Sources of Information in Tropical Medicine

APPENDIX

5

Sources of Information in Tropical Medicine TRUDIE LANG  |  LAURA MERSON

Summary Information is a vital driving force behind health sciences and the use and source of information in Tropical Medicine have important distinctions and special circumstances. Recent advances in technology, medicine and funding have rapidly increased the quantity and access to information with direct health benefits. But challenges remain in understanding the varied sources of information, in ascertaining quality among them and in ensuring access to those limited by resources and geography. Here, we provide comprehensive guidance on what sources of information are available, how to seek the most relevant information and how to judge quality and credibility. We will also discuss how information can be most effectively used and shared. Media has evolved far from the papyrus and hieroglyphics of historical medical practitioners and scholars. Different types of media lend themselves to varied purposes, such as patient education, health worker training, dissemination of research findings and influencing government and international bodies to change and improve healthcare policies. We examine who needs access to information within the field of tropical medicine, what type of information they need and for what roles and purposes and describe different types of information used in this field and their relative merits and limitations. We describe the most reliable mediums available in tropical medicine and give advice on how to determine quality between them. A large proportion of this section will focus on using digital technology and how it might be harnessed to enhance progress in tropical medicine. Finally, recommended sources of information are included, with more online.

Introduction: Why Information is Important The generation and distribution of information and the sharing and implementation of knowledge has always been of significant consequence in health sciences. This is especially true throughout the history of tropical medicine due to geography and the limitations that are brought about by different people interested in the same disease or health issue being located thousands of kilometers apart. Early Egyptian, Greek and Roman scholars developed rudimentary papyri records of apparent emergent new diseases documenting the characteristics of disease and suggested remedies. Later in the 1800s the founders of what we know as ‘tropical medicine’ were concerned with understanding illnesses that were not encountered in the northern hemisphere. In these

times, transferring information between researchers in far regions of the globe in order to understand, manage and treat illness was slow and cumbersome. Characterization and peer consensus building on identification and then later treatment and prevention of specific disease or health issues, such as snakebites, took literally decades. Theoretically now, in the twenty-first century, we can do all this in real-time, in vast groups – at the click of a button. It might seem as though we do not need to concern ourselves too much with information in our field of tropical medicine. Surely it is all straightforward these days with access to scientific papers and educational materials being universal and easy? Furthermore, we are over a century out of the times when we did not understand malaria, leprosy, dengue and other common foes, or know how to treat and manage them. But this is true only to a limited extent. There are important gaps in the understanding of each of these diseases and continued research including vaccinology, diagnosis, treatment, and genetics will fill some gaps and identify new ones. For some diseases, especially neglected tropical diseases, the gaps far outweigh the knowledge. Moreover, we are in an era of larger and higherdensity populations with increased mobility and access to global travel, therefore more rapid spread of disease and increased risk of epidemics and pandemics. Any new or emergent disease 100 years ago might have remained contained by geography. This however, is no longer the case. Today, our ability to combat the challenges that modern tropical medicine faces will depend in no small way on our willingness and capacity to rapidly share and exchange information and use novel mechanisms and technology to achieve this. We will also benefit from a change of attitudes and behaviour in the way we store, share, capture and use information.

What Information is Needed and What are the Challenges to Access? The large diversity in scientific disciplines, diseases, pathogens and geography within the field of tropical medicine calls for complex and wide-ranging information needs from varied stakeholders. Patients, healthcare workers, researchers, educators, governments, non-government and inter-government organizations, private sector and media all require rapid access to reliable and relevant resources. The availability of information has seen a sharp increase over the past couple of decades as a result of globalization, economic development and advances in technology. However, both the supply and the understanding of the potential of rapid access and information sharing, still lag the needs of 1273

1274

APPENDIX 5

players in the health arena. The following takes a look at the scope of information needs and some of the challenges of meeting those needs. INFORMATION ACCESS FOR INDIVIDUALS Populations within the tropical zone, for whom information on risks, prevention, diagnosis and management of tropical disease is vital, are among the fastest growing populations in the world; but diseases within the ‘tropical’ classification are no longer confined by latitudes. Effects of international travel, climate change, migration, drug resistance and changes in land use have dissolved geographic and cultural barriers to this multidisciplinary and diverse field. The information needs at the level of the individual are increasingly challenging to deliver as the number, diversity and geography of these users continues to increase. But providing access to information and access to informed health providers is a necessary foundation for improving health. Delivering information to communities through effective health education programmes is essential to promote prevention and appropriate health seeking behaviour. Motivating the adoption of interventions such as bed nets, sanitation and condoms relies on effective transmission of information about the risks of the diseases the interventions prevent. Communities also require education on the identification of signs, symptoms and severity of disease in order to inform decisions on selftreatment and when to seek a health professional. Key areas of high mortality, such as maternal and early infant death require focused community education programmes in order to encourage mothers to seek trained birth attendants or deliver their babies in government clinics. Giving communities access to this information is an effective approach to reducing morbidity and mortality because individuals become engaged and empowered to make educated decisions about their health. To make efficient use of community health education resources, the message must be culturally appropriate and targeted to the correct user. It must also reflect the economic context of the community as the availability of resources will determine the individual’s ability to use the information. The onus of delivering this information is on governments and in some cases, is supported by non-government and/or inter-government organizations. Investing in overcoming the geographic, cultural and language obstacles to effective delivery of health information to the communities that need it will provide returns of a healthier and more productive society. For much of the world’s population, the primary source of reliable health information is a healthcare provider. Implicit in access to an informed health provider is the assurance that recent and reliable information is available to that provider. Up-to-date research publications, health policies, diagnostic tools and treatment guidelines are necessary for doctors, nurses, clinical officers, midwives and pharmacists to make informed decisions and give good advice. Outbreak reports and current incidence data must reach emergency rooms, laboratories, pharmacies and care facilities rapidly to inform the response of the health workers who will encounter them and allow for resource planning. Existing real-time information dissemination networks must overcome technology and language barriers to deliver urgent information to a larger community. Training and continuing education should be made accessible to multidisciplinary health fields so that individuals can update their

