How to navigate the Net for clinical information
Lost in cyberspace? Try these tips to quickly find exactly what you are looking for on the Internet
From the October 1997 ACP Observer, copyright © 1997 by the American College of Physicians.
By Christine Kuehn Kelly
As any physician who has ventured online knows, using the World Wide Web for clinical research can be a real boon—or a real boondoggle. You want to keep up with the latest developments in medicine and possibly talk to your peers, but without getting lost in cyberspace.
The good news is that the quality of content on the Web has improved dramatically within the last few years. The Internet can quickly put you in touch with current journal articles, government studies and clinical guidelines, as well as forums for online discussion with your peers. "In areas such as HIV, the Internet has gone from being one way to find an answer to sometimes being the best way," said R. Hal Baker, ACP Member, medical consultant for ACP Online, the College's Web site.
Perhaps best of all, there are a number of new services and Web sites designed to help physicians find what they're looking for. Here are some tips on how to efficiently and effectively navigate the Net:
Go to sites made for physicians. Sites created for physicians and other health care professionals can help you cut through the digital clutter. Some of these services are free—some generate revenue through advertising—while others charge monthly access fees, but all try to provide quick access to medical information and communication forums known as newsgroups and listservs.
For example, one of these sites, Medical Matrix (www.medmatrix.org/), lists Web sites you can use while seeing patients. Like the best physician-specific sites, Medical Matrix lists only Web sites that it has already reviewed, so you don't have to waste your time checking out useless sites.
Physicians may want to look for medical sites that allow them to talk with colleagues—privately. "Communications with peers shouldn't be open to the public," explained Gary Malet, DO, a family physician in Stockton, Calif., who helped develop the Medical Matrix site. "Public newsgroups tend to be overwhelmed by consumer questions, disrupting communication."
Journal Club on the Web (www.journalclub.org/), a forum created by New York internist Michael Jacobson, FACP, summarizes articles from medical journals and appends reader comments. Recent discussions, also known as "threads," have involved subjects like "overanticoagulation and oral vitamin K" and "specificity of ANCA for vasculitis."
Explore listservs and newsgroups. Sites designed for physicians offer the privacy of physician-only membership, but there are ways to share information on the Internet with a much broader audience.
Listservs, also known as list servers, are a kind of e-mail distribution system. You "subscribe" to lists by sending an e-mail message to that list's server; all e-mails that are sent to that list are then sent to everyone subscribing to the list. (A list of some of the more than 300 medical listservs and how to subscribe to them is at the University of Wisconsin-Madison School of Medicine and Nursing's site: maddog.fammed.wisc.edu/hmid/hmid9_1_95. html#tt1a.)
The Usenet newsgroup system is another collection of digital forums. It includes about 20,000 electronic bulletin boards, many of which focus on specific diseases. To find listings of newsgroups, check out search options on your search engine and choose "search Usenet groups." AltaVista, Excite, HotBot and InfoSeek make this available.
But be sure to view listserv and newsgroup contents cautiously. Look for services that are moderated, or have their contents reviewed before being posted. To search newsgroups by topic, try DejaNews (www.dejanews.com/) or InReference (www.reference.com/).
Use search engines. Internet search engines allow you to type in a keyword (migraines, for example) and search the Internet for related information. Search engines are free to use, and each has its own way of searching the Internet.
AltaVista is one of the more popular search engines, but there are many to choose from. In addition, a new generation of monster search engines known as meta-search engines is being developed that allows users to conduct more than one search simultaneously. The MedBot search engine (www.med.stanford.edu/medworld/medbot/), for example, lets you use up to four searching tools that simultaneously display results on your screen.
Narrow your search. The main problem with Internet search engines is that you can easily get hundreds—or even thousands—of results. To narrow your search criteria, most search engines provide options to help you refine your search parameters.
Experts suggest finding a search engine that you like and becoming comfortable with its advanced search features. For example, the Excite search engine allows users to specify that search results "must contain," "must not contain" or "may contain" the keywords you provide.
To help limit your search, try the following search rules. Keep in mind, however, that these rules may differ slightly among different search engines.
- Boolean. This type of query forces search engines to return results that meet the criteria of AND, OR, NOT. For example, if you were looking for information on your 60-year-old patient's myasthenia gravis, you would type: "myasthenia AND gravis NOT neonatal" to limit your search.
- Quotation marks. Putting a phrase in quotations (for example, "myasthenia gravis edrophonium test") will usually keep all the words together during a search:
- Subject index. If the search engine gives you the option of using an index of subjects, use it to pick a more accurate search term.
- Locate. When searching for a specific phrase on an individual Web page, type the "ctrl" and "F" keys (for Macintosh users, type "command" and "F") to bring up a search engine for that page only.
Organize your bookmarks.When you see a Web page you like, you can bookmark its Internet address in your browser for future use. To create a bookmark in Netscape Navigator, go to the Bookmark menu and click on Add. In Internet Explorer, pull down the Favorites menu and click on Add to Favorites. (These instructions may vary for older versions of these browsers.)
After a few sessions of browsing, you'll probably have enough bookmarks to start a small library. To keep your bookmarks in order in Netscape Navigator, go to Window, select Bookmarks, go to Item, and select Insert Folder. You can then put all your similar bookmarks into one folder. To do the same thing in Internet Explorer, go to Favorites, select Organize Favorites and click on the Folder button.
Christine Kuehn Kelly is a Philadelphia-based freelance writer specializing in health care.
Five top sites for physicians on the Web
Top-notch physician-specific sites offer a wealth of clinical information-and privacy from patients looking for medical advice. Here is a short list of some highly-rated sites for physicians:
- ACP Online (www.acponline.org) includes articles from Annals of Internal Medicine and ACP Observer, an archive of ACP Journal Club, clinical extracts from Annals, a software directory, newsgroups for online discussions, Medline access and a review of Web sites.
- MD Consult (www.mdconsult.com) offers medical reference books including internal medicine textbooks, 350 clinical practice guidelines, drug information through Physicians GenRx, CME on the Web and discussion groups and forums.
- Medscape (www.medscape.com) is the Web's largest collection of freely available full-text peer-reviewed health articles. It includes access to the databases from the National Library of Medicine like Medline.
- Medsite Navigator (www.medsitenavigator.com) not only lists cutting-edge science and medicine Web sites but also includes a searchable drug database, online journals and practice guidelines.
- Physicians Online (www.po.com) doubles as a Web site and Internet service provider for physicians. It provides physicians with five free hours of Internet access per month under the basic plan, an e-mail address and the ability to communicate with other physicians.
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