FOCUSVolume 22, No. 1 January/February 2007

N u t r i t i o nfor children with special health care needs

center on human development and disability, university of washington, seattle, washington

Clicking Your Way to Nutrition Resources on the WebJanet G. Schnall, MS, AHIPInformation Management LibrarianUniversity of Washington Health Sciences Libraries Seattle, WA

INTRODUCTIONAccording to a recent Pew report, eight

out of ten Internet users are searching for health information online, with an increas-ing number (51%) interested in diet, nutri-tion, vitamins or nutritional supplements.1

Registered dietitians and other health care professionals need to search and evaluate information on the web for their own pro-fessional development as well as for the guidance of their patients who use the web for nutrition-related information.

The Internet can be a valuable source of health information, but not all sites are equally worthy or reliable. Information on the web may be incomplete, inaccurate, or overly simplified. The web lacks peer review or quality control; many sites are trying to sell a product and are biased or out of date; and anyone can publish on the web whether they are an expert, or not.

So, how can you begin searching the web for authoritative health and nutrition information? This edition of NUTRITION

FOCUS provides steps to searches that you can perform while reading the newsletter. You also will find sources of reliable and authoritative nutrition information and will learn how to obtain references and have selected types of research information sent to you.

EIGHT STEPS FOR WEB SEARCHES

STEP 1: SEARCH A DATABASE 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.

Editor’s Note– Web sites have been underlined for easy identification.

Figure 1 – Sample of PubMed Results with Limits Noted (see page 2)

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

To perform a basic search in PubMed:• Enter the subject into the search box.• Click the Limits button to limit the

search to English, human, a particular age group, type of publication (such as Review), etc.

• Click on the Go button.

Figure 1 (see page 1) is an example of a PubMed search on the topic of “nutrition in children with chronic renal failure.” Entered in the search box are the key-words: chronic renal failure child nutrition physiology. You will notice that the limits (listed under the top bar) were for preschool children �-5 years of age and children 6-1� years of age. The searcher also set limits on studies published only in English and only with human subjects. Limits help to narrow a basic search.

For more detailed information on search-ing PubMed, including short demonstration video clips, see PubMed at the UW (Uni-versity of Washington). This site is avail-able to any reader. The site is healthlinks.washington.edu/howto/pubmed

Obtaining the Journal Articles You Find in PubMed

PubMed will often have a link out from the journal citation to the full-text of the article. If you click on the link (which is an image of the journal logo), you will be directed to the journal publisher’s site and can order the article for a fee, usually more than $15 per article. If you are associated with a medical library, you can ascertain whether the journal is owned there elec-tronically or in print, which then would give you free access.

Another option is to go to your public library and request an interlibrary loan of the article, which is usually provided free-of-charge. A final option is to check with libraries at major education institutions. For example, The Document Services department at the University of Washington Health Sciences Libraries will also provide health-related articles for a fee that can be paid for with a credit card and requested by phone, email, fax or online. This service can be utilized by individuals both inside and

outside of the State of Washington. Use https://healthlinks.washington.edu/cgi-bin/docservices/pubmedreq.cgi to fill out a form for Document Services, or the Loansome Doc feature of PubMed, which allows you to order full-text articles from within the PubMed database. You may also check a list of free health-related electronic journals at Free Medical Journals (13 on nutrition) freemedicaljournals.com or Highwire Press highwire. stanford.edu

Open Access Journal SitesRecently there has been pressure for

publishers to provide access to articles without cost, often with only a short time delay after the article first appears. This is known as the Open Access model. BioMed Central biomedcentral.com is an indepen-dent publishing house providing immediate free access to peer-reviewed biomedical research, including the Nutrition Journal. PubMed Central pubmedcentral.gov is the National Library of Medicine’s free digital archive of biomedical and life sciences journal literature. Results of a PubMed search that include icons with orange bands indicate those citations are available full-text for free through PubMed Central.

In addition, many nutrition journals provide free access to abstracts but require paid subscriptions to full-text articles. Examples are the American Journal of Clinical Nutrition www.ajcn.org, Journal of Nutrition www.nutrition.org, Journal of the American Dietetic Association www.adajournal.org and Nutrition Reviews www.ingentaconnect.com/content/ilsi/nure.