knowledge with current resources. The potential for digital technology to be harnessed effectively in the area is tremendous and as yet, largely untapped. Concerted efforts to address this could bring more significant healthcare changes in developing countries than have been seen in recent history. The largest supplier of medical information to healthcare providers and the lay public is industry. There are ubiquitous sources of sensationalized, unreliable and profit-driven information available from media and marketers including pandemic panic campaigns, pharmaceutical marketing and advertisements for products including infant formula and cigarettes. These messages may complement or contradict health promotion and should be synergized or challenged by public health campaigns and education. Tipping the supply of new information towards reliable evidence-based knowledge is the charge of educational institutions and the academic community. INFORMATION FOR EDUCATIONAL, PROFESSIONAL AND ACADEMIC INSTITUTIONS Academic, health and professional institutions are responsible for generating and disseminating much of the world’s new scientific information. They are additionally the organizations that deliver primary and continuing health education to healthcare professionals. Digested information is distributed in many formats ready for implementation, including lectures and training courses, reports, guidelines, websites and presentations. But the most extensive supply of reliable undigested information is research results published in scientific journals. Access to these publications is essential for healthcare providers, but also essential between institutions to feed the cascade of scientific discovery. Lack of information can lead to duplication of studies and poorly planned or executed research, and therefore inadequate research conclusions. A strong global foundation of scientific literature requires contribution from researchers in developing and developed countries, robust peer review systems and access for all. The recent open-access trend in health research publication has increased the availability of quality information to many individuals and institutions that require it. But there is progress still to be made as the number of journals that are open access remain limited and the ability to access them is strongly divided by the limitations of internet access in general. The gap in ability to exchange information that exists between resource-rich and resource-limited settings is further widened by this unequal access. The information supply from resource-limited settings may be restricted by the requirement for authors, their institutions or funding bodies to cover the cost of publication. However, some journals waive publication fees for developing countries and reliable internet access continues to expand through technology and investment. As these improvements increase the availability of information, there is hope that the open access movement will expand further to include protocols, data collection tools and datasets on which the publications are based. INFORMATION FOR GOVERNMENTS, NON-GOVERNMENT AND INTER-GOVERNMENT ORGANIZATIONS The planning and delivery of health care, health policy and health governance is the responsibility of governments.

Non-government and inter-government organizations often support these efforts in degrees inversely correlated to the level of national development. In order to know what to deliver, these groups require access to high quality health statistics, which address the unique epidemiology and health-systems of the nation. In order to expedite the response to outbreaks and epidemics, governments require real-time data on disease incidence, diagnostic capacity and trends in drug sales. Availability of health economic data is necessary to develop treatment guidelines, plan budgets and funding, focus advocacy and allow rationalization of services. Collection of core epidemiological data and health indicators is key to strategic planning of logistics, provision and utilization management of healthcare services and to create the public information campaigns discussed above. And finally, evaluation of healthcare outcomes and the impact of health policy are imperative to improve the systems in place and provide better quality care with greater access. The challenges to health system improvements are many, and include the difficulties in collecting and analysing reliable information to inform decisions. The collection of reliable data is limited by political instability and availability of resources such as diagnostics, communication infrastructure and skilled healthcare workers. Data comparison is compromised by differences in collection methods, terminology and classifications, statistical methods and population coverage. There is an urgent need to address the reporting gaps, so that reliable health indicators can be analysed to determine effective health interventions. The global relevance of tropical medicine is increasing and unprecedented volumes of information are now available to meet the needs of individuals, institutions and governments. But large gaps remain in the effort to improve the quality and maximize the health benefits derived from that information. Addressing the barriers to transmission and uptake of information will empower individuals to make informed decisions about health. Removing geographic, technology and resource barriers will cause a cycle of positive feedback within the research community and fuel the generation of further research. Harmonizing international data collection through standardization and a systematic approach to coordination will allow for the design of health policy with the greatest possible benefit. Making this information readily available will promote the evaluation and development of those policies. Information is fundamental to decisions that improve health.

Types of Information Relevant and Important to Tropical Medicine The scale of relevant information ranges from a single case report to global trends in pharmaceutical trade. This information is increasingly abundant and rapidly distributed in diverse and vociferous forms of variable quality. It is important for individuals at all levels of health engagement to have access to, and be able to identify reliable and relevant resources. In tropical medicine, information takes many forms and can be obtained from varied sources between the main mediums of print and digital form. This section describes the main forms of information that are of most benefit to tropical medicine practitioners and researchers and considers the benefits and limitations of each in the context of tropical medicine.

Sources of Information in Tropical Medicine

1275

PEER-REVIEWED BIOMEDICAL PAPERS PUBLISHED IN JOURNALS There are specialized yet cross-cutting journals dedicated to tropical medicine, such as the Transactions of The Royal Society of Tropical Medicine and Hygiene and the American Journal of Tropical Medicine and Hygiene. Other journals have specific titles that focus more on diseases of poverty, neglected disease or one specific tropical disease such as malaria. Others have a focus that is very relevant to tropical medicine, such as parasitology or infectious disease. The broad interest high impact medical journals such as The Lancet, BMJ and Nature also publish papers within the tropical medicine field as all have a strong interest in global health and neglected diseases. The most widely used search resource for medical journal papers and books is PubMed (see: www.ncbi.nlm.nih.gov/pubmed/), which accesses MEDLINE, the vast bibliographic database of the US National Library of Medicine. Implicit hierarchy exists among journals, often based on perceived quality of peer review (including rejection rates) and coverage by popular databases, which enhances international visibility. Impact factor, an indicator of the annual number of citations a journal receives per article has become de facto status symbol for scientific journals despite popular dispute. Impact factor is assigned to all journals listed on the Institute for Scientific Information Web of Knowledge citation databases (Thompson Reuters, see: apps.webofknowledge.com), but neglects valuable regional journals covered by PubMed. Advances in journal publishing have emulated the electronic communication revolution. Advantages of online publishing include decreased length restrictions, the possibility of multimedia inclusion, reduced publishing time and the ability to link directly to references and related editorials. Electronic publishing has also made open access publishing possible due to the elimination of manufacturing and shipping costs of paper journals. Such access is free and unrestricted to all internet users. Some journals, such as the Public Library of Science group (PloS) and Bio Medicine Central are entirely open access. Other journals have certain papers designated as open access or allow the authors to pay a fee to make access open to all. Open access publishing shifts the cost of publication to the authors and in spite of reduced fees for low and middle income countries, it may limit publication access in these media. To improve access to subscription-based journals, the World Health Organization has set up Hinari (see: www.who.int/ hinari), a program supported by many publishers to enable no or low-cost access to medical literature in developing countries. Institutions in more than 100 countries and territories can register to access more than 7500 journals and 8000 electronic books. Other organizations provide document delivery services in low income settings. BOOKS The rapidly increasing amount of information available free on the internet endangers the popularity of printed books, but the value and reliance placed on formal textbooks still forms a major part of the search for information. This source was once reliant on the resources available to the individual, institution and/or library, which are often limited in areas where tropical medicine is especially relevant. Two valuable initiatives working to address this deficit are worthy of mention here.

