Evidence-Based Medicine

Decision-support; Translational medicine; Access to MEDLINE/PubMed; current literature; natural language processing; Handheld devices/PDAs/Smartphones

This project developed resources with the overall goal of providing the mobile physicians with real-time access to MEDLINE/PubMed for clinical decision support at the point of care. Many of these tools are mostly in a text-only format suitable for handheld devices and practitioners in low resource areas. Some applications make use of recent Web2.0 technologies such as spelling suggestions, slider interfaces and javascript utilities that make searching more interactive and convenient while some provide a free text, natural language entry to searching. Other tools utilize the extensive global phenomenon of text messaging with mobile phones.

Because NLM databases are accessed worldwide and citations are in English only, searching could be challengings to non-English speakers. There are also instances when expressing medical concepts and terms into English can be challenging. The benefits of searching in ones own native language are obvious, so multilanguage search tools for non-English speakers were developed. These allow healthcare providers and researchers to search in their native language, in Latin and non-Latin characters. Currently available versions include nine languages: Arabic, Chinese, French, German, Italian, Japanese, Portuguese, Russian and Spanish.

Evaluation and development of BabelMeSH, a multilanguage and cross-language search tool for healthcare personnel who might prefer to search MEDLINE/PubMed in the languages available. It allows healthcare providers and researchers to search in their native language. Through international collaborations, including WHO Eastern Mediterranean Regional Office in Cairo, BabelMeSH is now available in 9 languages. With the multilingual search portal, users can now search in Arabic, French, German, Italian, Japanese, Portuguese, Russian, Spanish and English.

PICO (Patient, Intervention, Comparison, and Outcome) Linguist is an application available through BabelMeSH that allows users to search Medline/PubMed in a more clinical and evidence-based manner. This work is significant because it is the only cross-language search portal on the Internet that allows the input in more than two languages. It is also unique because it allows the user to search in character-based languages (non-Latin alphabet), transform it to an English language search and retrieve citations published in any language or language combination. Full-text articles may be linked to the result if published online and available without subscription. requirements.

More than a trillion SMS or text messages were sent in 2006. It is one of the most widely used methods of electronic communicati on worldwide. Healthcare personnel use text messaging to communicate with patients and colleague. txt2MEDLINE was developed to allow convenient access to MEDLINE/PubMed through SMS.

• Leon SA, Fontelo P, Green L, Ackerman M, Liu F. Evidence-based medicine among internal medicine residents in a community hospital. BMC Medical Informatics and Decision Making 2007, 7:5 PMID: 17313680
• Fontelo P, Fang L, Ackerman M. Potential Applications of RFID Technology in Medicine. Telemedicine and e-Health. Apr 2007, Vol. 13, No. 2: 176.
• Fontelo P, Liu F, Muin M, Tolentino H, Ackerman M. txt2MEDLINE: Text-Messaging Access to Medline/PubMed. AMIA Annu Symp Proc. 2006;259-63. PMID: 17238343
• Fontelo P, Liu F, Ackerman M, Schardt C, Keitz S. askMEDLINE: A Report on a Year-Long Experience, AMIA Annu Symp Proc. 2006;:923. PMID: 17238542
• Liu F, Ackerman M, Fontelo P. BabelMeSH: Development Of a Cross-Language Tool for Medline/PubMed. AMIA Annu Symp Proc. 2006;:1012. PMID: 17238631
• Muin M, Fontelo P, Ackerman M. PubMed Interact: An Interactive Search Application for MEDLINE/PubMed. AMIA Annu Symp Proc. 2006;:1039. PMID: 17238658
• Muin M, Fontelo P. Technical development of PubMed interact: an improved interface for MEDLINE/PubMed searches. Muin M, Fontelo P. BMC Med Inform Decis Mak. 2006 Nov 3;6:36. PMID: 17083729
• Fontelo P, Liu F, Ackerman M. SMS (Short Message Service) for MEDLINE/PubMed Access at the Point-of-Care.. Telemed J and e-Health. 2006; 12(2):237.
• Muin M, Fontelo P, Liu F, Ackerman M. SLIM: an alternative Web interface for MEDLINE/PubMed searches - a preliminary study. BMC Medical Informatics and Decision Making 2005, 5:5. (Highly accessed)
• Fontelo P, Liu F, Ackerman M. MeSH Speller + askMEDLINE: Auto-completes MeSH Terms then Searches MEDLINE/PubMed via Free-text, Natural Language Queries. AMIA Annu Symp Proc. 2005;:957. PMID: 16779244
• Liu F, Fontelo P, Muin M, Ackerman M.Virtual Evidence Cart - RP (VEC-RP). AMIA Annu Symp Proc. 2005;:1034. PMID: 16779321
• Muin M, Fontelo P, Ackerman M. PubMed Informer: Monitoring MEDLINE/PubMed through E-mail Alerts, SMS, PDA downloads and RSS feeds. AMIA Annu Symp Proc. 2005;:1057. PMID: 16779344
• Ekong D, Fontelo P, Ackerman M. Computer Network for Health Care Organizations in Low-Resource Environments. Telemedicine and e-Health. Apr 2005, Vol. 11, No. 2: 245.
• Fontelo P, Liu F, Ackerman M. askMEDLINE: a free-text, natural language query tool for MEDLINE/PubMed. BMC Medical Informatics and Decision Making 2005, 5:5 doi:10.1186/1472-6947-5-5. PMID: 15760470 (Highly accessed)

