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Digital Futures Past Half a century ago, physicians and engineers shared a dream that computers would be able to deduce diagnoses, store medical records, and circulate information. Today, many fund...

International audience; Objectives The study aimed to qualitatively examine the perspectives of US-based physicians and academic global health programme leaders on how global health work shapes their viewpoints, values and healthcare practices back in the USA.DesignA prospective, qualitative exploratory study that employed online questionnaires and open-ended, semi-structured interviews with two participant groups: (1) global health physicians and (2) global health programme leaders affiliated with USA-based academic medical centres. Open coding procedures and thematic content analysis were used to analyse data and derive themes for discussion.Participants 159 global health physicians and global health programme leaders at 25 academic medical institutions were invited via email to take a survey and participate in a follow-up interview. Twelve participants completed online questionnaires (7.5% response rate) and eight participants (four survey participants and four additionally recruited participants) participated in in-depth, in-person or phone semi-structured interviews.Results Five themes emerged that highlight how global health physicians and academic global health programme leaders perceive global health work abroad in shaping USA-based medical practices: (1) a sense of improved patient rapport, particularly with low-income, refugee and immigrant patients, and improved and more engaged patient care; (2) reduced spending on healthcare services; (3) greater awareness of the social determinants of health; (4) deeper understanding of the USA’s healthcare system compared with systems in other countries; and (5) a reinforcement of values that initially motivated physicians to pursue work in global health.Conclusions A majority of participating global health physicians and programme leaders believed that international engagements improved patient care back in the USA. Participant responses relating to the five themes were contextualised by highlighting factors that simultaneously impinge on their ability to provide improved patient care, such as the social determinants of health, and the challenges of changing USA healthcare policy.This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial.

International audience; Low-income and middle-income countries are struggling with a growing epidemic of non-communicable diseases. To achieve the Sustainable Development Goals, their healthcare systems need to be strengthened and redesigned. The Starfield 4Cs of primary care—first-contact access, care coordination, comprehensiveness and continuity—offer practical, high-quality design options for non-communicable disease care in low-income and middle-income countries. We describe an integrated non-communicable disease intervention in rural Nepal using the 4C principles. We present 18 months of retrospective assessment of implementation for patients with type II diabetes, hypertension and chronic obstructive pulmonary disease. We assessed feasibility using facility and community follow-up as proxy measures, and assessed effectiveness using singular ‘at-goal’ metrics for each condition. The median follow-up for diabetes, hypertension and chronic obstructive pulmonary disease was 6, 6 and 7 facility visits, and 10, 10 and 11 community visits, respectively (0.9 monthly patient touch-points). Loss-to-follow-up rates were 16%, 19% and 22%, respectively. The median time between visits was approximately 2 months for facility visits and 1 month for community visits. ‘At-goal’ status for patients with chronic obstructive pulmonary disease improved from baseline to endline (p=0.01), but not for diabetes or hypertension. This is the first integrated non-communicable disease intervention, based on the 4C principles, in Nepal. Our experience demonstrates high rates of facility and community follow-up, with comparatively low lost-to-follow-up rates. The mixed effectiveness results suggest that while this intervention may be valuable, it may not be sufficient to impact outcomes. To achieve the Sustainable Development Goals, further implementation research is urgently needed to determine how to optimise non-communicable disease interventions.This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial.

This commentary examines the evolution of the biomedical communications system in the Western world. The examination touches on many aspects, including the application of new technology, the interoperative relationship between publications and data, changes in the information infrastructure, the convergence of specialties, and consequences for research and health care

Background: Researchers are developing methods to automatically extract clinically relevant and useful patient characteristics from raw healthcare datasets. These characteristics, often capturing essential properties of patients with common medical conditions, are called computational phenotypes. Being generated by automated or semiautomated, data-driven methods, such potential phenotypes need to be validated as clinically meaningful (or not) before they are acceptable for use in decision making. Objective: The objective of this study was to present Phenotype Instance Verification and Evaluation Tool (PIVET), a framework that uses co-occurrence analysis on an online corpus of publically available medical journal articles to build clinical relevance evidence sets for user-supplied phenotypes. PIVET adopts a conceptual framework similar to the pioneering prototype tool PheKnow-Cloud that was developed for the phenotype validation task. PIVET completely refactors each part of the PheKnow-Cloud pipeline to deliver vast improvements in speed without sacrificing the quality of the insights PheKnow-Cloud achieved. Methods: PIVET leverages indexing in NoSQL databases to efficiently generate evidence sets. Specifically, PIVET uses a succinct representation of the phenotypes that corresponds to the index on the corpus database and an optimized co-occurrence algorithm inspired by the Aho-Corasick algorithm. We compare PIVET’s phenotype representation with PheKnow-Cloud’s by using PheKnow-Cloud’s experimental setup. In PIVET’s framework, we also introduce a statistical model trained on domain expert–verified phenotypes to automatically classify phenotypes as clinically relevant or not. Additionally, we show how the classification model can be used to examine user-supplied phenotypes in an online, rather than batch, manner. Results: PIVET maintains the discriminative power of PheKnow-Cloud in terms of identifying clinically relevant phenotypes for the same corpus with which PheKnow-Cloud was originally developed, but PIVET’s analysis is an order of magnitude faster than that of PheKnow-Cloud. Not only is PIVET much faster, it can be scaled to a larger corpus and still retain speed. We evaluated multiple classification models on top of the PIVET framework and found ridge regression to perform best, realizing an average F1 score of 0.91 when predicting clinically relevant phenotypes. Conclusions: Our study shows that PIVET improves on the most notable existing computational tool for phenotype validation in terms of speed and automation and is comparable in terms of accuracy.

