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Where Nurse Anesthetists collaborate to develop a dynamic resource for Nurse Anesthetists.
Where CRNAs and student nurse anesthetists work toward the common goal of continuously improving our profession.
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Research Resources

Searching PubMed- Lesson 1*

Good Morning, Class!

Welcome to a course on how to search PubMed® via your home computer. Here are the objectives for today's lecture. After reading this material and performing the actions called for in today's text, you should be able to:

1. Describe what PubMed® is and how it is maintained and updated

2. Use your Internet Browser to access the National Library of Medicine's FREE PubMed® website

3. Conduct an initial search using two search terms

4. Select several citations

5. Send the selected citations in an e-mail message to me

Introduction:*

This class is an experiment. I hope that you will be patient with my efforts, and additionally that you will all comment freely on how I could improve these "Lessons". I will be giving you step-by-step instructions, but owing to the many ways in which people might be accessing the Internet, the steps might be out of line with what you are experiencing on your own computer. If so, please e-mail me to let me know.

For that same reason, you will note that I am using the most bare-bones of e-mail messages. I will not use any formatting (bold, italics, colors, etc.), and only occasionally add pictures or other multi-media goodies, because I cannot be sure that you all will be able to read such things. Let me know if you find the formatting troublesome- I have added a lot of "white space" to make it easier to read, but if it is too much, let me know.

When you e-mail me with problems, make sure that you tell me how you are accessing the Internet-

1. What type of computer/system do you have (Macintosh or Windows, XP or Vista, etc.)

2. What Browser software are you using (Internet Explorer, FireFox, Safari, etc.)

3. What type of e-mail program are you using (MS Outlook, Outlook Express, Macintosh Mail, Eudora)

Also, I suggest that you figure out a couple of things about your e-mail program so that you can save these materials for reference later:

1. Your e-mail program should allow you to create a new folder to store your mail.

2. Name the folder "PubMed Course"

3. Each time you receive one of these messages, transfer the message into the PubMed Course folder. I would also keep any correspondence between you and I in there as well. I know that there are various computer skill levels represented by the people reading these course materials. I ask those of you who are very experienced to have patience with my attempts to make this course understandable to even the newest "newbie" of the bunch. And those of you who _are_ newbies, please feel free to e-mail me if you don't understand what is going on. Or in the worst case scenario, give me a call-

Work: (509) 456-8150

Home: (509) 747-0819

No calls after 10pm Pacific, please! And it is ok to call me at work, although I may be busy. And again, as a final note, please give me feedback on the course and how you think it could be improved. Just send your comments to my e-mail address, <dsimonson@mac.com>.

PubMed- What it is*

To get started, click on the URL (Uniform Resource Locator) below. After it takes you to the PubMed website, come back to this message so that we can talk about what you are seeing. You may want to print this message out so that you can read along while you are clicking through the various parts of the website.

http://www.pubmed.gov

This will take you to the PubMed portal, which actually turns (after you click on it) into a different URL than what you just clicked on (you may note this if you look at the highlighted URL in your toolbar). Here it is:

http://www.ncbi.nlm.nih.gov/sites/entrez/

Don’t worry, they are both the same. You could have instead have typed in

http://www.pubmed.com

(note the “.com” instead of “.gov”) and it would take you to the same place. The PubMed folks wanted to make it as easy as possible for you, so they bought up all of the pubmed URL variations and made them all take you to the same place.

So where is www.ncbi.nlm.nih.gov/sites/entrez/? Let me decode some of the acronyms. “ncbi” is the National Center for Biotechnology Information. “nlm” is the National Library of Medicine. “nih” is the National Institute of Health. All three of these government programs join together to offer access to the gamut of scientific literature and data through one portal- “Entrez”. This French word for entry or portal is the name of “the integrated, text-based search and retrieval system used at NCBI for the major databases, including PubMed, Nucleotide and Protein Sequences, Protein Structures, Complete Genomes, Taxonomy, and others.” (1)

We obviously are only interested in the PubMed portion of the Entrez databases, which contain the references to articles in the Medical and Nursing literature, most of them found in the MEDLINE database maintained by the National Library of Medicine. If all of these acronyms are confusing to you, you are not alone. However, it is not necessary to be aware of all the details going on behind the scenes to become adept at searching the MEDLINE database through PubMed. The important point to remember is that PubMed is just a “front end” that allows you to search many different databases of medical literature easily and with a single interface.

