Handout on Searching the Orthopaedic Internet
by
Myles Clough, MD, DPhil

This material was first presented July 1999 at a workshop given at the Canadian Orthopaedic Association meeting in  St.Johns, Newfoundland. This is a transcription of the overheads and is provided as a reminder of what was discussed and a place to make notes. In addition, all Website addresses mentioned in the presentation are copied here. Note that some familiarity with using an Internet Browser (Internet Explorer) is assumed and that you can log on again without assistance if the Internet connection fails.

Orthopaedics on the Internet - Summary of presentation

1. Searching for good information

• Scope and depth of the Orthopaedic Internet
• Bibliographic Databases
• Internet Search Engines
• Workshop - undertaking real searches

2. Workshop

• Literature search - Medline
• Refined search of Medline
• Internet Search
• AltaVista
• OrthoSearch
• OWL

3. Scope of the Orthopaedic Internet

• Journal articles and abstracts
• Textbooks
• Illustrations
• Mailing Lists
• Case Presentations
• Patient Information
• Quackery/Misinformation/Advertising
• Vanity pages

4. Depth and Quality

Varies from erudite, well supported peer-reviewed material by authorities in the field
To
Dangerously misleading personal accounts and come-ons for untried treatment regimes.
However, it is probably true that somewhere on the Internet there is a piece of information in your field which you would be interested in - if only you could find it.

5. Medical Bibliographic Databases

Medline
http://www.ncbi.nlm.nih.gov/PubMed
Published world literature 

Search by author, title, keyword, MeSH heading
Restrict search by journals, dates, methodology etc.

Cochrane Reviews
http://www.update-software.com/ssweb/cochrane/revabstr/abidx.htm
Regularly updated reviews of subjects from the evidence based medicine point of view

EMBASE
http://www.healthgate.com/druginfo

Journal Tables of Contents ie. JBJS
http://www.jbjs.org/

6. What is the problem?

• Immense amounts of information and citations
• Literal searching
• Results in plethora of citations most of which are not relevant

7. Example

Gorhams Vanishing Bone Disease

• Medline Search using Gorham yields 6500 papers
• MeSH search shows that Gorhams disease is a synonym for Essential Osteolyis
• Search for Essential Osteolysis reveals 250 papers most of which are on the subject.

8. Background

• National Library of Medicine makes up Medline Database
• Enters citation, title, authors, keywords and MeSH classification
• Search looks for most recent papers with search string in the title, author list, keyword, same MeSH headings

9. MedLine Output

• Produces list of citations organized by date and match to your search string
• Since it will also bring up synonyms of your search string (= equivalent MeSH keywords) the list of citations can be unmanageably long
• As a result refinement of your search is a practical neccessity.

10. Refining Medline Searches

• Restrict to Orthopaedic journals - OrthoGuide
• Methodology Filter
• Boolean Logic

11. OrthoGuide http://www.orthoguide.com/ortho/

• Undertakes a Medline search using only an orthopaedic subset of the journals indexed by Medline.
• You can choose which journals you want
• Limit can be set - language, human studies and review articles.

12. Medline Methodology Filter

In PubMed ( http://www.ncbi.nlm.nih.gov/PubMed)

• Click on Clinical Queries
• Search can then be filtered with emphasis on
  • Diagnosis
  • Therapy
  • Aetiology
  • Prognosis
• And made either highly specific or highly sensitive.

13. Boolean Logic

Linking keywords by and, or, not
AND - both keywords must be present for the paper to be cited
OR - (default) the paper will be cited if either word is present
NOT - the paper will be cited if the first word is present and the second is not.

