Need a bloody nose be a nosebleed? or, lexical variants cause surprising results.
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Community Participation↗
Biomedical subjects
M E Sievert
Publications and source records attributed to M E Sievert.
In search of controlled evidence for health care quality improvement.
The purpose of this study was to measure the efficiency of simple searches in retrieving controlled evidence about specific primary health care quality improvement interventions and their effects. Searches were conducted to retrieve evidence on seven interventions and seven effect variables. Specific words and the closest Medical Subject Headings (MeSH) recommended by professional librarians were used to search the MEDLINE database. Searches were restricted to the MeSH publication type "randomized controlled trial." Two reviewers independently judged retrieved citations for relevancy to the selected interventions and effects. In selecting MeSH terms, the average agreement among librarians was 64.3% (+/-26.1) for interventions and 57.1% (+/-19.9) for effects. Analysis of the 755 retrieved reports showed that MeSH term searches had an overall recall rate of 58% while the same rate for textword searches was significantly lower (11%, p < .001). The difference in overall precision rates was nonsignificant (26% versus 33%, p = .15). In the group of MeSH searches, overall precision and recall was significantly lower for effects than for interventions (12% versus 52%, p < .001 and 41% versus 69%, p < .001). Two textwords appeared in more than 25% of the benchmark collection: reminder (25.7%) and cost (25.0%). The results of this study indicate that information needs for health care quality improvement cannot be met by simple literature searches. Certain MeSH terms and combinations of textwords yield moderately efficient recall and precision in literature searches for health care quality improvement. Clinicians and physician executives gaining direct access to bibliographic database could probably be better served by structured indexing of critical aspects of randomized controlled clinical trials: design, sample, interventions, and effects.
Abstracting and Indexing↗
An analysis of objective quality indicators on Year Book citations: implications for MEDLINE searchers.
PURPOSE: This study is an analysis of Mosby Year Book citations from Ovid Online's Comprehensive Core Medical Library (CCML). The purpose of this study was twofold: (1) to determine whether Year Book citations were more likely to be judged "key" than non-Year Book citations by clinicians; and (2) to determine whether the MEDLINE record of Year Book citations evaluated as key contained objective quality indicators that searchers might use to target key articles. BACKGROUND: As part of the MEDLINE/Full-Text Research Project, health care professionals evaluated search output from CCML on a five-point scale. The scale included the choice "key" for those items which the evaluator would not want to miss. Because the output contained items from the Year Book series, it was possible to determine whether the Year Book items were evaluated as key more frequently than expected. METHODS: This study analyzes the MEDLINE records corresponding to 110 references from the Mosby Year Book series evaluated as key by clinicians receiving search output from CCML. The records were examined for the presence of such searchable elements as Medical Subject Headings (MeSH) terms and publication types related to study design, evidence of research support, inclusion in the Abridged Index Medicus (AIM) subset, and a comments field. Also noted were the presence of a structured abstract, study design details in the author abstract, and inclusion in more than one Year Book. RESULTS: A chi-square test (p < .001 indicated that the proportion (33%) of Year Book citations marked key on the searches was significantly higher than that of non-Year Book citations (18%). When the occurrence of the searchable elements was compared to MEDLINE as a whole, the following access points appeared more frequently in the key Year Book records: study design terms categorized under epidemiologic methods in the MeSH Tree Structures; the checktag comparative study; AIM subset; comments field; and, publication types (pt) clinical trial, randomized controlled trial, multicenter study, and meta-analysis. CONCLUSIONS: These searchable elements should be helpful in targeting some, but not all, key articles in MEDLINE.
Chi-Square Distribution↗
Beyond relevance--characteristics of key papers for clinicians: an exploratory study in an academic setting.
