Specific Clinical Queries Research Articles

Gastrointestinal and genitourinary fluoroscopy: a pictorial essay of a useful evergreen technique.

Until recently, the use of direct contrast examinations with oral or intracavitary contrast agents was widespread in all general radiology departments. It provided significant answers to multiple clinical questions on the enteric organs and their mucosal surfaces. With the increased availability of CT and MRI, which also allow for the study of walls, as well as the accessibility of endoscopic examinations, the request and execution of fluoroscopy contrast studies have fallen considerably. Despite this, fluoroscopy contrast exams are still useful in specific clinical queries; therefore, radiologists should be able to provide their diagnostic contributions. This pictorial essay of clinical cases collected in our radiology department demonstrates the current demand for these examinations, the variety of the clinical questions we are called upon to answer and the need for continued expertise in execution and diagnostic interpretation of such studies.

Appraisal of clinical practice guidelines and consensus statements on obstetric anaesthesia: a systematic review using the AGREE II instrument

ObjectivesDespite the publication of hundreds of trials on obstetric anaesthesia, the management of these conditions remains suboptimal. We aimed to assess the quality and consistency of guidance documents for obstetric...

Accuracy of a Large Language Model as a new tool for optometry education

ABSTRACT Clinical relevance The unsupervised introduction of certain Artificial Intelligence tools in optometry education may challenge the proper acquisition of accurate clinical knowledge and skills proficiency. Background Large Language Models like ChatGPT (Generative Pretrained Transformer) are increasingly being used by researchers and students for work and academic assignments. The authoritative and conversationally correct language provided by these tools may mask their inherent limitations when presented with specific scientific and clinical queries. Methods Three sets of 10 queries related to contact lenses & anterior eye, low vision and binocular vision & vision therapy were presented to ChatGPT, with instructions to provide five relevant references to support each response. Three experts and 53 undergraduate and post-graduate students graded from 0 to 10 the accuracy of the responses, and the references were evaluated for precision and relevance. Students graded from 0 to 10 the potential usefulness of ChatGPT for their academic coursework. Results Median scores were 7, 8 and 6 (experts) and 8, 9 and 7.5 (students) for the contact lenses & anterior eye, low vision and binocular vision & vision therapy categories, respectively. Responses to more specific queries were awarded lower scores by both experts (ρ = –0.612; P < 0.001) and students (ρ = –0.578; P = 0.001). Of 150 references, 24% were accurate and 19.3% relevant. Students graded the usefulness of ChatGPT with 7.5 (2 to 9), 7 (3 to 9) and 8.5 (3 to 10) for contact lenses & anterior eye, low vision and binocular vision & vision therapy, respectively. Conclusion Careful expert appraisal of the responses and, particularly, of the references provided by ChatGPT is required in research and academic settings. As the use of these tools becomes widespread, it is essential to take proactive steps to address their limitations and ensure their responsible use.

Queries to the British Orthodontic Society.

As the representative body for orthodontic specialists, the British Orthodontic Society (BOS) provides advice and guidance to professionals and patients on a variety of topics. The BOS receive frequent queries from professionals and patients and, where appropriate, provide advice and guidance. By reflecting on the types of queries received, it is hoped that general guidance can be developed and 'frequently asked questions' information established to improve knowledge in these particular areas. Retrospective assessment of queries raised to the BOS. BOS headquarters, London. All queries raised to the BOS by professionals and patients from January 2017 to October 2018 were collated and divided into those raised by dental professionals or by patients. Within each group, all queries were further subcategorised into different topic areas. For each of the main topics, guidance will be developed to improve clinician and patient knowledge in these areas. In the time period assessed, 422 queries were received to the BOS, 51.8% (n = 229) were from patients and 48.2% (n = 213) from professionals. Commissioning was the most common topic queried by professionals (34.3%), which included NHS contracts and tendering. Queries regarding associate matters (9.4%), specific clinical queries (9.4%) and BOS issues (8.9%) were also common topics raised by professionals. The most common topic queried by patients was the eligibility for NHS treatment (29.3%), followed by specific clinical queries (22.3%) and seeking recommendations for clinicians (10.5%). Overall, a large number of queries were received by the BOS. While some queries required specific information from the BOS, the majority of queries could be addressed through already published information and guidance. This project identifies the more common queries and provides clear guidance on where to find the appropriate advice.

