Keeping up with a literature
A search answers a question already in mind, and keeping up is the other half: the alerts, feeds, digests, filtering services and colleagues that bring new literature to the reader, how often a writer rather than a clinician needs to look, and what each kind of filter selects on.
Keeping up and harvesting
A search needs a question in mind, so it does not help a reader whose goal is simply to keep up in a general sense with the topics that interest them and are critical to their day-to-day work. For clinicians and researchers, keeping up means following new information about specific disease states and therapeutic modalities, and researchers may add topics such as research methodologies or theoretical constructs. Harvesting, in contrast to simple searching, is the ongoing process of keeping up with the flood of information: setting aside a little time each day or week to download, skim, classify and store articles, preferably electronically, for potential future use. Its ultimate goal is to have the relevant articles find the reader rather than the other way round. What each reader harvests can be idiosyncratic, but the processes are common, and separating the wheat from the chaff remains a major challenge. A well-stored harvest also makes later searching for answers a more pleasant task, because the information was collected earlier and kept where it can easily be retrieved.
Keeping up with the medical literature is crucial for a medical communications writer, since it is the basis of every kind of text. It is also challenging, because of the huge and increasing number of publications produced each year. For such a writer, continuing professional development in the medical literature entails gathering and assimilating the most current knowledge and clinical data of a medical field, one of the most challenging tasks the writer faces; increasing competence in a specified therapeutic area, especially where the area may be vast and ever-increasing; and organising and shaping the knowledge collected to focus on the messaging required.
Table-of-contents and search alerts
Journals now almost universally publish online, often before print and in almost all cases before the printed issue arrives. The popular harvesting tools are automated delivery of electronic tables of contents and automated delivery of carefully scripted, search-generated lists of articles of interest.
Medical librarians once photocopied the tables of contents of relevant journals as they arrived and circulated the sheets for staff to circle the articles they wanted, and a reader without such a service was limited to the journals they subscribed to or received as a member benefit from their professional association, and to the tables of contents that journals in reciprocity agreements published for each other. Today anyone can subscribe to electronic tables of contents free: all the major publishers and some smaller ones let a user register for a free personal account and sign up for alerts, often from a journal's home page, and many publishers also provide an alerts area on their website where all of a user's alerts can be managed. Consolidation in publishing means a large share of medical journals now comes from a handful of the largest publishers, each of which offers this service. Finding a favourite journal's home page through an internet search often shows quickly whether it offers an alert. An online publishing platform is another good source: one then hosted 1,245 journals from over 140 publishers, browsable by topic or title, with alerts managed from a single tab.
Besides email alerts, some providers offer alerts as RSS feeds, a notification system for new web content, and a feed needs a feed reader, which can easily be installed if necessary; recent versions of Microsoft Outlook have one built in, so the feeds can be treated as email messages. Where a provider offers both, the choice is a matter of preference: a feed can be tried and dropped for email if email suits better, and the same choice applies to other kinds of alerts.
A search-generated alert turns a general question into an automated search set up with a free online service, which periodically emails a list of matching articles, and refining the specifications reduces the new articles to a more manageable number. Abstracts are usually free with a click, and for many articles the full text is free too. A personal profile on PubMed stores keyword searches, runs them against PubMed regularly and emails new matches automatically, and also stores and manages bibliographies and other collections of citations. Some services offer subject categories to register for, after which alerts arrive automatically on a regular basis, and one of them also lets the subscriber choose which journals generate the results. Some publishers offer alerts too: a publisher of online journals, many of them open access, offers registered users alerts by journal, by area of interest and by stored keyword search, and a large commercial platform offers ready-made topic alerts on free registration across a wide range of subjects, with subject, new-issue and custom search alerts managed together, free access to abstracts where available, and normally a licence needed for the full text. Commercial database vendors can also be a good harvesting source: a reader affiliated with a hospital or academic institution may be able to use a variety of research databases, which generally allow a personal account storing customised search strategies, as broad or as specific as wanted, with automatic alerts that can usually be configured in a variety of ways.
Selecting what to read
Restricting the choice to the journals a reader considers most worthy works only moderately well, because gems turn up in the most unlikely places and publication in a first-tier journal is not always a hallmark of quality. Readers look at titles first, so an article whose title lacks the relevant words or is not enticing is often passed over at first, and no abstract can redeem a poorly crafted title nobody clicks; the abstract then usually decides whether the paper is harvested. Commentaries are also available that can vet a paper.
