Level of Evidence as a Future Gold Standard for the Content Quality of Health Resources on the Internet

Objective: An assessment of the quality of health information on the Internet is an absolute necessity. In this study ‘sensitive’ information was defined as information found in documents published on the Internet, which could be used in a medical decision. For sensitive information, the main criterion chosen for the quality of the information was an indication of the level of evidence. A survey was conducted using the CISMeF health catalogue to assess how often a score of the level of evidence is mentioned in the information accessible on the Internet in French-language health resources.

Methods: Since 1999, members of the CISMeF team have systematically been searching for all documents containing ‘sensitive’ information and verifying whether the level of evidence was explicitly indicated as a score at least once in the document.

Results: As of June 2001, 10,190 resources were included in CISMeF; including 2964 textual ‘sensitive’ resources (29.1%). Out of all these resources, only 4.7% (95% confidence interval: 4.0 - 5.5%) indicated the level of evidence. A statistically significant difference in the prevalence of indicating the level of evidence according to resource types (e.g., 18.1% for guidelines compared to 0.0% for teaching material), year of publication (almost three times greater in 1997-2001 compared with 1990-1996) and publishers was observed.

Conclusion: As the number of people accessing the growing amount of information on the Internet is increasing daily, publishers have an ethical obligation to inform their readers about the validity of ‘sensitive’ information their sites contain. However, the vast majority of the French language Internet resources that were surveyed do not mention a score of the level of evidence for their sensitive information.

CISMeF: A Structured Health Resource Guide

In 1999, the Internet has become a major source of health information. The objective of CISMeF is to catalogue and index the main French-speaking health resources. In September 1999, the number of indexed resources totaled over 7,100 with a mean of 75 new sites per week. CISMeF uses two standard tools for organizing information: the Medline bibliographic database MeSH thesaurus and the Dublin Core metadata format. Resources included in CISMeF are described by the following: title, author or creator, subject and keywords, description, publisher, date, resource type, format, identifier, and language. To index resources, CISMeF uses five levels of hierarchy: “meta-term”, category, keyword, subheading, and resource type. CISMeF contains a thematic index, including medical specialities and an alphabetic index. CISMeF respects the Net Scoring, criteria to assess the quality of health information on the Internet. The CISMeF project offers a valuable tool for the French-speaking health community: 2,500 computer users visit the Web site each working day.

Interoperable atlases of the human brain

The last two decades have seen an unprecedented development of human brain mapping approaches at various spatial and temporal scales. Together, these have provided a large fundus of information on many different aspects of the human brain including micro- and macrostructural segregation, regional specialization of function, connectivity, and temporal dynamics. Atlases are central in order to integrate such diverse information in a topographically meaningful way. It is noteworthy, that the brain mapping field has been developed along several major lines such as structure vs. function, postmortem vs. in vivo, individual features of the brain vs. population-based aspects, or slow vs. fast dynamics. In order to understand human brain organization, however, it seems inevitable that these different lines are integrated and combined into a multimodal human brain model. To this aim, we held a workshop to determine the constraints of a multi-modal human brain model that are needed to enable (i) an integration of different spatial and temporal scales and data modalities into a common reference system, and (ii) efficient data exchange and analysis. As detailed in this report, to arrive at fully interoperable atlases of the human brain will still require much work at the frontiers of data acquisition, analysis, and representation. Among them, the latter may provide the most challenging task, in particular when it comes to representing features of vastly different scales of space, time and abstraction. The potential benefits of such endeavor, however, clearly outweigh the problems, as only such kind of multi-modal human brain atlas may provide a starting point from which the complex relationships between structure, function, and connectivity may be explored.

Performance evaluation of Unified Medical Language System®'s synonyms expansion to query PubMed

BACKGROUND

PubMed is the main access to medical literature on the Internet. In order to enhance the performance of its information retrieval tools, primarily non-indexed citations, the authors propose a method: expanding users' queries using Unified Medical Language System' (UMLS) synonyms i.e. all the terms gathered under one unique Concept Unique Identifier.

METHODS

This method was evaluated using queries constructed to emphasize the differences between this new method and the current PubMed automatic term mapping. Four experts assessed citation relevance.

