Figure 1. Examples of Reports of Effective MEDLINE Searches Incident # 03-U074-02 Effective Incident Report Form Ä Mediated User What was the situation that led to your need for this search? I've done psychotherapy with several high-functioning autistic children who had good language and learning skills but with a layer of depression that was significant to the extent of becoming suicidal. A psychiatrist told me about a new syndrome he'd just heard about called Aspeger's syndrome that seemed to describe these sorts of children. What specific information were you seeking? I wanted to know more about Aspeger's syndrome. What is it? Why did you choose to do a MEDLINE search instead of consulting some other information source you had available, such as textbooks, journals, or colleagues? The doctor who'd mentioned it to me didn't know anything more about it, and he's my best local source. MEDLINE was the next place to look. How did you explain your information need to the person carrying out the search? I gave her the name of the syndrome and told her it's a form of high-functioning autism. How was this search carried out to get the information you needed? I don't know how she carried out the search, but she said she could search under the direct name of the syndrome. What information did you obtain as a result of this search? There's been research on it both in Australia and England, and there's controversy about whether it really exists. The Australians described it first. They feel that you can do a urine test to look for a protein deficiency to identify it; the English say that it's just a checklist of behavioral symptoms. But there is agreement that there is a cyclic depression overlaying some cases of autism and that it tends to run in families. In what specific ways was this information helpful in your decision making? It was helpful to have verification that there is depression in children. The review board here at the hospital has tended to declare that autistic children are not cognitively able to be depressed. By showing them the articles I've been able to convince them that it did exist, even though the research was too new to know whether it's a behavioral or physical manifestation. What was the impact on the situation of having this information? I was able to get more psychotherapeutic treatment for autistic, depressed children, once the board was convinced they could benefit from it. Incident # 02-0745-03 Effective Incident Report Form Ä End User What was the situation that led you to do this search? There was a question raised in AIDS clinic about what the utility of betaÐ2 microglobulin was for assessing the activity of HIV infection. I wanted to research this topic to prepare a presentation to the AIDS clinic staff. We had heard about the betaÐ2 microglobulin test, but no one in our group was familiar enough with it to understand how useful it might be, or how to interpret it, for evaluating the condition of patients with AIDS. We were trying to decide if we should be doing this test here. What specific information were you seeking? Information on use of the betaÐ2 microglobulin test for evaluating the condition of AIDS patients. Why did you choose to do a MEDLINE search instead of consulting some other information source you had available, such as textbooks, journals, or colleagues? In the AIDS field, by the time something is published it's old hat, and by the time it's in textbooks it's ancient history. We wanted very current information. How did you carry out this search to get the information you needed? I went through Grateful Med. I used "betaÐ2 microglobulin," but it was not a MeSH word. I may have used it as a title word. I joined this with AND to "AIDS." I searched back 2Ð3 years, and ran it several times. No limiters were used. What information did you obtain as a result of this search? BetaÐ2 microglobulin is shed by cells that are turning over or dying. So the test is an index of disease activity. It's an index of white blood cell turnover. Therefore, elevated betaÐ2 microglobulin is also an indicator of other diseases besides AIDS. In what specific ways was this information helpful in your decision making? The test would be of some use for AIDS patients. It would give an idea of how rapidly lymphocytes are being destroyed, by HIV or anything else. It's not specific for HIV. What was the impact on the situation of having this information? I provided this information to the AIDS clinic. What was the outcome of the situation? We decided not to use the test. We don't think it's worth the high cost. But the information I got allows us to interpret the test results, for example, if someone else orders it. Incident # 02-U024-01 Effective Incident Report Form Ä Mediated User What was the situation that led to your need for this search? I had a patient who was very ill with Crohn's disease. She had lost a lot of weight, and it was very dangerous to her health. She also had other intestinal problems, as well as depression. I wasn't familiar with the latest ways of managing the problem, specifically, the nutritional aspects and the other complications. We were also considering surgery as an option. What specific information were you seeking? I wanted the latest information on managing weight loss, intestinal problems, and depression associated with Crohn's disease. Why did you choose to do a MEDLINE search instead of consulting some other information source you had available, such as textbooks, journals, or