MEDES: Development of a completely new Spanish medical bibliographic database

Sonia Cebrián Blanco
cebrian_sonia@lilly.com
Yolanda Mª Moreno Fernández 
 moreno_yolanda@lilly.com
Laboratorios Lilly, S.A.
Avda. de la Industria, 30
28108 Alcobendas(Madrid)
Tel. 916635093
Fax 916635341

SUMMARY

It is not necessary to talk about how important the medical databases are for the librarian work. Medline, Embase, Biosis, etc. are USA or Europe focused. Of course they include Spanish journals, but just a few of them, but the interfaces are in English, and sometimes it means a big problem for Spanish physicians.  There are few Spanish databases, the most important of them is called IME (Indice Medico Español), but the quality of this database has been discussed lots of time, because is not up to date (it has no records of 2002), and because it does not use a controlled list of keywords, so searching can be sometimes difficult. 

As a result or the situation, we decided to develop a new tool, completely designed and implemented in our company, in order to have all the information of the most important Spanish medical journals, with quality references (including abstracts and keywords) and up to date. We constituted an interdepartmental group and worked on the project for more than one year: design, development and testing. Once we had the database we introduced all the data from the chosen journals since 2001. This new database is called MEDES (MEDicina en Español) and includes the most important medical journals in Spain (up to 40) in 15 different therapeutic areas (endocrine, primary care, etc), a large description and a controlled keyword list. Nowadays is under the company intranet and in some specific Lilly web pages.

INTRODUCTION

Since the introduction of computers into business and daily life, the evolution of information systems has had considerable repercussions on the data administration. The centre of gravity of information, therefore, which concentrated on data processing, has polarised their structure. In this way databases came into existence. From the 1960s to the present, they have developed in a spectacular fashion, providing ways to administrate data and objects and the administration of knowledge.
	
On the other hand, the development of Internet as a tool for disseminating information, and the creation and use of the Intranet as a means of diffusion of information and for the administration of knowledge within institutions, has involved the appearance of a new space for the administration and development of databases. In this way a universal value is added to them which was previously unavailable.

For today’s professional of scientific information, databases have become an essential work tool in teaching and research centres. In the biomedicine area, specialised databases are indispensable for the recovery of information with the aim of disseminating the latest scientific advances, improving the practice of medicine, and contributing to the continuous training of health professionals.

THE APPEARANCE OF LARGE MEDICAL DATABASES

Nowadays we are witnessing an explosion of databases, which have become a source for decision-making and creative processes. It is well known that advances in the biomedicine area have been spectacular during the 20th century as a result of the two world wars,

Although it is true that since the 19th century there has been an awareness of the need for creating up-to-date medical bibliographic indexes, the need for health professionals to keep up to date has become more and more imperative. This need for information has encouraged the development of specialised medical databases. Publishing houses such as Excerpta Medica have undertaken various initiatives of this kind since the beginning of the 20th century, but it was not until the 1960s with the advance of technology that an appropriate tool appeared. In this way the two most important databases in biomedicine came into existence, with a wide coverage of international themes: Medline and Embase.

In Spain the first medical bibliography appeared in 1904, the Index Medicus Hispanis of J.P. Pascual i Prats. From 1928 to 1936 its equivalent was the Índice Español de Literatura Médica of J.B. Peset Aleixandre. From 1971 onwards the Spanish Medical Index (Índice Médico Español, IME), which covers nearly 40 years of medical literature published in Spanish and includes Spanish medical publications, was systematised. Until recent years it was two and a half years behind, did not use a controlled language, and did not include summaries of the referenced articles, although technical aspects have now improved considerably.

Recently, within the framework of the Network of Virtual Health Libraries of the Panamerican Health Organisation – World Health Organisation (Organización Panamericana de Salud, OPS - WHO), the Virtual Health Library (Biblioteca Virtual en Salud, BVS) has been set up in Spain. This network includes several bibliographical databases that are maintained by the countries producing them. In the case of Spain the Spanish Bibliographical Health Science Index (Índice Bibliográfico Español en Ciencias de la Salud, IBECS) which is developed by the National Library of Health Sciences, has been included. This database includes information on the scientific and technical production in Health Sciences that has appeared in Spain.

All these databases gather a great deal of information and have been designed to be used by information professionals. Although the NLM has recently launched with great success the free version of its Medline database, Pubmed, it cannot be said that the inexpert user will obtain the best results from his/her bibliographical searches without basic instruction in the use of this tool.

The scarcity of bibliographical listings has been one of the reasons that have motivated us at our centre to create the MEDES (Medicina en Español) database described below.

