InformaticsInformatics

Dwain Daniel D.C.Dwain Daniel D.C.

Objectives:Objectives:1.1. Describe growth of biomedical Describe growth of biomedical

informationinformation2.2. Describe the major sources of Describe the major sources of

biomedical information & the strengths biomedical information & the strengths and weaknesses of eachand weaknesses of each

3.3. Present the major biomedical indexes Present the major biomedical indexes and their importanceand their importance

4.4. Describe the basic structure of indexes Describe the basic structure of indexes and indexing proceduresand indexing procedures

5.5. Conduct Medline & MANTIS searchesConduct Medline & MANTIS searches

Changes in Number of Changes in Number of Scientists PublishingScientists Publishing

►There were approximately 1,000 There were approximately 1,000 scientists in 1800scientists in 1800

►This grew to nearly 100,000 in 1900This grew to nearly 100,000 in 1900►And to more than 3,200,000 by 1972 And to more than 3,200,000 by 1972

...Arch Dermatol 128: 1249-1256...Arch Dermatol 128: 1249-1256

► In 1984 it was estimated that 7,000 In 1984 it was estimated that 7,000 scientific articles were published scientific articles were published daily....all providing new informationdaily....all providing new information

ResponsibilityResponsibility

““Doctors of chiropractic, no less than Doctors of chiropractic, no less than other health professionals, can expect other health professionals, can expect to be held legally responsible for their to be held legally responsible for their knowledge, ability, performance (or knowledge, ability, performance (or lack thereof) within the informational lack thereof) within the informational base provided by the scientific base provided by the scientific literature.”literature.”Keating, JC: What is a chiropractic science journal: J Keating, JC: What is a chiropractic science journal: J

Chiropr Educ 3(3): 5-10, 1990Chiropr Educ 3(3): 5-10, 1990

What are the sources What are the sources of quality of quality

information?information?

Sources of Sources of Information*Information*► Scientific Journals (Primary)Scientific Journals (Primary)

► Indexes Indexes ► Books (secondary)Books (secondary)► Trade JournalsTrade Journals► Professional Magazines /NewspapersProfessional Magazines /Newspapers► Seminars (secondary)Seminars (secondary)► Fellow PractitionersFellow Practitioners► Detail PeopleDetail People► Etc.Etc.

Does knowledge Does knowledge change?change?

Journal of the National Cancer Institute, February 2, Journal of the National Cancer Institute, February 2, 20052005

► The incidence of skin The incidence of skin cancers has been increasing cancers has been increasing for the last 50 years in all for the last 50 years in all developed countries. developed countries.

► The greatest rise has been in The greatest rise has been in melanoma, which is the most melanoma, which is the most serious and most deadly serious and most deadly type of skin cancer.type of skin cancer.

► Public health officials have Public health officials have recommended that recommended that excessive sun exposure excessive sun exposure should be avoidedshould be avoided

Adverse Effects of SunburnAdverse Effects of Sunburn

►““Sunburn, high intermittent sun Sunburn, high intermittent sun exposure… were statistically exposure… were statistically significantly inversely associated with significantly inversely associated with death from melanoma”death from melanoma”

►““CONCLUSIONS: Sun exposure is CONCLUSIONS: Sun exposure is associated with increased survival associated with increased survival from melanoma.”from melanoma.”

► Journal of the National Cancer Institute. 2005 Feb 2;97 (3): 195-9Journal of the National Cancer Institute. 2005 Feb 2;97 (3): 195-9

And our Patients?And our Patients?

Read a Little of Everything Read a Little of Everything especially the Internet especially the Internet

% of Patients Using Web for % of Patients Using Web for Health**Health**

J Am Med Inform Assoc. J Am Med Inform Assoc. 2004 Nov–Dec; 11(6): 499–504.2004 Nov–Dec; 11(6): 499–504. Information about physical illness 82%

Information about nutrition and fitness 59%

Information about alterative treatments 33%

Information on experimental treatments 17%

►Patients not only get bad Patients not only get bad information…information…

►They get conflicting They get conflicting information information

Peer Reviewed, Scientific Peer Reviewed, Scientific Refereed Journals**Refereed Journals**

