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					     Nutrition
          for children with
          special health care needs
Volume 22, No. 1
                                                                      FOCUS                                          January/February 2007



Clicking Your Way to Nutrition
Resources on the Web
Janet G. Schnall, MS, AHIP                                                                                     Editor’s Note– Web sites
Information Management Librarian                                                                               have been underlined for
University of Washington Health Sciences Libraries                                                             easy identification.
Seattle, WA




INTRODUCTION                                     The Internet can be a valuable source         FOCUS provides steps to searches that you
   According to a recent Pew report, eight    of health information, but not all sites are     can perform while reading the newsletter.
out of ten Internet users are searching for   equally worthy or reliable. Information on       You also will find sources of reliable and
health information online, with an increas-   the web may be incomplete, inaccurate,           authoritative nutrition information and will
ing number (51%) interested in diet, nutri-   or overly simplified. The web lacks peer         learn how to obtain references and have
tion, vitamins or nutritional supplements.1   review or quality control; many sites are        selected types of research information sent
Registered dietitians and other health care   trying to sell a product and are biased or out   to you.
professionals need to search and evaluate     of date; and anyone can publish on the web
information on the web for their own pro-     whether they are an expert, or not.              EIGHT STEPS FOR WEB
fessional development as well as for the                                                       SEARCHES
guidance of their patients who use the web       So, how can you begin searching the
for nutrition-related information.            web for authoritative health and nutrition       STEP 1: SEARCH A DATABASE
                                              information? This edition of NUTRITION           TO FIND JOURNAL ARTICLES

                                                                                                  Search PubMed, pubmed.gov , the
                                                                                               National Library of Medicine’s premier
                                                                                               biomedical database of citations to journal
                                                                                               articles used by clinicians and researchers
                                                                                               worldwide, to find citations to articles on
                                                                                               nutrition. PubMed provides free access
                                                                                               to MEDLINE and other health-related
                                                                                               databases, with links to participating on-
                                                                                               line journals and other related databases
                                                                                               and web resources. It covers the fields of
                                                                                               medicine, nursing, dentistry, veterinary
                                                                                               medicine, health care systems, and preclini-
                                                                                               cal sciences. MEDLINE contains biblio-
                                                                                               graphic citations and author abstracts from
                                                                                               approximately 5,000 biomedical journals
                                                                                               published in the United States and world-
                                                                                               wide, with coverage extending back to
                                                                                               1950. Approximately 75% of the citations
                                                                                               in PubMed include abstracts.