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Point-of-Care Tools For The Mobile Clinician

PubMed for Handhelds

Features:

» Search Medline

» Read Journal Abstracts

» PICO (Patient, Intervention, Comparison, Outcome) Search

» askMEDLINE

» Disease Associations

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Collaborative Projects (CDC, Duke University Medical Center/Durham VA)

PICO A
PICO B

A collaborative project to evaluate the PICO interface (usability, precision/recall) to MEDLINE/PubMed was initiated with Duke University Medical Center and the Durham Veterans Administration Hospital (“A Validation Study of the e-utility, PICO, an electronic Search Interface to MEDLINE/PubMed”.) Residents and interns and attending physicians in the general internal medicine program and medical librarians are participating in the program. Regular weekly teleconferences were conducted between NLM and Duke to discuss activities and progress of this project.

The CDC collaboration involve UMLS tools and search interfaces to assist in their project to further define vaccine adverse reaction entries in patient medical records. EpiSPIDER is an application that plots emerging infectious disease information from ProMED Mail, combines it with country info from the CIA Factbook and PubMed, extracts location using natural language processing and plots them on Google Maps.

• Utilization of the PICO framework to improve searching PubMed for clinical questions. Schardt C, Adams MB, Owens T, Keitz S, Fontelo P.UBMC Med Inform Decis Mak; 2007 ; 7:16. PubMed ID: 17573961
• Tolentino H, Matters M, Walop W, Law B, Tong W, Liu F, Fontelo P, Kohl K, Payne D. A UMLS-based spell checker for natural language processing in vaccine safety. BMC Medical Informatics and Decision Making 2007, 7:3 PMID: 17295907
• Herman T, Matters M, Walop W, Law B, Tong W, Liu F, Fontelo P, Kohl K, Payne D. Concept Negation in Free Text Components of Vaccine Safety Reports. H Tolentino, M. Matters, W. Walop, B. Law, W. Tong, F. Liu, P. Fontelo, K. Kohl, D. Payne, AMIA Annu Symp Proc. 2006;:1122. PMID: 17238741
• Kim GR, Zambrowicz C, Zhang D, Fontelo P, Abbott PA. Promoting the Usability of Online AMIA Symposium Proceedings. AMIA Annu Symp Proc. 2005;:1008. PMID: 16779295

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Digital Imaging

Medical Image Database at NLM from the Armed Forces Institute of Pathology Electronic Fascicles
Virtual Slides at NLM from the Department of Pathology, Uniformed Services University

More than half of US medical schools use virtual slide for teaching histology, pathology and other subjects that required glass slides. Virtual slides can be viewed anywhere with a Web browser and Internet access.

The “Virtual Slide” project’s goal is to digitize glass slides and develop an archive of images for medical education. Glass slides were contributed by the Department of Pathology at the Uniformed Services University. This tool simulates the experience of examining a glass slide under the microscope (zooming, pan.) It is available worldwide to any user with a Web browser with a Flash player plug-in.

A related project links images from the AFIP Fascicles to MEDLINE -- as individual images are viewed, a search form for MEDLINE/PubMed is automatically filled-out with the title of the image. The user can then search MEDLINE.

• Fontelo P, DiNino E, Johanssen K, Khan A, Ackerman M. Virtual Microscopy: Potential Applications in Medical Education and Telemedicine in Countries with Developing Economies. Proceedings of the 38th Annual Hawaii International Conference on System Sciences (HICSS38) 2005, p. 153c.