2. Informatics Dwain Daniel D.C.

3. Objectives: 1. Describe growth of biomedical information 2. Describe the major sources of biomedical information & the strengths and weaknesses of each 3. Present the major biomedical indexes and their importance 4. Describe the basic structure of indexes and indexing procedures 5. Conduct Medline & MANTIS searches

4. Changes in Number of Scientists Publishing ► There were approximately 1,000 scientists in 1800 ► This grew to nearly 100,000 in 1900 ► And to more than 3,200,000 by 1972 ...Arch Dermatol 128: 1249-1256 ► In 1984 it was estimated that 7,000 scientific articles were published daily....all providing new information

5. Responsibility “Doctors of chiropractic, no less than other health professionals, can expect to be held legally responsible for their knowledge, ability, performance (or lack thereof) within the informational base provided by the scientific literature.” Keating, JC: What is a chiropractic science journal: J Chiropr Educ 3(3): 5-10, 1990

6. What are the sources of quality information?

7. Sources of Information* Sources of Information* ► Scientific Journals (Primary) ► Indexes ► Books (secondary) ► Trade Journals ► Professional Magazines /Newspapers ► Seminars (secondary) ► Fellow Practitioners ► Detail People ► Etc.

8. Does knowledge change?

9. Journal of the National Cancer Institute, February 2, 2005 ► The incidence of skin cancers has been increasing for the last 50 years in all developed countries. ► The greatest rise has been in melanoma, which is the most serious and most deadly type of skin cancer. ► Public health officials have recommended that excessive sun exposure should be avoided

10. Adverse Effects of Sunburn ► “Sunburn, high intermittent sun exposure… were statistically significantly inversely associated with death from melanoma” ► “CONCLUSIONS: Sun exposure is associated with increased survival from melanoma.” ► Journal of the National Cancer Institute. 2005 Feb 2;97 (3): 195-9

11. And our Patients? Read a Little of Everything especially the Internet

12. % of Patients Using Web for Health** J Am Med Inform Assoc. 2004 Nov–Dec; 11(6): 499–504. Information about physical illness82% Information about nutrition and fitness59% Information about alterative treatments33% Information on experimental treatments17%

13. ► Patients not only get bad information… ► They get conflicting information

14. Peer Reviewed, Scientific Refereed Journals** ► Journal editors of scientific journals have a solid base in scientific methods and procedures ► A panel of skilled researchers (peers) provide a critique of the research submitted to the journal ► Reviewers have varied research expertise to review multiple types of research

15. Scientific Journals*** ► Responsibility for Quality  The author  Peer Review  Editor Online Journal

16. Trade Journals** ► Responsibility for Quality  Author  Editor ?  Peer Review?

17. Magazines & Newspapers ** Magazines & Newspapers **  Responsibility for Quality  The author  Editor?

18. Informatics Avoid feeling like a lost puppy

19. Steps to gather information*** ► Choosing the right database ► Using the right terms ► Using Boolean arguments

20. Step One Databases

21. Indexes** ► M.A.N.T.I.S. (Manual, Alternative, & Natural Therapy Index System) ► Medline ► EMbase ► CINAHL ► Biosis ► Aidsline, Toxline, Cancerlit, etc.

22. Medline*** ► 17 Million records ► Covers broadly all areas of biomedicine ► Paid for by U.S. tax dollars (approx 250 million dollars last year) “free” ► Despite size, only indexes 18% of literature

23. MANTIS*** ► Largest index of scientific Alt. Med. Literature (284,000 articles) ► Indexes ALL chiropractic and osteopathic scientific literature ► Used by virtually all chiropractic colleges worldwide

24. Informatics Research*** ► MANTIS (Chirolars) “is shown to be the most effective searching tool” ► “The results of this study show that a field doctor’s search using the MANTIS data base is likely to be the faster and more complete than a search of the manual data bases or nonchiropractic computerized data base.”  Curl DD, Shapiro CS; Literature searching by a field doctor: a comparison of manual versus computerized methods; Chiropractic Technique 1993;(1): 15-22

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

26. Step Two Using the right words

27. Two types of searches*** ► Keyword search ► MeSH term search

28. Keyword searches ► Lumbalgia ► Backache ► Low back pain ► Lumbar pain ► Lumbago ► Pain in lower back ► Etc. ► Treatment ► Management ► Care ► Intervention ► Therapy ► Manipulation ► Etc.

29. 36 SEARCHES needed! ► With this example alone (6 terms to represent low back pain & 6 terms to represent therapy) you have 36 combinations possible for an author to use.

30. 2 Other KEY concepts ► If we had conducted 36 searches would we have gotten all the articles on low back pain? ► Would all the articles we retrieved with the 36 searches have been about low back pain? NO!!!!

31. The Solution: Indexing** ► In order to solve the problem described above the National Library of Medicine developed a restricted vocabulary for indexers to use… called MeSH for Medical Subject Headings (MeSH) ► There are approximately 35,000 index words used ► Indexes like Mantis & the nursing index CINAHL, like Medline, use these terms.

32. Example 1:*** ► Lumbalgia ► Backache ► Low back pain ► Lumbago ► Pain in the lower back ► Lumbar pain. ► = Low Back Pain ► No matter what word the author uses in the article, or even if the author does not use a single word like those to the left, the indexer translates this to “Low Back Pain”

33. Example 2:*** ► Treatment ► Management ► Care ► Intervention ► Therapy ► Manipulation ► = Therapy ► Again, regardless of the words used by the author, the indexer uses “therapy” to identify what doctors usually refer to as treatment

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

35. Therefore*** ► In order to get ALL of the articles related to the treatment of backache the search terms should be: ► Low Back Pain ► Therapy.

36. Step Three Using Boolean arguments

37. Boolean Arguments*** ► Provides powerful method of pulling from a large set of information....only the information you need. ► Primarily uses “AND”, “OR” & “NOT” statements ► “Sprains and strains”

38. The Importance of “AND” ► Black and Gus Black and Gus Black and Gus

39. Boolean “AND” Statements

40. Reproducibility of Literature Search** ► Where –the search was conducted ► When –the search was conducted ► How –the search was conducted  What Mesh or keywords were used  How were the boolean arguments created  Were there any other search restrictions (e.g. language, journal, etc.)

41. Summary ► Biomedical databases can provide a powerful tool for private practice, education or research ► They permit us to keep up with the rapidly growing body of information/evidence ► The key to using biomedical databases is knowing 1.Which databases to use, 2.What words to search with and, 3.How to construct a strong Boolean argument.

42. EVIDENCED BASED PRACTICE

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