The Search Principle blog

As part of the UBC Anesthesia’s Biennial Evidence Based Research Days, I was asked by Dr. Peter Choi, UBC Clinical Research Director, Assistant Professor of Anesthesia, to speak to his residents about finding the literature in anesthesia. How to search effectively, easily for most clinical questions. Overall, I think this group of residents enjoyed the debate around the primacy of keywords in Web 2.0, Google and Google scholar, and had no difficulties understanding the limitations of keywords – and the importance of MeSH searching.

As such, I presented the first two steps of the five-step EBM model, and focussed on framing a question and finding information to answer it. My somewhat subversive hypothesis was a hit: my sense is that 85-90% of all clinical questions in anesthesia can be adequately answered using carefully selected keywords, and DO NOT require MeSH searching. Where higher recall (exhaustive searches) is necessary (about 10-15% of all anesthesia research questions involving clinical trials, grants, rounds, systematic reviews and meta-analyses) structured MeSH searching is essential.

The residents agreed with me that most anesthesia questions do not require total recall as keywords are sufficient for browsing the literature in PubMed, Cochrane, Google Scholar, MSN Search and even this surprise GahooYoogle. We reviewed OVID MEDLINE, answered some PICOs, extracted search terms, mapped MeSH, exploded/ focussed, yadda yadda. We retrieved Googling your treatment for analgesia in labour from the April 1st, BMJ. Yowza.

This session was not so much about enforcing expert searching techniques on busy clinicians as it was about validating good, basic search habits. My evaluation of this group? As busy residents, they knew how to search MEDLINE, and understood retrieval issues of precision/ recall and how they affect retrieval of the best evidence, and ultimately impact clinical excellence. Did they become expert searchers? No. That wasn’t the goal.

The session was successful as it helped me to promote what I call IRT (information retrieval therapy) for anesthetists. Dean, is it OK to use Google scholar? Yes – let the search healing begin. Do anesthetists need periodic tune-ups on searching – another, emphatic yes. Next time, I’ll expect some food though. More about the actual searches we did in a few days.

Who would have known that blogging would open up so many new opportunities?

Call it making connections where none existed before – thanks apophenia. However, last week, I had to ask fellow search librarians Gary Price and Rita Vine for advice (and my savvy SLAIS students, librarian friend Eugene Barsky, super-librarian colleague Judy Inglis in Winnipeg, and Maureen from AACI) regarding this e-mail (spam?):

Dear Dean,

We would like to invite you to be our guest for an upcoming technology
briefing we are hosting to discuss and share with select individuals
Microsoft’s work in Search as it pertains to academia and research. This
invitation is being extended to a small group of individuals who
demonstrate foresight and thought leadership in the area of academic
research and pedagogy. Our goal is to engage and share with you the work
we are developing (and soon to be releasing) as well as understand your
perspectives and requirements for the technology we are developing as
part of an on-going dialog. This is the first in a series of on-going
engagements being hosted by the Windows Live Search product development
team at Microsoft.

As it turns out, I’ve got the day off, and I’m going to Microsoft’s Redmond campus this Friday April 7th. Should I be excited? I am, but I also want you all to know that I was worried about a conflict of interest (or, an appearance of one).

Be sure to watch me blog this next week in gory, agonizing – apophenic detail!

Do you use search engines responsibly?

Health care researchers and clinicians need to locate reliable, trustworthy information easily, and this is a constant challenge.

Search engines like Google and Google Scholar provide an easy means to access lots of useful medical content on the Web – but don’t be fooled. The strength of free search engines like Google, Yahoo and MSN Search are for general browsing, starting your research, and finding specific authors/ books/ articles.

Read more from the Vancouver Hospital’s newsletter, or contact your local health librarian for details about how these search engines can be used responsibly, or how to do more structured, methodical searching using MeSH, for example.

Today, I spoke to Master of Health Administration students at UBC Robson Square about searching medical databases, and retrieving the best evidence from PubMed. Beforehand, I perused this issue Evidence based management of the Harvard Business Review, reviewed Jan Wallace’s Health Administration guide, and this article. (By the way, Harvard authors Pfeffer and Sutton have just released this new book on evidence based management.)

Increasingly, the underlying principles of evidence-based practice (EBP) are being used by health administrators. Health managers (and government policymakers) are expected to adopt the five steps of EBP: question formulation; retrieval of evidence; assessing/ applying evidence; final analyses. Ironically, even though health managers expect clinicians to apply best evidence, the Harvard Business Review article suggests that they are slow to apply it themselves.

The barriers to EBP in health management are similar to those in clinical practice: lack of skills/ time; access and retrieval issues/problems; minimal control and policy intransigence. It must be said, however, that important differences exist between the cultures of medicine and management, particularly with respect to the latter’s research practices, evidence-base, and decision-making processes.

In the final assessment, appraising the evidence is only one issue of consideration for managers. The most experienced and effective health managers should nonetheless know about the EBP movement; my suggestion is to learn how to retrieve the evidence to ensure that you can assess and apply it when required.

A horse never runs as fast as when he has other horses to catch. – OVID (Roman Poet) 43 B.C.

OVID has a well-earned reputation as a thoroughbred among search interfaces. Since 1995 at least, the National Library of Medicine in the United States has provided free access to PubMed, making it possible for medical searchers anywhere on the planet to browse journal abstracts of current research.

