Cynthia J. Walker

Online Access to MEDLINE in Clinical Settings: A Study of Use and Usefulness

STUDY OBJECTIVE We introduced self-service access to the medical literature database, MEDLINE, into clinical settings to assess the frequency, patterns, purposes, and success of use. DESIGN Longitudinal descriptive study. SETTING Inpatient and outpatient services of a university medical center. PARTICIPANTS All trainees and attending staff working at the service sites were invited to participate; 158 (84%) did so. INTERVENTIONS Free online access was provided to MEDLINE through GRATEFUL MED software. Participants were offered a 2-hour introduction to online searching and 2 hours of free search time. MEASUREMENTS AND MAIN RESULTS For each search, a computer program requested identification of the user and the question to be addressed. Search transactions were recorded automatically. Interviews were conducted after a random sample of searches, and search questions were given to more expert searchers to run for comparison with the original. Eighty-one percent of participants did searches on study computers, at a mean rate of 2.7 searches per month. On comparison searches, participants retrieved 55% of the number of relevant articles retrieved by reference librarians (P = 0.024) and 50% more irrelevant articles (P less than 0.001). Forty-seven percent of searches on patient problems affected clinical decisions, but often on scanty information. CONCLUSIONS MEDLINE searching from clinical settings is feasible with brief training and affects clinical decisions. However, inexperienced searchers miss many relevant citations and search inefficiently. Further studies are needed to assess the impact of searching on physician performance and patient care.

How to Keep Up with the Medical Literature: III. Expanding the Number of Journals You Read Regularly

Clinicians can derive immense satisfaction from keeping abreast of new developments in patient care by regularly scanning the medical journal literature. Combined with good reading habits and self-discipline, this scanning generally can be accomplished within the time that most practitioners allot to attempting to keep up to date. We describe tactics for formulating a personalized journal-reading list and ensuring access to the key articles in ones field at a reasonable cost. These tactics begin with deleting low-yield journals from regular reading and adding journals more relevant to ones interests. The cost of multiple journal subscriptions can be reduced by circulating different journals among colleagues or by regular visits to the library. These tactics can be supplemented or replaced by using Current Contents or the Selective Dissemination of Information service of the National Library of Medicine and other database vendors.

How to Keep Up with the Medical Literature: VI. How to Store and Retrieve Articles Worth Keeping

The human mind is not well suited to storing and retrieving large amounts of infrequently used information. An effective personal filing system is needed if good articles that we encounter in our efforts to keep up to date are to be kept handy for future reference. Many options exist for the creation of a personal filing system. In this article, we assist the reader in the development of a tailor-made system that is based on making key decisions that strike a balance between filing needs and the lack of enthusiasm that most of us have for filing. The complexity of the system should match the number of purposes that your file must serve. Important additional considerations include how much time and effort you are willing to spend; where and how you will house your collection; how many articles you want to keep in the file; what standards you will apply in selecting material for your file; what subject headings are most appropriate for your articles; whether you will need to cross-reference; and what access you will have to personal computers.