Theory PDF 2021

Contents Image manipulation:........................................................................................... 6 Why are they manipulated?..................................................................................................................... 6 How to spot?....................

Contents Image manipulation:........................................................................................... 6 Why are they manipulated?..................................................................................................................... 6 How to spot?............................................................................................................................................. 6 Why do patients believe them?................................................................................................................ 6 Communication and networking:........................................................................ 7 Communication model:............................................................................................................................ 7 Communication model in a computer network........................................................................................ 7 Types of communication channels:.......................................................................................................... 8 Bandwidth:................................................................................................................................................ 8 Protocols:.................................................................................................................................................. 8 Physical Networks..................................................................................................................................... 8 Wired LAN:............................................................................................................................................ 8 Wireless LAN:........................................................................................................................................ 9 Network types:.......................................................................................................................................... 9 Organizational networks (not physical):................................................................................................... 9 Privacy and security in health context:.............................................................. 10 Examples of data that we’ll deal with:.................................................................................................... 10 Ethical concepts for data treatment:...................................................................................................... 10 Threats and safeguards:.......................................................................................................................... 10 mobile devices:....................................................................................................................................... 11 traditional role of doctor in flow of medical information:................................. 12 filter and interpreter:.............................................................................................................................. 12 why doesn’t this work anymore?........................................................................................................ 12 Patient centered medical practice:......................................................................................................... 12 Anti view on this practice:................................................................................................................... 12 Interaction in work environment:........................................................................................................... 12 Medical instruments:.............................................................................................................................. 13 Internet as an instrument:...................................................................................................................... 13 How is this change explained?............................................................................................................ 13 Adoption of internet in oman:................................................................................................................ 15 e-patient characteristics:.................................................................................. 16 definition:................................................................................................................................................ 16 What do E-patients do?.......................................................................................................................... 16 Patient behavior:................................................................................................................................. 16 E-Patient-doctor interaction outcomes:............................................................................................. 16 Patient demographic:.............................................................................................................................. 16 Medical sources:..................................................................................................................................... 16 Reliable sources:................................................................................................................................. 16 Suspect information:........................................................................................................................... 16 Discussion groups:.............................................................................................................................. 17 Email and social media:........................................................................................................................... 17 Benefits:.............................................................................................................................................. 17 Disadvantage:...................................................................................................................................... 17 Access to electronic medical records (EMRs):........................................................................................ 17 Access to medical footprint:................................................................................................................... 