How Complementary and Alternative Medicine Practitioners Use PubMed

Background PubMed is the largest bibliographic index in the life sciences. It is freely available online and is used by professionals and the public to learn more about medical research. While primarily intended to serve researchers, PubMed provides an array of tools and services that can help a wider readership in the location, comprehension, evaluation, and utilization of medical research. Objective This study sought to establish the potential contributions made by a range of PubMed tools and services to the use of the database by complementary and alternative medicine practitioners. Methods In this study, 10 chiropractors, 7 registered massage therapists, and a homeopath (N = 18), 11 with prior research training and 7 without, were taken through a 2-hour introductory session with PubMed. The 10 PubMed tools and services considered in this study can be divided into three functions: (1) information retrieval (Boolean Search, Limits, Related Articles, Author Links, MeSH), (2) information access (Publisher Link, LinkOut, Bookshelf ), and (3) information management (History, Send To, Email Alert). Participants were introduced to between six and 10 of these tools and services. The participants were asked to provide feedback on the value of each tool or service in terms of their information needs, which was ranked as positive, positive with emphasis, negative, or indifferent. Results The participants in this study expressed an interest in the three types of PubMed tools and services (information retrieval, access, and management), with less well-regarded tools including MeSH Database and Bookshelf. In terms of their comprehension of the research, the tools and services led the participants to reflect on their understanding as well as their critical reading and use of the research. There was universal support among the participants for greater access to complete articles, beyond the approximately 15% that are currently open access. The abstracts provided by PubMed were felt to be necessary in selecting literature to read but entirely inadequate for both evaluating and learning from the research. Thus, the restrictions and fees the participants faced in accessing full-text articles were points of frustration. Conclusions The study found strong indications of PubMed’s potential value in the professional development of these complementary and alternative medicine practitioners in terms of engaging with and understanding research. It provides support for the various initiatives intended to increase access, including a recommendation that the National Library of Medicine tap into the published research that is being archived by authors in institutional archives and through other websites.

Homepage description: I: Ok, so lets start with a search from the homepage. Go to Pubmed.com MF1: Ok, I am there. I: Have you ever been here before? MF1: Yes-many times. I: We can start by doing a simple search. Anything you'd like to know more about? MF1: Ok, I'd like to know more about umm, compliance. I am interested in the area of compliance. Umm, compliance with I'm sure there aren't any studies on this but anyway bandaging for lymphedema. I: Ok, so that's a pretty complicated topic. One good way to search it would be to do a Boolean search. Do you know what that is? MF1: Yes. I: Ok, so will put in compliance and then we'll put in and bandage. MF1: And the AND has to be capitals. I: umm, I don't think so, but do it anyways, it couldn't hurt. And then put in 'Lymphedema'. And then hit go. MF1: Yup. I: So how may did you get? MF1: I got 11. I: Ok, so will you look through them and se if they are useful to you? MF1: It's hard to tell just from the titles. But let's just see I'll get the abstract. Ok, the first one looks good. "Managing and promoting change". I: so you find abstracts useful? MF1: Yes, very. I: Can you go back to the list for a second? I just want to point out a few things out. So, let me point out a few things you probably know already. The first is that you know that these are citations, not articles, right? MF1: Yes. I: and you know what a citation is? MF1: Yes I: Great well the little picture of the piece of paper represents the citation and you can click into it and arrive at details of the citation-if there is an abstract then there are little lines in the piece of paper icon. If articles are free full text there is a green bar in the icon… MF1: Yes that's intuitive. I: So you know the difference between an article that is free online and one that is available online but is not free? MF1: Yes I look for the free ones. I: Ok, so one interesting thing we can do is as we find research results that are interesting to you we can amalgamate them on the clipboard. And then send the citations to your email in box. Have you done this before? MF1: I have. I: Oh, ok. So click the checkbox and then hit send to clipboard. And let me know when you are done. MT1 Ok, I am just clicking a few more off. I: Actually if you could just go back to that initial abstract I want to hit related articles. MF1: Yes, umm, ok, I got it clicked and where am I going to send it? I: Ok, do you see where it says send to? MF1: Yah, I do. I: Ok well choose clipboard first. MF1: Alright. Sorry, I usually send it my email. I: That's ok, so go back to the abstract by Seymor. Now if you do enjoy reading stuff by Seymor, you can always click on Seymor and it'll take you back to other articles that he's written. MF1: Right. Related articles: I: Or 'her'-since her name is Ellen. But now, I want you to hit related articles, to the side there, and I want to know what your thoughts are as to whether it pulls up a search list that reflects the initial abstract, that would be useful to you in other words. As they get useful check them off and send them to your clipboard. MF1: Well the first one is the one by Seymor. I: Yes the first one is always like the same it is the initial stepping stone. MF1: Well these are all about ulcers. I: Ok. MF1: I didn't really… it's similar but it's not the same as lymphedema but I'll send it to my clipboard. I: Well you don't have to send them if you don't want to see them. MF1: No, no that's fine, I do. I: Ok. So in terms of finding other articles that related to the first one, it took you in another direction. Is that true? MF1: Umm, I don't know. I'd have to go back to read the Ellen Seymor. I didn't read the whole abstract. I'd have to go back and look at that. Because may be the leg club model was important to it in the first place. I: Yah right it could be, right. MF1: Rather than Lymphedema. I: Yup. MF1: So how do I get back there. …. I: But at the same time it does talk about the reevaluation of the use of the long stretch bandages in favour of the short stretch -so it really does have something to do with bandaging. MF1: Oh yes it does. It certainly is about bandaging and about increased patient compliance. So that's what I am interested in. So the related articles tool did have some application.
Books: I: So have you ever looked for books before? MF1: no I: ok, see links to the right there? MF1: yes I: click on it and then on books. MF1: Ok, I: Do you see how some terms are underlined in blue? MF1: yes I: Well when you click on the term it takes you to books in which the term is mentioned. MF1: oh, I see I: So if you ever need a book on a subject then you find one this way. And note that we are in a books database. MF1: well that 's interesting but I like articles because they are more current. I: ok, good info. So you don't think you'll use the books function? MF1: well it depends, but I have never really thought about it before. I: Ok.
Linkout: I: Ok, another one is the Linkout button. Click on links and you'll see another little menu come up. And you'll see another little button come up called links. MF1: Ok yes. I: Have you ever used this tool before? MF1: I haven't. I: Ok, it shows you exactly where you would get this article. So if its available for free where you would get it -in a library or for sale by the publishers. So if you fall in love with an article, if you click on Linkout you can see how to get it. In this case it looks to me like there is also a free supplement that is provided about leg injuries. That is not the text, the text is where it says full text. Do you see where it says that? If you click on that you get taken to the publishers web site. MF1: Right. I: And unfortunately this is not a free article. You need a code or ID or something to be able to log into it. MF1: Ok, I am just going to look at the free one and see what they have. Hmm interesting, what's there. I: you mean the Medline plus web site? MF1: Yah. I: Have you ever been to Medline plus? MF1: umm, I think I have been to it some time, but not in any particular category of things. I: It's a resource for less technical information about a lot medical issues and problems. It is basically for lay people. MF1: Right. I: So you can find stuff about all different sorts of things on this web site, and this info. Is basically gleaned from the info in Pubmed. MF1: right. I: So you can always do great searches in Medline plus, and most is free-but you won't get access to actual full text article, MF1: No. I: Is that what you are looking for? More full text articles? MF1: I am, yes. I: ok, so it's useful but it's not exactly what you are looking for. MF1: No. I: ok, well, go back to our Linkout window and click on libraries. MF1: Ok, yes I: And hit all MF1: Oh yes I: And here you have a list of three universities that do carry the article. MF1: Uhh huh… I: I'm not sure what your access would be but you might be able to get the article from one of these guys-form the libraries.. the point is if you saw McGill or Uof M here, you might be able to go to those libraries and get the article. MF1: that is more, you wouldn't necessarily find this from the general page? I: Well what you find form the general page (homepage) if there is a free full text then. MF1: Yes, it'll show it on that page. And most of the time they aren't so … I: Yes, and most of the time there is more than one point of access to things, but linkout will provide you the information of where to get the resources if you are confused or can't find it or it is at a library. It'll also take you to other resources associated with it. MF1: right, right, ok.
Send to: I: There's another thing I want to show you and that's the clipboard. We've clicked off a couple of article citations and we've saved them to the clipboard. MF1: Yes, ok. I: So let's go back and look at them. MF1: Ok. I've got 5 here. I: So part of using Pubmed is to organize the research in such a way that you can stay on top of it all because you might collect a lot of research while your doing your search , and you might want to sort through them before you send them to your computer. MF1: Ok. I: So this is where you would do that. Here you have the ability to keep your clipbaorad alive for 8 hours or more. You can save 500 citations up there. So after you sort through them and unclick the one you don't like, you just click on send to and then click on whatever: file, email, printer. So try file. MF1: Ok. I: So do you see what it does? MF1: Not really. I: It makes it look like a typewriter file-no formatting which is easier for you to save on to your computer. MF1: Ok, so now I have to save it somewhere? I: Yes, exactly. MF1: I am used sending things to my email, but I am not used to putting them in a folder. I: Ok, well, we'll do email after this. I just wanted to show that you don't always have to email things to yourself you can MF1: I'm not so good at organizing my computer files. It's a waste of time when I can just email them to myself. I: Ok, so then select email, and then type in your email address. You can write something into the box there to remind you what this search is. MF1: Yah I have emailed myself before but normally I don't use the clipboard. I just send them without using the clipboard. I: So do you think the clipboard would be useful to you? MF1: Yes it is. I: Ok good. MF1: because as you say you can then look at it and decide whether or not the one you thought might be interesting, when you look at it against another one isn't so interesting. I: Right. Exactly the point. Ok, so let's move on to the next one. There's a couple of tools that will let you refine your search. MF1: Yes.

Mesh:
I: So we were actually quite lucky when we did the compliance search -we found a lot-11 is pretty good. Let's say there is a search you want to do and you don't know how to articulate, how it is talked about in the research literature. Click on MESH, on the blue navigation bar to the left. Have you done this before? MF1: Yes -well I have taken the tutorial, and I've tried to use it, and I know it provides you with headings I: Yah and what you should be thinking of MESH as is somewhere between a thesaurus and a dictionary. MF1: yes. I: so why don't we try to look up compliance and see what happens? MF1: ok. I've got one of seven. I: Ok, so here we've got the many different ways compliance is used. And you meant the first one MF1: Patient compliance-and guidance adherence is another one. I: So you mean both number 1 and number 5? MF1: Possible, yes. I: ok, well let's start with number 1. MF1: Ok. I: the most basic thing you can do with the term is put patient compliance in as your search term. So go back to Pubmed because now we are in the MESH database. And search patient compliance and lymhpedema or bandages. MF1: right I: So that's one way to use MESH that's very simple. And simple is good. MF1: Right I: So here there are some more entry terms and this is what we are really looking for, so it says …. Patient cooperation, family planning clinic attendance … etc, so let's use some of these-compliance patient, patient cooperation and let's go back to Pubmed and look under that -does that make sense? MF1: Yes but how do I get back to Pubmed? I: great question. Do you see where it says Search and Mesh? MF1: Yes. I: Drop down that tab and select Pubmed -go upwards. MF1: It's not under "P" -its up at the top. I: Ok so what should we look up? MF1: Patient compliance and Lymphedema because otherwise we'll get ulcers… I think we got more or less the same seven. I: How about we try cooperation? MF1: No items found. Another one is adherence and I don't know if that one works.,..
Combining through history: I: Well, let's move on to try something else. The first thing I want you to do is write patient compliance in the search bar and then search, ok? MF1: yes I: And let me know what you got for this one. MF1: 31165. I: ok, now erase that, and write Lymphedema, and then search. MF1: ok I: and now erase that and put in bandages and search. MF1: Ok. Actually let me change that to complex decongestive therapy. I: Ok. MF1: 29. I: Not much. MF1: But that's the complete therapy bandaging is only part of it. I: Now go to history and … MF1: Yah, I do this all the time. I: Oh... Ok. MF1: And we combine them, right? I: Right its kind of like doing a Boolean search. MF1: Yes, oh I find this very useful. I don't do Boolean nearly as much as doing this. Ok so 12 and 13 and number 14. (she combines them). So again I get 7. I: Well, it could be that there are only 7 articles about your topic. Ok. Well, have you ever used limits? MF1: I have used limits with dates mainly. And if I am searching for a particular author. That's about it, and may be English only or things like that. I: Ok, we click on it and we'll just go through the page. Why don't we put a few on and we'll search only for Lymphedema? MF1: Ok. I: So, which ones should we put? MF1: well, what about abstracts only and … I: And how about English? MF1: Ok, I: Ok and go. MF1: Well there is one here on maintenance therapy that looks good. I: We can now search for decongestive therapies within this list. MF1: well why don't we put therapy? I: I think that's a great idea. Head to 'history' and go to number 12. MF1: Well we really just need to put in number 17 and therapy, right? I: Oh mine is number 12 because you did more searches than me. So what did you say? MF1: therapy. So we enter number 17 AND therapy. So now we get 118. I: How do those look? MF1: Well, a lot of them are about Filariasis which I am not interested in, and I don't know how to eliminate that. I: Ok so you know how to eliminate that? MF1: No I: In your search field up top write NOT Filariasis MF1: Ok so now we are down to 85. (She looks through the list). Yes I can see that therapy is being used probably as a medical term rather than -you know like chemo therapy or radiation therapy, rather than decongestive therapy. So we could take this one and we could say AND decongestive therapy. I: Yah, put decongestive before the bracket… MF1: No I didn't put brackets. I: Oh, mine did it automatically. MF1: Ok well now I have only go three. I think the original search was better -those first seven, there is one or two that might be useful. They aren't exactly what I am interested in but they would be possibly useful pointers. I: Except that you can't get them. MF1: Yes, its too bad. It's the publisher's stranglehold on the universities. I: yes well … so, your search skills are really really strong, and I am not sure I helped you out too much, but you certainly helped me out and I really want to thank you for that. MF1: What do you mean, how did I help you out? I: Well I really liked your comment about the first search list being more relevant, about needing access to the research, and I liked how even though we tried to make our search strategy very complicated, I liked how it turned out the most basic one was useful. MF1: Well that's partly because I am quite familiar with this literature. And I have an automatic referral for NCBI every so often about updates of new research in this area. I: oh that's good news too. MF1: In this area, and for massage therapy generally, so as I say I can spot a new article, I should know the literature with my MA topic so. I: Well that's great. MF1: So how is this research going? I: Well it's coming along -it is interesting to see the different types of people who can benefit from Pubmed. MF1: So, I am interested if other people have complained about the lack of free access, or lack of access or am I the only one complaining? I: Well, I wouldn't say that you are complaining, it's more like you are making a good point. And a lot of people are unaware of what they can get their hands on and what they cannot. Some don't know all of the policies behind why some are free and some are not and so there is a lot of confusion out there. So the main issue is that people aren't asking the right questions, they don't feel entitled to see the literature. MF1: And do many of them have access to a medical library? I: Some from the CMCC do have access. MF1: oh yes, they have an excellent library I think. I: they do, but when they graduate they won't have that access anymore. MF1: No, that's the problem you see. It's very hard. I don't know what happens with medical practitioners once they've … I: Yah, it's a good question. I wonder if the CMA has an institutional membership with publishers or something…possibly when you belong to a professional association it is easier to get subscriptions MF1: well professional associations that have a lot of money may be, but for chiropractors and massage therapists they don't have that access-they don't have the money. I: So what happened with the Centennial College course? MF1: It was a good course. I: could you get access through Centennial college? MF1: Yes, well when I was taking the course I could -they had excellent access, and when I was doing my MA at Memorial, I had excellent access and also at Memorial you could go in and use the computers in the health sciences library. I: Are you not able to do that at McGill? MF1: They control it very, very, very tightly. I went in and asked if I could use the computer. I already had my list of articles that I knew I wanted, I was pretty sure I would want to print them. I wasn't searching, I had 6 articles I wanted to see, and they let me do that. So having done it once now I know how to do it, so I just have to find the right time when it's not busy because the medical school is very busy and I understand that libraries are for the student but they are also for the public and some universities are much more open to public access then others but I also know that publishers make universities sign these contracts which any person or member of the public could enter the library and read a journal or read a textbook. But if none of the journals are in hard copy then you have no access unless you can get on the computers. And it's a backwards step in my view. I: Well that's great. Great information. If you have any questions regarding Pubmed do feel free to email me and I can try to answer them. And I really appreciate your points of view and responses and they will come in handy! So thanks! MF1: thank you. I: Bye MF1: Bye.

Follow up Email response:
PubMed use is pretty good. After full access to publications, however, it is a little frustrating to have access only to abstracts. The contracts that the academic institutions (are forced to) sign with the publishers, limiting access to students and faculty only, mean less access for the public. When hard copies were available, anyone could read, digest, copy relative sections etc. Now, depending on the institutional policy, it may be difficult even to get access to view a full text. Needless to say the costs of individual articles is exorbitant.
Interview with CM2: I: So, should I explain how the homepage works, or is laid out? CM2: Actually, I have been here before, and have already done searches. So I have seen this page already. I: What should we look up? CM2: How about 'Inflammatory arthritis'?
(Several citations came up including one with an icon indicating free full text availability) I: Do you know what the icon signifies? CM2: I think it means that a full text is available. I: Yes, but it is available. How did you know that? CM2: I intuited that this was what it indicated.