RESULTS

Using UMLS, we were able to retrieve new citations in 45.5% of queries, which implies a small increase in recall. The new strategy led to a heterogeneous 23.7% mean increase in non-indexed citation retrieved. Of these, 82% have been published less than 4 months earlier. The overall mean precision was 48.4% but differed according to the evaluators, ranging from 36.7% to 88.1% (Inter rater agreement was poor: kappa = 0.34).

CONCLUSIONS

This study highlights the need for specific search tools for each type of user and use-cases. The proposed strategy may be useful to retrieve recent scientific advancement.

Markov models for fMRI correlation structure: Is brain functional connectivity small world, or decomposable into networks?

Correlations in the signal observed via functional Magnetic Resonance Imaging (fMRI), are expected to reveal the interactions in the underlying neural populations through hemodynamic response. In particular, they highlight distributed set of mutually correlated regions that correspond to brain networks related to different cognitive functions. Yet graph-theoretical studies of neural connections give a different picture: that of a highly integrated system with small-world properties: local clustering but with short pathways across the complete structure. We examine the conditional independence properties of the fMRI signal, i.e. its Markov structure, to find realistic assumptions on the connectivity structure that are required to explain the observed functional connectivity. In particular we seek a decomposition of the Markov structure into segregated functional networks using decomposable graphs: a set of strongly-connected and partially overlapping cliques. We introduce a new method to efficiently extract such cliques on a large, strongly-connected graph. We compare methods learning different graph structures from functional connectivity by testing the goodness of fit of the model they learn on new data. We find that summarizing the structure as strongly-connected networks can give a good description only for very large and overlapping networks. These results highlight that Markov models are good tools to identify the structure of brain connectivity from fMRI signals, but for this purpose they must reflect the small-world properties of the underlying neural systems.

Evaluation of multi-terminology super-concepts for information retrieval

BACKGROUND

Following a recent change in the indexing policy for French quality controlled health gateway CISMeF, multiple terminologies are now being used for indexing in addition to MeSH®.

OBJECTIVE

To evaluate precision and recall of super-concepts for information retrieval in a multi-terminology paradigm compared to MeSH-only.

METHODS

We evaluate the relevance of resources retrieved by multi-terminology super-concepts and MeSH-only super-concepts queries.

RESULTS

Recall was 8-14% higher for multi-terminology super-concepts compared to MeSH only super-concepts. Precision decreased from 0.66 for MeSH only super-concepts to 0.61 for multi-terminology super-concepts. Retrieval performance was found to vary significantly depending on the super-concepts (p<10^-4) and indexing methods (manual vs automatic; p<0.004).

CONCLUSION

A multi-terminology paradigm contributes to increase recall but lowers precision. Automated tools for indexing are not accurate enough to allow a very precise information retrieval.

Health multi-terminology portal: a semantic added-value for patient safety

Since the mid-90s, several quality-controlled health gateways were developed. In France, CISMeF is the leading health gateway. It indexes Internet resources from the main institutions, using the MeSH thesaurus and the Dublin Core metadata element set. Since 2005, the CISMeF Information System (IS) includes 24 health terminologies, classifications and thesauri for indexing and information retrieval. This work aims at creating a Health Multi-Terminology Portal (HMTP) and connect it to the CISMeF Terminology Database mainly for searching concepts and terms among all the health controlled vocabularies available in French (or in English and translated in French) and browsing it dynamically. To integrate the terminologies in the CISMeF IS, three steps are necessary: (1) designing a meta-model into which each terminology can be integrated, (2) developing a process to include terminologies into the HMTP, (3) building and integrating existing and new inter-terminology mappings into the HMTP. A total of 24 terminologies are included in the HMTP, with 575,300 concepts, 852,000 synonyms, 222,800 definitions and 1,180,000 relations. Heightteen of these terminologies are not included yet in the UMLS among them, some from the World Health Organization. Since January 2010, HMTP is daily used by CISMeF librarians to index in multi-terminology mode. A health multiterminology portal is a valuable tool helping the indexing and the retrieval of resources from a quality-controlled patient safety gateway. It can also be very useful for teaching or performing audits in terminology management.

