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Using the Internet for research.

OBJECTIVE: (1) To give an overview of research tools, techniques, and resources that are available on the Internet; and (2) to identify valid, pharmacy-related information that will reduce uncertainty in the problem-solving activities of practitioners. DATA SOURCES: The World Wide Web. STUDY SELECTION: Examples cited in the article were evaluated according to the criteria offered in the text as a prerequisite for their inclusion. DATA SYNTHESIS: Functional aspects of the Internet include communication, commerce, and content. Because a lack of control has led to mixed information quality, the use of Internet-based information for patient care and professional decision making should be subject to rigorous screening criteria. Pharmacists can use Web browsers combined with excellent search engines and search techniques to identify quality resources, including primary, secondary, and tertiary literature, either fee-based or free, and that can be sought actively or distributed on a schedule directly to the desktop of the pharmacist. CONCLUSION: The Internet can be an immensely helpful research tool, if used appropriately. Whether actively searching or passively receiving useful updates, the Internet can function as a value-added asset to any pharmacy practice.

Humans↗

Clinical Digital Libraries Project: design approach and exploratory assessment of timely use in clinical environments.

OBJECTIVE: The paper describes and evaluates the use of Clinical Digital Libraries Project (CDLP) digital library collections in terms of their facilitation of timely clinical information seeking. DESIGN: A convenience sample of CDLP Web server log activity over a twelve-month period (7/2002 to 6/2003) was analyzed for evidence of timely information seeking after users were referred to digital library clinical topic pages from Web search engines. Sample searches were limited to those originating from medical schools (26% North American and 19% non-North American) and from hospitals or clinics (51% North American and 4% non-North American). MEASUREMENT: Timeliness was determined based on a calculation of the difference between the timestamps of the first and last Web server log "hit" during each search in the sample. The calculated differences were mapped into one of three ranges: less than one minute, one to three minutes, and three to five minutes. RESULTS: Of the 864 searches analyzed, 48% were less than 1 minute, 41% were 1 to 3 minutes, and 11% were 3 to 5 minutes. These results were further analyzed by environment (medical schools versus hospitals or clinics) and by geographic location (North America versus non-North American). Searches reflected a consistent pattern of less than 1 minute in these environments. Though the results were not consistent on a month-by-month basis over the entire time period, data for 8 of 12 months showed that searches shorter than 1 minute predominated and data for 1 month showed an equal number of less than 1 minute and 1 to 3 minute searches. CONCLUSIONS: The CDLP digital library collections provided timely access to high-quality Web clinical resources when used for information seeking in medical education and hospital or clinic environments from North American and non-North American locations and consistently provided access to the sought information within the documented two-minute standard. The limitations of the use of Web server data warrant an exploratory assessment. This research also suggests the need for further investigation in the area of timely digital library collection services to clinical environments.

Geography↗

How to use and cite Internet resources, with special attention to radiation protection and health physics WWW sites.

This paper describes an Internet search for the phrases radiation protection and health physics using major search engines and discusses the search procedure and the related problems. Depending on the search engine used, the number of hits ranged from 10,000 to only 17. The author presents some of the most relevant Web sites for radiation protection and health physics, and gives their URLs. As expected, these are mainly the sites of major national and international organizations. The author discusses a model for citation of WWW resources and refers to Internet links where this issue has been elaborated in more detail. Numerous links to various institutions and Web resources are given as well.

Computer Communication Networks↗

A descriptive analysis of internet information regarding music therapy.

The purpose of the two studies reported here was to investigate and describe information available about music therapy that is likely to be found on the Internet. The top 20 Internet search engines were surveyed using the term "Music Therapy." Information concerning the first 25 sites listed per engine was collected. The following categories of information were described: the frequency of mention across the search engine sites, the type of site, whether the site gave a definition of music therapy, the orientation of that definition, the number of links, orientation of links, and the number of hits shown on the main page. A rank order was then compiled of the 267 sites listed across all searches. Results showed that American Music Therapy Association (AMTA) web page was the most frequent and highest ranked site across the 20 search engine sites. Sites from educational institutions were frequent, as were commercial sites. Most of the highest ranked sites gave traditional definitions (as defined by AMTA) for music therapy and associated links were conventional as well. These procedures were replicated one year later, although the question "What is Music Therapy?" was used as the search term. Results from this second search revealed only 145 sites. Of those, American Music Therapy Association web page was again the most frequent and highest ranked site across the search engines. Sites from educational institutions were frequent, as were commercial sites, however, only half of the highest ranked sites gave traditional definitions for music therapy.