Looking Around the PubMed Page*

After clicking on

http://www.pubmed.gov

You should be looking at the PubMed homepage. The NCBI logo should appear in the upper left-hand corner, then the PubMed logo to the right of that.

There are several things for you to note on this page before we get started searching. First of all, you should immediately "bookmark" the PubMed homepage so you can return easily. To do this, go up to your Bookmarks (Safari and FireFox) or Favorites (Windows Internet Explorer) menu, and choose Add. Now you will be able to return anytime by going to your Bookmarks or Favorites menu and selecting the PubMed Home choice.

On the left side of the page are several hypertext links (highlighted text which when clicked takes you to other pages) which will take you to pages explaining all about Entrez and PubMed. You could avoid any more of these classes if you simply read the help and example files listed here. I am hoping to provide you with a more CRNA-friendly explanation, however, so it may help to read the help files _and_ the lessons I am going to be sending you. The “Tutorials” link is particularly helpful, as they have video-based tutorials that explain in very user-friendly manner all of the subtleties of searching using NCBI and PubMed.

- This is an important place to stop if you are having problems. If you are not able to get to the PubMed web page, you need to stop here and e-mail me to let me know what problems you are having. You will not be able to complete the rest of this lesson until you are able to get to the PubMed homepage. List your phone number in the message, so that if it is apparent that you are too messed up for me to fix via e-mail I can call you.**

Performing Your First PubMed Search*

Now, after all of this discussion, we will get on to performing our first search. Once at the PubMed homepage, click your cursor on the text-entry box just after the “Search PubMed for” statement – it’s there toward the top of the page.

When you see your cursor blinking in the box, type in the following search terms:

myasthenia anesthesia

Now click on the “Go” button.

You should be taken to a web page listing the first 20 references that PubMed found with both “myasthenia” AND “anesthesia” located in them. If you look at the top of the list, you should see in small text, “Items 1 – 20 of 384”. This points out that of the 384 articles found (there may be more by the time you read this), and only the first 20 are on this page. You can move to the next 20 articles by clicking on the “Next” button you see to the far right of that statement.

For many of you, I offer congratulations! You have just completed your first PubMed search!

Selecting an Article to Review*

Once you have found an article amongst these that you are interested in, click on the little checkbox to the left of the number of the article. For this lesson, I would like you to click (at a minimum) the checkbox next to “Bogaert F, Verhaeghen D, Herregods L.; Myasthenia gravis and thymectomy: an anaesthetic approach.” Go down the list and check off any other the ones you are interested in. If you wish, you can go to the next page and do the same. Once you have clicked on all of the interesting articles, go to the top of the page and click on the drop-down menu just after “Display” and chose [AbstractPlus] (the brackets indicate that this is a menu choice).

You should see the page reload, and now the page should contain only those articles you checked off. This is one way to shrink the number of citations to a manageable few, although I will show you how to limit citations in other ways in the upcoming lesson.

This will give us a few citations to work with for the next step.

Sending the Citations via e-mail*

Now we will begin to see the power of PubMed. Let’s imagine that you have found 3 or 4 reference citations that support your position in a clinical discussion on myasthenia gravis and anesthesia. One of them is the Bogaert article you checked above. You would like to send these references to your colleague to inform your discussion.