Robust clustering of massive tractography datasets

This paper presents a clustering method that detects the fiber bundles embedded in any MR-diffusion based tractography dataset. Our method can be seen as a compressing operation, capturing the most meaningful information enclosed in the fiber dataset. For the sake of efficiency, part of the analysis is based on clustering the white matter (WM) voxels rather than the fibers. The resulting regions of interest are used to define subset of fibers that are subdivided further into consistent bundles using a clustering of the fiber extremities. The dataset is reduced from more than one million fiber tracts to about two thousand fiber bundles. Validations are provided using simulated data and a physical phantom. We see our approach as a crucial preprocessing step before further analysis of huge fiber datasets. An important application will be the inference of detailed models of the subdivisions of white matter pathways and the mapping of the main U-fiber bundles.

Optimization of the PubMed Automatic Term Mapping

PubMed, freely available on the internet, is the best known database for medical information. We propose a method of optimization of the PubMed Automatic Term Mapping (ATM) that includes MeSH terms. This method is evaluated using two queries constructed to emphasize the differences between the PubMed queries as they are at present and also between these queries and the optimized one. The proposed query is significantly more precise than the current PubMed query (54.5% vs. 27%). The optimized query proposed would be easy to implement into PubMed.

French Infobutton: an academic and business perspective

Infobuttons are context-specific links between clinical information systems and other online information resources. The objective of this study is to describe a French Infobutton, which will be sold in the French-speaking Health Information market.

[Quality and use of websites presenting public health education and training opportunities]

The objective of this work was to study the use of the Internet and the quality of the websites for postgraduate public health courses in France, and to compare them with equivalent courses in the United States of America. Between June 2004 and January 2005, the authorized public health diplomas proposed in France and in the United States were inventoried and listed, and then all websites of these public health diplomas were systematically visited and reviewed using a standardized questionnaire. In France, 36 public health courses (7 post graduate diplomas [DEA], 13 Masters degrees [DESS] and 16 masters of public health [MPH]) were identified and selected from 53 websites. Information on student profiles, prerequisite skills, the courses' curricula and program descriptions and the potential career opportunities were more frequently available for the MPH compared to the DEA and DESS. In United States, 66 MPH and 127 Master of Science in Public Health (MSPH) programs were accredited. The target public and validation methods were more often indicated on the American sites, while the prerequisite skills were more frequently found on the French sites. The recent implementation of the LMD (Bachelor's-Masters-Doctoral degrees) education system in France has encouraged the utilisation of Internet as an information and communications tool for the presentation and marketing of these new diplomas.

Cataloguing and displaying Web feeds from French language health sites: a Web 2.0 add-on to a health gateway

Among the numerous new functionalities of the Internet, commonly called Web 2.0, Web syndication illustrates the trend for better and faster information sharing. Web feeds (a.k.a RSS feeds), which were used mostly on weblogs at first, are now also widely used in academic, scientific and institutional websites such as PubMed. As very few French language feeds were listed or catalogued in the Health field by the year of 2007, it was decided to implement them in the quality-controlled health gateway CISMeF ([French] acronym for Catalogue and Index of French Language Health Resources on the Internet). Furthermore, making full use of the nature of Web syndication, a Web feed aggregator was put online in to provide a dynamic news gateway called "CISMeF actualités" (http://www.chu-rouen.fr/actualites/). This article describes the process to retrieve and implement the Web feeds in the catalogue and how its terminology was adjusted to describe this new content. It also describes how the aggregator was put online and the features of this news gateway. CISMeF actualités was built accordingly to the editorial policy of CISMeF. Only a part of the Web feeds of the catalogue were included to display the most authoritative sources. Web feeds were also grouped by medical specialties and by countries using the prior indexing of websites with MeSH terms and the so-called metaterms. CISMeF actualités now displays 131 Web feeds across 40 different medical specialities, coming from 5 different countries. It is one example, among many, that static hypertext links can now easily and beneficially be completed, or replaced, by dynamic display of Web content using syndication feeds.

Use of super-concepts to customize electronic medical records data display

Patient medical record systems (MRS) merely offer static applications, in which mostly unstructured text is linked to coded data. In these applications the more common presentation is a time oriented one, which does not allow easily for data and information retrieval. Concept oriented views based on supper-concepts (metaterms) initially defined in CISMeF to optimize Web medical search, was implemented in our MRS as specialties views. This work shows that these terminological tools are able to facilitate information retrieval.

