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1.  Health education interventions to raise awareness of rheumatic fever: a systematic review protocol 
Systematic Reviews  2013;2:58.
There is a significant global health burden associated with acute rheumatic fever (ARF) and rheumatic heart disease (RHD), especially in developing countries. ARF and RHD most often strike children and young adults living in impoverished settings, where unhygienic conditions and lack of awareness and knowledge of streptococcal infection progression are common. Secondary prophylactic measures have been recommended in the past, but primary prevention measures have been gaining more attention from researchers frustrated by the perpetual prevalence of ARF and RHD in developing countries. Health education aims to empower people to take responsibility for their own well-being by gaining control over the underlying factors that influence health. We therefore conducted a review of the current best evidence for the use of health education interventions to increase awareness and knowledge of streptococcal pharyngitis and ARF.
Methods and design
This article describes the protocol for a systematic review of the effectiveness of health education interventions aimed at increasing awareness and knowledge of the symptoms, causes and consequences of streptococcal pharyngitis, rheumatic fever and/or rheumatic heart disease. Studies will be selected in which the effect of an intervention is compared with either a pre-intervention or a control, targeting all possible audience types. Primary and secondary outcomes of interest are pre-specified. Randomized controlled trials, quasi-randomized trials, controlled before–after studies and controlled clinical trials will be considered. We will search several bibliographic databases (for example, PubMed, EMBASE, World Health Organization Library databases, Google Scholar) and search sources for gray literature. We will meta-analyze included studies. We will conduct subgroup analyses according to intervention subtypes: printed versus audiovisual and mass media versus training workshops.
This review will provide evidence for the effectiveness of educational components in health promotion interventions in raising public awareness in regard to the symptoms, causes and consequences of streptococcal pharyngitis, ARF and/or RHD. Our results may provide guidance in the development of future intervention studies and programs.
PMCID: PMC3720575  PMID: 23866796
Acute rheumatic fever; Awareness; Health education; Pharyngitis; Rheumatic heart disease
2.  Croatian Medical Journal Citation Score in Web of Science, Scopus, and Google Scholar 
Croatian Medical Journal  2010;51(2):99-103.
To analyze the 2007 citation count of articles published by the Croatian Medical Journal in 2005-2006 based on data from the Web of Science, Scopus, and Google Scholar.
Web of Science and Scopus were searched for the articles published in 2005-2006. As all articles returned by Scopus were included in Web of Science, the latter list was the sample for further analysis. Total citation counts for each article on the list were retrieved from Web of Science, Scopus, and Google Scholar. The overlap and unique citations were compared and analyzed. Proportions were compared using χ2-test.
Google Scholar returned the greatest proportion of articles with citations (45%), followed by Scopus (42%), and Web of Science (38%). Almost a half (49%) of articles had no citations and 11% had an equal number of identical citations in all 3 databases. The greatest overlap was found between Web of Science and Scopus (54%), followed by Scopus and Google Scholar (51%), and Web of Science and Google Scholar (44%). The greatest number of unique citations was found by Google Scholar (n = 86). The majority of these citations (64%) came from journals, followed by books and PhD theses. Approximately 55% of all citing documents were full-text resources in open access. The language of citing documents was mostly English, but as many as 25 citing documents (29%) were in Chinese.
Google Scholar shares a total of 42% citations returned by two others, more influential, bibliographic resources. The list of unique citations in Google Scholar is predominantly journal based, but these journals are mainly of local character. Citations received by internationally recognized medical journals are crucial for increasing the visibility of small medical journals but Google Scholar may serve as an alternative bibliometric tool for an orientational citation insight.
PMCID: PMC2859414  PMID: 20401951
3.  Quality and Certification of Electronic Health Records 
Applied Clinical Informatics  2010;1(2):149-164.
Numerous projects, initiatives, and programs are dedicated to the development of Electronic Health Records (EHR) worldwide. Increasingly more of these plans have recently been brought from a scientific environment to real life applications. In this context, quality is a crucial factor with regard to the acceptance and utility of Electronic Health Records. However, the dissemination of the existing quality approaches is often rather limited.
The present paper aims at the description and comparison of the current major quality certification approaches to EHRs.
A literature analysis was carried out in order to identify the relevant publications with regard to EHR quality certification. PubMed, ACM Digital Library, IEEExplore, CiteSeer, and Google (Scholar) were used to collect relevant sources. The documents that were obtained were analyzed using techniques of qualitative content analysis.
The analysis discusses and compares the quality approaches of CCHIT, EuroRec, IHE, openEHR, and EN13606. These approaches differ with regard to their focus, support of service-oriented EHRs, process of (re-)certification and testing, number of systems certified and tested, supporting organizations, and regional relevance.
The analyzed approaches show differences with regard to their structure and processes. System vendors can exploit these approaches in order to improve and certify their information systems. Health care organizations can use these approaches to support selection processes or to assess the quality of their own information systems.
PMCID: PMC3632276  PMID: 23616834
Quality; certification; electronic health record; medical records
4.  The Comparison of the Minimum Data Set for Elderly Health in Selected Countries 
Acta Informatica Medica  2015;23(6):393-397.
Ongoing increase in the elderly population in many developed countries has drawn attention to health of this age group. Recording adequate and relevant data for the elderly is considered as the basis for future planning for this segment of society. So this study was conducted to compare minimum data about elderly health in selected countries.
This review study was conducted through Internet and library studies. Key words were extracted from search engines and data bases including Google, Yahoo, Google Scholar, PubMed, ProQuest and Iranian National Medical Digital Library. Inclusion criteria included English language with no time limits. All articles, research projects, theses, guidelines and progress reports were retrieved from the United States, Sweden, Japan and Iran and reviewed. Also, websites of organizations responsible for elderly health in selected countries were visited and their documents were reviewed. Results from this search were provided narratively and finally were presented within comparison tables.
The findings of this study showed that elderly data in the selected countries are collected around four axis including minimum demographic data, medical histories, health assessment and financial data of elderly health.
Discussion and Conclusion:
Given the importance of the minimum data set of elderly health for future planning, the use of experiences of leading countries in elderly health seems necessary; however, localization of it according to the country’s needs is inevitable.