Additional Selected DatabasesThere are many other databases to

search when looking for nutrition-related articles. For example, if you are interested in citations and abstracts from the scien-tific literature on dietary supplements, the International Bibliographic Information on Dietary Supplements Database (IBIDS) would be a good start. Here are some databases to try:

1. AGRICOLA agricola.nal.usda.gov is a service of the National Agricultural

Library, containing bibliographic informa-tion for agricultural literature including many governmental child and adolescent nutrition publications and materials from associations, universities, and the private sector. It is organized into two data sets (books and journal articles).

�. The Food and Nutrition Information Center (FNIC) www.nal.usda.gov/fnic/databases.html maintains databases of nutrition education materials including the following six databases.

• Healthy School Meals Education and Training Materials Database is a com-pilation of educational materials devel-oped by universities, private industry, and government agencies for school personnel and others working in Child Nutrition Programs.

• Food Stamp Nutrition Connection pro-vides reliable, credible resources cre-ated by Food Stamp nutrition educators, federal, state and local governments, organizations and businesses.

• WIC Databases can be used to locate books, brochures, kits, videos, posters, etc. for staff training and/or participant education. The materials listed are from government and non-government sources.

• International Bibliographic Informa-tion on Dietary Supplements Database (IBIDS) ods.od.nih.gov/Health_In-formation/IBIDS.aspx provides access to bibliographic citations and abstracts from published, international, and scientific literature on dietary supple-ments. Choose to search the Full IBIDS Database, a subset of Consumer Cita-tions Only, or Peer Reviewed Citations Only.

• Food Safety Research Project Database provides users with information on re-search projects through the cooperation of government agencies, educational institutions and other agencies.

Nutrition Focus Vol. 22 #1 January/February 20073

• Native American Nutrition Infor-mation Database helps you find resources and information to assist with your nutrition education efforts with Native American audiences.

3. Gene Tests genecl in ics.org has current authoritative information on genetic testing and its use in the diag-nosis, management, and counseling of individuals and families with inherited disorders. It includes GeneReviews, expert-authored disease reviews, and international directories of genetic test-ing laboratories and genetics/prenatal diagnosis clinics.

4. Health and Wellness Resource Center provides access to health information in journals, newspapers, the Gale Encyclo-pedia of Medicine and the Alternative Health Encyclopedia. Check your local library for information. Some may be able to provide these sources online with your library card.

5. ProQuest includes mostly full-text access to journal and newspaper articles. It also may be available online through local library web sites.

For a listing of other databases, see Web Sites for Pediatric Nutritionists healthlinks.washington.edu/hsl/liai-sons/schnall/pediatr icnutri t ionists.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

(ADA) defines Evidence-Based Dietetics Practice as “the use of systematically reviewed scientific evidence in making food and nutri-tion practice decisions by integrating best available evidence with professional expertise and client values to improve outcomes”.3

Key evidence based practice and guidelines resources include PubMed, the Cochrane Database of Systematic Reviews (fee based), the National Guideline Clearinghouse and the ADA’s Evidence Analysis Library.

There are basically two good PubMed pubmed.gov strategies for retrieving evi-dence-based citations. The first is to limit your search to the type of article which limits your retrieval based on the type of material the article represents. Enter your terms in the Search box and then click on the Limit button. The Type of Article checklist from the Limits screen contains a list of frequently searched publication types. See Figure �. For example, use one or any of the following types to limit to evidence-based citations:

• Randomized Controlled Trial• Meta-Analysis • Practice Guideline• Clinical Trial

The second way to retrieve evidence-based citations is to use PubMed’s Clinical Queries www.ncbi.nlm.nih.gov/entrez/query/static/clinical.shtml section, ac-cessed from the PubMed navigation bar on the left side of the window under PubMed Services. The first filter on the Clinical Queries page is Search By Clinical Study Category, a specialized search query with built-in research methodology search filters intended to limit retrieval to research-based citations on clinical topics, e.g., randomized controlled trials. Five study categories or filters are provided: etiology, diagnosis, therapy, prognosis, and clinical prediction guides along with two emphasis categories or filters: broad, sensitive search (includes relevant articles but probably some less relevant) or a narrow, specific search (more precise articles, with less retrieval).

Just enter your topic in the Clinical Study Category and/or in Systematic Reviews to retrieve your evidence-based citations. Once you have executed a search in PubMed Clinical Queries, the resulting retrieval can then be further refined using PubMed’s Limits, e.g., English language.