Filtering services
There was then no reader rating system for papers like those on retail sites, but some websites purport to list and summarise the top papers of the past month or year, with email services that announce each new list. One free example, from a medical publishing group, sends alerts personalised to the reader's settings, in which all citations are highly rated for quality and clinical relevance, and its evidence centre offers a searchable archive. Several well-known commercial providers screen a variety of literature and present a filtered selection, one of them published by the publisher of a major general medical journal and offering free daily general, weekly specialty and monthly topical alerts, with a subscription fee for full access and more extensive alerting. Some current-awareness resources are newsletters, including specialty titles, and many began as print-only publications but most can now also be downloaded. Evidence-based medicine journals offer another route to prescreened literature, surveying a range of research and presenting clinically relevant highlights with expert commentary, and in another commercial service a large group of clinicians and researchers select, rate and evaluate the articles they judge most important for a searchable and browsable online database.
With so much information free online, a reader may be reluctant to pay for such services, but the filtering and organising they do can save a substantial amount of time and effort. Some providers make continuing medical education credit available with their products, and a reader at an institution that provides medical library resources may be able to use one or more of these pay services through an institutional licence. Becoming a rater of articles has some perks: one rating programme sends its raters articles that have passed criteria for scientific merit, arranges continuing medical education credit and supplies the highest-rated articles to all raters in a discipline, with the principal objective of supplying clinicians with a finite, very manageable stream of high-quality, highly relevant literature in place of an unmanageable flood of articles of lower quality and relevance for clinical care.
The US Centers for Disease Control and Prevention's Health Communication Science Digest provides access to recently published articles and reports relevant to the public health communication community, with abstracts and PDF copies of most articles reachable through a digital object identifier hyperlink included with each citation.
Reviews and guidelines
Keeping abreast of every medical field continuously and appropriately is not realistically feasible, so a writer must be able to appraise the available information critically to find their way among the peer-reviewed literature. Pre-filtered sources such as reviews can be essential for summarising a large amount of clinical data and helping answer clinical questions, although a study reported in 2017 found that systematic reviews reduce but do not eliminate the scatter of published clinical data across journals. Significant differences in this scatter were found between the World Health Organization's nine diseases with the highest burden: in otolaryngology, for example, randomised trials and systematic reviews have minimal scatter, while in neurology they are spread very widely. The increasing number of new journals makes the pattern more complex still. Guidelines are another source of summarised clinical data and can be based on observational studies or randomised trials, and although only a few comply with the Guidance for Developers of Health Research Reporting Guidelines, clinical guidelines can be invaluable because they represent a reviewed and agreed update of the latest thinking in a therapeutic area.
Colleagues
The literature is becoming increasingly vast and complex, with new journals introduced every year, while medical writers often work at the cutting edge of drug research and are expected to be fully conversant in the diseases they work on. One researcher with a background in computational analysis keeps up not with an algorithm to search and curate the literature but by talking to people: almost every really useful or inspirational article he has read came from a recommendation. Even so, in his view a deeper understanding of a field will always take some serious searching and reading. Bookmarking tools with social networking functions let readers share bookmarks with colleagues, so the colleagues' bookmarks become a further route to information.
How often to look
What a communications writer needs from the literature differs substantially from what a primary care or specialist physician needs. Physicians need to check it frequently, daily, weekly or monthly, whereas a communications writer needs a more top-level overview of a medical field, so less frequent checks may be appropriate, and the tools may consequently differ and different criteria apply in choosing sources. A series of feeds may be unsuitable where the task requires more in-depth knowledge, and the source should then offer more comprehensive information such as a summary of the latest clinical data, but feeds may be perfectly acceptable and useful for the latest update, for example of a manuscript just before submission. Whatever the source, it is essential that it is trustworthy, to ensure the reliability of the manuscript and the value of any quotation used.
Choosing a set of systems
Once the therapeutic area of interest is established, what a communications writer needs most are systems to keep up with changes in the literature quickly and effectively. Any such system should be based on a specific therapeutic area and should be effective, easy to access and use, not time-consuming and, if possible, free. Examples, far from exhaustive, include alert systems, namely tables of contents for several peer-reviewed medical journals through an aggregator, article alerts from open-access publishers based on a selection of preferred journals and email alerts from PubMed for selected journals or authors; congresses, attended free where possible or followed through key reports; one-day continuing medical education courses; seminars organised by universities, hospitals or recognised institutes; and review articles, in open-access review journals or in subscription journals. Regular surfing of such websites may be considered a good starting point, but the choice of system also depends on how often the searches are done. Alert systems, webinars, webcasts, feeds, blogs, miniblogs and some social networking sites can be specialised for specific medical fields and, selected over time, may give fast updates, and they are often the most popular systems among physicians. Surveys, however, find that alerting services are not always satisfactory or judged positively for content validity or for the application of evidence-based medicine to clinical practice. Where it is feasible, attending congresses, courses and seminars and reading review journals are more suitable and reliable sources of continuing professional development for a communications writer, and how often the searches are done and the meetings attended is a crucial factor in whether the update method succeeds.