Computers↗

Harvesting chemical information from the Internet using a distributed approach: ChemXtreme.

The Internet is a comprehensive resource of chemical information which is at the same time largely unstructured. It provides a wealth of scientific information such as experimental data and requires a suitable automated data mining and analysis tool for its meaningful exploration. The Java based software presented here, ChemXtreme, is developed for harvesting chemical information from the Internet employing the Google API in combination with a distributed client/server text analysis architecture based on JavaRMI. It represents the first and until now the only toolkit for automated structured data retrieval from the Internet which is itself open source. ChemXtreme employs the "search the search engine" strategy, where the URLs returned from the search engine are analyzed further via textual pattern analysis. This process resembles the manual analysis of the hit list, where relevant data are captured and, by means of human intervention, are mined into a format suitable for further analysis. ChemXtreme on the other hand transforms chemical information automatically into a structured format suitable for storage in databases and further analysis and also provides links to the original information source. The query data retrieved from the search engine by the server is encoded, encrypted, and compressed and then sent to all the participating active clients in the network for parsing. Relevant information identified by the clients on the retrieved Web sites is sent back to the server, verified, and added to the database for data mining and further analysis. The distributed further analysis of URLs in a client/server architecture scales very favorably, thus producing only minimal overhead.

Chemistry↗

Comparative analysis of medical web search using generalized vs. niche technologies.

One increasingly popular solution to the problem of information overload is the niche search engine, designed as a customized knowledge management tool to meet the needs of information seekers with similar interests. By limiting web crawling to a specific subject area, the niche engine is able to crawl deeper and more discreetly than commercial counterparts. This exploratory technology assessment study sought to examine differences in information search and retrieval patterns between commercial and niche search engines in areas of debated or uncertain healthcarer treatment. Findings suggest that while information found within the niche search is generally more trustworthy, niche searches leave out many reliable sources which are retrievable through commercial search engines. Also, consumer-friendly (non-technical) resources were found to be more prevalent using commercial search engines, suggesting greater relevance for the layperson within this domain.

Algorithms↗

Characterizing Internet searchers of smoking cessation information.

BACKGROUND: The Internet is a viable channel to deliver evidence-based smoking cessation treatment that has the potential to make a large population impact on reducing smoking prevalence. There is high demand for smoking cessation information and support on the Internet. Approximately 7% (10.2 million) of adult American Internet users have searched for information on quitting smoking. Little is known about these individuals, their smoking status, what type of cessation services they are seeking on the Internet, or how frequently these searches for cessation information are conducted. OBJECTIVE: The primary goal of this study was to characterize individuals who search for smoking cessation information on the Internet to determine appropriate triage and treatment strategies. The secondary goal was to estimate the incidence of searches for cessation information using publicly available search engine data. METHODS: We recruited individuals who clicked on a link to a leading smoking cessation website (QuitNet) from within the results of a search engine query. Individuals were "intercepted" before seeing the QuitNet home page and were invited to participate in the study. Those accepting the invitation were routed to an online survey about demographics, smoking characteristics, preferences for specific cessation services, and Internet search patterns. To determine the generalizability of our sample, national datasets on search engine usage patterns, market share, and keyword rankings were examined. These datasets were then used to estimate the number of queries for smoking cessation information each year. RESULTS: During the 10-day study period, 2265 individuals were recruited and 29% (N = 655) responded. Of these, 59% were female and overall tended to be younger than the previously characterized general Internet population. Most (76%) respondents were current smokers; 17% had quit within the last 7 days, and 7% had quit more than 7 days ago. Slightly more than half of active smokers (53%) indicated that they were planning to quit in the next 30 days. Smokers were more likely to seek information on how to quit and on medications; former smokers were more interested in how to cope with withdrawal. All participants rated withdrawal information and individually tailored information as being more useful, while displaying little interest in telephone counseling, expert support, or peer support. Publicly available data from large search engines suggest that 4 million Americans search for resources on smoking cessation each year. CONCLUSIONS: This study adds to the limited data available on individuals who search for smoking cessation information on the Internet, supports the prior estimates of the size of the population, and indicates that these individuals are in appropriate stages for both active cessation interventions and aggressive relapse prevention efforts. Continued development and evaluation of online interventions is warranted, and organizations seeking to promote cessation should carefully evaluate the Internet as a possible modality for treatment and as a gateway to other traditional programs.