Boolean:
I: Have you ever heard of a Boolean search before? CM2: I might've heard Boolean before, but I don't really know what it means. I need a refresher… I: Basically, it is a way of making your search more specific, or drilling down better, by using language as opposed to the features and functions of the database. CM2: Ok, I don't really get it. I: So, instead of just searching 'inflammatory arthritis', you'll put in 'inflammatory AND arthritis'. Do you see how that limits things? CM2: I don't really see how that's much different than just inflammatory arthritis. I: Well, when you are putting the AND in there you are telling the database to look for this AND that -it may not make much of difference with this example. But picture a Ven diagram, when you put two thing together, it's the space in common that is your search. Can you picture that? CM2: Oh yes, I get it now. I: Boolean operators include AND, OR, NOT. And sometime they widen the search and sometimes they limit it. Like if you did Chiropratic AND arthritis NOT knee pain. See how it would limit the search? CM2: Yeh, I get it. (We try chiropractic AND arthritis and pull up a number of articles.) CM2: That's really great. I will use the Boolean search methods even when using the different features of the database. This is incredibly important to know, use and understand. It's like the building blocks of searches. I've got to practice that one afterwards. I: Exactly, you could use this technique in all online searching-like Google for example.

Abstract:
[The candidate read over the abstracts and made a decision as to whether or not the article was useful to him. With this particular text he was not interested in reading the full article.] I: Does the abstract give you enough information? What does it tell you? CM2: The abstract gives enough information to help me make the decision as to whether I would want to read an article. So an abstract is really useful. If I felt the abstract was interesting, I would definitely need the full text to actually find the article useful to my work. An abstract only provides enough information to pass the first screening test. I: What do you think overall about the results, the research that we found? CM2: This information is not what I am looking for. It is too technical, too specialized.
(We clicked into a few other article citations. Two different types of buttons came up with the different abstracts. One indicated that an article was online but not free.) I: Ok, so see here that the article is available online, but it is not free full text. It just means that it is in electronic format, and you can access it online. Should we take a look? CM2: Sure thing. (We go to the publisher's homepage where the article is located) CM2: Ok, so what do we have here … I: Well, you have to register for it to get access to it. CM2: Ok, no, I am not interested in doing that. I: Ok, should we try a different one. There is a free full text.. CM2: Ok (We click back to the free full text citation.) I: Ok, so, again, a green bar indicated that it is free online. Let's click into the citation. CM2: Ok I: Ok, and now you see the button … CM2: Yup … this incredible it is so easy. I wish I could just finish reading the article right now ….
Related articles: I: Ok, now lets try using the related articles link to the side over there. CM2: I've used related articles before in other databases. I: Oh, great. So what do you think about it? CM2: As long as the initial article is relevant my needs, this feature would be really useful. But I do like it-it could be really useful. (Little time was spent on this tool as it was something the candidate had done before in other databases. He had used a similar tool before, and already knew that he liked it.) Books: I: Ok, do you see how there is a something called links next to related articles? CM2: Yup. I: Ok, click into it and select books. CM2: Ok, I have never seen this before. I: Ok, notice how near the search field where it says search in, it now says books? CM2: Yup. I: Ok, so we are not in Pubmed anymore, but in something called 'Bookshelf'. And all of the terms highlighted in here are referred to in books that are in this database. CM2: Ok, so, this is a database with books in it? I: Well, actually this is a database with information about books. There are abstracts and tables of contents, but not books. But your search terms were mentioned in these books. So the books are even necessarily about your search terms, but are mentioned. CM2: ok.. (He browses) I: Take your time to look through them … what do you think? CM2: I don't think I'll actually read any of these books. But it is good to know what is out there I just think I would rather have articles. I: Fair enough.

Linkout:
I: Did you see there was another option when you clicked on books? It is called link out. So head back to the citation, out of books, and choose that one. CM2: Ok, got it. I: So here we have a place to go to in case you do find that perfect article, and you want to try to get access to it. So you have the online options, which we looked at before, but you also have a list of libraries that have it. If you scroll down to libraries. So it's like a map that in essence tells you where the article is. (He looks around for a few minutes). I: What do you think about it? CM2: I really think this great. It is a useful tool because sometimes all of the information about the citation can be difficult to understand. Now that I get what this is for, it makes perfect sense. I might click into it if I really liked the looks of an article in order to ensure I know how to get it. I: You might even be able to get it from a library near by or something, like UofT. CM2: Yah -I could do that.
Limits: I: Ok, now let's try going to another tool to help you refine your search. So you were unhappy with the initial results, you found them too technical. So we can try to be more strategic with this one by limiting the types of articles and journals we look at. Click on limits-do you see it there? CM2: Got it I: Ok, so this limits the meta -information, for example the language of the article" CM2: Ok. I: So, what limits should we put on? We have a choice of different ones. CM2: Ok, lets try core clinical journals, English, and human. I: Would you like to limit to age range of the subjects? CM2: Ok, I think I'll do over 18. I: Ok, so take a minute and look through the list. CM2: Can I take a limit off? I: Sure you can do whatever you want, take your time … which one are you going to take off? CM2: The age range. (Much time was spent on playing around with the results given by placing different limits on search subjects.) CM2: I really like this one because I can get at exactly what I want. But sometimes we don't get any hits, so I think I need to play around with it. (Looks through the list some more) CM2: This would be a good time to begin using related articles because of how specific the searches are once you place limits on them. I: Great comment -that makes sense.
Send to functions: I: Ok, so one thing that you can do in Pubmed send things to your email inbox. Do you see the send to function up top? CM2: Yup I: Ok, so click on it an scroll down …have you ever emailed search results, citations to your self? CM2: I've done this before when I have found research on the web. I think its great it is very easy, and I like to keep things in my inbox. This is a great tool that I would use. I: Well there is another way to do something similar. You can save things up into a clipboard in Pubmed, and kind of compile a list of search results. Have you ever done this before? CM2: No, I have done email before, and I copy and paste research results when I do searches. I: Ok, do you see the little box next to the citation? CM2: Yes, got it I: Select it CM2: Ok I: Click send to and scroll down and click on clipboard CM2: Ok. I: So the citation that you selected is now saved on to your clipboard. But you then have to save that somewhere. You can't just leave it there. So now scroll down and hit send to text and do you see. CM2: Yah it looks different. I: Right it has no formatting so you can save it on to your computer. CM2: Ok, so this features (clipboard) is useful -it is so much easier than doing all that cutting and pasting. I think I'll use the clipboard feature, but not sure about the send to text feature. I find it a little confusing. I lesson on file management for my computer. May be then I could use the text feature better. I think I would send things to my email instead.
Full text: I: Can you tell me what you think about getting access to the research? Would you be able to work from abstracts and citations, or do you think you need to actually read the articles? CM2: It is incredibly important to have access to the full text of the article. I would even pay to access a full text article.
Future use: I: What tools do you see yourself using the most in the future? CM2: Hmm, I guess it would be the send to email to send my search results. I: What do you think the most valuable feature is? CM2: I really like related articles-I saw it in the other database and it is useful because it brings me to things that I would probably not have found otherwise -outside my own searching.
Reasons to use Pubmed I: Can you describe how you see yourself using Pubmed? CM2: I think I'll use it to get research, to get on the fly research to answer questions. But I wouldn't send my patients to use the database or conduct searches on this database after a consult with them because I think it would be too complicated. I would not refer them to Pubmed to find their own research.
General comments: I: Any general comments about the session, or Pubmed, anything you would like to add? CM2: After this I feel comfortable using Pubmed and am looking forward to using the new features I have learned.

Follow up email response:
Yes I have used Pubmed since our last conversation. I use it on a weekly basis. I use it to find information for patients and for myself. I am in the process of developing an acupuncture-related web site and writing a book on health-related topics. I have not purchased any articles (although I have been tempted), I tend to look at the full text articles and I have used the links (LinkOut and Books) with success. I like the way that it saves my limits so I don't have to reset them every time I change my topic search. I often use the related article section as well. I can't say that I have stayed away from any features in particular, perhaps this is because I am comfortable using the features that I mentioned above.

Interview with H3:
Homepage: I: Let's start from the homepage. Type in www.pubmed.com. And notice how when we get the page the URL changes. Just so you don't get too startled when you see that-it gets re-directed. But all you have to remember iswww.pubmed.com. H3: Ok, sounds good. I: So what would you like to search? H3: umm, can we do homeopathy? I: Ok, so just enter it into the search field there, the white box underneath the navigation bar. And just before you hit go, let me just explain a couple of things. H3: Ok I: Do you see how there is a black strip above the search bar? H3: yes I: Ok, and there is white writing in the strip. Well those are actually other databases that are more specialized that are part of Pubmed. You can click into them. And do you see how it says 'search in' and then it says Pubmed in a drop down format? H3: yes I: Well you can pull that down and go into those other databases. Its good so that you know where you are. Search in Pubmed automatically comes up though. H3: Ok. Great. I: So now hit go. (3000 results came up). Ok so here we have our search results, and I am just going to quickly go over this. Here is a list of what we call citations. That is every article and all of the information associated with the article is called a citation. That includes the authors, the journal name, the abstract etc. Let's click into one citation. Do you know all this already? H3: I know a little bit about this but I do need a refresher. It's stuff that I know but not really-like I didn't know the name citation. I: ok, great. Well in this citation we have the authors names, the journal article, the abstract, and do you see the little icon to the side there? It looks like a piH3e of paper? H3: yah I: Ok, that's a pretty important symbol. If it has lines in it means there is an abstract associated with the paper. So, form the search list you can click on it, and it'll take you into the citation.  I: You can choose what you want to see, but if you don't choose it'll automatically send  you the citation-author, title, journal, and I believe it send the abstract too. H3: So then how do I get the article? I: you can find the citation in Pubmed again, and then click on that button. H3; oh, I see. Hmm, I would rather have the article. Can I do that? I: Well you can look up the journal web site after our lesson and find the article that way. It doesn't have to be through Pubmed since this a free article. But having the information about the article will allow you to find it in the future. H3: Ok, I get it. So now that's in my inbox. I: It is indeed. H3: Oh, well that is really handy. I knew about sending stuff to the email before, but now I really understand why it's important. I: Right, as long as you know something about the article-you can find it again. That's why citations are important. Let's look at another way to keep information. Instead of sending thins to email, you can save it as a text file. So, select the article H3: Ok. I: And go back to where it says send to and find text. H3: oh, so now this is on my computer? How do I find it again? I: Well, actually, it's still just a web page, but with all of the formatting stripped. So you can easily save this to your computer and then refer to it later on. H3: I'm not really sure what I would do this. I would rather send thing sot my email inbox and then find the articles. I: Ok, one more way to save things and organize information is to save things to a clipboard. H3: Where is the clipboard? I: Well, the process is the same, but instead of sending it to text or email, you would choose … H3: Clipboard. I see it. I: But the advantage here is that you can select quite a few articles by checking into more than one box. And then you can save them all to the clipboard. And afterwards go through them and see which ones you want. H3: Ok, so select a bunch, and then send to clipboard. H3: I see why it would be useful -but I don't think I would ever really use it for myself. It is interesting to see whether there are whole books on a particular subject. But I am not sure I would really use it that often. I like journal articles because they are more specific. I: Fair enough. Ok, well, we have just a few more things to cover. Is that ok? H3: Definitely, this is helpful, I am really learning a lot. I: Great! Ok, hit a few times and we'll go back the citation we were working form. H3: Ok. I: Ok, go back to links where Books was. H3: Ok. Linkout I: And now choose Linkout. H3: Ok. I: So here we have basically a little map or guide to where this article can be found-how to get your hands on it. H3: umm, ok. I: Ok, so remember, Pubmed does not always provide access to the full text of the articles. It provides information about journals… and then it is up to you to get them, like at your library or something. H3: Right -so this tells me how to get them? But what about those links to journal web sites? I: You mean when we looked at a free one -with a green bar? H3: Yes. I don't remember doing this to get to the article? I: That's a great question actually. The link for the full text articles can usually be found in more than one place-right away when you click into the citation, and also from link out. But when the article is not free full text it's a little different. H3: Ok -so go to Linkout when the article is not free to find it. I: Well, kind of. First of all, not all articles are electronic. A lot of the new ones, but not all of the less recent ones. So, if an article is located at a library, you can go to Linkout and do you see where it says libraries? H3: Yes I: You can look up your library and see if they have the journal. So, just click into any of the libraries-actually check if they have UVic or UBC… H3: Ok -so .. I: Go to 'U' and it is an alphabetical list. H3: I don't see them. I: How about UofT? H3: Oh yes-it says electronic. I: Ok, so then UofT has the electronic version of the paper. So if you were a student at UofT you could probably get it through your library. H3: Well, too bad I'm not. I: Well, if you yourself wanted it you could get it too -you would have to pay for it. I'll show you how to do it from Linkout. H3: ok. I: So click out of libraries, and do you see where it says Elsevier Science and then full text? H3: Yes. I: Ok, click on that and it'll take you to the publisher's web site. H3: Ok … but it says you need a log in and password I: right you need to buy access -$30.00. H3: I see -so I would need to put in my credit card information? I: Exactly. Do you think you would even buy an article? H3: Well, it would depend on the article, and why I was using. It would also depend on whether I could find other articles that are free. So, if I was desperate to find information and couldn't find anything, then I might actually buy it. It depends on the situation. I: Ok, good to know. Now, let's just go back to Linkout-is it clear why you would use it? H3: I think so-to get access to the articles. I: Right, and what do you think about it? H3: Well, if I needed access I would use it. I think I'll look for mostly free articles so I could actually read them, so I might not even use Linkout, or need it. But I would use it if I found and non-free article and needed to get to it. I: ok, great. Thanks. Limits: I: Ok, so now lets move on to another tool, that has more to do with searching than about access. H3: OK. I: Limits. Do you see where it says limits up at the top? H3: Yup. I have done this once before. I: Ok. Well, do you mind if I explain anyways? H3: No-it will probably help me anyways. I: Ok, great. So what we have here are options to limit our search. So, even before putting your search terms in you could stop and think, and say, hey, I want to find articles that only have abstracts with them, or I only want articles that are in English ..or H3: Ok, so you click off the way you want to limit your search. I: Right, and then when you perform your search you get only items with those criteria. H3: So what do we have here … I: Ok, so take a look at the different options for a second… but do remember that the more limits you put on, most likely the fewer results you would find. H3: Ok, I am clicking on 'items with abstracts only' -I wouldn't read a paper without an abstract, 'English' and 'human'. I also want to choose editorials, as well as 'clinical trials', but I am not sure if that is possible, I: Hmm, I don't think so. You can only click off one at a time. H3: Ok, well, that's good enough for me. I: Ok, and now we do our search -let's stick just to complementary medicine though H3: Ok, so just put complementary medicine in the box. I: Right … so when you get the search list, just take a moment to look it over, and tell me whether or not you think the list is good-whether you want to read the articles or not, and if limits, basically worked well for you.  : I am not sure. I: Ok, well here is basically a quick and easy way to get to an article. Its like a roadmap to the where the articles are, either in paper or electronically. Which schools carry them. MF4: Ok. I: So, this article is free and easy to get to through Pubmed, but sometimes they aren't so easy. See the link called libraries? MF4: Yes. I: Ok, it is a list of libraries that have this article. I'm not sure if Centennial will be included on it, but if you have access to a library then this might be helpful. But there is a also a clear link to where you can get the article. MF4: Its true, when I was doing the course at Centennial, every time I used PubMed I found the abstract, but I tried to get the article. I couldn't get it and I had to go back onto Centennial's database to find it -so I could see why this is useful. Limits: I: Exactly, wonderful. So, let's move on to something else. Have you ever heard of limits before? MF4: I think so; we did it on the other databases. I: Ok, well let's go over it anyways. MF4: Ok. I: So do you see where it says limits at the top there? MF4: yes I: Ok, click into it. And here we have a list of options as which when chosen will help to limit or refine our search. It is kind of similar to Boolean in this respect. MF4: Ok. I: Well, one great limit is to limit the language. So you could choose to search only articles in English. MF4: Ok I: And also, let's say you're interested in searching a particular group of journals like complementary medicine journals. Do you see there is a selection? MF4: Well, can I put core clinical journals? I: Sure thing. And are you interested in women more than men? Boolean: MF5: Umm, something with pregnancy. Or is that too general? I: Hmm, may be a little too much. MF5: Ok, how about reflexology? I: And pregnancy? That might be good. MF5: Ok, so I would be typing in reflexology with the Boolean operator AND pregnancy? I: That's right. Very good. So you know how they work, right? MF5: Pretty much. They are just like ways of pairing things together to create topics. I: Right, they help you to pair things together to drill down, to limit your searches to be either more specific or more general. So let's say with reflexology OR complementary medicine AND pregnancy-do you see how it broadens it and limits it at the same time?
MF5: Uh huh. And should we be using capital letters when we do this? I: hmm, it might depend on the database, but I think in Pubmed we should use caps. I am not completely sure though. So we are at reflexology and pregnancy. MF5: Ok, 1-20 out 196. I: I got the same…. And the first one is Wickam? MF5: Yes. I: Great. Now, will you look through the abstracts and choose one that is good for you? That is interesting to you? MF5: (Takes some time). Well, they all look pretty interesting to me. I: Ok, actually, before we continue, I am going to give you a brief overview of what we are looking at. (I explain why things are highlighted in blue -clickable, the title, the name of the journal. Indexing for the database, the number beside the article for selecting an article to send to different places). MF5: I thought things were underlined because it lets you open up the, uh abstract. I: Well, you can do that or you can click into the abstract. But before we go there I just want you to notice different thing about the icon. MF5: Like if it is blank it means there is no abstract … I: Right, very good, I think you are better at this than me! MF5: Isn't it amazing -I have learned so much in a small period of time. Isn't it that if there is no writing there is no abstract, if it is green then there is access to the full text of the article? I: Perfect, ok, well let's just move on then. Ok, so you can go into it by hitting the icon or the author, MF5: But when we click into it, even if it is electronic, it doesn't mean that we can get access to it, we would have to subscribe to it, is that correct? I: Absolutely, you would need a subscription. So, how important is it to have access to the full text, or is it good enough to just look through the abstract? MF5: I usually base it on how the abstract sounds to me. If it sounds like it is something I would be interested in then, yeh, the full text of the article becomes a little more important so I could read at least the methods, and you know what, the whole thing, so I have to say its pretty important. I: It's important to you to have access if like the abstract but you have enough info from looking at the abstract to know whether you want it or not. MF5: Correct. I can use the abstract to judge. I: ok, good, can you read through this abstract and tell me your thoughts about it? MF5: well it talks here do you see about the p factor? I am not sure what that means... like, .0001, I don't remember what that term means. I'm not really up with statistics per say, I'm not really … I can understand some but not all. But the article, I mean the abstract seems pretty straight forward. I would be interested to see more. I: Ok, so just go back and let's go over some more features.
Related Articles: I: Ok, so this feature presents you with more drilled down information, actually, do you know what I mean by that? MF5: Refining the scope. I: Exactly, so what this does is take the info and it searches based on those criteria (I explain more). Look through this list and see if the abstracts are actually related to what you are looking for. MF5: Well, I would be interested in looking at number four. This one talks about Premenstrual symptoms and I am not sure how that relates to pregnancy. I: So a few would be… MF5: Yes, I am not sure of number 14, of a technical term here, it says something about pre-assessed something, are you aware of this term? I: Uh, no sorry.. MF5: Yeh, well, not a lot of these seem to be directly related to pregnancy, some of them but not a lot of them. I: So overall, would use the feature? MF5: Oh definitely, to see what it produces. If it produces nothing of interest I'll just go into something else. I: Ok. So let's go back to number 5 and we'll go to links. Choose books first.
Books I: So we are at the same abstract, but now there is a number of things highlighted in blue (I explain why… links to books … opportunity to seek out more context… ) MF5: Ok, let's look at lymphatic. I: (we click on lymphatic and I explain more). Ok, some of these books are actually online… do you see this is like a table of contents. In fact it looks to me like a compilation of journal articles. MF5: Ok, I think I am little lost here. Where are you? I: Ok, let's go back a few pages. MF5: Ok. I: SO, now click on the book cover you see there. MF5: Oh, I clicked on the number 147 beside that … ok, now I see. I: Ok, so this is the TOC, and you may search the book for whatever you wish to search for. Now let's do what you did. MF5: I am thinking actually that they all go to the same place, at least that is what I am thinking so its good… I: Yes, its good to make mistakes some times. Ok, so this is giving you the articles in the book relating to lymphatic drainage. (I explain more….). MF5: what kind of order are these terms in? Is there some sort of ranking system or something? Is it ok to ask that? I: Hmm, of course-it's good. You obviously get it. I assume that there is some sort of ranking, but I am not sure how exactly it is done. So what do you think of that feature. MF5: I really like it, if I am writing a thesis for a paper, I would see this as very useful. I: But, for what you do… do you see yourself using it very often? MF5: Well, I wouldn't say a great amount but I would use it on occasion. If I was doing in-depth research on something. I: And how often do you do on depth research? MF5: Not a lot. I: Ok. MF5: Well, when I was in school, I graduated a little while ago, the opportunity to search online wasn't really available. And that it is online… and now that I am an alternative health field it's a lot harder to find that information, I find.
Linkout I: (I explain the purpose of the tool). All of the information about how to access the article. Here we see the publisher -Elsevier, it is available online with subscription, as well as where it is available in libraries. So here the Ontario Scholars Portal has it. MF5: hmm, I am not quite familiar with that portal… I: ok, so here are all the colleges that have the article. Let's see if UofT has it. MF5: Well, I am close to McMaster…. I: Do you see yourself doing that? MF5: Well, it is a possibility. I don't particularly like paying for things online, I don't think that that's a safe measure with my credit card online, its something I am particular about, I have done it but I don't like doing it… I: I see…you don't like to give out your information.
Limits I: OK, let's go back to the homepage and go over another little feature. Limits-do you see up there in the tool bar… MF5: Yeh, I did look through the tutorial, I did this a while ago, I didn't actually do a search with it but I did look through it. I: Oh great, well, its basically another way to limit the scope (I explain all of the possibilities; language, gender, subsets. Abstract/no abstract. Entrez date. Ages, We put on some limits. We search reflexology and pregnancy). MF5: I guess we shouldn't put too many on. I: Yes, you might limit it too much MF5: Oh, this found a number of articles, and there is a free one down there too. Yes this looks pretty good. I: Ok, so between this and the related articles, which do you prefer? MF5: Hmm, I think I prefer this one although, although I know what I am looking for here. I: yes the tools are a little different in that respect. MF5: I think I would sue this one to look for something very specific but if I wanted to browse around I would use Related Articles.
Send to: I: Ok, so select an article and all I want you to do is place a little check mark in the box next to the number. Do you know how to send things to your email or save them on your computer? MF5: I have sent things to my email before. I: So this might be a little redundant. MF5: Oh that's ok… I: (I explain 'send to'). Let's start with email. (I explain all of the options-sending with abstract etc…) Do you know what 'html' is? MF5: Umm, I guess it would include all of the graphics. I: Right. (We mail citations to ourselves). You can send the information up to your clipboard and amalgamate and then decide what to do … MF5: Oh, but how do we then go to our clipboard? I: Well, let's just try it (we select things and send it to the clipboard). MF5: Oh there it is up there I just click on it then? I: I am never going to be able to teach you anything because you keep figuring things out.
Very good! MF5: Oh, I am sorry… I: No, no it is ok, I was just kidding. Ok, so let's send these to our email. MF5: Oh yes that's very good. But I have a question for you, it says here that all of the items that will be stored here will be lost after 8 hours of inactivity. So they will be lost if I don't do something with them? I: if you have stored them on your clipboard then yes, you will lose them. Do you know why? MF5: because it ends up taking up too much space on Pub med. I: Exactly. Ok, hit send to text and see how it looks like a typewriter I: (explains why this is important). So which one did you like the best? The email or… MF5: Well, I certainly did like the email the best. Although the clipboard function is great because you can sort though all of your results, so I would say a combination of those two. I: Ok, great, well we are just about done, do you have any questions? MF5: Well, I wanted to know about the Mesh database is. Mesh more specific? I: Well, it is basically a controlled vocabulary. So, it helps you find different ways of naming things or finding different terms for you to help you with your searches. I don't have much experience with it… MF5: Ok, well I can contact you in the future.. I: Yes, of course. Do you plan on using this in the future? MF5: Yes, I do… you reaffirmed things that I thought I was doing right... that was good, I m really happy we did that. I do picture myself using it. I: What do you think you would look up? How would you use it? MF5: Mostly, complementary and alternative therapy. I always have clients who are asking me about information that has come out on certain treatments so that is primarily what I would tend to use this for. Or if I come across article in magazines, I don't always trust what the author has written you know there may be a bias or an opinion and I would prefer to research the actual thing. I: Oh great, really interesting. Would use be able to help someone else in it? Recommend it to others. MF5: Oh definitely. I: So what did you think the most valuable feature was? MF5: I think going into the limits was, I really wanted to learn how to narrow my search, I think that is more beneficial than related articles. I: So, how will you do your searches in the future. MF5: I think I will go straight to limits now. Before, it was the Boolean operators, but it was too much information and I was worried I was going to get lost. But I think it will be easier with the limits. I: Ok, that is great information. Thank you. MF5: Thank you-that was great for me too.
Follow up: None.

