1. Section 4: Biomedical Information on the Internet

2. Review of EBM searching  EBM theory ：  best research evidence + clinical expertise + patient’s unique values + circumstances  Types of evidence:  Systematic review,Meta-analysis,RCT,Practice guideline,Case report  5S levels of evidence:  studies, synthesis, synopses, summaries, systems  Common sources of evidence for each S  refer to the list in Practice III or the lecture PPTs  PICO – well built clinical questions

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

4. ACP Journal Club  ACP Journal Club, a publication of the American College of Physicians, one of the two journals of ACP Journal Club Collection (The other is Evidence-Based Medicine)  Structured abstracts and commentary on recently published, methodologically sound, and clinically relevant research.  The editors of ACP Journal Club screen the top clinical journals on a regular basis and identify studies that are both methodologically sound and clinically relevant. They write an enhanced abstract of the chosen articles and provide a commentary on the value of the article for clinical practice. Using this source, clinicians can quickly understand and apply to their practice important changes in medical knowledge, without having to read and synthesize for themselves thousands of journal articles.

5. What is in The Cochrane Library? Cochrane Database of Systematic Reviews (Cochrane Reviews) Represents the gold standard of high-quality, evidence-based medical information; Free for abstract Database of Abstracts of Reviews of Effects (Other Reviews) Complements the Cochrane Reviews by quality-assessing and summarising reviews which have not been carried out by The Cochrane Collaboration. DARE is unique in that it is the only database to contain abstracts of systematic reviews that have been quality assessed. Each abstract includes a summary of the review together with a critical commentary about the overall quality. Produced by the CRD in York. Central Register of Controlled Trials (Clinical Trials) Includes details of published articles taken from bibliographic databases and other published resources. CENTRAL records include the title of the article, information on where it was published and, in many cases, the abstract. Cochrane Methodology Register (Methods Studies) Presents a bibliography of publications that report on methods used when conducting controlled trials. It includes journals articles, books and conference proceedings. Articles are taken from MEDLINE and from hand searches. Health Technology Assessment Database (Technology Assessments) Brings together details of completed and ongoing health technology assessments (studies of the medical, social, ethical and economic implications of healthcare interventions) from around the world. The aim of the database is to improve the quality and cost effectiveness of health care. Produced by the CRD in York. NHS Economic Evaluation Database (Economic Evaluations) As healthcare resources are finite, information about costs and effects are essential to making evidence-based decisions about competing healthcare interventions. Information about cost-effectiveness can be difficult to identify, appraise and interpret. NHS EED assists decision-makers by systematically identifying economic evaluations from around the world, appraising their quality and highlighting their relative strengths and weaknesses. Produced by the CRD in York. It also contains information about The Cochrane Collaboration and The Cochrane Collaborative Review Groups

7. “searching for all text schizo, drugs, atypical and antipsychotic. in All Fields in The Cochrane Database of Systematic Reviews" An Advanced Search of The Cochrane Library…

8. … Returns the following results: You can toggle between results listed for the different databases in The Cochrane Library here Use these links to restrict your search results to Reviews only, or Protocols (reviews in progress) only. Save or edit your search using these links.

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

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

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

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

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

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

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

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

18. Search by Clinical Study Category This specialized search query is intended for clinicians and has built-in search "filters" based on research done by R. Brian Haynes, M.D., Ph.D. at McMaster University in Canada. Five study categories or filters are provided: etiology diagnosis therapy prognosis clinical prediction guidelines Two emphasis categories or filters are provided: narrow, specific search -- will get more precise, relevant citations but less retrieval broad, sensitive search -- includes relevant citations but probably some less relevant; will get more retrieval

19. Medical Genetics Searches Finds citations related to various topics in medical genetics. Default is to All topics. Click on All check box to deselect; then click on topic(s) of interest. Developed in conjunction with the staff of GeneReviews: Genetic Disease Online Reviews at GeneTests, University of Washington, Seattle.

