Just wanted to wish all the members of Tuscaloosa 7 that are at MLA 2008 a happy, productive, and exciting conference attendance….it certainly sounds great (based on  A’Llyn’s blog)

Take care and have a great summer

I really like that fact that Fletch made use of actual reference questions for the tutorial examples. He also highlighted the importance of selecting the key words from the reference question to use as search terms.

I also liked the progression from a high-recall search strategy to one of greater precision. Showing the filters was an especially nice touch.

I like the bonus computer knowledge that was incorporated: vpn and showing that you can get the search terms from your browser memory (I committed the time wasting error of typing out Creutzfeldt-Jakob  and Alzheimer disease each time)

Another great feature was the discussion of the time-saving features such as e-mail and RSS, including the advantages of the RSS option over the e-mail.

Fantastic job

I like the fact that Brian built a solid foundation for the tutorial by describing a specific audience and topics. This set the stage for the very specific searches that were to follow.

The reminder that the tutorials are always there if you need them in the future was a good idea. Pointing out the option of restricting to major subject headings was an especially nice touch and a very useful feature. Another great feature was the demonstration of the variety of limits available. The theme of a select audience on a specific topic was brought home with the examples of specific author searches.

Awesome

p.s. I like that Powerpoint crayons theme……I use it a lot too

Cathy’s first module provided an excellent summary of PubMed features.

The author search was a first-rate demonstration of the different varieties of searching by author

The explanation of automatic term mapping, the discussion of the rationale for the selection of different limits and the reminder that limits remain in play were all extremely helpful pointers for searching.

I really enjoyed the great summary of how to process/interpret what shows up on the search screen and the  tips on how to work with results  on a practical level. The reminder to check out the related articles link was an especially nice touch.

In my opinion, this is something that could be shown to future  students of LS 534

Excellent job

I really appreciated the prior research that went into the presentation (i.e. the information on complementary and alternative medicine) There was even specific information on the tutorial’s intended audience.

I liked the different types of searches demonstrated, which included varying the limits used for each specific query. The inclusion of a specific author search was an especially nice touch to round out the spectrum of searches

I am also amazed at how Beth was able to make the tutorial fit into one module and run so smoothly and clearly (considering Captivate’s quirks). Beautiful job

I really appreciated the originality of the My NCBI topic choice for the tutorial. This feature would be very useful for people who conduct complex searches and / or who do a lot of searches. Discussing the updates feature for new items is especially pertinent for people who need to be updated on the latest developments to be found on their topic of interest.

This tutorial provided a variety of good tools for handling ‘information overload’ by showing how to best keep track of articles found in previous searches and by showing that you can keep you ’searches inbox’ tidy by deleting old sets when an updated one is already in place. The demonstration of sorting and other ways to customize would be very much appreciated by those who need to use NCBI regularly / on an ongoing basis.

This tutorial was also fun to watch because she interjected the right balance of humor along with the concepts. Wonderful job

BMJ Clinical Evidence – Sources of information

BMJ Group Website : http://group.bmj.com/

BMJ Publishing Group and Unbound Medicine Release all new BMJ Clinical Evidence for PDA from : PR Newswire (October 04, 2006). Accessed through General One File Database (Galegroup)

List of journals published by the BMJ http://group.bmj.com/downloads/bmjjournalsuserguide.pdf

BMJ Group; BMJ Clinical Evidence now available online to 20,000 Canadian Health Practicioners in Saskatchewan from: Biotech Week. Atlanta: August 1, 2007 p. 316. Accessed through Proquest Database

A list of BMJ Clinical Evidence sctions and reviews http://clinicalevidence.bmj.com/ceweb/topics/topics-static.jsp

Electronic resources reviews: Clinical Evidence by M.V. Taylor, Journal of the Medical Library Association 94(4) October 2006, pp. 478-480.

The US Sisters of the BMJ. Ronald M Davis; Richard Smith; Michael Wilkes. British Medical Journal; Feb. 17, 2007; Vol. 322, p. 380

BMJ Clinical Evidence

http://clinicalevidence.bmj.com/ceweb/index.jsp

DISEASEDEX GENERAL MEDICINE

Thomson Healthcare

http://home.thomsonhealthcare.com/About/

Micromedex launches Diseasedex™ General Medicine, a comprehensive tool to aid disease diagnosis and treatment. PR Newswire: NY July 10, 2002 (Proquest, AB/Inform Complete)

Micromedex offers new medical database: Mass High Tech: The Journal of New England Technology, July 08, 2002

Information on the partnership between Micromedex and Praxis

http://www.iscientia.org/iscientia/news2.php?id=5

The 411 on disease: Health Management Technology. September 2002, p. 65.

Electronic Resources Reviews: DISEASEDEX General Medicine. M.L. Brown, Journal of the Medical Library Association; April 2004; 92 (2). P. 281-282

DISEASEDEX™ General Medicine System

http://www.micromedex.com/products/diseasedexgeneral/

Just a Click Away – Using the Computer to Reach and Teach Staff, Patients and Families. Vandie Enloe, Kathy Ordelt and Patsy Rann. Children’s Healthcare of Atlanta. HCEA Conference September 21, 2006. (page 2 of 24)

Complete side note: These are two different publications that contain surveys of the different point of care tools - might these be the two surveys that were mentioned in class?

http://clinicalevidence.bmj.com/downloads/utexas.pdf

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1629448

Biomedical databases are sources of information for the practice of evidence based medicine. Sometimes, however, retrieving articles from the databases can become very time consuming because searches for identifying relevant information may also turn up irrelevant articles. In order to solve this problem, researchers have worked to develop search strategies to selectively retrieve different types of studies. (Bachmann et al 2002)

