Understanding and Using the Medical Subject Headings (MeSH) Vocabulary to Perform Literature Searches

Evolving Medical Knowledge: Moving Toward Efficiently Answering Questions and Keeping Current

The information needs of clinicians are many and varied; however, these information needs remain largely unmet. This likely diminishes the quality of patient care. Although it is important that physicians be proficient in critically evaluating the medical literature, it is more important that they become proficient in the "applied science of information management." Clinicians must learn the techniques and skills to find, evaluate, and use relevant and valid information both in the care of patients and in their careers of lifelong learning. Clinicians need sources for rapid retrieval of valid information at the point of care.

Ambulatory impedance cardiography: a systematic review

BACKGROUND

Standard noninvasive impedance cardiography has been used to examine the cardiovascular responses of individuals to a wide range of stimuli in critical care and laboratory settings. It has been shown to be a reliable alternative to invasive thermodilution techniques and an acceptable alternative to the use of a pulmonary artery catheter. Ambulatory impedance cardiography provides a similar assessment of cardiac function to standard noninvasive impedance cardiography, but it does so while individuals engage in activities of daily living. It offers portability and the option of managing complex patients in outpatient settings.

OBJECTIVE

To critically examine through a literature analysis the validity, reliability, and sensitivity of ambulatory impedance cardiography for the assessment of cardiac performance during activities of daily living.

METHODS

The Cochrane Database of Systematic Reviews (CDSR), The Cochrane Database of Methodology Reviews (CDMR), The Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), National Health Service Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA), and The Cochrane Methodology Register (CMR; 1966-2005); MEDLINE (1950-2005); and CINAHL (1982-2005) were searched using the following terms: ambulatory cardiac performance, impedance cardiac performance, AIM cardiac performance monitor, thoracic electrical bio-impedance, impedance cardiography, ambulatory impedance monitor, bio-impedance technology, ambulatory impedance cardiography, bio-electric impedance; also included were reference lists of retrieved articles. Studies were selected if they used an ambulatory impedance monitor to examine one or more of the following cardiovascular responses: pre-ejection period (PEP), left ventricular ejection time (LVET), stroke volume (SV), or a combination of these.

RESULTS

Studies have been predominantly descriptive and have been focused on a young, male population with a normal body mass index (BMI; 25-29 kg/m). Inconsistencies in determining specific markers of cardiac function (e.g., PEP and SV) across studies necessitated that results be reported by outcome for each study separately.

DISCUSSION

Ambulatory impedance monitors are valid and reliable instruments used for the physiologic measurement of cardiac performance. Sensitivity is established utilizing within-individual measurements of relative change. This is especially important in light of an aging population and technical advances in healthcare. Further research is warranted using nursing interventions that focus on an older, female population who have a BMI greater than 30 kg/m. Availability of noninvasive ambulatory measures of cardiac function has the potential to improve care for a variety of patient populations, including those with hypertension, heart failure, pain, anxiety, and depressive symptoms.

Searching the literature using medical subject headings versus text word with PubMed

OBJECTIVE/HYPOTHESIS

This study was conducted to investigate the performance of two search strategies in the retrieval of information from the National Library of Medicine (NLM) on otolaryngology-head and neck surgery related conditions and diagnoses using PubMed.

METHODS

Two search strategies-one based on the use of Medical Subject Headings (MeSH) and the second based on text word searching-were compared.

RESULTS

The MeSH search provided a more efficient search than the text word search.

CONCLUSIONS

Head and neck surgeons can most efficiently search the NLM using PubMed as a search engine by initiating the search with MeSH terms. Once a key article is identified, the searcher should use the "Related Articles" feature.

The Ontology Lookup Service, a lightweight cross-platform tool for controlled vocabulary queries

Background

With the vast amounts of biomedical data being generated by high-throughput analysis methods, controlled vocabularies and ontologies are becoming increasingly important to annotate units of information for ease of search and retrieval. Each scientific community tends to create its own locally available ontology. The interfaces to query these ontologies tend to vary from group to group. We saw the need for a centralized location to perform controlled vocabulary queries that would offer both a lightweight web-accessible user interface as well as a consistent, unified SOAP interface for automated queries.