1276

APPENDIX 5

First, the World Health Organization distributes a standard collection of 150 essential health sciences books named ‘Blue Trunk Library’ in developing countries (see: www.who.int/ghl/ mobile_libraries/bluetrunk). Second, the shift to digital format for libraries allows subscription access to online editions of texts, often at a discount to the printed version or supported by mechanisms such as Hinari for institutions in developing countries. Online textbooks are a recent and welcome development, which overcomes the inherent challenge of information quickly becoming outdated in large volume printed texts whose subsequent editions may be published years apart. Some electronic versions of textbooks, e.g. the Oxford Textbook of Medicine, 5th edn., and the text you are currently reading, undergo systematic updates and addition of key developments by authors after publication. GREY LITERATURE Beyond the bibliographic databases and publisher’s lists lie additional sources of information critical to tropical medicine. Grey literature is a broad classification for works released outside of commercial publication, which covers vital resources including treatment guidelines, diagnostic tools, reports, technical and working papers, patents, conference proceedings and curriculum. The broad range of sources and topics included in this classification means that the materials cover a wide spectrum of find-ability and validity. An informed approach to these issues can yield some of the best resources on health statistics, healthcare delivery and policy development. Access to grey literature has been transformed by the internet. It has simultaneously reduced the relevance of find-ability and increased the importance of deciphering the validity of this material. What was previously buried within government, library and institutional repositories can now be found in abundance with a comprehensive internet search using a popular engine. Appropriate search strings can overcome the limitations imposed by the absence of standard bibliographic identifiers and irregular (or absent) publication schedules. But there is opportunity for libraries to contribute further to the accessibility and persistence of quality grey literature by identifying the most relevant works of academic quality from reliable sources and cataloguing them, or details of where to find them, within their collections. All major health players regularly publish and update collections of grey literature. Governments, inter-government organizations and recognized academic institutions and nongovernment organizations are good starting points for recent and locally relevant publications. When searching on popular topics, established experts can be prioritized, but when the focus is more obscure, it may be necessary to consider lesserknown sources. In this case, the vital step is in the discernment of reliability of the material.

How to Determine if Publications are Reliable With an abundance of available publications, it is important to be able to determine the quality of information presented. This is often done by reputation alone, but that limits perceived credibility to well-known publishers, journals and authors. There is an abundance of reliable new or lesser-known resources,

which are necessary to provide the full scope of tropical medicine literature. Easy targets for books are university libraries where dedicated staff select and review materials stock material determined to be a credible source. Basic markers of journal quality are robust peer review processes, impact factor of the journal and a listing on MEDLINE. This does not mean that every book in the library or article in a top paper is reliable. Publications do have errors, misinterpretations, omissions and bias. The best policy is to read all available information critically and compare it with other sources in a full literature review. This is ideal, but may not be realistic to pursue. When evaluating the quality of a publication you may consider if the publisher is reputable and when it was published. Has the information has been independently reviewed and are the authors known experts? What else have they published, who is the work is funded by and have authors declared any conflicts of interest? If it is a trial publication, methodological considerations need to be taken into account: was the trial registered on an international registry before recruitment began and does the reporting match the registered methods and analysis? Does the reporting format fit international standards such as STROBE (Statement for cohort, case–control and cross-sectional studies, available at: www .strobe-statement.org) or CONSORT (Statement for reporting clinical trials, available at: www.consort-statement.org)? When reading through, consider if there is a good background with relevant and reliable references. Also, do the authors discuss assumptions or statistical modelling used to generate results? Are the authors open about the limitations of their work? Is the information presented enough to allow you to determine if you agree with the authors’ conclusions – and do you? Literature on tropical medicine is spread through general and specialized sources, so it is necessary to look at both when searching. When searching for literature you may wish to avoid starting with one source, and spreading the scope of the search based on the references in that source, then further from the references in those sources. This can lead to a biased selection of results, as authors may not include references to all work that does not support their own. Instead, look for literature reviews published by recognized and respected authors and groups who have conducted systematic reviews of all available literature. The leading example of such a resource is the Cochrane Collaboration (see: cochrane.org) who has more than 4600 reviews available at no or low cost to many countries through funded provisions.

The Use and Potential of Digital Technology The internet has rapidly accelerated the ease and speed of information dissemination in a variety of formats, as detailed above. In the field of tropical medicine, the effect of such access is revolutionary due to the conquering of geographical barriers. But there remain limitations to access and a need to discern quality and other sources of information, which have yet to be exploited online. Accessing information digitally is going to be (and for many already is) the primary source for obtaining information. In medicine and medical research, the ability to access information via the internet has transformed the ability to gain knowledge by the immediateness and sheer quantity of information