OBJECTIVE: The purpose of this study was to determine what factors beyond relevance influence a clinician's decision to choose to read one journal article over another in satisfying an information need. DESIGN: Seventeen health care providers were interviewed and then surveyed regarding the characteristics of key articles (those they would not want to miss). On a Likert scale, the clinicians graded forty-two characteristics for importance in the decision process. Relevance was assumed and not at issue. SETTING: The study took place in an academic health science center. SUBJECTS: The subjects were seventeen clinicians, all with patient care responsibilities. There were four internists, four surgeons, three family practitioners, three pediatricians, two psychiatrists, and one clinical psychologist. RESULTS: Factors beyond relevance that most often influenced the decision process pertained to methodological rigor, authors and their institutional affiliations, document types, and population studied. CONCLUSIONS: Among the clinicians surveyed, factors beyond topicality influenced judgments as to what constitutes an important article. The emphasis respondents gave to certain attributes is echoed in other published work and highlights the need for more intensive investigation of these non-subject indicators as search parameters. Improved searching capabilities might well lead to a significant reduction in the clinician's information overload.
Attitude of Health Personnel↗
Comparing clinical vocabularies using coding system fidelity.
Much effort has been directed toward the development of an ideal multipurpose controlled medical vocabulary for use in human and veterinary medicine. SNOMED International is one effort that has resulted in a larger and more complex nomenclature system. Although it was able to code more concepts, SNOMED International failed to statistically improve vocabulary fidelity when compared with the 30+ year old SNVDO vocabulary. We found that SNOMED has a lower intercoder consistency than SNVDO and that a greater number of codes were necessary to represent an individual concept. Our study shows a significant Coder-Vocabulary interaction which suggests that more emphasis should be placed on coding guidelines and coder training. Clinician data entry and coding may be necessary for maximum vocabulary fidelity.
Abstracting and Indexing↗
The Missouri Medical Informatics Thesaurus.
The Missouri Medical Informatics Thesaurus, containing approximately 2,000 sorted terms, arranged within a hierarchical structure, covers the multi-disciplinary medical informatics field more accurately than anything else available. Researchers at the University of Missouri-Columbia developed this thesaurus using the four primary methods of thesaurus construction to assure both literary and user warrant in the final terminology. The thesaurus can also be quickly revised to include the rapidly evolving terminology of the discipline.
Medical Informatics↗
A system for browsing the SNOMED International vocabulary.
We have developed a means for "browsing" an extremely large vocabulary of over 130,000 medical terms (SNOMED International, 3rd ed.). This vocabulary someday hopes to become a standard vocabulary and coding scheme for patient medical records. After obtaining the vocabulary in machine readable form (ASCII in standard data format--SDF) we wrote a meta program in Turbo Pascal which parsed and embedded control codes into an input file for importing the data into an "infobase" known as FolioVIEWS. Using this infobase, it became possible to rapidly and reliably navigate around the SNOMED vocabulary in a manner impossible with printed material. The FolioVIEWS search engine is robust and rapid and allows for easy access to the terms. The utility of the infobase in evaluating the SNOMED vocabulary has been quite good. The actual utility of SNOMED as a standard vocabulary remains to be evaluated.
Information Storage and Retrieval↗
Tools for the Internet.
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Computer Communication Networks↗
Currency of full-text medical journals: CCML and MEDIS vs. MEDLINE.
The authors ask whether full-text versions of medical journals are available for searching sooner than their biblographic counterparts. The journals in question are those found in the Comprehensive Core Medical Library (CCML) from BRS Information Technologies and in Mead Data Central's MEDIS Current Journal Files. All journals in these two files are full-text, and neither file contains any indexing features. Update schedules for the full-text version of the MEDLINE journals in each of these files were compared with the most recent issue available in the National Library of Medicine's (NLM) MEDLINE on five different dates. The data revealed substantial fluctuation in comparative currency for MEDIS/MEDLINE over the period of the test. On the date of the last snapshot, June 8, 1990, MEDLINE and MEDIS were offering the same currency for 43% of the journals, and MEDIS was providing first access to 29% of the titles. The CCML/MEDLINE comparison showed less variation. In the last snapshot MEDLINE and CCML were providing access to the same issue for 36% of the journals, and CCML was offering first access to 14%. Prior to publication, this paper was submitted to all three vendors for comment. Significant portions of their responses are quoted.