PMCID: PMC4720821  PMID: 26862252
Minimum data set; health; elderly
5.  The Role of Google Scholar in Evidence Reviews and Its Applicability to Grey Literature Searching 
PLoS ONE  2015;10(9):e0138237.
Google Scholar (GS), a commonly used web-based academic search engine, catalogues between 2 and 100 million records of both academic and grey literature (articles not formally published by commercial academic publishers). Google Scholar collates results from across the internet and is free to use. As a result it has received considerable attention as a method for searching for literature, particularly in searches for grey literature, as required by systematic reviews. The reliance on GS as a standalone resource has been greatly debated, however, and its efficacy in grey literature searching has not yet been investigated. Using systematic review case studies from environmental science, we investigated the utility of GS in systematic reviews and in searches for grey literature. Our findings show that GS results contain moderate amounts of grey literature, with the majority found on average at page 80. We also found that, when searched for specifically, the majority of literature identified using Web of Science was also found using GS. However, our findings showed moderate/poor overlap in results when similar search strings were used in Web of Science and GS (10–67%), and that GS missed some important literature in five of six case studies. Furthermore, a general GS search failed to find any grey literature from a case study that involved manual searching of organisations’ websites. If used in systematic reviews for grey literature, we recommend that searches of article titles focus on the first 200 to 300 results. We conclude that whilst Google Scholar can find much grey literature and specific, known studies, it should not be used alone for systematic review searches. Rather, it forms a powerful addition to other traditional search methods. In addition, we advocate the use of tools to transparently document and catalogue GS search results to maintain high levels of transparency and the ability to be updated, critical to systematic reviews.
PMCID: PMC4574933  PMID: 26379270
6.  Cirque du Monde as a health intervention 
Canadian Family Physician  2014;60(11):e548-e553.
To present Cirque du Soleil’s social circus program, Cirque du Monde, to explore its potential as a primary health care tool for family physicians.
Data sources
A review of the literature in PubMed, the Cochrane Library, PsycINFO, LaPresse, Eureka, Google Scholar, and Érudit using the key words circus, social circus, Cirque du Monde, and Cirque du Soleil; a Montreal-based initiative, Espace Transition, modeled on Cirque du Monde; and personal communication with Cirque du Soleil’s Social Circus Training Advisor.
Study selection
The first 50 articles or websites identified for each key word in each of the databases were examined on the basis of their titles and abstracts in the case of articles, and on the basis of their titles and page content in the case of websites. Articles and websites that explored an aspect of social circuses or that described an intervention that involved circuses were then retained for analysis. Because all literature on social circuses was searched, no criterion for year of publication was used.
No articles on the social circus as a health intervention were found. One study on the use of the circus as an intervention in schools was identified. It demonstrated an increase in self-esteem in the children who took part. One study on the use of the circus in a First Nations community was found; it contained nonspecific, qualitative findings. The other articles identified were merely descriptions of social circuses. One website was identified on the use of the social circus to help youth who had been treated in a hospital setting for major psychiatric disorders to re-enter the community. The team in the pediatric psychiatry department at Centre Hospitalier Universitaire Sainte-Justine, the children’s hospital in Montreal, Que, was contacted; they were leading this project, called Espace Transition. The unpublished preliminary findings of its pilot project demonstrate substantial improvements in overall patient functioning. According to Cirque du Soleil, there are several projects under way around the world researching the therapeutic value of social circuses.
Cirque du Monde is able to reach a marginalized population that is otherwise difficult for the health system to reach. This program has therapeutic potential because of its target population, its promotion of healthy habits, and the support that it offers through the group and its workers. Cirque du Soleil is investing heavily in this project. The lack of literature yielding robust data on the social circus is therefore an important issue.
PMCID: PMC4229178  PMID: 25392449
7.  Barriers to implement Electronic Health Records (EHRs) 
Materia Socio-Medica  2013;25(3):213-215.
During the past 20 years, with huge advances in information technology and particularly in the areas of health, various forms of electronic records have been studied, analyzed, designed or implemented. An Electronic Health Records (EHRs) is defined as digitally stored healthcare information throughout an individual’s lifetime with the purpose of supporting continuity of care, education, and research. The EHRs may include such things as observations, laboratory tests, medical images, treatments, therapies; drugs administered, patient identifying information, legal permissions, and so on. Despite of the potential benefits of electronic health records, implement of this project facing with barriers and restriction ,that the most of these limitations are cost constraints, technical limitations, standardization limits, attitudinal constraints–behavior of individuals and organizational constraints.
The aim of this study was to express the main barriers to implement EHRs.
This study was unsystematic-review study. The literature was searched on main barriers to implement EHRs with the help of library, books, conference proceedings, data bank, and also searches engines available at Google, Google scholar. For our searches, we employed the following keywords and their combinations: Electronic health record, implement, obstacle, and information technology in the searching areas of title, keywords, abstract, and full text.
Results and discussion:
In this study, more than 43 articles and reports were collected and 32 of them were selected based on their relevancy. Many studies indicate that the most important factor than other limitations to implement the EHR are resistance to change.
PMCID: PMC3804410  PMID: 24167440
Electronic Health Records; implement; barrier; technology.
8.  Web GIS in practice III: creating a simple interactive map of England's Strategic Health Authorities using Google Maps API, Google Earth KML, and MSN Virtual Earth Map Control 
This eye-opener article aims at introducing the health GIS community to the emerging online consumer geoinformatics services from Google and Microsoft (MSN), and their potential utility in creating custom online interactive health maps. Using the programmable interfaces provided by Google and MSN, we created three interactive demonstrator maps of England's Strategic Health Authorities. These can be browsed online at – Google Maps API (Application Programming Interface) version, – Google Earth KML (Keyhole Markup Language) version, and – MSN Virtual Earth Map Control version. Google and MSN's worldwide distribution of "free" geospatial tools, imagery, and maps is to be commended as a significant step towards the ultimate "wikification" of maps and GIS. A discussion is provided of these emerging online mapping trends, their expected future implications and development directions, and associated individual privacy, national security and copyrights issues. Although ESRI have announced their planned response to Google (and MSN), it remains to be seen how their envisaged plans will materialize and compare to the offerings from Google and MSN, and also how Google and MSN mapping tools will further evolve in the near future.