French MeSH Browser: a cross-language tool to access MEDLINE/PubMed

When searching the medical literature, health professionals and lay people strongly prefer to use their native language. Therefore, Medical Subject Headings (MeSH) translations would be helpful to those who are not fluent in English to access scientific papers indexed in the MEDLINE bibliographic database. Furthermore, medical terminologies such as MeSH are challenging in any language. In this context, a French MeSH Browser was developed.

Evaluation of meta-concepts for information retrieval in a quality-controlled health gateway

BACKGROUND

CISMeF is a French quality-controlled health gateway that uses the MeSH thesaurus. We introduced two new concepts, metaterms (medical specialty which has semantic links with one or more MeSH terms, subheadings and resource types) and resource types.

OBJECTIVE

Evaluate precision and recall of metaterms.

METHODS

We created 16 pairs of queries. Each pair concerned the same topic, but one used metaterms and one MeSH terms. To assess precision, each document retrieved by the query was classified as irrelevant, partly relevant or fully relevant.

RESULTS

The 16 queries yielded 943 documents for metaterm queries and 139 for MeSH term queries. The recall of MeSH term queries was 0.44 (compared to 1 for metaterm queries) and the precision were identical for MeSH term and metaterm queries.

CONCLUSION

Metaconcept such as CISMeF metaterms allows a better recall with a similar precision that MeSH terms in a quality controlled health gateway.

An introduction to the Semantic Web for health sciences librarians

OBJECTIVES

The paper (1) introduces health sciences librarians to the main concepts and principles of the Semantic Web (SW) and (2) briefly reviews a number of projects on the handling of biomedical information that uses SW technology.

METHODOLOGY

The paper is structured into two main parts. "Semantic Web Technology" provides a high-level description, with examples, of the main standards and concepts: extensible markup language (XML), Resource Description Framework (RDF), RDF Schema (RDFS), ontologies, and their utility in information retrieval, concluding with mention of more advanced SW languages and their characteristics. "Semantic Web Applications and Research Projects in the Biomedical Field" is a brief review of the Unified Medical Language System (UMLS), Generalised Architecture for Languages, Encyclopedias and Nomenclatures in Medicine (GALEN), HealthCyberMap, LinkBase, and the thesaurus of the National Cancer Institute (NCI). The paper also mentions other benefits and by-products of the SW, citing projects related to them.

DISCUSSION AND CONCLUSIONS

Some of the problems facing the SW vision are presented, especially the ways in which the librarians' expertise in organizing knowledge and in structuring information may contribute to SW projects.

A web-based teaching resource to prepare for final undergraduate examination: a French pilot study

Access to accurate and quality-controlled health information on the Internet for medical students is not an easy task. CISMeF is the search tool of a MeSH-indexed directory of medical Internet resources in French. Since 2004, a new French Pre-Residency Examination (PRE) is compulsory for all medical students in the 6th year of the curriculum. The goal of this study is to evaluate CISMeF as a tool to provide teaching resources available on the Internet covering PRE material. The CISMeF terminology and the PRE CISMeF module are described. To assess the CISMeF performance in covering PRE program, its precision (number of relevant resources/number of overall resources extracted by CISMeF) and coverage (number of PRE questions covered by at least one resource in the CISMeF gateway) were computed. The CISMeF module for the new French Pre-Residency Examination is efficient as it already covers 95.7% of the program with a precision of 82.2%. Our data demonstrates that CISMeF is acceptable to guide students' learning and should be a useful teaching resource for the preparation of the French Pre-Residency Examination.

A MEDLINE categorization algorithm

Background

Categorization is designed to enhance resource description by organizing content description so as to enable the reader to grasp quickly and easily what are the main topics discussed in it. The objective of this work is to propose a categorization algorithm to classify a set of scientific articles indexed with the MeSH thesaurus, and in particular those of the MEDLINE bibliographic database. In a large bibliographic database such as MEDLINE, finding materials of particular interest to a specialty group, or relevant to a particular audience, can be difficult. The categorization refines the retrieval of indexed material. In the CISMeF terminology, metaterms can be considered as super-concepts. They were primarily conceived to improve recall in the CISMeF quality-controlled health gateway.

