After a search has been performed, there is a link called "Related Articles" that appears to the right of each article referenced. Clicking on this link takes the user to a list of other articles that were indexed using nearly the same MeSH terms. (Articles are indexed using more MeSH terms than are probably used in most searches.) Therefore, if a search identifies an article that seems to be ideal, clicking on the "Related Articles" link generates a list of other articles with similar MeSH descriptors.

Single-citation matcher

The "Single-Citation Matcher" feature, located on the left menu bar of the main PubMed search page, allows one to enter a journal name (in full or using Index Medicus abbreviations), an author's name, full or partial article title, and the exact date or a range of dates. If one is searching for a specific article and can remember the title or author, this is a quick retrieval tool.

Clinical queries

The "Clinical Queries" feature, also located on the left menu bar of the main PubMed search page, supplies a specialized search intended for clinicians and uses built-in "filters" that are based primarily on the work of Haynes et al.[3] The user specifies one of four study categories (therapy, diagnosis, etiology, or prognosis) and indicates whether the search should be more sensitive (retrieving more relevant articles, but probably including some that are less relevant) or more specific (narrowly focused, but probably omitting a few).

Recently, a new filter has been added to the "Clinical Queries" feature called "Systematic Reviews," which aids in the retrieval of systematic reviews and meta-analyses.[16]

LinkOut

"LinkOut" is a relatively new feature intended to supplement and extend PubMed by providing links to a variety of online resources, including full-text publications, other databases, clinical information, biographic information about the authors, and other research information.

Cubby

"Cubby" allows the user to save search strategies and reuse them in the future. This is a free service, but one must register with PubMed to obtain a user name and password. This feature is particularly helpful for researchers or others who need to search or update a particular topic regularly.

Order documents (Loansome Doc)

This feature allows users to order the full text of any article indexed in MEDLINE. Registration is required, and the service is fee based.


General Tips for Improving Searches


An effective literature search is an iterative process. Continual evaluation of the search results is important. Several authors have described multistep techniques to improve the efficiency and effectiveness of literature searches.[3][17] Although some of the steps are fairly self-evident, the following tips can help improve search strategy.
Carefully read online user manuals or enroll in a short instructional course (given by a local medical library or medical society) on how to perform literature searches. Becoming acquainted with the search process and with the PubMed system significantly improves your results. One or two hours of instruction before beginning to perform searches can save dozens of hours spent on inefficient searches.
Carefully formulate your search question and plan your search strategy before going online and be willing to amend your strategy as you review your search results.
Familiarize yourself with the appropriate MeSH terms while planning your search. Modify your search to use only MeSH terms or, if appropriate, a combination of MeSH and free-text terms.
Display or preview the results of searches as you progress and review them for relevance.
Because a broad search may yield an unmanageable number of citations, you should increase the precision of your search by doing the following:
Rethinking the search strategy and narrowing it further
Making sure concept-based MeSH terms are used instead of free-text
Adding subheadings to the MeSH terms
Using more specific language if free-text searching is the only option
Adding additional relevant terms using the Boolean operator AND
Using the "Limits" feature, including language of articles, publication types, publication dates, and so forth
Increasing the recall of your search if your search yields too few hits by:
Broadening the question
Considering the use of additional, relevant terms using the Boolean operator OR
Using additional similar or related terms
Trying different combinations of the terms
Using a combination of MeSH terms and free text
Not using subheadings for MeSH terms
Not using the "Limits" feature
If you find no citations, be cautious. Try several approaches before coming to the conclusion that there is no literature on a subject.
Review some of the articles or at least the abstracts of the articles that are retrieved to make sure that they are helpful. Modify your search strategy as necessary.
By using the MEDLINE display for your results, you can display the MeSH terms for articles that are "on the mark" and use these MeSH terms for additional searching. Alternatively, you can use the "Related Articles" feature to find other similar articles.
Beginning with a broader subject approach and then narrowing your search is often more useful than trying to widen a search that was focused too narrowly.

Despite training and familiarization with search techniques and terminology, there still may be instances when a clinician or researcher is unable to retrieve a satisfactory number of relevant articles after designing and performing the search themselves. In these circumstances, a local medical library is a valuable resource for assistance and guidance in performing literature searches.


References
1. Weinberger D. Garbage in, great stuff out. Harv Bus Rev 2001;79:30-2.

2. Curtis KL, Weller AC, Hurd JM. Information-seeking behavior of health sciences faculty: the impact of new information technologies. Bull Med Libr Assoc 1997;85:402-10.

3. Haynes RB, Wilczynski N, McKibbon KA, Walker CJ, Sinclair JC. Developing optimal search strategies for detecting clinically sound studies in MEDLINE. J AMIA 1994;1:447-58.

4. Evidence-Based Medicine Working Group. Evidence-based medicine: a new approach to teaching the practice of medicine. JAMA 1992;268:2420-5.

5. Steinbrook R. Protecting research subjects: the crisis at Johns Hopkins. N Engl J Med 2002;346:716-20.

6. Klein MS, Ross FV, Adams DL, et al. Effect of online literature searching on length of stay and patient care costs. Adac Med 1994;69:489-95.

7. Lindberg DAB, Siegel ER. On assessing the impact of medical information: does MEDLINE make a difference? Meth Inform Med 1991;30:239-40.

