title: Usability of selected databases for low-resource clinical decision support.
abstract: BACKGROUND
  Smartphones are increasingly important for clinical decision support, but smartphone and Internet use are limited by cost or coverage in many settings. txt2MEDLINE provides access to published medical evidence by text messaging. Previous studies have evaluated this approach, but we found no comparisons with other tools in this format.
  
  
  OBJECTIVE
  To compare txt2MEDLINE with other databases for answering clinical queries by text messaging in low-resource settings.
  
  
  METHODS
  Using varied formats, we searched txt2MEDLINE and five other search portals (askMEDLINE, Cochrane, DynaMed, PubMed PICO, and UpToDate) to develop optimal strategies for each. We then searched each database again with five benchmark queries, using the customized search-optimization formats. We truncated the results to less than 480 characters each to simulate delivering them to a maximum of three text messages. Clinicians with practice experience in low-resource areas scored the results on a 5-point Likert scale.
  
  
  RESULTS
  Median scores and standard deviations from 17 reviewers were: txt2M2MEDLINE, 3.2±0.82 (control); askMEDLINE, 3.2±0.90 (p = 0.918); Cochrane, 3.8±0.58 (p = 0.073); DynaMed, 3.6±0.65 (p = 0.105); PubMed PICO, 3.6±0.82 (p = 0.005); and UpToDate, 4.0±0.52 (p = 0.002). Our sample size was sufficiently powered to find differences of 1.0 point.
  
  
  CONCLUSIONS
  Comparing several possible sources for texting-based clinical-decision-support information, our results did not demonstrate one-point differences in usefulness on a scale of 1 to 5. PubMed PICO and UpToDate were significantly better than txt2MEDLINE, but with relatively small improvements in Likert score (0.4 and 0.8, respectively). In a texting-only setting, txt2MEDLINE is comparable to simulated alternatives based on established reference sources.
authors: Missouri University Informatics Institute, Columbia, MO 65211, USA. lincolnsheets@gmail.com
authors: L
authors: L
authors: Sheets
authors: F
authors: F
authors: Callaghan
authors: A
authors: A
authors: Gavino
authors: F
authors: F
authors: Liu
authors: P
authors: P
authors: Fontelo
mesh_terms: D040421:Cell Phone; D020000:Decision Support Systems, Clinical / Q000592:standards*; D016239:MEDLINE; D008490:Medical Informatics / Q000379:methods* / Q000592:standards; D039781:PubMed; D057386:Search Engine / Q000379:methods / Q000706:statistics & numerical data; D060145:Text Messaging
keywords: Library information systems; ambulatory care; economic barriers; general healthcare providers; handheld devices
references: Telemed J E Health. 2012 Jan-Feb;18(1):14-7
references: 22150636
references: AMIA Annu Symp Proc. 2006;:259-63
references: 17238343
references: Psychol Bull. 1979 Mar;86(2):420-8
references: 18839484
references: J Am Med Inform Assoc. 2005 Mar-Apr;12(2):217-24
references: 15561792
references: AMIA Annu Symp Proc. 2007 Oct 11;:1135
references: 18694232
references: J Med Syst. 2006 Aug;30(4):241-9
references: 16978003
references: JAMA. 2007 Oct 24;298(16):1911-24
references: 17954542