There has been remarkable progress in identifying the causes of genetic conditions as well as understanding how changes in specific genes cause disease. Though difficult (and often superficial) to parse, an interesting tension involves emphasis on basic research aimed to dissect normal and abnormal biology versus more clearly clinical and therapeutic investigations. To examine one facet of this question and to better understand progress in Mendelian-related research, we developed an algorithm that classifies medical literature into three categories (Basic, Clinical, and Management) and conducted a retrospective analysis. We built a supervised machine learning classification model using the Azure Machine Learning (ML) Platform and analyzed the literature (1970-2014) from NCBI's Entrez Gene2Pubmed Database (http://www.ncbi.nlm.nih.gov/gene) using genes from the NHGRI's Clinical Genomics Database (http://research.nhgri.nih.gov/CGD/). We applied our model to 376,738 articles: 288,639 (76.6%) were classified as Basic, 54,178 (14.4%) as Clinical, and 24,569 (6.5%) as Management. The average classification accuracy was 92.2%. The rate of Clinical publication was significantly higher than Basic or Management. The rate of publication of article types differed significantly when divided into key eras: Human Genome Project (HGP) planning phase (1984-1990); HGP launch (1990) to publication (2001); following HGP completion to the "Next Generation" advent (2009); the era following 2009. In conclusion, in addition to the findings regarding the pace and focus of genetic progress, our algorithm produced a database that can be used in a variety of contexts including automating the identification of management-related literature.

ObjectiveThrough a literature review, we investigated the geographic information systems (GIS) methods used to define the food environment and the types of spatial measurements they generate.DesignReview study.SettingSearches were conducted in health science databases, including Medline/Pubmed, PsycINFO, Francis and GeoBase. We included studies using GIS-based measures of the food environment published up to 1 June 2008.ResultsTwenty-nine papers were included. Two different spatial approaches were identified. The density approach quantifies the availability of food outlets using the buffer method, kernel density estimation or spatial clustering. The proximity approach assesses the distance to food outlets by measuring distances or travel times. GIS network analysis tools enable the modelling of travel time between referent addresses (home) and food outlets for a given transportation network and mode, and the assumption of travel routing behaviours. Numerous studies combined both approaches to compare food outlet spatial accessibility between different types of neighbourhoods or to investigate relationships between characteristics of the food environment and individual food behaviour.ConclusionsGIS methods provide new approaches for assessing the food environment by modelling spatial accessibility to food outlets. On the basis of the available literature, it appears that only some GIS methods have been used, while other GIS methods combining availability and proximity, such as spatial interaction models, have not yet been applied to this field. Future research would also benefit from a combination of GIS methods with survey approaches to describe both spatial and social food outlet accessibility as important determinants of individual food behaviours.

A total of 8,251 references from seven medical journals from four language areas (English, French, German and Swedish) have been studied. The mean number of references per article varies from 13 to 27, the range is wide (2-63). Six per cent of the references are more than 25 years old and most of them could probably be omitted. The English language predominates to the degree (91%) that there is practically no influx from other language areas than those included in the study. A Medline search shows a much higher proportion of references in other languages (English 59%) and makes it likely that non-English references to a large degree are neglected by authors writing and reading only English. It is concluded that it should be possible to limit the number of references per original article to 20-25.

Objective: The research provides a chronology of the US National Library of Medicine's (NLM's) contribution to access to the world's biomedical literature through its computerization of biomedical indexes, particularly the Medical Literature Analysis and Retrieval System (MEDLARS). Method: Using material gathered from NLM's archives and from personal interviews with people associated with developing MEDLARS and its associated systems, the author discusses key events in the history of MEDLARS. Discussion: From the development of the early mechanized bibliographic retrieval systems of the 1940s and to the beginnings of online, interactive computerized bibliographic search systems of the early 1970s chronicled here, NLM's contributions to automation and bibliographic retrieval have been extensive. Conclusion: As NLM's technological experience and expertise grew, innovative bibliographic storage and retrieval systems emerged. NLM's accomplishments regarding MEDLARS were cutting edge, placing the library at the forefront of incorporating mechanization and technologies into medical information systems.

