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Mystery Solved! Part 1: Finding Reliable Health Information

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by Elizabeth Irish, MLS
Autism Asperger’s Digest| January/February 201

As a health sciences librarian and a mother of a son diagnosed with both Asperger’s Syndrome (AS) and Tourette’s, I know how overwhelming it can be to receive a diagnosis and then be faced with a seemingly endless amount of sometimes contradictory Web-based information. It’s easy to feel helpless when all you want is to be a knowledgeable, active member of your child’s team. Sometimes trying to find just the right article feels like searching for a needle in a haystack. Is it possible to take the mystery out of finding quality, reliable information without sifting through thousands of sites?

Absolutely! However, as Temple Grandin’s (2011) thoughtful column points out, there is no quick, easy solution. A good search requires time, patience, and a little planning to save time and frustration. This two-part series explores how to effectively design a search strategy, suggests key resources to investigate, and offers advice on how to evaluate the information you find so that you feel more empowered and confident in your findings.

Easy as 1, 2, 3
The first order of business is to decide what information you need.  This decision can seem deceptively easy.  What looks like a behavioral problem may be the result of a sensory issue, which can lead to the discovery of another physical condition. Issues are so intertwined that it can be difficult to pinpoint exactly what you want to find!

Try this three-step approach when planning your search:

  1. Summarize your concerns.
  2. Create a question.
  3. Select your terms.

This approach is rooted in evidence-based medicine principles used by physicians to create a clinical question.

Step 1: Summarize Your Concerns
Here’s an example of a possible scenario for step 1:

Your eight-year-old son was diagnosed with AS two years ago. He is currently in a social skills group that is going well although he still has problems with making friends. Based on these issues his pediatrician thinks it might be time to begin individual counseling sessions with a psychologist who is well-versed in AS. You’re concerned about starting counseling because you’ve heard how expensive it can be. Should you give the social skills group more time before starting individual counseling sessions?

You’re in the first stages of determining what you need, so in your summary include only the most relevant information. The summary stage helps clear your head of the more extraneous factors and gathers your thoughts. Don’t worry if you have multiple information needs. In this example there are a number of issues that jump out such as the cost of individual counseling sessions and effective therapies for children. If you end up creating more than one question, you’ll simply need to do more than one search! To avoid becoming overwhelmed you may want to create a searching schedule tailored to your concerns. For instance, one month research information on one aspect, the next another aspect, and so on. Prioritize your needs to decide what you search first.

Step 2: Create a Question
Developing the search question helps narrow your focus more. However you decide to pace your searching, if you create your question(s) using the PICO format (see sidebar at right/left), you’ll be ready to identify your search terms in step 3.

 P = Patient/Problem  What is your concern?
 I= Intervention  What do you want to do?
 C = Comparison  Is there a comparison to the intervention?(Not every question will have a “C.”)
 O = Outcome  What do you ultimately want

Let’s return to our scenario and create a question using this format. The PICO terms are in parentheses:

In children with AS (P), is a social skill group (I) more effective when combined with individual counseling therapy (C) to increase the ability to make friends (O)?

Step 3: Select Your Terms
Now that we have our question, in step 3 it’s time to select the most relevant search terms. Looking at the PICO terms:

P = Children with AS
I = Social skills training
C = Individual counseling sessions
O = Ability to make friends

The PICO terms from your question have transformed into your keywords for searching!  Note that 8-year-old boy was broadened to an age group since it was too focused. Now is the time to think of synonyms for your search terms. Some resources will allow you to use synonyms; some won’t. It’s always good to be prepared.

Now you’re ready for searching! Where to start depends upon your needs. A search engine, such as Google, can be a good place to start to find consumer information. Or, you may want to try a database, such as PubMed, to find professional articles first. Let’s take a look at these to see how to maximize searching effectiveness.