Interview with MM6
Background and homepage: MM6: We need to be able to search, well, Pubmed, and there is also an Ostmed: and Osteopothy database. Out of Texas University. One of them in the south there anyway. I have been there and have searched in there a little bit. I: How did you do? MM6: I did ok, looking for lower back resources/ articles and I did find a few. It is actually a web site, or a search for articles that has been discontinued. In other words, they have stopped adding to it they are only maintaining it.
Computer use: (MM6 describes himself as an "average at best" computer user.) I: How often do you use it and what do you do, mainly? MM6: I use every other day, email, communicating within the class for Osteopathy-we might send on an article. Little bit of searching. Year-end papers for the program. A few web sites.
Used the web to find out more about a personal medical issue: MM6: My daughter had nephrotic syndrome, so I just looked that up last week. I: Is she ok? MM6: She is actually, she basically healed herself. I: How did that happen? MM6: She had had a severe stomach illness with diarrhea, and after that she had become swollen. Really swollen. And we took her to the doctor because it wasn't going away, and he basically diagnosed this through the blood urine test. Anyway, he wasn't a real talkative guy so we searched it and found lots of material so, we read about that. We also had a Chinese medical doctor working in our office. She was kidney specialist, so she was pretty helpful. Actually much more optimistic about how it was going to go. She said 90% of kids heal themselves and sometimes they'll use a Chinese herb to help the process, whereas he (the doctor), was kinda leaning towards doing some meds, but they were pretty severe. So anyways her swelling went down over the course of the week, so I'll look things up as need be but I do not spend hours on the computer by any means. There were some articles, and I looked in Ostmed, and they would just give the abstract. One of the instructors said many times you can go to the library and get it for free. So I went to the library and the librarian told me that they can't get any articles from an American university or through the states. It has to be in Canada. So I had to contact them and pay for the article.

Regarding his thesis for the Canadian College of Osteopathy:
MM6: Well we can do a little study. But of course we still have to back this up with the research that's out there on our subject.

