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Medical Information, The Internet, and You
By Janabeth Fleming Evans R.N., R.N.C.

As a medical-legal consultant and Internet researcher I am asked every day to find authoritative medical literature references for a broad spectrum of topics. The information I am looking for may be used to support a claim, to debunk an expert theory, or to educate the attorney during the course of a case evaluation.

Changes in the way medical information is stored, accessed, and retrieved have created a wealth of health care information. The Internet provides free access to a great deal of the medical literature, either in full text or citation/abstract format. Because anyone with access to the Web can establish a Web page, many medical sites contain little useful information, even though they may be visually appealing. For this reason, the quality of information available varies from very good to poor, and some sites even intend to mislead. It is important to search for peer reviewed information, from an authoritative source.

I. Define The Search

Before you start your search, be clear as to the specific type of information you are seeking. It may be a standard of care for a particular procedure, it may be the rate of occurrence for complications related to a specialized treatment, or it may be basic information defining a disease or particular injury. You must identify the main concepts in your topic and determine any synonyms, alternate spellings, or variant word forms for the concepts.

In order to define your search, you will need a grasp of basic medical terminology. The medical terms used in your search usually come from records showing a diagnosis or particular treatment. The terms may include the name of a medication or specialized medical equipment. It is a good idea to keep a medical dictionary and drug guidebook close at hand as references, because spelling of medical terms must be accurate in order to get relevant search results.

Because the Web is not indexed in any standard manner, finding information can seem difficult. Search engines are popular tools for locating web pages, but they often return thousands of results. Search engines crawl the Web and log the words from the web pages they find in their databases. Without a clear search strategy, using a search engine is like wandering aimlessly in the stacks of a library trying to find a particular book.

II. Performing the Search

Most of the major medical literature search sites have tutorials or help functions to assist you in customizing your search. It may take some time to learn how to master the specific commands and options offered by the various search engines, but it pays off by helping you avoid hundreds of hours fruitlessly searching.

Do not let the similarity between the appearance and function of medical search sites fool you into thinking they are all alike. They are not. They use different rules and procedures to analyze your queries and decide what results are seen.

If you have tried a query a few times and are not getting the results you are looking for, switch to another search engine. It is natural after searching for awhile to have "favorite" search sites. In one way this is good, the more you use a particular site the more likely you are to master a particular tool. But, instead of relying on one search site for all your needs, try using several different sites on a regular basis. This way you will get a feel for which ones work best for specific types of searches. Over time, it will become automatic for you to select the "best" search site for each query from among the several that you know well.

Boolean operators (and, or, not) allow you to construct very precise queries that theoretically should give you very precise results. But this is not necessarily the case for two reasons. First search sites implement Boolean operators in slightly different ways. If you are going to use Boolean operators, be sure you understand exactly how each site implements them. Secondly, despite the apparent simplicity, Boolean logic is anything but simple. A misused "not" or a poorly "nested" phrase can lead to wildly inappropriate results. For a good Boolean primer, with helpful illustrations and examples is Boolean Searching on the Internet, from the University at Albany Libraries http://library.albany.edu/internet/boolean.html

Some search engines ignore certain words. They are never used to find a matching document, despite what amounts to a direct command when you type them into a search form. These are called "stop words" because the search engine does not "search" when they are found in its index. This is because the stop words are either too common to generate meaningful results, or are parts of speech like adverbs, conjunctions, prepositions, or forms of "be" that mean nothing unless they are part of a phrase with more "important" nouns and verbs. If you use a stop word in a query you may get wildly irrelevant results. How can you identify stop words? They are listed at Most of the 300 Most Common Words in English http://www.zingman.com/commonWords.html Some search engines will tell you when they are ignoring a stop word at the very top of a results page.

Another problem for the net-searcher is whether to use capital letters in a query. Some engines are case sensitive, while others are not. As a rule of thumb, it is best to always use lower case letters when you search This will typically return results that contain both upper and lower case letters.

It is a good idea to bookmark or print out the information you find. It is easy to believe once you have found a page or site using a search engine that you will find it again. It does not work that way. You may not get the same search results using the same terms if you repeat a search within an hour, let alone days or weeks later. The Web is in constant flux. Thousand of new pages are published to the Web every day, and thousands more moved to new "addresses", or are removed entirely. This means a particular "relevance" of a particular document for a specific search query also changes constantly, as it is compared to other documents added to or removed from the search engine index.

If you get stuck, and can not find what you are looking for on the Internet, do not stop looking. Sometimes your best bet for finding information is to log off and take a trip to your local medical library. Libraries have many resources that are not available on the Internet. And, the librarians are trained experts who are usually more than willing to help you find what you are looking for. Effective searching requires a blend of learned skills, common sense, and a bit of clever intuition.