Google It!
Google has transformed searching and grown from a simple tool to a wealth of resources, including email, images, video, and more. Google has a powerful engine you can manipulate to find what you need. Search results improve if you incorporate a few of the following tips:

  • Start with your most important term. Google prioritizes searches based on where the word appears in the search.
  • Use quotation marks around two words or a phrase you want to appear together (e.g., “social skills”).
  • Place a + sign in front of a word or phrase if you need it included (e.g., +Asperger’s Syndrome).
  • Google searches for word variations, so Asperger’s will pick up Aspergers and Asperger unless you use a + sign, which turns off this feature.
  • Use OR to expand and NOT to narrow your search. Note that AND is not necessary.
  • Google ranks the most relevant sites first, so for quick information the first sites may do.
  • Use the Similar link on the results page if you find a site you really like. It links you to related sites, which is a huge time saver!
  • Click the Advanced Search link for the option to do most of the above, plus limit by language, date, or domain (e.g., .edu, .com).

A word of caution: it’s possible to overuse tips. Depending on the topic you could narrow your search so much that you don’t retrieve anything at all! Low results aren’t the goal; it’s finding the right information.  Try various combinations until you find the one that works best for a particular question. As you work through the search, you may find other terms that will help. Don’t hesitate to add them to your strategy.

Finally, don’t be discouraged if your results vary by the day, hour, or minute.  Google uses filters to personalize your search, incorporating factors that include past searches. It even knows where you are and tailors some responses to location. You’re not doing anything wrong—it’s the ebb and flow of the Web.

Digging a Little Deeper
In Google’s search results, you may have seen a heading that begins, “Scholarly article to….” These results are from Google Scholar (http://scholar.google.com). It is almost identical to Google in both the basic and advanced search modes. The difference is that Google Scholar consists of professional literature, including journal articles, patents, and legal documents. Some of the material has free access while some information is password or copyright protected.

Google Scholar is definitely worth a look. The pool of information is smaller, so your result list will also be smaller.  Like a regular Google search, it lists results by relevance rather than date. An article might be a bit older, but it could be exactly what you need. Or, you can change the option to display recent articles first. Setting up an email alert is easy in Google Scholar, and it will notify you when new items that meet your search criteria are published. However, since Google Scholar includes only scholarly works, you will miss out on personal stories that might be useful.

If an article is not free, you can order it through your public library for no cost or a minimal fee. You may have to wait a little longer, but if time isn’t of the essence, you’ll save money.

Using PubMed
Another search option is PubMed (www.pubmed.gov), which focuses on professional medical literature. With over 20 million citations, PubMed is the brainchild of the U.S. National Center for Biotechnology Information (NCBI), part of the National Library of Medicine. The database is free and designed to be user-friendly.

However, even basic searching on PubMed has its own nuances. Here are some tips for navigating the site:

  • Alternate search terms pop up as you type. If you select one it will automatically search before other terms can be added. You will need to go back to add more terms.
  • AND, OR, and NOT can be used to focus a search.
  • Using Limits focuses a search and include age group, publication type, full-text articles, language, and publication date. Remember to remove limits before each new search!
  • PubMed saves search histories for up to eight hours in Advanced Search, so you can go back and modify as necessary.

Many times I’ve wanted to redo a PubMed search to see if there was any new information available on a topic. Thanks to PubMed’s My NCBI feature—a tiny, yet powerful link found on the top right-hand corner of the sitea search can be saved, set up to rerun at select intervals, and the results will be sent to your email. The searches don’t disappear; I have some that I did 10 years ago that are still available! In My NCBI it is also possible to set up filters for all of your searches that you can apply without having to re-create the wheel with each search.

PubMed’s MeSH Database
PubMed also offers a way to search by Medical Subject Headings (MeSH). MeSH terms are assigned to most articles in PubMed. Using MeSH terms will account for different spelling and synonyms. Whether you do a basic or MeSH search, there are a few more options on the results page. To see an abstract of the article, click on the title. If an abstract looks interesting, you can select Related Citations to see similar titles. Note that using this feature removes all the limits, so if you limited to children, you may now get articles dealing with adults as well. On this page you can also print or email using the Send To link. If the full-text article is available through PubMed Central, a free repository of select journals, there will be a link beside the citation. If the article isn’t free, ask for help at your public library!