Methods

The MEDLINE categorization algorithm (MCA) is based on semantic links existing between MeSH terms and metaterms on the one hand and between MeSH subheadings and metaterms on the other hand. These links are used to automatically infer a list of metaterms from any MeSH term/subheading indexing. Medical librarians manually select the semantic links.

Results

The MEDLINE categorization algorithm lists the medical specialties relevant to a MEDLINE file by decreasing order of their importance. The MEDLINE categorization algorithm is available on a Web site. It can run on any MEDLINE file in a batch mode. As an example, the top 3 medical specialties for the set of 60 articles published in BioMed Central Medical Informatics & Decision Making, which are currently indexed in MEDLINE are: information science, organization and administration and medical informatics.

Conclusion

We have presented a MEDLINE categorization algorithm in order to classify the medical specialties addressed in any MEDLINE file in the form of a ranked list of relevant specialties. The categorization method introduced in this paper is based on the manual indexing of resources with MeSH (terms/subheadings) pairs by NLM indexers. This algorithm may be used as a new bibliometric tool.

Level of evidence as a future gold standard for the content quality of health resources on the internet

OBJECTIVE

An assessment of the quality of health information on the Internet is an absolute necessity. In this study 'sensitive' information was defined as information found in documents published on the Internet, which could be used in a medical decision. For sensitive information, the main criterion chosen for the quality of the information was an indication of the level of evidence. A survey was conducted using the CISMeF health catalogue to assess how often a score of the level of evidence is mentioned in the information accessible on the Internet in French-language health resources.

METHODS

Since 1999, members of the CISMeF team have systematically been searching for all documents containing 'sensitive' information and verifying whether the level of evidence was explicitly indicated as a score at least once in the document.

RESULTS

As of June 2001, 10,190 resources were included in CISMeF; including 2964 textual 'sensitive' resources (29.1%). Out of all these resources, only 4.7% (95% confidence interval: 4.0 - 5.5%) indicated the level of evidence. A statistically significant difference in the prevalence of indicating the level of evidence according to resource types (e.g., 18.1% for guidelines compared to 0.0% for teaching material), year of publication (almost three times greater in 1997-2001 compared with 1990-1996) and publishers was observed.

CONCLUSION

As the number of people accessing the growing amount of information on the Internet is increasing daily, publishers have an ethical obligation to inform their readers about the validity of 'sensitive' information their sites contain. However, the vast majority of the French language Internet resources that were surveyed do not mention a score of the level of evidence for their sensitive information.

Metadata element set in a quality-controlled subject gateway: a step to a health semantic Web

BACKGROUND

Quality-controlled subject gateways are Internet services which apply a selected set of targeted measures to support systematic resource discovery. Considerable manual effort is used to process a selection of resources which meet quality criteria and to display a extensive description and indexing of these resources with standards-based metadata.

OBJECTIVE

Several metadata element sets are proposed to describe, index and quality health resources to be included in a French quality-controlled health gateway called CISMeF. The main objectives were to enhance Internet health document retrieval and navigation, and to allow interoperability with other Internet services.

RESULTS

The Dublin Core metadata element set is used to describe and index all Internet health resources included in CISMeF. For teaching resources, some elements from IEEE1484 Learning Object Metadata are also used. For evidenced-base medicine resources, specific metadata are employed which assess the health content quality. The HIDDEL metadata set is used to enhance transparency, trust and quality of health information on the Internet.

CONCLUSION

Comprehensive metadata element sets can be extremely useful to describe, index and assess health resources on the Internet in a quality-controlled subject gateway. Machine-readable metadata creates an Semantic Web which is more efficient for end-users as compared to the current Web.