17 Doctor characteristics in oman:......................................................................... 18 Oman dr’s attitude toward E-patient:.................................................................................................... 18 Patient characteristics in Oman:....................................................................... 18 Omani patient attitude:.......................................................................................................................... 18 Omani patient knowledge:..................................................................................................................... 18 Dave and his doctor’s relationship:................................................................... 19 How to prepare for the Omani E-patient........................................................... 19 Starting points:........................................................................................................................................ 19 Searching information in internet:.......................................................................................................... 19 Patient and internet life:......................................................................................................................... 19 Group discussion forums:....................................................................................................................... 19 Wikipedia:............................................................................................................................................... 19 Email and social media:........................................................................................................................... 19 Security, privacy, and liability:................................................................................................................ 20 Electronic medical records:..................................................................................................................... 20 Dealing with patients that love to use electronic devices:..................................................................... 20 Doctor’s personal information:......................................................................... 20  What about these “rate my doctor”?..................................................................................................... 20 Medical search engines: (practical)................................................................... 21 PubMed (and Medline):.......................................................................................................................... 21 How to search?................................................................................................................................... 21 Types of search:.................................................................................................................................. 21 Advanced pubmed Search:................................................................................................................. 22 PubMed (and MeSH): (practical)....................................................................... 22 MeSH....................................................................................................................................................... 22 Pubmed central PMC: (practical)....................................................................... 23 Google scholar: (practical)................................................................................ 23 Online medical resources (theory):................................................................... 24 Staying current with information:.......................................................................................................... 24 Challenges faced:................................................................................................................................ 24 Online resources..................................................................................................................................... 25 Digital library Examples (what could they be focused on?):............................................................... 25 Benefits of online resources:.................................................................................................................. 25 Ideal medical resources:......................................................................................................................... 25 Medical websites:............................................................................................. 26 Image manipulation:........................................................................................... 6 Why are they manipulated?..................................................................................................................... 6 How to spot?............................................................................................................................................. 6 Why do patients believe them?................................................................................................................ 6 Communication and networking:........................................................................ 7 Communication model:............................................................................................................................ 7 Communication model in a computer network........................................................................................ 7 Types of communication channels:.......................................................................................................... 8 Bandwidth:................................................................................................................................................ 8 Protocols:.................................................................................................................................................. 8 Physical Networks..................................................................................................................................... 8 Wired LAN:............................................................................................................................................ 8  Wireless LAN:........................................................................................................................................ 