PMCID: PMC1242244  PMID: 16176577
9.  Comparison of Four Search Engines and their efficacy With Emphasis on Literature Research in Addiction (Prevention and Treatment) 
Surveying valuable and most recent information from internet, has become vital for researchers and scholars, because every day, thousands and perhaps millions of scientific works are brought out as digital resources which represented by internet and researchers can’t ignore this great resource to find related documents for their literature search, which may not be found in any library. With regard to variety of documents presented on the internet, search engines are one of the most effective search tools for finding information.
The aim of this study is to evaluate the three criteria, recall, preciseness and importance of the four search engines which are PubMed, Science Direct, Google Scholar and federated search of Iranian National Medical Digital Library in addiction (prevention and treatment) to select the most effective search engine for offering the best literature research.
Materials and Methods
This research was a cross-sectional study by which four popular search engines in medical sciences were evaluated. To select keywords, medical subject heading (Mesh) was used. We entered given keywords in the search engines and after searching, 10 first entries were evaluated. Direct observation was used as a mean for data collection and they were analyzed by descriptive statistics (number, percent number and mean) and inferential statistics, One way analysis of variance (ANOVA) and post hoc Tukey in Spss. 15 statistical software. P Value < 0.05 was considered statistically significant.
Results have shown that the search engines had different operations with regard to the evaluated criteria. Since P Value was 0.004 < 0.05 for preciseness and was 0.002 < 0.05 for importance, it shows significant difference among search engines. PubMed, Science Direct and Google Scholar were the best in recall, preciseness and importance respectively.
As literature research is one of the most important stages of research, it's better for researchers, especially Substance-Related Disorders scholars to use different search engines with the best recall, preciseness and importance in that subject field to reach desirable results while searching and they don’t depend on just one search engine.
PMCID: PMC4070130  PMID: 24971257
Research; Search Engine; Substance-Related Disorders
10.  Epidemiology, Impact and Control of Rabies in Nepal: A Systematic Review 
PLoS Neglected Tropical Diseases  2016;10(2):e0004461.
Rabies is a vaccine-preventable viral zoonosis belonging to the group of neglected tropical diseases. Exposure to a rabid animal may result in a fatal acute encephalitis if effective post-exposure prophylaxis is not provided. Rabies occurs worldwide, but its burden is disproportionately high in developing countries, including Nepal. We aimed to summarize current knowledge on the epidemiology, impact and control of rabies in Nepal.
We performed a systematic review of international and national scientific literature and searched grey literature through the World Health Organization Digital Library and the library of the National Zoonoses and Food Hygiene Research Centre, Nepal, and through searching Google and Google Scholar. Further data on animal and human rabies were obtained from the relevant Nepalese government agencies. Finally, we surveyed the archives of a Nepalese daily to obtain qualitative information on rabies in Nepal.
So far, only little original research has been conducted on the epidemiology and impact of rabies in Nepal. Per year, rabies is reported to kill about 100 livestock and 10–100 humans, while about 1,000 livestock and 35,000 humans are reported to receive rabies post-exposure prophylaxis. However, these estimates are very likely to be serious underestimations of the true rabies burden. Significant progress has been made in the production of cell culture-based anti-rabies vaccine and rabies immunoglobulin, but availability and supply remain a matter of concern, especially in remote areas. Different state and non-state actors have initiated rabies control activities over the years, but efforts typically remained focalized, of short duration and not harmonized. Communication and coordination between veterinary and human health authorities is limited at present, further complicating rabies control in Nepal. Important research gaps include the reporting biases for both human and animal rabies, the ecology of stray dog populations and the true contribution of the sylvatic cycle.
Better data are needed to unravel the true burden of animal and human rabies. More collaboration, both within the country and within the region, is needed to control rabies. To achieve these goals, high level political commitment is essential. We therefore propose to make rabies the model zoonosis for successful control in Nepal.
Author Summary
Rabies has been known as a deadly disease in Nepal for decades, but information on epidemiology, impact and control remains scattered. We collected and summarized information from a variety of sources, including scientific literature and government agencies. Only little original research has been conducted on the epidemiology and impact of rabies in Nepal, leaving many questions unanswered. Official reports show that each year 100 livestock and 10–100 humans die of rabies, but these numbers very likely underestimate the true rabies burden. Availability and supply of anti-rabies vaccines have remained suboptimal and rabies control activities have been hampered by a lack of collaboration and comprehensiveness. High level political commitment is essential to overcome these problems and to reduce the burden of rabies. We therefore propose to make rabies the model zoonosis for successful control in Nepal.
PMCID: PMC4752342  PMID: 26871689
11.  Preventing breast cancer in LMICs via screening and/or early detection: The real and the surreal 
To review the present status of breast cancer (BC) screening/early detection in low- and middle-income countries (LMICs) and identify the way forward, an open focused search for articles was undertaken in PubMed, Google Scholar and Google, and using a snowball technique, further articles were obtained from the reference list of initial search results. In addition, a query was put up on ResearchGate to obtain more references and find out the general opinion of experts on the topic. Experts were also personally contacted for their opinion. Breast cancer (BC) is the most common cancer in women in the world. The rise in incidence is highest in LMICs where the incidence has often been much lower than high-income countries. In spite of more women dying of cancer than pregnancy or childbirth related causes in LMICs, most of the focus and resources are devoted to maternal health. Also, the majority of women in LMICs present at late stages to a hospital to initiate treatment. A number of trials have been conducted in various LMICs regarding the use of clinical breast examination and mammography in various combinations to understand the best ways of implementing a population level screening/early detection of BC; nevertheless, more research in this area is badly needed for different LMIC specific contexts. Notably, very few LMICs have national level programs for BC prevention via screening/early detection and even stage reduction is not on the public health agenda. This is in addition to other barriers such as lack of awareness among women regarding BC and the presence of stigma, inappropriate attitudes and lack of following proper screening behavior, such as conducting breast self-examinations. The above is mixed with the apathy and lack of awareness of policy makers regarding the fact that BC prevention is much more cost-effective and humane than BC treatment. Implementation of population level programs for screening/early detection of BC, along with use of ways to improve awareness of women regarding BC, can prove critical in stemming the increasing burden of BC in LMICs. Use of newer modalities such as ultrasonography which is more suited to LMIC populations and use of mHealth for awareness creation and increasing screening compliance are much needed extra additions to the overall agenda of LMICs in preventing BC.
