Need more info? Here's how to search like a pro.

A few hours spent with a good book or a website like this one can give you basic information on epilepsy, and sometimes much more. But sooner or later you will have a question about some specific problem or some new treatment that you've heard about -- something so specialized or so new that you can't find anything in the usual places. Now what?

Calling your doctor is one good option. But, as you well know, the doctor may be busy, and your question is so unusual that even the doctor might have to do some research to give you a good answer.

A more direct approach is to start by doing the same kind of research yourself. Then when you see your doctor again, you'll have more to talk about. The doctor can help you interpret what you've found and may even be able to act on it right away.

Where should I look?
How can I find what I'm looking for?
I found some search results -- What do they mean?
What are other ways of finding articles I want?
How can I save what I find?
Learning more

Where should I look?

The Internet
Using regular Internet search engines like Google or Yahoo! may produce links to a lot of web pages that mention the topic you're investigating. Some of them may even provide good information, but some will not and it can be hard to tell the difference.

Medical journals
Your doctor is likely to rely instead on medical journals. These weekly or monthly publications record the continuous rapid advances in medical information. They report the results of clinical trials that study things such as patterns of seizures and the effects of various types of medications and other treatments. Before articles are published, other experts called "peer reviewers" usually evaluate them to ensure that the design of the study and the way the results are reported seem to be scientifically valid, so the doctor feels more comfortable basing decisions on what these articles say. They also may publish "Reviews," which are summaries of up-to-date information on a broad topic, written by an expert.

There are so many medical journals, however, that no one can read them all, and subscriptions to most of them are very expensive. If you can't read every journal, how can you find out what has been published about the subject you want to investigate?

MEDLINE
Because you have access to the Internet, you can search for any topic in about 4500 important worldwide journals at once. The United States National Library of Medicine maintains a huge database called MEDLINE, which catalogs all the journals relevant to healthcare. The information is updated constantly so that you can read a summary of most articles almost as soon as they're published.

PubMed
The easiest way to find information in the MEDLINE database is to use the search system called PubMed, which is available free of charge at www.pubmed.gov. Typing a word into the search box at the top of the screen will produce a list of articles related t o that term. On the day this was written, however, the word "epilepsy" produced a list of nearly 69,000 articles! To find the specific information you're looking for, you will need to devise a plan (called a "search strategy") to narrow the list to a manageable number of articles.

You can also review PubMed articles from the last 90 days in pre-searched categories by visiting the PubMed Journal Articles section of the website, located under Resources.

How can I find what I'm looking for?

If you're looking for fairly general information in PubMed and are willing to sort through a large number of search results, you can just type in two or three terms connected by the word AND in capital letters.? For instance, typing in "epilepsy AND absence AND treatment" narrows the results from 69,000 articles to just under 2000 -- still a lot.

Newer articles generally are listed first, so something in the news may not be hard to find. If you're more interested in topic than timeliness, you'll want to change your approach a bit. Let's try looking for a specific seizure medicine, for instance. Typing "epilepsy AND absence AND valproate" produces over 300 items, still a large number but more manageable than thousands. Using the brand name "Depakote" in place of the generic name "valproate" yields a slightly smaller number of items, but it does work, even though as a rule medical journals use generic names in articles.

It works because PubMed searches a huge vocabulary called MeSH (Medical Subject Headings) for related words, including brand names. Unless instructed not to, PubMed "explodes" each term, also finding articles that use more-specific or alternate terms. For example, if you type in "valproate," it also will find articles that use "Depakote," "Depacon," or "valproic acid." If you type "absence seizures," it will find articles that use "petit mal epilepsy" (an older term) or "childhood absence epilepsy." This means that you don't need to keep searching for different versions of the same term or closely related terms. PubMed takes care of that for you.

I found some search results -- What do they mean?

When you search for terms in PubMed, the result is a list of items that look something like this:

PubMed

What does all this mean? Let's take it apart:

Wiebe S, Blume WT, Girvin JP, Eliasziw M.

is a list of all the authors of the article (last name and initials).
You can tell by the color and underlining that this is a hyperlink. If you click on it, you'll see more information about this article. In most cases this will include a type of summary called an abstract. If you want to look at it later instead, click on the check box to the left of the number.

If you come back to the list after looking at the abstract, you'll see that the list of authors has changed color, indicating that you've already looked at that item.

Related Articles, Links

provides links to related material or to the full article (though you usually will have to pay to see the complete article). See more information below about Related Articles.

PubMed

is a symbol that PubMed uses to show you at a glance that an abstract is available for that article.

If you see a blank rectangle (like a piece of blank paper), that means there is no abstract.

A randomized, controlled trial of surgery for temporal-lobe epilepsy.

The text just under the authors' names is the title of the article.

N Engl J Med. 2001 Aug 2;345(5):311-8.

The smaller text beneath the title shows where the article was published. This particular article was published in the New England Journal of Medicine on August 2, 2001. It was in volume 345, issue 5, on pages 311 to 318. (Most medical journals number their pages consecutively through the whole volume, which may include a year's issues. If you see that an article was published on page 750, that does not mean that there were 750 pages in that single issue!)

