Search

Background Academics in all disciplines increasingly use social media to share their publications on the internet, reaching out to different audiences. In the last few years, specific indicators of social media impact have been developed (eg, Altmetrics), to complement traditional bibliometric indicators (eg, citation count and h-index). In health research, it is unclear whether social media impact also translates into research impact. Objective The primary aim of this study was to systematically review the literature on the impact of using social media on the dissemination of health research. The secondary aim was to assess the correlation between Altmetrics and traditional citation-based metrics. Methods We conducted a systematic review to identify studies that evaluated the use of social media to disseminate research published in health-related journals. We specifically looked at studies that described experimental or correlational studies linking the use of social media with outcomes related to bibliometrics. We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases using a predefined search strategy (International Prospective Register of Systematic Reviews: CRD42017057709). We conducted independent and duplicate study selection and data extraction. Given the heterogeneity of the included studies, we summarized the findings through a narrative synthesis. Results Of a total of 18,624 retrieved citations, we included 51 studies: 7 (14%) impact studies (answering the primary aim) and 44 (86%) correlational studies (answering the secondary aim). Impact studies reported mixed results with several limitations, including the use of interventions of inappropriately low intensity and short duration. The majority of correlational studies suggested a positive association between traditional bibliometrics and social media metrics (eg, number of mentions) in health research. Conclusions We have identified suggestive yet inconclusive evidence on the impact of using social media to increase the number of citations in health research. Further studies with better design are needed to assess the causal link between social media impact and bibliometrics.

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.

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.

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 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.

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.

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.

This invited historical review traces the development and impact of two major data bases in the field of genetic toxicology. Discussed from a personal perspective are the Environmental Protection Agency (EPA) Gene-Tox Program and the EPA/International Agency for Research on Cancer Genetic Activity Profiles (GAPs) and their respective data bases. Whereas Gene-Tox was focused on the assessment of short-term tests and their role in predicting carcinogens and mutagens, GAPs and the GAP data base were designed specifically to aid in the evaluation of individual chemicals. Both data bases have been computerized. Gene-Tox is available on TOXNET and GAP is available in a personal computer format from the author. The Gene-Tox and GAP data bases appear to have had substantial impact, particularly on hazard identification activities in cancer risk assessment. © 1994 Wiley-Liss, Inc.1

The purpose of this study was to determine whether recent descriptions of multiple personality disorder are consistent with descriptions from the past. Clinical presentations and childhood histories obtained from early case reports of multiple personality disorder published between 1800 and 1965 (N = 52) were compared with recent case reports published in the 1980s (N = 54). Recent and past cases did not differ in age at diagnosis, length of treatment, duration of follow-up, presence of child and opposite gender personalities, and exposure to hypnosis. Recent cases differed significantly from past cases in mean number of personalities (12 vs. 3), age of onset (11 vs. 20 years), proportion of males (24% vs. 44%), and in prevalence of childhood abuse histories (81% vs. 29%). The authors discuss clinical and cultural factors that may have contributed to the change over time in the number of reported cases, complexity of personality structure, and description of etiological childhood trauma. Although a core set of symptoms has consistently been associated with this disorder over time, other important aspects have not been stable.

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.

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.

The foundation of evidence-based medicine is critical analysis and synthesis of the best data available concerning a given health problem. These factual data are accessible because of the availability on the Internet of web tools specialized in research for scientific publications. A bibliographic database is a collection of bibliographic references describing the documents indexed. Such a reference includes at least the title, summary (or abstract), a set of keywords, and the type of publication. To conduct a strategically effective search, it is necessary to formulate the question - clinical, diagnostic, prognostic, or related to treatment or prevention - in a form understandable by the research engine. Moreover, it is necessary to choose the specific database or databases, which may have particular specificity, and to analyze the results rapidly to refine the strategy. The search for information is facilitated by the knowledge of the standardized terms commonly used to describe the desired information. These come from a specific thesaurus devoted to document indexing. The most frequently used is MeSH (Medical Subject Heading). The principal bibliographic database whose references include a set of describers from the MeSH thesaurus is Medical Literature Analysis and Retrieval System Online (Medline), which has in turn become a subpart of a still more vast bibliography called PubMed, which indexes an additional 1.4 million references. Numerous other databases are maintained by national or international entities. These include the Cochrane Library, Embase, and the PASCAL and FRANCIS databases.

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 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.

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.

Objectives: The study examines how Loansome Doc services are implemented and used by libraries in the Southeast Region and describe end users' experiences with and attitudes toward Loansome Doc.

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.