20. Find Systematic Reviews This feature is provided to help clinicians locate systematic reviews and similar articles. It retrieves systematic reviews, meta-analyses, reviews of clinical trials, evidence-based medicine, consensus development conferences, and guidelines. Citations from journals specializing in clinical review studies are also included.

21. EBM databases: a summary

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

23. BioMedical Information on the Internet

24. Objective of this section  Learn how to use the internet for searching for medical resource, specific to your needs.  Guide you to some key Web sites for health and medicine.  Provide suggestions on ways to evaluate Internet sites and resources.  Help you start collecting your own list of useful Web sites to explore later.

25. The Internet for Health Professionals What can the internet offer?  Current and up-to-date information.  Access to both traditional and new sources of information.  Access to all resources through one piece of software.  The opportunity to discuss medical issues with colleagues and experts from around the world though email, discussion lists and newsgroups.  The opportunity to pursue your research interests and continuing medical education studies from your own desktop, at a time that is convenient to you.

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

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

28. General search engines Aim to help you search as much of the Web as possible. Search engines work by sending out a special computer program (eg. Spider or Crawler) to Web sites around the World to automatically create a huge index. The best-known search engines are:  GOOGLE http://www.google.com/GOOGLE  NORTHERN LIGHT http://nlresearch.com/NORTHERN LIGHT

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

30. Demonstrate the power of the Google’s ranking technology. Although such a simple search generated many hits (about 79,500,000), highly relevant Web sites were at the top of this list, such as Am Diabetes Asso, NIDDK and CDC, etc. All types of information resources mixed up together.

31. GOOGLE: searching  Simple search  Advanced search 1. Enter search terms in the query box; 2. Click the ’Google search’ button. you can search only for pages: that contain ALL the search terms, or the exact phrase, or at least one of the words, or NOT any of the words you type in written in a certain language created in a certain file format that have been updated within a certain period of time that contain numbers within a certain range within a certain domain, or website …….

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

33. Search syntax used at Google searchExample Phrase searching“gulf war syndrome” ‘OR’ search‘postpartum depression’ OR ‘baby blues’ Stop wordshepatitis +c Excluding termsosteoporosis -hrt File-type searchinganthrax filetype:pdf Domain searchsite:stanford.edu Locating pages that link to other sites link: www.nih.gov

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

35.  NORTHERN LIGHT http://nlresearch.comhttp://nlresearch.com  With special collection of full text journal and newspaper articles, it provides a rich and unique source of information.  Include: journals, business web ™, news, white papers.

37. General search engines Pros  Useful if you want to find a very precise piece of information  Will find something on every subject imaginable  Easy to search Cons  Can give you too many results –time consuming to sort through  Can return lots or irrelevant or inappropriate information

38. Web directories Aim to help you look through (or browse) many thousands of Web sites under a series of subject headings. Most are run commercially and use volunteers or hired-editors to select the Web sites and arrange them into subject lists. Two well known examples are:  YAHOO! HEALTH http://www.yahoo.com/Health/ YAHOO! HEALTH  OPEN DIRECTORY PROJECT http://dmoz.org/Health/ OPEN DIRECTORY PROJECT

39. Yahoo!Health

40. Contain both directory categories and individual Web sites. Although the resources identified in this search do not represent the total of all diabetes resources (fewer results than Google), they nevertheless provide an excellent starting point.

42. Open directory project

44. Web directories Pros  The subject lists mean you don’t have to think up search terms  Cover a very wide range of subjects: so good if you want popular sites as well as serious ones Cons  Relevant resources may be overlooked by inappropriate use of directory headings.  Significantly smaller and less up-to-date than their free-text search engines equivalents.  Can quickly become out of date.