Results

The Ontology Lookup Service (OLS) was created to integrate publicly available biomedical ontologies into a single database. All modified ontologies are updated daily. A list of currently loaded ontologies is available online. The database can be queried to obtain information on a single term or to browse a complete ontology using AJAX. Auto-completion provides a user-friendly search mechanism. An AJAX-based ontology viewer is available to browse a complete ontology or subsets of it. A programmatic interface is available to query the webservice using SOAP. The service is described by a WSDL descriptor file available online. A sample Java client to connect to the webservice using SOAP is available for download from SourceForge. All OLS source code is publicly available under the open source Apache Licence.

Conclusion

The OLS provides a user-friendly single entry point for publicly available ontologies in the Open Biomedical Ontology (OBO) format. It can be accessed interactively or programmatically at .

Searching the medical literature

Medical literature searches have become more complex because of the increasing amount of published material and the multiple available databases indexing those publications. Although newly graduated physicians may have received some training in literature searching as part of a medical school curriculum, most clinicians have received no formal training in this skill. In today's world of evidence-based medicine, access to published data is crucial, and the importance of a systematic approach to searching cannot be overemphasized. A brief review of searching techniques can greatly increase productivity while using the MEDLINE, Excerpta Medica, Science Citation Index, and other databases. Similarly, knowing the options available for remote access to databases and electronic delivery of articles can expedite the task of accessing publications.

A meta-data-based learning resource server for medicine

The World Wide Web (WWW) promises many advantages in the distribution and presentation of electronic learning modules for medical education. However, there is a well-known obstacle: finding the right offers on demand. We developed a solution based on international standards called Learning Resource Server Medicine (LRSMed), which provides a meta-data collection of electronic learning modules. Based on the meta-data, LRSMed offers a service for the learners to retrieve WWW resources at the time of learning. We used the IMS Learning Resource Meta-data Information Model as suitable meta-data specification, the eXtensible Markup Language (XML) as syntax for interfaces and the Oracle suite for implementation. LRSMed is available at http://mmedia.medizin.uni-essen.de/portal/. More than 260 learning resources are currently registered and described. So far a user-interface has been implemented which allows searching, commenting and editing. In the next future we will add an application programming interface (API) for the integration of LRSMed in portals, learning platforms and information systems of hospitals, medical practices or healthcare networks.

Evaluating and synthesizing qualitative research: the need to develop a distinctive approach

The growing popularity of qualitative research has led to calls for it to be incorporated into the evidence base. It is argued that, in seeking to respond to this challenge, it is important that we recognize the important differences between qualitative and quantitative research and that we take this into account in developing a distinctive approach. This paper outlines the distinctive contribution made by qualitative research with regard to the nature of the curiosity involved, the iterative research process and its treatment of data, analysis and findings. We caution against simply importing templates developed for systematic review of quantitative work, and make suggestions with regard to developing a new model for evaluating and synthesizing qualitative work. The proposed new model takes a critical look at some of the assumptions underpinning systematic review, such as the process of literature searching and selection of relevant material. Although there is potential for checklist items--such as purposive sampling, respondent validation, multiple coding, triangulation and grounded theory--to be used over-prescriptively in evaluating qualitative papers, it is argued that a more creative engagement with these concepts could yield a distinctive approach more appropriate for this type of work. Moreover, we speculate that some of the questions thereby raised might be usefully applied to consideration of established procedures for reviewing quantitative work.

Avaliação de descritores na angiologia e cirurgia vascular em artigos publicados em dois periódicos nacionais

A recuperação de referências na literatura biomédica está normatizada pelos Descritores em Ciências da Saúde (DeCS), contudo os autores de artigos científicos nem sempre obedecem ao regulamentado, o que causa dificuldade a localização da informação. Os autores avaliaram os Descritores em Ciências da Saúde em artigos de dois periódicos nacionais, na angiologia e cirurgia vascular no período de 1995 a 2000 em relação a adequada utilização dos descritores de acordo com a listagem do DeCS 2001 e do MeSH 1994. Foram estudados os descritores em 186 artigos publicados em 02 periódicos da especialidade. Foi observado que a maioria dos descritores empregados não estão de acordo com o DeCS 2001 e com o MeSH 1994. Concluiu-se que a indexação deva ser uma atividade dinâmica e que novos termos devem ser acrescentados para acompanhar o desenvolvimento da especialidade.Por outro lado, percebe-se uma desinformação por parte dos autores, que devem ser estimulados a utilizarem corretamente os descritores e a sugerirem a inclusão dos novos termos, como prevê a sistemática da indexação.