Dietary treatment of obesity is based on one or another of two premises: that the obese eat too much or that they eat the wrong things. The first is a tautology lacking explanatory power. The second is a meaningful and promising hypothesis but has yet to be effectively applied. At present, virtually all outpatient treatments of obesity, including behavior modification, are based on the first premise and consist of strategies for reducing the subject's caloric intake. Most such interventions produce short-term weight loss. Regain after the end of treatment remains the usual outcome. A survey of studies published in the period 1977-1986 and reporting on dietary or behavioral treatment of obesity reveals that the maximum percentage of body weight lost is, on average, 8.5 percent--no different from the value, 8.9%, in similar studies from 1966-1976, as reviewed by Wing and Jeffery. The principal determinant of success in such programs appears to be the intake weight of the subjects: the higher the intake weight, the more successful the intervention will appear to be. The goals and research methods of studies on dietary treatments for obesity are overdue for ethical as well as scientific reevaluation. The same may be said for the numerous programs providing such treatment outside the context of research.

This paper discusses concepts and terminology of some aspects of the autoimmune and rheumatic disorders as related to medical reference work. Details of anatomic, biochemical, and pathologic processes are not discussed. Knowledge of the specific terminology involved in this area may help to ensure a good approach to developing prudent strategies for database searching of the medical literature and, therefore, is reviewed. MeSH thesaurus terms are shown and textword synonyms are presented that provide tools for thorough searching techniques. Commonly used medical jargon as well as older terminology for this area is also explained. Examples of specific search strategies are illustrated.

The National Library of Medicine, located in Bethesda, MD, is the largest repository of medical literature in the world. Its vast holdings now comprise 2.3 million volumes and 3.6 million additional items, including manuscripts; photographs, prints, and other pictorial material; and extensive collections of microfilmed and audiovisual records. Today, this world-famous library faces a range of challenges related to the storage of the formidable volume of new material from around the world, the preservation of older documents, and the demand for technology-driven dissemination of information.

The coding of information in the computer representation of clinical trials is essential both for the rationalisation of the activities involved in the production of therapeutic information for evidence-based decision support and for the integration of the messages produced by these activities with clinical information and electronic patient record systems. There is no standard coding system available, however, so building on existing evaluations, we performed a simple semi-quantitative evaluation of ICD-10, CDAM, MEDDRA, MESH, READ, SNOMED and UMLS to provide objective criteria for the choice of a coding system. Inclusion and exclusion criteria for four clinical trials recorded in TriSum constituted the corpus of evaluation texts. Criteria included coding coverage, size, integration and language coverage. The results of the comparison lead us to choose SNOMED as the most appropriate coding system for our needs. The absence of a European Medical Language System project is observed, as is the need for combinatorial as opposed to enumerative systems.

Dr. William Stewart Halsted, the first chief of surgery at the Johns Hopkins Hospital, made many contributions to the field of surgery and played a major role in the early success of the Johns Hopkins Hospital. Many consider him to have been the most innovative and influential surgeon that this country has produced. Among his many contributions are the introduction of local and regional anesthesia; the development of the intestinal suture; an operation for advanced breast cancer, an operation for the cure of inguinal hernia, and the first successful resection of a periampullary tumor; and many contributions to thyroid and parathyroid surgery, vascular surgery, and orthopedic surgery. However, his two most important contributions were the introduction of the philosophy of safe surgery and a system for training surgical residents in this country. 1,2 However, there was another surgeon who perhaps made even more basic contributions to the early success of the Johns Hopkins Hospital and Medical School and to the field of medicine at large. This individual actually planned the Johns Hopkins Hospital and oversaw its construction, which took 11 years, played an important role in integrating teaching and research into the hospital structure and function, helped recruit its early faculty/staff members, and made important contributions to the Johns Hopkins School of Medicine. In addition to his contributions to Hopkins, he made major pioneering and lasting contributions to the collection, storage, and retrieval of biomedical information. This individual was a member of the American Surgical Association and perhaps one of its most productive and brilliant members. However, even in those cities where he spent most of his career, Washington DC, Baltimore, Philadelphia, New York, and to a lesser extent Boston, he remains relatively unknown. In reviewing his life and his career, there are many lessons to be learned from the incredibly productive and successful career of Dr. John Shaw Billings. 3–5

Evidence-based medicine requires new skills of physicians, including literature searching.To determine which literature retrieving method is most effective for GPs: the printed Index Medicus; Medline through Grateful Med; or Medline on CD-ROM.The design was a randomized comparative study. In a continuing medical education course, three groups of health care professionals (87 GPs and 16 other health care professionals) used one of the literature retrieval methods to retrieve citations on four search topics related to general practice. For the analysis in pairs, we used the search results of the 75 participants who completed all four assignments. As outcome measures, we used precision, recall and an overall search quality score; we also had a post-course questionnaire on personal characteristics, experience with computers, handling medical literature and satisfaction with course instruction and search results.The recall and overall search quality scores in the Index Medicus groups (n = 32) were higher (P =0.001) than those in the CD-ROM groups (n = 31). In addition, the search quality scores in the Grateful Med groups (n = 12) were higher (P0.003) than those in the CD-ROM groups. There were no differences in precision.In the period 1994-1997, the printed Index Medicus was the most effective literature retrieval method for GPs. For inexperienced GPs, there is a need for training in electronic literature retrieval methods.