available. From the perspective of tropical medicine, access to a fast internet connection is the key factor, because in many regions of the world, fast and reliable connectivity is still not yet a reality or still relatively new. In these areas, information is limited primarily to books and printed journals and is dependent on the quality or wealth of the library and the speed and expense of the postal service. However, this is changing rapidly and internet access is increasing in Africa, Asia and South America. People are increasingly using mobile phone networks to access the internet and ongoing infrastructure advances continue to rapidly improve access. One such example is the internet cable programme in Africa that was completed in South Africa in 2011. This huge length of cable now connects West Africa with Southern Africa, Eastern Africa and Europe. In many developed regions, the internet has been easily accessible for decades and it is now second nature to use facilities such as PubMed to access research papers and texts. Most universities and medical institutions in these regions have subscriptions that allow immediate access for staff and students, to a requested paper. This has made a dramatic impact on how medical personnel and researchers can access and apply current data and reports to their working practices. As developing countries improve access and speed of the internet, it is increasingly important that journals and/or funding agencies provide open access to journals, as the greatest barrier to access shifts from infrastructure to subscription costs. Formal information released on the websites of organizations such as the World Health Organization, The World Bank, Ministries of Health, funding bodies, Medical Research Councils and regulatory bodies (such as the US Food and Drug Administration or European Medicines Agency) are very important and these institutions use the internet as their primary source of releasing information. The great advantage of digital release of such information is that it can be kept current. Previously, the release of guidelines or recommendations via printed form, or even via CD-ROMS became outdated very quickly, and the danger was that these old versions remained on shelves and were referred to well beyond the time they remained relevant. Other very useful materials are those put up by organizations working in a specific field. This might be disease-specific or cross-cutting. These websites may be operated by University departments, medical research organizations or funders. The best of these provide resources and learning materials as well as links to other websites that they recommend. While the large volume of different websites might be overwhelming, there are some simple considerations that can help distinguish quality material from that which is less useful. Below, we provide some examples of the diverse and high quality resources that are available. In terms of establishing whether or not the material is of high quality, the following points are helpful to consider: • Who has set up the website? This may be obvious (e.g. the World Health Organization website) or you might need to look for an ‘about’ page. The latter is more typical if the website has been set up by a network or collaboration. Then, consider whether this is a respected group or organization. If the material comes from a network or collaboration it is often reassuring to see several partners and at least one or two from a reputable organization. If the website has been set up by an individual or a group of people, this may be less reliable. Authors should be listed

Sources of Information in Tropical Medicine

1277

on the materials they write, either by name or by organization. • Is the website of high quality? Does the website look credible and have those involved ensured that required statements on privacy and data are present as well as a terms and conditions policy? These statements are important and also give reassurance that the site is being responsibly managed and maintained. • Is the material moderated or reviewed? Consider the nature of the material; is it a discussion forum or a paper or similar written piece? Good websites will have a statement about how the material has been reviewed and or moderated. Discussion forums and blogs often allow users to post straight on the website, which is good practice provided those operating the website have a process for quality management and moderation. Also check for references. Information published as fact should be substantiated and the source of the information made available. • Is the material free and open access? Is feedback and contribution invited and encouraged? These elements are not necessarily a mark of quality and accuracy but as we will go on to explain, open access and interactive-type sites can be beneficial, as other users might have rated the material and this will help establish whether it will be of use and relevant to you. • Can you see how up-to-date the material and the overall site is? If articles are dated or if there are members or discussions, you can see how often material is updated and when others have recently contributed. This is a good way to see whether the site is current, up-to-date and being used by others. In many areas of modern life, the latest advances in digital technology are being applied. Most people are well aware of successful use of these types of website and good global examples are Facebook, LinkedIn and Amazon. These companies have successfully exploited the interactive elements to build communities and to determine what information the user is trying to find. The online social and professional networking sites work because they use digital technology to find people who know each other or share common interests, connect them together and allow people to share various types of media and communications in an instant. Commercial platforms like Amazon work by learning from users’ searching and browsing history. The Amazon website learns about its customers each time they visit and over time, builds up a comprehensive picture of the user’s interests. The fields of tropical medicine and global health should also exploit this digital technology and there is a vast potential gain to be had by doing so. Those working in tropical medicine are typically located in diverse areas and people working in the same field can be separated by thousands of miles. Resources are also limited for training and meetings because many tropical diseases are neglected or are rare diseases that attract limited commercial funding. In this environment, linking researchers together on the internet, rather that face-to-face would be valuable. People can meet and connect far more often than the limited opportunities they may or may not get to attend meetings or go on training courses. There are active initiatives on the use these highly interactive applications on websites to create professional communities throughout the world, in the field of tropical medicine. The aims of these platforms are to

1278

APPENDIX 5

share knowledge and methods and to support better practice and research via the open access to peers and knowledge. One example is The Global Health Network (see: www .theglobalhealthnetwork.org), which could be described as an online science park and it is striving to use the latest digital technology to support research in tropical medicine. It is a collection of websites located together on a digital ‘e-hub’ and those using any of the member websites can move between them to seek reliable information, methods and tools for research and practice. Websites such as The Global Health Network have taken cutting edge digital technology to create platforms that can link researchers and research groups with the shared aim of supporting research or improving practice. Within The Global Health Network, the many constituent websites each focus on their own topic but are located together on a shared hub, all built from the same digital template, to provide a familiar format for the user. The Global Health Network and its constituent websites have the shared ethos of supporting research, and aims to achieve this by increasing the opportunity and access for individual scientists and research groups to collaborate and by open sharing of knowledge, training and research methods. Each research community focuses on a specific therapeutic area (e.g. respiratory disease, reproductive health or oncology); type of research (e.g. diagnostics or microbiology); or are cross-cutting research support communities (e.g. clinical trials and research ethics). These types of communities are successful because they are built and led by researchers from these fields, who have built these sites because of their realization that there is a need for a space online where scientists can access each other to share knowledge, methods and tools, as well as to build collaborations and work on joint activities. These types of websites, including general sites such as Facebook and Amazon, as well as those specifically for working in tropical medicine and international health (see below for examples) are utilizing the second generation website technology. This is known as Web 2.0. Across the industrialized world, Web 2.0 communities are growing and leading change. The philosophy of Web 2.0 is about communities of practice and tacit knowledge sharing. Communities of practice are where people with a similar interest or need come together, and in the context of this discussion, these groups would come together online, to improve ‘practice’ in whatever area they share a common interest. Communities of practice explain to each other how to do something, often by sharing their experiences or solutions. In tropical medicine, the ethos of ‘community of practice’ has always been present however, the greatest limitation has been the cost of travel. The result has been that most efforts to share skills, resources and methods have been limited to better funded diseases, health issues, locations. Now a much greater impact may be made if there is greater sharing of knowledge between therapy areas and across varied regions. The combination of the Web 2.0 technology and the philosophy of community of practice make this possible. Community of practice is not about companies or organizations telling customers what they want, or large institutions setting guidelines and delivering downward cascades of dictated instruction. Using Web 2.0 technology to apply the philosophy of community of practice concerns those involved in an activity telling others how they did it and sharing their methods. This has only been harnessed as yet to a limited extent in tropical medicine but doing so fully could bring about

and speed up major advances in both treatment practices and research in resource-limited settings. This new way of learning and accessing knowledge and information may appear too informal and fraught with risks of unreliability and of being undisciplined. However, rigour and quality are achievable and these are largely obtained democratically and by the way in which people use these online platforms. Wikipedia was developed as an online encyclopaedia and the term ‘wiki’ is now in general use. A wiki is defined (on Wikipedia) as a website whose users can add, modify, or delete its content via the internet. A powerful wiki feature that could bring significant advances to tropical medicine if applied and taken up correctly, is that a wiki enables communities to write documents collaboratively. This could be used for developing new treatment guidelines perhaps, or for collaborative protocol writing. The concerns over the use of wiki’s in science and medicine are about quality and validity. Normally there is no prior review or modification before an entry to a wiki is posted live, and this could result in low quality submissions. Having users register and create a user account can mitigate this problem. Users who post using their real name and affiliation will be motivated to submit high quality entries as people’s reputations are involved. If others disagree with a post then they are able to comment and suggest corrections and modifications. Experience has shown that users do write high quality and valid comments on these types of professional sites because they are open and can be read by peers. Therefore, the concern that information found on these platforms is inferior due to the lack of traditional peer review is unfounded and conversely it could be claimed that if these sites are well-read then the quality of the review could be higher, as it is entirely open and democratic. Digital access to information then offers the tropical medicine practitioner, student or researcher an exciting, varied and expanding wealth of information. How this information is sought and used needs to be considered in terms of the quality of the website from which it was accessed. Determining whether material can be trusted is achievable by considering some straightforward points. The future for accessing knowledge and information will be increasingly dependent on the internet and so providing equitable access across the globe is becoming more important. It is not just a matter of countries having access to fast internet cables or satellite technology but the end-user, clinician, student or researcher having access to some form of screen that will determine true ability to use this powerful resource.

Where to Find Information This section aims to list and summarize varying types of information that is available and relevant in varying forms and how to find it. This is a generic summary and gives links and short summaries where possible about the nature and scope of the source. ONLINE SEARCH ENGINES, DATABASES AND PUBLIC ACCESS CATALOGUES There are several catalogues of literature available on the internet that are particularly relevant to tropical medicine practitioners and researchers. In order to use these, an understanding of

the structure and indexing of databases, while not critical, would be beneficial, alongside an understanding of various search strategies. Tutorials in how to use these databases are available. For example, see: www.nlm.nih.gov/bsd/disted/ pubmed.html Online public access catalogues (OPACs) are among the most common and highly accessed databases of information on tropical medicine. Most OPACs are for single libraries or institutions, such as those at universities. Some, however, are catalogues for national libraries, which often have large holdings. An index of national libraries, such as the British Library and the Library of Congress, is available via Wikipedia. Some OPACs are union catalogues covering more than one library, for example all of the libraries in a multi-university system or a consortium. Some excellent examples include: (a more extensive list is available in the electronic version of this text) ClinicalTrials.gov US National Institutes of Health. This online resource describes over 145 000 clinical studies in over 185 countries. This is useful for recruiting trials and complements Cochrane Library’s bibliography of (published) clinical trials – www.clinicaltrials.gov The Cochrane Library A major online resource (updated quarterly) for evidence-based medicine. Included is a database of over 7800 full-text systematic reviews, with an increasing number on infectious and tropical diseases; a database of abstracts of reviews of effectiveness; a comprehensive bibliography of clinical trials as well as a handbook on critical appraisal and the science of reviewing research – www.thecochranelibrary.com This is free to many developing countries via HINARI. For further details of the Cochrane Collaboration and its specialist groups (particularly the Infectious Diseases Group) – www.cochrane.org Global Health Network A network of health-related websites connected together on a shared digital hub, all aiming to support research – www.theglobalhealthnetwork.org Google Scholar Based on the popular Google search engine, Google Scholar indexes a substantial part of the scientific literature. It contains an internal mechanism for linking citations and is free. – www.scholar.google.com ITM Institute of Tropical Medicine, Antwerp, Belgium. One of the world’s leading institutes for training, research and services delivery in tropical medicine and health care in developing countries. It has a highly specialized library facility – www.itg.be PubMed National Library of Medicine, Bethesda MD, USA. A free database accessing the MEDLINE database of references and abstracts on life sciences and biomedical topics – www.pubmed.gov WHOLIS World Health Organization Library Information System An index of all WHO publications – http://dosei .who.int Wiley An academic and professional publisher with an extensive multidisciplinary collection of online resources covering life, health, social and physical sciences and humanities – www.wiley.com OPEN ACCESS MEDICAL LITERATURE A fundamental factor which affects information access is whether the material is freely available or has a cost. The following links provide access to medical literature that is free.

Sources of Information in Tropical Medicine

1279

Alternatively, several donor agencies finance access to medical journals and books. (a more extensive list is available in the electronic version of this text) BMC BioMed Central Publisher of over 250 open access journals – www.biomedcentral.com Google Books Excellent database of available texts, many with sections or full content available for preview or download – www.books.google.com HINARI Health Inter Network Access to Research Initiative Allowing free or low cost access for developing countries to major journals in biomedical and related social sciences – www.who.int/hinari/en INASP/PERI International Network for the Availability of Scientific Publications Program for the Enhancement of Research Information. Access to full text journals (incl. extensive bibliographic database information and document delivery) for not-for-profit institutes in developing countries – www.inasp.info/peri/ National Academies Press Created by the United States National Academy of Sciences, has over 4,000 books on science, engineering and medicine available free for download – www.nap.edu Open J-Gate Informatics (India) Ltd Promoting free and unrestricted access to scholarly and research journals – www.openj-gate.org PLOS Public Library of Science journals A collection of access journals, including ‘PLOS Neglected Tropical Diseases’ – www.plos.org PMC PubMed Central (US National Library of Medicine – National Institutes of Health) A free full text archive of biomedical and life sciences journal literature. Many long established high impact journals (as well as new journals, including the BMC series of online journals) offer their back-sets free – several stretching back many decades to their very first volume – but there is generally an embargo for the most recent issues – www.ncbi.nlm .nih.gov/pmc/ SciVerse ScienceDirect A leading full-text scientific database offering journal articles and book chapters from more than 2,500 peer-reviewed journals and more than 11,000 books – www.sciencedirect.com ONLINE ACCESS TO TREATMENT AND PRACTICE GUIDELINES Communities rely on their healthcare providers to have up-todate access to the current best practice and the latest guidelines, recommendations and treatment protocols. Here are some examples of guidelines that are available online and other sources of information where the latest recommendations or practices are made available. Several of these general tropical medicine-related websites (e.g. WHO) contain excellent information on individual diseases. Country specific treatment guidelines are often available on the websites of the country’s Ministry of Health or National Institute of Health. (additional links are available in the electronic version of this text) Agency for Healthcare Research and Quality, National Guideline Clearinghouse – www.ahrq.gov IDSA Infectious Disease Society of America – www .idsociety.org/IDSA_Practice_Guidelines WHO World Health Organization Guidelines– www.who .int/rpc/guidelines

Sources of Information in Tropical Medicine 1279.e1

African Index Medicus WHO Regional Office for Africa, Brazzaville, Congo. A free, online quarterly publication of medical references with selected abstracts from material published in and about Africa including journals, books, reports, theses etc. It also includes African medical journals not indexed in other abstracting/indexing journals – http://indexmedicus.afro.who.int AHILA Association for Health Information and Libraries in Africa and AIM African Index Medicus An index of African health literature and information sources – www.ahila.org

The British Library – www.bl.uk CAS Chemical Abstracts Service A division of the American Chemical Society, this is the world’s authority for chemical information with the objective to find, collect and organize all publicly disclosed substance information – www.cas.org Clinical Evidence An online compendium of what works in health care. It is a subscription database, but is free to developing countries through the HINARI. – www .clinicalevidence.com

1279.e2

APPENDIX 5

COPAC A merged online catalogue of university research libraries and specialist libraries – www.copac.ac.uk CRD Centre for Reviews and Dissemination Databases, University of York, UK. A production of three databases: Database of Abstracts of Reviews of Effects (DARE), NHS Economic Evaluation Database (NHS EED) and Health Technology Assessment Database (HTA Database). These are freely available from the CRD database website and as part of the Cochrane Library – www.crd.york.ac.uk/ crdweb/ Dialog An online search service, including a biomedical database – www.dialog.com DIMDI German Institute of Medical Documentation and Information An organization responsible for medical information, classification and management – www .dimdi.de

EbscoHost A leading database and eBook provider for libraries and other institutions catering to the information needs of researchers – www.ebscohost.com EMBASE A major (subscription-based) alternative to PubMed/MEDLINE, covering 5 million+ records as well as 2,000 biomedical journals not currently on MEDLINE. Especially strong in pharmacological information. EMBASE is the electronic edition of the extensive set of subject- specific Excerpta Medica bibliographic journals – www.info.embase.com Global Health CABI Publishing, Wallingford, UK. A subscription-based database for tropical medicine and parasitology – www.cabi.org

Sources of Information in Tropical Medicine 1279.e3

Global Health Trials An online resource to support the design, conduct and operation of clinical trials – www.globalhealthtrials.org

1279.e4

APPENDIX 5

IDS Institute of Development Studies University of Sussex, UK. A useful series of databases on development issues, many of which contain information on interdisciplinary aspects of health in the developing world. This is a free online database – www.ids.ac.uk In particular, see ELDIS – www.eldis.org and ID21 www.eldis.org/id21ext/

ISI Web of Knowledge A subscription-based multidisciplinary science database that identifies which articles have been cited most frequently, and who has cited them – www.isiwebofknowledge.com

Sources of Information in Tropical Medicine 1279.e5

Libdex A worldwide index of libraries, library catalogues and books – www.libdex.com Library of Congress Online Catalogue – http://catalog .loc.gov LILACS Latin American and Caribbean Literature on Health Sciences (BIREME), São Paulo, Brazil. A free online resource that includes references from the region’s medical and health journals, theses, books, conferences and governmental publications. The database is essential for Latin American literature not indexed elsewhere. The BIREME server also contains a number of additional databases on Latin American health topics – www.bireme.br NISC African Healthline, South Africa. An online collection of bibliographic databases covering all aspects of African health issues – www.nisc.co.za

Ovid Technologies, Inc Provides online access to bibliographic databases and journals – www.ovid.com Popline Population Information Program Johns Hopkins School of Public Health, Baltimore, MD, USA. An important online database on reproductive health with excellent coverage of AIDS and other STDs, and maternal and child health in the developing world, including references from books, articles and technical reports. It also includes much unpublished material and grey literature from nongovernmental organizations active in the developing world. Available free on the internet and by mail to developing countries – www.popline.org or Popline Digital Services, 111 Market Place, Suite 310, Baltimore, MD 21202, USA.

1279.e6

APPENDIX 5

SATELLIFE Makes medical information resources available to health professionals in low-income countries through a global network called HealthNet – www.healthnet.org SciVerse Scopus Subscription-based database combining peer-reviewed journals, conference proceedings, book series, abstract records, patents and web sources. Also features extensive citation linking with hundreds of millions of references – http://www.info.scopus.com Source The International Online Resource Centre on Disability and Inclusion. Useful free database providing access to books, articles, reports and training manuals, focusing on the management and practice of primary health care and disability in developing countries. It includes much material published in developing countries that is not available in other databases – www.asksource.info STN International An online scientific and technical information service dedicated to meeting the information needs of scientists – http://stnweb.cas.org TRIP Database Searches many high-quality medical information sites, giving direct, hyperlinked access to the largest collection of evidence-based material on the web, including elements of the Cochrane Library, such as the systematic reviews and abstracts of reviews of effectiveness and Clinical Evidence, as well as articles from premier online journals. This is useful if access to the Cochrane Library is not available – www.tripdatabase.com

Tropical Diseases Web Ring A free service dedicated to linking tropical diseases resources – http://myweb.tiscali .co.uk/tropring/ringform.html WHO Global Database on Child Growth and Malnutrition Online compilation of child growth and malnutrition data from nutritional surveys conducted around the world since 1960 – www.who.int/nutgrowthdb WHO Reproductive Health Library A collection of the best evidence-based research in reproductive health, including the full text of all relevant Cochrane reviews as well as other assessed articles. Practical advice is also available on implementing best evidence into practice – www .who.int/rhl

Sources of Information in Tropical Medicine 1279.e7

AJOL African Journals Online in association with INASP International Network for the Availability of Scientific Publications. An online service to provide access to African–published research. Access to over 300 African scientific journals; no free full text, but a document delivery service is provided – www.ajol.info

1279.e8

APPENDIX 5

CINAHL Cumulative Index to Nursing and Allied Health Literature This research database provides full text for hundreds of nursing and allied health journals indexed in the CINAHL database – www.ebscohost.com/cinahl/ DOAJ Directory of Open Access Journals Lund University Libraries. A portal to thousands of free, full text, quality controlled scholarly and scientific journals covering a range of subjects and languages – http://www.doaj.org

FreeBooks4Doctors.com – Promoting free access to medical books – http://www.freebooks4doctors.com FreeMedicalJournals.com The Amedeo Group offers over 3,700 free journals; with a useful and free update service, i.e. subscribers receive weekly e-mail notifications about newly published articles on selected topics – www .freemedicaljournals.com

1280

APPENDIX 5

WHO World Health Organization Health Topics – http:// www.who.int/topics WHO TDR Special Programme for Research and Training in Tropical Diseases – www.who.int/tdr ONLINE LEARNING, E-SEMINARS AND INTERACTIVE MECHANISMS FOR GAINING KNOWLEDGE AND INFORMATION In addition to resources such as journals, books, guidelines and reports, there is also an increasing amount of interactive teaching, learning and knowledge resources. Many are free and are very useful mechanisms for increasing knowledge and skills – especially in regions or situations where access to training and learning is limited by geography or access to funding. (a more extensive list is available in the electronic version of this text) Medicus Mundi A list of postgraduate training programs in international health – www.healthtraining.org Institute of Tropical Medicine (ITM), Antwerp, Belgium Illustrated Lecture Notes on Tropical Medicine. The English edition is freely available from this website; English and Spanish editions can be obtained on CD-ROM at a low price. Mail to: [email protected] – www.itg.be/ILNtropmed/ KABISA Interactive Training Software A computer-based training tool for diagnostic skills in tropical and subtropical medicine. Available in eight languages and three levels of competency. Free download or CD-ROM available – www.kabisa.be TALC Teaching Aids at Low Cost Slide sets and books for sale at low cost, as well as a series of free CD-ROMs containing teaching materials, articles and other full-text information. PO Box 49, St Albans, Herts AL1 5TX, UK – www.talcuk.org Wellcome Trust Topics in International Health, London (now distributed by TALC, see above). A CD-ROM series each containing interactive tutorials, hundreds of photographic images and a glossary of terms: Acute Respiratory Infection; Dengue; Diarrhoeal Diseases; HIV/AIDS; Human African Trypanosomiasis; Leishmaniasis; Leprosy; Malaria; Nutrition; Schistosomiasis; Sexually Transmitted Infections; Sickle Cell Disease; Trachoma; Tuberculosis. Prices discounted for individuals and users from developing countries – www.wellcome.ac.uk DISEASE OUTBREAK AND EPIDEMIOLOGY INFORMATION Up-to-date information on disease outbreaks, epidemics and general disease epidemiology data is of great importance to tropical medicine. The following is a list of organizations or sources where information in this area can be accessed: (additional links are available in the electronic version of this text) GAR Global Alert and Response (WHO) An integrated global alert and response system for epidemics and other public health emergencies based on strong national public health systems and capacity and an effective international system for coordinated response – www.who.int/csr ProMed Program for Monitoring Emerging Diseases An internet-based reporting system dedicated to rapid global dissemination of information on outbreaks of

infectious diseases and acute exposures to toxins – www.promedmail.org WHO Weekly Epidemiological Record – www.who.int/wer/ WHO The Global Health Atlas Giving statistics on infectious diseases – http://apps.who.int/globalatlas Also see DengueNet and FluNet via links on this site ONLINE RESEARCH AND PUBLIC HEALTH COMMUNITIES There are an increasing number of online platforms being set up to enable researchers and health practitioners in tropical medicine to establish professional networks and online communities. The aim of these digital communities is broadly to facilitate collaboration and the sharing of knowledge. The following are some examples of established online scientific communities in the field of tropical medicine: Afro-NETS African Networks for Health Research and Development – www.afronets.org E-DRUG An electronic discussion group on essential drugs – www.essentialdrugs.org The Global Health Network This network operates like an online science park and is a collection of varied collaborations and projects – each aiming to support and enhance research in Global Health via the sharing of knowledge and methods – www.theglobalhealthnetwork.org HIFA Health Information for All by 2015 Established to progressively meet the information needs of all healthcare providers, HIFA hosts five online discussion networks linking health professionals, publishers, policy-makers, researchers, librarians, information professionals and citizen representatives. Focus on health students, nurses and midwives, mothers and care givers, community health workers – www.hifa2015.org HRWEb A web-based, interactive platform aimed at improving health, equity and development through research. Particularly aimed at research focusing on improving health in low- and middle-income countries and populations, but it will be useful to high income countries as well – www.healthresearchweb.org ORGANIZATIONS AND INSTITUTIONS WORKING IN TROPICAL MEDICINE Various organizations are highly influential in the field of tropical medicine through their roles as funders, regulators, educators or in research. These organizations can be valuable sources of information. This could be in the form of their own reports and guidance materials, or as publications or recommendations. A sample of organizations is listed below. (a more extensive list is available in the electronic version of this text) Global Fund to Fight AIDS Tuberculosis and Malaria – www.theglobalfund.org MSF Médecins sans Frontières – www.msf.org TDR UNDP/UNICEF/World Bank/WHO Special Programme for Research and Training in Tropical Diseases – www.who.int/tdr UNAIDS Joint United Nations Program on HIV/AIDS – www.unaids.org WHO World Health Organization – www.who.int

Sources of Information in Tropical Medicine 1280.e1

Hardin MD Free Medical Journals A capability allowing for subject searches in free PubMed journals – www .lib.uiowa.edu/hardin/

HighWire Free Medical Journals Stanford University. Over 2,250,000 free full-text articles – www.highwire.stanford .edu/lists/freeart.dtl

1280.e2

APPENDIX 5

MedicalStudent.com A digital library of authoritative medical information specifically geared towards medical students – www.medicalstudent.com

MSF Médecins sans Frontières, Doctors without Borders Publishes a collection of reference books freely available for download – www.refbooks.msf.org

Sources of Information in Tropical Medicine 1280.e3

OAIster An open archive union catalogue of over 25 million digital resources from over 1,100 contributors (also includes journal articles) – www.oaister.org