Figure 2 – Example of PubMed Type of Article Limits

Nutrition Focus Vol. 22 #1 January/February 20074

See Figure 3 for an example of a PubMed Clinical Queries request.Example: If you want to see research-based citations on the use of zinc to treat the common cold, enter your topic ‘zinc common cold’ in the search box under the Search by Clinical Study category. Since you are interested in treatment, make sure the button to the left of the study category ‘therapy’ is selected. Then choose the emphasis of your search. The default is a narrow, specific search. To run the search, click Go. Then click Limits and select English and human. Results of the search are now limited to research-based citations (randomized controlled trial studies) that are in English and concerning humans.

Also on the Clinical Queries page is Find Systematic Reviews (Figure 3), which help locate systematic reviews and similar articles. It combines your search term(s) with citations identified as systematic re-views, meta-analyses, reviews of clinical trials, evidence-based medicine, consensus development conferences, and guidelines. Example: To find systematic reviews and similar articles on calcium supplementa-tion, type ‘calcium supplementation’ in the query box in the Find Systematic Reviews section, and click the Go button. On the results screen, further restrict your search to English language articles and hu-man studies by clicking Limits under the query box on the Features Tab and choosing

English from the language list and humans. Then click the Go button to the right of the query box near the top of the window.

The Cochrane Database of System-atic Reviews (CDSR) cochrane.org is a fee-based, full-text database containing systematic reviews and protocols (reviews still in progress) of the effects of health care interventions. A systematic review is a literature review focusing on a question which tries to identify, appraise, select and synthesize all high quality research relevant to that question. The CDSR reviews mainly randomized controlled trials and is the “Gold Standard” for finding high quality, systematic reviews. An example of a nutri-tion-related systematic review question or query in CDSR is Dietary Interventions for Recurrent Abdominal Pain (RAP) in Children.

The National Guideline Clearing-house www.guidel ine.gov is a free, comprehensive database of evidence-based clinical practice guidelines sponsored by the Agency for Healthcare Research and Quality. Its mission is to provide health professionals with a mechanism to obtain objective information on clinical practice guidelines. The database includes struc-tured abstracts, links to full-text guidelines when available, ordering information for print copies, and a guideline comparison utility. You can find nutrition related

guidelines, such as Nutrition Support for Neurologically Impaired Children and Overweight in Children and Adolescents: Pathophysiology, Consequences, Preven-tion, and Treatment.

The ADA’s Evidence Analysis Library (EAL) www.adaevidencelibrary.com is a synthesis of the best available nutrition re-search on important dietetic practice ques-tions. The EAL includes Bibliographies of high quality research on a topic; Conclusion Statements that provide concise statements of the collective research on a question; Grades for each Conclusion Statement that provide a way for practitioners to determine how certain is the Conclusion Statement, based on the quality and extensiveness of the supporting evidence; and Evidence Summaries, brief, narrative overviews that synthesize the major research findings on a given topic. The EAL also provides Evi-dence-based Guidelines, “systematically developed statements based on scientific evidence to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.”4 The ADA is presently working on more guidelines, such as pediatric weight management, Diabetes Type 1 and �, and nutrition in spinal cord injury. The EAL is available at no cost to ADA members and is a quick way to keep up with the latest available research in nutrition and dietetics.

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 your PubMed search, i.e., “child nutrition

Figure 3– Example of PubMed Clinical Queries Limited by Clinical Study Category or Systematic Reviews

Nutrition Focus Vol. 22 #1 January/February 20075

developmental disorders”, save the search, choose how often you want to receive no-tification that new citations on that topic have been added to the PubMed database, (weekly, monthly, and even what day you like best), and then recent PubMed citations will be sent automatically to your email in whatever format you choose. See Figure 4. Free registration is required. See PubMed: My NCBI healthlinks.washington.edu/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

STEP 4: USE NUTRITION WEB SITES

There are many excellent resources available on the web specifically dealing with nutrition, covering all aspects from general dietary information to very specific dietary needs.

For example look at using some of these nutrition web sites to find information on

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 the Community web site depts.washington.edu/nutrpeds provides information on training and resources for community dietitians to assure quality pediatric nutri-tion care. Here you can locate information about a three day training conference on pediatric nutrition in Seattle in June �007, as well as some frequently used guidelines on how to evaluation nutritional status, including a specialty growth chart for chil-dren with cerebral palsy, and links to child nutrition resources.