We present current data pertaining to angiogenesis of the ovary throughout the follicular and luteal phases of the ovarian cycle, in various ovarian pathologic conditions and in benign and neoplastic diseases. MEDLINE, Current Contents, and Index Medicus were searched for studies published between January 1966 and October 1998. All studies that incorporated human and animal models of angiogenesis of the normal ovarian physiologic state and pathologic conditions including both benign and neoplastic ovarian diseases were reviewed. Current literature supports that angiogenesis is an important component of both follicular and luteal phases of the ovarian cycle that correlates well with maturation of secretory endometrium. Angiogenesis also participates in various pathologic processes of the ovary, including follicular cyst formation, polycystic ovary, ovarian hyperstimulation syndrome, and both benign and malignant ovarian neoplasms. In the future a knowledge of specific angiogenic patterns of various pathologic processes may assist in the application of antiangiogenic medications in targeted therapy of benign and neoplastic diseases of the ovary.

OBJECTIVE: The results differ concerning randomized controlled trials of the effects of metformin on blood glucose regulation and body weight. To get a systematic overview, a meta-analysis of the efficacy of metformin was performed by comparing metformin with placebo and sulfonylurea. RESEARCH DESIGN AND METHODS: All randomized controlled trials published since 1957 were selected by searching the Current List of Medical Literature, Cumulated Index Medicus, Medline, and Embase, Meta-analysis was performed calculating weighted mean difference (WMD) of fasting blood glucose, glycosylated hemoglobin, and body weight. RESULTS: Nine randomized controlled trials comparing metformin with placebo and ten comparing metformin with sulfonylurea were identified. The WMD between metformin and placebo after treatment for fasting blood glucose was -2.0 mmol/l (95% CI -2.4 to -1.7) and for glycosylated hemoglobin -0.9% (95% CI -1.1 to -0.7). Body weight WMD was not significant after treatment. Sulfonylurea and metformin lowered blood glucose and glycosylated hemoglobin equally, while there was a significant WMD of body weight (-2.9 kg [95% CI -4.4 to -1.1]) because of a 1.7-kg mean increase after sulfonylurea and a 1.2-kg mean decrease after metformin. CONCLUSIONS: Metformin lowers blood glucose and glycosylated hemoglobin significantly, compared with placebo. Metformin and sulfonylurea have an equal effect on fasting blood glucose and glycosylated hemoglobin, but the body weight is significantly lower after metformin compared with sulfonylurea treatment because of an increase in body weight after sulfonylurea treatment.

One of the many uses of a computer is to facilitate searching the medical literature. The number of physicians performing their own searches is increasing significantly, 6 and several converging trends have contributed to this increase. First, the database represented by the compendium of published medical literature is enormous, and is not immediately accessible to most clinicians. Additionally, the volume of new information is increasing at a rapid pace. Further, practicing physicians are becoming more computer literate, and medical schools and residency training programs are teaching students and residents how to use computers in their practice. Concurrently, the older, cumbersome access to searching these databases has evolved into easier "point and click" or menu-driven interfaces. Finally, the importance of "evidence-based" medicine is becoming more apparent. 3 In the past, literature searches have been used primarily for research and manuscript preparation. Today, however, computer-assisted literature searches are frequently used to assist in patient care and clinical problem solving. 7,8,9 Users of literature searches have reported that they are extremely useful in several aspects of patient care, including choosing the most appropriate diagnostic test, properly diagnosing a medical condition, developing an appropriate treatment plan, and implementing a treatment plan. 8,9 Users also have reported that findings from literature searches have resulted in improved patient outcomes overall, and in some cases have contributed to the implementation of life- or organ-saving treatments. 9 In fact, in one study the use of on-line literature searches early in the course of hospitalization resulted in significantly lower hospital costs and charges, and shorter lengths of stay, than in matched control patients with the same diagnoses where literature searches were not performed. 7 Even more impressive, the patients in the group where literature searches were performed had a higher average level of illness severity than patients in the control group, which would usually result in higher costs and a longer length of stay in the literature-search group.