Homepage:
I: Have you ever heard of Pubmed before? MM6: Yes. I: It's a life sciences database with full text articles in it. Sometimes these articles are a little difficult to read and specific. So we don't only use this database to find information. MM6: Oh, ok. I: Journals is another database. 'Books' is another database, of info about books, like textbooks. Genome structure… all of these are very specialized databases. You can access the databases when you scroll mouse over the white, and you can click into the different databases. MM6: Ok. I: Most web sites provide more than one point of access to a database. And so you can get to any of these databases by clicking on the drop down menu where it says search Pubmed. MM6: Oh yeah, ok, and there is many more actually. I: Right! So the ones across the black bar are probably the oldest and the most used divisions, and the ones that drop down get even more highly specialized. Ok? MM6: Right. I: Now down the blue bar are some more tools and more databases. You have access to the journals database, if you want just click into it quickly. MM6: Umm, down on the left side? I: 'Yes, do you see where it says …' MM6: Yup, ok. I: You see it has information about all of the journals. And then there is the MeSH database, if you click on that." CM16: Yup, ok. I: And the MeSH database is a controlled vocabulary database. And this is not actually a database with information about articles. It is information about how to search Pubmed. So that if you were looking for something in Pubmed but don't know how Pubmed would refer to it… MM6: Yah. I: Then this is where you would look up your search terms. We can try it at the end and practice it. It's a very useful thing but it's a bit complicated. Must know that you can locate it through this blue bar so if you ever need it you know where to find it. MM6: Alright. I: Then there is single citation matcher. So if you already know about an article, and you want to find that article this is where you would do it. And you don't have to fill in ALL the fields. just give it enough information so that the database can call the article. So, my point is, with all this, that there is always several ways to get to one place. MM6: Right, ok, perfect. Looks good. I: Now hit Pubmed on the black bar, and we'll get back to where we started. Just a little bit more of an orientation. There's the tabs that look like folder tabs. MM6: Right: limits, preview, etc… I: Right, so just know where those are. And what we'll do first is, you are into osteopathy? MM6: yes. I: Ok, that'll be our first search. Type osteopathy into the field, and then hit go. MM6: Alright. We've got a few. 258,000. I: Yes, and that's not a good thing since you don't have the time to go over this many articles. MM6: Right. I: Ok, so the first tool that we are going to do is Boolean searches. And actually, Boolean is a search technique that uses language as a way to limit the scope of your subject. And it is actually not even a Pubmed feature. Its something you can apply to all databases. MM6: Oh, really? I: And there are three Boolean techniques: AND, OR or NOT. So if you put osteopathy AND joints, make sure AND is in caps, you are essentially limiting the scope of your subject matter because you are essentially making it more specific. MM6: Yup. I: If you did osteopathy AND joint NOT knee, you would get any article that mentions joints, but no article with joints and knee-so you are limiting further. MM6: Gotcha, right. I: If you hit osteopathy OR joints, I don't know why, you would be widening the scope of your search. Got it? MM6: Yes, yes … I: And that you can even apply to Google, by the way. So if you were trying to find some literature by just going to Google, and you were having trouble finding stuff, you can use the Boolean technique to search. MM6: Ok, that's good. I: So, let's hit osteopathy AND joints and then hit go. MM6: Ok, yeh, well, its 15, 000. I: That's it? Ok, well, let's stick with this 15,000. We are not going to go through ALL of them, but I just want to orient you within this search screen. Basically you have at the top something, you see where it says 'display': summary, Show: 20, sort and send to? MM6: Yes. I: Ok these are all options about how you can see this list. So, it could be that you only want to see the abstract or the brief, so you can play around with this. I keep it on summary because I am not an expert in Pubmed, but once you play with it more, you can change around not the search results, but how you see the search results. You can present the information to yourself in a more helpful way. I think this is pretty good though… MM6: Sure. I: You can show up to 500 at one time, or you can show only 5, in case you don't want to look at all of this information at once. You can also sort it alphabetically by author, journal the most recent or the earliest. So then we have our citation. Do you know what a citation is? MM6: Well, you better explain it to me. I'm not exactly sure… I: Ok, no problem. A citation is just the name of the author, the journal, the abstract. It's what we call that group of elements. So number one is a citation. Does that make sense to you? MM6: Ok, yup. I: So, all of that information is called the citation. Next to the citation is an icon of a piece of paper. Do you see that? MM6: Yes, I do. I: And do you see how number three does not have any lines on it? MM6: Yes. I: Ok, what do you think that means? MM6: umm, no lines on it. There might not have written a longer, there might not be any wording on it? I: Kind of ... it means there is no abstract associated with it. An abstract is a common part of a citation. It often has an abstract, but doesn't necessarily have one. It does have to contain an author's name, and the name of a journal, but it doesn't have to contain an abstract. MM6: Right. I: Most journal articles do have abstracts associated with them. An abstract is a little summary of what is contained within the journal article. It is a summary of the main points and findings. So, basically, number 3 does not have a summary, but number 2 does. MM6: Right. I: And that little paper icon identifies that. MM6: Gotcha, so we've got an abstract when there are lines on it. I: Exactly. MM6: On one of the articles I had ordered, we had an abstract there, and I thought, it was more to test out this whole system because the abstract was helpful but I thought I would get the whole article. So on a few of them they sent me the full article, but on that one they still charged me, but it was only the abstract anyway. So I didn't need to order the article because all there way the abstract… but it didn't say that. I: Oh, that doesn't sound fair… MM6: It was a rip off… I: So you paid for the abstract? MM6: Yes, well exactly. Because I said I want the articles on these, it was four articles, they sent them out, but the one of them was still just the abstract. I: You should get your money back. MM6: Well your right. I: I am serious! Because an abstract is essentially, almost like advertising for a paper! You shouldn't pay for advertising… MM6: Yah, exactly, well I thought this is crazy I mean I have the abstract right there. Ok, well that's just a sideline, ok, let's continues. I: No, no, that's important. I actually want to hear more of your voice than mine. I tend to talk a lot so you can cut me off any time you want… MM6: Alright. I: So I want you to notice how on the citations, each one has a blue name that is a link essentially. So let's click into the first one, and I'll show you what a full citation looks like. MM6: Alright, ok, now this is the authors with the blue underlines. I: Right, and the reason why their names are still underlined in blue (after we have clicked into a full view of the citation), is that you can click into that link and find more articles by the same authors. MM6: Oh I see. I: Alright, you then have 'Chang. Gun. Med. Journal', which is the name of the journal. Then you have 2005, 28, 6, 411-20. Those are the year the issue and the pages, then you have the title. Then you have some info about who they are and where they are from, and then you arrive at the abstract. MM6: So this is the summary of their study ... ok, got it. I: Exactly. Ok, so now just go back, and I'll show you a couple of other things… MM6: Wait, 'related articles', to the right there, that's related articles that these authors have done? I: That's a very good question-we are going to go over related articles soon enough-so that's great. But in short, what that function is is articles related to this article. Not necessarily to the author. The way to get more articles written by the author is by clicking on the author's name which is underlined. But the way to get more articles like this one is by clicking on this button. Soon enough, when we find an awesome article for your needs, we are going to click the related articles button, and see if it works for you. MM6: Ok, alright, but for now, you just want me to go back. I: Yes, there are still a couple of things to go over. MM6: Ok, it's all good so far. I: Ok, so now just scroll down, and what we want to find is one of the pieces of paper that has either a green or an orange bar on it. I haven't seen any yet. MM6: I don't see any yet either. We should probably go to the next page. I: Oh, I found one, number 37. MM6: Yup-I got it. I: Ok -that green bar across the top indicates that this article is free. So click into it … MM6: Yup, xxxxovitis inflammation of the tendon… (we find a Spanish article) I: I will show you a way to limit the languages so that doesn't have to happen. MM6: Ok. How about we look at 52? It says free full text. And this one is in English. I: Ok, I don't see an abstract… did you click into it? MM6: I did.
I: OK, so I want you to notice that the way you end up accessing the free full text article is by going to the journal's web site. So the Journal of Rheumatology essentially, has a web site where they publish their research. So note that the article is not located within this database, you have to go t another web site to get it. MM6: Right. I: So if you just hit journal of Rheumatology, and we'll go that web site. MM6: Got it. I: Ok, and here we have our authors, and umm…. MM6: Ok, good. I: Ok, I still don't see an abstract for this article… MM6: Yah and you can use the abstract to decide if the article is worthwhile. I: Right! Now if you go back to the Pubmed window, I would like to point something out. MM6: Ok, I'll get rid of this… I: Ok, notice that it says 'publication type: editorial'. MM6: Yup-I see that. I: Ok so basically an editorial is an opinion piece of certain issues. It is generally not a research study. So one of the reasons why this one might not have an abstract is because it is not a research study, and therefore there is no 'findings' to summarize. It is almost like a letter. MM6: Ahh, gotcha I: Alrighty then, let's go back and find something else. Hit next. MM6: 67 has one… looks good. I: Ok, look at the abstract, and let me know whether the article looks interesting, and whether the abstract itself is helpful to you in determining, in being able to evaluate the article… and take your time. MM6: Ok (Time passes). Yes, well it encapsulates…. I mean they laid out what happens. Umm, surgical intervention, and then post-op. So, it's an abstract and I think it's fairly clear. I: Are you interested in reading more about it? MM6: Umm, I mean yeah, yeah, this is an area of interest. They are talking about ligaments in the lower back and umm, Hematoma, I mean this is probably not… I mean yeah it says right here-rare case. Because I was going to say this isn't something I ever run across. I: Yes. MM6: So that would be the only part about it that would, you know myself, I wouldn't go into this one because of that. I: Because it's rare? MM6: Yah, the rarity of it. And, well would we see this or not? I mean, possibly. I mean the person would have no idea, just have back pain, and you know we would end up looking at this. But I haven't seen one in 16 years. I: Oh! Ok! Well, for now, let's move on. Put a check mark into the little box near the number 1. MM6: So click, ok, put a check in number one. I: And then I want you to hit send to at the top of the page, and hold the mouse down and scroll down to clipboard. MM6: Ok, sorry, tell me where you want me to go again? I clicked on number 1. I: Ok, and go up to send to, do you see that at the top there? Send to… MM6: Ok that I am having trouble with. Its at the top, in the blue? I: Nope, it says display… MM6: Oh yes, I see it gotcha, ok sorry. I: Its ok… just hit on the arrow downwards and MM6: Ok, go to clipboard. I: Ok, now you'll see it says in pink (I read the instructions). MM6: Right, ok, so you kind of archived it. I: Right, well what you did was you saved it, well, Pubmed is like your workspace and you saved it into your workspace so that you can look at it a little later. So at the end of the hour, we can go and delete if we find it useless. But, we'll just keep it there for now, and we'll go back and evaluate what types of papers we have there and which ones you might want to email to yourself later on at the end of the hour. And note, that these articles don't stay here forever, they get deleted after a while. I: Right, so we have 278 articles that relate to the initial article. Which means, may be we have a list of articles that is useful to you! So have a look through them and tell me whether indeed they are related to your interests. Tell me whether these are even better than the last ones. MM6: Ok, well, the first two are the same ones. Ummm, ok they are talking about acupuncture with it. Ok, so now they are going through the pharmacology to treat it. (reads to himself a little more). I: Oh! MM6: Umm, so yeh, now I think its … well the first few we had the same articles, then there was one on acupuncture and now a lot of it is getting into more, uh, pharmacology, surgery, we even have one further down that talks about ankle sprains. I: So do you think that these articles are really related to the first one? MM6: Not so much-just the one really, near the top. Yah, the first two were the same, then we had an herbal dietary thing, then we had the acupuncture, and then from there on below four, it, yah, not as much. MM6: Gotcha and its got full text highlighted… I: You have access to records, taxonomy tree.. so when you become a Pubmed expert you will be able to use all of these tools. It's one of the things that comes with staying in Pubmed. Does that make sense to you? MM6: Umm yes. I: Ok, let's close out of this for now, and click on the 'free full text article' button. MM6: Yup-so I'm there. I: ok, you've got the article, you've got services and functionality-it links you up to Pubmed and to something else called Web of Science. And remember this is not a database but a journal web site. Ok, you can even go to the current issue of PNAS (the name of the journal), and browse through it if you wish to. MM6: I see, ok, that's good. I: And then you can subscribe. MM6: Of course. I: Ok, so close out of this window, now actually, you might wonder why this particular article is free, while other articles in the MM6ournal are not-you have to subscribe to it. It could be that they have a policy by which they release their articles six months after they have been published, a delayed release, or may be they just decided to release this one free for some reason-who knows why… MM6: Yes, right obviously, I am just scrolling around, very few have the full text articles. I: It really depends on the topic. Some have a lot and some don't. MM6: So, if I want to see some of these other articles that only has the abstract, then I am going to have to umm, contact that university or journal or what have you. I: Yes, exactly, and I'll show you how to do that more efficiently. But first, will you try to send yourself this article? MM6: Sure, I can do that. I: Ok, what do you do first? MM6: Ok, I have to click on number 1 and then send to clipboard. I: Yes, but its number 54 … MM6: But I am in the article… I: Close out of the article first, go back to the search list and MM6: Oh, ok, I see now. Number 54, got it. I: Great. It's easy to get lost, eh? MM6: Yes, and the problem that I've got is that we have no drapes on our window and I am fighting the sun to see the computer screen. I: Why don't you take a minute to fix it? You shouldn't be uncomfortable while we do our interview. Take  MM6: At the very top-bookshelf. Yep! I: Well, before it used to say search Pubmed, and now it says search books for "PAIN" because we had clicked on PAIN in the abstract, ok? And so pain is mentioned again 3444 in Hstat, 478 items in Cancer, 297 times in Physical Education and Medication Board review… etc… so these are books, not necessarily about pain, but have pain in them. And sometimes, it will be a book about whatever the search term is, it just depends on what the book is. Does that make sense? MM6: Yes. I: So let's go back to the first citation that we were working with when we clicked on Pain. (Still in the Bookshelf database). MM6: OK. I: Ok, just take note that any word that is underlined in this abstract is connected to a book. If you want, you can click into one of them and check it out. MM6: Yes, got it. I: Do you think this is a useful tool? MM6: Umm, I don't know. It doesn't really tell me-well, ok, the word pain is in all these books-but the word pain, I've probably got 30 medical books in front of me and I'm sure the word pain is mentioned there many times. But I don't know how that would link very well, with narrowing the search down for me. I: Ok, good to know. Ok, well, let me tell you a little bit more without convincing you. Let's say you were looking up massage 'therapy and lower back' and you went into 'books' to check out if there was an entire book on the subject. MM6: Yes, ok true enough. That could work. If you had a more general heading, as opposed to these small words that could be, well there would probably be a few then may be the book itself, I don't know if you click onto them book itself, does it tell you anything more about the book (referring to the picture of the cover page that you can click on to find out more about it). I: Good question, we were just going to go there. Let's see what that does. (We click on it). I: Ok, I think this book is associated with the National Library of Medicine. And you have here I think the table of contents with what is in the book. So you can get some pretty specific information about what is in the book form this tool. If you are looking for a specialized book, and you hit the books database to see if there is any more specialized information, you can find some good info. MM6: Yes, I can see how this would be useful. And then obviously we would have to buy them… I: Yah or you could take it out of the library. Again…I don't want to persuade you of anything. I just want to present a scenario that is useful to you. I am not giving you a fair shot when choosing pain. It's not the best example. MM6: No it isn't but you broadened my thoughts on it. I: Ok, so now I want to do limits. Located at the top in the tab. MM6: Ok, I clicked back to our list. I: Yah, good, exactly. MM6: So, we are looking for limits… I: Can you actually tell me once again what our topic was? MM6: Sure, it was viscera and spinal pain. I: Ok, great. So working again with the first abstract. Click into Limits. Basically this is a tool that allows you to narrow the scope of your search, but not by searching the contents of the article, but rather by searching the information about the article. So, for instance we had trouble at the beginning, because we found a free full text article, but it was in Spanish. Here is where we would go to limit by languages. Do you see where it says that within the limits screen? MM6: I see something called "All Fields'. I: Close all fields, and just look at the screen first to see what the info is on the screen. MM6: I must be losing it because I am not even in all fields anymore. (lost). I: Ok, click back please MM6: ok, I am back to the list. I Ok, click on limits again. We'll just try it again. MM6: Ok, so yah, I've got limits. I: ok, and it says limited to: and then you see all fields, publication types, ages, entrez date. You don't see those fields? MM6: Well, I guess, its got limited to "all fields" at the bottom. I: Did you put on a limit may be? MM6: umm I don't think so… I went to the 'limits' tab, I see 'all fields'… I click on that but I don't see languages. It's got 'All fields, experiment types, filters…. MM6: Well, I just went into the first one, which didn't have it, so its just going to be an abstract without the full article. Umm, so I went in, had a look at the abstract, then went into Linkout, and it's not in the university list, so I couldn't remember if we did this. So, if it's not at the library, in the list here, is there any other way for me to get it? I: Umm, some times if it's available electronically, then you can get it. But it looks like its not. If it's a PDF and it sits on another web site, then usually if it is you'll see a little sign that says EBSCO, or EBSCO full PDF access, and you would be able to click on that and be able to order it right to your computer. But unfortunately, for some reason, this one does not have that. Let me just look at something. I want to see if it's a print journal. Can you do me a favour and just tell me what the date is on it? MM6: Ok, I am just clicking in. You're at the first one? I: Yah-Fleurmonde? MM6: Yes, that's it. Uhh, the date, summer 2005. I: Its really weird. It looks like everything here has it only in print. I am looking over this list (in Linkout) and it says print collection. Let me see I am going to go into University of Toronto and see if I can email it to you. MM6: Ok. I: this means, I am going to log into my UofT web site, and umm, look it up in their resources. What I do is, I look up the name of the journal. What's the name of the journal. MM6: Umm, ok, I guess it is the first part-oh I got it, Ethnicity And Disease. I: ok, great. This is just an interesting little side bar. I have never done this with anyone! (We chuckle). I: Ok, I can do this for you, but It'll take a few minutes. Should we bother? MM6: hmm, I don't know. It'll just be seeing if its there? That doesn't help me anyway… I: No, if its online it will, I will forward it to you… as sort of a favour. MM6: Oh, yah, yah, yah. You could get it for me. But umm, but I won't be able to do this all the time, say get me this article… I: Well if I was in a good mood may be. So what should we do? Forget it, or? How about this, I'll do it when we get off the phone. Ok, when you went to link out to look for it, everything was in print, so it was difficult to get the article. MM6: Right so even though it just shows on my page as an abstract, I should check link out because I may be able to get it. I: I think we should click through and find an example of a linkout where there is an electronic article right there. Umm, that's what I would like you to see right now. MM6: Ok, if you want to do the even ones I can do the odds. I: Ok, that sounds great. … oh, sorry, but I found one already. Go to number three… MM6: Ok, so got to Linkout-oh but is it right there? Ok., so I know right away when I pull it up that I can get it. I: Oh right, I didn't see that. You're right. You'll see right away if you can get it. But this one you would have to pay for. MM6: Oh, I'd have to pay for it. I: Yah, in fact, why don't you click on it and see what happens. MM6: I did go into it. Ok, so go back into it. Umm, so well, ok there is the abstract, and the other part is in German. I: Right, so when you click on it it asks for your username and password. And do you see on the side? The login? MM6: So you know right away that you need an account with them. I: Yup. Most American ones will have Ebsco or Ingenta button. This one is a different button because it is a German article. Ebsco and Ingenta are giants in the publishing industry. MM6: And they may or may not be charging for it. I: No, most likely they will be charging for it! MM6: Oh. I: Unless you see the green or the orange bar on the abstract icon, they will be charging for it. MM6: Yes, ok, so basically if I need to get an article here, well, I mean I can always click in and see if I can get it at the university. But UBC, I have never seen SFU, and UBC, only comes up sometimes so it seems like most of the articles I would not be able to see. There is not a lot of green and orange bars around. I: But what you might be able to do is go to UBC and talk to a librarian, and see what she could do for you. about how to get more specific in order to limit the search: so, you say what kind of back pain? Low back pain, and then you ask in relation to what? And it is in relation to pain. So you have Low AND back AND pain … (tape ends. We have a conversation about research while I switch the tape. My question was lost but it had something to do with access to the research). MM6: A large part of me wanted to do this because of doing papers for the Osteopathic college is a big motivation. But its also nice to be able to, now that I know a little bit, even if I was not doing the college, to try to stay you know somewhat up to date on the current recent articles on whatever it is. You know PMJ (?), or neck pain or whatever. But of course if people go in and they can only read abstracts and they can never get the papers it is limiting. I: Exactly. MM6: Well, hopefully things will change… I: We'll see. Alright should we talk about limits? MM6: Limits, sure, ok. I: So, I was telling you how Boolean changes the content of the search. And so limits changes the stuff around the content. The parameters around the content. Like, what type of field its in, or when it was published or what language it was in, or umm, what type of journal its in, who was in the study. That stuff is meta-data, its not really the stuff of the content of the journal article, but its stuff that every article has. Every article has people with a gender, a language that it's written in… and you can control that without going into the actual theme and content. Does that make sense to you? MM6: Yup. I: ok, so we are going to do, low and back and pain and we'll put on some limits. Ok, so first let's choose English. MM6: Yup. I: Ok, and humans. MM6: Yup. I: Male? MM6: Sure. I: Ok in subsets, we'll put it to core clinical journals, which means we are going to limit from other journals which are kind a outside of the fold. MM6: ok, dental journals … I see I: Yes, we don't need any of that stuff. We aren't really interested in back pain associated with any dental problems. We'll put Entrez date a year. And then hit go. MM6: Ok, I just have to punch back in low back pain. I: Ok, low and back and pain. We got a lot of hits on that one let's see what happens now. MM6: right. Ok. Yes, well that did a lot, 49. I: there you go. Will you look through the list and tell me if it's a good list? MM6: (after a few minutes). Looks pretty good. I: great, well that was limits. So, notice how there is a yellow band across the top, and it reminds us of what your limits are. If you put on too many, you go back in and change it. What would happen if we put too many on? MM6: We'll limit and cut out some you actually want. Like gender for instance, I assume they must have done studies on females as well. I: right, so if you put on too many limits, you would limit your search and you may not come up with anything. So you would want to take some limits off. So this yellow band reminds you of what your limits are, and you can go I and change them. Click on the tab on limits and see like this is what you have already got and you can change it. If you put this in combination with your search, low back pain, you get something pretty specific. You wouldn't get any German titles for instance. It's a little less daunting.
MM6: Ok right. That's useful. I: well that's limits and that's about all I had to show you… do you have any questions? MM6: Hmm, well, let's see, I did want to ask you one. You were talking about access… and that there are groups trying to get access and I know I was talking to a librarian here at the public library and she said in BC they were trying on working on, and the government was pushing this forward, although I haven't heard anything lately on trying to link the public library with the university library so that anybody that has a library card can access SFU and UBC you know obviously they are linked with many of the other universities across north American and around the world so they are trying to make it more you know user friendly or allowing a lot more people to access. I: Wow, that's great. MM6: Did you hear anything about that in Ontario? I: hmmm, I'm not sure exactly, but I know there is alliances behind a lot of the different universities especially between libraries. So that's something worth looking into on my part to find out whether they can share electronic subscriptions with each other. .. So that's really interesting. MM6: Yah I thought so, but of course it's not in the cusp and you know how fast government works. I: Well, I'll look into that…great. MM6: And then in a couple of months I'll check in with you… because I got a course coming up, so after that I'll try to mess around in Pubmed. I: Sounds good. Thanks for taking the time MM6: oh, no it was good I appreciate it. I: Email me if you have any questions. MM6: Ok, thanks. Bye. I: Bye.
Interview with MF7 I: (I begin by explaining what we are going to do on Pubmed). Our goal is to drill down as much as possible to the find the least amount of references possible. MF7: yeah so you don't have to, yeah, uh huh, I get it… I: Ok, so with that as our goal, you have to recognize that this is not going to actually find us the articles, its only going to find you information about the papers. MF7: Oh, you mean Pubmed does that? I: It's an 'Index', it does not contain the actual papers. MF7: Oh, ok!! I: Yah, and that is one of the reasons why we are going to do this study. To put it very simply, one of the goals is to open research up. Now, research in the form of papers is locked up. You often have to pay to get access to it. MF7: oh, like the journals and stuff that they are actually published in. I: If you go to a university, its not so bad because often times but not always, the university will have a subscription to the journal. In contrast to this is the existence of the Open Access movement. Now that it is so easy to publish information in digital information, there are few reasons why access to scholarly research, particularly if it is subsidized by federal research grants, should be limited. MF7: That's so true. I: So we are going to go through Pubmed, and I'll show you how to actually get the free articles, because there are some that are free. Some even release their journals articles later on and make them Open Access like 6 months after they have been published. MF7: Right… I: So I am going to show you how to recognize the free from the not so free, and I also want your opinion on whether you think you will use these articles. MF7: Well with my teaching, part of what with classes b/c it is post grad work to a variety of people, I usually present articles about topics that we have covered in class with manual lymph drainage and decongestive therapies. And it's a real challenge to find more recent stuff. Right now what I have gleaned is usually from other people, and it's probably dating back to 1997. To 2003 in terms of what I have got on file, which is hard copy only. So it would be nice to upgrade to drop a couple and add a few because students always ask where does that research come from. I can name my researchers but it's nice if I can provide these other articles. I: Ok, well I'll teach you now how to use Pubmed so you can get some relevant material, or at least look into whether there is good stuff for your practice. And I'll show you what the principles of searching Pubmed are. Ok, so we'll start now with the first screen that we are looking at (homepage). Now Pubmed is an Open Access database, which means it is free for everyone in the world to use, as long as they have a computer. And it's published by the National Library of Medicine. Now when you type in Pubmed, it redirects to another web site. MF7: Oh yes, that NCBI address? I: Exactly, it does that automatically. MF7: Ok. I: Ok, there's all sorts of tools and tricks that you can use on this web site that'll help you find good information. So, we'll start with something very basic, umm the first is, do you see the black bar at the top. MF7: [lists what is written on the black bar, all of the databases associated with Pubmed} I: Basically this one page that you are looking at is kind of an umbrella to multiple databases full of information. And as the information grows they might create more databases. And the reason why its not one big database, why there are these divisions, is because it is probably easier if you separate it according to them or topic. [I then explain what the divisions are]. There is crossover between all of the databases. You can click into all of the databases. MF7: Ok, by clicking into the bar. I see. I: Yah, but don't click into it right now. You can do similar things, if you take a look at the blue bar running down the side of the page where there are more options. MF7: Oh, I see! I: And then it says 'search Pubmed'. MF7: Oh yes… I: and you can drop that down, and again you have access to the main databases and even more. MF7: Ok. I: Ok, so the first thing we are going to do is a Boolean search. And this is not even a high tech way of searching. It simply means that you are going to take your subject matter and limit it by being more specific. So choose a subject matter. MF7: Ok, so I type in 'for lymph systems'. I: no 'for', just lymph systems. MF7: the latest research on lymph systems would be nice. You see the field of Lymphology is growing because umm, for years and years till 1999 they didn't give it a whole lot of credence in terms of its relationship to the circulatory system. And in 199 there was some huge research that came out from some heavy weights, that showed that the lymph system was really, really important. So now we've got people on 4 continents to be lymphologists and be the first on their block to publish stuff. So I want to know what it is they are discovering. I belong to the international society of lymphology and I also receive the journal of lymphology here in North America, but that's it. There's a lot going in Europe and Asia that I know nothing about unless they publish in lymphology or unless they present at the ISL. So that's one aspect of what I am interested in. I: Well, there is a good way to get the most current research possible, but for now, let's just search lymph system. MF7: ok, so I just put that in like that? Lymph system? Boolean: I: Yes and hit go. Ok, there are 13385 hits. Let's drill down. How could we get information that might be more helpful? Because there are too many hits… what else could we put with this topic? MF7: Ok, how about umm, anatomy? I: Ok, lymph systems and anatomy. The AND basically limits the scope of the topic. If you say lymph system, then you will get anything in the database that says lymph system. If you add AND anatomy, then you will be searching from anything that has both of the terms-which will be fewer. MF7: Ok, so I put AND? Ok… oh yeah, it does lower it. I: That's called a Boolean technique. You put in AND OR NOT. That uses the logical structure of language to drill down. And its not Pubmed technical tool. MF7: Ok, right. Well there is still lots of stuff there I: why don't we try to put a NOT-how about NOT cancer? MF7: So, I put a NOT? I: And this is called a search string, it can grow a lot longer. But we still have too many, how about if we say not lymph nodes? MF7: Let's see, hmmm, what about ONLY lymph systems and nothing else? B/c some of these I see are in response to immunity, I see renal stuff here which I am not interested in. I: Well, only doesn't really work. It isn't considered a BOOLEAN term. AND< OR, NOT are Boolean terms. But we can say NOT renal. MF7: Well that eliminated about 1000! I: Ok, well, I think I've made my point. Try Googling 'Boolean' to learn more about it. MF7: Google Boolean? You can do that? I: Yes, so you can find documents and resources on the topic. MF7: Ok, let me just write down a note on the side here. I: So now let's go down the list, and I'll show the components of the page. Click onto the second page and click under number 33. MF7: Ok, there it is. I: What's different about this one as opposed to the other ones? MF7: The green and the orange. I: Exactly. They signify that it is free. K: Oh, cool! I: Yes, the green means free, the orange means that it can be found in Pubmed central, another database of free articles associated with Pubmed. Now I want to explain the citation information to you. (I go through the information with her). MF7: Ok, well I have another question for you: what if we put 'free' into the search criteria at the top? (i.e. as part of the search string). I: Great question! No, because the way the search works is that it searches the contents of the article. So unless free was talked about in the article, it would not come up. However, there is a way to limit to free articles: and that is if you search the Pubmed Central database. Remember at the top? We I mentioned there was a number of databases that could be searched? MF7: Ahh, ok! I get it. I: Except you might not want to do that, as it would be a little limited. There wouldn't be that much related to your subject in that database. MF7: Oh, ok. I: (I explain the components of the citation-the icon, etc.). If there's no lines on the little paper icon, then it means there is no abstract. MF7: So there is no summary? I: Yes, an abstract is like a summary. And most articles have them, but some don't. So click on the author, the blue… MF7: Ok. I: Ok, so can you read over the abstract, and judge for me a couple of things: whether the article could be helpful to you, and whether you would want to read the full article, or whether the abstract provides you with enough information to be useful to you… MF7; Ok, well its not useful for me, for what I do, but it does tell me some information that I didn't know before (she chuckles). The cell type that they are talking about, the engagement of it. I: Ok, that's totally fine-I mean we selected it randomly because it was free. Ok, well let me tell you about the format of the citation. By the way, one whole thing: a journal an abstract an author etc… that's called a citation. It consists of all of the information about the article that you are looking at now. MF7: Ok, citation is author, abstract, and what else? I: the title, the issue the year… MF7: Uh huh. I: so now let's go look at the article. We'll look at the red button (the free full text). MF7: Ok, I click on it, and I'll enlarge it because it comes up as another window. I: now basically what happened was another browser window popped open and went this web site, and here is the article. Notice this web site has a lot of the same tools as in the Pubmed environment… (I explain that more). Therefore a lot journal web sites now have the same kind of functionality as Pubmed. So they have developed it the way Pubmed developed their site. MF7: So the full text would include the full text as well as the article? I: well, we are talking about the actual article when we refer to Pubmed. Because most articles, even 'not free' articles have abstracts. MF7: Ok, I thought maybe they cut that out too (in other words she doesn't really understand the purpose the abstract serves as an indexing mechanism). I find it interesting that they have corrections posted (this article has corrections posted). that's very cool. I: It is cool, that's the benefit of the web, you get to link up the different things, and publish really quickly. In a print form it would be a little different. MF7: Yes, you would have to wait until your next issue came out. I: Ok, now close this browser window, out of the full text, and I'll show you the difference between the two buttons. MF7: Ok, so I just click out of the window with the article. I: Yup, and click on the free FTA in the Pubmed. MF7: Ok, and it has the same blurb … I: So what would be the difference between the two buttons? MF7: Let me see… first of all, I'm not sure. I: Well, look into the left hand corner of the browser what do you see? MF7: I see free in Pubmed central? I: exactly, so as opposed to going to the journal web site, we are still within Pubmed, and that's the major difference. You are still in Pubmed. This is Pubmed central, a Pubmed database. MF7: ok, so green means free and orange means free in Pubmed central. I: Exactly. So now let's close out of this for now, I just wanted to give you navigation through Pubmed. I: Let's find the original article that I sent you… and we'll go to single citation matcher on the blue band. (we click into it). Ok, so let's find that original citation in Pubmed by using single citation matcher. MF7: And it's not a freebie. I: Great-you're right. I got this article for you from my library and sent it to you. MF7: Oh, that's so nice of you! I: Well, it wasn't much, I did it on my computer from the comfort of my home.

