General Informations

During the IMHA workshop in Barcelona, November 28-29, it has been decided that the first step towards a harmonisation of maritime medicine training was to be the constitution of an international maritime medicine database. This database could also be the common medium in the field of maritime medical research.

 An international steering committee was created and the responsibility to set up the project fell upon the French representatives, in this instance the University of Western Brittany, UBO.

A database is a system of information management dealing with the gathering, the storage, the treatment and the circulation of this information. It is thus a complex tool which needs to be studied in depth before beginning any kind of carrying out.  It is also a system which must be permanent and apt to continuous up-dating: these two conditions require our having at our disposal both the adequate budget and a minimum of staff.

1. what needs?

 The needs were determined during the workshop in Barcelona. A coherent teaching in maritime medicine must refer to the same accurate sources. Yet, if big databases such as Medline for example already possess numerous data on this theme, the latter are disparate on the one hand and non-exhaustive on the other hand.

The relevance of a specialised database, supervised by the representatives of the maritime physicians community, and gathering all the international data in this field, is thus big. It would enable lecturers responsible for teaching maritime medicine to share common and accurate resources.

This database, regularly up-dated, would also be an essential tool for the different medical research centres, whose mission would consist in supplying it with information in some badly-known fields of this speciality as well. It would lastly be a matchless tool for all physicians practising in maritime medicine, be it in the field of prevention, of aptitude criteria to embark, of maritime occupational medicine, or in specific pathologies, in the management of emergencies at sea, or maritime telemedicine.

2. what context?

Numerous questions arise as soon as one imagines what a service such as this international maritime medicine database could be.

The amount of data, their disparity, the heterogeneity of texts, the language in which they were written, all these elements show how vast such a task is.

Technical problems actually turn out to be quite varied. The term “content” brings together different headings:

What do we want to find in this database?

 The steering committee already gave the main orientations of this project in matter of content during the workshop in Barcelona.

1. consider the following levels:

-international

-European

-national

-universities

2.database chapters:

-regulation/legislation

-professional standards

-professional reports

-lectures/universities/theses

-specialists

-users

-organisations: sailors, ship-owners, others, maritime medicine societies

-services

the gathering of some data shouldn’t at first sight be a problem, as for example international regulations concerning health in the maritime circle from the IMO and ILO, the different societies dealing with maritime medicine, these data having already been acquired and thus being easy to find.

Data per country and per different professional standards will already be harder to retrieve.

The greatest difficulty will probably lie in the collection of medical data. It will be necessary to define beforehand a cataloguing of these data.

Another point: will we make do with references of the works, the abstracts, or will we need to collect the documents in their entirety?

Then a problem will crop up, that of the language in which the text was written, when different from English.

It can be admitted that only publications issued from 1980 onwards will be taken into account (with the exception of previous “first” publications).

      which validation?

The validation of the documents will be a key issue to be debated. On which standards shall we rely to admit a document in the database, and thus ensure its scientific relevance?

It seems licit to us here to adopt the methodology used in Evidence Based Medicine, concerning the critical reading of a medical publication. Critical reading is carried out taking into account three dimensions:

- internal validity of the documents: is the result real and reliable?

- absence of bias

 - statistical reality of the result: statistically significant difference obtained on the criterion of main judgement at the outcome of the carrying out of a single statistical test (absence of multiplicity of statistical tests).

- external coherence: has the result been verified by others?

     - result confirmed by at least another

     - meta-analysis with heterogeneity

     -coherence with fundamentals: biological, epidemiological, and physio- pathological ones.

- clinical relevance: is the result relevant as regards questions raised in practice, and can it be extrapolated to all the concerned maritime population?

     -relevant criterion for clinical judgement, corresponding to a precise objective.

     -definition of the pathology identical to that used in practice.

The publications in reviews with a reading committee have a favourable prejudice against their being accepted in the database, subject to an agreement with the criteria above mentioned.

      Which classification should be adopted? Code of cataloguing

The international norm ISO 690 defines the presentation of bibliographical references. It defines compulsory fields, (authors, titles, date of publication, etc…) and optional ones (pagination, collection, etc..), but leaves a certain freedom concerning the presentation of the selected bibliographical elements.

 The editorial norms acknowledged within one’s disciplines must then prevail.  Concerning medicine, the most universal norm is the Vancouver Style Norm (Vancouver Convention).

The code of cataloguing is the whole of data identification rules. Indeed standardized formats ( international norm ISO 2709) exist. This norm determines three elements:

-the structure of the recording of the document.

-the indicator of content.

-the data of the content.

It here seems obvious that it deals with the running of systems which can only be handled by a research department professional.

It is the same too for the different norms applicable to the documents, like the SGML norm (Standard Generalized Mark-up Language) of the ODA norm (Office Document Architecture). It is the list of elements which must be found in a kind of document and the way in which they can combine with one another.

       Which indexing?

 The aim of indexing is to reduce, organize and gather information so as to rapidly locate a document, a set of documents, excerpts from texts, as an answer to a question on the expected content of the latter.

It consists in assigning to or extracting from the document an element meant to represent what it deals with, its theme.

The function of the index is thus to direct towards the source of information. One generally opts for systems with key-words or controlled by a thesaurus, in which Boolean operators (AND, OR, BUT…) are used to hone the research.

More precise systems exist, e.g. REMEDE in medicine, or PRECIS (Preserved Context Index System).

Here too it is a matter of technical choice that will have to be assured, after discussions with research department professionals.

3. which medium?

There is no database without a performing computer medium able to meet the criteria described above.

This medium will have the possibility to be posted on the internet, at the disposal of fee-paying subscribers.

 A certain number of products corresponding to this whish already exist on the market.

 We have asked some professionals about this theme, in particular the computer scientists and librarians of the maritime library La Pérouse (Ifremer/IRD/CNRS/UBO).  These professionals recommended us the Refworks software in particular. This software has the advantage of proposing an effective database system, meeting international norms, immediately operational and accessible to internet subscribers in the whole world. A presentation of this software will be proposed at the next workshop scheduled in Brest in April 2004.

4. which financial resources?

The financial resources necessary for the elaboration of such a project will have to be found through public or private funding (ILO, IMO, European Community…) for the conception and the setting, then by the income from subscriptions for the functioning.

5. which surveillance?

The general control of the database will be under the authority of the IMHA. It is necessary that a specific international community validates the entries in the database in agreement with the chosen criteria. A member of the steering committee could be a correspondent for the database of his country or a group of countries.
The language used will thus be English.

        Dr Dominique Jégaden