9 Network types:.......................................................................................................................................... 9 Organizational networks (not physical):................................................................................................... 9 Privacy and security in health context:.............................................................. 10 Examples of data that we’ll deal with:.................................................................................................... 10 Ethical concepts for data treatment:...................................................................................................... 10 Threats and safeguards:.......................................................................................................................... 10 mobile devices:....................................................................................................................................... 11 traditional role of doctor in flow of medical information:................................. 12 filter and interpreter:.............................................................................................................................. 12 why doesn’t this work anymore?........................................................................................................ 12 Patient centered medical practice:......................................................................................................... 12 Anti view on this practice:................................................................................................................... 12 Interaction in work environment:........................................................................................................... 12 Medical instruments:.............................................................................................................................. 13 Internet as an instrument:...................................................................................................................... 13 How is this change explained?............................................................................................................ 13 Adoption of internet in oman:................................................................................................................ 15 e-patient characteristics:.................................................................................. 16 definition:................................................................................................................................................ 16 What do E-patients do?.......................................................................................................................... 16 Patient behavior:................................................................................................................................. 16 E-Patient-doctor interaction outcomes:............................................................................................. 16 Patient demographic:.............................................................................................................................. 16 Medical sources:..................................................................................................................................... 16 Reliable sources:................................................................................................................................. 16 Suspect information:........................................................................................................................... 16 Discussion groups:.............................................................................................................................. 17 Email and social media:........................................................................................................................... 17 Benefits:.............................................................................................................................................. 17 Disadvantage:...................................................................................................................................... 17 Access to electronic medical records (EMRs):........................................................................................ 17  Access to medical footprint:................................................................................................................... 17 Doctor characteristics in oman:......................................................................... 18 Oman dr’s attitude toward E-patient:.................................................................................................... 18 Patient characteristics in Oman:....................................................................... 18 Omani patient attitude:.......................................................................................................................... 18 Omani patient knowledge:..................................................................................................................... 18 Dave and his doctor’s relationship:................................................................... 19 How to prepare for the Omani E-patient........................................................... 19 Starting points:........................................................................................................................................ 19 Searching information in internet:.......................................................................................................... 19 Patient and internet life:......................................................................................................................... 19 Group discussion forums:....................................................................................................................... 19 Wikipedia:............................................................................................................................................... 19 Email and social media:........................................................................................................................... 19 Security, privacy, and liability:................................................................................................................ 20 Electronic medical records:..................................................................................................................... 20 Dealing with patients that love to use electronic devices:..................................................................... 