Figure 1.  Examples of Reports of Effective MEDLINE Searches

Incident # 03-U074-02
Effective Incident Report Form  Mediated User

What was the situation that led to your need for this search? 
I've done psychotherapy with several high-functioning autistic
children who had good language and learning skills but with
a layer of depression that was significant to the extent of
becoming suicidal.  A psychiatrist told me about a new syndrome
he'd just heard about called Aspeger's syndrome that seemed to
describe these sorts of children.  

What specific information were you seeking?  I wanted to know
more about Aspeger's syndrome.  What is it?

Why did you choose to do a MEDLINE search instead of consulting
some other information source you had available, such as
textbooks, journals, or colleagues?  The doctor who'd mentioned
it to me didn't know anything more about it, and he's my best
local source.  MEDLINE was the next place to look.  

How did you explain your information need to the person carrying
out the search?  I gave her the name of the syndrome and told her
it's a form of high-functioning autism.  

How was this search carried out to get the information you
needed?  I don't know how she carried out the search, but she
said she could search under the direct name of the syndrome.  

What information did you obtain as a result of this search? 
There's been research on it both in Australia and England, and
there's controversy about whether it really exists.  The
Australians described it first.  They feel that you can do a
urine test to look for a protein deficiency to identify it; the
English say that it's just a checklist of behavioral symptoms. 
But there is agreement that there is a cyclic depression
overlaying some cases of autism and that it tends to run in
families.  

In what specific ways was this information helpful in your
decision making?  It was helpful to have verification that there
is depression in children.  The review board here at the hospital
has tended to declare that autistic children are not cognitively
able to be depressed.  By showing them the articles I've been
able to convince them that it did exist, even though the
research was too new to know whether it's a behavioral or
physical manifestation.  

What was the impact on the situation of having this information? 
I was able to get more psychotherapeutic treatment for autistic,
depressed children, once the board was convinced they could
benefit from it.  

Incident # 02-0745-03
Effective Incident Report Form  End User

What was the situation that led you to do this search?  There was
a question raised in AIDS clinic about what the utility of beta2
microglobulin was for assessing the activity of HIV infection.  I
wanted to research this topic to prepare a presentation to the
AIDS clinic staff.  We had heard about the beta2 microglobulin
test, but no one in our group was familiar enough with it to
understand how useful it might be, or how to interpret it, for
evaluating the condition of patients with AIDS.  We were trying
to decide if we should be doing this test here.  

What specific information were you seeking?  Information on use
of the beta2 microglobulin test for evaluating the condition of
AIDS patients.  

Why did you choose to do a MEDLINE search instead of consulting
some other information source you had available, such as
textbooks, journals, or colleagues?  In the AIDS field, by
the time something is published it's old hat, and by the time
it's in textbooks it's ancient history.  We wanted very current
information.  

How did you carry out this search to get the information you
needed?  I went through Grateful Med.  I used "beta2
microglobulin," but it was not a MeSH word.  I may have used
it as a title word.  I joined this with AND to "AIDS."  I
searched back 23 years, and ran it several times.  No limiters
were used.  

What information did you obtain as a result of this search? 
Beta2 microglobulin is shed by cells that are turning over or
dying.  So the test is an index of disease activity.  It's an
index of white blood cell turnover.  Therefore, elevated beta2
microglobulin is also an indicator of other diseases besides
AIDS.  

In what specific ways was this information helpful in your
decision making?  The test would be of some use for AIDS
patients.  It would give an idea of how rapidly lymphocytes are
being destroyed, by HIV or anything else.  It's not specific for
HIV.  

What was the impact on the situation of having this information? 
I provided this information to the AIDS clinic.  

What was the outcome of the situation?  We decided not to use the
test.  We don't think it's worth the high cost.  But the
information I got allows us to interpret the test results, for
example, if someone else orders it.  

Incident # 02-U024-01
Effective Incident Report Form  Mediated User

What was the situation that led to your need for this search?  I
had a patient who was very ill with Crohn's disease.  She had
lost a lot of weight, and it was very dangerous to her health. 
She also had other intestinal problems, as well as depression.  I
wasn't familiar with the latest ways of managing the problem,
specifically, the nutritional aspects and the other
complications.  We were also considering surgery as an option.  

What specific information were you seeking?  I wanted the latest
information on managing weight loss, intestinal problems, and
depression associated with Crohn's disease.  

Why did you choose to do a MEDLINE search instead of consulting
some other information source you had available, such as
textbooks, journals, or colleagues?  I wanted the latest
information, and also good review articles.  I looked at
textbooks, but they didn't have any depth of information. 
Colleagues were not much help.  