Related Articles:
So now we are going to find more article but by using this article as the starting point, because you liked this article. We are going to use the related article tool. Using this article as the starting point, if you hit the button related articles, you'll see what happens. MF7: 404 articles… I: and number 2 is free. MF7: oh, Susan Harris, yes, I know her… I: Please check out whether it is really related to what you are looking for. MF7: Yah, it is related. I actually don't care for this lady too much. We lock horns over some issues. But she is really well respected in the field. I: Ok, and would you want to read something by her MF7: yah, I usually do… I: Ok, well have a look at the rest of the list, and see if the list is relevant to you, to see if the related articles really are related… MF7: Oh, yes ok. Well, there are some that look interesting (number 6) but I would probably have to go somewhere to get it… related articles worked perfectly. I: Ok, just remember that related articles searches based on the initial article-not on a Boolean search string. It's a good trick if you have something by somebody and you want to find more based on them, then you can use the related articles technique.

Books:
I: Actually click into number 6, and I'll show you something else. Please click on books. MF7: Oh, this is different, it shows the article and it shows the abstract, and it is really highlighted. I: Ok, so look where it used to search Pubmed what does it say now? MF7: Books. I: Exactly, we are now in the books database. And so, stuff that is highlighted here is mentioned in a book somewhere. It's a good tool if you need in depth information about something.
MF7: So when I read this abstract that is all highlighted, and I clicked on a term in here that is highlighted, it would take me to an article in a book? I: Well, kind off. It may not be an article in a book, but it might be a textbook or a specialized book about something. It might be mentioned in a book. MF7: Wow that's great. Yah, I have read articles that are part of books… I: Well, it would be more like a book, say about cancer, and lymphedema might be mentioned in it. MF7: right, ok … I: So if you're looking for information that goes beyond being just an article, this is a good tool because often times, even, libraries carry these books. MF7: Well I often go up to UBC and use the library there… its great. Now, I have a question. Underneath these publications types I see, not highlighted, but I see clinical trial and randomized control trial. They are not highlighted or anything, but that's telling me what? I: It is telling you what type of study it is… MF7: Now underneath that it says MeSH terms. Some are highlighted and some are not. What's that? I: MeSH is another database. Those terms that are highlighted are in the MeSH database. MF7: so if I clicked on that to take me to more resources that I would be interested in… I: Nope, its not that kind of database… it is a controlled vocabulary database. Sometimes the language that Pubmed uses for something is different than the language you or I would use for something. So, if I called my arm, 'arm' they might be more specific by referring to tricep, elbow, forearm. If I were to look up arm in Pubmed it might not come up, because what I call arm, the literature might call tricep, bicep, elbow and forearm. So, then I would go to MeSH and look up arm, and it would tell me that when searching Pubmed I must use tricep, bicep and forearm, to find what I am looking for. MeSH holds all of the terms that might be associated with arm, so that if you are having no luck searching the Pubmed, you can make sure you are searching it correctly. MF7: So it's not something that I would be using much of. I: well let's say you weren't finding anything under lymphedema, you go check it out in MeSH and see if possibly you weren't searching correctly. MF7: Oh I see… Linkout: I: well, if we have the time to look at it we will, but we have some more stuff to look at. Click on links, and go to linkout… MF7: (She reads what it says) I: This tool provides a list of ways of arriving at the article. It's a list of publishers, centres institutes libraries. Etc.. MF7: It says full text available through Ebsco, Ingenta. I: Well that's important to know because they are two publishers that UBC has links with. So this tool tells you the publication information about the article, if you ever wanted to get it. You could even order it online. MF7: Very, very useful. It also says documentary delivery Infotrieve. I: If you do want to get your hands on an article, you are dying to read it and want to pay for it, that's a service that will get the article for you. I: So Limits allows you to drill down in a way that is different than the BOOLEAN way that used at the beginning of the hour. Its doesn't limit by theme or topic, but rather by what we call 'meta data', which is information that all articles have-i.e. a title, an author, a language, a type of study. Pull down the drop menu on 'subsets'. You here have a choice between different journals. Select core clinical journals. This means we will be searching only the core clinical journals as opposed to all of the journals in the index-of which there are many. In our case for example it will exclude all articles/journals in the complementary medicine part of the index. MF7: I like keeping it to core clinical journals because they are well recognized in the medical community. I: That's the idea-if you choose to limit to CCJ, then you will be limiting the scope of your search. Do you see why that would happen? MF7: Right…languages, should we put English? I: Sure-and we'll put women for gender, and the more we put on the more we will limits and thereby get fewer results. (We put more limits on: Entrez date -one year. We select review for publication types}. Now we have our limits on, so let's do a search. [we do it and go to another screen, we put in her email address] I: now if you wanted to select more than one, you would just check off more than one article. MF7: Wow! I: it sends the info into your email in box. So you can send the information to yourself, and go up to UBC, check your email and find the citations there. Or ask the librarian to help you… no writing it down. MF7: Cool. So let me just say this back to you: for the ones that are not free, I could take this list to UBC that I emailed myself and get the articles, and bring it to the librarian. I: Well yeah, it's a good way to send the information to yourself instead of having to write it down. Or when you do a presentation and use information from a paper you often times need the citation information to give to people, so this is a way to keep that information. The other thing that its used for is if you find an article and you don't have time to look at it, you save the information in your email inbox and you go back to it. It allows you to retrieve it again. MF7: Wow. I: So you can go back into single citation matcher and find it through there. Ok, now let's check out another function. Go down to 19 again, and click of a bunch of citations. Go back to your send to function, and slide it up to 'clipboard'. MF7: Ok, it says '4 items were added to clipboard'. I: Exactly. MF7: Ok, but where is my clipboard on my computer? I: Good question-this is not your computer's clipboard. It is Pubmed's clipboard. MF7: laughs-ok, I was worried there for a second. I: Ok, so let's say you have been doing research for a presentation somewhere in Europe, and you are finding these great resources, and you want to put the information somewhere as you go about your searches. So, you save thing to clipboard as you are doing your searches. You might go for lunch for an hour, come back, and you would still have the items on your clipboard. It's a temporary storage place. MF7: Ok, so now we go to clipboard (the tab up top). And it says items 1-5, and it renumbers them. I: Ok, now go to the send to function and go to email, MF7: Hey, my email stayed in there. I: It has a memory -so hit mail once you are ready. It'll email all those citations to you. Ok, we are actually done with that. MF7: Thank you so much, I so appreciate your time! I: It's my pleasure, you are helping me out… MF7: It's very cool. I: Do you have any questions? MF7: I did have one, but can't remember… shoot. Ok, I don't remember. I: Well, feel free to email me anytime you want if you have questions. Its better for me if you ask, I want to know what your questions. I might email you too, and ask you for an update. MF7: That's perfectly ok. I: Alright, have a good trip bye. MF7: Thanks a lot, ok, bye.