III. Where to Search For Medical Information


Medical Search Engines/Website Lists

Medical information on the Internet is growing and diversifying. Every month more information is added and it becomes more challenging to sift through the many sites to find the content you are looking for. Traditional search engines do not focus on medical sites, and therefore some very valuable sites are overlooked or not updated into the index.

To date, there is no all-inclusive engine for searching medical sites. Nor is there a single engine that adequately and throughly indexes just the most reputable sites. These are a sampling of sites that will search for and retrieve up-to-date, applicable and current postings from peer-reviewed sources.

National Library of Medicine
http://www.nlm.nih.gov

The NLM is a very large database and the efficiency of a search can be aided by a review of the MESH (medical subject heading) "trees" at http://www.nlm.nih.gov/mesh/ The mesh trees incorporate the specialized language of the NLM classification system. Failure to use the appropriate language will result in a null or irrelevant search. For example: the phrase kidney calculi should be used instead of kidney stones.

Medline (accessible from various sites)

MEDLINE is the NLM's premier bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and the preclinical sciences. MEDLINE contains bibliographic citations and author abstracts from more than 4,300 biomedical journals published in the United States and 70 other countries. The file contains over 11 million citations dating back to the mid-1960's. Coverage is worldwide, but most records are from English-language sources or have English abstracts. Medline is free, and is accessible from various sites, such as Medscape, Pubmed, and Healthgate..

Pubmed
http://www.ncbi.nlm.nih.gov/PubMed/

The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at web sites of participating publishers.

Publishers participating in PubMed electronically supply NLM with their citations prior to or at the time of publication. If the publisher has a web site that offers full-text of its journals, PubMed provides links to that site, as well as sites to other biological data, sequence centers, etc. User registration, a subscription fee, or some other type of fee may be required to access the full-text of articles in some journals.

PubMed provides access to bibliographic information which includes MEDLINE as well as:

The out-of-scope citations (e.g., articles on plate tectonics or astrophysics) from certain MEDLINE journals, primarily general science and chemistry journals, for which the life sciences articles are indexed for MEDLINE. Citations that precede the date that a journal was selected for MEDLINE indexing. Some additional life science journals that submit full text to PubMedCentral and receive a qualitative review by NLM.

Medscape
http://www.medscape.com

Medscape is a multi-specialty Web service for clinician and consumers that combines information from journals, medical news providers, medical education programs, and materials created for Medscape. Here you will find a combination of peer-reviewed publications, a free version of drug information via the "First Data Bank File" and free Medline.

Healthfinder
http://www.healthfinder.gov

Healthfinder is a free gateway to reliable consumer health and human services information developed by the U.S. Department of Health and Human Services. healthfinder can lead you to selected online publications, clearinghouses, databases, web sites, support and self-help groups, as well as the government agencies and not-for-profit organizations that produce reliable information for the public.

MD Consult
www.mdconsult.com

Founded by leading medical publishers that include Mosby and W.B. Saunders, MD Consult

integrates peer-reviewed resources from over 50 publishers, medical societies, and government

agencies. From this site you can obtain full text from 40 respected medical reference books from a variety of specialties, 50 medical journals, and MEDLINE. In addition you can obtain comprehensive USP drug information (beyond the scope of a PDR), more than 600 clinical practice guidelines. This is not a free service, but for a small fee you can have access by the day, month or year. Also there is a free seven day trial membership.

Medical Matrix
http://www.medmatrix.org

Medical Matrix is a source for a wide variety of online resources that include major journals, textbooks, disease and conditions, and patient education. To access this site you must complete an online registration form.

MedScout
http://www.medscout.com

Because it has few graphics, MedScout is very quick, yet it offers very broad and well-organized content. It also conveniently lists diseases by International Classification of Diseases (ICD 9). Medscout indexes hundreds of medical web sites. It supports its services by advertising and selling medical products.

Medical World Search
http://mwsearch.com

Medical World Search was especially developed for the medical field. Medical World Search can aid medical practitioners, researchers, or anyone with basic knowledge of medicine, to formulate an optimally precise query to search the World Wide Web and find exactly the information they need. The major goals of Medical World Search are to provide a search engine that operates over a selection of the most high quality medical sites on the Web and to facilitate searching by using a medical thesaurus that understands medical terminology and can thus search for related terms automatically.

MD Choice.com
http://www.mdchoice.com/index.asp

This site is founded by academic physicians. Their goal is to make access to the Internet's vast health and medical information as efficient and reliable as possible for healthcare professionals as well as consumers. MDchoice.com has combined the content of several award-winning medical websites including NetMedicine.com, Physician's Choice, and EMBBS.com (The Emergency Medicine and Primary Care Home Page). A panel of board certified physicians in the U.S. evaluate the Web's medical content.

Achoo
http://achoo.8media.org

Achoo is a comprehensive health care database on the Internet with over 7000 indexed and searchable health care sites. The site is organized by categories that include Human Life, Practice of Medicine, Business of Health, and What's New. This site provides a comprehensive index of medical sites, but is mainly consumer focused and does omit a great deal of the professional level content.

Guidelines Clearing House
www.guidelines.gov

This site is a public resource for evidence-based clinical practice guidelines. NGC is sponsored by the Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and Research) in partnership with the American Medical Association and the American Association of Health Plans. A medical term search will retrieve objective, detailed information on clinical practice guidelines. Results in a search will obtain: structured abstracts (summaries) about the guideline and its development, a utility for comparing attributes of two or more guidelines in a side-by-side comparison, syntheses of guidelines covering similar topics, highlighting areas of similarity and difference, links to full-text guidelines, where available, and/or ordering information for print copies and, annotated bibliographies on guideline development methodology, implementation, and use.

IV. General Information Searching

Search engines rely on computer programs called spiders or robots to crawl the Web and log the words on each page. With a search engine, keywords related to a topic are typed into a search "box." The search engine scans its database and returns a file with links to websites containing the word or words specified. Because these databases are very large, search engines often return thousands of results. Without search strategies or techniques, finding what you need can be like finding a needle in a haystack.

General search engines are good for finding information and sites on a specific topic. The search results generally will contain many irrelevant sites, and you will need to "sift" through your results to find information that is useful.

There are many tutorials for web searching techniques on the Internet. One particularly good tutorial, which you may download and print for reference is Bright Planet's "Deep Content" tutorial.
http://www.brightplanet.com/deepcontent/tutorials/search/index.asp

This is an in-depth Web searching tutorial, organized to proceed from the basics to more advanced topics. It has 12 parts containing over 60 topics.

Listed below are some of the more popular general search engines.

General Information Search Engines/Website Lists

Google
www.google.com

Google consistently turns up high-quality, highly relevant results. Google does well on specific queries such as American Pediatric Neurological Organizations, and broad-topic searches, such as Medical Professional Organizations. It's also great at targeting a specific home page. Depending on your query, you may get stock quotes, or related news stories for example. My favorite feature is Google's ability to view cached copies of results pages. When the page you want to access is no longer live, you can view a cached copy of the way it looked the last time Google crawled it. Google offers only basic query customization features, including phrase searching and foreign-language filtering. You can use plus or minus signs to include or exclude keywords, or you can head to the Advanced Search page for drop-down pick lists to construct complex searches. There is a similar page" feature as well as a translator for foreign language websites.

About
www.about.com

About.com uses "professional Guides" to research and collect over a million useful sites in over 700 topic areas. About.com is a great place to start a web inquiry as long as you're not looking for anything to specific. Think of it as a resource library for popular subjects. Uses Sprinks (powered by the competent Inktomi) as a default search engine if it can't find your query at about.com.

Dogpile
http://www.dogpile.com

Dogpile uses a different concept to search the Internet than most other general content search engine. Rather than maintaining its own database of Web site addresses and their contents, Dogpile searches the databases maintained by the other general content search engines, such as Excite and Yahoo and Alta Vista, as well as databases maintained by Usenet newsgroups, ftp sites, newswires, and business news sources. Dogpile begins by searching the larger general content search engine databases and general purpose directories, and then gradually moves through smaller, more specific search engines. The user is permitted to alter the order of search, however.

Open Directory Project
http://dmoz.org/

The goal of this new engine is to produce the most comprehensive directory of the web, Similar to Yahoo, listings are organized by category and reviewed by editors. The ODP is a Web directory, not a search engine. Although they do offer a search query, the purpose of the ODP is to list and categorize web sites. They do not rank, promote or optimize sites for search engines. The ODP is simply a data provider.

Pandia
http://www.pandia.com/

Created and maintained by P&S Koch of Oslo, Norway, Pandia Search Central aims to serve as a major search portal, pooling a number of searching tools and guides. These include a metasearch engine that indexes AltaVista, HotBot, Yahoo, Looksmart, Go Infoseek, GoTo, and WebCrawler at once; a news service and search engine; the Pandia Goalgetter, a concise search tutorial; the Pandia Plus Directory, powered by the Open Directory Project; "Q-cards," which help users form advanced queries on a number of selected search engines and directories; and a Pandia Sherlock plug-in for Mac users.

WebFerret
http://www.zdnet.com/ferret/download.htm (free download)

WebFerret is free software that searches the internet for you. (This type of program is called a "bot.") WebFerret uses several search engines, looking as deeply as you like to "ferret" out the pages you're interested in. You can search the entire text of pages, their titles and descriptions, just their titles, or even just their URLs. What you choose determines how fast WebFerret works. In addition, WebFerret will eliminate duplicates by URL, title, or host. WebFerret will list the pages it finds by relevance, title, address or source, then you can save your search as WebFerret search results (an ASCII file or HTML). Since WebFerret is a small program, so it can work in the background.