45. Evaluated medical directories Aim to help a particular audience find high quality Web sites for their particular needs. They are often created by specialist organisations (eg. educational or professional organisations) who often employ qualified subject experts to select and organise Web sites under subject headings, and write descriptions of the sites. Examples include:  MEDICAL MATRIX http://www.medmatrix.org/ MEDICAL MATRIX  INTUTE: Health & Life Science http://www.intute.ac.uk/healthandlifesciences/ INTUTE: Health & Life Science  HEALTH ON THE NET (HON) http://www.hon.ch/ HEALTH ON THE NET (HON)

46. Medical Matrix  Managed by the American Medical Informatics Association (AMIS)  Eight top-level headings, featured links, annotated description of the indexed resource. Note: Users can browse Medical Matrix free of charge. Searching the database, however, is restricted to subscribers.

47. All the sites listed look as though they have serious educational content with a description written by a subject expert. Can be an excellent way of finding relevant and authoritative documents in a very short space of time.

49. Intute:Health and Life Sciences  Health and Life Sciences Gateway  Medicine (formerly OMNI)  Nursing, Midwifery and Allied Health  Veterinary  Bioresearch  Natural History  Agriculture, Food and Forestry  BioethicsWeb - biomedical ethics  MedHist - history of medicine resources  Psci-com – public engagement with science and technology

50. Intute:Medicine  Searching  Over 31,000 records, each one hand selected and described by a subject specialist.  Simple or advanced searches, keyword or “phrase searching”.  Refine your search results  Browsing  using NLM classification and MeSH headings  far more precise and focused

51. Browse by MeSH

52. Harvester to broaden your searches Other subject groups A- Arts and Humanities S- Science, Engineering and Technology So- Social Sciences

53. Health on the Net (HON)  Special features are two widely-used medical search tools (HONselect and MedHunt) and the HON Code of Conduct (HONcode).

54. HONSelect  Search integrator  Use MeSH, a database of 33,000 medical terms.  Combine six information types into one service-- web sites, medical images, news, scientific articles, clinical trials, conferences/ events.  Four popular categories

55. HONSelect Search Example

56.  Full text search engine.  Web documents is organized in four categories: All, Hospitals, Support, Events. * HONselect is suitable for users who have identified their needs with some precision in advance. * MedHunt search is not restricted to medical terms but ranges far more widely. MedHunt- Medical Document Hunter

57. MedHunt Search Example

58. Evaluated medical directories Pros  Good if you need trustworthy results for serious work or research  You get fewer, but more relevant results, as the subject specialists have filtered out a lot of the inappropriate sites Cons  As individuals compile the directories, potentially useful resources are over looked.  Most evaluated subject directories are still very much in their infancy, and consequently the number of resources identified thus far is quite small.

59. The biomedical Web  Professional Organizations  BioMedical Journals  BioMedical Portals  Interactive Learning  BioMedical Images  Consumer Health Information

60. Professional Organizations  Government organizations World Health Organization (WHO) National Institutes of Health (NIH) American Centers for Disease Control and Prevention (CDC) US food and drug administration (FDA)  Professional societies/Professional associations Federation of American Societies for Experimental Biology (FASEB) American College of Physicians (ACP)  medical schools, hospitals, research centers ……

61. National Institutes of Health (NIH)  The NIH, a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research. http://www.nih.gov/http://www.nih.gov/

62. Helpful resources ABOUT NIH  NIH Institutes, Centers & Offices http://www.nih.gov/icd/ http://www.nih.gov/icd/  News and Events - the lastest research advances, NIH-sponsored conferences and events… http://www.nih.gov/news/index.htmlhttp://www.nih.gov/news/index.html  Health Topic A to Z http://health.nih.gov/see_all_topics.asp http://health.nih.gov/see_all_topics.asp  Clinicaltrials.gov - offers information for locating federally and privately supported clinical trials for a wide range of diseases and conditions in the U.S and around the world. http://www.clinicaltrials.gov/http://www.clinicaltrials.gov/  Computer Retrieval of Information on Scientific Projects (CRISP) - Research funded by NIH -Search many ways. http://crisp.cit.nih.gov/ http://crisp.cit.nih.gov/  PubMed  MedlinePlus