Figure 4 –Example of My NCBI Request for PubMed Updates via Email

Figure 5 – Sample of a MedlinePlus Search Related to a Specific Diagnosis

Nutrition Focus Vol. 22 #1 January/February 20076

The Food and Nutrition Information Center www.nal.usda.gov/fnic offers over 2,000 links to credible, accurate, and practical resources on food and human nutrition for nutrition and health profes-sionals, educators, and consumers, includ-ing a section on “Special Need Kids”, food composition manuals, dietary supplements, as well as other resources and databases.

The Food and Nutrition Service (FNS) www.fns.usda.gov/fns administers the nutrition assistance programs of the U.S. Department of Agriculture. The mission of FNS is to provide children and needy fami-lies better access to food and a more healthy diet. This web site includes information on its food assistance programs and compre-hensive nutrition education efforts.

Nutrition.gov www.nutrit ion.gov pro-vides online access to federal government information on food and human nutrition all in one place.

STEP 5: SEARCH PATIENT EDUCATION SITES

MedlinePlus medlineplus.gov is the #1 source for basic quality consumer and patient medical information. It is an easy to use site that provides links to extensive information on over 700 diseases and con-ditions; current health news reports; a medi-cal encyclopedia with over 4,000 entries on diseases, tests, symptoms, injuries and surgeries and including full-text illustra-tions; a medical dictionary; lists of hospitals and physicians; interactive tutorials with pictures and audio; preformulated basic PubMed searches; and extensive informa-tion on prescription and non-prescription drugs and herbals. There is also a Spanish version.6

For example, on the Cystic Fibrosis web page you can find a general overview of cystic fibrosis; a link to Nutrition for Your Child with Cystic Fibrosis (Four to Seven Years) from the Cystic Fibrosis Foundation in the Nutrition category; a list of clinical trials to join; an interactive tutorial, Cystic Fibrosis, from the Patient Education Institute; alternative therapies; and a review of research. MedlinePlus is also available

in Spanish. You can click on links to various treatments, a list of organizations that spe-cialize in cystic fibrosis, and a directory of physicians. The Medical Encyclopedia entry for Cystic Fibrosis includes excellent illustrations, e.g., a child’s chest with cystic fibrosis, and the drug and herbal section allows you to check on side effects of drugs used in cystic fibrosis, e.g., albuterol. The new herbal compendium includes evidence information on licorice root, goldenseal, Echinacea and rosemary. See Figure 5 (page 5).

To review, if you need articles or re-search studies, go to PubMed, and for information written for patients, start with MedlinePlus.

Additional patient education web resources

If you can’t find what you need in Med-linePlus you can try leading health web sites. Table 1 lists the top ten most useful health-related sites for consumers.

Cross-Cultural Healthcare ResourcesIf you work with patients from a variety

of ethnic backgrounds, there are some ex-cellent cross-cultural healthcare resources on the web designed to bridge language and cultural barriers during brief patient visits.

EthnoMed ethnomed.org is a cross-cul-tural medicine database containing infor-

Table 1 - Medical Library Association’s “TOP 10” MOST USEFUL WEB SITES (in alphabetical order)

www.mlanet.org/resources/medspeak/topten.html

Cancer.gov www.cancer.govFrom the National Cancer Institute

CDC: Centers for Disease Control and Prevention www.cdc.govGood site for information on traveler’s health and communicable diseases.

ClinicalTrials.gov www.clinicaltrials.govConsumer-friendly database of govern-ment-sponsored clinical trials of experi-mental treatments for life-threatening diseases and conditions.

American Academy of Family Physi-cians familydoctor.org

healthfinder www.healthfinder.orgGateway to reliable consumer health information developed by the U.S. De-partment of Health and Human Services. Information is reviewed from selected online publications, clearinghouses, da-tabases, web sites, and support and self-help groups, as well as the government agencies and non-profit organizations.

MayoClinic.com www.mayoclinic.comIncludes high quality medical information from the Mayo Clinic. Includes questions and answers from Mayo specialists.

Medem medem.com/MedLB/medlib_entry.cfmHealth care information from a partner-ship of medical societies, including the American Medical Association.

