Searching Medline with Internet Grateful Med
by
Mel Heiman, MD

Living in the "information age" is empowering and yet at times frustrating.   Educational videos on demand, live surgical demos on your home computer, virtual medical meetings, and the advice and experience of the orthopaedic world is a reality.   Finding the information one needs is like looking for the proverbial "needle in a haystack" and unfortunately the haystack gets bigger every day.  Internet search will improve in speed and accuracy (See the Scientific American article on "clever" searching, entitled Hypersearching the Web), but for now Internet Grateful Med is useful for searching the literature, assuming that one is willing to spend a little time learning how to use the system.

There are other good search engines that help with specific needs. To limit your search to orthopaedic journals use OrthoGuide (http://www.orthoguide.com/ortho/), as it performs a Medline search using only an orthopaedic subset of journals. You may choose which journals to include and other limits may be set, i.e.. language, human studies and review articles.  By using PubMed one can fine tune a search by clicking on clinical queries and filtering by diagnosis, therapy, etiology or prognosis.   (See PubMed Workshop) Using Internet Grateful Med

Always log onto the system with this bookmark: (http://igm.nlm.nih.gov/).   There are useful instructions and examples posted on the basic web site (http://igm.nlm.nih.gov/splash/IGM.survival.guide.html). One may click on the blue "i" at the upper left of most screens to get context-sensitive help and then return to the search page.  Some simple search steps and examples:

1.  Choose Medline as data base (or other on the list if appropriate)

2.  Enter Query term.  Choose if subject, author, or title of paper. Keep subject choice as simple as possible and avoid and/or boxes at the start of your search.   Be sure radio button is on for your selection. [ not ]

3.  Click on "M" (find MeSH/Meta Terms) at bottom of page.

4.  Select concepts that match your search goals by clicking on select. Click on the hyper link (blue letters) to fine tune your selection (often useful).  If nothing makes sense you may need to reconsider and rephrase your subject query.

5.  If you access the hyper link, make your choice and then click on the green button to proceed.

6.  Now click on "select qualifiers" to focus search and choose by checking off the sub concepts most appropriate for your search.  Again you may click on any of the hyper links (blue) to further define your search.

7.  Click on "return to major concept screen" and click box "Must be major topic of citations".  Now you can click on "Return to search screen" You have defined your search subject as precisely as possible. Now proceed down the page and specify (by clicking on the arrows at each category and making a selection) languages, year range, choice of journals, etc.

8. Now you may click on bottom of page at left to "Perform Search".  If you find the desired articles you are lucky indeed.  If you can find one article close to the mark click on related articles and you will usually be successful.  If not one can return to the search screen and click on "Analyze Search" to get some further advice.

Examples:

Topic one: Surgical treatment of Perthe's disease

Enter femoral head as search topic and then click on mesh terms. Select Legge-Perthes Disease and then click "continue formulating search".  Click on qualifiers and select surgery.  Check box "Must be major topic of citations". Click on "return to search".  Note that the femoral head subject now has a * and includes qualifiers.  Set language english, study group human, all ages, 1980 or later, set publication type as review, both sexes, and all journals . Perform search and 2 papers are noted.  Click on related articles for Dr. Catterall's citation and find about 169 reasonable references. [the numbers will change as citations are added]

Topic two: Surgical repair of knee meniscus

Start with meniscus and click on mesh terms.  Choose concept: Menisci, tibial.
Click on select qualifiers and choose surgery and then click on "return to search screen".  Limits same as example #1. Perform search and get about 51 citations.  Select Dr. Ken Dehaven's review article (Meniscus repair,
DeHaven KE, Am J Sports Med. 1999 Mar-Apr;27(2):242-50). Click on related articles and find about107 references.

Topic three: Surgical approaches to revision of the femoral component in hip arthroplasty

Enter hip as search subject. Click mesh terms and select  hip arthroplasty as Major mesh term.  Click on "continue formulating search".  Click "select qualifiers to focus search" and check methods. Click on "return to major concept screen".  Check box "Must be major topic of citations" and then click "return to search screen".  Do search with limits unchanged and the result is c. 36 citations.  Find an article on extended trochanteric osteotomy (Extended proximal femoral osteotomy, Aribindi R, et al., Instr Course Lect. 1999;48:19-26) and click "related articles" with a return of c.102 fairly good references.

You may click on the box to the left of each paper of interest and the click on the "Fetch for Display" button to get a list of your favorites.  One may click on the "full citation" button to get an abstract if available. You may download your results and take to the office by clicking the "Download to Disk" button. One may also obtain papers of special interest using "Loansome Doc"(http://tendon.nlm.nih.gov/ld/loansome.html) by setting up an account with a participating library http://www.nlm.nih.gov/pubs/factsheets/loansome_doc.html).   Not all institutions will send the paper by E mail and the expense involved may vary considerably.  If are in the USA you can find a participating library at http://www.nlm.nih.gov/nno/nnohome.html
If you practice outside of the USA and Canada try http://www.nlm.nih.gov/ild/main.cfm.   Both CISTI (e-mail:
cisti.medlars@nrc.ca) and ZBMed (e-mail: Docline@zbmed.uni-koeln.de) offer this service worldwide.

One of the features of IGM is that your "visit" is registered and your path through the database is recorded. This rather Orwellian circumstance allows you to go back to the exact same search or indeed refer to it (by registrant number and number of pages visited) . Since it is an Orthogate principle that Internet work should perhaps be improved on but shouldn't have to be repeated, we could register literature searches as an ISOST service on the Orthogate site giving the date, the defining features of the search and the number of citations found plus the email address of the searcher. This work is so tedious that I never want to repeat it unless I have to! To register your search you have to say so at the beginning otherwise the "path" through the database will be lost when you sign off.

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