Options available--from start to finish--for obtaining data from DNA microarrays II

Microarray technology has undergone a rapid evolution. With widespread interest in large-scale genomic research, an abundance of equipment and reagents have now become available and affordable to a large cross section of the scientific community. As protocols become more refined, careful investigators are able to obtain good quality microarray data quickly. In most recent times, however, perhaps one of the biggest obstacles researchers face is not the manufacture and use of microarrays at the bench, but storage and analysis of the array data. This review discusses the most recent equipment, reagents and protocols available to the researcher, as well as describing data analysis and storage options available from the evolving field of microarray informatics.

Searching the medical literature on the Internet

The volume of new information being added to the medical literature is expanding quickly. Hence, computer-assisted literature searches frequently are used to assist in patient care and clinical problem solving, including choosing the most appropriate diagnostic tests, properly diagnosing medical conditions, and developing and implementing suitable treatment plans. This article describes techniques for performing more efficient medical literature searches using the PubMed interface of MEDLINE.

Which coding system for therapeutic information in evidence-based medicine

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.

A MeSH based intelligent search intermediary for Consumer Health Information Systems

GIN Austria (Gesundheitsinformationsnetz Austria) offers patients and consumers reliable medical knowledge about diseases, wellness and disease management in an easy understandable way and enables them to quick and incessant access to informations about the Austrian health system and Austrian health organizations. To achieve full customer (patients, citizens) satisfaction to find relevant information we propose a concept of a vector-model oriented IR-Tool based on the controlled vocabulary of the MeSH Thesaurus (german version). By this approach users who are often not used to scientific terms and expressions are supported to build up their own query with MeSH Main Headings. In a second step broader and narrower Main Headings are added to the query vector by the system. For this calculation an adapted version of the Floyd-Warshall algorithm for directed, azyclic graphs is used. The tool is part of the GIN Search Modul, which will ease gathering health information from different heterogenous internet datasources.

Overview of Evidence-based Medicine: Challenges for Evidence-based Laboratory Medicine

Evidence-based medicine (EBM) has been driven by the need to cope with information overload, by cost-control, and by a public impatient for the best in diagnostics and treatment. Clinical guidelines, care maps, and outcome measures are quality improvement tools for the appropriateness, efficiency, and effectiveness of health services. Although they are imperfect, their value increases with the quality of the evidence they incorporate. Laboratory professionals must direct more effort to demonstrating the impact of laboratory tests on a greater variety of clinical outcomes. Laboratory and clinical practitioners must be familiar with many of the accessible electronic and paper tools for searching for evidence. Detailed statistical and epidemiologic knowledge is not essential, but critical appraisal skills and a competent understanding of the strengths and weaknesses of systematic review and metaanalysis are necessary. Overemphasis on complexity and failure to recognize time limitations are major barriers to translating EBM into everyday practice. Emphasizing and practicing the role of the laboratory professional as a skilled clinical consultant strongly grounded in evidence as well, in addition to better integration of laboratory and clinical information and improved laboratory reports will overcome most barriers. There is a poverty of good, primary studies of test evaluations. Institution of more consistent standards for the design and reporting of studies on diagnostic accuracy should improve the situation. If nothing else, systematic reviews have demonstrated the need for more good-quality primary research in laboratory medicine.