Reading factor: a bibliometric tool to manage a virtual library

Among the many bibliometric criteria used to evaluate biomedical journals, the impact factor is the most commonly used. Despite its limitations, it quantifies the influence of a journal on secondary publications. It does not however evaluate the practical usefulness of primary documents. Usefulness is field-related and varies greatly among specialities. We introduce a new bibliographic criterion, the "reading factor", and define it as the ratio between the number of electronic consultations of a particular journal (i.e., number of clicks on a hyper-link) and the mean number of electronic consultations of all the journals studied (itself calculated by dividing the total number of electronic accesses by the number of journals in the database). We describe its observed distribution, relative to that of the impact factor, based on electronic consultation records from our University Hospital medical digital library, where full-text electronic versions of 45 major biomedical journals have been available since December 1997. From this analysis we found no correlation between the 1999 reading factor and the 1998 impact factor of these 45 journals, and we observed a dramatic change in the hierarchy of journals upon using the reading factor as the yardstick rather than the impact factor. Moreover, we describe how using the reading factor has helped in managing the collection of our University Hospital's virtual library. The selection of journals to be discarded from the virtual library for the year 2001 was based on journals' RF values and this process will repeated over the coming years. The reading factor also permits a cost-analysis of a virtual library.

CONCLUSION

The measurement of the reading factor is highly automated, practical and efficient. It appears as a new tool for electronic collection management by librarians, well fitting with economical data.

Doc'CISMEF: a search tool based on "encapsulated" MeSH thesaurus

In the year 2000, the Internet became a major source of health information for the health professional and the Netizen. The objective of Doc'CISMeF (D'C) was to create a powerful generic search tool based on an structured information model which â encapsulates' the MeSH thesaurus to index and retrieve quality health resources on the Internet. To index resources, D'C uses four sections in its information model: 'meta-term', keyword, subheading, and resource type. Two search options are available: simple and advanced. The simple search requires the end-user to input a single term or expression. If this term belongs to the D'C information structure model, it will be exploded. If not, a full-text search is performed. In the advanced search, complex searches are possible combining Boolean operators with meta-terms, keywords, subheadings and resource types. D'C uses two standard tools for organising information: the MeSH thesaurus and the Dublin Core metadata format. Resources included in D'C are described according to the following elements: title, author or creator, subject and keywords, description, publisher, date, resource type, format, identifier, and language.

Webmastering in academic institutions: a new job opportunity

In cyberspace, the health webmaster could be regarded as a virtual editor-in-chief, in charge of content and design. In this circumstance, he/she must follow quality criteria when building any resource. At the Rouen University Hospital (RUH), we have chosen "Net Scoring" as an effective tool to aid the design of a quality Web site. "Net Scoring" contains a list of 49 criteria which fall into eight categories: credibility, content, links, design, interactivity, quantitative aspects, ethics, and accessibility. The webmaster is the key element of the editorial board process. He/she must regularly monitor the Web site in order to retrieve information about whether the site is used and by whom: the method most commonly used is log analysis. At the RUH, an average of 9,000 unique machines visit our Web site each working day. Webmaster is a new job opportunity in academic institutions, in particular for medical informaticians and medical librarians both whom are information science professionals.

Cost effectiveness of a medical digital library

The rapid increase in the price of electronic journals has made the optimization of collection management an urgent task. As there is currently no standard procedure for the evaluation of this problem, we applied the Reading Factor (RF), an electronically computed indicator used for consultation of individual articles. The aim of our study was to assess the cost effective impact of modifications in our digital library (i.e. change of access from the Intranet to the Internet or change in editorial policy). The digital OVID library at Rouen University Hospital continues to be cost-effective in comparison with the interlibrary loan costs. Moreover, when electronic versions are offered alongside a limited amount of interlibrary loans, a reduction in library costs was observed.

A search tool based on 'encapsulated' MeSH thesaurus to retrieve quality health resources on the internet

In the year 2001, the Internet has become a major source of health information for the health professional and the Netizen. The objective of Doc' CISMeF (D'C) was to create a powerful generic search tool based on a structured information model which 'encapsulates' the MeSH thesaurus to index and retrieve quality health resources on the Internet. To index resources, D'C uses four sections in its information model: 'meta-term', keyword, subheading, and resource type. Two search options are available: simple and advanced. The simple search requires the end-user to input a single term or expression. If this term belongs to the D'C information structure model, it will be exploded. If not, a full-text search is performed. In the advanced search, complex searches are possible combining Boolean operators with meta-terms, keywords, subheadings and resource types. D'C uses two standard tools for organising information: the MeSH thesaurus and the Dublin Core metadata format. Resources included in D'C are described according to the following elements: title, author or creator, subject and keywords, description, publishers, date, resource type, format, identifier, and language.