► Journal editors of scientific journals Journal editors of scientific journals have a solid base in scientific methods have a solid base in scientific methods and proceduresand procedures

►A panel of skilled researchers (peers) A panel of skilled researchers (peers) provide a critique of the research provide a critique of the research submitted to the journalsubmitted to the journal

►Reviewers have varied research Reviewers have varied research expertise to review multiple types of expertise to review multiple types of researchresearch

Scientific Scientific Journals***Journals***

► Responsibility for Responsibility for QualityQuality The authorThe author Peer ReviewPeer Review EditorEditor

Online Journal

Trade Trade Journals**Journals**

► Responsibility for QualityResponsibility for Quality AuthorAuthor Editor ?Editor ? Peer Review?Peer Review?

Magazines & Magazines & Newspapers **Newspapers **

Responsibility for QualityResponsibility for Quality The authorThe author Editor?Editor?

InformaticsInformatics

Avoid feeling like a lost Avoid feeling like a lost puppypuppy

Steps to gather Steps to gather information***information***

►Choosing the right databaseChoosing the right database►Using the right termsUsing the right terms►Using Boolean argumentsUsing Boolean arguments

Step OneStep One

DatabasesDatabases

Indexes**Indexes**

►M.A.N.T.I.S.M.A.N.T.I.S. (Manual, Alternative, & (Manual, Alternative, & Natural Therapy Index System)Natural Therapy Index System)

►MedlineMedline►EMbaseEMbase►CINAHLCINAHL►BiosisBiosis►Aidsline, Toxline, Cancerlit, etc.Aidsline, Toxline, Cancerlit, etc.

Medline***Medline***

►17 Million records17 Million records►Covers broadly all areas of Covers broadly all areas of

biomedicinebiomedicine►Paid for by U.S. tax dollars (approx 250 Paid for by U.S. tax dollars (approx 250

million dollars last year) “free”million dollars last year) “free”►Despite size, only indexes 18% of Despite size, only indexes 18% of

literatureliterature

MANTIS***MANTIS***

►Largest index of scientific Alt. Med. Largest index of scientific Alt. Med. Literature (284,000 articles)Literature (284,000 articles)

► Indexes ALL chiropractic and Indexes ALL chiropractic and osteopathic scientific literatureosteopathic scientific literature

►Used by virtually all chiropractic Used by virtually all chiropractic colleges worldwidecolleges worldwide

Informatics Research***Informatics Research***

► MANTIS (Chirolars) “is shown to be the most MANTIS (Chirolars) “is shown to be the most effective searching tool”effective searching tool”

► ““The results of this study show that a field The results of this study show that a field doctor’s search using the MANTIS data base is doctor’s search using the MANTIS data base is likely to be the faster and more complete likely to be the faster and more complete than a search of the manual data bases or than a search of the manual data bases or nonchiropractic computerized data base.”nonchiropractic computerized data base.” Curl DD, Shapiro CS; Literature searching by a Curl DD, Shapiro CS; Literature searching by a

field doctor: a comparison of manual versus field doctor: a comparison of manual versus computerized methods; Chiropractic Technique computerized methods; Chiropractic Technique 1993;(1): 15-221993;(1): 15-22

Other Comments***Other Comments***

►““At last, it is possible to access ALL the At last, it is possible to access ALL the chiropractic literature with just a few chiropractic literature with just a few key strokes.” key strokes.” Wagnon RJ. The Journal ofWagnon RJ. The Journal of Chiropractic Chiropractic Education 1990;3(4)Education 1990;3(4)

Step TwoStep Two

Using the right wordsUsing the right words

Two types of searches***Two types of searches***

►Keyword searchKeyword search►MeSH term searchMeSH term search

Keyword searchesKeyword searches

► LumbalgiaLumbalgia► BackacheBackache► Low back painLow back pain► Lumbar painLumbar pain► LumbagoLumbago► Pain in lower backPain in lower back► Etc.Etc.

► TreatmentTreatment► ManagementManagement► CareCare► Intervention Intervention ► TherapyTherapy► ManipulationManipulation► Etc.Etc.