MedlinePlus medlineplus.govExcellent resource from the National Library of Medicine, providing infor-mation on diseases and conditions, a medical encyclopedia and dictionary, locations and credentials of doctors, dentists and hospitals, access to orga-nizations, consumer health libraries, international sites, publications, drug pharmacopoeias, and more.

NOAH: New York Online Access to Health www.noah-health.org/Full-text consumer health information in English and Spanish.

Oncolink www.oncolink.upenn.eduMultimedia oncology information re-source, providing comprehensive infor-mation about specific types of cancer, updates on cancer treatments and news about research advances.

Nutrition Focus Vol. 22 #1 January/February 20077

mation about cultural beliefs and medical issues pertinent to healthcare of ethnic groups in the Seattle area, in particular Southeast Asian and East African groups. For example, included in EthnoMed is a Report on Somali Diet: Common Dietary Beliefs and Practices of Somali Participants in WIC Nutrition Education Groups as well as cultural information on Vietnamese beliefs on the care of children.

Culture Clues depts.washington.edu/pfes/cultureclues.html includes tip sheets designed to increase awareness about concepts and preferences of patients from diverse cultures. Culture Clues is a useful tool to help in communicating with your patient, as it describes how a particular culture, for example, Latino, deals with illness, who makes the medical decisions in the family, and what are the norms about touch in that culture.

SPIRAL (Selected Patient Information Resources in Asian Languages) spiral.tufts.edu provides consumer informa-tion specifically in Chinese, Cambodian, Vietnamese, Laotian and other Asian lan-guages. It includes a section of handouts on nutrition, e.g. the Asian Food Pyramid in Korean.

STEP 6: USE E-TEXTBOOKSThe Merck Manual of Medical Infor-

mation www.merck.com/mmhe includes a chapter on Disorders of Nutrition and Metabolism. It is a good free source to look at for basic information on diseases and conditions, such as cystic fibrosis and diabetes mellitus.

UptoDate www.uptodate.com is an elec-tronic textbook that provides comprehen-sive up-to-date reviews of clinical topics in multiple specialties written by experts in the field and using available evidence that is of clinical relevance. It is a fee-based web site and one of the most heavily used resources in the University of Washington Health Sciences Libraries. For example, if you are working with a child with Crohn’s disease, you may want to look at the article on the “Management of Crohn’s Disease in Children and Adolescents”, which includes

a section on Nutrition Therapy. UptoDate is also an excellent resource for basic recent background on a large number of diseases and conditions.

The Medical Nutrition Handbook naa.medicine.wisc.edu is a quick reference to evidence-based guidelines, dietary modi-fications for common medical problems (including obesity, diabetes, hypertension, lipid disorders, and the metabolic syn-drome), practical patient recommendations, and pertinent references. Each module outlines the goals of nutrition care, provides guidelines for evaluation of nutritional sta-tus, and reviews nutritional management. The modules contain links to valuable web-based references and tools, including clinical treatment guidelines, diet assess-ment methods, estimation of portion sizes, and nutrition content of restaurant foods.7

emedicine.com www.emedicine.com is a web site that includes regularly updated articles on over 7,000 diseases and disor-ders, current practice guidelines, and evi-dence-based content. For example, there is a special section on Pediatric Nutrition with articles on failure to thrive and rickets.

STEP 7: NAVIGATE THE WEB BEYOND BASIC GOOGLE

How to search the web:Navigating the web is often difficult due

to the size of the web and the lack of qual-ity standards. A search on Google google.com for the word “nutrition” retrieves 148 million web sites and one would need to evaluate each to see if they are pertinent and relevant sites. Search engines, such as Google and Yahoo!, allow you to search through large indexes of web sites created by computer programs called robots or spiders. Results are displayed according to relevancy. Comprehensiveness will vary among search engines.

Google is the largest search engine, com-prising over eight billion pages.8 Results are sorted by relevance using Google’s Pag-eRank analysis, determined by links from other pages with a greater weight given to authoritative sites.9

To search Google:¨ Type the subject of your search in the

search box.¨ Google will automatically include all

the words from the search box in the web site.

¨ Google will recognize phrases and search those terms adjacent to each other, or use “double quotes” for phrase searching.