The Shared Hospital Electronic Library of Southern Indiana (SHELSI) research project was designed to determine whether access to a virtual health sciences library and training in its use would support medical decision making in rural southern Indiana and achieve the same level of impact seen by targeted information services provided by health sciences librarians in urban hospitals.Based on the results of a needs assessment, a virtual medical library was created; various levels of training were provided. Virtual library users were asked to complete a Likert-type survey, which included questions on intent of use and impact of use. At the conclusion of the project period, structured interviews were conducted.Impact of the virtual health sciences library showed a strong correlation with the impact of information provided by health sciences librarians. Both interventions resulted in avoidance of adverse health events. Data collected from the structured interviews confirmed the perceived value of the virtual library.While librarians continue to hold a strong position in supporting information access for health care providers, their roles in the information age must begin to move away from providing information toward selecting and organizing knowledge resources and instruction in their use.

BACKGROUND: Since 1987 research articles have been catalogued with the author's affiliation address in the 40 databases of the Medical Literature Analysis and Retrieval System (MEDLARS) of the National Library of Medicine, Bethesda, Md. The present study was conducted to examine the Canadian entries in MEDLARS to interpret past and future trends and to combine the MEDLARS demographic data with data from other sources to rank Canadian research output of human studies both nationally and internationally. METHODS: The PubMed Web site of the National Library of Medicine was used to count medical articles archived in MEDLARS and published from Jan. 1, 1989, through Dec. 31, 1998. The articles attributed to Canadian authors were compared by country, province, city, medical school, hospital, article type, journal and medical specialty. RESULTS: During the study period Canadian authors contributed on average 3% (standard deviation [SD] 0.2%) of the worldwide MEDLARS content each year, which translated to a mean of 11,067 (SD 1037) articles per year; 49% were human studies, of which 13% were clinical or controlled trials, and 55% involved people aged 18 years or less. In total, 68% of the articles were by authors affiliated with Canadian medical schools; those affiliated with the University of Toronto accounted for the greatest number (8604), whereas authors affiliated with McGill University had the greatest rate of annual increase in the quantity published (8%). Over one-third (38%) of the articles appeared in Canadian journals. When counted by specialty, 17% of the articles were by authors with clinical specialties, 5% by those with surgical specialties and 3% by those with laboratory specialties. INTERPRETATION: The annual rate of increase in research output for Canada was more than 3 times higher than that seen world wide. Canada is now ranked seventh among countries contributing human studies to MEDLARS. The increase indicates that Canada's medical schools are productive, competitive in making contributions to medical science and are supporting Canadian journals.

A large number of good surgical studies have been published in The Netherlands, putting the country at the top of the list in the Western world. It is remarkable that the highest productivity was found in small countries and in countries with a low population. Most of the large European countries have a low scientific output according to the method used in the present study. The Scandinavian countries, Holland, and Switzerland have the best scientific index according to these results. It could be that the larger countries, such as Germany, Italy, France, and Spain, tend more to publish in national journals. Perhaps it is not common in some some countries and regions to publish data in English--which certainly has a negative effect on the scientific index of such a country. The high productivity found among Dutch surgeons could be explained by the fact that the 700 surgeons in a small country with a relatively high population are well organized: Almost all Dutch surgeons are members of the national surgical society. All of them can speak and write English very well. Participation in the activities organized by the national society is high. Scientific meetings where surgeons and assistants get together for a day or two are held twice a year. In addition quality controls are carried out at all teaching and nonteaching hospitals. Through this the surgeons in this relatively small country know each other quite well, which promotes cooperation when studies are undertaken. The Netherlands is just large enough for relevant clinical studies to be conducted and it may be that we initiate a relatively large number of such studies. It is a democratic country in which surgeons and researchers are offered the freedom and opportunity to conduct research and publish their results as they like without being hindered by hierarchic structures. Together, these factors create a scientific climate in The Netherlands which stimulates the organization of multicenter and clinical studies.

Although the question on the efficacy of chlorhexidine therapy for the clinician's adult patient may not have been totally answered, a greater perspective on this treatment modality was gained by the reader because of the quality of the overview cited, and the evidence-based approach used by the authors in performing the overview.

The addition of chemotherapy to postoperative radiation therapy in the treatment of high grade astrocytoma results in a modest increase in 12 and 24 month survival. It is, at present, unclear whether single agent or combination drug therapy constitutes the best drug regimen for these patients. Despite this uncertainty, multi-drug regimens have become standard therapy for some high grade astrocytomas.One year survival data derived from over 2,100 patients enrolled in 9 randomized clinical trials were analyzed using the meta-analytic techniques previously described by Peto et al. This analysis compared the proportion of patients surviving one year treated with multi-drug regimens versus single agent treatment (usually BCNU). All patients included in this analysis also underwent surgery and radiation therapy as part of their clinical management.A summary odds ratio was calculated following a statistical analysis showing a lack of heterogeneity among the included studies in terms of their estimate of effect. The calculated Peto odds ratio was 1.22 with a 95% confidence interval of 0.99-1.36. These data indicate that combination drug treatment is associated with an approximately 22% decreased 1 year survival as compared with single agent therapy.This analysis suggests that the available data do not support the use of combination chemotherapy regimens in this patient population. Additional randomized clinical trials are needed to clearly determine whether any multidrug treatment scheme is superior to currently available single agent therapies.

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

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.