See related article and editorial Study objective: The Science Citation Index "impact factor" is the only available quantitative estimate of a journal's scientific contributions. However, the derivation of this factor contains an intrinsic bias that underestimates the impact of emergency medicine journals. We wished to test the hypothesis that use of an alternative criterion standard would provide an improved profile of the scientific contributions of emergency medicine journals relative to those of other specialties. Methods: We used an observational, longitudinal, comparative design in which all Index Medicus citations from Advanced Cardiac Life Support (ACLS) publications were aggregated by journal and then stratified by specialty. Proportions and proportionate trends, relative to total citations, were reported by specialty, facilitating comparison of emergency medicine with other disciplines. Results: Among all eight ACLS publications (1974-1994) 4,062 citations met the inclusion criteria. Emergency medicine journals were referenced in 16% of eligible citations (99% confidence interval [CI], 14% to 17%), a figure exceeded only by internal medicine and cardiology journals. Emergency medicine was the only discipline to show a significant proportionate increase in contributions over the 20-year study period ( P 2 for linear trend analysis). Conclusion: Contrary to the implications of a low impact factor, an analysis of journal citations in ACLS publications over two decades suggests that emergency medicine has made significant contributions to a broad and important area of scientific inquiry. [Barnaby DP, Gallagher EJ: Alternative to the Science Citation Index impact factor as an assessment of emergency medicine's scientific contributions. Ann Emerg Med January 1998;31:78-82.]

In the National Cancer Act of 1971, the Director of the National Cancer Institute (NCI) was given a mandate to “Collect, analyze, and disseminate all data useful in the prevention, diagnosis, and treatment of cancer, including the establishment of an International Cancer Research Data Bank (ICRDB) to collect, catalog, store, and disseminate insofar as feasible the results of cancer research undertaken in any country for the use of any person involved in cancer research in any country” (National Cancer Act of 1971, S 1828, 92nd Congress, 1st Sess (1971)). In subsequent legislation, the audience for NCI's information dissemination activities was expanded to include physicians and other healthcare professionals, patients and their families, and the general public, in addition to cancer researchers. The Institute's response to these legislative requirements was to create what is now known as the Physician Data Query (PDQ®) cancer information database. From its beginnings in 1977 as a database of NCI-sponsored cancer clinical trials, PDQ has grown to include extensive information about cancer treatment, screening, prevention, supportive and palliative care, genetics, drugs, and more. Herein, we describe the history, editorial processes, influence, and global reach of one component of the PDQ database, namely its evidence-based cancer information summaries for health professionals. These summaries are widely recognized as important cancer information and education resources, and they further serve as foundational documents for the development of other cancer information products by NCI and other organizations.

Health Services Technology/Assessment Text (HSTAT), an online collection of documents pertaining to clinical practice guidelines, HIV/AIDS treatment information, and health care decision making, was recently introduced by the National Library of Medicine. Access to HSTAT is available through the NLM Full-Text Retrieval System (FTRS), a document search and retrieval system developed by the Information Technology Branch of NLM. Internet FTP, Gopher, and World Wide Web clients may also be used to obtain documents from the HSTAT collection.

Electronic networks can provide access to other nurses locally and around the world via electronic mail and on-line interactions. Networks can give nurses access to information and to the data that are processed and stored in computers in their own facility and in computers at remote sites. The major international networks, Internet, FidoNet, and BITNET each offer these opportunities. In addition, Internet, the network most useful to nurses, allows access to Sigma Theta Tau's International Nursing Library, E.T. Net, and the MEDLARS family of bibliographic data bases. Taking advantage of the services and resources networks offer can facilitate nursing practice, education, and research.

We have previously described a user-interactive rule-based computer program (Dyna-SaurI) designed for dynamic thesaurus integration, and demonstrated its efficacy on integrating dermatological subsets of the MeSH and SNOMED thesauruses. In the present study, we have refined our rules for merging and mapping multiple thesauruses and tested these rules. We then applied them with a set of optimized parameters to the integration of a third thesaurus, a subset of the International Coding Index for Dermatology, with the Integrated MeSH-SNOMED thesaurus. The parameter changes resulted in improved ranking of more specific and conceptually closer terms.

Background Information technology (IT) is increasingly being used in general practice to manage health care including type 2 diabetes. However, there is conflicting evidence about whether IT improves diabetes outcomes. This review of the literature about IT-based diabetes management interventions explores whether methodological issues such as sample characteristics, outcome measures, and mechanisms causing change in the outcome measures could explain some of the inconsistent findings evident in IT-based diabetes management studies. Methods Databases were searched using terms related to IT and diabetes management. Articles eligible for review evaluated an IT-based diabetes management intervention in general practice and were published between 1999 and 2009 inclusive in English. Studies that did not include outcome measures were excluded. Results Four hundred and twenty-five articles were identified, sixteen met the inclusion criteria: eleven GP focussed and five patient focused interventions were evaluated. Nine were RCTs, five non-randomised control trials, and two single-sample before and after designs. Important sample characteristics such as diabetes type, familiarity with IT, and baseline diabetes knowledge were not addressed in any of the studies reviewed. All studies used HbA1c as a primary outcome measure, and nine reported a significant improvement in mean HbA1c over the study period; only two studies reported the HbA1c assay method. Five studies measured diabetes medications and two measured psychological outcomes. Patient lifestyle variables were not included in any of the studies reviewed. IT was the intervention method considered to effect changes in the outcome measures. Only two studies mentioned alternative possible causal mechanisms. Conclusion Several limitations could affect the outcomes of IT-based diabetes management interventions to an unknown degree. These limitations make it difficult to attribute changes solely to such interventions.