PMCID: PMC4127620  PMID: 25114864
Breast cancer; Screening; Early detection; Mammography; Clinical breast examination; Breast self examination; Ultrasonography; Awareness; Developing countries; Low- and middle-income countries
12.  Impact of Community-Based DOT on Tuberculosis Treatment Outcomes: A Systematic Review and Meta-Analysis 
PLoS ONE  2016;11(2):e0147744.
Poor adherence to tuberculosis (TB) treatment can lead to prolonged infectivity and poor treatment outcomes. Directly observed treatment (DOT) seeks to improve adherence to TB treatment by observing patients while they take their anti-TB medication. Although community-based DOT (CB-DOT) programs have been widely studied and promoted, their effectiveness has been inconsistent. The aim of this study was to critical appraise and summarize evidence of the effects of CB-DOT on TB treatment outcomes.
Studies published up to the end of February 2015 were identified from three major international literature databases: Medline/PubMed, EBSCO, and EMBASE. Unpublished data from the grey literature were identified through Google and Google Scholar searches.
Seventeen studies involving 12,839 pulmonary TB patients (PTB) in eight randomized controlled trials (RCTs) and nine cohort studies from 12 countries met the criteria for inclusion in this review and 14 studies were included in meta-analysis. Compared with clinic-based DOT, pooled results of RCTs for all PTB cases (including smear-negative or -positive, new or retreated TB cases) and smear-positive PTB cases indicated that CB-DOT promoted successful treatment [pooled RRs (95%CIs): 1.11 (1.02–1.19) for all PTB cases and 1.11 (1.02–1.19) for smear-positive PTB cases], and completed treatment [pooled RRs (95%CIs): 1.74(1.05, 2.90) for all PTB cases and 2.22(1.16, 4.23) for smear-positive PTB cases], reduced death [pooled RRs (95%CIs): 0.44 (0.26–0.72) for all PTB cases and 0.39 (0.23–0.66) for smear-positive PTB cases], and transfer out [pooled RRs (95%CIs): 0.37 (0.23–0.61) for all PTB cases and 0.42 (0.25–0.70) for smear-positive PTB cases]. Pooled results of all studies (RCTs and cohort studies) with all PTB cases demonstrated that CB-DOT promoted successful treatment [pooled RR (95%CI): 1.13 (1.03–1.24)] and curative treatment [pooled RR (95%CI): 1.24 (1.04–1.48)] compared with self-administered treatment.
CB-DOT did improved TB treatment outcomes according to the pooled results of included studies in this review. Studies on strategies for implementation of patient-centered and community-centered CB-DOT deserve further attention.
PMCID: PMC4744041  PMID: 26849656
13.  Health sciences libraries building survey, 1999–2009 
A survey was conducted of health sciences libraries to obtain information about newer buildings, additions, remodeling, and renovations.
An online survey was developed, and announcements of survey availability posted to three major email discussion lists: Medical Library Association (MLA), Association of Academic Health Sciences Libraries (AAHSL), and MEDLIB-L. Previous discussions of library building projects on email discussion lists, a literature review, personal communications, and the author's consulting experiences identified additional projects.
Seventy-eight health sciences library building projects at seventy-three institutions are reported. Twenty-two are newer facilities built within the last ten years; two are space expansions; forty-five are renovation projects; and nine are combinations of new and renovated space. Six institutions report multiple or ongoing renovation projects during the last ten years.
The survey results confirm a continuing migration from print-based to digitally based collections and reveal trends in library space design. Some health sciences libraries report loss of space as they move toward creating space for “community” building. Libraries are becoming more proactive in using or retooling space for concentration, collaboration, contemplation, communication, and socialization. All are moving toward a clearer operational vision of the library as the institution's information nexus and not merely as a physical location with print collections.
PMCID: PMC2859257  PMID: 20428277
14.  Keywords to Recruit Spanish- and English-Speaking Participants: Evidence From an Online Postpartum Depression Randomized Controlled Trial 
One of the advantages of Internet-based research is the ability to efficiently recruit large, diverse samples of international participants. Currently, there is a dearth of information on the behind-the-scenes process to setting up successful online recruitment tools.
The objective of the study was to examine the comparative impact of Spanish- and English-language keywords for a Google AdWords campaign to recruit pregnant women to an Internet intervention and to describe the characteristics of those who enrolled in the trial.
Spanish- and English-language Google AdWords campaigns were created to advertise and recruit pregnant women to a Web-based randomized controlled trial for the prevention of postpartum depression, the Mothers and Babies/Mamás y Bebés Internet Project. Search engine users who clicked on the ads in response to keyword queries (eg, pregnancy, depression and pregnancy) were directed to the fully automated study website. Data on the performance of keywords associated with each Google ad reflect Web user queries from February 2009 to June 2012. Demographic information, self-reported depression symptom scores, major depressive episode status, and Internet use data were collected from enrolled participants before randomization in the intervention study.
The Google ads received high exposure (12,983,196 impressions) and interest (176,295 clicks) from a global sample of Web users; 6745 pregnant women consented to participate and 2575 completed enrollment in the intervention study. Keywords that were descriptive of pregnancy and distress or pregnancy and health resulted in higher consent and enrollment rates (ie, high-performing ads). In both languages, broad keywords (eg, pregnancy) had the highest exposure, more consented participants, and greatest cost per consent (up to US $25.77 per consent). The online ads recruited a predominantly Spanish-speaking sample from Latin America of Mestizo racial identity. The English-speaking sample was also diverse with most participants residing in regions of Asia and Africa. Spanish-speaking participants were significantly more likely to be of Latino ethnic background, not married, completed fewer years of formal education, and were more likely to have accessed the Internet for depression information (P<.001).
The Internet is an effective method for reaching an international sample of pregnant women interested in online interventions to manage changes in their mood during the perinatal period. To increase efficiency, Internet advertisements need to be monitored and tailored to reflect the target population’s conceptualization of health issues being studied.
