Haynes R B, McKibbon K A, Walker C J, Ryan N, Fitzgerald D, Ramsden M F
McMaster University, Hamilton, Ontario.
Ann Intern Med. 1990 Jan 1;112(1):78-84. doi: 10.7326/0003-4819-112-1-78.
We introduced self-service access to the medical literature database, MEDLINE, into clinical settings to assess the frequency, patterns, purposes, and success of use.
Longitudinal descriptive study.
Inpatient and outpatient services of a university medical center.
All trainees and attending staff working at the service sites were invited to participate; 158 (84%) did so.
Free online access was provided to MEDLINE through GRATEFUL MED software. Participants were offered a 2-hour introduction to online searching and 2 hours of free search time.
For each search, a computer program requested identification of the user and the question to be addressed. Search transactions were recorded automatically. Interviews were conducted after a random sample of searches, and search questions were given to more expert searchers to run for comparison with the original. Eighty-one percent of participants did searches on study computers, at a mean rate of 2.7 searches per month. On comparison searches, participants retrieved 55% of the number of relevant articles retrieved by reference librarians (P = 0.024) and 50% more irrelevant articles (P less than 0.001). Forty-seven percent of searches on patient problems affected clinical decisions, but often on scanty information.
MEDLINE searching from clinical settings is feasible with brief training and affects clinical decisions. However, inexperienced searchers miss many relevant citations and search inefficiently. Further studies are needed to assess the impact of searching on physician performance and patient care.
我们将医学文献数据库MEDLINE的自助访问引入临床环境，以评估其使用频率、模式、目的和成功率。
纵向描述性研究。
一所大学医学中心的住院和门诊服务部门。
邀请了在服务地点工作的所有实习生和主治 staff 参与；158人（84%）参与了。
通过GRATEFUL MED软件提供对MEDLINE的免费在线访问。为参与者提供了2小时的在线搜索介绍和2小时的免费搜索时间。
每次搜索时，一个计算机程序要求识别用户和要解决的问题。搜索交易自动记录。在随机抽取的搜索样本后进行访谈，并将搜索问题交给更专业的搜索人员运行，以便与原始搜索进行比较。81%的参与者在研究计算机上进行搜索，平均每月搜索2.7次。在比较搜索中，参与者检索到的相关文章数量是参考馆员检索到的55%（P = 0.024），不相关文章数量多50%（P小于0.001）。47%关于患者问题的搜索影响了临床决策，但往往基于稀少的信息。
经过简短培训后，在临床环境中搜索MEDLINE是可行的，并且会影响临床决策。然而，缺乏经验的搜索者会错过许多相关引用，搜索效率低下。需要进一步研究来评估搜索对医生表现和患者护理的影响。