Creating the gene ontology resource: design and implementation

The exponential growth in the volume of accessible biological information has generated a confusion of voices surrounding the annotation of molecular information about genes and their products. The Gene Ontology (GO) project seeks to provide a set of structured vocabularies for specific biological domains that can be used to describe gene products in any organism. This work includes building three extensive ontologies to describe molecular function, biological process, and cellular component, and providing a community database resource that supports the use of these ontologies. The GO Consortium was initiated by scientists associated with three model organism databases: SGD, the Saccharomyces Genome database; FlyBase, the Drosophila genome database; and MGD/GXD, the Mouse Genome Informatics databases. Additional model organism database groups are joining the project. Each of these model organism information systems is annotating genes and gene products using GO vocabulary terms and incorporating these annotations into their respective model organism databases. Each database contributes its annotation files to a shared GO data resource accessible to the public at http://www.geneontology.org/. The GO site can be used by the community both to recover the GO vocabularies and to access the annotated gene product data sets from the model organism databases. The GO Consortium supports the development of the GO database resource and provides tools enabling curators and researchers to query and manipulate the vocabularies. We believe that the shared development of this molecular annotation resource will contribute to the unification of biological information.

[Development of evidence-based clinical practice guidelines; a model project integrating external evidence and clinical expertise]

BACKGROUND

Internationally, evidence-based clinical practice guidelines have been established for several years. In Germany, they are now gaining increasing importance.

OWN STUDIES

The Institute of Health Economics and Clinical Epidemiology at the University of Cologne has developed a mostly standardized process for evidence-based guideline development. This process has been implemented in such a way that reproducibility, validity and practicability of guidelines can be assured: evidence from research (external evidence) has been searched and evaluated according to the criteria of the Agency of Health Care Policy and Research (AHCPR). Through cooperation with clinical experts, this evidence has been transferred into practicable recommendations. In addition, acceptance of guideline users and patients was improved by applying this method.

CONCLUSION

Evidence-based guidelines are considered as an appropriate tool to assist medical decision-making of all stakeholders involved. The process will be demonstrated developing an evidence-based guideline for obesity treatment.

A model for enhancing Internet medical document retrieval with "medical core metadata"

OBJECTIVE

Finding documents on the World Wide Web relevant to a specific medical information need can be difficult. The goal of this work is to define a set of document content description tags, or metadata encodings, that can be used to promote disciplined search access to Internet medical documents.

DESIGN

The authors based their approach on a proposed metadata standard, the Dublin Core Metadata Element Set, which has recently been submitted to the Internet Engineering Task Force. Their model also incorporates the National Library of Medicine's Medical Subject Headings (MeSH) vocabulary and MEDLINE-type content descriptions.

RESULTS

The model defines a medical core metadata set that can be used to describe the metadata for a wide variety of Internet documents.

CONCLUSIONS

The authors propose that their medical core metadata set be used to assign metadata to medical documents to facilitate document retrieval by Internet search engines.

Standard Generalized Markup Language for self-defining structured reports

Structured reporting is the process of using standardized data elements and predetermined data-entry formats to record observations. The Standard Generalized Markup Language (SGML; International Standards Organization (ISO) 8879:1986)--an open, internationally accepted standard for document interchange was used to encode medical observations acquired in an Internet-based structured reporting system. The resulting report is self-documenting: it includes a definition of its allowable data fields and values encoded as a report-specific SGML document type definition (DTD). The data-entry forms, DTD, and report document instances are based on report specifications written in a simple, SGML-based language designed for that purpose. Reporting concepts can be linked with those of external vocabularies such as the Unified Medical Language System (UMLS) Metathesaurus. The use of open standards such as SGML is an important step in the creation of open, universally comprehensible structured reports.

DESCRITORES EM CIÊNCIAS DA SAÚDE NAS TESES E DISSERTAÇÕES DE MESTRADO, NA ÁREA DE DOENÇAS RESPIRATÓRIAS

O processo de indexação consiste em duas fases: primeira, identificar e representar o conteúdo intelectual de um documento; segunda, traduzir a análise do assunto para uma linguagem específica, utilizando descritores. Na biblioteca do Instituto de Doenças do Tórax da UFRJ, a indexação de periódicos biomédicos e teses era realizada por meio de um vocabulário controlado - DeCS (Descritores em Ciências da Saúde). O objetivo desta pesquisa era identificar se os autores das teses de Mestrado em doenças respiratórias estavam usando o DeCS para indexar. Os descritores de 29 teses de Mestrado de Tisiologia e Pneumologia, de 1990 a 1996, foram estudados. A coleta de dados evidenciou que 29 autores empregaram 101 descritores (3,48 descritores/autor). Quatro (14%) dos autores utilizaram adequadamente os descritores do DeCS. Em conclusão: catorze por cento dos autores de teses de Mestrado empregaram corretamente os descritores.