DESIGN AND CREATION OF THE DATABASE

At the beginning, the need arose for organising the resources of the library in a systematised way in order to be able to know exactly the information available and also to be able to recover the information easily. To this end a database was elaborated for the exclusive use of the Medical Information Department, with a minimal bibliographical description, little more than a topographical catalogue, in Reference Manager, for the journals management constituting the collection of our service Spanish medical publications. However, little by little awareness has arisen of the need of a database creation, accessible to all potential internal clients, to comply with the double objective of keeping them informed as to medical publications appearing in Spain, and as a tool for the recovery of information.

The beginnings of this new project, the creation of a database strictly for a specific number of users, were confused, as initially the attempt was made to continue with the programme previously in use or its web page version, open to internal users. The project was also not conceived in its entirety, as the idea was to continue with a similar level of work and resources. It was soon observed that with this approach our set objective would not be reached. If more money and time were to be invested, the ideal thing to do would be to create a database accessible to the largest possible number of users later on. It was soon clear, that in order to tackle this project the database used up to then would have to be abandoned.

A team was created to analyse the situation and subsequent assessment of the viability of this project, which magnitude of starting a new database from scratch. Right from the beginning the decision was taken, that this new tool should be designed for the user. Once this analysis had been carried out, the documentary and computing requirements were established.

Requirements.-

	A list of the overall requirements was established as a starting point for the initiation of the design and administration of the database.

1.- Database access. The database should be accessible from the Intranet. Access by means of the Intranet was a basic requirement, since as has been mentioned, the Intranet offers great possibilities for the dissemination and accessibility of information in an institution. At the same time the choice of computer programme should allow us to increase the number of users when the decision is taken to move on to the following phase of the project. This is the opening of the consultation of the database from the Intranet to an Extranet, so that it can be consulted openly. The number of potential users who may consult the database at the same time must therefore be taken into account.

2.- Database fields. The database should have clear and well-defined fields, as it was to be consulted both by information professionals and by internal users little used to handling these tools. The following essential fields were therefore defined: authors, source, type of document, notes, summary, and keywords.

3.- Search system. Its search system must be based on Boolean algebra.

4.- Screens’ structure. Screens and results should be simple and clear. It was considered important that the search screens be simple and well structured so that the user can orientate himself/herself easily. Likewise, it was pointed out that the search result screens must structure the information in accordance with established criteria that make the reading of the results easier.

5,- Search modes. It should at least include the free and advanced search modes, thus offering various possibilities according to the experience of the user.

6.- Keywords. All the references will be indexed by keywords. These keywords should be unequivocal, full of meaning, and easy to understand. The programme chosen should allow the creation of a thesaurus or a list of keywords, both when introducing the references and on the various search screens. It is important for it to be powerful but easy to handle.

7.- References Content. The whole contents of the journals will be included. It was decided to do this together with an exhaustive compilation of Spanish scientific production, independently of the type of publication involved.

8.- Summaries. All the references include a summary by the author. It is a fact that the inclusion of summaries of the articles in a database increases its value as a documentary tool and gives more complete information. This was another important detail when searching for a programme suitable for designing the database. The summary fields occupy a lot of memory, so the programme should allow the storage of a large number of them (always thinking of the future of the project). At the same time, they must allow recovery by this field, which can be so important, especially for the user with little experience in documentary recovery.

9.- Accessibility and handling. It should offer easy access and easy handling. Both these and an attractive screen design are essential conditions. This last was one of the most decisive aspects influencing the software application to be chosen. The team had a very clear idea of the concepts to be included in the different search screens, since as has been mentioned, the database was designed with the final user always in mind. This final user, the health professional, does not use complex search screens or Boolean algebra.

10.- Name of the database. A short name, both easy to remember and descriptive, was sought. MEDES (Medicina en español) was the name chosen.

Selection of sources: titles, thesaurus, and publications

The journals were selected taking into account the most relevant titles concerning the therapeutic fields researched by the laboratory. The time limit set for the initiation of the database was the year 2001, as the idea was that the database should cover the most recent publication period. In keeping with this criterion, the updating frequency was established as monthly.

In the establishment of the documentary requirements, the most controversial aspects were those relating to thesaurus creation and authors’ summaries. We were aware of the fact that, as T. Tóth has pointed out, a good database is much more valuable if an accurate index is included together with an articles summary. After searching in vain for a medial thesaurus in Spanish to meet our needs, the decision was made to create an internal one. At first the keywords would be listed in order to establish subsequent relationships until a working thesaurus emerges.

As for the authors’ summaries, these were included without major problems since the database was only for internal use. However, whether a free-access version on the Internet should be possible, a licence was negotiated with the publishing houses whose journals are included, so that the summaries could be consulted on the open system.

      	MEDES has been conceived from the start as a reference database without direct access to the document. Thanks to the software used however, if in the future this should be considered necessary, a new access field to the web page of the journal where the complete text is to be found can always be included in each reference.