Object Transcranial motor evoked potential (TcMEP) monitoring is frequently used in complex spinal surgeries to prevent neurological injury. Anesthesia, however, can significantly affect the reliability of TcMEP monitoring. Understanding the impact of various anesthetic agents on neurophysiological monitoring is therefore essential. Methods A literature search of the National Library of Medicine database was conducted to identify articles pertaining to anesthesia and TcMEP monitoring during spine surgery. Twenty studies were selected and reviewed. Results Inhalational anesthetics and neuromuscular blockade have been shown to limit the ability of TcMEP monitoring to detect significant changes. Hypothermia can also negatively affect monitoring. Opioids, however, have little influence on TcMEPs. Total intravenous anesthesia regimens can minimize the need for inhalational anesthetics. Conclusions In general, selecting the appropriate anesthetic regimen with maintenance of a stable concentration of inhalational or intravenous anesthetics optimizes TcMEP monitoring.

Few evaluations and statistical comparisons of bibliographic databases have been published. As a drug information center, we were particularly interested in databases providing references on adverse drug reactions (ADRs). Ten drugs were randomly chosen from the 2000 files at our center. Nine databases were selected according to the high frequency of references concerning ADRs: eight online systems (MEDLINE, BIOSIS, TOXLINE, Iowa Drug Information System, PASCAL, EMBASE, PHARMLINE, and International Pharmaceutical Abstracts [IPA]), and one Compact Disk Read Only Memory (CD-ROM) system (Core MEDLINE). The total number of references, the number of references from 1987 to 1989, and the number of relevant references from 1987 to 1989 were analyzed using the Friedman two-way ANOVA by ranks. The overlap between databases for only one drug, carboplatin, and the quality:cost ratio were also studied. Considering the total number of references, TOXLINE and EMBASE were significantly superior to IPA, PHARMLINE, PASCAL, and Core MEDLINE. For the period 1987–1989, EMBASE was significantly superior to PASCAL, IPA, PHARMLINE, and Core MEDLINE with regard to total number of references, and significantly superior to PASCAL, Core MEDLINE, and IPA with regard to relevance. MEDLINE, TOXLINE, and EMBASE had the best quality:cost ratio. EMBASE had the slightest overlap of references, with 53 percent of the unique references on carboplatin. This comparative evaluation showed that the ability of bibliographic databases to provide information on ADRs is dependent on both the size and the quality of each database.

As part of a U.S. government effort to inform the public about toxic or hazardous chemicals released into the environment, the National Library of Medicine (NLM) and the Environmental Protection Agency (EPA) are jointly producing the TRI (Toxic Chemical Release Inventory) databanks which consist of two separate files, TRI87 and TRI88. Both files reside on NLM's TOX-NET system. The files contain geographic information about reporting facilities and land, air, and water release data for approximately 300 listed chemicals.

As part of a U.S government effort to combat AIDS, the National Library of Medicine (NLM) is expanding its information services in this area. In response to the Health Omnibus Program Extension Act of 1988, NLM has expanded its AIDS Bibliography, enhanced its DIRLINE file with AIDS-related organizations, and developed three new online MEDLARS (Medical Literature Retrieval and Analysis System) databases: AIDSLINE, AIDSTRIALS, and AIDSDRUGS. NLM's AIDS-related programs and services are discussed.

Controlled vocabularies of "preferred names" and registry systems are essential in electronic indexing, storing, searching, and retrieving the world′s published literature. The most efficient and comprehensive search is accomplished by using the preferred name. Without a controlled vocabulary or a registry system, it would be necessary to remember every name that might have been used by authors since January 1966, in order to retrieve all the citations on a chemical from over 7.8 million citations currently in the National Library of Medicine′s MEDLINE and its backfiles. The task of creating the list of subject descriptors that make possible the surveillance of published literature via electronic databases requires the participation of the scientific community in developing domain-specific nomenclature, drug classification, controlled vocabularies, and registry systems as well. The biological unions of the International Council of Scientific Unions and its Committee on Data for Science and Technology are major contributors to the establishment and dissemination of standards for biological terminology and nomenclature. The objectives of the IUPHAR Nomenclature Committee include the development of a rational framework for the nomenclature of receptor classes or families and a classification for therapeutic agents. This will help define rules for the characterization and classification of receptors that are stable and easy to comprehend. The International Union of Pharmacology publishes guidelines for the classification of drugs and the nomenclature of receptors and ion channels.