The basis for using the Internet to support the information needs of primary care

Synthesizing the state of the art from the published literature, this review assesses the basis for employing the Internet to support the information needs of primary care. The authors survey what has been published about the information needs of clinical practice, including primary care, and discuss currently available information resources potentially relevant to primary care. Potential methods of linking information needs with appropriate information resources are described in the context of previous classifications of clinical information needs. Also described is the role that existing terminology mapping systems, such as the National Library of Medicine's Unified Medical Language System, may play in representing and linking information needs to answers.

Research fundamentals: II. Choosing and defining a research question

This is the second in a series of articles developed by members of the SAEM Research Committee to describe a stepwise approach to the research process. This series is aimed at junior academic emergency physicians (EPs), as well as nonacademic EPs with an interest in the research process. This article describes the development of a testable research hypothesis. While a multitude of sources provide interesting questions for consideration, choosing and refining the research question, so that it can be tested adequately and answered completely, are difficult tasks.

A browser based image bank, useful tool or expensive toy?

DIBS, the Digital Image Banking System, is a web browser based environment for depositing and withdrawing generic medical images. These can be annotated or modified on an individual's computer for use in talks and lectures. DIBS is programmed in 'C', to query and update a database as well as producing web pages on the 'fly'. Images are deposited using an interactive form, minimizing data entry and are received in a digital format or are digitized on demand. Three interfaces allow DIBS to be searched; an image map of the human body presents a simple graphical interface, whilst more specific searches can be performed by selecting categories from predefined scrolling menus or using a full text search. When a DIBS search is performed, preview thumbnail images and descriptions are provided, linked to the full size images that can be saved locally along with the text description. DIBS offers fast and convenient access to a wide range of medical images, eliminating the time consuming process of producing one's own slides or borrowing from colleagues. It is proving to be a useful tool within our Medical School but some copyright, ethical and image security issues still need to be resolved.

Searching the medical literature

The widespread use of computers and the Internet have made searching the medical literature easier and more accessible to most physicians. The National Library of Medicine (NLM) maintains MEDLINE, a comprehensive, cross-referenced database of citations to the medical literature covering 1966 to the present. The NLM maintains several other literature databases that are also available online. In 1996, the NLM began providing free, unlimited access to MEDLINE to all Americans over the World Wide Web. This article discusses how to perform effective and efficient literature searches using MEDLINE and other databases.

In search of a dose-response relationship with radiotherapy in the management of recurrent rectal carcinoma in the pelvis: a systematic review

PURPOSE

A systematic review of the literature was undertaken to address the question: "What is the most effective dose fractionation schedule for the relief of symptoms in patients with pelvic recurrence from rectal or colorectal carcinoma?"

METHODS AND MATERIALS

Cancerlit/Medline-computerized databases were searched between the years 1966-1996. Studies that explored the response to radiotherapy in patients with pelvic recurrence from rectal/rectosigmoid carcinoma were included. Factors that may contribute to differences in results were postulated in advance and the variations encountered between articles were presented. Articles with data applicable to recurrent disease only were included in the primary analysis. The effect of including articles that reported outcomes of recurrences with unresectable primaries and residual disease was presented as a sensitivity analysis.

RESULTS

Only retrospective series (level V evidence) were available. The many sources of potential bias inherent in retrospective analyses make the data suitable for hypothesis generation only. Comparison of response was made between "lower" vs. "higher" doses, using 45-50 Gy as the dividing dose, base on the primary analysis. There were no significant differences observable in terms of initial response and the proportion maintaining a response at 6 months, within the range of doses employed. When data from articles that reported outcomes of recurrent disease with primary untreated cancers and postoperative residual disease were included, there was a suggestion for a more favorable response with higher doses. This requires cautious interpretation within the methodological limitations of the data.

