Which literature retrieval method is most effective for GPs?

BACKGROUND: Evidence-based medicine requires new skills of physicians, including literature searching. OBJECTIVE: To determine which literature retrieving method is most effective for GPs: the printed Index Medicus; Medline through Grateful Med; or Medline on CD-ROM. METHODS: The design was a randomized comparative study. In a continuing medical education course, three groups of health care professionals (87 GPs and 16 other health care professionals) used one of the literature retrieval methods to retrieve citations on four search topics related to general practice. For the analysis in pairs, we used the search results of the 75 participants who completed all four assignments. As outcome measures, we used precision, recall and an overall search quality score; we also had a post-course questionnaire on personal characteristics, experience with computers, handling medical literature and satisfaction with course instruction and search results. RESULTS: The recall and overall search quality scores in the Index Medicus groups (n = 32) were higher (P = <0.001) than those in the CD-ROM groups (n = 31). In addition, the search quality scores in the Grateful Med groups (n = 12) were higher (P < 0.003) than those in the CD-ROM groups. There were no differences in precision. CONCLUSION: In the period 1994-1997, the printed Index Medicus was the most effective literature retrieval method for GPs. For inexperienced GPs, there is a need for training in electronic literature retrieval methods.

A model for the evaluation of search queries in medical bibliographic sources.

The aim of this study was to develop a model to evaluate the retrieval quality of search queries performed by Dutch general practitioners using the printed Index Medicus, MEDLINE on CD-ROM, and MEDLINE through GRATEFUL MED. Four search queries related to general practice were formulated for a continuing medical education course in literature searching. The selected potential relevant citations from the course instructor and the 103 course participants together served as the basic set for the three judges to evaluate for (a) relevance and (b) quality, with the latter based on journal ranking, research design and publication type. Relevant individual citations received a citation quality score from 1 (low) to 4 (high). The overall search quality was expressed in a formula, which included the individual citation quality score of the selected and missed relevant citations, and the number of selected non-relevant citations. The outcome measures were the number and quality of relevant citations and agreement between the judges. Out of 864 citations, 139 were assessed as relevant, of which 44 citations received an individual citation quality score of 1, 76 of 2, 19 of 3 and none of 4. The level of agreement between the judges was 68% for the relevant citations, and 88% for the non-relevant citations. We describe a model for the evaluation of search queries based not only on the relevance, but also on the quality of the citations retrieved. With adaptation, this model could be generalized to other professional users, and to other bibliographic sources.

Management of bibliographic information by Dutch researchers in general practice.

BACKGROUND: As a result of changes in information technology and the rapid growth of publications methods of searching the literature have changed. Systematic searching of the growing literature has become very important. It is not known whether researchers in general practice search systematically, and whether they have incorporated computerized sources in their research practice. OBJECTIVES AND METHODS: We aimed to assess the methods of literature research used by GPs. We interviewed eight GP researchers, two information specialists and a psychologist working in primary health care organizations. RESULTS: The GP researchers began their search in their private book collections, or asked colleagues for information. Later in the search process, they used computerized information sources. Medline on CD-ROM and the computer-based indexes of two Dutch journals were most widely used. The GPs found it difficult to locate the appropriate terms to describe their research questions. Knowledge of the methodology of literature research, and skills required to use the information sources efficiently were lacking. There was a need for instruction and training in the use of information sources. GPs need a telephone help desk where their questions can be answered adequately. CONCLUSIONS: GP researchers search the literature unsystematically. Although computerized databases were being used, knowledge and skills related to the use of these information sources must be improved.

[Pheochromocytoma as a cause of collapse and hypertension during a stay in the tropics]. / Feochromocytoom als oorzaak van collaps en hypertensie tijdens een tropenreis.

Two male patients aged 47 and 26 ears had long-standing, slowly progressive complaints of sudden headache, nausea, vomiting and faintness. Their symptoms grew much worse during an active holiday in the tropics. Phaeochromocytoma was diagnosed. After resection the complaints resolved. A slumbering phaeochromocytoma may become manifest due to increased vasodilation and exertion during a temporary stay in the tropics.

Use of information sources by family physicians: a literature survey.

Analysis of the use of information sources by family physicians is important for both practical and theoretical reasons. First, analysis of the ways in which family physicians handle information may point to opportunities for improvement. Second, such efforts may lead to improvements in the methodology of literature research in general. This article reports on a survey of the literature on information use by family physicians. Eleven relevant research publications could be found. The data showed that family physicians used colleagues most often as information sources, followed by journals and books. This outcome corresponded with results in other professions. Several factors influenced the use of information sources by family physicians, including the physical, functional, and intellectual accessibility of the source; the physician's age; participation by the physician in research or education; the social context of the physician; practice characteristics; and the stage of the information-gathering process. The publications studied suggested ways to improve information gathering in the areas of computerization, education, library organization, and journal articles.

Towards an oncological resection of gall bladder cancer.

The ongoing poor results of surgery for gall bladder cancer are at least partially due to an inadequate adjustment of the current resection modalities to the spreading characteristics of the tumour. No improvement can be expected as long as inadequate resections are performed. Thorough investigations concerning different ways of tumour spread of gall bladder cancer are available in the literature. Assessment of this data demonstrates that the area of potential loco-regional tumour spread consists of the gall bladder, the liver segments IV and V, the hepatico-choledochal duct and all the lymphatic tissue in the hepatoduodenal ligament. A survey of the literature on tumour spread and extended resections, combined with the clinical experience of four of our own patients, is presented. Only en-bloc resection of this complete area as a standard procedure for gall bladder cancer stages T1NOMO-T3N1 aMO can lead to better results.

Chondrosarcoma of the lobar bronchus with prolonged postoperative survival.

Primary chondrosarcoma originating from the bronchus is very rare. We describe the case of a 71 year old man with a large chondrosarcoma originating from the left lower lobe bronchus. The tumour was resected and, in contrast to most patients with such tumours, this patient is well, without complaints or abnormalities on X-ray or computed tomographic (CT) scan, 3 yrs after surgery. Tumour characteristics, symptoms, diagnosis and treatment are discussed. Radical surgical resection is the treatment of choice.

Research into the results of resection of hilar bile duct cancer.

We found mentions of 581 resections of hilar bile duct cancer in the literature to January 1989. Resection in 499 patients, reported or updated since 1980, resulted in an operative mortality of 12% and a 5-year survival rate of 13%. Resections confined to the hepatic duct confluence or extended to the quadrate lobe led to an 8% operative mortality and a 7% 5-year survival rate, although resections combined with major liver resection gave a 15% operative mortality and a 17% 5-year survival rate. Despite the best treatments available, present-day resection modalities are usually still not radical. Extension of resection in the retrohilar and hepatoduodenal direction might further improve the long-term surgical results.

A remarkable subhepatic tumour.

Although foreign-body pseudotumours are not particularly rare, the diagnosis is not often considered. The case history is presented of a patient with a surgical gauze left after a cholecystectomy performed 23 years before. The incidence of these pseudotumours and the variety of clinical pictures in relation to the condition are described.

Hemihepatectomy and replacement of the afferent hepatic blood supply in the dog. Resection of liver and hepatoduodenal ligament.

Hemihepatectomy along with portal vein or hepatic artery replacement in dogs was well tolerated, but combined with replacement of both vessels it was lethal because of outflow block and shock. Total liver blood flow should be kept as high as possible during such procedures in man.