Google has many useful special features. You can use the Cached link under a result to view a page even when the live version is unavailable. When you select the Similar pages link for a particular result, Google automatically searches the web for related pages. The Search within results link at the bottom of your results screen allows you to further refine your web search. There is also a new Google feature that provides links at the top of your search results page for certain topics that help you quickly narrow your search. For example, search “obesity” and see in your results screen topic-specific links to your search in order to focus and improve your results, such as links to treat-ment, symptoms, for health professionals, alternative medicine, etc.

If you are familiar with many of these special features of Google, you may also want to search the web using Advanced Google or Google Scholar. Advanced Google www.google.com/advanced_search?hl=en offers many options for making your searches more precise and getting more useful results than using Google’s standard search box. For example, with Advanced Search, you can limit your search to pages that are created in a certain file format, i.e., PDF under File Format will normally retrieve more scholarly type web sites as the PDF format is often used for articles and reports; that specify where your search terms appear on the web page, i.e. in the title, under Occurrences; that have been updated in a certain period of time, i.e. pages updated in last 3 months; and that are within a certain domain, i.e., typing in .gov will limit your retrieval to a government web site.

Nutrition Focus Vol. 22 #1 January/February 20078

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.

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-ample, type the word “apple” in the search box, and on the left side you will see the results clustered into categories, such as Mac, fruit, recipe, etc. Clustering is useful to learn at a glance the types of information available and to uncover results that may otherwise be buried.

DogPile dogpile.com makes searching the web easier by return-ing the best results from leading search engines, including Google, Yahoo!Search, MSN, and Ask.com, instead of searching each of these search engines separately. You can also use DogPile to search for audio, images, and video formats.

Tips and strategies for searching the web: No one search engine queries the entire web. If you don’t find what you are looking for with one search engine, try another. Select one or two tools and get to know them well. Read the Help screens carefully to pick up hints on how to formulate your searches. Try the Advanced Search options. And finally, know when NOT to search. Ask yourself:

Is it worth your time? Would a phone call to a colleague or librarian be more produc-

tive? Is the information you seek likely to be on the web?

STEP 8: LOOK FOR QUALITY: TIPS FOR EVALUATING WEB SITES

The web epitomizes the concept of “Caveant lector et viewor: Let the reader and viewer beware.”10 Anyone using the web should be skeptical and evaluate the information on a web site.

Evaluation StrategiesMuch of the same criteria you use to evaluate books and journals

also apply to web sites. First, use the Criteria for Evaluating Web Sites checklist in Table 2 on page 9 to evaluate the credibility of the web site.

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)

The URL includes the name of the host computer which can indicate the purpose of the web site. Look for the following com-mon abbreviations:

.edu educational site

.gov federal government site

.com commercial site

.org professional organization

Commercial sites, which are identified by .com, may represent a company using the web for commercial purposes, for example, to sell a product. However, many commercial sites include credible and valuable information. In fact, hospital sites may have .com in their URLs. When looking at .com and also .org sites, look for information that identifies the sponsor of the site, funding contribu-tors, the purpose of the site or bias of the organization supporting the site, etc. This information is often found under the “About” button present on many web sites.

For additional information on how to evaluation websites, try A User’s Guide to Finding and Evaluating Health Information on the Web www.mlanet.org/resources/userguide.html or MedlinePlus Guide to Healthy Web Surfing www.nlm.nih.gov/medlineplus/healthywebsurfing.html, which links to a 16 minute tutorial on evaluating Internet health information.

FINAL THOUGHTSMark Twain said, “Supposing is good, but finding out is better.”12

So navigate the web wisely to find nutrition information, using the web sites cited here or searching on your own and evaluating the sites you find. All web sites mentioned in this article plus many more can be found listed on Web Sites for Pediatric Nutritionists healthlinks.washington.edu/hsl/liaisons/schnall/pediatricnu-tritionists.pdf

And if all else fails to find the information you seek, be sure to ask a librarian, your ultimate search engine!

Figure 6 - Web Site Address Guide

Nutrition Focus Vol. 22 #1 January/February 20079

Table 2 - CRITERIA FOR EVALUATING WEB SITES

Authority Is the author clearly identified? Are the author’s credentials listed? Is there an institutional affiliation? What authority does the author have to write about the subject? Can you easily contact the author for clarification of information?

Accuracy Is the information accurate? Does the site offer a list of references or links to support the information

presented? Is the source of information clearly stated? Is there an explanation of the research method used to gather data?

Objectivity Is the purpose of the site clearly stated? Is the information impartially presented? Is sponsorship acknowledged? Is this a non-commercial site?

Coverage Does the site satisfy the needs of its intended audience? Is the subject coverage comprehensive? Does the site offer extra features not available in other formats?

Currency Is the site current? Was the site updated recently? Are the links kept up-to-date?

Design Is the site clearly organized? Is there an internal search engine? Is the site user friendly? Can the site be accessed reliably? Do visual effects enhance the resource?

REFERENCES1. Fox S. Health information online. Pew Internet and

American Life Project. May 17, 2005. Available at: www.pewinternet.org/pdfs/PIP_Health-topics_May05.pdf. Accessed December 26, 2006.

2. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ. 1996 Jan 13;312(7023):71-72. Available at: www.bmj.com/cgi/content/full/312/7023/71 . Accessed January 11, 2007.

3. American Dietetic Association. Evidence-Practice Committee Report. Spring 2006. Available at: www.eatright.org/cps/rde/xchg/ada/hs.xsl/governance_8382_ENU_HTML.htm. Ac-cessed January 8, 2007.

4. Blumberg-Kason S, Lipscomb R. Evidence-based nutrition practice guidelines: A valuable resource in the Evidence Analysis Library. JADA. 2006 Dec; 106(12):1935-1936.

5. Lundberg GD. Perspective from the editor of JAMA, The Journal of the American Medical Association. Bull Med Libr Assoc. 1992 Apr;80(2):110-114. Avail-able at: www.pubmedcentral.nih.gov/pic-render.fcgi?artid=225632&blobtype=pdf . Accessed January 11, 2007.

6. About MedlinePlus. U.S. National Library of Medi-cine. April 3, 2006. Available at: www.nlm.nih.gov/medlineplus/aboutmedlineplus.html. Accessed January 9, 2007.

7. Underbakke G, McBride PE, Spencer E. Web-based resources for medical nutrition education. Am J Clin Nutr. 2006 Apr;83(4 suppl):951S-955S.

8. Sullivan D. Search Engine Sizes. January 28, 2005. Available at: searchenginewatch.com/show-Page.html?page=2156481. Accessed December 29, 2006.

9. Notess GR. Review of Google. October 10, 2006. Available at: www.searchengineshowdown .com/features/google/review.html. Ac-cessed December 29, 2006.

10. Silberg WM, Lundberg GD, Musacchio RA. Assessing, controlling, and assuring the quality of medical information on the Internet: Caveant lector et viewor – let the reader and viewer beware. JAMA. 1997 Apr 16;277(15):1244-1245.

11. Schnall JG, Hull EE. Criteria for Evaluating Web Sites. Available at: healthlinks.washington.edu/howto/navigating/criteria.pdf. Ac-cessed December 27, 2006.

12. Twain M. Mark Twain in Eruption. 3rd ed. New York, 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 January/February 200710

10-9306Nutrition FocusVol# 22, No. 1CHDD, University of Washington Box 357920Seattle, WA 98195-7920

NUTRITION FOCUS is published six times per year by the Nutrition Section at the Center on Human Development and Disability, University of WashingtonAnnual subscription rate is $36.00 ($45.00 US funds for international subscriptions) and must be prepaid to the University of Washington. Mail your payment, complete address and phone number to the editor. Some back issues are available. For a list of these or to share resources and comments please contact the Editor: Sharon Feucht, M.A., R.D., Nutrition Focus, CHDD-University of Washington, Box 357920, Seattle, WA 98195-79�0. Phone: �06-685-1�97 • FAX: �06-598-7815 • email: sfeucht@u.washington.edu

Current subscription or renewal questions should be addressed to the Nutrition Focus Sub-scription Manager, Nancy Saunders. Contact her at CHDD-University of Washington, Box 357920, Seattle, WA 98195-7920. Phone: �06-616-3831 • FAX: �06-598-7815 • e-mail: charbert@u.washington.edu

For those with access to the internet we have a web page at http://www.chdd.washington.edu/ucedd/ctu_5/nutritionnews_5.html

Featured in future issues of NUTRITION FOCUS

• Nutrition Concerns for Children with Seizure Disorders

• Physical Activity for Children with Special Health Care Needs