Sometimes this line also includes other information, such as the language if the article is not in English, or the type of article. "Review" indicates a summary of up-to-date information. Another type is a "Meta-analysis," in which many similar studies are statistically combined. A meta-analysis may be published if only small studies of a particular topic have been performed.

PMID: 11484687 [PubMed - indexed for MEDLINE]

PMID is the PubMed identification number. Every article in the database is assigned a unique number. Many articles have the same authors or similar titles, but if you know this number, you can type or paste it into the search box and go straight to the article you want.

The words in brackets tell the indexing status of the article. Like this sample, most say "indexed for MEDLINE" but some newly received items say "in process" or "as supplied by publisher." These have not yet been indexed with MeSH terms, so they will be less likely to turn up in a search until the indexing is completed.

The abstract page, which you reach by clicking on the authors' names, includes the same information about the source and indexing status, and tells what university or hospital the authors are affiliated with. This page also may include an address where an author can be contacted and a link to the website of the journal where the article was published.

What are other ways of finding articles I want?

Related Articles
Another helpful feature of PubMed is "Related Articles." As shown above, to the right of each list of authors you'll see the words "Related Articles, Links." Clicking on "Related Articles" brings up a new list of articles on topics closely related to that particular article. This means that if you find one article that directly addresses the subject you want to know about, you can find a lot of similar articles with one click. "Related Articles" are listed in order of relevance, beginning with the article you started with.

Limits
"Limits" is another way of narrowing your search for information. Sometimes a lot of the articles listed in your search results may report studies about animals, or they may be articles in a foreign language with no English-language abstract available. Or perhaps they're about elderly people and you're only interested in articles about children. Clicking on the word "Limits" just under the search box will produce a set of boxes where you can choose the limitations that will help you find only the kind of article you want.

For example, in the Ages box you can choose "All child: 0-18 years." You can check off "only items with abstracts" and choose English in the Languages box. You can ensure that you don't get any very old, outdated articles by typing years next to Publication Date, such as 1996 to this year. With these particular limits, searching again on "epilepsy AND absence AND valproic acid" produced a list of only 36 items instead of 300.

Be careful not to limit your searches too much, though, or you might miss seeing something that will really interest you. It might seem harmless to limit your search to articles in English, for instance, but if you don't specify a language, you can read English-language abstracts of articles published in other languages.

How can I save what I find?

After you've found PubMed listings for some articles that seem relevant to your question, what can you do with them?

Perhaps you're searching on a modem that ties up your phone line, so you'd like to read the abstracts offline later. Perhaps you'd like to print out some abstracts and take them with you when you visit the doctor. Or perhaps you're doing research for a friend or relative and want to send a few items to that person by e-mail. All of these things are easy to do with PubMed.

Gathering articles
If you want to gather a number of article listings to read or print later, you can do that by using your Clipboard. Click on the box next to the number of any item you want to save, and a check mark will appear. When you've checked off everything of interest, go to the drop-down list after "Send to" and choose "Clipboard." Then click on "Send to" and all the items you checked off will be saved for you in a separate list. If you want to, you can then perform other searches and add more items to your Clipboard.

Just keep in mind that PubMed will empty your Clipboard if you don't do anything on the site for an hour. (Inside an hour, you can even go away and come back without losing the Clipboard!) To see what's on your Clipboard, click on "Clipboard" under the "Go" button near the top of the screen.

Working with articles
When you've found an item of particular interest, or when you've finished gathering everything you want on the Clipboard, there are several things you can do:

  • You can save abstracts or a list of articles as a file on your computer to read or print later. Just choose File in the "Send to" box and click on "Save this file to disk." Then you can choose where to put it on your computer and give it a name. It will be saved as a plain text document that you can edit with your word processor. (If you want a collection of abstracts rather than just a list of articles, first choose "Abstract" in the "Display" box so all the abstracts are listed one after another.)
  • If you're reading an abstract online, you can print it right away. Just choose Print from the File menu at the top of your browser screen. (Hint: first use "Send to" Text to save time and ink.)
  • You can e-mail an abstract or list of articles to someone else (or yourself) by choosing E-mail in the "Send to" box and filling in that person's e-mail address. You can also choose what format to use and add a personal message
  • You can order the full text of an article, either from the publisher or from a medical library through a program called "Loansome Doc." You'll need to register for the program and will need to pay a fee for most articles.

Learning more

PubMed also has other features that will help you find and save the information you want. If you have questions about how to use PubMed, you may find the answer in the Help section of the site. To become a real expert, spend some time working through PubMed's Tutorial, which demonstrates all of these features and more.


? AND in capital letters is called a Boolean operator. Others include OR and NOT. For the example above, it doesn't make much difference whether you use AND—just typing "epilepsy absence treatment" gives nearly the same results. But if PubMed finds that two terms you've typed make up a phrase, it will search for the phrase instead of the individual words. That may not be what you want. Using AND will force PubMed to look for both words separately.

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