Building and Querying RDF/OWL Database of Semantically Annotated Nuclear Medicine Images.

As the use of positron emission tomography-computed tomography (PET-CT) has increased rapidly, there is a need to retrieve relevant medical images that can assist image interpretation. However, the images themselves lack the explicit information needed for query. We constructed a semantically structured database of nuclear medicine images using the Annotation and Image Markup (AIM) format and evaluated the ability the AIM annotations to improve image search. We created AIM annotation templates specific to the nuclear medicine domain and used them to annotate 100 nuclear medicine PET-CT studies in AIM format using controlled vocabulary. We evaluated image retrieval from 20 specific clinical queries. As the gold standard, two nuclear medicine physicians manually retrieved the relevant images from the image database using free text search of radiology reports for the same queries. We compared query results with the manually retrieved results obtained by the physicians. The query performance indicated a 98% recall for simple queries and a 89% recall for complex queries. In total, the queries provided 95% (75 of 79 images) recall, 100% precision, and an F1 score of 0.97 for the 20 clinical queries. Three of the four images missed by the queries required reasoning for successful retrieval. Nuclear medicine images augmented using semantic annotations in AIM enabled high recall and precision for simple queries, helping physicians to retrieve the relevant images. Further study using a larger data set and the implementation of an inference engine may improve query results for more complex queries.

Multivariate Risk Scores and Patient Outcomes in Advanced Heart Failure

Significant improvements in survival have occurred for patients with advanced heart failure, with an increasing array of therapeutic options sharing quite varied properties of cost, invasiveness, and impact on life expectancy. Risk models allow patients and providers to achieve a better understanding of prognosis than is possible through unstructured holistic assessment. This article reviews scoring systems for heart failure prognostication in the general sense and in the setting of providing answers to specific clinical queries. Topics addressed include outpatient survival, risk of inpatient and post-discharge mortality, potential changes to clinician decision-making through better understanding of prognosis, and mortality after having a left ventricular assist device placed or receiving an implantable cardiac-defibrillator.

Sensitive Clinical Queries retrieved relevant systematic reviews as well as primary studies: an analytic survey

Objective To determine how well the previously validated broad and narrow Clinical Queries for treatment, diagnosis, prognosis, and etiology studies, retrieve not only primary studies but also relevant systematic reviews. Study Design and Setting Using the Clinical Hedges Database housed at McMaster University, we tested the retrieval performance of the Clinical Queries. Results For most purpose categories (therapy, diagnosis, prognosis, and etiology) and most databases (MEDLINE, EMBASE, CINAHL, and PsycINFO), the sensitive (broad) Clinical Queries search terms had sensitivities higher than 90% for retrieving relevant systematic reviews as well as primary studies. When testing specific (narrow) Clinical Queries, in 8 of 12 cases, specificity was 94% or higher, but sensitivity dropped below 50%. For all purpose categories and all databases, performance was improved when combining the sensitive or specific Clinical Queries with our existing sensitive or specific systematic review search filter using the Boolean OR; sensitivities ranged from 90.7% to 99.7% and specificities ranged from 92.4% to 98.0% with sensitivities higher than 50%. Conclusion The sensitive Clinical Queries for therapy, diagnosis, prognosis, and etiology perform well in retrieving not only primary studies but also systematic reviews. Search performance can be improved by combining the Clinical Queries with our sensitive or specific systematic review filter.

Comparison of the efficacy of three PubMed search filters in finding randomized controlled trials to answer clinical questions

The aim of this study was to compare the performance of three search methods in the retrieval of relevant clinical trials from PubMed to answer specific clinical questions. Included studies of a sample of 100 Cochrane reviews which recorded in PubMed were considered as the reference standard. The search queries were formulated based on the systematic review titles. Precision, recall and number of retrieved records for limiting the results to clinical trial publication type, and using sensitive and specific clinical queries filters were compared. The number of keywords, presence of specific names of intervention and syndrome in the search keywords were used in a model to predict the recalls and precisions. The Clinical queries-sensitive search strategy retrieved the largest number of records (33) and had the highest recall (41.6%) and lowest precision (4.8%). The presence of specific intervention name was the only significant predictor of all recalls and precisions (P = 0.016). The recall and precision of combination of simple clinical search queries and methodological search filters to find clinical trials in various subjects were considerably low. The limit field strategy yielded in higher precision and fewer retrieved records and approximately similar recall, compared with the clinical queries-sensitive strategy. Presence of specific intervention name in the search keywords increased both recall and precision.

Evaluation of PubMed filters used for evidence-based searching: validation using relative recall

The research sought to determine the value of PubMed filters and combinations of filters in literature selected for systematic reviews on therapy-related clinical questions. References to 35,281 included and 48,514 excluded articles were extracted from 2,629 reviews published prior to January 2008 in the Cochrane Database of Systematic Reviews and sent to PubMed with and without filters. Sensitivity, specificity, and precision were calculated from the percentages of unfiltered and filtered references retrieved for each review and averaged over all reviews. Sensitivity of the Sensitive Clinical Queries filter was reasonable (92.7%, 92.1-93.3); specificity (16.1%, 15.1-17.1) and precision were low (49.5%, 48.5-50.5). The Specific Clinical Queries and the Single Term Medline Specific filters performed comparably (sensitivity, 78.2%, 77.2-79.2 vs. 78.0%; 77.0-79.0; specificity, 52.0%, 50.8-53.2 vs. 52.3%, 51.1-53.5; precision, 60.4%, 59.4-61.4 vs. 60.6%, 59.6-61.6). Combining the Abridged Index Medicus (AIM) and Single Term Medline Specific (65.2%, 63.8-66.6), Two Terms Medline Optimized (64.2%, 62.8-65.6), or Specific Clinical Queries filters (65.0%, 63.6-66.4) yielded the highest precision. Sensitive and Specific Clinical Queries filters used to answer questions about therapy will result in a list of clinical trials but cannot be expected to identify only methodologically sound trials. The Specific Clinical Queries filters are not suitable for questions regarding therapy that cannot be answered with randomized controlled trials. Combining AIM with specific PubMed filters yields the highest precision in the Cochrane dataset.

Developing search strategies in Medline on the occupational origin of diseases

In order to support occupational health practitioners, researchers, and experts (clinical librarians, guideline developers) who search the scientific literature in PubMed (Medline), we developed and evaluated an easy-to-use and effective search strategy. We tested different combinations of search terms, in answering four case vignettes calculating sensitivity and precision in retrieving literature from a gold standard. The use of the Clinical Queries filter from PubMed was evaluated. Based on the outcomes, we developed guidelines for a professional search strategy, using a flow chart. For the occupational health practitioner, we found a sensitivity of at least 65% with a precision of 20%, when terms for occupation and type of industry were combined with terms for disease. For the occupational health expert, a high sensitivity of more than 90% was found adding terms for risk factors to the strategy. Combining the search terms with the sensitive Clinical Queries etiology filter in PubMed, enhanced the precision. Using the specific Clinical Queries etiology filter in PubMed results in a substantial loss of relevant articles. To search for studies on the occupational origin of diseases in Medline, we propose to start with the proper name for the occupational disease. If this does not exist, use a specific term for the occupation and type of industry in combination with terms for disease. To improve the sensitivity of the search, a search term for the specific risk factor should be added. If there is no relevant occupational title available, it is worth trying the general search terms occupational diseases or occupational risk.