colleagues? I wanted the latest information, and also good review articles. I looked at textbooks, but they didn't have any depth of information. Colleagues were not much help. How did you explain your information need to the person carrying out the search? I asked her to use the terms "Crohn's" and "complications of nutrition." How was this search carried out to get the information you needed? I don't know how the search was done. What information did you obtain as a result of this search? I got several good review articles. I also got some articles specifically about nutritional support and intestinal complications. In what specific ways was this information helpful in your decision making? It gave me background for thinking about my patients. I can't remember if our specific choice of treatment was guided by the references, or if we got advice from a consultant. What was the impact on the situation of having this information? We did home hyperal with this patient--a central venous line for hyperalimentation, for giving sugar and fats and protein IV. We decided that she didn't need surgery at this time. What was the outcome of the situation? She went home, gained weight, and got pregnant--she did well. Her prognosis for Crohn's is that she will eventually need surgery, because her disease is still active. But she hasn't needed surgery yet, and it's been over a year. Incident # 01-0466-02 Effective Incident Report Form Ä End User What was the situation that led you to do this search? We were interested in the sequence of the genes of ovalbumin Ä chicken egg white. We wanted to transform plants to produce ovalbumin. This was a research project in our laboratory. What specific information were you seeking? We were looking for the gene sequence. It had been known for awhile but we needed to know where it was published. Why did you choose to do a MEDLINE search instead of consulting some other information source you had available, such as textbooks, journals, or colleagues? Its convenience. How did you carry out this search to get the information you needed? Text: ovalbumin AND sequence OR gene. I also searched by author's name. What information did you obtain as a result of this search? I found a series of papers we weren't aware of which contained the properties and sequence of the ovalbumin gene and techniques for isolation and utilization. In what specific ways was this information helpful in your decision making? It allowed us to devise a research project where we could clone the gene into a plasmid and transform plants to increase their nutritional value. What was the impact on the situation of having this information? We were funded for the next three years to pursue studies. Without this information we would not have been funded. What was the outcome of the situation? We have transformed plants to produce ovalbumin. We reported at the AAAS meeting recently. We used carrots, potatoes, petunias. Ultimate goal: these more nutritious plants may become commercially available. Figure 2. Examples of Reports of Ineffective MEDLINE Searches Incident # 01-0443-01 Ineffective Incident Report Form Ä End User What was the situation that led you to do this search? I was writing an article on chest wall recurrences. There was a lot of literature on that area. These are recurrences of breast carcinoma in patients who had adjuvant chemotherapy but no radiation until the recurrence had occurred. What specific information were you seeking? Studies in women after mastectomy who had adjuvant chemotherapy and later had a recurrence in the breast wall with no other evidence of cancer. They were only to have had radiation at time of recurrence. Why did you choose to do a MEDLINE search instead of consulting some other information source you had available, such as textbooks, journals, or colleagues? I consulted everything. MEDLINE was the best. How did you carry out this search to get the information you needed? I used MeSH Ä breast neoplasm and chest wall recurrence. I did also by text words Ä mastectomy. I went all the way back. I did several searches. What information did you obtain as a result of this search? There were only 4 articles written on this type of thing. Mostly reassurance that I didn't miss important information from journals I hadn't read. In what way was the search or its results unsatisfactory? It was difficult to get across to the computer the timing of the disease. I had too broad an area. I wanted a photograph of these patients. Patients will live 15 years after mastectomy with many different types of surgery and therapy. It was hard to eliminate these other sequences from my search result. What search results would have been more helpful in your decision-making? If I could have sequenced different modalities. I wish I could have done it more quickly and concisely. What was the impact on the situation of not having the information? If I would have missed one of the articles it would have looked bad, especially if the author of one of the 4 articles would have been a reviewer; I might not have gotten the paper published. What was the outcome of the situation? I did write and publish the paper. My advice to people has changed, mostly as function of my study. Nationally we are getting away from postÐop radiation, and now give surgery and chemotherapy. There is an enormous incidence of chest wall recurrence Ä as high as 40% recurrence in large primary tumors, positive axillary nodes. I now recommend radiation in these patients.