Adolescent↗

Cancer-related complementary and alternative medicine online: factors affecting information retrieval.

Cancer patients increasingly turn to the Internet for health information. As the use of complementary and alternative medicine (CAM) is also increasing, we studied the likelihood that consumers will incidentally encounter CAM information while searching the Internet and the factors that influence CAM information retrieval. We evaluated results retrieved from ten cancer-related searches in six common search engines, and found that 16.2% of 1121 results contained CAM information. Sponsored (i.e. paid) results contained more CAM information than non-sponsored results (38% vs. 7.5%, p<0.001). Sponsored results in the Overture and Google search engines accounted for 51% and 39% of results on the first page. These search engines also retrieved the most CAM web pages. The type of cancer used as the search keyword did not influence the number of CAM-related web pages retrieved. However, the synonyms of cancer used as search keywords differed in their retrieval of CAM web pages (p<0.001). We conclude that clinicians should help consumers recognize sponsored listings and encourage search engines to clearly identify sponsored results.

Complementary Therapies↗

Searching for cancer information on the internet: analyzing natural language search queries.

BACKGROUND: Searching for health information is one of the most-common tasks performed by Internet users. Many users begin searching on popular search engines rather than on prominent health information sites. We know that many visitors to our (National Cancer Institute) Web site, cancer.gov, arrive via links in search engine result. OBJECTIVE: To learn more about the specific needs of our general-public users, we wanted to understand what lay users really wanted to know about cancer, how they phrased their questions, and how much detail they used. METHODS: The National Cancer Institute partnered with AskJeeves, Inc to develop a methodology to capture, sample, and analyze 3 months of cancer-related queries on the Ask.com Web site, a prominent United States consumer search engine, which receives over 35 million queries per week. Using a benchmark set of 500 terms and word roots supplied by the National Cancer Institute, AskJeeves identified a test sample of cancer queries for 1 week in August 2001. From these 500 terms only 37 appeared >or= 5 times/day over the trial test week in 17208 queries. Using these 37 terms, 204165 instances of cancer queries were found in the Ask.com query logs for the actual test period of June-August 2001. Of these, 7500 individual user questions were randomly selected for detailed analysis and assigned to appropriate categories. The exact language of sample queries is presented. RESULTS: Considering multiples of the same questions, the sample of 7500 individual user queries represented 76077 queries (37% of the total 3-month pool). Overall 78.37% of sampled Cancer queries asked about 14 specific cancer types. Within each cancer type, queries were sorted into appropriate subcategories including at least the following: General Information, Symptoms, Diagnosis and Testing, Treatment, Statistics, Definition, and Cause/Risk/Link. The most-common specific cancer types mentioned in queries were Digestive/Gastrointestinal/Bowel (15.0%), Breast (11.7%), Skin (11.3%), and Genitourinary (10.5%). Additional subcategories of queries about specific cancer types varied, depending on user input. Queries that were not specific to a cancer type were also tracked and categorized. CONCLUSIONS: Natural-language searching affords users the opportunity to fully express their information needs and can aid users naïve to the content and vocabulary. The specific queries analyzed for this study reflect news and research studies reported during the study dates and would surely change with different study dates. Analyzing queries from search engines represents one way of knowing what kinds of content to provide to users of a given Web site. Users ask questions using whole sentences and keywords, often misspelling words. Providing the option for natural-language searching does not obviate the need for good information architecture, usability engineering, and user testing in order to optimize user experience.

