Finding Orthopaedic Knowledge Online more of what you want, less of what you don’t Christian Veillette M.D., M.Sc., FRCSC Assistant Professor, University of Toronto Shoulder & Elbow Reconstructive Surgery University Health Network Deputy Editor, Information and Communication Technology Clinical Orthopaedics and Related Research Email: orthonet@gmail.com

Objectives Develop a strategy for searching the Internet for high quality resources to use when learning on the fly Compare different Internet search tools and determine which tool is better for a certain search Understand common search syntax Use the advanced search functionality of the major search engines

Develop a strategy for searching the Internet for high quality resources to use when learning on the fly

Compare different Internet search tools and determine which tool is better for a certain search

Understand common search syntax

Use the advanced search functionality of the major search engines

Where you need the information

Next Best

Is the Internet an appropriate place to look for high quality orthopaedic information? Information overload Commercial bias No quality assurance All common and legitimate comments - Biermann et al. JBJS (Am) 2006; 88:1134-1140

Information overload

Commercial bias

No quality assurance

Yes Lack of a strategy for searching the Internet limits success EBM = PICO Search = FRIAR Effective search engine use requires learning and practice Different types of information, different search engines Different coverage, different search features, different algorithms for sorting results Must KNOW your Internet resources

Lack of a strategy for searching the Internet limits success

EBM = PICO

Search = FRIAR

Effective search engine use requires learning and practice

Different types of information, different search engines

Different coverage, different search features, different algorithms for sorting results

Rapid Internet Preview Search Engines General: Google, Yahoo, Ask, Live Health: Medstory Textbook Wheeless Hyperguide OKO Emedicine Medscape Orthopaedia OWL Directory Web – Google Custom Search PubMed Fast Literature Search

Search Engines

General: Google, Yahoo, Ask, Live

Health: Medstory

Textbook

Wheeless

Hyperguide

OKO

Emedicine

Medscape

Orthopaedia

OWL

Directory

Web – Google Custom Search

PubMed Fast Literature Search

Power Searching on the Web Jargon terms Multiple keywords Quotation marks OR Parentheses Limit by site Limit by filetype + (plus sign) - (minus sign) ~ (tilde sign)

Jargon terms

Multiple keywords

Quotation marks

OR

Parentheses

Limit by site

Limit by filetype

+ (plus sign)

- (minus sign)

~ (tilde sign)

Power Searching on the Web Jargon terms = Technical terms Multiple keywords = Avoid simple search Quotation marks = Exact phrase searching OR = Concept groupings Parentheses = Multiple concept groups Limit by site/title Limit by filetype + (plus sign) = Stopword searching - (minus sign) = Exclude ~ (tilde sign) = Thesaurus or synonym searching

Jargon terms = Technical terms

Multiple keywords = Avoid simple search

Quotation marks = Exact phrase searching

OR = Concept groupings

Parentheses = Multiple concept groups

Limit by site/title

Limit by filetype

+ (plus sign) = Stopword searching

- (minus sign) = Exclude

~ (tilde sign) = Thesaurus or synonym searching

Tip 1: Use Jargon Terms Specialized or technical terminology If the sites we wish to avoid are patient oriented Use language patients wouldn’t understand

Specialized or technical terminology

If the sites we wish to avoid are patient oriented

Tip 2: Multiple Keyword Search Avoid simple keyword search Use at least 3 terms - http://www.keyworddiscovery.com/kd-manual13.html

Avoid simple keyword search

Use at least 3 terms

Tip 3: Quotation Marks for Exact Phrase Searching Most useful when the words to be searched are not very specific the words have different meanings in various subject areas having the words adjacent to each other changes the meaning it is important that the same word is repeated

Most useful when

the words to be searched are not very specific

the words have different meanings in various subject areas

having the words adjacent to each other changes the meaning

it is important that the same word is repeated

Tip 3: Phrase Searching Results have fewer false positives.

Results have fewer false positives.

Tip 4: Boolean OR Use this when you want ANY of the terms, not ALL of the terms with at least one of the words Be sure to capitalize the word “OR” so Google does not ignore it Concept grouping “ hip osteonecrosis” OR “hip avascular necrosis” OR “hip AVN” OR “osteonecrosis femoral head”

Use this when you want ANY of the terms, not ALL of the terms

with at least one of the words

Be sure to capitalize the word “OR” so Google does not ignore it

Concept grouping

“ hip osteonecrosis” OR “hip avascular necrosis” OR “hip AVN” OR “osteonecrosis femoral head”

Tip 4: Boolean OR Results have fewer false negatives.