The Internet continually offers more opportunities to find information on medical and related topics. However, with the expanding resources comes a larger challenge for net-researchers to find the information they are seeking. The more experience the researcher gains the more proficient they become in finding pertinent data.

Janabeth F. Evans, R.N., R.N.C. has a degree in Nursing from Oklahoma State University and a Litigation Paralegal Certificate from the University of Oklahoma Law Center. She was a nursing instructor for ten years and has been a medical legal consultant since 1990. Ms. Evans is currently President/Owner of Attorney's Medical Services, Inc. in Marshall, TX. In 2002 she was named the Association of Trial Lawyers of America's Paralegal of the Year. She provides litigation support for attorneys across the United States and specializes in case reviews and Internet information resources. Her website is http://www.attorneysmedicalservices.com and her e-mail address is jana@attorneysmedicalservices.com.

Additional Internet Resources

Anatomy
www.anatomy.org/i4a/pages/index.cfm?pageid=1

Anesthesiology
www.abanes.org
www.asahq.org

Cardiology
www.acc.org
www.augusta.net/atlantic/ascp.ascpscm.html
www.asecho.org
org.umc.edu/iash/homepage.htm
www.americanheart.org

Chiropractic
www.amerchiro.org
www.accoweb.com
www.chiromed.org
www.nysca.com

Emergency Services
www.aaem.org
www.abem.org
www.acep.org

Endocrinology
www.aace.com
www.women-in-endo.org
www.diabetes.org

Gastroenterolgy/Liver
www.acg.gi.org
www.gastro.org
www.asge.org
www.sgna.org
www.liverfoundation.org

General Medicine
www.aafp.org
www.abms.org
www.ama-assn.org
http://www.ameripat.com
www.aamc.org
www.msweb.net/aaps/
www.nysafp.org
www.nycms.org

Hematology
www.hematology.org

Iatrogenic Injuries
www.iatrogenic.org

Immunology
http://www.ashi-hla.org/
http://www.aaaai.org

Infectious Disease
http://www.idac.org/idlinks.html
http://pages.prodigy.net/pdeziel/
http://www.cdc.gov/ncidod/id_links.htm
http://www.amm.co.uk/

Internal Medicine
www.acponline.org
www.abim.org
www.sgim.org

Obstetrics/Gynecology
www.acog.org
www.abog.org
http://www.accesspub.com/tempobg/soc/socm.htm

Midwifery
www.acnm.org

Neurology
www.stroke.org/
http://www.aan.com/
http://www.neuroguide.com/

Oncology
www.asco.org
www.cancernet.nci.nih.gov
www.oncolink.upenn.edu
www.cancer.org

Opthamology
www.eyenet.org
www.ascrs.org
www.asoprs.org
www.glaucoma-foundation.org/info/

Optometry
www.aaopt.org
www.aoanet.org

Orthopedics
www.aaos.org
www.sportsmed.org

Pediatrics
www.aap.org

Pharmacy
www.aphanet.org

Physical Therapy
www.aaptnet.org
www.apta.org
www.nationalrehab.org

Physiology
www.faseb.org/aps/

Plastic Surgery
www.facial-plastic-surgery.org
www.plasticsurgery.org

Podiatry
www.apma.org
http://www.footandankle.com/podmed/

Preventative Medicine
www.acpm.org

Psychiatry
www.abpn.com
www.psych.org

Pulmonology
www.lungusa.org
http://www.aarc.org/
http://www.chestnet.org/
http://www.thoracic.org/

Radiology
www.asrt.org
www.rsna.org
www.acr.org

Rheumatology
www.rheumatology.org
www.arthritis.org

Surgery
www.facs.org

www.acfas.org (foot and ankle)

www.fascrs.org (colon and rectal surgeons)
www.womensurgeons.org

Urology
www.auanet.org
www.kidney.org

Vascular Medicine
www.svmb.org

Veterinary Medicine
www.abvp.com
www.avma.org

Medical Terminology


http://mywebmd.com/encyclopedia
http://www.nlm.nih.gov/medlineplus/mplusdictionary.html
http://medmatrix.org
http://home.ipoline.com/~guoli/med/Ohead.htm
http://www.edae.gr/dictionaries.html
www.medicinenet.com (then click on dictionary)
www.4woman.org/nwhic/references/dictionary.htm (on line med dictionaries and journals)
http://courses.smsu.edu/jas188f/690/medslpterm.html
http://www.thebody.com/treat/gloss.html

Lage Listing of Medical-Related Sites


http://www.sciencekomm.at/links/medicine.html














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