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AAP News Vol. 18 No. 4
April 2001, p. 159
Lost on the Web? Try these tips for focusing your searchesS. Andrew Spooner, M.D., FAAP
Investigate a portal Publishers of books and journals know that reference information offered via a Web site can be more convenient than the print form. To this end, almost all print material in medicine is offered in some way via the Internet. For most clinical questions, it might be more efficient simply to use an online collection of textbooks than a wide-open search of the whole Internet. These "portals" to information cost some money, but not as much as the textbooks, journals and other published materials would cost if purchased in hard copy. MD Consult was the first portal of this sort, and it remains a good one for pediatrics. Located at www.mdconsult.com, it contains pediatric textbooks (e.g., Nelson’s and the AAP Red Book), pediatric journals in full text, drug information, and pediatric patient handouts among other things. What’s even better is that you can search all of these sources simultaneously, so that a piece of information located only in a textbook or only in the GenRx drug information database will come out in your search. This saves you time, since you will not have to search multiple sources of information. Medscape (www.medscape.com) and WebMD (www.webmd.com) also offer collections of reference material. For example, WebMD offers the textbook Scientific American Medicine. While this is not a pediatric text, it does have broad coverage. Another advantage of all these portals is that they offer Web-based continuing medical education credits, generally at no extra charge. A portal with pediatric content may be the only thing you need on the Internet! MEDLINE methods The National Library of Medicine (NLM) offers free access to its databases at www.nlm.nih.gov. A version of the MEDLINE database that is worth spending some time with is PubMed. PubMed offers a simplified search interface that allows searching by age group, as all MEDLINE interfaces do. It also offers a feature that allows you to find similar articles once you find an article you like. By repeatedly using these "find similar" features, you can quickly narrow your search to just a few relevant articles. The NLM also offers a service called MEDLINE Plus (www.medlineplus.gov) that puts a consumer information "wrapper" on the MEDLINE database. At this Web site, users see a collection of links to information on the Internet, organized by disease state. MEDLINE Plus also includes a section on child health, with such topics as autism, circumcision and whooping cough. It is a good site to refer patients to, since the links to online sources of information are carefully screened for quality. Consider pediatric Web indexes Several individuals and organizations devote time to categorizing the pediatric content of the Internet for you. Spending a few minutes familiarizing yourself with each of these resources will save time when you need some information in a hurry, especially if your portal does not come through for you. Perhaps the most versatile of the pediatric indexes is the Harriet Lane WWW Links, hosted at http://ww2.med.jhu.edu/peds/neonatology/poi.html, and managed by Christoph Lehmann, M.D., FAAP, of the AAP Section on Computers and Other Technologies. This site allows one to search its own database of more than 5,000 links to pediatric information on the Internet, plus it simultaneously searches select other data sources for you, namely NLM’s PubMed, the Merck Manual, a clinical trials database, Online Mendelian Inheritance in Man, Pediatrics and the AAP Web site. For example, a recent search on the string "nephrotic syndrome therapy" returned 16 hits from the site’s database of Web pages (with brief descriptions), and one click allowed access to a relevant chapter of the Merck Manual. Another click pulled up articles from Pediatrics on the latest research into this clinical entity. Because of the size of the Harriet Lane WWW Links database, you may find that your searches pick up a lot of "noise" (Web pages that are not especially relevant, but which may mention the words in your search). There are more focused pediatric indexes that may allow you to focus in on more relevant sites faster. Two such sites are GeneralPediatrics. com (www.generalpediatrics.com) and PEDINFO (www.pedinfo.org). These sites have a much smaller database, but the authors of these sites focus more on placing the site links into a carefully constructed hierarchy, rather than on offering a flexible database search. You should visit each of these to see which fits your personal style of accessing information. Conventional search engine Sometimes even the peds-specific sites fail, and you need to search the whole Internet to find what you want. This is particularly true if you are looking to link two concepts for which no one dedicated Web site exists. For example, if you have a patient who has heard of a novel alternative therapy for a certain condition, and none of your online textbooks (including the alternative therapy textbook from MDConsult) have any information, you might want to submit these terms to a search engine to see if anyone anywhere has connected the two. (Of course, once you find it, you will have to judge its validity, but at least you might get a chance to see what your patients are reading and be able to give them more focused advice.) There are many search engines out there. One that has received a lot of attention lately is Google (www.google.com). Google uses a proprietary algorithm to rank sites according to how many other sites point to it. Using this algorithm, the sites that rise to the top of the search results tend to be a bit more reliable and relevant. Other search sites include Alta Vista (www.av.com), HotBot (hotbot.lycos.com/) and Yahoo ( www.yahoo.com, which uses the Google search engine). The nicest feature of Yahoo in searching for medical information is that it segregates the search results by Yahoo categories, Web sites and Web pages. Depending on what you are looking for, you can turn to one of these three pages to start reviewing links. For example, if you are looking for a relatively obscure bit of information, looking at listings of Web pages will be more fruitful than looking at Web sites; the information you are looking for might be buried so deep in the Web site that you may never find it. Likewise, when you are searching for an ill-defined concept, looking at a list of Yahoo categories may take you to large sections of the Yahoo index that you might not have guessed contained sites of interest. Each search engine site has its own rules for forming queries. While most of the search engines work well if you simply type in a phrase that described the concept you are looking for, sometimes it is profitable to take a minute to learn how to construct logical queries. It only takes a minute, and your searches will be more powerful as a result. For example, at Alta Vista, if you wanted to find sites dealing with pediatric nephrology, you might submit the query "nephrology AND (pediatric or paediatric)" in order to include sites with the British spelling variation. The same query on another search engine may have a slightly different syntax. Pick a search engine that seems to fit your style, learn a little about its query syntax, and you’ll find everything on the Internet. Meta-search If you can’t pick one search engine you like, a meta-search may be the answer for you. A meta-search is simply a simultaneous search of multiple search engines. At www.dogpile.com, you can try this out to see if it works better for you. This technique is particularly useful once all the above possibilities are exhausted and you want to convince yourself that the information really does not exist on the Internet. Quality of information If you use a pre-screened collection of links like MEDLINE Plus, you can be more certain that the information you get is from a reliable source. But what if you (or, more importantly, your patients) find information on the Internet that seems to apply to a clinical situation, but whose quality is unknown? How do you counsel your patients about how to estimate quality of information they obtain? There is no reliable test, but patients should consider three factors in judging the quality of health care information on the Internet: authorship, disclosure and accountability. Three questions to ask when presented with Internet information are: (1) Who is the author of this information, and does this person or group have credentials appropriate to the type of information that is presented? (2) Is it clear whether the author has relationships (e.g., to a manufacturer) that would tend to affect the presentation of information? (3) Are references given to primary literature or other data that would allow cross-checking of facts? These questions will not allow one to avoid all Internet quackery, but it should get patients thinking about a critical view of Internet information.
Dr. Spooner chairs the AAP Section on Computers and Other Technologies and is a member of the AAP Task Force on Medical Informatics. For more information, e-mail him at aspooner{at}aapscot.org.
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