As follow up:
The next day I sent MF7 a resource on Boolean-clarifying precisely what it does and how to do it, the various rules. She wrote back immediately and as she states: "Boy! You read my mind! I was just wondering about the use of the word OR, and thought I'd check out Boolean on the web, and here's you with the helpful info!". And what that means is: Pubmed has decided how to index and categorize different subjects and themes according to a particular vocabulary. So, let's say you are a chiropractor and you are looking up "chiropractic'. You wouldn't be able to find anything if chiropractic was referred to by Pubmed as massage. So you would go into MeSH and look up how Pubmed refers to chiropratic. You would find that instead of putting in chiropractic, you would find more results on your material by calling it massage. Not a great example, but it is like a synonyms dictionary. Does that make sense? MF8: Kind of, I guess. I: how about we start with a search? What would you like to search? MF8: We could search fibromyalgia. (We type it in and find 3600 items. I explain elements of the citation to her. I start with the icon of the paper: she already knows how to distinguish whether there is an abstract and whether an article is free. We find a free article on fibromyalgia.) MF8: The only problem is that the ones that are free are not the ones I was wanting. Naturally.
(We look at number 28, a free article, but it is not what she wants. At this point it is necessary to 'drill down'. We need to be more specific.) I: What would you like to search for? MF8: What massage techniques are valuable for fibromylagia, and what studies have found common causes and links between patients. I read in one of the articles about the trauma that fibromyalgia patients have experienced. Those sorts of things. I: So links between fibromyalgia and massage therapy techniques. What are the commonalities between people that have fibromyalgia. Pain and suffering and past experiences.
I: (I explain a basic search. I then explain Boolean to her. She has never heard of Boolean before. We try 'Fibromyalgia AND massage OR chiropractic'. We are limiting the scope of the search, and widening the scope of massage. She seems to understand the explanation of Boolean. We stick with Fibromyalgia AND massage. We get 31 results. MF8: Wow. I see the difference (referring to the difference between the searches). I: Ok, so have a look at the results and let me know whether they seem useful to you. (We choose number 8, and look at the abstract.) I: Does the abstract provide sufficient information? MF8: Definitely need to read the article. It does not tell us enough here. (I go over the functions available on a citation: title, abstract, name of journal, and the button to get to the article, should we have access.) MF8: Can I ask a question: I am trying to remember what the number is (referring to the vol. and issue). What is that again? I: those are the volume and the issue and the page numbers. The author is in blue and this signifies that they are linked up to other articles who have written other articles. Also, note the different types of publication types: review versus clinical study. This one is a review study. MF8: Ok. I: I also want you to notice the related articles link, and then next to it something called links. Bookshelf: I: ok, so what do you think is going on here? MF8: Its got the abstract with a bunch of words highlighted. Lets see, what if I go to massage therapy… (I explain books indexed in Pubmed that have keywords linked to other sources. I explain to her that she could order whole books related to her subject matter, and that she look for books in the Books database that I showed her earlier. MF8: Ok, so they are actually books, not just the articles? I: Exactly, you might even be able to find the books somewhere else -like on Amazon or something. MF8: Ok. Related articles: I: Ok, related articles is useful to broaden your search beyond just the search terms we put in. It could broaden the scope beyond the initial search so its good when you are not quite hitting your gold mine. (We hit related articles, and I give her a minute to look over the search results.) MF8: So, it's bringing up other articles related to complementary medicine because that's what the main title was for that article. Umm, but I am sure that if I had chosen a different article in the first place, it would have ones that be more specifically related to what my interests were. There are ones here that are really interesting here, that I am sure I would go searching through because they do seem quite related. I: By the way, I see a lot of article by 'Ernst E', that was our initial author, that's how this related articles function works. It often does the search by author or by subject matter. But basically, you want to find an article that is almost useful or perfect, and then you want to hit related articles. Every time you use this function, in relation to a particular article, it might take you in a new direction… MF8: Yes! I: Do you see what I mean? You can't just look at an entire list and use related articles. But you use one article to generate a list of related article. MF8: Yah -I get it. I: Actually, there is a free one here… are you interested in it? MF8: Yes, I see it-but it is related to complementary medicine. Because complimentary medicine was in the title of the one we started this search with. I: Very good! So, you're not interested in it? MF8: But it is free… and there is also number 14 that is free-that one looks good too. I: Ok, so put a check mark next to number 14 and then I want you to take a look at number 19. MF8: Yep-that looks interesting! I: Ok, so now let's hit related articles on that one, and do you see how it puts at the top the one we were originally looking at … MF8: Yes. (We look through this new list for free articles, and find one free article. We click on it.) MF8: So, when I check marked the article before, I didn't know how to go to them after that … I: Yes, I am going to explain that to you right now. So I want you to hit this [free article], but you might actually want to read it. And then I want you to go to 'send to'. Do you see it up there at the top? Well, with this function you can send the article or articles you selected in a couple of different ways. You can send it to your email, you can send it to the clipboard, you can send it to a file or a text file. So which would you like to do? MF8: Umm, I don't know… sure. I: Ok so drag down and select email. By the way, have you even done this before? MF8: No … I haven't. I: Great, I love that! Ok, so now up pops up the option of what information we want to send to our email. We can send the summary, the brief, the abstract, the citation, the XML "basically you can send anyone of those elements to your email. Most people tend to send the abstract, and you send it as an html or a text file. You can put a little reminder in the text box there to remind you what exactly its about. Put your email address in, and then hit mail. And it will arrive in your inbox for you to read… one day. MF8: Yah… ok, there we go, mail, alright. I: Then other thing you can do is send it to 'text'. MF8: Oh yes. I: Basically doping this takes all of the extra formatting out of the page, and it makes it a lot easier to save on to your computer, or send along somewhere. Now hit back, and lets go back to the abstract, and we'll try out send to clipboard. Are you with me? MF8: Yup. I: Do you see a pink ribbon at the top and within that it says one item was added to clipboard? MF8: Hang on a sec, I am just trying to type out the directions at the same time. Ok, so you said one item was added to clipboard, yep-got it. I: Ok, so know how you said before that you have trouble because you check things off and you don't know what happens to them afterwards? MF8: Yes, ok. I: Well, this is what happens, if you check them off and then send them to your clipboard, those items, citations, remain on your clipboard until you are ready to do something with them. So may be you want to email all of your citations that you have checked off as you have done your research at once, or may be you want to send them all to text, and send them to a text file onto your computer. Sending to clipboard allows you to accumulate a number of citations, and then sift through them afterwards. Notice that when you save things to the clipboard it says: 'clipboard items will be lost after 8 hours of inactivity.' This means that if you take a break, make sure you get back to your computer 7 hours and fifty-five minutes later if you have left something on the clipboard that you do not want to lose. Do get what I mean? MF8: Yes, except I don't know how to access my clipboard.
I: Oh, I'll show you-good question! Do you see a bunch of tabs at the top of Pubmed? They say 'limits' 'preview' 'history' and…clipboard details? MF8: Oh, ok .. I see it. I: Right so if you click into this area you will be in the clipboard. MF8:I was thinking, oh I don't know. I: Yes ... I think we are used to using MS Word, where we don't see the clipboard too easily because we don't save thing to a clipboard-we aren't sending information back and forth, but here you can actually see it. So ultimately you can compile a list of resources as you do your searches and save it and go through it, and there it is on the clipboard. MF8: Very useful-so then you can put a bunch of different ones on there or something? I: Exactly... so what you can do hypothetically is lets say you keep on using the related articles function, like you keep on clicking through the searches RA pulls up. Every once on a while you find an article that is interesting to you. All you have to do is check it off and send it to the clipboard and then keep on going so you are not interrupting your flow of work. MF8: Yah -that is very useful. I: Ok, so far we not found a totally awesome article. May there isn't anything that suits you, but may be we can search better. One way to do this is by hitting the limits function, located near the clipboard function. Do you see it: limits? MF8: Oh, ok. I: So click on that and basically instead of limiting using the Boolean terms we are going to limit by what we call meta-data. Do you know what meta-data is? MF8: Umm, no. I: That's ok-you are quite 'normal' for not knowing what it is because it's a pretty technical term. But, in essence, meta-data is information about information. Every article in this index has some basic information to it: a title, an author, a language. Not every article has an abstract, but many do. And these categories are examples of meta-data. Does that make sense to you? MF8: Yup. I: So in 'limits' we are going to limit our search by playing around with the meta data. So let's start by limiting by language-let's say you do not want any article in Japanese -or better yet, any articles in a language other than English. So, hit English, and you will get rid of all of those extra articles that aren't useful to you because they are in other languages. You can limit to humans or animals as the research subjects-so humans. MF8: Yup. I: Abstracts: this is an interesting one for you. As someone who does not have access to full text information, it might be useful to limit according to abstracts. If you do this, then you will only pull up articles that have abstracts associated with it. And you are reliant on the abstract because it is the only way you have a sense of what the article is about. MF8: Yes. I: There is limiting by gender-so if you want to research articles about either men or women. But we'll keep it gender neutral. MF8: Yes. I: Subsets -it for people looking for something more specific. Like a separate section of the database. If we choose Pubmed Central, we are guaranteed to find articles with full text as PMC is a full text article database. The caution here is that the nature of the articles are often very scientific, or it is older information. And for publication types, we get to choose, like, the genre of the article. Perhaps you want cutting edge research trials as opposed to a review of the literature or an editorial that is mostly the opinion of the writer. We'll keep it as regular-i.e. no limiting of publication types. MF8: Ok-I need a little bit of time. Publication types, can you repeat what you were saying about that? I didn't get it. I: Sure thing -publication types, well you know how there are different types of articles? Some are research studies, where the writers actually discovered something new, and others are some guy writing his opinion about a certain topic. These get classified. Like, the first would be called a clinical trial, and the other an editorial. So the index basically classifies each article according to what type of article it is-be it a research study, an opinion, or even just some guy summarizing the existing literature on a topic after he researched it in the library.
(MF8 is not familiar with the different types of literatures available to researchers.) I: Now... I left the limits off of publication types because I was concerned that MF8: We wouldn't find anything… I: Exactly -because we are running out of time. So, to summarize: we have English, Humans, and Pubmed Central as our third limit. We could also do ages -do you see that? MF8: Yah-I see it, but, yah, I don't know. I: Well, it could be good for you because let's say we could look for fibromyalgia only in adults. MF8: Yah, but the adults are just 19-44, or 45-64 and blah blah blah. But it doesn't really count 19-80. I: But it does say 19 plus… (It was in a hidden drop down box that Laura did not see or explore originally). MF8: Oh there it is! I: Alright, should we put that on? MF8: Sure lets do it. I: Ok, now we'll search fibromyalgia. MF8: Ok, so we're doing this up in the search thing, right? I: Yah-once you have out your limits on, just go straight up to the search field and hit go after you have put in your search term. MF8: Six articles -and they are all free. (This is because we searched in Pubmed Central. We look through the articles for good ones, and we choose number 5.) I: ok, so this is free in BMJ. Do you know what BMJ is? MF8: Oh, hold on a sec. What did I do? I must have gone to the next page. Ok, BMJ… I: BMJ is a very high ranking journal called the British Medical Journal. Its online, and they make some of their articles available online for free. Now you saw that some of the articles had both an orange and green bar on the icon. MF8: Yup. I: Basically the orange signifies that article is available not only online, but online within the Pubmed environment. That is, Pubmed central. So it's not only that you have to go to another web site to access the article. But you can stay within the pubmed interface. When you see a green bar, you can click on the icon, and another browser window will open with that article open, but it will have taken you into another web site or location. But with this you stay within Pubmed-so you have at your fingertips many of the tools and functions that you would have within Pubmed. MF8: You said it in a different way now, so doesn't it just mean that um, its within Pubmed so that you can access the free full article staying within Pubmed, and you don't have to pay for and order it through somewhere else an all that? I: Yes, but a green bar would mean that as well. But a green an orange bar mean so you can stay in Pubmed and get it-it's actually in Pubmed, or what is called Pubmed Central. And when you get more accustomed to the interface, you'll realize how valuable it is to be able to stay in Pubmed, not get lost, and also take advantage of the Pubmed tools that we have been learning today. MF8: Ok-I get it now. I: Ok-so, let's take another glance around here. Do you see where it says limits up top? MF8: Ok, I think I highlighted and went to the abstract, so I better go back to where you might. Are you on page one where it says one to six items? I: No, I clicked on the icon. MF8: Ok, there it says limits. Yes, I see. I: So, I just want to show how the limits that we placed on there stay on. And its just a reminder to you that you've got limits on, so that the next time you do a search you know that they are there. You actually have to take them off yourself. If you leave them on, and forget, then you won't get full searches. So that's just a warning for you. MF8: So, if you do a different search at a different time, they'll still be there? I: Well, I'm not sure about that; if you close out of Pubmed, they go away. But some people stay on this thing for hours at a time, so it is always good to remind them that they've got limits on so they don't commit suicide or something if they aren't getting good searches. MF8: (laughs). I: Now hit the free full text article. Hit that. And now it is going into Pubmed Central, and it is giving you the article. So take a look around at it. MF8: right. I: It gives you the article in Pubmed. Do you see what I mean? They have tried to make the article a little more accessible. So finding something in Pubmed Central is a good thing. MF8: Nice. (she takes notes on this). I: So, do you see how this opened up in a new browser window. So you can minimize it for now and read it later. Or notice on the side there is a whole bunch of functionality: "Pubmed articles by Mcfarlane Macbeth and Syllman", who are the writers of the article. So lets do a little test. Close out of this window and we'll go to the other full text web site, the BMJ. See there is two buttons available to us for this article. Got to the blue button and click on it. MF8: Oh, man, what did I do? Oh, ok… I got it -I thought I had x'd it instead of minimized it. Ok. Here were are. Yup-I opened up the BMJ. I: So, now we are not in Pubmed anymore, we are in BMJ. And it is the same article. It's the same information, and there is some functionality offered by this web site-its just not Pubmed-its different. You might be able to get some other info from it-it has related articles function too. And it also brings in ways to get back to Pubmed. Does that make sense to you? MF8: I've just got to find it here-oh here it is. So there is stuff down the right hand side. And I see where you are. Yes. I: So this is the functionality offered by the BMJ web site. And what they are trying to do is make it as easy as possible to link up between different articles and information. I just wanted you to note the difference between the green and the orange. One is that it takes you to the journal web site, and one is that it takes you to a Pubmed web site. One isn't necessarily better than the other as it looks like journal web sites are beginning to include similar tools and functions as those available in Pubmed. Ok, so x out of BMJ, and I now I want you to email this article to yourself, without my help. It's a pop quiz. MF8: [laughs]. And begins to do that. Should I send the abstract and the citation? I can't send the full article to myself? I: No, you can send the citation will allow you to look up the article again. MF8: Ok, I'll just keep the abstract. And ok, it has been sent. I: Awesome. Ok, now I want you take the limits off. MF8: Alright, let me see. Ok, I clicked the check mark off. Does that change it immediately? I: Check it out: click into limits and see if the check marks are still there. MF8: No, not there anymore. I: Ok, that covers most of what I wanted to show you. I am having a little trouble with follow up -so if you ever want another session or feel like you need something-even to go over the exact same tools, feel free to email me whenever you want. MF8: Great. Thanks. I: Actually let me go over one other thing with you. Sorry-once I get going I can't stop. Do you see the blue band on the left side of the page, and there it says single citation? MF8: Yes. I: Ok, so let's say you find the end all and be all of articles somewhere else and you want to find it in Pubmed. Here you would put in the journal title and the author's name and the words in the title, and hit go. So let's say you are trying to find a particular article that you already know about, and you know some of the citation information. This is how you would find it. Does that make sense? MF8: Yup. I: Ok, so that's single citation matcher. Then there is batch citation matcher. I: ok, I would do cracking knuckles first because we aren't finding the articles yet we are just finding the terms. MF8: Yes, it didn't have any items found. What about joint manipulation? I am sure they'll have a zillion. Or, high velocity manipulation? No items. I: Hold on a sec… I don't see anything here. So it is cracking knuckles and… MF8: the development of osteoarthritis. But I can't see how they are going to have that when they don't have cracking knuckles. Let's see… no. No items found. You know it doesn't matter umm, it found a whack of articles listed by just doing a general google search, and then reading a few articles, or like ok here is one study done and they cited another so I could probably search for those specific studies and read them myself. I: Yah, or you could put the study into Pubmed and do related articles MF8: Yah that would work. I'll just make a note of that (types). Cool, that's helpful. Thank you. I: So do you think you'll use Pubmed? Do you think it is helpful? MF8: oh, god yes. I: really? Like, everyday? MF8: probably not because I don't have it at work… but I'd say probably weekly anyways,. I: ok, do feel free to send me questions when you have them. And it was great meeting you. MF8: thank you so much for your help. I: Ok goodnight MF8: ok, bye. I: Do you have any specialties in massage therapy? MM9: well there is no such thing as a specialty in MT, but if you mean special interests, back pain, orthopedic. I: ok, so the two articles I sent you… so you found one to be helpful, and one to be too medical? MM9: No, the other one was too boring. I mean as a massage therapist I'm not likely to be dealing with drugs or hearing much about anybody's drug history and yet we did have a little bit of background and continuing education on painkillers but it was a voluntary course and I wasn't that interested in taking it. I'm not really interested in pharmaceuticals. I find them I mean they don't help people they kill them by the hundreds. I certainly don't advise people to take pharmaceuticals. If someone's got symptoms of something, and I know what drugs they are taking, I might go to the extent of looking them up for the patient or if I suspect they might have a problem I would tell them to go call their doctor or pharmacist immediately, I have had that on occasion. So that's my interest in drugs. I: ok. In general then, in terms of the fibromylagia article, can you just give me some basic thoughts of it MM9: well FB is easy to write about because there is always something new on the subject. I've read a lot of them over the years. I have treated people with FB with people that either knew they had it or didn't know they had it because of the trigger points. I find it interesting that there is literally something underneath your hands can have so many takes on what it is. And everything from drugs to massage or whatever. I am interested because it is interesting to see how people are looking at the same thing. If I had FB I would be very frustrated because I would want to find the real answer of something that actually works…so I don't find this a conclusive article at all but it is interesting to read about. I: Ok, great. Sounds like you have good critical reading skills. MM9: Yah, I do, if you told me I had to write an essay on this I would be coming back with a lot more precise information. I: No I just want your thoughts, so that's great. And your PS education? MM9: BA from Reid college, in Portland Oregon. I did professional modern dance training at the Vancouver School of the Arts, two years later I took two years counseling psychology courses in Victoria. Of course I went to the Canadian College of Massage and hydro-therapy taken umpteen post-graduate workshops. I have had Anthony Robbins personal power training.

