Abstract
Twenty years ago, researchers identified the difficulties physicians have in answering the clinical questions that arise during medical care (Covell, Uman, & Manning, 1985). Fifteen years ago, the “Evidence-based medicine” movement arose (Cohen, 2001) and exhorted clinicians to use computers to look up the answers to questions as they arise during clinical care. Fortuitously for the proponents of evidence-based medicine the Internet matured in the 1990s{Hersh 1996 #3370}, epitomized by the launching of PubMed by Al Gore in June, 1997. PubMed, developed by the National Institutes of Health, provided the first free access to millions of biomedical research articles at MEDLINE. Unfortunately, the Internet has not fulfilled its potential to assist physicians in answering clinical questions. A recent study found that physicians obtain answers to only 40% of questions that arise during patient care (Ely, Osheroff, Chambliss, Ebell, & Rosenbaum, 2004); this rate is not much different than the rate of 30% reported 20 years ago (Covell et al., 1985).
Key Terms in this Chapter
MEDLINE: The database of citations and links to much of the world’s biomedical research. MEDLINE is maintained by the National Library of Medicine of the National Institutes of Health. More information is available at http://www.nlm.nih.gov/databases/databases_medline.html.
Systematic Hypertexts: We introduce this term to distinguish online hypertexts that have a systematic method to their creation and maintenance. These methods have either been shown in studies or requested by physicians in surveys to improve the validity or usability of medical information. Examples of methods to increase validity include systematic editorial processes such as use of peer review of chapters, extensive attribution of evidence with footnoting, regular and frequent updates, systematic literature surveillance or searches, and objective grading of source evidence. Examples of techniques to improve usability include succinct, actionable answers and a standardized structure for each chapter. We propose that systematic hypertexts replace textbooks as a principle information resource.
The Unified Medical Language System (UMLS®): Metathesaurus is a vocabulary that links together multiple medical vocabularies. More information is available at http://www.nlm.nih.gov/pubs/factsheets/umls.html.
Primary, Secondary, and Tertiary Publications: Primacy publications are source documents such as journal articles and press releases. Secondary publications are summaries and syntheses of primary publications. Examples of secondary publications include practice guidelines, review articles, and meta-analyses. Tertiary publications are printed textbooks and online hypertexts.
PubMed: The public search engine for MEDLINE that is maintained by the National Center for Biotechnology Information. PubMed is available at http://pubmed.gov.
SUMSearch: SUMSearch is a federated medical search engine that in response to a query from a user performs live searches of remote Internet sites and automates revising of searches that retrieve excessive or too few documents. SUMSearch is available at http://sumsearch.uthscsa.edu.
MeSH Terms: MeSH stands for Medical Subject Headings (MeSH®). It is a set of keywords and vocabulary produced by the National Library of Medicine and used for indexing, cataloging, and searching for biomedical and health-related information and documents. More information is available at http://www.nlm.nih.gov/mesh/.