MEDLINE↗
Virtual shelves in a digital library: a framework for access to networked information sources.
OBJECTIVE: Develop a framework for collections-based access to networked information sources that addresses the problem of location-dependent access to information sources. DESIGN: This framework uses a metaphor of a virtual shelf. A virtual shelf is a general-purpose server that is dedicated to a particular information subject class. The identifier of one of these servers identifies its subject class. Location-independent call numbers are assigned to information sources. Call numbers are based on standard vocabulary codes. The call numbers are first mapped to the location-independent identifiers of virtual shelves. When access to an information resource is required, a location directory provides a second mapping of these location-independent server identifiers to actual network locations. RESULTS: The framework has been implemented in two different systems. One system is based on the Open System Foundation/Distributed Computing Environment and the other is based on the World Wide Web. CONCLUSIONS: This framework applies in new ways traditional methods of library classification and cataloging. It is compatible with two traditional styles of selecting information searching and browsing. Traditional methods may be combined with new paradigms of information searching that will be able to take advantage of the special properties of digital information. Cooperation between the library-informational science community and the informatics community can provide a means for a continuing application of the knowledge and techniques of library science to the new problems of networked information sources.
Catalogs, Library↗
Evaluation of controlled vocabulary resources for development of a consumer entry vocabulary for diabetes.
BACKGROUND: Digital information technology can facilitate informed decision making by individuals regarding their personal health care. The digital divide separates those who do and those who do not have access to or otherwise make use of digital information. To close the digital divide, health care communications research must address a fundamental issue, the consumer vocabulary problem: consumers of health care, at least those who are laypersons, are not always familiar with the professional vocabulary and concepts used by providers of health care and by providers of health care information, and, conversely, health care and health care information providers are not always familiar with the vocabulary and concepts used by consumers. One way to address this problem is to develop a consumer entry vocabulary for health care communications. OBJECTIVES: To evaluate the potential of controlled vocabulary resources for supporting the development of consumer entry vocabulary for diabetes. METHODS: We used folk medical terms from the Dictionary of American Regional English project to create extended versions of 3 controlled vocabulary resources: the Unified Medical Language System Metathesaurus, the Eurodicautom of the European Commission's Translation Service, and the European Commission Glossary of popular and technical medical terms. We extracted consumer terms from consumer-authored materials, and physician terms from physician-authored materials. We used our extended versions of the vocabulary resources to link diabetes-related terms used by health care consumers to synonymous, nearly-synonymous, or closely-related terms used by family physicians. We also examined whether retrieval of diabetes-related World Wide Web information sites maintained by nonprofit health care professional organizations, academic organizations, or governmental organizations can be improved by substituting a physician term for its related consumer term in the query. RESULTS: The Dictionary of American Regional English extension of the Metathesaurus provided coverage, either direct or indirect, of approximately 23% of the natural language consumer-term-physician-term pairs. The Dictionary of American Regional English extension of the Eurodicautom provided coverage for 16% of the term pairs. Both the Metathesaurus and the Eurodicautom indirectly related more terms than they directly related. A high percentage of covered term pairs, with more indirectly covered pairs than directly covered pairs, might be one way to make the most out of expensive controlled vocabulary resources. We compared retrieval of diabetes-related Web information sites using the physician terms to retrieval using related consumer terms We based the comparison on retrieval of sites maintained by non-profit healthcare professional organizations, academic organizations, or governmental organizations. The number of such sites in the first 20 Results from a search was increased by substituting a physician term for its related consumer term in the query. This suggests that the Dictionary of American Regional English extensions of the Metathesaurus and Eurodicautom may be used to provide useful links from natural language consumer terms to natural language physician terms. CONCLUSIONS: The Dictionary of American Regional English extensions of the Metathesaurus and Eurodicautom should be investigated further for support of consumer entry vocabulary for diabetes.
Community Participation↗