8. Lindberg DAB, Segel ER, Rapp BA, et al. Use of MEDLINE by physicians for clinical problem solving. JAMA 1993;269:3124-9.

9. Attia J, Margetts P, Guyatt G. Diagnosis of thyroid disease in hospitalized patients: a systematic review. Arch Intern Med 1999;159:658-65.

10. Wright J, Johns R, Watt I, Melville A, Sheldon T. Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure: a systematic review of the research evidence. BMJ 1997;314:851-60.

11. Lowe HJ, Barnett GO. Understanding and using the medical subject heading (MeSH) vocabulary to perform literature searches. JAMA 1994;271:1103-8.

12. McEntyre J, Lipman D. PubMed: bridging the information gap. Can Med Assoc J 2001;164:1317-9.

13. Medical Research Council Streptomycin in Tuberculosis Trials Committee. Streptomycin treatment of pulmonary tuberculosis. BMJ 1948;2:769-82.

14. Suarez-Almazor ME, Belseck E, Homik J, Dorgan M, Ramos-Remus C. Identifying clinical trials in the medical literature with electronic databases: MEDLINE alone is not enough. Cont Clin Trials 2000;21:476-87.

15. Corrall CJ, Wyer PC, Zick LS, Bockrath CR. How to find evidence when you need itPart 1: Databases, search programs, and strategies. Ann Emerg Med 2002;39:302-6.

16. Kotzin S. MEDLINE and PubMed will be able to synthesise clinical data. BMJ 2002;324:791.

17. Chambliss ML. Personal computer access to MEDLINE: an introduction. J Fam Pract 1991;32:414-9.

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musheera
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Re: Searching The Medical Literature On The Internet
« Reply #2 on: /November/ 07, 2005, 03:50:12 AM »

Dear Nuha
Thanks for the wondeful post....
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cleo_md
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Re: Searching The Medical Literature On The Internet
« Reply #3 on: /January/ 25, 2006, 10:44:18 AM »

You are most welcome Musheera
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mednma
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Re: Searching The Medical Literature On The Internet
« Reply #4 on: /January/ 25, 2006, 12:57:23 PM »

Lovely topic.You should make ti available permenantly as a sticky or something.

A comment about EMBASE. It is simply the European equivalent of medline. You know that Medline is an American database primarily and therefore there is some degree of North American bias. Many European journals are not indexed by medline but indexed by EMBASE and vice versa so a comprehensive search should really include both. Also there are other databases that index some journals of specialist interest like for example PSYCHINFO which indexes journals of psychology/psychiatry interest and related desciplines like social sciences..etc. If you are interested in searching for articles on the health impact of domestic violence , for example, you'd be better off searching PSYCHINFO than MEDLINE or EMBASE. There is also CINAHL which is a bibliographic databse for nursing and allied health where many palliative care journals are indexed. Same as the British Nursing Index. There is also HMIC = Health Management Information Consortium where Public Health and service provider interest topics can be found.
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cleo_md
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Re: Searching The Medical Literature On The Internet
« Reply #5 on: /January/ 27, 2006, 08:10:38 AM »

Dr Noha ,
? ? ? ? ? ? ? ?Thank you for your comments . I do agree Medline and EMBASE should both be used for a more comprehensive search . I am now personally using both along with softwares as MDconsult which is linked to infotrieve to obtain the full text in the shortest time possible .

Speaking of research- and since you are an oncologist. Are you aware of any literature mentioning? nesidioblastosis' relation to myelodysplastic disorders? I have a case report which I think may add to the link between both. I have found one article from 1999's Diabet Med - An autopsy report actually but nothing else.
I will try to consult with our Hematology/Oncology professors today too . It's been on my mind all night Smiley

Thanks again !
Nuha

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mednma
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Re: Searching The Medical Literature On The Internet
« Reply #6 on: /January/ 27, 2006, 03:48:31 PM »

My dear Nuha

I have no idea what you're talking about!? Roll Eyes I transiently heard of nesidioblastosis but it isn't something you find oncologists talking about much. I don't know about haematologists. Try those. In the UK , oncologists dont even do lymphomas or myelomas anymore. It's all gone to the haematologists. I did manage to get 3 months of lymphoma training before they were snatched away but even then there was no mention of? nesidioblastosis at MDT meetings with haematologists. Sorry couldn't help. Good luck with your case report.
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cleo_md
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Re: Searching The Medical Literature On The Internet
« Reply #7 on: /January/ 28, 2006, 12:42:50 PM »

Dr Noha, Thank you for you prompt reply . Nesidioblastosis is indeed a very rare condition . I have noticed that oncology and hematology in the UK is very sharply demarcated . Here fellows are usually combined then they choose one or the other . A few fellowships are only one of the 2 . I remember sometime ago when i visited the Royal Marsden in Surrey , some of the specialists were just myeloma and leukemia. I do believe that specialization is important and fruitful when not taken to an extreme.
I will try to find someone at Dana Farber who may have heard about it .
Thanks again for your reply Smiley
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walid
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Re: Searching The Medical Literature On The Internet
« Reply #8 on: /September/ 26, 2006, 05:10:58 AM »

Thanks a lot
My regards
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