Benchmarking↗

Product-related emphasis of skin disease information online.

BACKGROUND: In 2000, 41 million people searched for medical information online. The quality of that information is unregulated, variable, and not well studied. OBJECTIVE: To quantify and compare the numbers and types of Internet sites matched for 10 diverse skin conditions through different search systems. DESIGN: Search strategies were performed at 6-month intervals via Netscape Navigator, using 3 search engines and 1 directory. Ten skin conditions were chosen to represent common (psoriasis and eczema), cosmetic (wrinkles and cellulite), difficult-to-treat (alopecia, mastocytosis, granuloma annulare, and xanthoma), and uncommon (dermatitis herpetiformis and epidermolysis bullosa) problems. Search strings were designed to generate lists of Web sites that provide educational or product-related information. Results were compared. SETTING: The Saint Louis University information technology server, July 9, 1999, December 16, 1999, and February 5, 2000. MAIN OUTCOME MEASURES: Comparisons of the total number, top 10 ranking, and type (educational vs product-related) of sites that matched through different search systems at 6-month intervals. RESULTS: The total number of matched sites for different skin conditions varied up to 100-fold. This number increased by 30% to 316% between July and December 1999. The largest number of Web sites related to wrinkles, followed by Web sites related to common conditions. Product-related sites outnumbered educational sites, especially for common and cosmetic conditions. Although there were differences in the total number of sites found through different search engines, the ratios of product-related to educational sites were similar. Different search engines yielded different top 10 match lists for the same condition. The top 10 lists included higher proportions of educational sites than the total match lists for all conditions except cellulite. Within the top 10 lists, the rank order of well respected sites varied by search engine used and changed over time. CONCLUSIONS: Patients are increasingly accessing the growing body of data available through the Internet. Most Web sites contain information related to products. Until standards are enacted to govern the distribution of online medical information, consumers are at risk for obtaining misinformation and buying ineffective products. To better guide patients, physicians must become familiar with this ever-changing information.

Female↗

Evaluation of web-based osteoporosis educational materials.

BACKGROUND: Many women are unaware of risk factors for and consequences of osteoporosis. Hence, patient education is an essential step in preventing and managing osteoporosis. Unfortunately, numerous studies have demonstrated a mismatch between the reading difficulty of typical patient education materials and the reading ability of many American adults. METHODS: We examined the readability and quality of web-based information on osteoporosis using the Suitability Assessment of Materials (SAM) and DISCERN instruments. The three most widely used Internet search engines, Google, Yahoo, and MSN, were selected based on popularity according to Nielsen/Net Ratings. The search term osteoporosis was entered to generate the first 30 websites listed by each of the three search engines. Several websites appeared on all three search engines; we identified 27 unique websites. RESULTS: Overall, 51.9% of materials were rated by the SAM as not suitable. Most materials scored poorly for their reading level (82.6% were rated not suitable), with an average reading level at grade 11.5 +/- 2.8. The mean DISCERN score for overall description of treatment options was 35.7 +/- 18.0, indicating inadequate quality. Most materials had low quality in a number of indicators, including accuracy and biased presentation of information. CONCLUSIONS: Web-based osteoporosis information is written above the reading ability of most American adults, and much of it lacks adequate quality.

Comprehension↗

The retrieval effectiveness of medical information on the web.

The World Wide Web has become such an extensive health information repository in the world that it is increasingly difficult to search for relevant medical information. Many search tools have been developed to help users look for relevant health information on the web, but most of them are still not efficient. In this paper, we discuss some available on-line solutions to medical information retrieval and compare the performances of some general and medicine-specific search engines with the MediAgent, which has been developed by the National University of Singapore (NUS) Medical Informatics Programme. Although a number of medicine-specific searching techniques have been developed, the difficulty of finding medical information still remains because medical search engines are generally not as effective as generic search engines. Different from other search tools, MediAgent's efficiency was quite high, taking only an average of 1.5 links to retrieve the answers, but its retrieving effectiveness is not good enough due to the short period of operation. Whilst the MediAgent project cannot claim to have all the solutions, it nevertheless offers a new alternative to system implementation. New techniques need to be explored in order to overcome the issues of medical information retrieval on the Internet.