Tip 5: Concept Group Searching with Parentheses Group terms that should be processed together, at the same time and in the same way in the search Want to combine with another concept or term Question: Do steroid injections improve shoulder pain? Concept 1 = “steroid injections” Concept 2 = “shoulder pain” Concept 3 = “improve”

Group terms that should be processed together, at the same time and in the same way in the search

Want to combine with another concept or term

Question: Do steroid injections improve shoulder pain?

Concept 1 = “steroid injections”

Concept 2 = “shoulder pain”

Concept 3 = “improve”

Tip 5: Concept Group Searching with Parentheses (“steroid injection" OR cortisone OR depomedrol OR triamcinolone) (improve OR help OR placebo) (“shoulder pain” OR “subacromial impingement” OR “rotator cuff tear”)

(“steroid injection" OR cortisone OR depomedrol OR triamcinolone) (improve OR help OR placebo) (“shoulder pain” OR “subacromial impingement” OR “rotator cuff tear”)

Tip 6: Limit by site When you want to control the quality of the search results Want government reports on total hip replacement? “ total hip replacement" site:fda.gov When you know a site that is likely to have what you need Want CME on topic from the AAOS, but without using their site search engine? CME ("shoulder replacement" OR “shoulder arthroplasty"”) site:aaos.org When you want to locate a known document Remember a patient guide but not what organization released it? (acute back pain OR “acute back pain”) site:.org

When you want to control the quality of the search results

Want government reports on total hip replacement?

“ total hip replacement" site:fda.gov

When you know a site that is likely to have what you need

Want CME on topic from the AAOS, but without using their site search engine?

CME ("shoulder replacement" OR “shoulder arthroplasty"”) site:aaos.org

When you want to locate a known document

Remember a patient guide but not what organization released it?

(acute back pain OR “acute back pain”) site:.org

Tip 6: Limit by site (“total hip replacement" OR "total hip arthroplasty") site:clinicaltrials.gov

(“total hip replacement" OR "total hip arthroplasty") site:clinicaltrials.gov

Tip 7: Limit by filetype When you have reason to suspect that the answer you need will be in a certain format white papers, presentations, reprint Find a presentation ((osteonecrosis OR AVN) (hip OR femur OR “femoral head”)) filetype:ppt Find a reprint ((osteonecrosis OR AVN) (hip OR femur OR “femoral head”)) filetype:pdf

When you have reason to suspect that the answer you need will be in a certain format

white papers, presentations, reprint

Find a presentation

((osteonecrosis OR AVN) (hip OR femur OR “femoral head”)) filetype:ppt

Find a reprint

((osteonecrosis OR AVN) (hip OR femur OR “femoral head”)) filetype:pdf

Tip 7: Limit by filetype ((osteonecrosis OR AVN) (hip OR femur OR “femoral head”)) filetype:ppt

((osteonecrosis OR AVN) (hip OR femur OR “femoral head”)) filetype:ppt

Tip 8: + (plus sign) Google ignores common words and characters such as where, the, how , and other digits and letters If a common word is essential to getting the results you want, include it by putting a "+" sign in front of it Be sure to include a space before the "+" sign ACJ separation type +III

Google ignores common words and characters such as where, the, how , and other digits and letters

If a common word is essential to getting the results you want, include it by putting a "+" sign in front of it

Be sure to include a space before the "+" sign

ACJ separation type +III

Tip 8: + (plus sign) ACJ separation type +III

ACJ separation type +III

Tip 9: - (minus sign) Use the minus sign to exclude terms from results when there is a clustering of irrelevant results Help refine a search bone-grafting in the treatment of ununited femoral shaft fractures nonunion femoral (shaft OR diaphysis) "bone-grafting“ -supracondylar –hip -neck

Use the minus sign to exclude terms from results when there is a clustering of irrelevant results

Help refine a search

bone-grafting in the treatment of ununited femoral shaft fractures

nonunion femoral (shaft OR diaphysis) "bone-grafting“ -supracondylar –hip -neck

Tip 9: - (minus sign) nonunion femoral (shaft OR diaphysis) "bone-grafting“ -supracondylar –hip -neck

nonunion femoral (shaft OR diaphysis) "bone-grafting“ -supracondylar –hip -neck

Tip 10: Use Advanced Search nonunion femoral shaft OR diaphysis "bone grafting" -supracondylar -neck -hip If creating this search string comes naturally, you don’t need Advanced Search

Medstory

FRIAR F rame R elevant Search Concepts I rrelevant Search Concepts A lternate Terms for Relevant Concepts R eview - P.F. Anderson, http://www-personal.umich.edu/~pfa/pro/8fold/