20 Doctor’s personal information:......................................................................... 20 What about these “rate my doctor”?..................................................................................................... 20 Medical search engines: (practical)................................................................... 21 PubMed (and Medline):.......................................................................................................................... 21 How to search?................................................................................................................................... 21 Types of search:.................................................................................................................................. 21 Advanced pubmed Search:................................................................................................................. 22 PubMed (and MeSH): (practical)....................................................................... 22 MeSH....................................................................................................................................................... 22 Pubmed central PMC: (practical)....................................................................... 23 Google scholar: (practical)................................................................................ 23 Online medical resources (theory):................................................................... 24 Staying current with information:.......................................................................................................... 24 Challenges faced:................................................................................................................................ 24  Online resources..................................................................................................................................... 25 Digital library Examples (what could they be focused on?):............................................................... 25 Benefits of online resources:.................................................................................................................. 25 Ideal medical resources:......................................................................................................................... 25 Medical websites:............................................................................................. 26 Image manipulation: Why are they manipulated? Cultural reasons Improving physical appearance (typical weight loss, etc) Not liking the person (e.g Stalin’s photo edits) How to spot? 1. Look for any curved lines in the background 2. Reflections not matching 3. Editing image and saving it as png (leaves white background) 4. Copy pasted crowd 5. Increased number of hands 6. 2 suns 7. Unrealistic legs // hands 8. Person holding fake bag handle without bag 9. Smoke/water, etc 10. Image perspective not matching with background (people not standing, look like they’re hovering) Why do patients believe them? Confirmation bias -> they desperately believe the image and want this to be applied to them (e.g plastic surgery) Communication and networking: Communication model: This describes all forms of human communication - Sender sends a message to a receiver through a communication channel (air, wifi, wire, letter, alarm farm etc), the receiver then sends a feedback (response to message) - Code/language is needed and must be understood by both the sender and receiver In the fire examples, both sender and receiver know it’s a warning that enemy is here - Noise is anything that interferes with communication Communication model in a computer network Computer (sender) ↓ Modem (Modulator / demodulator) ↓ network cable / wifi / etc (communication channel equivalent) + transmission specification (language equivalent) ↓ Modem (Modulator / demodulator) ↓ computer or other device (receiver) - the sender sends an email/webpage (message equivalent) - the receiver sends a reply (confirmation bits) -> confirms that the information is received - broken cable / interference is a noise type of data stored in both sender and receiver is DIGITAL, but it’s in an analog form in the communication channel. It’s converted by the modulator, then de-converted by the demodulator Types of communication channels: - The types have “theoretical speeds” -> they wont always have the same speed you should know: (at least what I understand, dr doesn’t want you to memorize the numbers) Fastest: Fiberoptic cable Slowest: Dialup Bandwidth: - measurement of the capacity of the communication channel. Categories are: Voiceband (or low bandwidth) -> SLOWEST Medium band -> MEDIUM SPEED Broadband (DSL and above) -> HIGH SPEED Apart from dial up, all the other communication channels shown in the previous slide is broadband Thickness of the pipe in here means bandwidth, the thicker, the higher Protocols: - communication rules and codes so that devices can communicate with each other. internet uses TCP/IP protocol (no need to know the detailed name) URL (www.google.com) -> DNS (domain name server) -> IP 62.231.244.11 DNS is like a computer that holds all the information about the sites Physical Networks - A communication system with two or more connected computers -> allows information exchange Wired LAN: Node -> any device on a network (In a wired LAN, nodes are connected with each other by cables) Special node types: Client -> device that requests service from other nodes (client can also be a software) Server -> node that shares resource with other nodes (provides the service to the client) Hub -> central node for other nodes (hub, modem/router, switch) (hub allows connecting all nodes together) Network interface card (NIC) -> connect any node to network Network operating system -> operating system for network Distributed processing -> large number of computers working on a single task Host computer -> computer that stores files Network administrator -> human that handles the network Wireless LAN: Same as wired LAN, but without cables but: 1. Wireless access point -> helps expand the wireless network range 2. Nodes can still be connected to the modem with wires Network types: PAN (personal network area) -> bluetooth (example) LAN (local area network) -> a building full of connected computers, multiple buildings, largest is a university LAN Home network -> LAN in a private home If the network has 2 same devices (like 2 computers) connected, it’s home, If only 1 type of device is connected (1 computer, 1 headphone, 1 phone) -> pan MAN (metropolitan area