Choice and creation of the software

After the definition of the requirements, the next step is the search for a software application that can be adapted to these requirements. The distributors of various databases already on the market were contacted and some of these products were tested. None of them were found to be suitable for our needs, generally due to their failure to meet requirements such as the possibility of creating a thesaurus incorporated into the database or the number of users who can consult the database at the same time.

As no software application on the market could be adapted to our needs, the internal creation of such software began to be considered as the solution. In order to do this, contact was made with the systems department of the company, to whom the problem was explained and the requirements exposed. Finally, it was decided that the software should be created by the systems department itself based on an institutional software application (Oracle).

Once the software to support the database had been chosen, a work group was created, made up of Medical Information Department and Systems Department members, which defined point by point each of the fields of the database. It is not necessary to go any deeper, in the environment that concerns us, into the difficulties that communication between two departments of this kind may involve, as the purely documentary approach is generally at odds with the computing situation. However, the fact that this is an internal software application turned out to be a great advantage as a result was obtained that satisfied both departments.

Two different interfaces were created. One of these is for internal use for data registration and will be used only by documentalists to supply the database. The other is the recovery screen for the final user. The second screen was considered much more important functionally and aesthetically; it is partly responsible for the success of the database.

On the internal screen the most developed section was that concerning the list of keywords. This allows the creation of a controlled list, to which words can be incorporated and deleted, both individually and in groups, and the substitution and creation of synonyms which allow us, from the recuperation screen of the final user, to create relations of synonymy without the user realising it. Much work was also done on the authors’ field so that recovery is possible from the user’s screen, either by free search or from the index, as will be explained later. Finally, another important field was that of the summary, in which a generous maximum number of characters was established, so as to be able to introduce all kinds of summaries, and in which the summary can be copied from other places (web pages or databases) to make the analysis quicker. Care was also taken so as not to lose accents or symbols in this process.

MEDES: resultant screen for the final user

	After to test it, the user interface was prepared and we managed to adjust it to our initial project. In this way the search possibilities are simple search, advanced search, by journal title, and by incomplete reference, as is explained below.

Simple search

This is the simplest of all; what was proposed was an improvement on the display of the results. After introducing one or more words in the search box, the results appear grouped three by three, following these criteria: term(s) found in the title of the article and in the keyword; term(s) found in the author’s summary; term(s) found in authors.

If the user click on “see all” the complete list of the references obtained in the search can be seen.

The search does not distinguish between upper case and lower case letters or letters with accents from those without. If several words are placed in inverted commas it will search for exactly those terms and in the same order. Common words such as from, the, in, or those not contributing any information to the search will be eliminated.

Advanced search

This system allows a more specific search by limiting criteria. On this screen a term can be sought that only occurs in the title, in the author’s summary, and/or in the keyword by inserting it in “search criteria” A simultaneous search using these criteria is also possible.

If the user wishes to make the search by keywords, there are boxes to which the keywords can be added, after finding them in the existing list. There are several search boxes joined by Boolean operators for carrying out more complex searches.

To carry out a search by author there are two possibilities: the surname can be looked for directly in the corresponding box or it can be selected from the list of authors offered to the user.

Likewise, the search can be narrowed down by specifying the “type of publication” or the year.

Display of results

In both cases, if the user wishes to consult a complete reference, i.e. see the author’s summary and the keywords, he/she should click on the icon to the left of the reference or click on “select all” and then “see/print”. This option also permits the printing of the complete reference(s) desired.

If the user click on each of the authors of an article, all the publications by the same author included in MEDES can be recovered.

There is also the possibility of directly requesting the complete text of the article from the internal users. To do so, click on the icon to the left of each reference; the application will be generated automatically.

The user can also see the search strategy that has been followed if click on the icon in the upper left hand corner of the search screen, next to the total search result figure.

Search by journal

This search can be made by title or by thematic area. If the letter corresponding to the initial is clicked on, a list will appear showing all the MEDES journals beginning with this letter. You can click on the icon to the left of the desired title, the user will see the volumes and numbers of the years included in MEDES at that moment. If the user clicks on each number he/she will be able to recover all the references to the articles in that number.

Incomplete reference

This search mode is designed to recover a single reference if only a few data are known from it. By filling in the form that appears on the screen with the data available (it is not necessary to know them all), the complete reference can be recovered provided that the journal is included in MEDES.

Conclusions

	After many months of work, MEDES has became  operative. The results of all these efforts can be seen in this living tool, as a database must be continuously updated to make it more and more complete and accessible to users.

	This experience has been, in short, more positive than negative, although we are aware that the creation of this our creature means a commitment to our users with no time limit. As a living tool, it will continue to demand our continuous attention and vigilance.

	Our next stage is to convert the current keyword index into a complete thesaurus, which constitutes a new and fascinating professional challenge.