1280.e4

APPENDIX 5

SciELO Scientific Electronic Library Online (BIREME) A portal with over 900 Latin American open access journals – www.scielo.org

Sources of Information in Tropical Medicine 1280.e5

SpringerLink Provides access to millions of journals, books, protocols, series and reference works – www.springerlink .com

UNICEF Runs a distribution centre that mails out free printed copies of selected UNICEF publications – www.unicef.org/publications/index_freepubs.html

1280.e6

APPENDIX 5

CDC United States Center for Disease Control – www .cdc.gov

Sources of Information in Tropical Medicine 1280.e7

NICE United Kingdom National institute for Health Care Excellence – www.nice.org.uk

TropIKA Tropical Diseases Research to Foster Innovation and Knowledge Application – http://tropika.net

1280.e8

APPENDIX 5

DPDx Laboratory Identification of Parasites of Public Health Concern A website developed and maintained by the Division of Parasitic Diseases and Malaria (DPDM), an arm of the CDC. Offering reference and training facilities anad diagnostic assistance most of the information is available free online – www.dpd.cdc.gov/

Global Health Trials: e-learning Centre A set of courses and learning material to support the design and operation of clinical trials – http://globalhealthtrials.tghn.org/ elearning/

Sources of Information in Tropical Medicine 1280.e9

DermIS Dermatology Information Service Access to image atlases complete with diagnoses and differential diagnoses, case reports and additional information on almost all skin diseases – www.dermis.net

GIDEON Global Infectious Disease and Epidemiology Network Online subscription-based knowledge management tool that helps you diagnose infectious diseases and stay up to date on the latest trends in epidemiology and treatment – www.gideononline.com

1280.e10

APPENDIX 5

TRREE Aims to provide basic training, while building capacities, on the ethics of health research involving humans so that research meets highest standards of ethics and promotes the welfare of participants – www.elearning.trree.org

Sources of Information in Tropical Medicine 1280.e11

WHO Special Programme for Research and Training in Tropical Diseases (TDR) Image Library. Thousands of mages and videos available on the TDR website and by CD-ROM – www.who.int/tdr

WHO Regional and Other Offices – www.who.int/regions Organizations providing funding opportunities in tropical medicine: Bill and Melinda Gates Foundation – www.gatesfoundation .org Foundation Center – www.fdncenter.org/funders GrantsNet – www.grantsnet.org Wellcome Trust – www.wellcome.ac.uk WHO TDR Grants – www.who.int/tdr/grants KEEPING UP-TO-DATE: USING INFORMATION FEEDS Many organizations that provide information operate digital information feed services. These can be very helpful in ensuring access and awareness of the latest relevant information. Setting up alerts that are sent to you via e-mail, or that you can read as personalized alerts on websites, is a sophisticated and intelligent way to sort through the immense and seemingly endless amount of information, to ensure you are aware of important developments in your field. A common example is ‘really simple syndication’ (RSS) feeds. RSS feeds are software programs that regularly aggregate the latest information on set topics (usually identified by tags) and make it available for access via web pages. Another example is eTOCs. These are simply an electronic table of contents that can be e-mailed to subscribers and can be set up to include or exclude specific areas or topics. Simple e-mail alerts can also be a useful mechanism for being made aware of new information and being able to sort and screen the nature of these notifications. In this era of ever increasing digital information, the use of information feeds is recommended and is

Sources of Information in Tropical Medicine

1281

likely to become more sophisticated. Feeds are available from many of the sources listed above.

Conclusion Sources of information in tropical medicine are highly dynamic within a rapidly changing scientific environment. Much of the information suggested here are digital and therefore able and likely to change often compared with printed material. The links given are current at the point of publication but may change and, while every effort has been made to give a broad and representative list of information sources, it certainly will have omissions. With the rapid uptake and lowering access costs, internet access to information should become faster and easier. A major factor in tropical medicine for seeking information will be the availability of fast internet connection and access to a computer, smart phone, tablet – or future hardware. If costs continue to fall, relative to the cost of living, then this will make specialist and high quality tropical medicine information more widely accessible to healthcare workers and research staff, which will be of great benefit to public health. A significant change in access and availability of information in tropical medicine would come if more data, methods and knowledge were to be made free and open access to all online. If protocols, operating procedures, data and methods were more widely shared then research and standards would be raised and practitioners would have better access to evidence and guidelines. Information is a vital driving force behind health sciences. It is important to ensure access to information in the settings where it is most critical.

Sources of Information in Tropical Medicine 1281.e1

ENIVD European Network for Diagnosis of Imported Viral Diseases An exchange of information for the improvement of diagnostics for imported viral diseases – www.enivd.de

Eurosurveillance A weekly open access free online journal devoted to the epidemiology, surveillance, prevention and control of communicable diseases –www.eurosurveillance .org

1281.e2

APPENDIX 5

GeoSentinel The Global Surveillance Network of the International Society of Travel Medicine and Centers for Disease Control involved in monitoring all travel related illnesses – www.istm.org/geosentinel/main Globalhealthfacts.org Global data on HIV/AIDS, TB, Malaria and more – http://globalhealthfacts.org

Measure DHS Demographic and Health Surveys – www .measuredhs.com MMR Morbidity and Mortality Weekly Report of the Centers for Disease Control – www.cdc.gov/mmwr

Sources of Information in Tropical Medicine 1281.e3

American Society of Tropical Medicine and Hygiene – www.astmh.org CDC Centers for Disease Control – www.cdc.gov COHRED Council on Health Research for Development Commission for Africa – www.cohred.ch

FAO Food and Agriculture Organization of the United Nations – www.fao.org

1281.e4

APPENDIX 5

International Federation of Red Cross and Red Crescent Societies – www.ifrc.org

International Society of Travel Medicine – www.istm.org

Sources of Information in Tropical Medicine 1281.e5

Royal Society of Tropical Medicine and Hygiene – www .rstmh.org

1281.e6

APPENDIX 5

UNICEF United Nations Children’s Fund – www.unicef.org World Bank The International Bank for Reconstruction and Development (IBRD) and the International Development Association (IDA) – www.worldbank.org

Sources of Information in Tropical Medicine 1281.e7

DFID United Kingdom Department for International Development – www.gov.uk/dfid FIC Fogarty International Center – www.fic.nih.gov

1281.e8

APPENDIX 5

USAID United Stated Agency for International Development– www.usaid.gov