Homepage:
(We start at Pubmed.com. We start off with basic things, explanation of the Pubmed web site.) I: Which would you prefer to look up, back pain or Fibromyalgia? MM9: Back pain I: Ok, so type back pain into the search field. MM9: Ok, type into where it says Pubmed, or where it says 'for?' I: Put it in right after for. MM9: Ok, I got back pain. There is going to be a billion of articles. Yeh, really, there is 21 000! I: Ok so there is 21, 000 articles. 2569 are reviews MM9: So what's that? I: That's reviews of the literature MM9: Oh yeh, yeh, yeh… I: now that's too many. I just wanted to show you how the object of the game is to limit as much as possible the object of your search. MM9: Yeh, makes sense. I: umm, it's a little different, we limited a tiny bit more. It shaved off a few. It cleaned out anything that's got drugs in the article. MM9: Right. I: So that's an example of drilling down and limiting scope right there. They are basic library skills that do not pertain only to this database but to all. Even Google. MM9: Yah, this is good. I: I found a doc on Boolean search techniques for someone else and I can send it to you if you want a visual diagram of how they work. MM9: Ok, sure. But doesn't Google. Have that? I think I went through some sort of study thing there I can't remember. You know, it's advanced search and then you click on something and then it'll tell you how to set I up … I: I think you are right, you can do it in advanced search. MM9: Yeh, I think so. Anything you got that makes it simpler you know that would help because some of this I do late at night, and just going through Googling is just too tiring. I: Ok, I'll send it along. And you can also play along with other things like brackets and starts. MM9: Yeh, what does that do? Brackets and stars? I: Brackets keeps two search terms together. (I explain more using the example of Massage therapy). MM9: So you bracket massage and separately therapy? I: No I think you bracket it as one term so that any article that has it as one term comes up… but we should look into that more.. I am not an expert in it. But there are other Pubmed tools that will really help limit searches in a similar way. It is a good idea to know about the basics though … a librarian could help. MM9: Ok. I: Ok we'll go back to our initial search of back pain and massage therapy .. MM9: What, oh, ok I'll just erase the whole thing and start over. I: Sure thing. I: Ok, so there is different ways of, well different people would refer to back pain in different ways. If you were a medical doctor you would think of it in one way, a psychologist you would think of it in another way. MM9: Or more to the point, if you were a chiropractor and a medical doctor you would think of these things in different ways and I am curious, it may be political if they had set this up in such a way where the word 'subluxaction' 1 does not occur here in any way. Where that word in itself means something quite different to a medical doctor then it does to a chiropractor when it comes to small tiny restriction in motion or small tiny misalignment. But the medical profession still doesn't believe such things can occur so I see here that there is not such thing here as 'subluxation' in the sense that the chiropractor means it -very interesting. I: Yes, exactly, this is why we want your feedback. So that's a great point, so, it is political. Ok, so basically you got exactly why there is a MESH database. We are all separated by our disciplines. And therefore we use language in different ways. MM9: Yah! I: But sometimes we want to find things and cross from one discipline to another … MM9: Well, why is there, I am noticing down here at the bottom low pack and I see subheadings, and economics here-I mean what in the world … I mean umm… at the top of my head I don't see how these would connect up. But as I think more I could see there might be a connection…yes it does take the term far and wide. I: I don't see that… MM9: ok, see below subheadings. I: Ok, yah I see it. MM9: I am amazed at the different topics they associate with back pain. I wouldn't have 1 thought they were connected but yeh, economics and curing low back pain! I: Isn't that interesting. Great well you really got it. Scroll down and see entry terms. We could even combine low back pain in a number of different ways (I explain more MM9: (Reads out the article name) I: Do you see it says full text article? MM9: Oh! So they are going to give me the article? I: Exactly! So the object of the game, if you don't have an affiliation with an institution or a subscription to EBSCO or Ingenta, is to find free articles. And when you see a green bar, in the icon in the Pubmed database, it means it is free. And when you click on this icon, another web site will open that contains the article. MM9: I am just writing that down. Ok so I am going to click on that and see what happens. I: Ok, yah, MM9: Ok, I see what you got here … it is a whole article. I: Yah, it's the whole article, and basically the whole journal, Minerva Medica, you can download the PDF to your desktop and you can even explore the rest of the web site if you want to and see if there are more free articles. Sometimes when you hit a journal that has a free article, the whole journal may have adopted an open access policy. You also have search functions within the journal web site so that the whole web site is like a mini Pubmed. MM9: Right. I: Can you let me know whether or not you would find this useful? Can you read the abstract and let me know? MM9: the one we just clicked into? I: Yes please. Skim through it and let me know if you would comprehend it and be interested in it. MM9: Well not really, they are using slightly different terminology. I mean it's a bit awkward for me in a hurry, but I'd have to say, for example, "bio-psychosocial syndrome", I mean I have never heard that term before. They may have made it up, from what I can tell for the purpose of the article by the look of it, but then again, may be not. Umm, rehabilitation and water, probably within hydro-therapy in North America at least. But then again, in Europe, I mean Europe is where hydro-therapy came from. So rehabilitation and water therapy, it's a funny use of terms. But I am not sure what their use of terms is. So, I would be stumbling through this, and thinking well do they mean the same thing and I would probably go try to find something that I could understand right off the bat. Umm, what a massage therapist is looking for, this is a little too theoretical and general, so if I was trying to keep up with whatever this local focus is, I'd be looking for protocols for treating low back pain and massage therapy if there were such a thing and may be trying to get a better protocol than the one the MPA has, I'd be more on 'protocol', 'orthopedic', 'massage therapy', those types of words. And umm, at least, I think I would be. So I would avoid anything that had to do with drug approaches or psycho-therapy, though they would be important to know if they were there. I: Good feedback. Good critical assessment. MM9: I mean this is what I think for BC, I am not sure what is true for Ontario. I: No, I mean I am interested in what everyone thinks. I am looking to understand more about the tools available in the database…what you will use, and what you think of the articles. MM9: Well, we always need to learn more, and we are less likely to want to learn more about what somebody else is doing because talk about holistic and all the rest of it, we are still not! And so show me more on musculo-skeletal soft tissue hands on massage therapy, or show me more about neurology and musculo-skeletal if you are a chiropractor, and especially chiropractic approaches. And if you are an orthopedic MD you know, its different, you don't care about the first two! I: Yes, we shouldn't assume anything, we still have to find out more about it. So, great feedback! Ok, click on #22, go back to it, which is another one with a green bar. Look over the abstract and let me know whether it looks god. MM9: Oh, ok. Yah this looks pretty good actually. This is the sort of thing that happens to appeal to me and I know something about treating people and from my own problems and my response is that, well first of all, the term 'meso-therapy', umm, they really need to define that, I don't know what in the world they are talking about, I assume its something like massage. We run into this when we are looking for research on massage therapy is, umm, two kinds of problems just around that. There is different, umm, designations for massage therapy. I mean you never see that for medical stuff, you see it for massage therapy. I mean a medical doctor is a medical doctor is a medical doctor. But a massage therapist is meso-therapist sometimes, or a myo-fascial therapist sometimes, I: Or a lymphologist? MM9: Those are different hands on work in the general umbrella of massage therapy. And then the are other problems is that massage therapy is so different around the world in terms of the training. You just can't study, one of the biggest problems in research in massage therapy is that most of it does not come from Canada, and the training for Massage therapists anywhere other than Canada and Europe is so vastly less, in terms of number of hours and depth that you can't, you know, read a study, where it says that a massage therapist did this or that because if it was done in BC you can't assume that the massage therapist would do the same thing, or do it as well. Because there is just less consistency between massage therapists then between physios. Just our training: you can go for a 100 hours in the US and become a massage therapist. Here in BC it is 3000 hours. So there is got to be some difference there when they use the word massage therapy. And, evolutionarily, we've got 3000 hours now, but when I went to school in 1981, it was 1500 hours, or 1000 hours. So it has grown and it depends on when the article was written. In terms of the article here, I am not sure exactly what meso-therapy is, but I assume it is some form of massage. But I am interested in it because this article treats a problem that I see in probably about 90% of back pain people, and most of the people that I treat are low back people and it is a difficult problem, it is usually chronic so you are left with what can I do that will help this person that is not merely symptomatic so when I read about sacro-illiac support has the best result here along with mesotherapy, those are approaches, hands on massage, that I have actually recommended, I don't agree that it is difficult to diagnose, or that its primary, and everything else comes out from there -I mean yes it may be a problem, but it is certainly related to something else. I: ok, how about we look it up in Mesh? MM9: Ok, that's a great idea. I: Ok, so go to the side bar there first., so let's look up messo-therapy and then hit go. MM9: I think it is two words. No items found. I: Yes, but do you see what its says there? Suggestions, Hydro-therapy… thermo therapy (and others). Click on hydro-therapy because that's probably the one you know best. MM9: umm, surprised they don't have massage therapy there … that might be more politics. MM9: Ok, I: great now put your email address in and hit send and it'll send the email to you. MM9: ok I hit mail, and off it goes. OK, so it'll have a link right to this article ? I: I don't think it'll have a link to the article, but it will have one to the citation in Pubmed. MM9: Ok, so let's say I was doing research on a topic, say, I don't know, and every time saw something in Pubmed that I liked the abstract and I wanted to kind of put them all together I would go email, email, email, and then I could in my email system all put them into the same file? I: Well, let me show you another function that is similar so go back to the LBP list. MM9: ok I: Ok, so there are three items in our list that are free. MM9: Which ones are we talking about? I: Yes, 24,25,26 are free. They all have green tabs. So let's say you want to look at those later on. Select them, scroll up to the top of the screen and send it to clipboard. So again it is the send to function but you are send it to your clipboard instead of email. MM9: Yup. I did that. I: Ok, above that it says three items are added to clipboard. So the question is now, how do I look at my clipboard, right? MM9: Yup. I: Ok, see on top of that there are tabs? And it says, clipboard? Click on it. MM9: oh, ok. I: So here is your clipboard. MM9: I've got three of them up here now. I: Now you can send these to your email by selecting them and send to email. So basically you can select your articles as you do your searches, save them to the clipboard, sort through them again afterwards and then send them to yourself. MM9: oh, ok, I get that. I am trying to write it down so I can get it. So, I click them off and that lets me save them for later. I: Right you don't necessarily need the exact article, but you need to know how to find it. So, let's say you hit on three amazing articles, all you need is the name of it and the journal info. and you can retrieve it in the future. This sends you that info and you can keep it for as long as you want. MM9: If I wanted to save the abstracts, is there a way to do that? I: Ok, well you go to you email preferences, when you are taken to the email screen it asks you what you want to send, what information you want to send. But I am going to ask that we move onto the next tool because we should wrap this up soon. You can always email me your questions. MM9: Ok. I: Ok, so selecting number 26 again, back to our original search list. MM9: Click on the authors or click on the box. I: Click on the authors to get into the abstract. The box for saving the citation or selecting it to send it somewhere. MM9: Right. So I am back at the abstract. I: Ok because you liked this article, let's say you want to find more articles like it. So let's hit related articles, on the right side of the screen. MM9: Ok, I: So what this tool does, if you found and article you think is great and you want more like it, and want to find more information like it, we hit related articles. So instead of specifying search criteria this tool uses that initial article or abstract to search for more like it. MM9: So it uses source article for finding similar ones. I: that's exactly it. It's another way of searching the database. MM9: Ok, got it. I: Ok, so look through the first few and take a few minutes to tell me whether these articles are really related and useful for you. Take a good 5 minutes for this. MM9: ok. Can I put the phone down when I do this? I: Sure. (time passes) MM9: ok, I've looked at 6 now. How many did you want me to look at? I: That's great. That's enough. Ok, so what do you think? Give me a sense as to whether this would be a good shortcut to limit your searches. MM9: Umm, right. I think that first of all, I would have to believe I don't know everything and I would learn something. A lot of us feel that way. Some don't feel they need to know more… but yes, this is interesting. I would have to have a pretty strong reason for doing this. One of the reasons would be that I myself have a back problem and I am not receiving treatment adequately. And the other might be that I have a patient that I have a particular interest in and I want to find out more either form the point of view of doing something for them or getting them onto someone who can help them out. Even though we are not allowed to diagnose or anything. I have to be motivated in the first place to look up articles. But if I were motivated, then yes, I did like this tool. I would use it because I found some really relevant stuff. I: Ok, great answer. Ok, now I was hoping we could choose just any article, except for a free one because I want to show you another tool. MM9: Ok. I: Ok, so let's go back to our search results. Click on number 3, click into it and then click into Links. So where related articles was, there was a little link called Links, and then choose Link out. Hey that's really expensive. I can see why students anyways and poor people get ground to a halt. It is nice to have Pubmed here any everything but its hard to really get a hold of the article unless you live right next door to the right university -not just the university. If you go to the university they'll have Medline, they won't just have Pubmed, right? So they can get into these articles if they are willing to do it and then you just pay for the expensive Xerox machine and its less than 30 dollars. I: ok, click into it. You can access article in 2 ways. One by going to BMJ.com, and the second via Pubmed Central -go to Pubmed Central, and basically another window pops up with the same article. So you stay in Pubmed, to access the article. MM9: Right.

Limits
(we look at the difference between Pubmed and BMJ.com. End of recorded interview here).

Interview with CF10
Background: (In reference to living in Grenoble and being a chiropractor there) CF10: I was in a terrible situation of timewarp because nothing is as advanced as it is here and the wiring and such. So any of the work that I had done for the profession was done the old fashioned way. So when I came back they said would you like to teach, I realized what kind of gap I was in. So I put myself into everything ... to get with it. For me, I have come along way, but I but by north American standards I have a long way to go. I: It's a learning curve and it gets easier. CF10 That is very true because from what I knew before and what I know now is nothing short of fantastic! Compared to my sister who is right up there, I am back down here again (points to the ground). I: Do you know what a browser is? CF10: that thing there with an arrow? I: (I go through the various parts of the computer. I explain about bells and whistles on web sites and why people have trouble using them.) CF10: Oh that makes sense because I can understand why things don't work for me… I: (More about research. I talk more about free access to research. Describe purpose of the study). As a chiropractor is research useful to your professional development? How would you use it? CF10: That raises a very interesting question because patients do come in and say "there is a paper on my condition", but they have gotten it out of Google which is medical information that is very non-specific. You know anybody could put their paper out there so it is not scientifically sound. You know they are just basically narratives so that is another reason why I would like to have access to something decent. You know that research can corroborate. I: (I talk more about the professional having to answer to the patient when confronted by a research paper). CF10: Yah, and it's a hard one to answer to and I'd appreciate if you can give me an answer because I tell them things like that and they say 'yeh sure'. I: Does that happen often? How often does it happen? CF10: Often enough. You'd be surprised how often it (people showing up to her with a paper) happens. People who are really hooked on the thing they go in there and they'll come back in weeks time on their next visit and say here's what I have found on my condition. So it happens several times a month. I: How does that make you feel, as the chiropractor? CF10: Well, I welcome the challenge, so that's not a problem. My problem is telling them that what they are finding in Google is not that sound scientific information because any practitioner out there, anybody can put something out onto Google or their other office web site but its not necessarily valid. And doesn't apply to their case because the scientific reasoning isn't sound, but, how can I say this? They don't buy what I say? You know when I tell them that there are better sites. I: this is a particular mindset that you as a service provider have to deal with….you have to battle information with information…you can pull rank without demeaning them. You'll see why people have this mindset when you see Pubmed. So how long have you being doing it for? CF10: 32 years in May. I was in the Alps in Grenoble. I was there for 23 years. I have two sons. We talk about France. In reference to the article I sent her prior to the interview: CF10: Well that's why I asked you about the visceral part, I really need that. I couldn't get past the www.science.org because it asked me for a subscription that I couldn't get to the paper, so does that mean in here you have a system whereby you get instant access to it? I: Well that is because this is basically a database or an index (I explain to her what these are, bring in old library searching as a comparison). CF10: Well, I was the first librarian at CMCC when it came to the new campus. Books and writing are my passion, when I started as librarian because we knew that we needed terribly because our profession was ready to go to the national institute of neurological diseases major congress in Washington so we realized we had no indexing, so I started CRAC, which is the chiropractic research archives collection, so that was as a result of my work, so I knew that people were going to in that direction. I can relate to this then, but it is methodology that is sadly lacking. CF10: Would you mind if we did this to the other paper tough? The urological paper? I: Not at all, let's do it. Ok, do you see its says click here? You would need a subscription to this article even though there is a button right here. If you were looking at this one yesterday and could not get access, it says to me that you did not really have access from home. CF10: Well, CMCC does not subscribe to every single journal. There is a whole bunch that we have access to so we don't have to pay, and it is linked with UofT. So since I am a member of CMCC I have access. People who are not members would not have access, so I do not know how they would get passed that. But if I take the British Medical Journal, which is very relevant, to our profession-they have made their issue more specific, which means that you can only get their information within the first two weeks. After that, they charge for access. (We go back to talking about the citation.) I: (I talk more about browser windows and how many windows can be open at once. I then explain Related Articles, how it is another way of drilling down based on the first abstract). Do you see why? CF10: Yes, yes, we are good there. I: Ok, can you look at this list and tell me whether the information is useful to you? CF10: Oh, those are all fine by me. Those are great. Especially this one would be great too. That one is quite appropriate. I don't want to read anymore about headaches; I am headached out. I: It is giving you a headache? CF10: (She laughs). I: Ok, do you see the difference between this icon and this icon (one has lines and one does not). CF10: Yes. I: Well when there are lines it means there is an abstract, and when there are not there is none. CF10: Uh huh. What would the reason for that be? … it is very interesting, especially for a journal like that. I: Well, let's take a look at it. Oh it's a review. That's why there is no abstract. CF10: How do you flip around in the page so quickly? I: Oh it's because I am dragging it around. Would you like to try it? CF10: (she tries it). Oh ok, I got it. (She checks off many articles from the related articles) search) I: So what do you think of related articles? CF10: oh, it's great. I did find a lot of article that I want to read.
Send to: I (I explain the send to function. We send to email. We sent 8 articles to her email. Is how her how to choose what information she can send to her email in box. We send the summary to her email). CF10: Now the summary is what? I: It is what you just saw in the list. Abstract, title, author… you can also write something to remind yourself of what the search was about. CF10: Can you put visceral pain? I: Sounds good. Do you want to write that in? CF10: (She types it in). I do 'the seek and yee shall find' method (referring to her email inbox). I: Ok, and put your email address in there. CF10: (She does it and sends the information). So basically it would be a good idea to go back to email is to go and use this. I: Yes, well I want to know those things, whether you do in fact end up using the database and the articles you get from it. CF10: Yes, yes, ok. I: Ok, so now do a Boolean search of a particular topic, and we'll replicate what we just did but you do it on your own. CF10: (thinks for a minute), Ok, visceral pain AND women. (She types it in). I: Will this expand or limit your search? CF10: Limit.
Related Articles: I: Ok, great, that's right. So, find a really excellent article so that we can try out "related articles". I: So what is "related articles" going to do for you? CF10: Related Articles is going to give me everything that is specific to the text of this article. I: Do you see this one? CF10: Yes, it looks like it has green on it. We did not cover green. I: Let's click into it and see what it means… CF10: Oh it gives you the full text. And they are always green? I: Well there is orange too, which you want to look for… is this a useful article for you? CF10: It's a bit too heavy; it is going to go beyond what I need clinically. I: Ok, well let's open it up anyways and see it, at least. CF10: Oh there is more green here (She scrolls through it). Ok, let's do this one, can we look at it. I: Sure, click the icon or the name, whatever you want. CF10: (takes a few minutes to read). Again this is too technical for me. I: Ok, so when you clicked on the related articles from your initial search it took you on a string you didn't want to go in… so it may not always serve you. CF10: uh huh. I: To see the free full text and how it works, click on the red button, scroll down, did you see this? This is the entire article right there. CF10: Again this would be way too technical for what I need. I: But do you see how easy it is to get to free articles? CF10: It is one click away. (She reads more through the list. All the information from this list seems too technical for her). I: Ok, let's go back. CF10: How do I go back just click here? Oh no… what did I do? I: It's ok, anything that you have done can be undone. CF10: Yes that was my biggest fear, I am always afraid I am going to lose something or that something will blow up or something. I: It's hard to delete something off the computer. They are designed to help you not delete. I am going to show you some more tools right now, but I basically I want to make clear that when you arrive at this site to find information you want to drill drown and down and down because there is so much information on this site. There are many ways to do this. One way is to place limits on.