One strategy mentioned in the class readings was the use of search filters (hedges) to improve the retrieval of clinically relevant and scientifically sound reports. An example in the article demonstrated that combining clinical trial (pt) AND myocardial infarction in PubMed reduced the number of articles for myocardial infarction from 116,199 to 8,956 articles and effectively removed case reports and laboratory and animal studies. (Haynes, 2005)

Another article by Haynes et al, 2006 illustrated how the use of selected single terms and combinations of MeSH terms and textwords could retrieve age specific studies in Medline. A search example used ‘Huntington disease’ in Medline, which brought up 5907 articles. For physicians who did not have time to process this, a more specific approach was demonstrated: combining ‘randomized controlled trial.mp OR randomized controlled trial.pt’ and ‘aged,80 and over.sh. OR age.tw’ narrowed the search down to 5 articles.

Speaking of Randomized controlled trials (RCT’s), they were described in an article by Corrao et al 2006, as the sound study design to recognize strong evidences about therapy. However, Corrao el al discovered that if you use the search string with the term ‘randomized’, this may exclude studies about therapy in which ‘randomized’ could be spelled ‘randomised’ The authors proposed a strategy to cover this possibility, by having the term ‘randomised’ joined onto ‘randomized’ by an OR (a Boolean operator). Corrao et al 2006

Yet another article discussed the importance of formulating search strategies to find RCT’s in order to increase the efficiency of systematic reviews. Zhang et al 2006

In the article, The Highly Sensitive Search Strategy (HSS) is described as a standard search strategy recommended by the Cochrane Collaboration to identify RCT’s in the MEDLINE database. The authors combined the top two phases of HSSS with the free-text terms ‘volunteer, crossover, versus and the MeSH term Cross-over studies, respectively. The results of the study showed that adding the free text word ‘versus’ to the first two phases of the HSSS provides a modest balance of the precision and sensitivity in the reviews studied (Zhang et al, 2006).

The idea of searching the Medline database with 15 million citations (Zhang et al, 2006) (which is probably an even higher number currently) is very daunting. Additionally, the articles demonstrated how complicated the search process can be; that the inclusion or exclusion of one or two terms can change the search results; it was quite fascinating to read about. I am quite in awe of these expert searchers and their ability to nimbly navigate the maze of biomedical databases. As I take my first steps along the search path, I am pretty sure that I will trip and fall numerous times, but hopefully (one of these days, months, years) I will eventually start to get the hang of things.

If you are interested in epidemiology or pandemics or detective stories, or just looking for a really interesting read, I venture to suggest reading FLU: The story of the great influenza pandemic of 1918 and the search for the virus that caused it by Gina Kolata (1999).

“The plague took off in September of that year, and when it was over, half a million Americans would lie dead. The illness spread to the most remote parts of the globe….And no matter where it struck, the virus went after an unusual group - young adults who generally are spared the ravages of infectious diseases.” (Kolata, 1999, page 5).

The book also describes the work of scientists who tried to follow the trail of the virus…the accounts reminded me of a line from Jordan’s (2002, p. 163) Understanding Medical Information: “Epidemiology borrows and adapts tools and methods from may sources including biology, clinical medicine, laboratory medicine…these tools and methods, combined with curiosity, persistence, keen observation of human behavior, copious notes, and the use of what is termed ’shoe leather’ to track down and document events have produced impressive results in the prevention and control of disease.”

The book is a great blend of history, mystery and scientific hypothesis … I hadn’t expected that a description of a scientific investigation would be a fascinating read, but I really enjoyed this book…

I watched an episode of “House” last night . Part of the story revolves around the difficulty of treating a patient ‘remotely’ (i.e. the patient is in the South Pole). The extra twist is that Dr. House actually appears to ‘like’ this patient. Fellow doctors point out that ‘this is the most time that House has ever spent with a patient.’ Dr. House actually calls this patient by name and asks questions like “are you okay?” The medical puzzle is finally solved when it is discovered that the patient has a broken toe (and has bone marrow leaking into her system). House berates himself for cutting the physical exam short (i.e. did not check her feet/let her keep her socks on) and regrets the fact that the case could have been solved days ago, had he just been more thorough.

This reminded me of the article How doctors think by Jerome Groopman, that was published in the New Yorker (Jan. 29, 2007). Groopman has published a book by the same title. There is a line in the article that echoes the House episode:

“I was furious with myself. Because I liked Brad, I hadn’t wanted to add to his discomfort and had cut the examination short.”

So it would appear (from these two examples at least) that it could actually be ‘better’ for you that your doctor doesn’t like you and acts according to the implied ideal of ‘a dispassionate and rational actor’ (Groopman, 2007). Unfortunately, Groopman cites that cognitive psychologists have shown that ‘when people are confronted with uncertainly - the situation of every doctor attempting to diagnose a patient - -they are susceptible to unconscious emotions.’

Since there appears to be no getting away from these ‘unconscious emotions’ are there any ideas on how to handle this? Croskerry (cited in Groopman) mentioned one step that can be taken ‘to recognize that how doctors think can affect their success as much as how much they know, or how much experience they have.’ This added awareness can contribute to an examination of the doctor’s thinking process, to see if there are any other factors to consider. In this case, it was the comment of a team member that helped jog House’s memory about that he missed. In other instances it might be going over the patient history one more time or the help of a computerized decision support system that provides the extra information or it could be a medical librarian delivering a relevant article to the physician that helps to solve the puzzle….