36 SEARCHES needed!36 SEARCHES needed!

►With this example alone (6 terms to With this example alone (6 terms to represent low back pain & 6 terms represent low back pain & 6 terms to represent therapy) you have 36 to represent therapy) you have 36 combinations possible for an author combinations possible for an author to use.to use.

2 Other KEY concepts2 Other KEY concepts

► If we had conducted 36 searches If we had conducted 36 searches would we have gotten all the articles would we have gotten all the articles on low back pain?on low back pain?

► Would all the articles we retrieved Would all the articles we retrieved with the 36 searches have been with the 36 searches have been about low back pain?about low back pain?

NO!!!!

NO!!!!

The Solution: Indexing**The Solution: Indexing**

► In order to solve the problem described In order to solve the problem described above the National Library of Medicine above the National Library of Medicine developed a restricted vocabulary for developed a restricted vocabulary for indexers to use… called MeSH for Medical indexers to use… called MeSH for Medical Subject Headings (MeSH)Subject Headings (MeSH)

► There are approximately 35,000 index There are approximately 35,000 index words usedwords used

► Indexes like Mantis & the nursing index Indexes like Mantis & the nursing index CINAHL, like Medline, use these terms.CINAHL, like Medline, use these terms.

Example 1:***Example 1:***

►LumbalgiaLumbalgia►BackacheBackache►Low back painLow back pain►LumbagoLumbago►Pain in the Pain in the

lower backlower back►Lumbar pain.Lumbar pain.

► = = Low Back Low Back PainPain

► No matter what word No matter what word the author uses in the the author uses in the article, or even if the article, or even if the author does not use a author does not use a single word like those single word like those to the left, the indexer to the left, the indexer translates this to “Low translates this to “Low Back Pain”Back Pain”

Example 2:***Example 2:***

►TreatmentTreatment►ManagementManagement►CareCare►InterventionIntervention►TherapyTherapy►ManipulationManipulation

► = = TherapyTherapy► Again, regardless of Again, regardless of

the words used by the words used by the author, the the author, the indexer uses indexer uses “therapy” to identify “therapy” to identify what doctors usually what doctors usually refer to as treatmentrefer to as treatment

►In order for the indexer In order for the indexer to assign the MeSH to assign the MeSH heading “low back heading “low back pain”, it must have been pain”, it must have been an important part of the an important part of the article!!!article!!!

******

Therefore*** Therefore***

► In order to get ALL of the articles In order to get ALL of the articles related to the treatment of backache related to the treatment of backache the search terms should be:the search terms should be:

►Low Back PainLow Back Pain►Therapy.Therapy.

Step ThreeStep Three

Using Boolean argumentsUsing Boolean arguments

Boolean Arguments***Boolean Arguments***

►Provides powerful method of pulling Provides powerful method of pulling from a large set of information....only from a large set of information....only the information you need.the information you need.

►Primarily uses “Primarily uses “ANDAND”, “”, “OROR” & “” & “NOTNOT” ” statementsstatements

►““Sprains and strains”Sprains and strains”

The Importance of “AND”The Importance of “AND”

►Black and GusBlack and Gus

Boolean “AND” StatementsBoolean “AND” Statements

Reproducibility of Reproducibility of Literature Search**Literature Search**

►Where –the search was conductedWhere –the search was conducted►When –the search was conductedWhen –the search was conducted►How –the search was conductedHow –the search was conducted

What Mesh or keywords were usedWhat Mesh or keywords were used How were the boolean arguments createdHow were the boolean arguments created Were there any other search restrictions Were there any other search restrictions

(e.g. language, journal, etc.)(e.g. language, journal, etc.)

SummarySummary► Biomedical databases can provide a Biomedical databases can provide a

powerful tool for private practice, powerful tool for private practice, education or researcheducation or research

► They permit us to keep up with the They permit us to keep up with the rapidly growing body of rapidly growing body of information/evidenceinformation/evidence

► The key to using biomedical The key to using biomedical databases is knowing databases is knowing

1.1. Which databases to use,Which databases to use,

2.2. What words to search with and,What words to search with and,

3.3. How to construct a strong Boolean How to construct a strong Boolean argument.argument.

EVIDENCED BASED PRACTICEEVIDENCED BASED PRACTICE

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