     Figure 1 – Sample of PubMed Results with Limits Noted (see page 2)
center on human development and disability, university of washington, seattle, washington
To perform a basic search in PubMed:             outside of the State of Washington. Use          Library, containing bibliographic informa-
 • Enter the subject into the search box.        https://healthlinks.washington.edu/cgi-          tion for agricultural literature including
 • Click the Limits button to limit the          bin/docservices/pubmedreq.cgi to fill            many governmental child and adolescent
   search to English, human, a particular        out a form for Document Services, or the         nutrition publications and materials from
   age group, type of publication (such as       Loansome Doc feature of PubMed, which            associations, universities, and the private
   Review), etc.                                 allows you to order full-text articles from      sector. It is organized into two data sets
 • Click on the Go button.                       within the PubMed database. You may also         (books and journal articles).
                                                 check a list of free health-related electronic
                                                 journals at Free Medical Journals (13 on         . The Food and Nutrition Information
    Figure 1 (see page 1) is an example of a
                                                 nutrition) freemedicaljournals.com or            Center (FNIC) www.nal.usda.gov/fnic/
PubMed search on the topic of “nutrition
                                                 Highwire Press highwire. stanford.edu            databases.html maintains databases of
in children with chronic renal failure.”
                                                                                                  nutrition education materials including the
Entered in the search box are the key-
                                                 Open Access Journal Sites                        following six databases.
words: chronic renal failure child nutrition
                                                    Recently there has been pressure for
physiology. You will notice that the limits
                                                 publishers to provide access to articles          • Healthy School Meals Education and
(listed under the top bar) were for preschool
                                                 without cost, often with only a short time          Training Materials Database is a com-
children -5 years of age and children 6-1
                                                 delay after the article first appears. This is      pilation of educational materials devel-
years of age. The searcher also set limits on
                                                 known as the Open Access model. BioMed              oped by universities, private industry,
studies published only in English and only
                                                 Central biomedcentral.com is an indepen-            and government agencies for school
with human subjects. Limits help to narrow
                                                 dent publishing house providing immediate           personnel and others working in Child
a basic search.
                                                 free access to peer-reviewed biomedical             Nutrition Programs.
                                                 research, including the Nutrition Journal.
   For more detailed information on search-
                                                 PubMed Central pubmedcentral.gov is               • Food Stamp Nutrition Connection pro-
ing PubMed, including short demonstration
                                                 the National Library of Medicine’s free             vides reliable, credible resources cre-
video clips, see PubMed at the UW (Uni-
                                                 digital archive of biomedical and life              ated by Food Stamp nutrition educators,
versity of Washington). This site is avail-
                                                 sciences journal literature. Results of a           federal, state and local governments,
able to any reader. The site is healthlinks.
                                                 PubMed search that include icons with               organizations and businesses.
washington.edu/howto/pubmed
                                                 orange bands indicate those citations are
                                                 available full-text for free through PubMed
Obtaining the Journal Articles You                                                                 • WIC Databases can be used to locate
                                                 Central.
Find in PubMed                                                                                       books, brochures, kits, videos, posters,
   PubMed will often have a link out from                                                            etc. for staff training and/or participant
                                                    In addition, many nutrition journals
the journal citation to the full-text of the                                                         education. The materials listed are
                                                 provide free access to abstracts but require
article. If you click on the link (which is                                                          from government and non-government
                                                 paid subscriptions to full-text articles.
an image of the journal logo), you will be                                                           sources.
                                                 Examples are the American Journal of
directed to the journal publisher’s site and
                                                 Clinical Nutrition www.ajcn.org , Journal
can order the article for a fee, usually more
                                                 of Nutrition www.nutrition.org , Journal of       • International Bibliographic Informa-
than $15 per article. If you are associated
                                                 the American Dietetic Association www.              tion on Dietary Supplements Database
with a medical library, you can ascertain
                                                 adajournal.org and Nutrition Reviews                (IBIDS) ods.od.nih.gov/Health_In-
whether the journal is owned there elec-
                                                 www.ingentaconnect.com/content/ilsi/                formation/IBIDS.aspx provides access
tronically or in print, which then would
                                                 nure .                                              to bibliographic citations and abstracts
give you free access.
                                                                                                     from published, international, and
                                                 Additional Selected Databases                       scientific literature on dietary supple-
   Another option is to go to your public
                                                     There are many other databases to               ments. Choose to search the Full IBIDS
library and request an interlibrary loan of
                                                 search when looking for nutrition-related           Database, a subset of Consumer Cita-
the article, which is usually provided free-
                                                 articles. For example, if you are interested        tions Only, or Peer Reviewed Citations
of-charge. A final option is to check with
                                                 in citations and abstracts from the scien-          Only.
libraries at major education institutions.
                                                 tific literature on dietary supplements, the
For example, The Document Services
                                                 International Bibliographic Information           • Food Safety Research Project Database
department at the University of Washington
                                                 on Dietary Supplements Database (IBIDS)             provides users with information on re-
Health Sciences Libraries will also provide
                                                 would be a good start. Here are some                search projects through the cooperation
health-related articles for a fee that can be
                                                 databases to try:                                   of government agencies, educational
paid for with a credit card and requested
by phone, email, fax or online. This service                                                         institutions and other agencies.
                                                 1. AGRICOLA agricola.nal.usda.gov
can be utilized by individuals both inside and
                                                 is a service of the National Agricultural

Nutrition Focus Vol. 22 #1                                                                                       January/February 2007
 • Native American Nutrition Infor-               (ADA) defines Evidence-Based Dietetics                The second way to retrieve evidence-
   mation Database helps you find                 Practice as “the use of systematically reviewed   based citations is to use PubMed’s Clinical
   resources and information to assist            scientific evidence in making food and nutri-     Queries www.ncbi.nlm.nih.gov/entrez/
   with your nutrition education efforts          tion practice decisions by integrating best       query/static/clinical.shtml section, ac-
   with Native American audiences.                available evidence with professional expertise    cessed from the PubMed navigation bar on
                                                  and client values to improve outcomes”.3          the left side of the window under PubMed
3. Gene Tests g e n e c l i n i c s . o r g has                                                     Services. The first filter on the Clinical
current authoritative information on                 Key evidence based practice and guidelines     Queries page is Search By Clinical Study
genetic testing and its use in the diag-          resources include PubMed, the Cochrane            Category, a specialized search query with
nosis, management, and counseling of              Database of Systematic Reviews (fee based),       built-in research methodology search filters
individuals and families with inherited           the National Guideline Clearinghouse and the      intended to limit retrieval to research-based
disorders. It includes GeneReviews,               ADA’s Evidence Analysis Library.                  citations on clinical topics, e.g., randomized
expert-authored disease reviews, and                                                                controlled trials. Five study categories or
international directories of genetic test-          There are basically two good PubMed             filters are provided: etiology, diagnosis,
ing laboratories and genetics/prenatal            pubmed.gov strategies for retrieving evi-         therapy, prognosis, and clinical prediction
diagnosis clinics.                                dence-based citations. The first is to limit      guides along with two emphasis categories
                                                  your search to the type of article which limits   or filters: broad, sensitive search (includes
4. Health and Wellness Resource Center            your retrieval based on the type of material      relevant articles but probably some less
provides access to health information in          the article represents. Enter your terms in the   relevant) or a narrow, specific search (more
journals, newspapers, the Gale Encyclo-           Search box and then click on the Limit button.    precise articles, with less retrieval).
pedia of Medicine and the Alternative             The Type of Article checklist from the Limits
Health Encyclopedia. Check your local             screen contains a list of frequently searched        Just enter your topic in the Clinical Study
library for information. Some may be              publication types. See Figure . For example,     Category and/or in Systematic Reviews
able to provide these sources online with         use one or any of the following types to limit    to retrieve your evidence-based citations.
your library card.                                to evidence-based citations:                      Once you have executed a search in
                                                    • Randomized Controlled Trial                   PubMed Clinical Queries, the resulting
5. ProQuest includes mostly full-text               • Meta-Analysis                                 retrieval can then be further refined using
access to journal and newspaper articles.           • Practice Guideline                            PubMed’s Limits, e.g., English language.
It also may be available online through             • Clinical Trial
local library web sites.