F rame

R elevant Search Concepts

I rrelevant Search Concepts

A lternate Terms for Relevant Concepts

R eview

Rapid Internet Preview Search Engines General: Google, Yahoo, Ask, Live Health: Medstory Textbook Wheeless Emedicine Medscape Hyperguide OKO Orthopaedia OWL Directory Web – Google Custom Search PubMed Fast Literature Search

Search Engines

General: Google, Yahoo, Ask, Live

Health: Medstory

Textbook

Wheeless

Emedicine

Medscape

Hyperguide

OKO

Orthopaedia

OWL

Directory

Web – Google Custom Search

PubMed Fast Literature Search

Wheeless’ Textbook of Orthopaedics www.wheelessonline.com Duke University and Data Trace Search or Browse Hypertext format, cross-referenced Note form References

www.wheelessonline.com

Duke University and Data Trace

Search or Browse

Hypertext format, cross-referenced

Note form

References

EMedicine http://www.emedicine.com/orthoped/index.shtml

http://www.emedicine.com/orthoped/index.shtml

Medscape Orthopaedics http://www.medscape.com/orthopaedics

http://www.medscape.com/orthopaedics

ORTHOPEDICS hyperguide http:// www.ortho.hyperguides.com

http:// www.ortho.hyperguides.com

OKO http://www5.aaos.org/oko/login.cfm

http://www5.aaos.org/oko/login.cfm

What are they missing? Social Technologies Collaboration & Community Who are your people? Who do you want to tell what? Who do you want information from? Web 2.0 Wikis Sharing Openness User Generated Content Social Networks

Social Technologies

Collaboration & Community

Who are your people?

Who do you want to tell what?

Who do you want information from?

Personal Knowledge Management “ Knowledge is created by people” … through … C omparisons C onsequences C onnections C onversations

“ Knowledge is created by people”

… through …

C omparisons

C onsequences

C onnections

C onversations

Orthopaedia.com

Orthopaedia.com

Rapid Internet Preview Search Engines General: Google, Yahoo, Ask, Live Health: Medstory Textbook Wheeless Emedicine Medscape Hyperguide OKO Orthopaedia OWL Directory Web – Google Custom Search PubMed Fast Literature Search

Search Engines

General: Google, Yahoo, Ask, Live

Health: Medstory

Textbook

Wheeless

Emedicine

Medscape

Hyperguide

OKO

Orthopaedia

OWL

Directory

Web – Google Custom Search

PubMed Fast Literature Search

Orthopaedic Web Links (OWL) www.orthopaedicweblinks.com

www.orthopaedicweblinks.com

OWL Web

OWL Metasearch Searches several major search engines Compares top returns from each Smaller collection ? More relevance Problems with complex strings

Searches several major search engines

Compares top returns from each

Smaller collection

? More relevance

Problems with complex strings

Rapid Internet Preview Search Engines General: Google, Yahoo, Ask, Live Health: Medstory Textbook Wheeless Emedicine Medscape Hyperguide OKO Orthopaedia OWL Directory Web – Google Custom Search PubMed Fast Literature Search

Search Engines

General: Google, Yahoo, Ask, Live

Health: Medstory

Textbook

Wheeless

Emedicine

Medscape

Hyperguide

OKO

Orthopaedia

OWL

Directory

Web – Google Custom Search

PubMed Fast Literature Search

PubMed www.pubmed.gov Internet Interface with Medline Database National Library of Medicine (USA) Over 100 Orthopaedic Journals not all journals Citation includes Authors, Title, Reference, Abstract, Subject Classification

www.pubmed.gov

Internet Interface with Medline Database

National Library of Medicine (USA)

Over 100 Orthopaedic Journals

not all journals

Citation includes

Authors, Title, Reference, Abstract, Subject Classification

Fast PubMed Search Enter search string with jargon terms Use as many as possible Terms that ‘must’ be in the article Find an on-subject article Read abstract to make sure Click on Related Articles First 10 should be on-subject If too many click Review tab

Enter search string with jargon terms

Use as many as possible

Terms that ‘must’ be in the article

Find an on-subject article

Read abstract to make sure

Click on Related Articles

First 10 should be on-subject

If too many click Review tab

Full Internet Bibliography Orthopaedic Portals Textbooks Directories Organizations “ Push” sites EBM Electronic Journals Discussion Sites Commercial Sites Patient Information Search Engines PubMed Social Networks

Orthopaedic Portals

Textbooks

Directories

Organizations

“ Push” sites

EBM

Electronic Journals

Discussion Sites

Commercial Sites

Patient Information

Search Engines

PubMed

Social Networks

Which type of site is useful? Depends on your topic and purpose

Thank you The Orthopaedic Internet: A Collaborative Resource