Cachexia has been known to physicians since ancient Greek times as a 'signum mali ominis' in various diseases indicating end stage disease and poor quality of life. Cardiac cachexia is recently receiving growing attention as modern treatment options prevent early death from cardiac events and more patients live with chronic compensated heart failure. Nevertheless, observation and clinical documentation of this condition go back as long as medical science itself. Pioneering studies on the reasons and mechanisms of cachexia were performed several decades ago. These studies provide fundamental insights and guidance towards a better understanding of cachexia. This review presents an overview of early thoughts and milestone studies on metabolic abnormalities and cachexia in chronic heart failure.

The National Library of Medicine's MEDLINE (MEDLARS Online) database was the first database to be searched nationwide via value-added telecommunication networks. Now available on the World Wide Web free of charge from the National Library of Medicine and from many other sources, it is the world's most heavily used medical database. MEDLINE is unique in that each reference to the medical literature is indexed under a controlled vocabulary called Medical Subject Headings (MeSH). These headings are the keys that unlock the medical literature. MeSH multiplies the usefulness of the MEDLINE database and makes it possible to search the medical literature as we do today. This paper commemorates the 40th anniversary of the introduction of MeSH and salutes some of the farsighted persons who conceived and developed the MEDLINE database.

The year 2000 provides a symbolic opportunity to assess the past initiatives in anesthesia research. As in many other fields, medical research has benefited from utilizing computerized data bases to facilitate enumerating areas of interest. We have created a baseline survey of past research in the fields of anesthesia, anesthetics, analgesia, and analgesics to highlight Canadian studies.The survey was undertaken using the Medical Literature Analysis and Retrieval System (MEDLARS) medical literature archive for the years 1995 through 1999. The principal categories and sub-categories of MEDLARS' anesthesia classifications were counted for 70 countries contributing to the archive.Canadian contributions ranged from 141 (1992) to 185 (1999) and represented annually 3% of the world total in the anesthesia categories. The greatest number of studies (30-38%) were about adults aged 19 to 44 yr, and there were between 4% and 14% more studies of females than males. "Pharmacology" and "therapeutic use" were the most frequent topics, lidocaine, fentanyl, and propofol were the most studied anesthetics, and non-steroidal anti-inflammatories, opium, morphine, and fentanyl were the most studied analgesics. Among the types of studies, those classified as "quality of health care" occurred most frequently (16%). Canadian trends closely follow world trends.The collected counts provide a comprehensive overview of research trends for the past five years.

A systematic manual search for articles related to consultation-liaison psychiatry was compared to a computerized search of the same journals during the same period that was done with the Medical Literature Analysis and Retrieval System (MEDLARS). More artides were located with the manual method (94%) than with MEDLARS (65%). (AmJ Psychiatry 1990; 147:1040-1042) T he review article is an essential tool for the modem medical researcher. Faced with a vast and ever-growing quantity of scientific data and the need to follow research in a wide variety of disciplines, the clinical scholar uses reviews as a time-saving source of information. In an optimal research review, studies on a cleanly defined topic of research are methodically identified, summarized, and compared, and future directions for research are discussed (1). Given the influence of review articles on research progress, it is critical that the selection of articles to be reviewed not be skewed by author preference. This is particularly important for meta-analysis, in which the data from a number of studies are pooled. The author must make an objective and reproducible search of the scientific literature. One strategy that review authors commonly use to avoid selection bias is to carry out a computer-assisted search using the Medical Literature Analysis and Retrieval System (MEDLARS) on other computerized system for searching the medical literature. Although a computerized search using key words to define the research topic seems to be an exhaustive and nonbiased time-saving approach to combing the mesearch literature, studies have found evidence to the contrary. DeNeef (2) performed a series of MEDLARS searches for articles on nosocomial streptococcal infections and found that no search identified more than

The authors discuss new library services and support for a podiatric residency program. They present information on how to conduct medical literature searches through the use of MEDLINE and CD-ROM MEDLINE. Information on interlibrary loans also is provided.

Background: A literature review was conducted to analyze developments in the epidemiology, pathogenesis, treatment, and prevention of frostbite injury. Increased participation in outdoor activities, as well as the epidemic of homelessness, makes knowledge of the treatment of frostbite crucial for physicians in both rural and urban areas. Methods: A literature search, using the key words “frostbite” and “cold,” was done using MEDUNE and Index Medicos. This search focused on the epidemiology, pathogenesis, treatment, and prevention of frostbite. Results: Research done during the past 15 years has clarified the pathogenesis of frostbite injury and led to a better understanding of how to limit tissue loss. The etiology of frostbite is commonly related to alcohol use, psychiatric illness, or motor vehicle problems. The pathogenesis is linked to tissue freezing, hypoxia, and the release of inflammatory mediators. The initial clinical manifestations of frostbite injury are similar for superficial and deep tissue damage, so early treatment is identical for all injuries. Optimum therapy is based on the rapid reversal of tissue freezing by rewarming in 1 04-108°F water and the institution of oral and topical antiprostaglandin therapy to limit the release of inflammatory mediators. Conclusion: Rapid triage and treatment of frostbite can lead to dramatic improvements in outcome and prognosis. Increased awareness of antiprostaglandin therapy and preventive measures is crucial for physicians in diverse practice environments.