The display line towards the top of the page should say “Display [AbstractPlus] Show [20] [Sort By] [Send to]”. Click on the [Send to] drop-down menu and choose “E-mail”. This will load a new page where you can specify sending the citations to your colleague. You can accept the default formats and sorting, and in the box titled “Your name or additional text” you can type in your name and “PubMed Homework”. Then, in the box labeled E-mail, type my email address: dsimonson@mac.com

Click on the “Mail” button. You may want to repeat this process and put down your own email address instead of mine. Then the results will be sent to your inbox as well.

Your homework is done!! When I get the message, I will respond and let you know how you did. In the meantime, try out a few more searches just to give yourself some practice. Have fun- you can’t screw up!

This is the End of Lesson 1*

References

(1) http://www.ncbi.nlm.nih.gov/Database/index.html

Searching PUBMED- Lesson 2*

This is the second installment of a series of short lectures describing how one can access the medical literature through the National Institute of Medicine’s Internet portal, PubMed.

Review of Lesson 1*

Lesson 2 - Objectives*

Here are the objectives for today's lecture. After reading this material and performing the actions called for in today's text, you should be able to:

1. Register for “My NCBI”, the service associated with PubMed that adds powerful features to your PubMed experience

2. Perform a search and follow links to related articles, saving the articles to your My NCBI Clipboard

3. Save the contents of the Clipboard to your My NCBI Collections for future use.

4. Send the contents of your Collection in an email.

Introduction*

In the last lesson, you learned how to perform a simple search of the MEDLINE database via PubMed. In this lesson, we begin by first having you register for “My NCBI”, the service which allows you to personalize and strengthen your PubMed search abilities. For example, after you register for My NCBI, you will be able to save and manage your searches easily for future reference.

Registering for My NCBI*

Start up your Internet Browser (Internet Explorer, Firefox, Safari, etc.). You should have "bookmarked" the PubMed website last lesson, but just in case you didn't, the URL is:

<http://www.ncbi.nlm.nih.gov/sites/entrez/>

(Remember to Bookmark the page, or in the case of Internet Explorer, “Add to Favorites”)

In the upper right-hand corner of the web page, you should see a small blue box entitled, “My NCBI”, with [Sign In] and [Register] underlined. Before choosing Register, first click on the small “?” question mark that appears next to My NCBI. This will take you to the My NCBI help book. There you will find a “FAQ” explaining everything we are about to discuss. If my explanations fail, you can always return here to get further help.

Once you get to the Help page, if you click on “What Is My NCBI”, you will get a brief explanation of the service:

My NCBI is a tool that retains user information and preferences to provide customized services. It allows you to save searches, select filtering options, and set up automatic searches that are sent by email. To be able to use My NCBI, your Web browser must accept cookies. If your Web browser is set to block pop-ups, you will need to allow pop-ups from NCBI Web pages to use My NCBI.

Those two notes- your web browser must accept cookies, and you can’t block pop-ups from NCBI web pages, are important. This is often a source of frustration for novice users who have turned off these features in their Browser software to avoid the annoyance of pop-up windows or are afraid of “cookies”. If you begin following my instructions and notice that things are not happening as they should, this may be the source of your trouble. If you can’t figure out how to enable cookies and pop-ups from a site, email me and I’ll try to help you out.

After familiarizing yourself with the help available, hit the “Back” button on your browser to take you back to the PubMed homepage, or choose it again from your Bookmarks/Favorites menu. Now we will register for My NCBI. Click on the [Register] link in the blue My NCBI box in the upper right-hand corner of the PubMed homepage and follow the instructions for registering.

Create a username and password and complete the rest of the registration form. Note that entering your e-mail address is an option. I suggest giving your email address because it will allow them to send you your password should you forget it.

A note about passwords: there are a lot of password “schemes” out there, but here is the one I have used for years and that I recommend. I have two passwords – a “money” password and one for everything else. When I register for things like this, where there is no money involved and thus minimally risky, I use my non-money password. If I am registering with my bank or a credit card site or other sites which may risk my identity or my MONEY, I use my “money” password, which I obviously guard very closely.