network) -> 100 miles2 (single metropolitan area) WAN (wide area network) -> country wide network or large GAN (global area network) -> internet Organizational networks (not physical): 1. Intranet: - Private network within organization // provides information to employees (or students) - Employees must have login information to get access - Information will be shown according to the employee position (student cant see other’s grades) 2. Extranet: - Network that connects organization -> allows suppliers and other access 3. Firewall: - Security system, protect against external threat 4. VPN (virtual private network): - Set of protocol allowing for privacy -> user connects to a proxy server - Can be used to disguise location Basic idea: If it’s http -> NOT SAFE protocl If it’s https -> SAFE protocol Privacy and security in health context: Examples of data that we’ll deal with: Assignments / Research data / Patient data / Research subject information / Confidential reports / Personal information / For teachers -> exam and test papers + student mark and grades Ethical concepts for data treatment: - Privacy and confidentiality -> patient’s details must be private, etc - Accuracy - Currency -> keeping information update to date - Property -> who own the data? (this determines what can be done) - Access -> who should have access to the data? Threats and safeguards: 1. Threat: users accessing materials they should not: Safeguards: - Users are allocated unique identifier (one per person) -> s173153 THIS CAN BE SHARED - Password (may have requirements; minimum length, lowercase/uppercase, periodic change) THIS CANNOT BE SHARED; PRIVATE - Level of access granted differently (like intranet) - Access terminated once user laves - Anti-virus and anti-spyware software 2. Threat: electronic access through trojan, virus, cookies, key logger, crypto jacking, ransomware. Safeguards: - Antivirus (must be kept up to date) **editor note: literally windows defender is fine but sure - Anti-spyware (e.g super antispyraware, spybot s&d - Ad blockers (ublock origin) - Firewall 3. Threat: Third party accessing data while transmitted Safeguards: - Only send sensitive data in HTTPS connections - Encrypt / password protect data files (veracrypt) - Use a VPN 4. Threat: Identity and credit card theft (phishing scareware) through threat 2 Example: - emails that threaten to pay money to get exposed (for something not real) -> ignore these - emails that look for a conversation at a personal level, then propose a vague request to send money to the person (purpose of email is to gather person identity)-> ignore these - scareware -> bought software that acts like an antivirus but does nothing  5. threat: identity tracking through cookies and linking to other online systems safeguards: (similar to 2) - anti-spyware - ad blocker - use the cheaper device 6. Threat: blocking and monitoring email and activity and employee by employer Safeguards: - Understand the limits of the laws and employment restrictions - Use personal device - Tell employer 7. Threat: accidental loss of data Safeguard: - Store info in file server - Store info in cloud storage (good drive, etc) - Backup of personal computer - Backup in external storage (and make sure they’re away from computer) 8. Other safeguards: - Don’t overshare personal information - Clear history file Chrome: chrome://settings/clearBrowserData I Browsing History, Clear Data. Edge: Three-dot menu I History Firefox: History I Show All History - control browser security Chrome: chrome://settings/ Edge: Three-dot menu I Settings I Privacy, Search & Services Firefox: Three-line menu I Settings I Privacy & Security - do not respond to scam messages, simply ignore and delete - check urban legends through sites like snopes **there are more sites mentioned but their name is stupid obvious it’s used for detecting if an urban legend is fake or not - password protect or encrypt files (impossible to get back the decryption password if forgotten) mobile devices: the risk comes from the fact they’re portable - don’t store passwords - don’t leave phone unattended - check which app has access to your email - encryption through EDS for android and (crypto decipher and crypto disk) traditional role of doctor in flow of medical information: filter and interpreter: - filter out medical information and only use relevant information - interpret medical information -> apply it into patient -> explain into simpler language to them patient receives information, and gives “informed consent” if needed this is known as the paternalistic model “doctor knows best” patient gives info, doctor gives medical info // the doctor informs and the patient consents (informed consent) why doesn’t this work anymore? 1. Patient centered medical practice 2. New type of patient -> E-PATIENT Patient centered medical practice: Empowers patient, but may be a burden on them Anti view on this practice: Shifting the decision burden on the least competent person; the patient Interaction in work environment: Engeström's Activity Systems Model “in any interaction system model, there is: - Subject -> person in charge - Object -> person receiving information - Outcome -> intended purpose of interaction - Instruments -> tools used for communication - Rules -> things that subject and object are allowed to do - Community -> communication between co-workers (subjects in this case) - Division of labor -> people working behind the scenes (reception, etc) Medical instruments: - Require professional training in their use (stethoscope can be used by anyone but not all know why it’s used) - Subjects (doctors) are trained, objects (patients) are not - Medical and healthcare professionals have complete ownership and control to instrument - Ownership and control gives subject power Internet as an instrument: - Used by patients, sometimes even better than medical professionals - Widely used by them - Rapid increase by users across time 95% of omani people use internet today How is this change explained? Everett Roger’s classification of population groups in terms of innovation adoption Innovators -> adopt innovation immediately, sometimes before release Early adopters -> adopt soon after release Early majority -> interested but only adopt in a few weeks Late majority -> interested, but doesn’t want to get it right now Laggards -> do not want to adopt, but must adopt Diffusion process: accumulating new adopters: Example shows 3 innovations, all successful but vary in adoption speed Critical mass (take-off) -> dangerous area for innovation Why? Area where early adopters start to use the innovation, then then the early majority -> late -> laggards If they’re not satisfied -> product fails around the critical mass Adoption of internet in oman: the critical mass take-off area is where the adoption for internet could’ve failed If it was difficult to use by early adopters OMAN IS CURRENTLY IN THE LAGGARDS PHASE e-patient characteristics: definition: the term is linked to medical instruments, and means patients who are: EQUIPPED ENABLED EMPOWERED ENGAGED In their healthcare decision by gathering information from the internet about the medical condition What do E-patients do? 1. Look for information on the internet from various sources 2. Make decisions based on that information: - see a health professional (50%) - Treat themselves Now, returning to the traditional role of a doctor, the patient and doctor both bring information instead Patient behavior: 1. Over-aggressive -> misinformed // worsens relationship 2. Richer consultation -> improves relationship E-Patient-doctor interaction outcomes: 1. Receive better information from the internet than doctors 2. Find information but do not inform doctors (reason is prior experience) 3. Doctor ignores patients’ findings Patient demographic: - All demographic groups use the internet - Highest being aged 10-17 - Groups 5-15 15-24 most likely to use internet than general population - Frequency search on behalf of others Medical sources: Reliable sources: BMJ, Lancet, etc Problems: Confusion by methods, protocols, contradictory trials // Outdated, inappropriate, impenetrable medical jargon Suspect information: Found from general search engines Problem Wrong, dangerous, and commercially motivated Can be helped by: Doctor recommendations: help increase the quality of search by epatient Discussion groups: Patients connect with other patients - Positive impact on patient health; it’s “self-correct” Email and social media: - Used internationally - Social media is used less than email Benefits: Saving time -> changing appointment date, asking general questions about condition Asynchronous communication -> helps to think and reflect before answering Give well-constructed questions Refer to further references and guides Disadvantage: Topic and acceptability -> diagnosis cannot happen through email Lack of face-to-face interaction Re-imbursement -> who pays for that time? Security and privacy Access to electronic medical records (EMRs): - EU Patients have direct access to their medical records - Patients can change data but only to a certain extent (age, disease history, etc) Leads to patients being more positive about electronic devices in general: 1. Not fearful of tests 2. Use home-tests and recording devices Access to medical footprint: Patients will find you ONLINE There are sites that rate doctors as well Doctor characteristics in oman: - Half of omani doctors are aware of E-patients + interact electronically with them - Also use email with patients, but a majority use social media - Majority of them find patients coming with information - Half recommend sites to patients - ^^ no relationship between the two - Most commonly recommend sites: 1. Google 2. Medscape 3. Youtube Oman dr’s attitude toward E-patient: - Positive about patients bringing material - Not bothered by loss of control (patient using medical instrument) - Prepare to change prescription for better informed patients Patient characteristics in Oman: - Less know about E-patient - Half (42) communicate with email - A small number interacts by social media - Small number use internet for health-related activities - Very low say doctors recommend websites - No difference between acute and chronic condition treatment (searching for medical information online) Omani patient attitude: - Positive about bringing material to drs - See improvement in patient doctor relationship due to better informed patients, but concerned about impact on time - ^^^ chronic patients are more aware than acute Omani patient knowledge: - High in oman compared to other countries - Usage of these apps is inversely related to age - Similar source of info used in other countries Dave and his doctor’s relationship: Good working relationship because: 1. Balance between exchange of medical information and personal information doctor suggested dave to go drink a bottle of wine; because he knows dave well enough to say that 2. The doctor’s ability to prescribe acor.org; this shows: o He knew the site existed and knew dave will obtain information o He was prepared to tell dave that he doesn’t know the answer, and dave should check the site 3. The dam -> represents wall around the data that blocks patient from seeing it How to prepare for the Omani E-patient Starting points: - Recognize internet access has grown and is increasing - Understand that Omani people use the internet similarly to other countries, but prefer usage of social media (WhatsApp) over email - Research must be updated daily Searching information in internet: - Find out if patient used internet - Search and provide sites suitable for the patient demographic and social background - Prepare to explain research methods (in trusted source, patients might get confused) - Advise patients of evaluating the site (tell patient to act as a filter) -> kapoun’s criteria - Encourage patient to be involved in decision making - Know the patient’s level of knowledge Patient and internet life: - Be aware of patient’s internet role - Be aware of the doctor-patient relationship -> make sure it’s positive not negative - Don’t dismiss any information provided by the patient Group discussion forums: - Be aware of benefits and risks of discussion groups - Guide patients on discussion group usage (rules, etc) - Contribute to that group, supply information, answer general questions but not diagnose Wikipedia: - You can edit or make new topics if needed, no reason to wait Email and social media: 1. Set boundaries, limits, and expectations + use professional email + don’t friend patients 2. Learn how to write correctly, avoid humor or sarcasm 3. Experiment with conference calling or telemedicine skills if can be done Security, privacy, and liability: - Make sure data records are encrypted and secure - Know the limits and the law - Advise patients on the basics of security Electronic medical records: - Write clearly, accurately, and with sensitivity (patient will LOOK at the record) - Have a system that allows patient to alter the information or make notes if needed - Use a patient portal (like SQU portal) Dealing with patients that love to use electronic devices: - Advise them on which device is suitable for their condition - Advise them on how to use them and what to avoid Doctor’s personal information: - Be aware of what you do in the web (everything that gets in the internet stays there permanently) - The information to put out on the public may affect: 1. Doctor-patient interaction 2. Job applications 3. Decrease your “rate my doctor” sites rating What about these “rate my doctor”? 