Although Medline covers many of the significant medical periodical articles published in developed countries, there is still a considerable amount of medical and health documentation from countries outside the major industrialized areas which is not included. This paper outlines various initiatives to address this, and goes on to describe the setting up, on a cooperative basis, of the African Index Medicus, the problems encountered and progress made. ‘Even if we should presume that most of the world's valid, important biomedical information originates in the West—and there is evidence (…) to suggest that this is wilful self delusion—what about at least a minority contribution from the rest? The 2% participation in international scientific discourse allowed by Western indexing services is simply too little to account for the scientific output of 80% of the world.’1

Abstract Our objective was to compare cardiovascular event rates in patients with mild or moderate hypertension who received nifedipine with active drug controls. We performed a MEDLARS search using the MeSH heading “hypertension” and the text word “nifedipine” to identify all articles that were published between 1966 and August 1995 in English, French, German, Italian, and Spanish languages and that involved human subjects. The computerized search was supplemented by a manual search of article bibliographies. Review of 1880 citations revealed 98 randomized controlled clinical trials that met protocol criteria. Articles were extracted independently by two doctors who were blinded for author, institution, and treatment regimen, using a structured, pretested extraction form. Differences of opinion were resolved by consensus. Fourteen events occurred in 5198 exposures (0.27%) to nifedipine and 24 events in 5402 exposures (0.44%) to other active drug controls. Unadjusted odds ratios for nifedipine versus controls were 0.49 (95% confidence interval [CI], 0.22-1.09) for definitive events (death, nonfatal myocardial infarction or stroke, revascularization procedure) and 0.61 (95% CI, 0.31-1.17) for all events (definitive plus increased angina). The odds ratio for nifedipine monotherapy (sustained- or extended-release in 91% of exposures) was nonsignificantly higher for definitive and all events (odds ratio, 1.40; 95% CI, 0.49-4.03 and odds ratio, 1.39; 95% CI, 0.59-3.32, respectively). The odds ratio for nifedipine in combination with another drug was significantly lower for definitive and all events (odds ratio, 0.09; 95% CI, 0.01-0.66 and odds ratio, 0.15; 95% CI, 0.03-0.65, respectively). Differences in odds ratio for nifedipine monotherapy and combined therapy were statistically significant ( P =.02 for definitive events and P =.001 for all events). Results support the safety of sustained- and extended-release nifedipine in the treatment of mild or moderate hypertension when it is used in combination with other drugs.

A digital library enables users to interact effectively with information distributed across a network. These network information systems support search and display of items from organized collections. In the historical evolution of digital libraries, the mechanisms for retrieval of scientific literature have been particularly important. Grand visions in 1960 led first to the development of text search, from bibliographic databases to full-text retrieval. Next, research prototypes catalyzed the rise of document search, from multimedia browsing across local-area networks to distributed search on the Internet. By 2010, the visions will be realized, with concept search enabling semantic retrieval across large collections.

The National Information Center on Health Services Research and Health Care Technology (NICHSR), located at the National Library of Medicine (NLM), mounted a database called Health Services Technology Assessment Research (HSTAR). HSTAR pulls together a number of online resources which cover topics such as clinical practice guidelines, technology assessments, and clinical trials. This article gives a brief overview of the database and some hints for effective searching.

The volume of publications on any given topic makes it difficult to select an appropriate subset of publications for review by an expert panel. This paper proposes a method for selecting a subset using a protocol that attempts to order publications based upon good research methods. The protocol was followed by graduate students with no expert knowledge of the area they were reviewing. They reduced 11730 articles on the topic of EMF and Health risk to 68 articles that were reviewed by an expert panel. The interrater reliability was 96% and 94% of the relevant articles were captured by this process.

Numerous authorities have emphasized the need for expanding the quantity and quality of physical medicine and rehabilitation (PM&R) research and academic productivity. Thus far, however, attempts to evaluate academic productivity have involved the manual sampling of relevant specialty journals. This approach greatly underestimates productivity. By conducting a computer-facilitated search for PM&R-related publications and then contacting the most academically prolific PM&R departments to verify the computer-generated data, it was found that computer search strategies more accurately estimate PM&R academic productivity. PM&R publication activity increased by 15% in the United States and 46% internationally over the period 1988 to 1990. At least 76% of the United States residency programs in PM&R had scientific publications over this period. With ever increasing emphasis placed on academic productivity, the trend of increasing productivity can only be expected to continue in the future.