  For a listing of other databases, see
Web Sites for Pediatric Nutritionists
healthlinks.washington.edu/hsl/liai-
sons/schnall/pediatricnutritionists.
pdf

STEP 2: SEARCH FOR
EVIDENCE
   Health professionals today want
to apply the scientific method to their
practice. What exactly is evidence-
based practice? The standard defini-
tion of evidence-based medicine is the
“conscientious, explicit, and judicious
use of current best evidence in making
decisions about the care of individual
patients. The practice of evidence based
medicine means integrating individual
clinical expertise with the best available
external clinical evidence from system-
atic research.”2

   More specifically for registered dieti-
tians, the American Dietetic Association                         Figure 2 – Example of PubMed Type of Article Limits
Nutrition Focus Vol. 22 #1                                                3                                          January/February 2007
    See Figure 3 for an example of a           English from the language list and humans.       guidelines, such as Nutrition Support for
PubMed Clinical Queries request.               Then click the Go button to the right of the     Neurologically Impaired Children and
Example: If you want to see research-          query box near the top of the window.            Overweight in Children and Adolescents:
based citations on the use of zinc to treat                                                     Pathophysiology, Consequences, Preven-
the common cold, enter your topic ‘zinc            The Cochrane Database of System-             tion, and Treatment.
common cold’ in the search box under the       atic Reviews (CDSR) cochrane.org is
Search by Clinical Study category. Since       a fee-based, full-text database containing          The ADA’s Evidence Analysis Library
you are interested in treatment, make sure     systematic reviews and protocols (reviews        (EAL) www.adaevidencelibrary.com is
the button to the left of the study category   still in progress) of the effects of health      a synthesis of the best available nutrition re-
‘therapy’ is selected. Then choose the         care interventions. A systematic review is       search on important dietetic practice ques-
emphasis of your search. The default is a      a literature review focusing on a question       tions. The EAL includes Bibliographies of
narrow, specific search. To run the search,    which tries to identify, appraise, select and    high quality research on a topic; Conclusion
click Go. Then click Limits and select         synthesize all high quality research relevant    Statements that provide concise statements
English and human. Results of the search       to that question. The CDSR reviews mainly        of the collective research on a question;
are now limited to research-based citations    randomized controlled trials and is the          Grades for each Conclusion Statement that
(randomized controlled trial studies) that     “Gold Standard” for finding high quality,        provide a way for practitioners to determine
are in English and concerning humans.          systematic reviews. An example of a nutri-       how certain is the Conclusion Statement,
                                               tion-related systematic review question or       based on the quality and extensiveness
   Also on the Clinical Queries page is        query in CDSR is Dietary Interventions           of the supporting evidence; and Evidence
Find Systematic Reviews (Figure 3), which      for Recurrent Abdominal Pain (RAP) in            Summaries, brief, narrative overviews that
help locate systematic reviews and similar     Children.                                        synthesize the major research findings on
articles. It combines your search term(s)                                                       a given topic. The EAL also provides Evi-
with citations identified as systematic re-       The National Guideline Clearing-              dence-based Guidelines, “systematically
views, meta-analyses, reviews of clinical      house www.guideline.gov is a free,               developed statements based on scientific
trials, evidence-based medicine, consensus     comprehensive database of evidence-based         evidence to assist practitioner and patient
development conferences, and guidelines.       clinical practice guidelines sponsored by        decisions about appropriate health care for
Example: To find systematic reviews and        the Agency for Healthcare Research and           specific clinical circumstances.”4 The ADA
similar articles on calcium supplementa-       Quality. Its mission is to provide health        is presently working on more guidelines,
tion, type ‘calcium supplementation’ in the    professionals with a mechanism to obtain         such as pediatric weight management,
query box in the Find Systematic Reviews       objective information on clinical practice       Diabetes Type 1 and , and nutrition in
section, and click the Go button. On the       guidelines. The database includes struc-         spinal cord injury. The EAL is available at
results screen, further restrict your search   tured abstracts, links to full-text guidelines   no cost to ADA members and is a quick way
to English language articles and hu-           when available, ordering information for         to keep up with the latest available research
man studies by clicking Limits under the       print copies, and a guideline comparison         in nutrition and dietetics.
query box on the Features Tab and choosing     utility. You can find nutrition related
                                                                                                STEP 3: KEEP CURRENT WITH
                                                                                                EMAIL ALERTS AND HEALTH
                                                                                                NEWS
                                                                                                   Information overload! It is estimated that
                                                                                                over two million articles are published in
                                                                                                biomedical journals every year.5 In order
                                                                                                to keep current on a topic, you can use an
                                                                                                email alert service. Email alert services
                                                                                                deliver current citations to your email based
                                                                                                on a search strategy you create. In most cases,
                                                                                                abstracts of the articles are provided.