1. Be aware of how you handle the reviews: Correcting a patient’s review might break the patient confidentiality Reply to the review but make sure it doesn’t affect the patient’s confidentiality Taking the feedback and actually applying it if it’s constructive Medical search engines: (practical) The internet is a global library We access the library with search engine like: 1. Google -> both medical and non-medical, but limited 2. PubMed -> search engine for formal search of medical and health literature PubMed (and Medline): Database and search engine -> commonly used to search through the MEDLINE database They’re both Developed and maintained by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) Pubmed is the search engine medline is the database - Registration is not required but will be lack features (course doesn’t teach about register required things) How to search? Pubmed has a search box, similar to google, same functions too 1. Adding “” between text will make sure the it will only find the text containing the exact word Number of results drop rapidly when adding “ “ 2. Searching without “ “, e.g sleep disorders Pubmed will automatically assume you’re searching for sleep “and” disorders 3. Avoid common words, only write keywords (for, and, etc) Aspirin heart attack prevention is better than “Aspirin for heart attack prevention” because not all related articles will specifically write that sentence order Types of search: Simple subject search: - Lists articles not sites - You can customize the shown content Simple author search: - Instead of writing keywords, write the author’s surname THEN initials - If the name is a common word, add the initials (wood KS) Anthony S fauci -> fauci AS (all initials are made letters) Advanced pubmed Search: 1. Click “advanced” on search box 2. On the “all fields” box -> change to author 3. Insert search term to fauci ( you can leave it as it is or select the initials) 4. Click and -> adds fauci[author] in the query box 5. Change the field to “date of publication” -> add dates in the box 6. Click and -> 7. Click search Results will be shown, viewing all articles made by anyone named fauci - You can click the arrow next to AND and choose “OR” or “NOT” This means that the search will include: keyword or keyword keyword but NOT this keyword - You can click the arrow next to search and choose “add to history” This adds the search into the history without leaving the site If you’ve searched before, scroll down and you’ll find a history of the searches done, you can click number under “result” and it’ll show the results PubMed (and MeSH): (practical) Condition names may have many different names and terms MeSH Medical Subject Headings -> allows consistent and accurate searching MeSH are used as keywords by authors Pubmed -> mesh -> medline 1. Click advanced 2. If you scroll down, you’ll find the history of your searches 3. Click on the arrow in one of the searches 4. You’ll see that the search is connected with other terms automatically, this done by MeSH So how to control it?  1. Go to the main pubmed page (with the searchbox) 2. Scroll down and find MeSH database -> click it 3. In the search box, insert the term and click search 4. Click the page of the term 5. You’ll see all the related terms recorded in the MeSH 6. Scroll down and you’ll find the hierarchy structure 7. you can check “restrict to major MeSH 8. go into the search build (right of the page) then “add to search builder” 9. only the major MeSH term will be added ** you can instead of checking the “restrict to major MeSH” select the other terms shown then add to builder - Usually in a normal search, MeSH will automatically include all the related term, this is known as automatic explosion - - When clicking the term, on the right it’ll show you the sites where the keyword was recorded “major topic” -> shows articles that specifically use the term mentioned - Starting from step, you can instead check the box next to the term and add it to the search build on the right - Search for a different term in the search box above, repeat the step above - Click search pubmed, the engine will search for articles relating both terms Pubmed central PMC: (practical) Database that contains FULL articles (not just bibliographic information) Some articles will show “FREE pmc article” -> means that they’re available for view in PMC Articles are not prestigious as those in medline but still good Google scholar: (practical) A google Search engine that searches general articles, including government records and other things - Search results are not strictly medical - Flexible unlike google search or pubmed - Searches many resources apart from medline - Not as advanced as medline but more advanced than google search - Shows the times an article has been cited - Usually has links to full text version  - Alerts feature (if registered) -> google scholar does search instead of the user if they created an alert about a topic Online medical resources (theory): Staying current with information: Challenges faced: Educational: Medical textbooks are expensive Articles are added very quickly in medline Some will be out of dated Not all is proved Education focuses where we can find the information now, not “know everything” Diffusion of information: Spread of information across organization all the way to the medical professionals No effective method to spread Translational challenge Will the professionals apply the new information translated from research? Evolutionary challenge Occurs due to diseases changing over time -> textbooks related to old information are no longer regarded Diseases are also diagnosed earlier -> older interventions are no longer appropriate either Retention challenge You probably don’t remember the Things you’ve learned in the previous semester Present knowledge is INVERSE with year of graduation Accessibility challenge Not everyone has equal access to internet - Bad internet - Journals behind paywalls - Information might break copyright and other laws Online resources Internet is becoming the new main source of knowledge instead of library Digital library Examples (what could they be focused on?): Newsletter updates (email) CME (continuing medical education) Journals Books Drugs Benefits of online resources: - Updated more frequently than paper based Ideal medical resources: Medical websites: