Clinicians Need for Information

Searching for the Evidence

When asked
they need it twice a week
When observed
they need it 60 times a week

Clinicians Need for Information

When shadowed:
we need it up to 60 times per week
(twice per every three patients)
affect eight decisions per day
but we get only 30% of it
and that comes from passers-by
my textbooks are out of date
my journals too disorganized

Structure of Database

Medline Database
National Library of Medicine
Bethesda, Maryland
Abstracts of 3,500 journals
70 countries
Philippines not included
More than 30,000 new articles added per month
9 million articles since 1966

The Medline Database

DATABASE

DATABASE

PATIENT
PATIENT
PATIENT
PATIENT
PATIENT
PATIENT
NAME:PATIENT
PATIENT
_________________
NAME:
_________________
NAME:
PATIENT
_________________
NAME:_________________
MEDLINE
_________________
NAME:
NAME:
_________________
NAME:
_________________
NAME:
AGE:
_________________
______ SEX:
SEX:______
______
NAME:
AGE:
_________________
______
AU:
____________________
AGE:
______
SEX:______
______
AGE:
______
SEX:
AGE:
______
SEX:
______
AGE:______
______ SEX:
SEX:
______
AGE:
______
AGE:
ADDRESS:
______ SEX:
SEX:
______________
______
AGE:
ADDRESS:
______
______________
______
TI:
_____________________
ADDRESS:
______________
ADDRESS:
______________
ADDRESS:
______________
ADDRESS:
______________
ADDRESS:
______________
ADDRESS:
TEL.NO.
NO.
______________
________________
ADDRESS:
TEL.
______________
________________
SO:
____________________
TEL.
NO.
________________
TEL.NO.
NO. ________________
________________
TEL.
TEL.
NO. ________________
________________
TEL.
NO.
TEL.
NO.
________________
TEL.
NO.
________________
AB:
____________________

PATIENT
PATIENT
PATIENT
PATIENT
PATIENT
PATIENT
NAME:PATIENT
PATIENT
_________________
NAME:
_________________
NAME:PATIENT
PATIENT
_________________
NAME:
_________________
NAME:
_________________
NAME:
_________________
NAME:
_________________
NAME:
AGE:
_________________
______ SEX:
SEX:______
______
NAME:
AGE:
_________________
______
NAME:
AGE:
_________________
______
SEX:______
______
AGE:
______
SEX:
AGE:______
______ SEX:
SEX:
______
AGE:
______
AGE:
______ SEX:
SEX:
______
AGE:
ADDRESS:
______
______________
______
AGE:
ADDRESS:
______
SEX:
______________
______
AGE:
ADDRESS:
______ SEX:
______________
______
ADDRESS:
______________
ADDRESS:
______________
ADDRESS:
______________
ADDRESS:
______________
ADDRESS:
TEL.NO.
NO.
______________
________________
ADDRESS:
TEL.
______________
________________
ADDRESS:
TEL.
NO.
______________
________________
TEL.
NO.
________________
TEL.NO.
NO. ________________
________________
TEL.
TEL.
NO. ________________
________________
TEL.
NO.
TEL.
NO.
________________
TEL.
NO.
________________

FIELDS

RECORDS

FIELDS

RECORDS

The Medline Database

The Medline Database

Millions of Articles

8
7

Main frame access

6
5
4

NLM

3
2

1
0
66

69

72

75

78

81

84

87

90

93

96

Years

The Medline Database

Literature Retrieval Method

Randomized comparative study (Verhoeven et al, 2000)
Three groups
Index Medicus
Gratefulmed
Medline CD-ROM

Information explosion
700 MB of information
400,000 abstract per disc

Results
Index Medicus better than Medline CD-ROM
Gratefulmed better than Medline CD-ROM
Index Medicus same as Gratefulmed

Searching MEDLINE

Searching MEDLINE

The Boolean Logic

The Boolean Logic

B
1
2 3
4 5
6
15

10

11

8
12
7 13
14

TB

1
2 3
4 5
6
15

16

10

RCTs
11

8
12
7 13
14
16

MENINGITIS

C
A OR B

(A AND B) OR C

TB OR RCTs

A AND B

A AND (B OR C)

TB AND RCTs

A AND B AND C

A AND (B AND C)

TB AND RCT AND MENINGITIS

PubMed Home Page

Develop a Search Strategy

Identify the key concepts (should include the PIOM
discussed earlier)
Determine alternative terms for these concepts (can be
facilitated with MESH term search)
Refine your search (use limits like publication dates,
study subjects, study designs, patient age, etc)

Advanced Search Strategy

Advanced Search Strategy

Advanced Search Strategy

An Exercise
A 35 year old male came to your clinic complaining
of dizziness and headache. His BP was 150/100 and is
currently taking nifedipine 10 mg three times a day. Despite
this dose his BP remained uncontrolled.

Search MEDLINE for the most relevant article to

answer the clinical dilemma.