                                                                                                   PubMed’s My NCBI is your free per-
                                                                                                sonal space on the NLM computer system
                                                                                                for storing search strategies you have
                                                                                                created in order to generate updates. For
                                                                                                example, if you are interested in keeping
                                                                                                up-to-date with recent articles on child
                                                                                                nutrition in developmental disorders, set up
   Figure 3– Example of PubMed Clinical Queries Limited by Clinical Study
                                                                                                your PubMed search, i.e., “child nutrition
                     Category or Systematic Reviews
Nutrition Focus Vol. 22 #1                                          4                                             January/February 2007
                                                                                              dietary needs of children with cerebral
                                                                                              palsy.

                                                                                                The American Dietetic Association
                                                                                              www.eatright.org has valuable information
                                                                                              for health professionals, such as position
                                                                                              papers and bibliographies on topics such as
                                                                                              HIV/AIDS nutritional needs, as well as for
                                                                                              consumers. Searching for children with
                                                                                              cerebral palsy, there is a useful ADA posi-
                                                                                              tion paper on “Providing Nutrition Services
                                                                                              for Infants, Children and Adults with De-
                                                                                              velopmental Disabilities and Special Health
                                                                                              Care Needs” along with some patient-
                                                                                              specific material: Nutrition Fact Sheets and
                                                                                              a Good Nutrition Reading List.

                                                                                                 The Assuring Pediatric Nutrition Care in
    Figure 4 –Example of My NCBI Request for PubMed Updates via Email                         the Community web site depts.washington.
                                                                                              edu/nutrpeds provides information on
developmental disorders”, save the search,     STEP 4: USE NUTRITION WEB                      training and resources for community
choose how often you want to receive no-       SITES                                          dietitians to assure quality pediatric nutri-
tification that new citations on that topic       There are many excellent resources          tion care. Here you can locate information
have been added to the PubMed database,        available on the web specifically dealing      about a three day training conference on
(weekly, monthly, and even what day you        with nutrition, covering all aspects from      pediatric nutrition in Seattle in June 007,
like best), and then recent PubMed citations   general dietary information to very specific   as well as some frequently used guidelines
will be sent automatically to your email in    dietary needs.                                 on how to evaluation nutritional status,
whatever format you choose. See Figure 4.                                                     including a specialty growth chart for chil-
Free registration is required. See PubMed:       For example look at using some of these      dren with cerebral palsy, and links to child
My NCBI healthlinks.washington.edu/            nutrition web sites to find information on     nutrition resources.
howto/myncbi.html for details on setting
up an email alert on PubMed.

   The Arbor Clinical Nutrition Updates
(ACNU) www.nutritionupdates.org is a
free evidence-based electronic nutrition
journal for health professionals, summariz-
ing recent clinical research papers appear-
ing in nutrition and medical literature with
added commentaries.