Taking Advantage of the Power of My NCBI*

Now that you are registered with My NCBI, we are going to perform another search of the literature and I will then show you how to take advantage of the features provided. Let’s begin.

Go to the PubMed homepage

<http://www.ncbi.nlm.nih.gov/sites/entrez/>

If you are already signed in to My NCBI, the blue box in the upper right-hand corner should say “Welcome (your user name)” [Sign Out]. If not, click on [Sign In].

As we continue, let’s imagine that you are trying to re-write the pre-operative fasting guidelines for your facility. Your facility currently requires 8 hours NPO, and you have heard that others have begun using more liberal guidelines. You want to use “Evidence Based Practice” principles, thus you are looking for articles that will not only make you aware of the latest trends, but will assist you in making your case for the approach you decide to take.

To that end, in the “Search PubMed For” box, type “anesthesia fasting” and click “Go”. This will give us a listing of all of the articles that have both anesthesia and fasting in them. When the list appears, click on the following article (it appeared as # 3 in my results):

McKenna G, Manton S. Pre-operative fasting for intravenous conscious sedation used in dental treatment: are conclusions based on relative risk management or evidence? Br Dent J. 2008 Aug 23;205(4):173-6.

When the article citation and abstract appears, review it. We are now going to add it to your “My NCBI Clipboard”. This lets you select and retain articles as you jog around your results, then presents them to you at the end for you to save or discard as you wish.

In the line of menus appearing just above the article,

Display [AbstractPlus] Show [20][Sort By][Send to]

Click on [Send to] and choose “Clipboard” from among the options in the menu that drops. You may remember that we chose “E-mail” in the last lesson. The page will now reload, and you will see that you have added the item to your Clipboard, where it will be saved for up to 8 hours.

At this point, let’s take a look around what is displayed on this page. You should have the author’s names and the title of the article, as well as the abstract (if there is one). If you don’t see these, choose [AbstractPlus] from the dropdown menu just to the right of “Display”. Pay close attention to the list of “Related Articles” that appears to the right of your current article and abstract. These articles can be very important in your search- PubMed is working behind the scenes to try to help you refine your search to exactly what you are looking for. In this case, you should see an article entitled

Pre-operative fasting guidelines: an update. [Acta Anaesthesiol Scand. 2005].

Click on that link to be taken to the article. Once again, add this article to your Clipboard by going to the [Send to] menu above. Note that an asterisk * has been added to your Clipboard tab just under the search box above.

You should now be able to see a new list of articles to the right under “Related Articles”. Click on

Preoperative fasting. [Br J Surg. 2003]

As before, add this article to your clipboard by choosing “Clipboard” from the [Send to] menu. Now, under the related articles, click on

Preoperative fasting for adults to prevent perioperative complications. [Cochrane Database Syst Rev. 2003]

Add this to your clipboard as well. Going to the Related Articles, let’s choose one final article and add it to our Clipboard:

The evidence base behind modern fasting guidelines. [Best Pract Res Clin Anaesthesiol. 2006]

Using the Clipboard*

Now that we have added these 5 articles to our My NCBI Clipboard, let’s take a look at it. Click on the Clipboard* tab at the top of your page- it is there among the following tabs:

[Limits][Preview/Index][History][Clipboard*][Details]

You will be taken to the Clipboard page, and you should now see all 5 articles listed in the [Summary] format, which just lists their authors and titles. Since we are not interested in the dental literature, let’s remove

from our list. To do that, put a check in the little checkbox to the left of the article. Then go above to the [Send to] menu, and choose “Clip Remove” from the drop-down menu. You will get a dialog box to confirm your request – “Are you sure you want to delete these items from Clipboard?” Click OK. The page will reload, and the article will have been removed.

Note in the tabs above the articles, you have [All:4][Review:4]. This means that 4 out of 4 of the articles we have chosen are “Review” articles- articles that review the literature. Perfect for our purposes, where we are trying to review the literature to inform our new preoperative fasting guidelines.