63. ClinicalTrials.gov

64. Practice: Using the Clinicaltrials.gov, find the clinical trails data for diabetes for persons over 66?

65. CRISP

66. PRACTISE: search for NIH-funded projects about diabetes in FY2008.

68. American Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/http://www.cdc.gov/

69. Practice: Using CDC Wonder, find prevention guidelines of SARS.

70. US food and drug administration (FDA) http://www.fda.gov/ http://www.fda.gov/

71. World Health Organization http://www.who.int/ http://www.who.int/

72. Medical Journals  Three models of scholarly publishing 1. E-print archives: Everything is free and available to all via the Web. In the biomedical sciences, however, this model has not been widely accepted. 2. New publishers – economic alternatives: Subscription journals still exist but are published by not-for-profic organizations. BioMed Central (BMC) represents the biggest single alternative to the traditional medical publishers. 3. Free back-files archives: All research should be free on the Web after a period of time, say 6 months or 12 months and so on. Current issues would only be available to subscribers.

73. Medical Journals  Acess to journals on the Web 1. Publisher site ScienceDirect, HighWire Press, Springerlink,etc. 2. Aggregator Services ProQuest, OVID, EBSCO,etc. Note: Check with our library for access to full-text e-journals. http://www.cmu.edu.cn/library/showpage.asp?pageid=351http://www.cmu.edu.cn/library/showpage.asp?pageid=351

76. Medical Journals Open Access Journal Sites  http://highwire.stanford.edu/lists/freeart.d tl http://highwire.stanford.edu/lists/freeart.d tl  http://www.pubmedcentral.com/ http://www.pubmedcentral.com/  http://www.biomedcentral.com/ http://www.biomedcentral.com/  http://www.freemedicaljournals.com/ http://www.freemedicaljournals.com/ Further resources:  http://www.healthnet.org/essential-links/fulltext-e-journals.html http://www.healthnet.org/essential-links/fulltext-e-journals.html

77. This the HireWire Press free article database. Users have access to over 2,009,596 full text articles.

78. PubMed Central is a free archive of articles that have been deposited in this free repository.

79. BioMed Central is an open access publisher that makes access to published articles freely available to the public. The journals are funded by an author pays model.

80. FreeMedicalJournals.com lists journals sites that make their content free to all users. Journals are listed by A-Z, speciality, and language.

81. This is the AED/SATELLIFE Essential Health Links gateway that links to relevant WWW sites for the health community in developing and transitional countries.

82. Medical Portals Aim to address all the information and educational needs from a single site. Examples include:  Medscape http://www.medscape.com/http://www.medscape.com/ Free access, 300 000 doctors and 1.2 million other user subscribed; around 30 specialty sites, provide access to MEDLINE, DrugInfo and various image database; CME programme; ……  MD Consult http://www.mdconsult.com/http://www.mdconsult.com/ Access fees, over 250 000 subscribers, owned by Elsevier Science; over 600 peer-reviewed clinical guidelines,……

84. Medcape’s Specialty homepage contain:  Featured CME highlighted educational activities for the week (generally updated twice a week);  In Focus the top articles of the week (generally updated twice week);  Today's News the top news stories of the day (updated daily);  CME Center recent professional educational activities by specialty;  Resource Centers sections on specific conditions or topics of interest;  Expert Corner Ask the Experts based on topics of concern according to specialty;  Conference Center reports and highlights from key medical meetings;  Discussions a forum for discussions with your peers;  Library Journals, textbooks, and reference tools.