Trial Registration NCT00816725; (Archived by WebCite at
PMCID: PMC3906894  PMID: 24407163
Internet intervention; prevention; depression, postpartum; research subject recruitment; women; Spanish speaking
15.  Asynchronous and Synchronous Teleconsultation for Diabetes Care: A Systematic Literature Review 
A systematic literature review, covering publications from 1994 to 2009, was carried out to determine the effects of teleconsultation regarding clinical, behavioral, and care coordination outcomes of diabetes care compared to usual care. Two types of teleconsultation were distinguished: (1) asynchronous teleconsultation for monitoring and delivering feedback via email and cell phone, automated messaging systems, or other equipment without face-to-face contact; and (2) synchronous teleconsultation that involves real-time, face-to-face contact (image and voice) via videoconferencing equipment (television, digital camera, webcam, videophone, etc.) to connect caregivers and one or more patients simultaneously, e.g., for the purpose of education.
Electronic databases were searched for relevant publications about asynchronous and synchronous tele-consultation [Medline, Picarta, Psychinfo, ScienceDirect, Telemedicine Information Exchange, Institute for Scientific Information Web of Science, Google Scholar]. Reference lists of identified publications were hand searched. The contribution to diabetes care was examined for clinical outcomes [e.g., hemoglobin A1c (HbA1c), dietary values, blood pressure, quality of life], for behavioral outcomes (patient-caregiver interaction, self-care), and for care coordination outcomes (usability of technology, cost-effectiveness, transparency of guidelines, equity of access to care). Randomized controlled trials with HbA1c as an outcome were pooled using standard meta-analytical methods.
Of 2060 publications identified, 90 met inclusion criteria for electronic communication between (groups of) caregivers and patients with type 1 and 2 or gestational diabetes. Studies that evaluated teleconsultation not particularly aimed at diabetes were excluded, as were those that described interventions aimed solely at clinical improvements (e.g., HbA1c or lipid profiles).
In 63 of 90 interventions, the interaction had an asynchronous teleconsultation character, in 18 cases interaction was synchronously (videoconferencing), and 9 involved a combination of synchronous with asynchronous interaction. Most of the reported improvements concerned clinical values (n = 49), self-care (n = 46), and satisfaction with technology (n = 43). A minority of studies demonstrated improvements in patient-caregiver interactions (n = 28) and cost reductions (n = 27). Only a few studies reported enhanced quality of life (n = 12), transparency of health care (n = 7), and improved equity in care delivery (n = 4). Asynchronous and synchronous applications appeared to differ in the type of contribution they made to diabetes care compared to usual care: asynchronous applications were more successful in improving clinical values and self-care, whereas synchronous applications led to relatively high usability of technology and cost reduction in terms of lower travel costs for both patients and care providers and reduced unscheduled visits compared to usual care. The combined applications (n = 9) scored best according to quality of life (22.2%). No differences between synchronous and asynchronous teleconsultation could be observed regarding the positive effect of technology on the quality of patient-provider interaction. Both types of applications resulted in intensified contact and increased frequency of transmission of clinical values with respect to usual care. Fifteen of the studies contained HbA1c data that permitted pooling. There was significant statistical heterogeneity among the pooled randomized controlled trials (χ2 = 96.46, P < 0.001). The pooled reduction in HbA1c was not statically significant (weighted mean difference -0.10; 95% confidence interval -0.39 to 0.18).
The included studies suggest that both synchronous and asynchronous teleconsultations for diabetes care are feasible, cost-effective, and reliable. However, it should be noted that many of the included studies showed no significant differences between control (usual care) and intervention groups. This might be due to the diversity and lack of quality in study designs (e.g., inaccurate or incompletely reported sample size calculations). Future research needs quasi-experimental study designs and a holistic approach that focuses on multilevel determinants (clinical, behavioral, and care coordination) to promote self-care and proactive collaborations between health care professionals and patients to manage diabetes care. Also, a participatory design approach is needed in which target users are involved in the development of cost-effective and personalized interventions. Currently, too often technology is developed within the scope of the existing structures of the health care system. Including patients as part of the design team stimulates and enables designers to think differently, unconventionally, or from a new perspective, leading to applications that are better tailored to patients' needs.
PMCID: PMC2901046  PMID: 20513335
chronic diseases; diabetes mellitus; telemedicine; remote consultation; teleconsultation; videoconferencing; telemonitoring
16.  Unlocking Index Animalium: From paper slips to bytes and bits 
ZooKeys  2016;153-171.
In 1996 Smithsonian Libraries (SIL) embarked on the digitization of its collections. By 1999, a full-scale digitization center was in place and rare volumes from the natural history collections, often of high illustrative value, were the focus for the first years of the program. The resulting beautiful books made available for online display were successful to a certain extent, but it soon became clear that the data locked within the texts needed to be converted to more usable and re-purposable form via digitization methods that went beyond simple page imaging and included text conversion elements. Library staff met with researchers from the taxonomic community to understand their path to the literature and identified tools (indexes and bibliographies) used to connect to the library holdings. The traditional library metadata describing the titles, which made them easily retrievable from the shelves of libraries, was not meeting the needs of the researcher looking for more detailed and granular data within the texts. The result was to identify proper print tools that could potential assist researchers in digital form. This paper outlines the project undertaken to convert Charles Davies Sherborn’s Index Animalium into a tool to connect researchers to the library holdings: from a print index to a database to eventually a dataset.
Sherborn’s microcitation of a species name and his bibliographies help bridge the gap between taxonomist and literature holdings of libraries. In 2004, SIL received funding from the Smithsonian’s Atherton Seidell Endowment to create an online version of Sherborn’s Index Animalium. The initial project was to digitize the page images and re-key the data into a simple data structure. As the project evolved, a more complex database was developed which enabled quality field searching to retrieve species names and to search the bibliography. Problems with inconsistent abbreviations and styling of his bibliographies made the parsing of the data difficult. Coinciding with the development of the Biodiversity Heritage Library (BHL) in 2005, it became obvious there was a need to integrate the database converted Index Animalium, BHL’s scanned taxonomic literature, and taxonomic intelligence (the algorithmic identification of binomial, Latinate name-strings). The challenges of working with legacy taxonomic citation, computer matching algorithms, and making connections have brought us to today’s goal of making Sherborn available and linked to other datasets. Partnering with others to allow machine-to-machine communications the data is being examined for possible transformation into RDF markup and meeting the standards of Linked Open Data. SIL staff have partnered with Thomson Reuters and the Global Names Initiative to further enhance the Index Animalium data set. Thomson Reuters’ staff is now working on integrating the species microcitation and species name in the ION: Index to Organism Names project; Richard Pyle (The Bishop Museum) is also working on further parsing of the text. The Index Animalium collaborative project’s ultimate goal is to successful have researchers go seamlessly from the species name in either ION or the scanned pages of Index Animalium to the digitized original description in BHL - connecting taxonomic researchers to original authored species descriptions with just a click.