Creating Collections*

As I pointed out, the My NCBI Clipboard goes away in 8 hours. Because we may want to add to this list of articles, or delve further into the related articles and links they contain, we are going to save them into a “Collection” so they don’t get lost. This is one of the most important features of My NCBI- it gives you the ability to return to a search and continue your work at a later time.

From the [Send to] menu, choose “Collections”. You will get a window asking you to confirm your choice. Click “OK” and you will see a small window entitled “Save Collection”. Make sure the button for “Create new collection” is highlighted, and then enter a name for the collection by overwriting the “4 items”. Let’s call this Collection “Preoperative Fasting”. Don’t worry about removing the items from the clipboard, they will be gone in 8 hours anyway.

Once you have saved these articles into your My NCBI Collections, you will be able to access them by simply clicking on the little blue My NCBI link that is always present in the upper right-hand corner of the page when you are signed in. You will be taken to the “My Saved Searches and Collections” page. Click on “Collections” and you will see Preoperative Fasting as the first on the list.

Don't Forget Your Homework!*

For today's homework, send me the contents of your Preoperative Fasting Collection. To do that:

On the “Collections” page, click on the link to your Preoperative Fasting collection. When the items show up, choose “E-mail” from the [Send to] menu. Put your name and “PubMed Homework” in the box, then my email address, dsimonson@mac.com in the box labeled E-mail and click “Mail”.

In the next lesson we will learn more about using the features of My NCBI to keep us up to date on the current literature, and how to access the full text of articles.

Happy Searching!

Searching PUBMED- Lesson 3*

This is the third installment of a series of short lectures describing how one can access the medical literature through the National Institute of Medicine’s Internet portal, PubMed.

Review of Lesson 1 and 2*

In Lesson 1, you should have learned how to access the PubMed website via your Internet Browser. You should now be able to perform a basic search, highlight several articles of interest, and email the results to yourself or to a colleague. In Lesson 2, you should have learned how to register for My NCBI, the service which allows you to personalize and strengthen your PubMed search abilities. Then you learned how to save articles to your My NCBI “clipboard”, put them in your My NCBI Collections for future use, and email them to a colleague (me).

Lesson 3 - Objectives*

Here are the objectives for today's lecture. After reading this material and performing the actions called for in today's text, you should be able to:

1. Locate the full text of articles where possible

2. Discuss options for acquiring full text articles – pay, free text, use of library services.

3. Send links to full text articles to a colleague.

Introduction*

In the last lesson, you learned how to utilize the power of My NCBI to save your searches an allow you to work with them in the future. We are now going to follow up on that work by re-visiting those articles we found and working with the citations to acquire them as full text where possible and to share the citations and abstracts with others via our own email client software.

Start up your Internet Browser (Internet Explorer, Firefox, Safari, etc.). You should have "bookmarked" the PubMed website last lesson, but just in case you didn't, the URL is:

http://www.ncbi.nlm.nih.gov/sites/entrez/

(Remember to Bookmark the page, or in the case of Internet Explorer, “Add to Favorites”)

In the upper right-hand corner of the web page, you should see a small blue box entitled “My NCBI”. If you are using the same web browser and computer that you used for the last class, you may very well see that you are already signed in – just below the “My NCBI” it will say “Welcome [your username]” [Sign Out]. If you are not signed in, it will show [Sign In] and [Register] underlined. Click on [Sign In] and enter your username and password to log back in. If you are at your home computer, you may want to check the box that says “Keep me signed in unless I sign out”. That way you will be automatically signed in the next time you log on- unless you have your security set to reject “cookies”.

Now we are going to return to our previous search. Click on My NCBI just above your username in the upper right-hand corner of the page. This should take you to “My Saved Searches and Collections”, and you should see our work from last session: “Preoperative Fasting”. Click on this link.

