Internet Basics

searching for medical information

Introduction
During the last 20 years, the Internet has exploded on the computer scene as a topic of international interest Computer networks initially reserved for scientists, governments, and educational institutions have become available to corporations (large/small) and even individual users

What is available on the Internet?

Information and tools to be downloaded
journal articles useful applications, e.g. CATmaker

Presented in different formats (docs, pictures, data)

Searching data

Electronic mail to communicate with other people

Personal email Mailing lists Attachments

World wide web (WWW), websites/webpages Internet Relay Chat (IRC) E-conference Newsgroups /Usenet

The Evidence Pyramid

Tergantung atas pertanyaan dan jawaban yang ingin dicari

Penyakit, penyebab, pengobatan, diagnosis dsb.

Community Department

Medical information . (1)

One solution for the problem of obsolescence of professional education is problem-based learning or learning by inquiry.
confronted by a clinical question ( unsure of the current best answer), we need to develop the habit of looking for the current best answer as efficiently as possible.

The success of learning by inquiry depends heavily on

being able to find the current best evidence to manage pressing clinical problems a task that can be either quick and highly rewarding or time consuming and frustrating.

Medical information . (2)

How to find current best evidence, formulate .
the key question to seek an answer the best answer to the clinical problem that you currently have stored in your brain (being as quantitative as possible) the evidence resources (both traditional and avant-garde) that you would consult to find best current answers.

General search strategy

Clinical problem Define important, searchable question Select most likely resource Select second most likely resource

Design search strategy

Summarize the evidence Apply the evidence Poor yield

Design search strategy

Summarize the evidence

Community Department

Where to start?
PubMed: www.pubmed.org BMJ: www.bmj.com New England Journal of Medicine: www.nejm.com Other search portals or journal websites (free or by subscription)

British Medical Journal www.bmj.com

.PDF file (Open using Adobe Acrobat)

Search strategies
Feature Truncation Exact phrase Wildcard Key * Or $ ? Explanation Analy* = analysis, analytic, analytical, analyse, etc Words must be adjacent to each other heart attack Gyn?ecology = gynaecology, gynecology Randomi?* = randomisation, randomization, randomised Article must include both terms Article can include either term Exclude article containing the term Exp: econom* NOT economy

Boolean

AND OR NOT

Boolean Logic

AND

21

Boolean Logic

OR

22

Boolean Logic

NOT

23

Searching steps
1. Define the clinical question (remember: P-I-C-O) 2. Extract keywords from the question 3. Determine a search strategy 4. Evaluate search results 5. Revise search strategy (if needed) based on above results

Example - Diagnosis
In under-five year old children, does an elevated reticulocyte count (compared to normal reticulocyte count) increase the likelihood of iron deficiency anemia? Keywords: reticulocyte AND iron deficiency anemia AND diagnostic test Limit search by age: children (<5 years)

Example - Therapy

In neonates, does vitamin K administration (compared to no vitamin K) reduce the incidence of hemorrhagic disease of the newborn?
Keywords: neonate AND vitamin K AND hemorrhage Limit search by publication type: clinical trials

Can medical practice be evidence-based?