CONCLUSION

The optimal dose fractionation schedule for the palliation of pelvic recurrence from rectal carcinoma remains undefined. Well-designed randomized studies, with study arms that are sufficiently diverse biologically to allow the detection of a dose-response relationship if one existed, equipped with suitable symptom control end points, are necessary to provide a clinically relevant answer.

An evidence-based medicine approach to the diagnosis and management of musculoskeletal complaints

Evidence-based medicine is an approach to clinical practice and teaching that emphasizes decision-making based on rigorous analysis of clinical research tailored to the individual characteristics of a specific patient. As such, it can be considered the scientifically grounded art of medicine. Through evidence-based guidelines, pathways, and algorithms, the care of populations of patients may also be facilitated by informing individual practitioners of optimal decision-making in specific situations or providing the foundation for comprehensive "disease management" programs. These programs coordinate care for patients with chronic conditions, such as rheumatoid arthritis and osteoarthritis, across time and multiple disciplines. We present an approach to the development of decision-making aids, including guidelines and algorithms, which should be helpful in the care of individual patients and populations for whom physicians and other healthcare practitioners are responsible.

Developing indicators for the Medicare Quality Indicator System (MQIS): challenges and lessons learned

BACKGROUND

The Medicare Quality Indicator System (MQIS), initiated in 1993, was intended to form the basis for the Health Care Financing Administration's (HCFA's; Washington, DC) hospital-based quality measurement system. The MEDSTAT Group (Washington, DC) established quality indicator development methods for five clinical conditions, including early-stage breast cancer, diabetes mellitus, and upper gastrointestinal and lower intestinal bleeding.

DEVELOPMENT OF QUALITY INDICATORS

Five national expert panels were convened to identify scientifically based hospital processes of care related to positive patient outcomes, as described in research studies and/or broadly accepted by the medical and allied health professions as indicators of high-quality care.

LESSONS AND CHALLENGES

One of the most important lessons learned was the need for a narrow clinical focus for each quality indicator module. If the focus was adequately narrowed, all other tasks could be accomplished more efficiently and less ambiguously. Also, selection of the expert panel chair should occur early because of the chair's pivotal contributions to the clinical focus selection, literature review, and development of draft quality indicators. Perhaps the most starting finding and biggest challenge was the paucity of scientifically sound literature to support the clinical topics; except for the breast cancer studies, most of the available literature was categorized as flawed to some degree. A critical challenge for development of quality indicators is to translate what has been learned from the best scientific efficacy studies into indicators of effective rather than efficacious care.

CONCLUSIONS

In choosing quality indicators, disease incidence and potential for quality improvement are important parameters. Although the former is relatively easy to define, the latter is not.

Optimal search strategy for clinical trials in the Latin American and Caribbean Health Science Literature Database (LILACS)

OBJECTIVE

To define and disseminate the optimal search strategy for clinical trials in the Latin American and Caribbean Health Science Literature (LILACS). This strategy was elaborated based on the optimal search strategy for MEDLINE recommended by Cochrane Collaboration for the identification of clinical trials in electronic databases.

DESIGN

Technical information.

SETTING

Clinical Trials and Meta-Analysis Unit, Federal University of São Paulo, in conjunction with the Brazilian Cochrane Center, São Paulo, Brazil. (http://www.epm.br/cochrane).

DATA

LILACS/CD-ROM (Latin American and Caribbean Health Science Information Database), 27th edition, January 1997, edited by BIREME (Latin American and Caribbean Health Science Information Center). LILACS Indexes 670 journals in the region, with abstracts in English, Portuguese or Spanish; only 41 overlap in the MEDLINE-EMBASE. Of the 168,902 citations since 1982, 104,016 are in human trials, and 38,261 citations are potentiality clinical trials. Search strategy was elaborated combining headings with text word in three languages, adapting the interface of the LILACS. We will be working by locating clinical trials in LILACS for Cochrane Controlled Trials Database. This effort is being coordinated by the Brazilian Cochrane Center.