How did you explain your information need to the person carrying
out the search?  I asked her to use the terms "Crohn's" and
"complications of nutrition."  

How was this search carried out to get the information you
needed?  I don't know how the search was done.  

What information did you obtain as a result of this search?  I
got several good review articles.  I also got some articles
specifically about nutritional support and intestinal
complications.  

In what specific ways was this information helpful in your
decision making?  It gave me background for thinking about my
patients.  I can't remember if our specific choice of
treatment was guided by the references, or if we got advice from
a consultant.  

What was the impact on the situation of having this information? 
We did home hyperal with this patient--a central venous line for
hyperalimentation, for giving sugar and fats and protein
IV.  We decided that she didn't need surgery at this time.  

What was the outcome of the situation?  She went home, gained
weight, and got pregnant--she did well.  Her prognosis for
Crohn's is that she will eventually need surgery, because her
disease is still active.  But she hasn't needed surgery yet, and
it's been over a year.  

Incident # 01-0466-02
Effective Incident Report Form  End User

What was the situation that led you to do this search?  We were
interested in the sequence of the genes of ovalbumin  chicken
egg white.  We wanted to transform plants to produce ovalbumin. 
This was a research project in our laboratory.  

What specific information were you seeking?  We were looking for
the gene sequence.  It had been known for awhile but we needed to
know where it was published.  

Why did you choose to do a MEDLINE search instead of consulting
some other information source you had available, such as
textbooks, journals, or colleagues?  Its convenience.  

How did you carry out this search to get the information you
needed?  Text:  ovalbumin AND sequence OR gene.  I also searched
by author's name.  

What information did you obtain as a result of this search?  I
found a series of papers we weren't aware of which contained the
properties and sequence of the ovalbumin gene and techniques for
isolation and utilization.  

In what specific ways was this information helpful in your
decision making?  It allowed us to devise a research project
where we could clone the gene into a plasmid and transform plants
to increase their nutritional value.  

What was the impact on the situation of having this information? 
We were funded for the next three years to pursue studies. 
Without this information we would not have been funded. 

What was the outcome of the situation?  We have transformed
plants to produce ovalbumin.  We reported at the AAAS meeting
recently.  We used carrots, potatoes, petunias.  Ultimate
goal:  these more nutritious plants may become commercially
available.  

Figure 2.  Examples of Reports of Ineffective MEDLINE Searches

Incident # 01-0443-01
Ineffective Incident Report Form  End User

What was the situation that led you to do this search?  I was
writing an article on chest wall recurrences.  There was a lot of
literature on that area.  These are recurrences of breast
carcinoma in patients who had adjuvant chemotherapy but no
radiation until the recurrence had occurred.  

What specific information were you seeking?  Studies in women
after mastectomy who had adjuvant chemotherapy and later had a
recurrence in the breast wall with no other evidence of cancer. 
They were only to have had radiation at time of recurrence.  

Why did you choose to do a MEDLINE search instead of consulting
some other information source you had available, such as
textbooks, journals, or colleagues?  I consulted everything. 
MEDLINE was the best.  

How did you carry out this search to get the information you
needed?  I used MeSH  breast neoplasm and chest wall recurrence. 
I did also by text words  mastectomy.  I went all the way back. 
I did several searches.  

What information did you obtain as a result of this search? 
There were only 4 articles written on this type of thing.  Mostly
reassurance that I didn't miss important information from
journals I hadn't read.  

In what way was the search or its results unsatisfactory?  It was
difficult to get across to the computer the timing of the
disease.  I had too broad an area.  I wanted a photograph of
these patients. Patients will live 15 years after mastectomy with
many different types of surgery and therapy.  It was hard to
eliminate these other sequences from my search result.  

What search results would have been more helpful in your
decision-making?  If I could have sequenced different modalities. 
I wish I could have done it more quickly and concisely.  

What was the impact on the situation of not having the
information?  If I would have missed one of the articles it would
have looked bad, especially if the author of one of the 4
articles would have been a reviewer; I might not have gotten the
paper published.  

What was the outcome of the situation?  I did write and publish
the paper.  My advice to people has changed, mostly as function
of my study.  Nationally we are getting away from postop
radiation, and now give surgery and chemotherapy.  There is an
enormous incidence of chest wall recurrence  as high as 40%
recurrence in large primary tumors, positive axillary nodes.  I
now recommend radiation in these patients.