PMCID: PMC4741219  PMID: 26877657
Metadata; Digitization; Linked Open Data
17.  Google Scholar as replacement for systematic literature searches: good relative recall and precision are not enough 
Recent research indicates a high recall in Google Scholar searches for systematic reviews. These reports raised high expectations of Google Scholar as a unified and easy to use search interface. However, studies on the coverage of Google Scholar rarely used the search interface in a realistic approach but instead merely checked for the existence of gold standard references. In addition, the severe limitations of the Google Search interface must be taken into consideration when comparing with professional literature retrieval tools.
The objectives of this work are to measure the relative recall and precision of searches with Google Scholar under conditions which are derived from structured search procedures conventional in scientific literature retrieval; and to provide an overview of current advantages and disadvantages of the Google Scholar search interface in scientific literature retrieval.
General and MEDLINE-specific search strategies were retrieved from 14 Cochrane systematic reviews. Cochrane systematic review search strategies were translated to Google Scholar search expression as good as possible under consideration of the original search semantics. The references of the included studies from the Cochrane reviews were checked for their inclusion in the result sets of the Google Scholar searches. Relative recall and precision were calculated.
We investigated Cochrane reviews with a number of included references between 11 and 70 with a total of 396 references. The Google Scholar searches resulted in sets between 4,320 and 67,800 and a total of 291,190 hits. The relative recall of the Google Scholar searches had a minimum of 76.2% and a maximum of 100% (7 searches). The precision of the Google Scholar searches had a minimum of 0.05% and a maximum of 0.92%. The overall relative recall for all searches was 92.9%, the overall precision was 0.13%.
The reported relative recall must be interpreted with care. It is a quality indicator of Google Scholar confined to an experimental setting which is unavailable in systematic retrieval due to the severe limitations of the Google Scholar search interface. Currently, Google Scholar does not provide necessary elements for systematic scientific literature retrieval such as tools for incremental query optimization, export of a large number of references, a visual search builder or a history function. Google Scholar is not ready as a professional searching tool for tasks where structured retrieval methodology is necessary.
PMCID: PMC3840556  PMID: 24160679
Literature search; Literature search; Methods; Literature search; Systematic; Information storage and retrieval; Google Scholar; Medline
18.  Reducing Alaska Native paediatric oral health disparities: a systematic review of oral health interventions and a case study on multilevel strategies to reduce sugar-sweetened beverage intake 
International Journal of Circumpolar Health  2013;72:10.3402/ijch.v72i0.21066.
Tooth decay is the most common paediatric disease and there is a serious paediatric tooth decay epidemic in Alaska Native communities. When untreated, tooth decay can lead to pain, infection, systemic health problems, hospitalisations and in rare cases death, as well as school absenteeism, poor grades and low quality-of-life. The extent to which population-based oral health interventions have been conducted in Alaska Native paediatric populations is unknown.
To conduct a systematic review of oral health interventions aimed at Alaska Native children below age 18 and to present a case study and conceptual model on multilevel intervention strategies aimed at reducing sugar-sweetened beverage (SSB) intake among Alaska Native children.
Based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Statement, the terms “Alaska Native”, “children” and “oral health” were used to search Medline, Embase, Web of Science, GoogleScholar and health foundation websites (1970–2012) for relevant clinical trials and evaluation studies.
Eighty-five studies were found in Medline, Embase and Web of Science databases and there were 663 hits in GoogleScholar. A total of 9 publications were included in the qualitative review. These publications describe 3 interventions that focused on: reducing paediatric tooth decay by educating families and communities; providing dental chemotherapeutics to pregnant women; and training mid-level dental care providers. While these approaches have the potential to improve the oral health of Alaska Native children, there are unique challenges regarding intervention acceptability, reach and sustainability. A case study and conceptual model are presented on multilevel strategies to reduce SSB intake among Alaska Native children.
Few oral health interventions have been tested within Alaska Native communities. Community-centred multilevel interventions are promising approaches to improve the oral and systemic health of Alaska Native children. Future investigators should evaluate the feasibility of implementing multilevel interventions and policies within Alaska Native communities as a way to reduce children's health disparities.
PMCID: PMC3873640  PMID: 24377091
oral health disparities; Alaska Native health disparities; dental caries prevention; children; dental workforce; primary intervention in oral health; sugar-sweetened beverages
19.  Towards better digital pathology workflows: programming libraries for high-speed sharpness assessment of Whole Slide Images 
Diagnostic Pathology  2014;9(Suppl 1):S3.
Since microscopic slides can now be automatically digitized and integrated in the clinical workflow, quality assessment of Whole Slide Images (WSI) has become a crucial issue. We present a no-reference quality assessment method that has been thoroughly tested since 2010 and is under implementation in multiple sites, both public university-hospitals and private entities. It is part of the FlexMIm R&D project which aims to improve the global workflow of digital pathology. For these uses, we have developed two programming libraries, in Java and Python, which can be integrated in various types of WSI acquisition systems, viewers and image analysis tools.
Development and testing have been carried out on a MacBook Pro i7 and on a bi-Xeon 2.7GHz server. Libraries implementing the blur assessment method have been developed in Java, Python, PHP5 and MySQL5. For web applications, JavaScript, Ajax, JSON and Sockets were also used, as well as the Google Maps API. Aperio SVS files were converted into the Google Maps format using VIPS and Openslide libraries.
We designed the Java library as a Service Provider Interface (SPI), extendable by third parties. Analysis is computed in real-time (3 billion pixels per minute). Tests were made on 5000 single images, 200 NDPI WSI, 100 Aperio SVS WSI converted to the Google Maps format.