Emergency medicine journal clubs

OBJECTIVE

To ascertain the status of journal club within emergency medicine (EM) residency programs and to describe 3 currently used formats.

METHODS

The directors of U.S. Residency Review Committee for Emergency Medicine (RRC-EM)-approved residency programs were surveyed to determine the features of their programs' journal clubs. Responses to 3 questions assessing the degree of satisfaction (5-item scales from very good to very poor) with the "current format," "resident participation," and "faculty participation" from the survey were grouped according to the program director's impressions of resident and faculty "enjoyment" (2 3-item scales) and whether the journal club is a "success" (3-item scale) to develop an overall satisfaction index. Three journal club formats currently in use at EM residencies are described in detail.

RESULTS

Of the 101 directors surveyed, 91 (90%) responded. The respondents' overall satisfaction index was highest when the journal club was held in the evening (p < 0.008) or at a faculty member's home (p < 0.0004). The format of the journal club (e.g., by topic, with a statistical focus, with a research design, focus, or as a clinical practice update) was not associated with the overall satisfaction index.

CONCLUSION

Journal clubs associated with EM residencies vary in format and perceived success. The 3 representative journal clubs illustrate different format options.

Developing a database of published reports of randomised clinical trials in pain research

A database of randomised clinical trials (RCTs) in pain research published from 1950 to 1990 was created following an extensive literature search. By applying a refined MEDLINE search strategy from 1966 to 1990 and by hand-searching more than 1,000,000 pages of a total of 40 biomedical journals published during the period 1950-1990, more than 8000 RCTs were identified. The RCTs were published in more than 800 journals and over 85% appeared between 1976 and 1990. If the trend of the last 15 years persists, a total of more than 15 000 RCTs will be published in pain relief by the year 2000. A detailed description of methods to ensure efficient use of resources during the identification, retrieval and management of the information in pain relief and other fields is given. Emphasis is made on the importance of refining MEDLINE search strategies, on the use of volunteers to hand-search journals and on careful monitoring of each of the steps of the process. The potential uses of the database to guide clinical and research decisions are discussed.

How to systematically review the medical literature

In contrast to traditional narrative reviews, systematic reviews are true hypothesis-driven research. Meta-analysis is a form of systematic review in which studies are selected and combined by use of a predefined protocol to reduce bias and subjectivity. A sensitivity analysis shows how results vary through the use of different assumptions, tests, and criteria. The most valid synthesis of information occurs when published and unpublished materials are subjected to the same rigorous evaluation and when results are calculated with and without unpublished sources of data. A good systematic review captures the reader's attention through a skillful blend of numbers and narrative and qualifies for publication as original research in a peer-reviewed journal. Otolaryngologists have published systematic reviews of varying quality since 1990. This article should help improve the quality and validity of future efforts.

Can reliable Down's syndrome detection rates be determined from prenatal screening intervention trials?

OBJECTIVES - To develop a standardised approach for analysing Down's syndrome screening performance in clinical practice and to apply it to published intervention trials in order to estimate detection and false positive rates more accurately. METHODS - Peer reviewed intervention trials, grouped by specific combination of analytes, were reanalysed. Revised detection rates were calculated for each study, taking into account both the high spontaneous loss during the last half of pregnancy and the possible under ascertainment of Down's syndrome live births not detected by screening. Collective screening performance was estimated, when possible, using a published methodology based on fitting receiver-operator characteristic curves. RESULTS - Sixteen trials were analysed; 11 using three, and five using two, analytes. Collective screening performance for the triple analyte trials was Down's syndrome detection rates of 57, 64, and 69% at amniocentesis referral rates of 3, 5, and 7% respectively. Four of the five studies involving two analytes performed less well, individually, when compared with the overall performance of the three analyte studies. It was not possible to estimate collective performance for the two analyte studies because there were too few. CONCLUSIONS - Accurate Down's syndrome detection rates are difficult to obtain in intervention trials owing to two potential biases, both of which tend to produce overestimates of the true rates. These sources of bias need to be taken into account when analysing and reporting Down's syndrome intervention trials. The methodology presented here offers the opportunity to achieve a more reliable, standardised estimate of both individual and collective intervention trial screening performance.