Humans↗

Assessing domains of uncertainty in critical Web-based healthcare communities.

Search engines and Web-based directories play a central role in facilitating access to online health information. In this environment consumers often find and act upon health information of variable quality, with little input from health professionals. As an added concern, when consumers access health information on the Web via a search engine they often fail to discuss the information with a healthcare provider, especially in areas of perceived medical uncertainty. For many health consumers, the Internet may be the primary (or even sole) source of health information, especially where consumers lack access to, or trust in, trained providers. To date the corresponding role of search engine technology use and efficacy has received relatively little attention, however. This study serves as an exploratory technology assessment that explains the application of keyword effectiveness indexing (KEI) analysis in estimating the ability of commercial search engines to return relevant results for healthcare consumers. Findings suggest that KEI can serve as a useful health search profiling tool, though its applicability may vary across domains.

Community Health Services↗

[Quality analysis of internet information on epicondylitis radialis humeri].

AIM: By means of conventional internet search engines we assessed the World Wide Web for the topic "epicondylitis radialis humeri" and analysed the content of the listed pages for their quality and transparency. METHODS: Three of the most frequently used internet search engines were utilised to search the World Wide Web for the terms "tennis arm", "tennis elbow" and "epicondylitis". The first 50 listed internet addresses per search engine were scrutinised in respect to the authors' source, financier of the web page and whether commercial interests were evident. Furthermore, the medical content concerning radial epicondylitis was analysed using a 10-point score. RESULTS: After elimination of repetitive and not accessible internet pages, as well as web pages only giving links to further web-sites or chat-rooms, we were able to evaluate 137 internet sites. The average content-score of all pages was low with 2.91 +/- 3.27 SD. Web-pages, where authorship could not be identified or where commercial interests were clearly evident, had the lowest content-scores. Sites authored by or associated with orthopaedic surgeons had a significantly higher content-score (6.84 +/- 3.17 SD) in comparison to other initiators of web-pages (p < 0.0001). CONCLUSION: The facts derived from the World Wide Web when searching for information on epicondylitis radialis humeri are mostly of low professional quality and transparency. Orthopaedic surgeons need to point out this problem to patients who additionally inform themselves on the internet. If the desire for browsing the web for further information concerning musculoskeletal pathology exists, orthopaedic surgeons should tell their patients which web sites are suitable.

Databases, Factual↗

Searching for information on the Internet using the UMLS and Medical World Search.

Medical World Search is a search engine for medical information on the Internet that distinguishes itself from other search engines by its built-in knowledge of medical terminology through its use of the National Library of Medicine's UMLS and its carefully selected but large database of medical sites. After discussing some of the previous uses of the UMLS for medical information retrieval, we describe the Medical World Search system. In October 1996, Medical World Search became operational on the World Wide Web at http:@www.mwsearch.poly.edu. It has been operating uninterrupted since then. We review our experiences with creating a search engine for medical information on the Internet and using the UMLS in this application. The UMLS has some clear advantages in this application. Some aspects of the UMLS also decrease its usefulness in information retrieval. Medical World Search's usage by medical information seekers is summarized. future directions for research are outlined.

Computer Communication Networks↗

Gastrointestinal cancer web sites: how do they address patients' concerns?

BACKGROUND: We studied the quality of web sites containing information on gastrointestinal cancer, focusing on the way these web sites dealt with the special concerns of these patients. MATERIALS AND METHODS: Searching the Internet for German-language gastroenterological cancer web sites, we collected 9,947 web pages from 14 search engines. Evaluation was done with a 36-item questionnaire. Information quality, availability of the web sites, and web site attributes considering patients' concerns and potential embarrassment were analyzed using a scoring system. RESULTS: Belonging to 165 web sites, 1,763 of 9,947 (17.7%) web pages found by search engines provided relevant information. Five hundred forty-seven (5.5%) hits were partly relevant, and 7,637 (76.8%) were irrelevant or not available. Most web sites reported about surgery (92.1%), chemotherapy (88.5%), and radiotherapy (73.9%). Of the web sites, 46.7% (n=77), 34.6% (n=57), and 21.8% (n=36) gave information about the author(s) itself, their qualifications, and references of their information, respectively. Search engines ranked web sites giving no information on evidence-based medicine higher than other web sites, whereas web sites providing this information accurately showed higher link popularities. Patients' concerns and potential embarrassment were best addressed by gastrointestinal web sites initiated by private individuals or web sites directed to both a patient and physician audience. CONCLUSIONS: With regard to gastrointestinal cancer web sites, many search engines may be ineffective, and patient emotional needs and concerns are often disregarded. Also, physicians should guide their patients through the Internet to find high-quality information and use link-popularity-based search strategies.