You will be taken to the list of the articles that we found last session when we were looking up preoperative fasting guidelines. I will next talk about how to get the full text of any one of the articles in your Collection. One of the great advantages of these PubMed searches is that in many cases, you are able to download the full text of the article as soon as you find it. In the old days, you would have had to ask the librarian to find the article for you, and paid by the page to have her copy it for you.

Obtaining Full Text of Articles*

Having access to the full text of any article that you choose is one of the miracles of the Internet. More and more scientific, medical, and nursing journals are making some or all of their content available online. Sometimes they make all of their publications free for downloading, sometimes articles printed before a certain date, and sometimes (as in the case of the New England Journal of Medicine), they make certain public policy articles and editorials available for free.

If you subscribe to a journal, you are usually granted access to the full text of all of the articles. For example, as a member of the AANA you have access to the full text of the AANA Journal via our website- simply log on to

http://www.aana.com

and on the members’ homepage click on the link on the left-hand side of the page entitled “Resources”, then on the menu choice that appears entitled “Publications”. You will be able to download any issue from 2002 forward, with the exception of the 3 most recent issues.

The Adobe Acrobat Reader software is usually required to view many of these documents. To make sure you don’t have problems, you should make sure that your Acrobat Reader software is fully up-to-date. You can do this by going to

http://www.adobe.com

and clicking on the “Get ADOBE® READER” link to download the latest version

In today’s lesson, we are first going to download a free full text article, then we will look into what is usually required to access and acquire an article from a publisher who charges a fee per article. So let’s get to work.

Make sure you are at the PubMed website by clicking on this link:

http://www.ncbi.nlm.nih.gov/sites/entrez/

Now, in the Search PubMed for box at the top of the page, type the following words, including the quotation marks (you can also just copy and paste the next line into the box)

"preoperative fasting in children"

and click on [Go].

This should give you another 4 articles. The one we are interested in is

Splinter WM, Schreiner MS. Preoperative fasting in children. Anesth Analg. 1999 Jul;89(1):80-9.

It appears as article #2 in my list. Let’s add it to our Preoperative Fasting Collection. Click the little check box to the left of the “2” that precedes the article, and then go up to the [Send to] menu just above and choose [Send to] Collections. You will get a little window asking you what you want to do. Choose “Append to an existing collection”. You should now see “Choose a collection”, and when you click on the Collections drop-down menu, choose “Preoperative Fasting” and then click “Ok”.

Note: if you don’t see these things, it may be either that you are not signed in under My NCBI or that you didn’t complete that part of the last lesson. Go back and do Lesson 2 again! Or call or email me with your problem.

Once you have the article added to your collection, click on the blue “My NCBI” at the upper right of the page. You are taken to the Saved Searches and Collections page. Click on your Preoperative Fasting collection. You should now see all of your saved articles from our last lesson, along with this most recent one we just added. From the Display menu above, choose “AbstractPlus” from the drop-down menu.

You will now see the 5 articles and their abstracts. Again, look to the right side of the page, and you will see that each article has a little icon in a small box. For example, the Cochrane Database Syst Rev. article by Brady and Kinn has a little box to the right that says “FULL TEXT AVAILABLE ONLINE” above the Wiley InterScience® logo. These icons will take you to the website of the publisher of that article, and (for a fee that varies from $15 to $30) you will be able to obtain a copy of the article for your personal use.

But now comes the fun part. Scroll down a little further and note the little icon to the far right of the “Preoperative fasting in children” article by Splinter and Schreiner - it should say “Full Text FREE Anesth Analg”

Click on that icon and you will be taken to the full text of the article courtesy of the Anesthesia-analgesia website. I note that their policy is to allow free access the full text of articles for all but the most recent issues. Articles from the most recent issues cost $15. A laudatory policy and one I hope that other journals will adopt.

Note when you get to the article that you have many options. On the right, under the “This Article” menu, you can choose to access the pdf version, which will look exactly like the print edition. You can also choose to be alerted when anyone else cites this article, and you can even email the article to a colleague (remember this for your homework later!).

