By Mark A. Schroeder, MD, Washington University
A hematology textbook weighs around 8 pounds, equivalent to lugging around a microscope. With the rapid expansion of Internet and Web-based databases for information and research, a hematology fellow no longer needs to carry around heavy textbooks for reference. However, an unrefined Web search can lead to thousands of results and misleading information. Thus, it is essential that one can rapidly access reliable, up-to-date, and evidence-based information in order to provide optimal treatment for our patients. Although we are all thankful for this rapid access to novel information, I would argue that in some sense it makes the current job of a hematology fellow much more daunting. With the exponential growth in scientific knowledge and its dissemination, it is ever more important to be on top of current treatment and research. The ability to perform a detailed and efficient search online for answers to clinical problems is an essential skill to master. But where do you start and what electronic resources can be trusted?
Find out what resources are available through your institution. Most academic programs will be associated with a university library that has group licensing for journals and online electronic reference texts.
The resources listed below are just some of the many available online resources; this is by no means an exhaustive list.
Where should you start when you are fielding an initial consultation? Resources useful for quick answers to clinical questions include the following:
ASH-SAP - Provides free access to registered fellows and is a general reference for all major hematologic diagnoses.
Hematology (ASH Education Program Book) - Published yearly by ASH, this is a searchable, general reference for up-to-date reviews of hematology topics presented at the annual meeting.
NCCN - The National Comprehensive Cancer Network provides treatment guidelines in PDF format for hematologic and solid malignancies as well as manuscripts at the end of the guidelines supporting and recognizing the strength of the recommendations.
National Cancer Institute (NCI): PDQ® - NCI’s Web site will serve as a reference for staging and prognostic information as well as treatment regimens for hematologic and solid malignancies.
ClinicalTrials.gov - If you are looking for clinical trial information for which your patient may be eligible, then this is the place to start.
Atlas of genes and cytogenetics - Provides a detailed reference to unravel what your patient’s cytogenetic results mean and to find out what genes may be involved with certain leukemias and lymphomas.
In addition, part of a hematologist’s job is to educate the patient about his or her disease. Even patients who are savvy enough to search the Internet may not be able to identify reputable sites from those providing unreliable information. The following sites offer quick, reliable references for your patients and provide guidance on how they can obtain additional information.
Get an extensive list of patient Web sites on ASH’s Web site. Unlike other organizations or even the NIH, ASH removes patient Web sites that do not remain current and accurate. All patient education information on this page is regularly vetted by ASH.
PDQ – NCI’s Comprehensive Cancer Database - NCI’s Web site provides patient handouts for hematologic malignancies.
Cancer.Net - The official patient information website of the American Society of Clinical Oncology (ASCO).
After you have found initial information on a patient case, you may want to search additional information on clinical trials or prepare for presentation of the case at Grand Rounds. The following are resources useful in preparing for talks/lectures and for general education:
ASH’s Hematology Library - Summarizes all the online resources provided by ASH, including the Education Program Book, ASH annual meeting abstracts, ASH-SAP, ASH Teaching Cases, and ASH Image Bank.
Cochrane Reviews - Too many phase II and III trials to sort through? Maybe someone has performed a meta-analysis and this is a good place to start.
PubMed - The national library of medicines search engine is the first line for evidence-based, peer reviewed literature searches. To become efficient with this search engine, you must learn MeSH or Medical entry Subject Headings. Start your search by clicking the "MeSH database search tab" on the left. This ensures that the terms you are using are the terms the database uses and will optimize your search. You can search for multiple MeSH terms and send them to the search box with the drop-down tab. If you still cannot narrow your search, try the limits tab.
ASCO - The official Web site of the American Society of Clinical Oncology includes information on education books and annual meeting presentations, summaries and abstracts.
Shortly after your first year of fellowship you will want to be keeping an eye out for jobs or granting opportunities. Check out the ASH Job Bank and the ASH Grants Clearinghouse.
If you still must carry around that cumbersome textbook, perhaps you can put it to better use by using it as a prop to prevent your laptop from burning your legs as you are efficiently surfing the internet for answers to your clinical questions.
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