Gastrointestinal Neoplasms↗

The Internet as a source of information on breast augmentation.

The Internet was evaluated as a source of information for the layperson on the topic of breast augmentation. Three commonly used search engines (Excite, AOL, and Yahoo) were employed using the term "breast augmentation." These sites were then evaluated by each of three experienced plastic surgeons for their quality and content. Separately, 17 health Web sites were identified as authoritative by means of recommendation in lay publications. Each "supersite" was accessed, and its search engine was used. The top 10 hits for "breast augmentation" on each site were then evaluated by the senior author for content (Matthews). We found the majority of sites identified by the general search engines (AOL, Excite, Yahoo) to be physician Web sites. Forty-one unique sites were found that applied to the topic. Four of the "hits" did not actually apply to the topic. In general, the applicable Web sites contained limited but accurate procedural details and offered an interactive forum, most commonly email responses. Photographic documentation was given in less than half the sites reviewed, and most of the results shown were only "good" outcomes. Most sites did not discuss any complications of surgical procedures, but those that did were usually accurate. Eighty-three percent of the sites were biased toward a particular surgical technique. The reviewers believe that only about 15 percent of the sites were acceptable to recommend to their patients. The senior author accessed 17 Web sites that are considered authoritative health information Web sites. Each of these sites was searched for information on breast augmentation by means of its internal search engine. Only 29 percent (5 of 17) had any information in their top 10 hits. Three sites had only chat transcripts. One site had limited but accurate information with a link to the American Society of Plastic Surgeons, and one site had scientific information on product safety. No site met the criteria of accurate, complete information on the surgical procedure of breast augmentation. This study demonstrates that it is difficult for the average layperson to get authoritative information quickly and easily on at least one aspect of cosmetic surgery.

Female↗

Textpresso: an ontology-based information retrieval and extraction system for biological literature.

We have developed Textpresso, a new text-mining system for scientific literature whose capabilities go far beyond those of a simple keyword search engine. Textpresso's two major elements are a collection of the full text of scientific articles split into individual sentences, and the implementation of categories of terms for which a database of articles and individual sentences can be searched. The categories are classes of biological concepts (e.g., gene, allele, cell or cell group, phenotype, etc.) and classes that relate two objects (e.g., association, regulation, etc.) or describe one (e.g., biological process, etc.). Together they form a catalog of types of objects and concepts called an ontology. After this ontology is populated with terms, the whole corpus of articles and abstracts is marked up to identify terms of these categories. The current ontology comprises 33 categories of terms. A search engine enables the user to search for one or a combination of these tags and/or keywords within a sentence or document, and as the ontology allows word meaning to be queried, it is possible to formulate semantic queries. Full text access increases recall of biological data types from 45% to 95%. Extraction of particular biological facts, such as gene-gene interactions, can be accelerated significantly by ontologies, with Textpresso automatically performing nearly as well as expert curators to identify sentences; in searches for two uniquely named genes and an interaction term, the ontology confers a 3-fold increase of search efficiency. Textpresso currently focuses on Caenorhabditis elegans literature, with 3,800 full text articles and 16,000 abstracts. The lexicon of the ontology contains 14,500 entries, each of which includes all versions of a specific word or phrase, and it includes all categories of the Gene Ontology database. Textpresso is a useful curation tool, as well as search engine for researchers, and can readily be extended to other organism-specific corpora of text. Textpresso can be accessed at http://www.textpresso.org or via WormBase at http://www.wormbase.org.

Abstracting and Indexing↗