Let’s now examine one of the pay-to-view websites. Click on the Wiley icon to the right of the article “Preoperative Fasting” by Ljungqvist and Søreide. On this page you can click on the “Full Text: HTML, PDF” (click on the PDF) and you will be asked to register if you wish to access the article. If you do wish to purchase a copy, all you would have to do would be to supply credit card information and so on and you would have full access to download it to your computer. You could then print it out and take it in to work to use in your presentation on updating preoperative fasting guidelines.

Don't Forget Your Homework!*

For today's homework, go back to the Preoperative Fasting in Children by Splinter and Schreiner article and go to the Anesthesia-Analgesia website by clicking on the Full Text icon to the right of the citation. Once there, under the “This Article” menu on the right, choose “Email this article to a colleague” and send a copy to me. Be sure to include your name and email address as requested, so I know who it is from.

In the next lesson (out in a couple of weeks- I am going to the Ophthalmic Anesthesia Society meeting next weekend!) we will learn more about using Limits to make our searches more productive and on using the features of My NCBI to keep us up to date on the current literature.

Happy Searching!

____________________________

This is the 4th installment of a series of short lectures describing how one can access the medical literature through the National Institute of Medicine’s Internet portal, PubMed...

Review of Lesson 1 - 3*

In Lessons 1 through 3, you have learned how to:

Lesson 1: access the PubMed website via your Internet Browser, how to perform a basic search, highlight several articles of interest, and email the results to yourself or to a colleague.

Lesson 2: how to register for My NCBI, the service which allows you to personalize and strengthen your PubMed search abilities. You also learned how to save articles to your My NCBI “clipboard”, put them in your My NCBI Collections for future use, and email them to a colleague (me).

Lesson 3: in the last lesson, you learned how to locate and download the full text of articles (where applicable) and how to send links to the full text of articles to your colleagues.

Lesson 4 - Objectives*

Here are the objectives for today's lecture. After reading this material and performing the actions called for in today's text, you should be able to:

1. Use the “Advanced Search” function to more easily perform certain types of searches

2. Create a new search that you will save for future use

3. Using the power of your My NCBI registration, have PubMed send you periodic notices via email when any new articles that satisfy your search criteria are published.

Introduction*

You now have the full power of PubMed at your discretion. From this point on, you will be able to use the scientific literature to either support your practice or tell you why you should change. You will be able to participate at the highest level in discussions about anesthesia practice.

In this lesson, you will add something even more powerful: from this day forward, you can rest assured that you will be alerted to any new evidence that might advance or complicate your practice. You will have the National Institute of Medicine sending you personal email messages alerting you to new findings as they are published. If, for example, you have taken a stand in your department on either NPO status, anticoagulant status, cardiac stents, epidural steroid effectiveness, consciousness monitoring, or any of a myriad of controversial subjects in our field, you will now be able to set up a PubMed search that will automatically notify you weekly or monthly of any articles published in on the subject.

Let’s go to the website. Either click the link below or go to your bookmark/favorite for PubMed:

http://www.ncbi.nlm.nih.gov/sites/entrez/

As you have done in previous lessons, in the upper right-hand corner of the web page, you should see a small blue box entitled “My NCBI”. If you are not already signed in (in which case you will see “Welcome [username]”), sign in with your username and password.

Using the Advanced Search*

While the “Search PubMed for” box is very useful, many times you might be looking for a specific article or have other very specific objectives for your search. In that case, it might be useful to use the Advanced Search function. To do this, click on the “Advanced Search (beta)” link that is just to the right of the “Search PubMed for” box.

You will be taken to the Advanced Search page. If, for example, you knew the name of the author, the journal, and the year of the article, you could find it fairly quickly. Try this:

In the “Search Author for” box, type “Nuttall” In “Search Journal for” box, type “Anesthesiology” In “Search Publication Date for” box, type “2008”

Now click on the “Search” button below and to the right.