How to select publications on occupational health: the usefulness of Medline and the impact factor

OBJECTIVES

Publications in the field of occupational health appear in various journals, including those of other medical specialties. This complicates the follow up of literature for specialists in this field. On the basis of Medline and the impact factor, this diversity was assessed, and a cost effective method for selecting the most pertinent journals in the practice of occupational health was proposed.

METHODS

A Medline search identified all the articles published in 1998 with occupational diseases or occupational exposures as the main topic. These articles were classified based on the journals in which they appeared. The journals were then compared according to their subject area, the number of articles that were published in the fields studied, and their impact factor.

RESULTS

The search retrieved 2247 articles, published in 577 different journals in 1998. Each journal published between one and 105 articles during this period (mean 3.89). However, only 1.4% of the journals accounted for more than 25% of the total articles published. More than half of the articles were published in journals dealing with general practice or medical specialties other than occupational health. Only 66% of retrieved journals had an impact factor, and more than 80% of the articles were published in journals with an impact factor <2.

CONCLUSION

Simply following up occupational health journals is not sufficient to meet the requirements of the occupational health professional. Moreover, the use of the impact factor cannot be considered as a reliable research tool to assess follow up. Two lists of eight and 38 journals were thus set up. They permit a literature coverage of 27% and 52% respectively in the specific fields studied, and this seems to be the optimal compromise between time and literature covered. Lastly, practical procedures are suggested to follow up literature and obtain abstracts from selected journals on the internet.

A study comparing centralized CD-ROM and decentralized intranet access to MEDLINE

OBJECTIVE

The purpose of this study was to evaluate the efficacy of a decentralized intranet access in each medical department as opposed to centralized unique MEDLINE access in the medical library.

DESIGN

A two-phase questionnaire to evaluate MEDLINE use was given to junior and senior physicians at Rouen University Hospital (RUH). Phase I (August-October 1996) corresponded to a time period when centralized access was the only means of access available and phase II (August-October 1997) to a time period following the introduction of decentralized intranet access.

RESULTS

A total of 168 physicians filled out at least one phase of the questionnaire, among whom 123 (73%) filled out both phases. Use of MEDLINE significantly increased in 1997 (average of 10.2+/-1.1 searches in three months) versus 1996 (average of 4.9+/-0.7 searches in three months, P<0.0001). The aim of searches changed, becoming significantly more care oriented in phase II (P<0.0001). The number of searches performed by the physicians alone increased (P<0.0001) and searches performed by the librarian decreased (P<0.0001) in phase II. The method of searches also changed, as searches by author (P< 0.0001), by journal (P = 0.0042), and by free word (P = 0.0027) increased in phase II. Knowledge of the following concepts of MEDLINE significantly increased: explosion (P<0.0001), scope note (P<0.0001), Abridged Index Medicus (AIM) journals (P<0.0001), Medical Subject Headings (MeSH) qualifier (P<0.0001), and focus (P<0.0001).

CONCLUSION

A decentralized intranet access to MEDLINE increased the number of searches and knowledge of this bibliographic database. MEDLINE intranet access modified the purpose and the methods of searching.

CISMeF: cataloque and index of French speaking health resources

In 1999, the Internet has become a major source of health information. The objective of CISMeF is to catalogue and index the main French-speaking sites and documents concerning health. Currently, the number of resources already totalled over 6,100 with a mean of 75 new sites each week. CISMeF contains a thematic index, including medical specialities and an alphabetic index. CISMeF uses two standard tools for organising information: the MeSH (Medical Subject Heading) thesaurus from the Medline bibliographic database (National Library of Medicine) and the Dublin Core metadata format. A brief description of the site is systematically added. CISMeF respects the Net Scoring, criteria to assess the quality of health information on the Internet. The CISMeF project fulfils a valuable tool for the French-speaking health community: 2,500 machines visit the Web site each working day.

CISMeF: a structured health resource guide

In 1999, the Internet has become a major source of health information. The objective of CISMeF is to catalogue and index the main French-speaking health resources. In September 1999, the number of indexed resources totaled over 7,100 with a mean of 75 new sites per week. CISMeF uses two standard tools for organizing information: the Medline bibliographic database MeSH thesaurus and the Dublin Core metadata format. Resources included in CISMeF are described by the following: title, author or creator, subject and keywords, description, publisher, date, resource type, format, identifier, and language. To index resources, CISMeF uses five levels of hierarchy: "meta-term", category, keyword, subheading, and resource type. CISMeF contains a thematic index, including medical specialities and an alphabetic index. CISMeF respects the Net Scoring, criteria to assess the quality of health information on the Internet. The CISMeF project offers a valuable tool for the French-speaking health community: 2,500 computer users visit the Web site each working day.

A new approach for clinical biological assay comparison and standardization: application of principal component analysis to a multicenter study of twenty-one carcinoembryonic antigen immunoassay kits

BACKGROUND

Principal component analysis (PCA) is a powerful mathematical method able to analyze data sets containing a large number of variables. To our knowledge, this method is applied here for the first time in the field of medical laboratory analysis.

METHODS

PCA was used to evaluate the results of a blind comparative study of 21 carcinoembryonic antigen (CEA) reagent kits used to determine CEA concentration in a panel of sera from 80 patients.

RESULTS

The mathematical technique first eliminated the variations attributable to the use of different calibrators. The PCA representation then gave a global view of the dispersion of the kits and allowed the identification of a main homogeneous group and of some discrepant kits.

CONCLUSIONS

PCA applied to the in vitro diagnostic reagent field could contribute to the standardization process and improve the quality of medical laboratory analyses. A standardization method using a panel of patient sera is proposed.

[CISMeF: catalog and index of French-speaking medical sites]

The Internet has now become a major source of health information. The aim of CISMeF is to catalogue and index the main French-speaking sites and documents concerning health. This project was initiated by Rouen University Hospital. Its URL is http://www.chu-rouen.fr/cismef. CISMeF covers all areas of health care and medical sciences, and is indexed both alphabetically and according to subject. It was set up on a Sun workstation under the Sun UNIX operating system and is entirely based on static HTML. By May 1999, the number of sites and documents indexed was already over 6,500, with a mean of 75 new sites added each week. CISMeF is updated via a five-step process: resource collection, filtering, description, classification, and indexing. The Net Scoring criteria are used to assess the quality of health information on the Internet. These criteria concern eight categories: credibility, content, links, design, interactivity, quantitative aspects, ethics and accessibility. CISMeF uses two standard tools to organize information: the MeSH (medical subject heading) thesaurus from the Medline reference database (National Library of Medicine, USA) and the Dublin core metadata format. The sites and documents included in CISMeF are described using the following elements from the Dublin core project: title, author or creator, subject and keywords, description, publisher, date, resource type, format, identifier, and language.

Assessment of bibliographic databases performance in information retrieval for occupational and environmental toxicology

OBJECTIVE

To determine the efficiency of the major bibliographic databases by assessing the percentage of references among the total literature available that can be retrieved from each database. We also evaluated the best database combinations to carry out an exhaustive search.

METHODS

BIOSIS, EMBASE, MEDLINE, NIOSH-TIC, and TOXLINE were searched on two topics: allergy to latex and asbestos and mesothelioma, in the title, abstract, or keywords (textwords). This search was performed for the years 1994 and 1995. All the records were classified by journal and author's name and were verified for each record whether or not it was indexed in each database. Statistical analysis was performed with chi 2 test.

RESULTS

777 articles in 510 issues were found. The efficiency of each database (percentage of articles recovered) and of combinations varied between 11% and 63% for one database and between 42% and 86% for a combination of two databases. The reasons why these differences exist between databases, and within a database, between two different subjects or two different years are reported.

CONCLUSION

Firstly, it is not advisable to assert that a bibliography is complete when only one database is searched. Secondly, the efficiency of the databases may be quite different. Finally, it is suggested that the best way to be as exhaustive as possible is to search two or more databases-for example, in EMBASE and TOXLINE, or to a lesser extent EMBASE and MEDLINE. This seems to be the best compromise solution between time consumed for searching and efficiency.