Applications based on our method and libraries can be used upstream, as calibration and quality control tool for the WSI acquisition systems, or as tools to reacquire tiles while the WSI is being scanned. They can also be used downstream to reacquire the complete slides that are below the quality threshold for surgical pathology analysis. WSI may also be displayed in a smarter way by sending and displaying the regions of highest quality before other regions. Such quality assessment scores could be integrated as WSI's metadata shared in clinical, research or teaching contexts, for a more efficient medical informatics workflow.
PMCID: PMC4305973  PMID: 25565494
20.  A Case Study of a Retracted Systematic Review on Interactive Health Communication Applications: Impact on Media, Scientists, and Patients 
In October 2004, a flawed systematic review entitled “Interactive Health Communication Applications for People with Chronic Disease” was published in the Cochrane Library, accompanied by several press releases in which authors warned the public of the negative health consequences of interactive health communication applications, including the Internet. Within days of the review's publication, scientists identified major coding errors and other methodological problems that invalidated the principal conclusions of the study and led to a retraction. While the original study results and their negative conclusions were widely publicized in the media, the retraction seemed to go unnoticed.
This paper aims to document an unprecedented case of misinformation from a Cochrane review and its impact on media, scientists, and patients. As well, it aims to identify the generic factors leading to the incident and suggest remedies.
This was a qualitative study of the events leading to the retraction of the publication and of the reactions from media, scientists, and patients. This includes a review and content analysis of academic and mass media articles responding to the publication and retraction. Mass media articles were retrieved in May 2005 from LexisNexis Academic and Google and were classified and tallied. The extended case method is employed, and the analysis is also applied to comparable publishing events.
A search on LexisNexis Academic database with the query “Elizabeth Murray AND health” for the period of June 2004 to May 2005 revealed a total of 15 press reports, of which only 1 addressed the retraction. Google was searched for references to the review, and the first 200 retrieved hits were analyzed. Of these, 170 pages were not related to the review. Of the remaining 30 pages, 23 (77%) were reports about the original publication that did not mention the retraction, 1 (3%) was a bibliography not mentioning the retraction, and 6 (20%) addressed the retraction, of which only 1 was a non-Cochrane–related source.
Analyzed retrievals showed that the mass media gave more coverage to the Cochrane review than to the retraction or to a related systematic review with a similar scope but a different conclusion. Questionable results were prematurely disseminated, oversimplified, and sensationalized, while the retraction was hardly noticed by the public. Open commentary by scientists and patients helped to rapidly identify the errors but did not prevent or correct the dissemination of misinformation.
PMCID: PMC1550646  PMID: 15998609
Retraction of publication; online systems; mass media; patients; medical errors; editorial policies
21.  Prophylactic vaccination against human papillomavirus infection and disease in women: a systematic review of randomized controlled trials 
Human papillomavirus (HPV) is now known to be a necessary cause of cervical cancer, and prophylactic HPV vaccines aimed at preventing genital warts, precancerous cervical lesions and cervical cancer are now available. To gauge the potential impact on disease burden, we performed a systematic review of the evidence from randomized controlled trials.
We conducted a systematic search of the literature to identify all randomized controlled trials of prophylactic HPV vaccination. Reports in 5 electronic databases covering 1950 to June 2007 (MEDLINE, MEDLINE in process, EMBASE, the Cochrane Central Registry of Controlled Trials and the Cochrane Library), bibliographies of all included studies and of narrative reviews (2006–2007), clinical trial registries, Google Scholar, public health announcements, selected conference proceedings (2004–2007) and manufacturers' information on unpublished data or ongoing trials were screened against predefined eligibility criteria by 2 independent reviewers. Vaccines had to contain coverage against at least 1 oncogenic HPV strain. The primary outcome of interest was the frequency of high-grade cervical lesions (high-grade squamous intraepithelial lesion, or grade 2 or 3 cervical intraepithelial neoplasia). The secondary outcomes were persistent HPV infection, low-grade cervical lesions (low-grade squamous intraepithelial lesion or grade 1 cervical intraepithelial neoplasia), external genital lesions, adverse events and death. Meta-analysis of the data was done in all cases where adequate clinical and methodological homogeneity existed.
Of 456 screened reports, 9 were included in the review (6 were reports of randomized controlled trials and 3 were follow-up reports of initial trials). Findings from the meta-analysis showed that prophylactic HPV vaccination was associated with a reduction in the frequency of high-grade cervical lesions caused by vaccine-type HPV strains compared with control groups: Peto odds ratio 0.14 (95% confidence interval [CI] 0.09–0.21) from combined per-protocol analyses, and 0.52 (95% CI 0.43–0.63) from modified intention-to-treat analyses. Vaccination was also highly efficacious in preventing other HPV-related infection and disease outcomes, including persistent HPV infection, low-grade lesions and genital warts. The majority of adverse events were minor. The incidence of serious adverse events and death were balanced between the vaccine and control groups.
Among women aged 15–25 years not previously infected with vaccine-type HPV strains, prophylactic HPV vaccination appears to be highly efficacious in preventing HPV infection and precancerous cervical disease. Long-term follow-up is needed to substantiate reductions in cervical cancer incidence and mortality.
PMCID: PMC1950172  PMID: 17671238
22.  Novel Data Sources for Women’s Health Research: Mapping Breast Screening Online Information Seeking Through Google Trends 
Academic radiology  2014;21(9):1172-1176.
Rationale and Objectives
Millions of people use online search engines every day to find health-related information and voluntarily share their personal health status and behaviors in various Web sites. Thus, data from tracking of online information seeker’s behavior offer potential opportunities for use in public health surveillance and research. Google Trends is a feature of Google which allows internet users to graph the frequency of searches for a single term or phrase over time or by geographic region. We used Google Trends to describe patterns of information seeking behavior in the subject of dense breasts and to examine their correlation with the passage or introduction of dense breast notification legislation.
Materials and Methods
In order to capture the temporal variations of information seeking about dense breasts, the web search query “dense breast” was entered in the Google Trends tool. We then mapped the dates of legislative actions regarding dense breasts that received widespread coverage in the lay media to information seeking trends about dense breasts over time.
Newsworthy events and legislative actions appear to correlate well with peaks in search volume of “dense breast”. Geographic regions with the highest search volumes have either passed, denied, or are currently considering the dense breast legislation.