You should come up with a list of 4 articles that Dr. Nuttall has published in Anesthesiology this year.

Now let’s go back to the Advanced Search page. Hit the Back button on your browser or click on the Advance Search link above. You will note that this search is now listed in your “PubMed Search History” as #1. The time you performed the search (Eastern Time) is shown, as well as the number of hits you got- in this case, 4.

As you drop down this page, you can see that you can easily limit your searches to just the type of articles you want- for example, articles on humans, review articles, articles in English, or articles on newborns. Importantly, you can click on the “Links to free full text” box if you only want articles where you can download the full text of the article.

Saving a Search*

Let’s create a more interesting Search and save it.

Go to the Advanced Search page and click on the “Clear History” button in the bottom right hand corner of the “PubMed Search History” box. This will remove all traces of your search for Dr. Nuttall’s articles. Let’s now construct a search that will allow us to keep on the cutting edge of the controversy over coronary artery stents.

In the “Search by Author, Journal, Publication Date, and more” box, the first line says “Search [Author] for”, followed by a box for you to enter text. Click on the [Author] menu and choose [All Fields] from the drop-down list. Now type “coronary artery stents” in the box. On the next line, click on the [Journal] menu and choose [All Fields] once again. Type “anesthesia” in this next box.

Let’s add some limits: Go down to the “Limit by Topics, Languages, and Journal Groups”, and under “Type of Article”, click the box for “Practice Guideline” and also for “Review”. Then under “Languages”, click on “English”.

Now click on the “Search” box. On the resulting search results page, I got 180 hits: 1 practice guideline, and 179 Review articles. I clicked on the checkboxes next to several articles I found interesting and then used the [Send to] menu to send them to a new collection I made up called “Coronary Stents”. Try that yourself. If you have trouble, consult Lesson 2 where I discuss setting up Collections.

After you have saved some articles to your new “Coronary Stents” collection, go back to the Advanced Search page. To do that, from anywhere you can just click on PubMed to be taken to the PubMed homepage, and then on the Advanced Search link to go to a list of your recent searches.

Once you are back at the Advanced Search page, you should see the following search listed under PubMed Search History:

Search ("coronary artery") AND ("anesthesia") Limits: Practice Guideline, Review, English

Click on the number to the left of this search, and choose “Go” from the menu that drops down. You will be taken to the listing of articles from before.

To save this search:

Click on the “Save Search” link that has appeared under the “Advanced Search (beta)” link. On the page that comes up, select the text after “Name of Search” and replace it with “Coronary Stents”, then click “Save”.

Signing Up for Notifications*

Now comes the fun part. On the page that comes up after you have clicked Save, you will be allowed to sign up for e-mail updates of new search results. This means that any time a new practice guideline or review article discussing coronary stents comes up, you will be automatically sent a notice by PubMed and will be able to view it. Since PubMed often gets citations prior to publication, you will be able to trump anyone in your department with the latest information.

To sign up for the notification, make sure that your email address is correct (if it isn’t, go to the My NCBI button in the upper right-hand corner and update your profile) and then click on the appropriate buttons. I clicked on “Yes, once a month” button and took the default of Saturday as the day. I left the other buttons as is. Then click “Save” and you are done.

Try to think of another search that you might find useful. In my case, I have “ophthalmic anesthesia” (limits: Humans, English) as one of my saved searches. If you have an interest in a specialty practice, here is the chance to keep yourself at the very top of your game.

Don't Forget Your Homework!*

For your homework, send me an email telling me the terms and limits of a search you have saved. If you need help figuring out the proper search terms, let me know what you are interested in and I will try to help you out.

Congratulations – You Have Completed the Course*

This 4th lesson concludes the course. If you are interested in going further and learning how to use a dedicated reference manager application called EndNote®, please send me an email and I will send you instructions on how to download the application and put it to use.

Let me know if you enjoyed the course, and any ideas you have for improvements.

Happy Searching!