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This resource review evaluates the “clinical queries” function of PubMed, a component of the Medline search interface developed by the National Center for Biotechnology Information, a division of the National Library of Medicine (NLM). PubMed is a free, web based, public Medline search interface developed in cooperation with biomedical literature publishers to facilitate access to literature citations and linkages to full text journals at the web sites of participating publishers. This review considered the following clinical scenario:
A 62 year old man presents for routine follow up of hypogonadism. After an attempt at transdermal patch treatment resulted in excessive skin irritation, he has been receiving periodic testosterone enanthate injections. He recently heard about a testosterone gel preparation that would be more convenient for him, and wonders if it would be an effective alternative. You conduct a quick search to find information from well designed studies.
One benefit of PubMed is its ability to yield productive searches without requiring familiarity with the Medical Subject Heading (MeSH) vocabulary that is the basis of Medline citation indexing. The clinical queries function extends this benefit by filtering retrieval to a smaller subset of methodologically sound studies meeting evidence-based standards in 4 categories relevant to adult general medicine: treatment, diagnosis, aetiology, and prognosis. The search filters are largely based on the work of Haynes et al,1 in which various combinations of text words and MeSH terms are combined to optimise retrieval of methodologically sound clinical studies. Balancing the number and relevance of citations across a wide variety of clinical topics is accomplished by allowing searches that are more sensitive (more relevant citations but more that are less relevant) or more specific (fewer retrieved citations, but more likely to be relevant). The operating characteristics of these search filters are available at the PubMed web site (http://www.ncbi.nlm.nih.gov/entrez/query/static/clinicaltable.html).
For the scenario above, the clinical queries function was used to search using the term “testosterone gel,” and selecting “therapy” and “specificity.” 5 citations were retrieved, the first a relevant randomised controlled trial (RCT) showing improved sexual function, mood, muscle strength, and body composition values in hypogonadal men treated with transdermal testosterone gel. No link to full text was available from the publisher. 3 of the citations dealt with studies in women, and 1 in boys. Use of the “related articles” button for the first citation revealed 101 additional citations; several appearing on the first screen also represented relevant RCTs. When the search was repeated with an emphasis on “sensitivity,” 31 citations were obtained, with additional relevant citations but also others dealing with less relevant issues including basic mechanisms, pharmacokinetics, specific patient populations, animal studies, and in vitro effects.
The clinical queries feature of PubMed is a useful resource for rapidly filtering and displaying methodologically sound and clinically relevant citations on treatment, diagnosis, aetiology, and prognosis from the Medline database. It has considerable utility for busy clinicians needing rapid access to original study data to support clinical decisions. Among its limitations are the incomplete access to full text articles and the lack of a critical appraisal component for selected citations.
Ratings for this resource
Methods/Quality of information: ★★★★★
The research staff at McMaster University in Canada has undertaken a study funded by the NLM to update and expand on the methodological search filters found in the clinical queries function of PubMed. Search filters will be developed and validated for a greater number of purpose categories, including treatment/quality improvement, diagnosis, prognosis, aetiology, clinical prediction guides, economics, and qualitative studies (7 v 4 categories in the previous study); and by handsearching a larger journal set to establish the gold standard (172 v 10 journal titles in the previous study). Handsearching of the 172 journal titles is underway. Aside from Medline, methodological search filters will be developed for EMBASE/Excerpta Medica, PsycLIT, and CINAHL. Look for the results of this endeavour in the latter part of 2001.