Our study demonstrated that any legislative action and respective news coverage correlate with increase in information seeking for “dense breast” on Google, suggesting that Google Trends has the potential to serve as a data source for policy-relevant research.
PMCID: PMC4399798  PMID: 24998689
Dense breast; Legislation; information seeking; Google Trends
23.  Information Systems for Patient Follow-Up and Chronic Management of HIV and Tuberculosis: A Life-Saving Technology in Resource-Poor Areas 
The scale-up of treatment for HIV and multidrug-resistant tuberculosis (MDR-TB) in developing countries requires a long-term relationship with the patient, accurate and accessible records of each patient’s history, and methods to track his/her progress. Recent studies have shown up to 24% loss to follow-up of HIV patients in Africa during treatment and many patients not being started on treatment at all. Some programs for prevention of maternal–child transmission have more than 80% loss to follow-up of babies born to HIV-positive mothers. These patients are at great risk of dying or developing drug resistance if their antiretroviral therapy is interrupted. Similar problems have been found in the scale-up of MDR-TB treatment.
The aim of the study was to assess the role of medical information systems in tracking patients with HIV or MDR-TB, ensuring they are promptly started on high quality care, and reducing loss to follow-up.
A literature search was conducted starting from a previous review and using Medline and Google Scholar. Due to the nature of this work and the relative lack of published articles to date, the authors also relied on personal knowledge and experience of systems in use and their own assessments of systems.
Functionality for tracking patients and detecting those lost to follow-up is described in six HIV and MDR-TB treatment projects in Africa and Latin America. Preliminary data show benefits in tracking patients who have not been prescribed appropriate drugs, those who fail to return for follow-up, and those who do not have medications picked up for them by health care workers. There were also benefits seen in providing access to key laboratory data and in using this data to improve the timeliness and quality of care. Follow-up was typically achieved by a combination of reports from information systems along with teams of community health care workers. New technologies such as low-cost satellite Internet access, personal digital assistants, and cell phones are helping to expand the reach of these systems.
Effective information systems in developing countries are a recent innovation but will need to play an increasing role in supporting and monitoring HIV and MDR-TB projects as they scale up from thousands to hundreds of thousands of patients. A particular focus should be placed on tracking patients from initial diagnosis to initiation of effective treatment and then monitoring them for treatment breaks or loss to follow-up. More quantitative evaluations need to be performed on the impact of electronic information systems on tracking patients.
PMCID: PMC2223184  PMID: 17951213
Anti-retroviral therapy; developing countries; information systems; patient follow-up; HIV/AIDS; Tuberculosis
24.  Google Scholar is not enough to be used alone for systematic reviews 
Background: Google Scholar (GS) has been noted for its ability to search broadly for important references in the literature. Gehanno et al. recently examined GS in their study: ‘Is Google scholar enough to be used alone for systematic reviews?’ In this paper, we revisit this important question, and some of Gehanno et al.’s other findings in evaluating the academic search engine.
Methods: The authors searched for a recent systematic review (SR) of comparable size to run search tests similar to those in Gehanno et al. We selected Chou et al. (2013) contacting the authors for a list of publications they found in their SR on social media in health. We queried GS for each of those 506 titles (in quotes ""), one by one. When GS failed to retrieve a paper, or produced too many results, we used the allintitle: command to find papers with the same title.
Results: Google Scholar produced records for ~95% of the papers cited by Chou et al. (n=476/506). A few of the 30 papers that were not in GS were later retrieved via PubMed and even regular Google Search. But due to its different structure, we could not run searches in GS that were originally performed by Chou et al. in PubMed, Web of Science, Scopus and PsycINFO®. Identifying 506 papers in GS was an inefficient process, especially for papers using similar search terms.
Conclusions: Has Google Scholar improved enough to be used alone in searching for systematic reviews? No. GS’ constantly-changing content, algorithms and database structure make it a poor choice for systematic reviews. Looking for papers when you know their titles is a far different issue from discovering them initially. Further research is needed to determine when and how (and for what purposes) GS can be used alone. Google should provide details about GS’ database coverage and improve its interface (e.g., with semantic search filters, stored searching, etc.). Perhaps then it will be an appropriate choice for systematic reviews.
PMCID: PMC3733758  PMID: 23923099
MeSH Keywords: Google Scholar; information retrieval; PubMed; searching; systematic reviews
25.  Interventions to encourage discussion of end-of-life preferences between members of the general population and the people closest to them - a systematic literature review 
BMC Palliative Care  2013;12:40.
Discussing end of life preferences can be beneficial, and it is thought that the best time to have these conversations is usually when people are well. This review aims to establish current evidence for the effectiveness of community-based interventions to encourage people to consider, and to discuss with those closest to them, their preferences for end of life care or what they wish to happen after their death.
A systematic literature review was undertaken. A systematic search was conducted using Scopus and Google, and academic experts were contacted. Studies were included if they evaluated interventions intended to encourage people to discuss their end of life preferences with those closest to them, or to address known barriers to these discussions. Reported outcomes had to relate to attitude or behaviour change in the target group, or target group perceptions of the intervention. Studies were excluded if the intervention targeted only people with a life-limiting illness, or intended specifically to facilitate communication of end of life preferences between patients and healthcare staff. Studies were systematically described and assessed for quality. There was no attempt to combine results of different studies.
The Scopus search identified 5,743 citations, and the Google search identified over 40,000, of which the first 40 pages were scanned. Five studies were included, four identified through the Scopus search and one from a book identified through Google. Three studies reported positive results, two were less positive. A peer education programme on end of life planning for older people, featuring small discussion workshops, was positively appraised by participants. An arts project bringing hospice users and school pupils together appeared to help normalise death for school pupils. A public information ‘roadshow’ engaged people using an informal questionnaire survey, facilitating conversations between people who participated together. Public lectures by physicians intending to promoting home death as a possibility were unsuccessful in changing attitudes at six months follow-up. A module on end of life planning delivered as part of ‘expert patient’ education programme on the management of chronic illness was not well received by participants.
Available evidence highlights the importance of actively engaging people rather than passively providing information, and of ensuring an appropriate context for interventions. However, data are limited and there is a need for more research and for sharing of best practice.
PMCID: PMC3826509  PMID: 24188214
Public health; End of life; Palliative care; Health promotion

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