Limits:
(We go to limits and click off many. She understands what and why we are clicking off.) CF10: Oh yes, complimentary medicine. I: (I explain Pubmed date versus Publication date). CF10: Yes, I understand, but if we don't fill it in it'll still understand it … I: Yah, it just ignores it. Ok and let's say you want items with abstracts. So do you see what these limits do? CF10: They refine and limit the search. I: Right. So what does this mean? CF10: That the search will become specific to my needs. I: Right-like Boolean is a limiter and 'Limits' is a limiter. OK right visceral pain and women again, let's try it. CF10: Ok. Wow -one article. I: From a complimentary medicine article, so it might have a lot value. CF10: Yes, yes very good. So do we want to read it? I: Sure… go ahead and take a look. CF10: Ok, it's interesting. That's about all I can say. I am not that interested in this aspect of visceral pain. I: Ok, so now I want you to look up anything you want, whatever way you want to. Note that the limits are still, so you can leave them or take them off, and I'll be here if you have a question. CF10: (She looks for something and find nothing, and laughs). I: Don't feel bad, may be you put too many limits on the subject. Remember, complimentary medicine is still on. If you were to try core clinical journals… sorry. CF10: Oh yes I was going to do that.
(We find many articles) CF10: This one looks interesting, and this one is really cool. (She looks through the list some more.) Ok, what would you like me to do? Go into Related articles? I: What would you like to do? Remember, if you really like this article you can check it off and email it yourself, but you don't have to. CF10: Ok, I think I'll do that. (She actually sent the article to text by accident and got very nervous). I: (I explain the send to text function). (She has a little trouble sending to email, but she practices a few times to get it.) I: Do you think you would use the limits when you were searching? CF10: Probably not every time. I think I would use the limits if I have a problem patient who comes at me with a Google paper, like if she was a 45 year-old female who found something and said, why don't I try this? But when I am browsing I wouldn't put the limits in.
I: And what about related articles? CF10: Uhh, when I see the word Spinal there I certainly would go hunting. I would definitely go for related articles there. I: And boolean terms? What did you think of that process? CF10: Yes, that was very useful knowledge. Anne explained that to me before but she did it in the principle of MeSH. But I found like I don't think I can remember readily… I: What the Mesh Stuff? CF10: Yes. I: Yes, MeSh is tough. CF10: ok, don't confuse me… History: I: Ok, let me show you a couple of more things about Pubmed. Do you remember how I said it is hard to delete things? Well, history gives you exactly looked for at the different points in time. It is a record of your work. (I explain in detail to her the entire page). CF10: Does it keep it forever? I: You have 8 hours of inactivity. And you can combine your searches… CF10: ohh… I: What would happen if you combined your searches? CF10: It would narrow it down even more. I: Right. It even tracked your related article search. It's great because it is so easy to get lost in your searches. CF10: That is great. (she plays around more with it, seems impressed).

Clipboard:
I: (I explain the function of clipboard -saving them while researching instead of sending to email. We select a bunch of articles, and we send them to the clipboard. They are random files. We go step by step. I explain the functions of it as well.) CF10: The CMCC librarian provides me with an enormous amount of information now on evidence based practices because that was another one of my weak areas and that happened while I was away. So I put all her stuff into a special folder. Once a month I go in and see what's applicable and not applicable. I read them all. I went in yesterday and I think I must have deleted a bunch of them because they were not relevant. So, what happens when I want to keep a few of those permanently? I: Good question, what should you do? CF10: Can I call you? I: Hmm CF10: I would send it email? But that's not the right answer. I: Why not? I think that's a great answer. CF10: Yes, because then from my email I can send it my folder or I can print it. I: Ok, so what would you do to send it to your email? CF10: (She goes through the process… and sends them to herself … and without my help). I: Great well done. Well, I think that's about it for today. Do you know the Pubmed URL? CF10: I draw a blank on what URL is… I: It basically means the location. And the url for pubmed is µ www.pubmed.com §.
Interview with CM11: I: Ok, first, the object is to drill down. You want to narrow down your topic as much as possible and get as specific as possible. CM11: Uh huh.
Boolean: I: you don't necessarily want to be large-you want to be small. In order to do this, the first thing we are going to go through is a Boolean search. So let's say you want to look up 'effectiveness of chiropractic'. So you want to do effectiveness AND chiropractic. So you are basically limiting your topic this way because your topic in general is chiropractic but by putting the effectiveness in, then you are making it more specific. You are drilling. CM11: So the AND forces them together? I: Exactly, it forces them together -putting them together makes them more specific. CM11: uh-huh. I: So if you put effectiveness AND chiropractic AND government, you would get even fewer, but in a sense that is what you want. Ok, you want as few as possible. You can also do effectiveness AND chiropractic NOT massage therapy -you know like make it more specific that way. That's what called a Boolean search-I am sure you have done this before. CM11: Well, government is not necessary. My problem is with this work is that I get a lot of people talking about this but the information is related to tiny little projects like a case study or something. I: Yes. CM11: Doesn't have great impact. So I am looking for big studies. I: Well, you can limit by the type of studies that you want to get at. But that's a little further on in our study. CM11: ok, ok. So effectiveness and chiropractic is ok then… (We do the Boolean search). I: And you know about the rules like if you put the * symbol after chiropractic… CM11: You know, I don't-I sort of know the rules, but I don't really. So, what is the rule? I: If you put the star after chiropractic, it is basically like truncating. And it'll then find anything with chiropractic in it -like, well what else is there? CM11: Well, there could be chiropractor! I: Exactly, so that's what that does. CM11: So, it'll take the root? I: Yes, exactly. CM11: Actually, I didn't know that -I had seen it before, but I didn't know what it was. (he looks through results), is this the total amount on the list?1-2? I: Well, let me take you through things first, and I'll show you all around the web page.
These here are the authors, in the blue. And when it is blue, you know that you can click on it. This is the title of the article, name of the journal, and then this is the Pubmed number. CM11: This looks like a good one (referring to the article). I: There is actually a lot about children and chiropractic… CM11: Yeh, I just read today that our director of research, is also the editor of the chiropractic association's journal, has an article going into the journal of pediatrics about childhood chiropractic. And just this morning I looked over the article. I: Wow, pretty impressive. We should get your journal linked up with Pubmed. But that's a whole other story… CM11: Yes, he's trying to, but it's not that straightforward. I: Yes, it takes a lot of time. But this is basically what you've got here. The author, the title. The name of the journal. And the reference number. Here you have a little sign. And I want you to notice what this is. This is an icon, and these lines within the icon indicate that there is an abstract that you can read. So, if there is no lines there, and let me scroll down to show you what it looks like, (We scroll down and find one with the orange and green labels, free full text in Pubmed.) oh, here is an interesting one, this icon indicates that is available online and open access within the Pubmed interface/database . CM11: Oh Humphries (referring to the author of the article), I know him. I: Oh, do you? So just note those differences in the icon. CM11: Ok, so this one means that it is freely available? I: Exactly. In fact you can click into it. See, it says free full text article. And it is available in Pubmed Central. In other words, you don't have to leave the Pubmed web site to go and get this article. Pubmed central is another database with full text that is associated with Pubmed. All you need to do is click on it to get to the article. CM11: Click here? I: Well, not yet. Have a look at this abstract and let me know whether it is even a useful article to you. CM11: No. It should be but it isn't, its… now this is interesting. And I don't know how a Boolean search could control for this but quite often we have folks who publish things and they discover that such and such a diagnostic tool is good, or that more research is needed. I: Oh. So they write something and the actual findings are not so great-are ambiguous. CM11: They don't take us anywhere. This one here (He quotes from the paper) doesn't advance our agenda. I: You might find that more with chiropractic and emerging medicine because it is an emerging field and is only now being written about in peer-reviewed journals. CM11: Yah, yah. I: Let's look at the next one by your buddy Humphries. (he looks over the next Humphries article) CM11: Again, no this will not be useful. I: Do you think if we found an article that was "related to" this, it might be useful? CM11: That's quite possible. I: Ok, let's then try another little feature of this web site. CM11: Ok, but I don't understand why there are two. (referring to the green and the orange bars on the icon). I: Ok, well why don't we have to look at both… (I show him the difference: we click on the journal website button to get to the article, and then we go to the PMC web site. We evaluate the differences-going over the added functionality in Pubmed central as compared to the other journal web site). So, just to be sure the one will take you to a journal web site, and the other will keep you in Pubmed … CM11: Oh, ok. So for my purpose it sounds like the Pubmed option is more robust. I: There are costs and benefits associated with both. CM11: In my case I am not the end user; I am a conduit. Chances are the people I work with can understand it better and find it more easily than me (referring to the researchnot really answering my question.) So it seems to me that Pubmed will serve as a meeting place for … you see I might write a letter to the minister of health, and he or she, it happens that there is a HE and SHE occupying these roles today, might read the letter and then click on the link to Pubmed, and that would make sense to them. I think Pubmed also is known outside. I: You would be still be finding all your info in Pubmed. It's just a matter of getting at the Open access or free article in Pubmed. Would you prefer to stay in Pubmed or go to another web site to find it? Even if its one click away? CM11: My feeling is that I would stay in Pubmed.
Abstract: CM11: The other thing about my kind of work is that I am not working as an academic, I am working as an administrator and I am mostly interested in, when you ask me to look at an article, I would go immediately to what did they find to and then if that has meaning for me, then I would like to go into the article to see what they did. For a couple of reasons. One is no one ever does an abstract that is exactly right. No one who has ever done research has ever done an abstract that exactly covers the detail of what's done inside. So when you actually read the research paper you see more. Of course you see more, but you see more in different ways. So, you really do need to look inside. But if this doesn't give me an indication of what's inside the article then I don't look. What's interesting though I would sometimes read this conclusion, and find that it doesn't really help the chiropractors cause, but the article does… I: So using the abstract to judge whether the article is useful isn't really the best way to determine this… CM11: No, it's only marginally effective. There was a study done in the New England Journal of Medicine by a number of people, one of them was Ted Krauger, and they were studying chiropractic and its effectiveness for relieving asthma in children … they did discover by certain criteria that it didn't absolutely do it. But when you read the article you discover the children were healthier and coughed less. But you had to read the article to find out, because the criteria they established for the conclusions were of this less, Actually reading the quail[itative] stuff you realized they were better off. They didn't take drugs anymore. I: So stuff is left out of the abstract that is really important. CM11: In terms of that case they definitely were and that happens quite often. So the abstract is a good indicator for me but it is never enough, and it never provides that robust meaty quote that I need, because it sort of homogenizes it all. Abstracts are wonderful, they give you a start, but you have to read the damn thing before I know if there is actually stuff in there for me to use. I: Very interesting. That's the type of stuff we are trying to figure out. CM11: Well I also read Men's Health Magazine, and in MHM they have some pages where they have snippets of highlights of research. They just take a little piece of an abstract and just give you the broad overview. But that's ok for that context. But if you actually want to impress people to make decisions about health care dollars in Canada you really need to know what its saying. So for my purposes I do need to have access to that stuff. I: Ok, very interesting. Good commentary-good info. Let's try something else that's pretty cool. We are trying to get better information or more information.
Related Articles: I: Now instead of doing a whole search over, we are going to use this article, and do you see that link (related articles link), and basically that pull up articles that relate to your initial one. So here you see the initial one, just in case you've forgotten, an then all of these afterwards were found, miraculously, pulled up another 19 articles that related to this initial one. So if you are starting with a good stepping point and you want more like it, then you hit related articles and it find more articles for you. CM11: Now, you did send me …this article appeared before in what you sent me, and I noticed that when I clicked on this we got 20 or something, but originally we didn't have those 20. When I clicked on an article the related articles to that weren't necessarily all referenced in the original bunch. I: err, I lost you… sorry. CM11: Me too. Ok, let's go back. I: Ok. CM11: there are 20 items here. So these are related by Virtual search. Now you would think that if we clicked on this one, we would get all the same ones again… (asking why we don't get the same results as with our Boolean search -effectiveness and chiropractic). I: Ahh, I see, no well, you see it searches the info in this abstract. It's not searching for effectiveness and chiropractic. So, effectiveness and chiropractic is found in all of these abstracts, CM11: Yah… I: But what Related Articles did, in a much more complicated way, is searched the metadata and the abstract and put together a list based on what was in this… CM11: Oh, so its no longer controlled by the "effectiveness and chiropractic." I: Right, exactly CM11: Just articles related to this one... so you could have 400 related to this one. I: Yah, well we only got 20, but you can search over and over again. CM11: Ok, but that means that our related articles can be much better than this one, or totally different from what we are looking for. So, what would I do with those? I: Well, you have to look through the list and let me know if it actually worked for you. CM11: Ok, there's no way I can say take these articles and let me know if I can do anything with these. I: Umm, I see what you mean, is there any other way of automatically filtering out the articles. CM11: Yah, is there some sort of filtration thing, I mean, I would look through the list but … I: No, the assumption would be that the initial Humphries article was so perfect that you wanted another 20 articles like it. CM11: And then whatever they are, I would then look inside and see there was no other I: Or the Humphries article was almost perfect but was missing particular dimensions. I am going to hit related articles so that may be the perfect article would come up. It is also good at finding open access articles so if you scroll down a little bit see there's another one that is open source. And they seem all to be from Biomed, or complementary and alternative medicine. Which may be good or may be not. CM11: It's interesting how often we do get this kind of result. (Referring to research results within the article we were looking at). "the lack of acceptance reference standard contributing to the weak sensitivity findings". Means nothing. Its just we did all this work we can't tell you anything. I: Right. Well, it does mean something. CM11: its good for the academic world… but I: Right. It doesn't help you make your case, for your point CM11: Yah, it's just … Send to: I: Well, may be lets try some other things. So basically I want to make sure that instead of finding awesome information, I want to make sure you know what to CM11: Right, how to do stuff… I: So, let's pretend that Humphries is a good article, and you want to recall it in the future or send it to somebody. So click off this radio button right here, and then pull down that tab there. Then hit send to. Ok, what you might do is put a little note here that says something about the article-could be a note to yourself or to the person you are sending it to. "dear Me, xyz". Put your email address in there. And then hit mail. Ok, this pink ribbon here denotes that the email was sent to you. CM11: Oh, I never used this facility. I: Yeh-and this is all free by the way. I don't have any special rights or anything. This is available to you at your home, at your desk anywhere you are… so you don't need the librarian to help you find things. You can call them up and send them to yourself… CM11: Well, I need her to send me the PDF of the article… I: Right. Of course. Ok, now if you are at your desk, Hit send to text. Ok, now it has turned this information about the article into a text file. No images or anything, there is only text which has no formatting. You can save this on your desktop in a Pubmed file that you save all of your research in… the idea is that it strips it of all formatting and allows you to hold onto just the information very easily. CM11: But when I have done that, I have saved sufficient information for me to find the article again. I: Exactly. But you haven't actually saved the article. CM11: No, what we often do when we come across an article that is useful we think chiropractic folks are interested in knowing about is put it in a reference library on our web site and if we can we'll have a hot link to something. Technically that's enough to have in a library. But if a person could click on something that's free and see everything themselves, that's better. I: Yes, but this is more for you. Like, if you have a folder full of information about articles, and they are interesting to you, but you want just the information about it. Then this function is useful. It gets you to the information easily for future reference. Its not really hyperlinked or anything. It's not active. It's just the info about the article you liked.