PubMed EBM searching for handheld devices

Unbound MEDLINE (http://www.unboundmedicine.com/medline/ebm/) provides a clean, simple interface for filtered clinical query searches in PubMed data. Keyword and  “advanced” searching, as well as “browse by topic,” are also available.  While it looks great in a web browser, it was designed with the handheld device in mind.  Unbound MEDLINE is a service of Unbound Medicine (http://www.unboundmedicine.com/), which “develops next-generation knowledge management systems in healthcare.” 

Thanks for this tip to Exploring the Evidence Base (http://clinicallibrarian.wordpress.com/), a “bliki” from the Centre for Clinical Effectiveness in Melbourne.

Following Computers in Libraries online

davidrothman.net offers a number of feeds making it easy to follow CIL 2008 – through blogs, conference wiki feeds, Technorati, YouTube, Twitter, Flickr, SlideShare, del.icio.us — and even a “SuperFeed” that combines them all. Take a look: How to: Follow CIL 2008 online via RSS

Unanswered Questions, part 2

The second research article is part of series published by Ely et al.:

Ely JW; Osheroff JA; Maviglia SM; Rosenbaum ME: Patient-care questions that physicians are unable to answer. J Am Med Inform Assoc 2007 Jul-Aug;14(4):407-14. Epub 2007 Apr 25 . PMID 17460122

This is a follow-up to a previous study in which the investigators had observed primary care physicians and recorded questions that arose during patient care. In the current study, the investigators worked with the questions for which physicians had pursued answers, but were unable to find them.

In the current study, the investigators analyze a portion of the unanswerable questions, categorize them, and try to find answers using a select list of resources that were “clinically oriented, generally available, and commonly used in practice.” I found the resource set interesting: UpToDate, Micromedex, Medline (actually PubMed, from the URL), National Guideline Clearinghouse, Harrison’s Principles of Internal Medicine, Nelson Textbook of Pediatrics, the Sanford Guide to Antimicrobial Therapy, the Red Book, eMedicine, and Google (!!). Three of the investigators report a current or past association with Thomson, which produces Micromedex.

The investigators were able to find answers to 70% of the questions studied in at least one of the 10 resources. They point out that they performed a “leisurely” search averaging 3.8 minutes per resource per question (up to 10 resources each), while the physicians who could not find the answers may at most have had a couple of minutes between patients. (Anyone who can get something useful from Google in 3.8 minutes is a more focussed searcher than I! I get distracted following interesting links.)

The authors reported their findings as an unanswered question taxonomy, recommendations for physicians, and recommendations for authors. I was most interested in their advice for physician/answer seekers.

The authors take issue with the PICO search strategy format, citing a poor phrasing of the question as one reason that physicians are unable to find an answer. While the PICO strategy is likely to find evidence-based answers, they contend, the answers don’t necessarily match the physician’s original question.

Their recommendations for physicians, to be more effective in finding answers, include selecting the most appropriate resource (handbooks and clinically oriented reviews rather than comprehensive textbooks); rephrasing questions to better match the type of information found in clinical resources (women with “fibrocystic disease” rather than “previous benign breast biopsies”); and using more effective search terms (treatment for “triglycerides” rather than for “very-low-density-lipoprotein cholesterol”).

I find PICO useful in reference interviews, myself. I may not structure my search strategy around the PICO format, but it helps me to ask the right questions, so that I know the patron asking for “pressure ulcers and surgery” wants to prevent skin ulcers in postop patients rather than to treat skin ulcers with surgery.

It seems to me that learning to break a question into component parts (which the article does touch on) and put it back together in a way that makes sense for the resource at hand would be a valuable skill for any searcher. The PICO format is one way, but not the only way, to do that. It also helps to know the resources well, know how to use the controlled vocabulary when it’s available, understand Boolean search logic … Searching 101.

Unanswered Questions

I’ve been reading a couple of research articles about unanswered (or unanswerable) questions that arise during physicians’ treatment of patients. I’ll address them in separate posts.

Here’s a link to a classical music piece while we ponder this issue: Charles Ives’ The Unanswered Question

Norlin C; Sharp AL; Firth SD: Unanswered questions prompted during pediatric primary care visits. Ambul Pediatr 2007 Sep/Oct; 7(5): 396-400. PMID 17870649

This article was featured in AHRQ Research Activities, which reported that Pediatricians often do not pursue answers to questions that arise during medical visits. (Research Activities 2008 Mar; 331: 7.)

The article examines types and frequency of questions that arise during office visits by children with or without special health care needs; whether the pediatrician intends to pursue an answer; and how often he or she follows through on pursing answers.

I found the list of reasons for not intending to pursue an answer interesting; in addition to insufficient time and unimportance of the question, pediatricians indicated that they doubted the existence of relevant information, were uncertain where to look, did not have an appropriate resources, or did not trust the resource that was available.

The authors’ conclusions: that clinically relevant questions for which pediatricians do not have a ready answer arise during almost 20% of primary care visits, but answers are pursued for only a few. Lack of time and not knowing where to look are the primary reasons given for not pursuing answers.

I would be interested to know what resources the pediatricians had on hand, and particularly what they didn’t trust. I wonder, if a question is important and lack of time is an issue, what barriers prevent them from turning to a librarian?

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