  In addition, there are many health news
web sites to help you keep up with new
health discoveries and announcements:

CNN Health       www.cnn.com/HEALTH

New York Times Health
www.nytimes.com/pages/health

USA Today Health
www.usatoday.com/news/health/
healthdigest.htm

Yahoo! News      news.yahoo.com

                                                Figure 5 – Sample of a MedlinePlus Search Related to a Specific Diagnosis
Nutrition Focus Vol. 22 #1                                          5                                          January/February 2007
   The Food and Nutrition Information                 Table 1 - Medical Library Association’s “TOP 10” MOST USEFUL WEB SITES
Center www.nal.usda.gov/fnic offers                                               (in alphabetical order)
over 2,000 links to credible, accurate,                              www.mlanet.org/resources/medspeak/topten.html
and practical resources on food and human
nutrition for nutrition and health profes-         Cancer.gov www.cancer.gov                         Medem medem.com/MedLB/
sionals, educators, and consumers, includ-         From the National Cancer Institute                medlib_entry.cfm
ing a section on “Special Need Kids”, food                                                           Health care information from a partner-
                                                   CDC: Centers for Disease Control and
composition manuals, dietary supplements,                                                            ship of medical societies, including the
                                                   Prevention www.cdc.gov
as well as other resources and databases.                                                            American Medical Association.
                                                   Good site for information on traveler’s
                                                   health and communicable diseases.                 MedlinePlus medlineplus.gov
    The Food and Nutrition Service (FNS)
                                                                                                     Excellent resource from the National
www.fns.usda.gov/fns administers the               ClinicalTrials.gov www.clinicaltrials.gov
                                                                                                     Library of Medicine, providing infor-
nutrition assistance programs of the U.S.          Consumer-friendly database of govern-
                                                                                                     mation on diseases and conditions, a
Department of Agriculture. The mission of          ment-sponsored clinical trials of experi-
                                                                                                     medical encyclopedia and dictionary,
FNS is to provide children and needy fami-         mental treatments for life-threatening
                                                                                                     locations and credentials of doctors,
lies better access to food and a more healthy      diseases and conditions.
                                                                                                     dentists and hospitals, access to orga-
diet. This web site includes information on
                                                                                                     nizations, consumer health libraries,
its food assistance programs and compre-
                                                   American Academy of Family Physi-                 international sites, publications, drug
hensive nutrition education efforts.
                                                   cians familydoctor.org                            pharmacopoeias, and more.
   Nutrition.gov www.nutrition.gov pro-            healthfinder www.healthfinder.org                 NOAH: New York Online Access to
vides online access to federal government          Gateway to reliable consumer health               Health www.noah-health.org/
information on food and human nutrition            information developed by the U.S. De-             Full-text consumer health information
all in one place.                                  partment of Health and Human Services.            in English and Spanish.
                                                   Information is reviewed from selected
                                                                                                     Oncolink www.oncolink.upenn.edu
STEP 5: SEARCH PATIENT                             online publications, clearinghouses, da-
                                                                                                     Multimedia oncology information re-
EDUCATION SITES                                    tabases, web sites, and support and self-
                                                                                                     source, providing comprehensive infor-
   MedlinePlus medlineplus.gov is the              help groups, as well as the government
                                                                                                     mation about specific types of cancer,
#1 source for basic quality consumer and           agencies and non-profit organizations.
                                                                                                     updates on cancer treatments and news
patient medical information. It is an easy         MayoClinic.com www.mayoclinic.com                 about research advances.
to use site that provides links to extensive       Includes high quality medical information
information on over 700 diseases and con-          from the Mayo Clinic. Includes questions
ditions; current health news reports; a medi-      and answers from Mayo specialists.
cal encyclopedia with over 4,000 entries
on diseases, tests, symptoms, injuries and
surgeries and including full-text illustra-
                                                  in Spanish. You can click on links to various
tions; a medical dictionary; lists of hospitals
                                                  treatments, a list of organizations that spe-      Additional patient education web
and physicians; interactive tutorials with
                                                  cialize in cystic fibrosis, and a directory        resources
pictures and audio; preformulated basic
                                                  of physicians. The Medical Encyclopedia               If you can’t find what you need in Med-
PubMed searches; and extensive informa-
                                                  entry for Cystic Fibrosis includes excellent       linePlus you can try leading health web
tion on prescription and non-prescription
                                                  illustrations, e.g., a child’s chest with cystic   sites. Table 1 lists the top ten most useful
drugs and herbals. There is also a Spanish
                                                  fibrosis, and the drug and herbal section          health-related sites for consumers.
version.6
                                                  allows you to check on side effects of drugs
                                                  used in cystic fibrosis, e.g., albuterol. The      Cross-Cultural Healthcare Resources
   For example, on the Cystic Fibrosis web
                                                  new herbal compendium includes evidence               If you work with patients from a variety
page you can find a general overview of
                                                  information on licorice root, goldenseal,          of ethnic backgrounds, there are some ex-
cystic fibrosis; a link to Nutrition for Your
                                                  Echinacea and rosemary. See Figure 5               cellent cross-cultural healthcare resources
Child with Cystic Fibrosis (Four to Seven
                                                  (page 5).                                          on the web designed to bridge language
Years) from the Cystic Fibrosis Foundation
                                                                                                     and cultural barriers during brief patient
in the Nutrition category; a list of clinical
                                                     To review, if you need articles or re-          visits.
trials to join; an interactive tutorial, Cystic
                                                  search studies, go to PubMed, and for
Fibrosis, from the Patient Education
                                                  information written for patients, start with       EthnoMed ethnomed.org is a cross-cul-
Institute; alternative therapies; and a review
                                                  MedlinePlus.                                       tural medicine database containing infor-
of research. MedlinePlus is also available