14. Refining the search

• Find the paper that is most relevant
• Click on [See Related Articles]
• If this helps it may be useful to repeat it with a different paper

15. Results of Medline Searching for Osteolysis 

- assuming an interest in failed hip replacements

• Simple PubMed search 3273
• Osteolysis and hip and arthroplasty 286
• Related articles 101
• Clinical query/aetiology/specific 9
• Orthoguide simple 826
• Orthoguide Human English Reviews 78
• Related articles 110

16. Other Medline tips

• Ask for 200 - 1000 citations per page if you are expecting a large number.
• Then you can use the browsers search facilty for finding the paper you want.
• Use MeSH terms wherever possible
• Limit by year of publication

17. Looking for Posted Material

• Major Search engines
• OrthoSearch
• Orthopaedic Web Links
• Other Portal sites

18. Major Search Engines

AltaVista http://www.altavista.com/  268 pages
Excite http://www.excite.com/  271
HotBot http://www.hotbot.com/  52
Yahoo http://www.yahoo.com/  478
Northern Light http://www.northernlight.com/   1427
Inference Find http://www.infind.com/     10
Google http://www.google.com/ 1035

19. Problems with search engines

• Huge number of sites
• Only a proportion of the sites actually on the Internet
• Sites can be and are designed to be attractive to search engines.
• Thus the search is biased to slick sites

20. Orthosearch http://www.orthosearch.com/ 

• Organized into 11 categories
• Osteolysis brought up 200 pages in the Journals category - mostly abstracts of journal articles

21. Orthopaedic Web Links OWL

• http://orthogate.org/owl
• Browsable collection of over 3000 links
• Over 40 different categories
• Part of the Orthogate Project
• Inherently impossible to keep up
• Some form of comprehensive guide to the Orthopaedic Internet is neccessary if quality assessment is to be done.

22. Searching the Orthopaedic Internet - Workshop

• Literature search.
• Please select a topic and conduct a Medline Search
• Refined search
• Internet Search
• AltaVista
• OrthoSearch
• OWL
• Save the result of your search to a disk

23. Textbooks

Wheeless Textbook of Orthopaedics http://www.medmedia.com/

WorldOrtho http://www.worldortho.com/

24. Illustrations & Image Banks

Orthopod Images
http://www.imagelib.telemed.co.uk/default.htm

Belfast Image Bank
http://os1.os.qub.ac.uk/catalogue/index.html

Trauma Image Bank
http://www.trauma.org/imagebank/imagebank.html

25. Mailing Lists

Archives + search engine

Orthopod
http://www.mailbase.ac.uk/lists/orthopod/archive.html

Hand
http://www.mailbase.ac.uk/lists/hand/archive.html

Arthroplasty
http://www.mailbase.ac.uk/lists/arthroplasty/archive.html

Spine
http://www.mailbase.ac.uk/lists/spine/archive.html

Sports Medicine
http://www.mailbase.ac.uk/lists/sportmedorth/archive.html

26. Case Presentations

Dupont Institute
http://gait.aidi.udel.edu/res695/homepage/pd_
ortho/educate/clincase/clcasehp.htm

GICD Case Studies in Spinal Instrumentation http://www.gicd.org/casestud.htm

Belgian Orthoweb Case Reports http://www.belgianorthoweb.be/cases_uk.htm

OWL http://orthogate.org/owl/casedisc.html

Orthopod Cases http://www.orthogate.org/orthopod/cases.htm

27. Patient Information

Southern California Orthopaedic Institute
http://www.scoi.com/

Orthogate Patient Education
http://patient.orthogate.org/

OWL Patient Information Pages

http://owl.orthogate.org/

28. Other links about searching

The "Clever" Project - Advanced Search strategy at IBM
Almaden Research Lab
http://www.almaden.ibm.com/cs/k53/clever.html

Scientific American review article about this

http://www.sciam.com/1999/0699issue/0699raghavan.html

Search Engine Watch
Contains information on the latest progress in search engines.
(http://www.searchenginewatch.com/ )

Google Search Engine
http://www.google.com/
(See the brief description of this search engine's strategy and comparison with Clever in
the Scientific American article above. )

How do I find information on...?:
A template for searching the Internet By Richard Kiley 

Part 1
http://www.wellcome.ac.uk/en/1/homlibinfacthiiarc6fnd.htm

Part 2
http://www.wellcome.ac.uk/en/1/homlibinfacthiiarc7fnd.htm