Getting Help With PubMed
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General Information from NLM:
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(colistin OR colistimethate) AND (critical care OR intensive care OR intensive care unit OR critical illness OR ICU) (link to these search results)
colistin[mh] OR colistin[tiab] OR colistin[substance name] OR colistimethate[tiab] OR colistimethate[substance name]) AND (Acinetobacter[mh] OR Acinetobacter infections[mh] OR Acinetobacter[tiab]) AND (pneumonia[tiab] OR pneumonia[mh]) (link to these search results)The first search fails to retrieve approximately two-thirds of the citations retrieved by the search focused on Acinetobacter pneumonia, a striking lack of overlap that may have a significant impact on the search results you might provide the requestor with. Refining the query with a few quick follow-up questions for the clinician can enable a much more productive and efficient, and likely much more relevant, searching process.
To continue with the topic of locating and assessing background resources for the clinical question, it may be useful to explore the appropriateness of a resource such as Wikipedia. The relevance and quality/reliability of Wikipedia entries are issues that are likely of central interest to the larger health sciences library community. This clinical case presents an opportunity to take a look at the type of medical information present in Wikipedia. To get a quick snapshot, let’s look at the first five medical concepts presented in Table 1 of the case study.
Respiratory failure -- this entry is a stub, i.e. “too short to provide encyclopedic coverage” of the topic. The entry describe two types of respiratory failure, causes, and one sentence on treatment. While the entries that are linked to for the causes tend to be fairly lengthy and descriptive, with links to external references, this particular entry is not clinically useful as the information presented is sparse and not clinically detailed.
Ventilator-associated pneumonia (VAP) – a more in-depth entry than Respiratory Failure, discussing the symptoms and signs, diagnosis, pathophysiology, microbiology, treatment, prevention and epidemiology and prognosis of VAP. For the purposes of background reading to understand this medical concept, there seems to be enough information to obtain a clear "picture" of the condition. Ideally, we might prefer to see more external references than just the ATS/IDSA Guidelines, but these guidelines are a concrete start. Also, the guidelines are available with free full-text online, but that link is not yet included in the entry. Interestingly enough, the last change made to the article as of this posting was removing its status as a stub. Quite a difference between the respiratory failure and this one.
Acinetobacter – the length of this entry is between that of the entry for respiratory failure and that for VAP. The entry describes at the basic level the identification, description, and treatment for the organism. The treatment section does state the success of colistin for treatment, it but no external reference is provided for independent verification. One section of the entry is marked as needing considerable re-write. Two of the references listed link to PubMed.
Chronic Liver Failure w/ Hepatic Encephalopathy – The entry for Liver Failure is two paragraphs long, with four references provided. It clearly lacks the needed information in context to the clinical question. Not categorized as a stub, but perhaps is should be?
Typing in “chronic liver failure” leads the user to the “Liver Failure” entry discussed above; there is also a separate entry for hepatic encephalopathy. The HE entry fares somewhat better in a quick evaluation than some of the other entries - this entry is accurate in its description of the condition; however, only pathogenesis, grading and treatment are briefly covered. The latest substantive edit was in February 2006 to correct a statement on the effectiveness of lactulose, and a reference is provided. However, the very next paragraph indicates the decline of the use of Neomycin, with no external references to support the statement.
Bronchoscopy - - the importance of the bronchoscopy for this case is essentially to understand the basics of the procedure if unfamiliar, and this entry meets that need. While the entry is not lengthy, it is of sufficient details to understand the aspects involved – including a link to an image from a public-domain website. And look! The references include a link to MedlinePlus articles.
Preliminary conclusions: Even this brief snapshot of Wikipedia has utility for understanding the issues involved in a resource that allows anyone to edit the content. These issues are commonly heard when the topic of Wikipedia arises, and in the particular context of medicine - unsupported statements, widely varying level of detail, and problems with clinical relevance or direct applicability to clinical questions, such as the one explored by this case, will need to be carefully considered.
Additional general commentary on Wikipedia:
- "The Faith Based Encyclopedia," written by a former Brittanica editor-in-chief
- "Internet Encyclopedias Go Head to Head," from Nature; this has been disputed and fairly widely discussed online
- "Can Wikipedia conquer expertise?," from the New Yorker