Nutrition Focus Vol. 22 #1                                              6                                             January/February 2007
mation about cultural beliefs and medical          a section on Nutrition Therapy. UptoDate is
issues pertinent to healthcare of ethnic           also an excellent resource for basic recent      To search Google:
groups in the Seattle area, in particular          background on a large number of diseases          ¨ Type the subject of your search in the
Southeast Asian and East African groups.           and conditions.                                      search box.
For example, included in EthnoMed is a                                                               ¨ Google will automatically include all
Report on Somali Diet: Common Dietary                The Medical Nutrition Handbook naa.                the words from the search box in the
                                                                                                        web site.
Beliefs and Practices of Somali Participants       medicine.wisc.edu is a quick reference to
                                                                                                     ¨ Google will recognize phrases and
in WIC Nutrition Education Groups as well          evidence-based guidelines, dietary modi-
                                                                                                        search those terms adjacent to each
as cultural information on Vietnamese              fications for common medical problems                other, or use “double quotes” for phrase
beliefs on the care of children.                   (including obesity, diabetes, hypertension,          searching.
                                                   lipid disorders, and the metabolic syn-
Culture Clues depts.washington.edu/                drome), practical patient recommendations,           Google has many useful special features.
pfes/cultureclues.html includes tip sheets         and pertinent references. Each module            You can use the Cached link under a result
designed to increase awareness about               outlines the goals of nutrition care, provides   to view a page even when the live version
concepts and preferences of patients from          guidelines for evaluation of nutritional sta-    is unavailable. When you select the Similar
diverse cultures. Culture Clues is a useful        tus, and reviews nutritional management.         pages link for a particular result, Google
tool to help in communicating with your            The modules contain links to valuable            automatically searches the web for related
patient, as it describes how a particular          web-based references and tools, including        pages. The Search within results link at the
culture, for example, Latino, deals with           clinical treatment guidelines, diet assess-      bottom of your results screen allows you to
illness, who makes the medical decisions           ment methods, estimation of portion sizes,       further refine your web search. There is also
in the family, and what are the norms about        and nutrition content of restaurant foods.7      a new Google feature that provides links
touch in that culture.                                                                              at the top of your search results page for
                                                   emedicine.com www.emedicine.com is               certain topics that help you quickly narrow
SPIRAL (Selected Patient Information               a web site that includes regularly updated       your search. For example, search “obesity”
Resources in Asian Languages) spiral.              articles on over 7,000 diseases and disor-       and see in your results screen topic-specific
tufts.edu provides consumer informa-               ders, current practice guidelines, and evi-      links to your search in order to focus and
tion specifically in Chinese, Cambodian,           dence-based content. For example, there is       improve your results, such as links to treat-
Vietnamese, Laotian and other Asian lan-           a special section on Pediatric Nutrition with    ment, symptoms, for health professionals,
guages. It includes a section of handouts          articles on failure to thrive and rickets.       alternative medicine, etc.
on nutrition, e.g. the Asian Food Pyramid
in Korean.                                         STEP 7: NAVIGATE THE WEB                             If you are familiar with many of these
                                                   BEYOND BASIC GOOGLE                              special features of Google, you may also
STEP 6: USE E-TEXTBOOKS                                                                             want to search the web using Advanced
   The Merck Manual of Medical Infor-              How to search the web:                           Google or Google Scholar. Advanced
mation www.merck.com/mmhe includes                    Navigating the web is often difficult due     Google www.google.com/advanced_
a chapter on Disorders of Nutrition and            to the size of the web and the lack of qual-     search?hl=en offers many options for
Metabolism. It is a good free source to            ity standards. A search on Google google.        making your searches more precise and
look at for basic information on diseases          com for the word “nutrition” retrieves 148       getting more useful results than using
and conditions, such as cystic fibrosis and        million web sites and one would need to          Google’s standard search box. For example,
diabetes mellitus.                                 evaluate each to see if they are pertinent       with Advanced Search, you can limit your
                                                   and relevant sites. Search engines, such as      search to pages that are created in a certain
UptoDate www.uptodate.com is an elec-              Google and Yahoo!, allow you to search           file format, i.e., PDF under File Format
tronic textbook that provides comprehen-           through large indexes of web sites created       will normally retrieve more scholarly type
sive up-to-date reviews of clinical topics         by computer programs called robots or            web sites as the PDF format is often used
in multiple specialties written by experts         spiders. Results are displayed according         for articles and reports; that specify where
in the field and using available evidence          to relevancy. Comprehensiveness will vary        your search terms appear on the web page,
that is of clinical relevance. It is a fee-based   among search engines.                            i.e. in the title, under Occurrences; that
web site and one of the most heavily used                                                           have been updated in a certain period of
resources in the University of Washington             Google is the largest search engine, com-     time, i.e. pages updated in last 3 months;
Health Sciences Libraries. For example, if         prising over eight billion pages.8 Results       and that are within a certain domain, i.e.,
you are working with a child with Crohn’s          are sorted by relevance using Google’s Pag-      typing in .gov will limit your retrieval to a
disease, you may want to look at the article       eRank analysis, determined by links from         government web site.
on the “Management of Crohn’s Disease in           other pages with a greater weight given to
Children and Adolescents”, which includes          authoritative sites.9


Nutrition Focus Vol. 22 #1                                               7                                           January/February 2007
Google Scholar (beta) scholar.google.com searches for scholarly
literature, including peer-reviewed papers, theses, books, abstracts
and technical reports. It finds articles from academic publishers,
professional societies, universities, etc. as well as scholarly articles
on the web. The “cited by” link identifies how often the piece has
been cited in other scholarly literature. However, access to the full
text of many of the results are only available with a subscription.
Although Google Scholar helps you identify scholarly research,
use it with caution, as it is not a reliable sole source for searching
scholarly literature.
                                                                                             Figure 6 - Web Site Address Guide
Metasearch engines, such as Clusty and DogPile, allow you to
send searches to more than one search engine at a time.

Clusty clusty.com has all the speed and functionality of Google,
but adds clustering of citation results in the left margin. For ex-               The URL includes the name of the host computer which can
ample, type the word “apple” in the search box, and on the left                indicate the purpose of the web site. Look for the following com-
side you will see the results clustered into categories, such as               mon abbreviations:
Mac, fruit, recipe, etc. Clustering is useful to learn at a glance the            .edu educational site
types of information available and to uncover results that may                    .gov federal government site
otherwise be buried.                                                              .com commercial site
                                                                                  .org professional organization
DogPile dogpile.com makes searching the web easier by return-
ing the best results from leading search engines, including Google,               Commercial sites, which are identified by .com, may represent a
Yahoo!Search, MSN, and Ask.com, instead of searching each of                   company using the web for commercial purposes, for example, to
these search engines separately. You can also use DogPile to search            sell a product. However, many commercial sites include credible
for audio, images, and video formats.                                          and valuable information. In fact, hospital sites may have .com
                                                                               in their URLs. When looking at .com and also .org sites, look for
Tips and strategies for searching the web: No one search engine                information that identifies the sponsor of the site, funding contribu-
queries the entire web. If you don’t find what you are looking for             tors, the purpose of the site or bias of the organization supporting
with one search engine, try another. Select one or two tools and               the site, etc. This information is often found under the “About”
get to know them well. Read the Help screens carefully to pick up              button present on many web sites.
hints on how to formulate your searches. Try the Advanced Search
options. And finally, know when NOT to search. Ask yourself:                     For additional information on how to evaluation websites, try A
   Is it worth your time?                                                     User’s Guide to Finding and Evaluating Health Information on the
   Would a phone call to a colleague or librarian be more produc-             Web www.mlanet.org/resources/userguide.html or MedlinePlus
     tive?                                                                     Guide to Healthy Web Surfing www.nlm.nih.gov/medlineplus/
   Is the information you seek likely to be on the web?                       healthywebsurfing.html , which links to a 16 minute tutorial on
                                                                               evaluating Internet health information.
STEP 8: LOOK FOR QUALITY: TIPS FOR
EVALUATING WEB SITES                                                           FINAL THOUGHTS
   The web epitomizes the concept of “Caveant lector et viewor:                   Mark Twain said, “Supposing is good, but finding out is better.”12
Let the reader and viewer beware.”10 Anyone using the web should               So navigate the web wisely to find nutrition information, using the
be skeptical and evaluate the information on a web site.                       web sites cited here or searching on your own and evaluating the
                                                                               sites you find. All web sites mentioned in this article plus many
Evaluation Strategies                                                          more can be found listed on Web Sites for Pediatric Nutritionists
   Much of the same criteria you use to evaluate books and journals            healthlinks.washington.edu/hsl/liaisons/schnall/pediatricnu-
also apply to web sites. First, use the Criteria for Evaluating Web            tritionists.pdf
Sites checklist in Table 2 on page 9 to evaluate the credibility of
the web site.                                                                     And if all else fails to find the information you seek, be sure to
                                                                               ask a librarian, your ultimate search engine!
   Next, determine the type of site by analyzing the uniform
resource locator (URL), more commonly known as the web site
address. The address will give a good hint as to the origin of the
site. (See Figure 6)