85. Interactive Learning  Virtual interactive patient simulations Tuarma Moulage http://www.trauma.org/resus/moulage/moulage.htmlhttp://www.trauma.org/resus/moulage/moulage.html  Lecture notes,tutorials and multimedia textbooks Lectures: Supercourse - epidemiology, the internet and global health http://www.pitt.edu/~super1/ http://www.pitt.edu/~super1/ Tutorials: the Internet Pathology Laboratory http://www- medlib.med.utah.edu/WebPath/TUTORIAL/TUTORIAL.htmlhttp://www- medlib.med.utah.edu/WebPath/TUTORIAL/TUTORIAL.html Textbooks: Merck Manual of Diagnosis and Therapy http://www.merck.com/ubs/mmanual http://www.merck.com/ubs/mmanual  Online CME courses Online CME http://www.cmelist.com/list.htmhttp://www.cmelist.com/list.htm  Examinations MCQs http://www.mcqs.com/http://www.mcqs.com/  Virtual conferencing Medscape Conference Center, Videocasting

86. Medical Images  Medical image databases Images.MD http://www.images.md/users/index.asphttp://www.images.md/users/index.asp Bristol Biomedical Image Archive http://www.brisbio.ac.uk/http://www.brisbio.ac.uk/ Images from the History of Medicine http://www.ihm.nlm.nih.gov/http://www.ihm.nlm.nih.gov/  Search Engines: Image Retrieval Google Image Finder http://images.google.com/http://images.google.com/ AltaVista Image Search http://uk.altavista.com/http://uk.altavista.com/ Karolinska Institute page of image-related links http://www.mic.ki.se/Medimages.html http://www.mic.ki.se/Medimages.html

88. Consumer health information  Patient questions Where can I find information about a particular illness? Where can I find out more information about a drug I have been prescribed? How can I prepare for a consultation? How does the performance of one hospital compare with another?......  Key sites MEDLINEplus http://www.medlineplus.gov/http://www.medlineplus.gov/ US Pharmacopoeia http://www.intelihealth.com/IH/http://www.intelihealth.com/IH/ Pocket Doctor http://www.pocketdoctor.co.uk/http://www.pocketdoctor.co.uk/ Ask the Doc http://www.intelihealth.com/http://www.intelihealth.com/

89. MEDLINEplus  A patient-centered resource developed by the National Library of Medicine

90. MEDLINEplus Health Topics

91. MEDLINEplus Health Topics Example

92. Evaluating Internet Resources  The Web is full of information and data from all over the world.  Excellent resources reside alongside dubious.  Anyone can publish anything!

93. Evaluating Internet Resources  Evaluate using Criteria for Evaluating Web Resources  Determine the type of site by analyzing Web Site Addresses  Helpful Evaluation  AMA Guidelines for medical and health information sites on the Internet (2000) http://jama.ama-assn.org/cgi/content/full/283/12/1600 http://jama.ama-assn.org/cgi/content/full/283/12/1600  A User's Guide to finding and evaluating health information on the web http://www.mlanet.org/resources/userguide.html http://www.mlanet.org/resources/userguide.html  HON: Published code of conduct for web publishing of health information (HONcode)

94. Criteria for Evaluating Web Resources  Accuracy  Authority  Objectivity  Currency  Coverage, intended audience FROM: Kapoun, Jim. "Teaching undergrads WEB evaluation: A guide for library instruction." C&RL News (July/August 1998): 522-523. http://www.library.cornell.edu/olinuris/ref/webcrit.html

95. Analyze the Website Address  edu  org  com  gov  mil http://www.cdc.gov/nip/child.htm sub directory Domain name Hypertext transfer protocol filename Top level domain

96. Learning More  To find out more about using the Internet to find reliable information, I would strongly recommend that you take one of the tutorials (whichever best fits your subject) from the menu of Health & Life Sciences topics:  www.vts.intute.ac.uk www.vts.intute.ac.uk  This will introduce you to some useful starting points in your Internet searching and will look in more detail at how you can assess the quality and reliability of the sites that you find

97. Notes  Change of the 4 th /the last practice date to:  Nov 27, 10:00-12:00am  To review this course, please download the lecture PPTs from the folder “pub-medical information retrieval” on ftp.cmu.edu.cn  The review synopsis will be issued together with the Practice Exercises IV on the teacher’s QQ space: http://151437680.qzone.qq.comhttp://151437680.qzone.qq.com