A look at Google Scholar, PubMed, and Scirus: comparisons and recommendations

The beta version of Google Scholar (GS) has attracted worldwide attention from health professionals and librarians since its launch in November 2004 [1–4]. Though it purports to “locate scholarly literature across all disciplines in [many] formats” and to offer “the best scholarly search experience for users” [5], GS has generated considerable debate in library circles about its usefulness [6–8]. How do librarians educate users about Google’s shortcomings when they (and their services) are becoming increasingly google-ized? Some nagging questions about GS persist: what is “scholarly” in Google’s view? how big is GS? how many databases, journals, dot.edu and dot.gov sites are indexed? how often is it updated or refreshed? In this article, we discuss what is known about GS and run simple tests of its coverage. Then, GS is compared to PubMed and its major strengths and weaknesses discussed. Scirus is also discussed (its pros and cons) as a free search alternative to GS. Based on the requirements for complex searches, we make a recommendation for using OVID MEDLINE for specific clinical queries.

How to find evidence when you need it, part 4: Matching clinical questions to appropriate databases

Practitioners seeking enhancement of clinical care through consideration of research require rapid and efficient point-of-care access to current studies and summaries pertaining to specific clinical queries. MEDLINE and other large databases usually contain the citations relevant to such questions but frequently fall short of the practical requirements of busy clinicians. We present a summary of the knowledge and skills required for physicians to select and use smaller databases appropriate to particular types of questions arising from emergency care. We outline a step-by-step approach that begins at the bedside with the sorting of questions into appropriate categories of knowledge and research design. We identify commonly encountered pitfalls in the process of connecting a particular question to an appropriate database. We illustrate the approach through a set of demonstration questions pertaining to patients presenting to emergency departments with chest pain consistent with acute coronary ischemia. We describe a selection of resources and databases and summarize their performance in locating articles relevant to the demonstration questions.

Critical Care Assembly Critically Appraised Topics (CCCATS) Library

The Critical Care Assembly Critically Appraised Topics is a website that provides updates in relevant and controversial critical care topics using an evidence-based approach. In reviewing this site we browsed through the online offerings and assessed the information provided as well as the user interface. Each critically appraised topic (CAT) is structured so that the following information is included: the search strategy employed to identify significant trials in the area; a summary of each article identified, which includes a grading of the evidence, number of patients and major results; and short editorial comments. Each CAT is peer reviewed and updated as the literature warrants. The current library of CATs includes evidence-based reviews of 14 topics, including the following: weaning protocols; prone position in acute respiratory distress syndrome; vasopressin in septic shock; continuous renal replacement therapy in sepsis; thrombolytic therapy for acute pulmonary embolism (updated); glucose control in the critically ill; maximizing oxygen delivery in critically ill patients; and low tidal volume ventilation in acute respiratory distress syndrome. An example of the first topic is 'Noninvasive ventilation in hypoxemic respiratory failure'. According to the information provided on the website, PubMed and Uptodate were searched for articles published after 1990, using specific clinical queries such as 'noninvasive ventilation' and 'acute respiratory failure'. Seven trials were critically evaluated and their results summarized. Finally, the author of the CAT summarizes the study results and provided recommendations. This CAT was last updated in August 2001. This online resource is intended for intensivists and respiratory physicians devoted to critical care. It provides a brief summary of topics that are extremely important and helps intensivists to identify the most recent literature for each topic. Other positives include a direct link to PubMed, the abstract of each trial, and a brief summary of each trial including design and major results. In general, the conclusions of each of these reviews are reasonable and objective. Finally, there is an invitation for the public to submit CATs. There is unlimited access to the site, no particular browser or any special software is required, and it is easy to navigate. The owner is the American Thoracic Society – a reputable scientific society. Limitations of this site include the following. At present, there are only 14 CATs, most of which have been written by one individual. In addition, at the moment, only two topics have been updated. Finally, it would be helpful to include some CATs that are relevant to pediatrics.

Evaluation of a teaching hospital necropsy service.

The information returned to the hospital clinician after a necropsy was investigated in a series of 1000 patients. It was found that specific clinical queries were answered in 83% of cases, that the necropsy corrected the major clinical diagnosis in 36% of cases, and that 29% of cases were used for undergraduate or postgraduate teaching. The results demonstrate the continuing value of the necropsy as an investigative and educative procedure.