Nutrition Focus Vol. 22 #1                                                 8                                             January/February 2007
              Table 2 - CRITERIA FOR EVALUATING WEB SITES
                                                                                    REFERENCES
                                                                                    1. Fox S. Health information online. Pew Internet and
                                                                                        American Life Project. May 17, 2005. Available at:
  Authority                                                                             www.pewinternet.org/pdfs/PIP_Health-
    Is the author clearly identified?                                                  topics_May05.pdf. Accessed December 26,
                                                                                        2006.
    Are the author’s credentials listed?
                                                                                    2. Sackett DL, Rosenberg WM, Gray JA, Haynes RB,
    Is there an institutional affiliation?                                             Richardson WS. Evidence based medicine: what it
    What authority does the author have to write about the subject?                    is and what it isn’t. BMJ. 1996 Jan 13;312(7023):71-
                                                                                        72. Available at: www.bmj.com/cgi/content/
    Can you easily contact the author for clarification of information?                full/312/7023/71. Accessed January 11, 2007.
                                                                                    3. American Dietetic Association. Evidence-Practice
                                                                                        Committee Report. Spring 2006. Available at: www.
  Accuracy                                                                              eatright.org/cps/rde/xchg/ada/hs.xsl/
    Is the information accurate?                                                       governance_8382_ENU_HTML.htm. Ac-
    Does the site offer a list of references or links to support the information       cessed January 8, 2007.
                                                                                    4. Blumberg-Kason S, Lipscomb R. Evidence-based
     presented?
                                                                                        nutrition practice guidelines: A valuable resource
    Is the source of information clearly stated?                                       in the Evidence Analysis Library. JADA. 2006 Dec;
    Is there an explanation of the research method used to gather data?                106(12):1935-1936.
                                                                                    5. Lundberg GD. Perspective from the editor of JAMA,
                                                                                        The Journal of the American Medical Association.
  Objectivity                                                                           Bull Med Libr Assoc. 1992 Apr;80(2):110-114. Avail-
    Is the purpose of the site clearly stated?                                         able at: www.pubmedcentral.nih.gov/pic-
                                                                                        render.fcgi?artid=225632&blobtype=pdf.
    Is the information impartially presented?                                          Accessed January 11, 2007.
    Is sponsorship acknowledged?                                                   6. About MedlinePlus. U.S. National Library of Medi-
                                                                                        cine. April 3, 2006. Available at: www.nlm.nih.
    Is this a non-commercial site?                                                     gov/medlineplus/aboutmedlineplus.html.
                                                                                        Accessed January 9, 2007.
  Coverage                                                                          7. Underbakke G, McBride PE, Spencer E. Web-
                                                                                        based resources for medical nutrition education.
    Does the site satisfy the needs of its intended audience?
                                                                                        Am J Clin Nutr. 2006 Apr;83(4 suppl):951S-955S.
    Is the subject coverage comprehensive?                                         8. Sullivan D. Search Engine Sizes. January 28, 2005.
    Does the site offer extra features not available in other formats?                 Available at: searchenginewatch.com/show-
                                                                                        Page.html?page=2156481. Accessed
                                                                                        December 29, 2006.
  Currency                                                                          9. Notess GR. Review of Google. October 10, 2006.
    Is the site current?                                                               Available at: www.searchengineshowdown.
                                                                                        com/features/google/review.html. Ac-
    Was the site updated recently?                                                     cessed December 29, 2006.
    Are the links kept up-to-date?                                                 10. Silberg WM, Lundberg GD, Musacchio RA.
                                                                                        Assessing, controlling, and assuring the quality of
                                                                                        medical information on the Internet: Caveant lector
  Design                                                                                et viewor – let the reader and viewer beware. JAMA.
    Is the site clearly organized?                                                     1997 Apr 16;277(15):1244-1245.
    Is there an internal search engine?                                            11. Schnall JG, Hull EE. Criteria for Evaluating Web
                                                                                        Sites. Available at: healthlinks.washington.
    Is the site user friendly?                                                         edu/howto/navigating/criteria.pdf. Ac-
    Can the site be accessed reliably?                                                 cessed December 27, 2006.
                                                                                    12. Twain M. Mark Twain in Eruption. 3rd ed. New York,
    Do visual effects enhance the resource?                                            NY: Harper; 1940:324.


    From- Schnall JG, Hull EE. Criteria for Evaluating Web Sites. Available at:
    healthlinks.washington.edu/howto/navigating/criteria.pdf.
    Accessed December 27, 2006.11




Nutrition Focus Vol. 22 #1                                             9                                 January/February 2007
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