However, for those needing an easily navigable tool and full-text linking, not to mention structured systematic search functionality, OVID’s interface has been indispensible, for many years. But times are different, more open, less dependent on structured environments; could OVID be on the wane?

Circa 2006, open access is on the rise; full-text content trumps navigability. True, OVID will still be needed in medicine for some time; its new generation interface is still an important gold standard. But, as of April 1st, UBC Library has decided to abandon OVID for EBSCO – for our nursing and psychology databases, CINAHL & PsycINFO. This will be a shock to some end-users, but medical search has been destablized by Google scholar and open access journals. Why should libraries pay big bucks for any tool when cheaper (or free) alternatives are on offer?

Goodbye to CINAHL on OVID. As open access in medicine deepens, expect to see other commercial search tools get cheaper or move to open search models.

It is inevitable.

Health librarians take note: Google is considering a health portal similar to what I described here. Adam Bosworth has been appointed chief architect for a Google spinoff known only as Google Health. But be aware – according to sources, we are entering a whole new search era, and this is just the start of the vortal craze.

Last week, Google Health was discussed with nary a ripple in library circles; but bloggers speculated about its significance. What does this mean for medical search? For one, knowledge of vertical search will be critical, especially for patients; ie. Kosmix, Healthline, WebMD. Freeing up peer-reviewed abstracts beyond PubMed and making more of it searchable is a trend to watch.

In the absence of proper indexing in vortals, how will searchers improve relevancy and precision/ recall of results? Serious searchers were taken aback last week when it was announced that MEDLINE’s qualifiers/ subheadings would be reduced from 83 to 42. So much for expert searching. Will EBM filters need revising, as a result?

Finally, rumour has it that Microsoft is working on an academic search tool to compete with Google Scholar. Stay tuned – this will be very interesting.

(Thanks to Jon Brassey of TRIP for alerting me, and Search Engine Watch).

According to an article in Saturday’s Globe and Mail – “Prescription for Canada: an unfettered medical journal” – the cure for what is ailing the Can Med Assoc Journal is twofold: first, a move to a fully independent, not-for-profit journal for medical research; second, an open access (OA) model similiar to the Public Library of Science (PLoS).

UBC’s John Willinsky, who resigned last week from the CMAJ Board, is quoted in the article as saying: “.. the events at the CMAJ suggest an alternative scientific publication may be needed in Canada”. Willinsky adds that “The advantage of this [OA] model is that it can be started quickly and at low cost. We don’t want to rush into this, but we could definitely do it.”

The backlash against the CMAJ seems to fit into a global trend described by Thomas Friedman as “flattening” in The World Is Flat: A Brief History of the Twenty-first Century. Simply put, the digital revolution makes it possible for researchers to collaborate easily, and for decisions to be made less hierarchically – more “flattened”. Globalization 3.0, as he calls it, is driven by technology, new economic models and individual innovation. (By the way, Globalization 1.0? The discovery of North America in 1492!)

Whatever model is adopted, CMA’s Board needs to restore editorial freedom and move the journal toward more transparency. They got the open access part right, but need to recognize the importance of freedom and transparency in a world that is increasingly going global – and flat.

I am in Calgary, Alberta watching the 2006 World Figure Skating Championships. Though regarded as equal parts sport and art, skating can be viewed from a scientific perspective as well; for example, how do the laws of physics apply to rotation, axis and velocity? See this study in the Canadian Journal of Applied Physiology or read about Alexander Mishin’s work in biomechanics.

Put simply, sports biomechanics is the science of optimizing sport technique. Through video footage analysis, coaches will often compare and contrast an athlete’s technique (or form) with others. In figure skating, the ongoing goal is to improve or correct an athlete’s technique, and prevent injuries as a result of faulty foot and/ or body alignment. As such, biomechanics is linked to anthropometry and evidence-based sports medicine.

For more information, see this keyword search in PubMed, or plain, old Google; for more peer-reviewed research, try: Google Scholar as well as Scirus. For a systematic view of this topic, try the UBC Library’s Human Kinetics Guide.

Mozart‘s music – it’s been said – is medicine for the heart and mind. In fact, music has many applications in medicine and in neuro-development (see the Mozart effect in MEDLINE and Google Scholar.)

Music can be used in many clinical settings: the operating room, palliative care and for relaxation as patients move through the health system – it should be used more.

Music therapists study the effect of music in therapeutic situations (in MEDLINE, see the MeSH “music therapy“). To give you an idea of the scope of music’s effects in medicine, see this recent British Medical Journal study, an RCT, on didgeridoo playing.

And, finally, don’t forget that 2006 is Mozart’s 250th anniversary. If you want to hear more, listen to the many open access NPR programs on Mozart. – Dean

Think of mashups as making connections where none existed before. Content created anew, using disparate data from RSS feeds, public databases, or open data sources. In searching, ‘mash-ups’ (see wikipedia) are websites that pull content from disparate sources onto a single page. Here’s a simple example: helicobacter pylori, which can cause infection.

Mashup is a Web 2.0 phenomenon, a result of blogs, wikis, Google scholar, PubMed, even open access journals in remix. Mashups are similar to aggregators (and multi-file search tools) – they save time, bring content together in one place, and make it searchable. Portals – remember Google Medicine – put content in one place and make it searchable, whereas mashups aggregate it “on the fly”.

Sorry about the over-crowding of search concepts! Here are a few examples of medical mash. Mashup is a search trend to watch.