PubMed’s MeSH Database provides an advanced search method that incorporates medical subjects headings (MeSH) and subheadings. MeSH terms are the National Library of Medicine’s controlled vocabulary and are used for indexing articles. Before running a MeSH search, you need to decide:

  • on a MeSH term.
  • if you would like to narrow the MeSH term with subheadings.
  • whether you want to restrict to MeSH major topic to include or exclude other MeSH terms.

To start select MeSH Database on PubMed’s home page. Type your word, and a list of selected MeSH terms appear. Autistic Disorder, Asperger Syndrome, and Child Development Disorders, Pervasive are three examples of relevant MeSH terms. All MeSH terms come with a definition, so you can determine if the heading meets your needs. Once a MeSH term is selected, you can refine your search in a few ways:

Apply Subheadings. First, consider selecting subheadings. For instance, if you are interested in treatment, click the boxes by drug therapy, rehabilitation, and therapy. These subheadings are then applied to the MeSH term to narrow the search. Remember: subheadings vary by term!

Restrict to Major MeSH Topic. This option means the MeSH term you’ve selected is a main focus of the article.

Use the MeSH Hierarchy. A list of MeSH categories appears at the bottom of the screen. Depending upon the heading there may or may not be additional headings below the heading you’ve chosen. If there are additional headings, you can decide whether or not to include them by checking the box, “Do not include MeSH terms found below this term in the MeSH hierarchy.”  The default is to include the additional MeSH terms. However, MeSH terms are very specific, so if you’ve selected Child Development Disorders, Pervasive but don’t really want Asperger Syndrome, check the box to change the default.

At this point add your search to the PubMed Search Builder by clicking on Add to search builder button. You can add additional MeSH terms to the search builder by repeating the MeSH term selection process, clicking the Add to search builder button again, and clicking on the And button. Your search will appear in the box above these buttons. Once you have entered all the MeSH terms for your search, click on the Search PubMed button. The results page will appear. At this point add limits to your search to focus your results even more.

Some Final Thoughts
Nothing is as rewarding as finding what you need with as little angst as possible. Remember there are subtle nuances to searching that randomly plugging words into a search bar might not pick up. Not only can the search terms you use impact your results, the resource you choose can as well, so choose wisely. Just as spectrum kids have similar characteristics but are unique individuals, each resource has its own personality.

Now that you’ve learned how to effectively design a search strategy and have an idea of key resources to explore, how do you evaluate your findings? What clues point you to a quality website? Are there sites that can help take guesswork out of evaluating information? Stay tuned for “Mystery Solved! (Part 2): Evaluating Health Websites” in the March/April 2012 issue of AADigest.

Reference
Grandin, T. “Finding Good Information on the Internet.” Autism Asperger’s Digest Magazine. July/August 2011.

For Additional Help: Go Straight to the Source!
Google. “Basic Search Help.” Accessed September 28, 2011.
Google. “More Search Help.” Accessed September 28, 2011.
Google. “More Search Help.” Accessed September 28, 2011.
Google Scholar. “Advanced Scholar Search Tips.” Accessed September 28, 2011.
Google Scholar. “Searching Google Scholar.” Accessed September 28, 2011.

National Center for Biotechnology Information (US). “PubMed Help.” Accessed September 28, 2011. www.ncbi.nlm.nih.gov/books/NBK3827/

For More Information
Haroon, M., and R. Phillips. “There Is Nothing Like Looking, If You Want to Find Something”—Asking Questions and Searching for Answers—The Evidence-based Approach.” Archives of Disease in Childhood Education and Practice 95 (2010): 34–9.

Elizabeth Irish, MLS, AHIP, is Assistant Director at Schaffer Library of Health Science, Albany Medical College in Albany, New York.

Copyright © Autism Asperger’s Digest. 2012. All Rights Reserved. Distribution via print is prohibited without written permission of publisher.


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Comments

  1. Kim Fields says:

    You can now read Part 2 of Elizabeth’s great article on AADigest’s website!

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