提升指南/共识报告质量 推进医学期刊高质量发展

临床实践指南(简称指南)和专家共识(简称共识)作为医疗实践的重要指导性文件,可以规范医务人员的诊疗行为,提升医疗服务质量、降低医疗成本,是医务人员进行决策的准则和依据。指南/共识的规范化报告有助于提升其学术质量、权威性和透明性,可以促进其有效传播与实施,因此提升指南/共识报告质量具有重要现实意义。本文分析了目前我国医学科技期刊指南/共识的报告现状及存在问题,并从出台相关政策、开展培训、宣传推广等方面提出相应建议与对策,以期为提升我国指南/共识报告质量提供思路,推进医学期刊高质量发展。     

基于引文网络的医学各学科间知识流动的规律与启示

以CNKI引文数据库医药卫生专题下的数据为研究对象,利用社会网络分析方法,分析了我国医学领域内的知识交流特点。结果表明：临床医学的知识流入量和知识流出量都位居第一,是知识交流网络中的核心;基础医学是其他医学学科的理论基础,属于医学网络中的重要知识源;中医学与外科学及其他临床类学科的交流密切;在跨学科医学研究中肿瘤学表现得比较活跃;口腔医学和精神病学在知识交流网络中与其他学科的交流较少,是独立性较强的两个学科。利用这些特点开展学科信息推送服务,可提高信息服务的针对性,加速不同医学学科间的知识交流,推动医学领域内的跨学科合作研究。     

Implementation of the Clinical Encounters Tracking system at the Indiana University School of Medicine

The Indiana University School of Medicine (IUSM) Office of Medical Education &Student Services directed the IUSM Educational Technology Unit to develop a Clinical Encounters Tracking system in response to the Liaison Committee on Medical Education's (LCME) updated accreditation standards. A personal digital assistant (PDA) and centralized database server solution was implemented. Third-year medical students are required to carry a PDA on which they record clinical encounter experiences during all clerkship clinical rotations. Clinical encounters data collected on the PDAs are routinely uploaded to the central server via the PDA HotSyncing process. Real-time clinical encounter summary reports are accessed in the school's online curriculum management system: ANGEL. The resulting IUSM Clinical Encounters Tracking program addresses the LCME accreditation standard which mandates the tracking of medical students' required clinical curriculum experiences.     

Mayo Clinic Library education programs.

The health-related sciences programs of Mayo Foundation, including those related to librarianship, are conducted in an internationally known center for medical education, clinical practice, and medical research. Students have access to all the educational resources of Mayo Clinic. Appointees to the programs enjoy the benefits of more than half a century of experience in medical education that includes the training of residents, research fellows, interns, and medical students. The health-related sciences programs, like the Mayo Graduate School of Medicine and the Mayo Medical School, are part of the Division of Education of the Mayo Foundation, a nonprofit charitable corporation responsible for the support and conduct of education and research as an integral part of medical and health care.     

A Study of the Impact of Medical Libraries on Clinical Decision-Making in Nigeria University Teaching Hospitals

This study is aimed at examining the impact of an institution's medical library on the clinical decision-making of medical officers in two Nigerian University Teaching Hospitals. Medical information sources consulted by medical officers in Nigeria University teaching hospitals were examined. The results of the study revealed that the information provided by the library was appropriate to their clinical decisions. Medics rely mostly on their institution's library and personal data collections for information. Information is sought for the purposes of managing patients, evaluating new drugs, and support for the diagnosis of ailments. Scientific and technical journals, Index Medicus, Excerpta Medical, CD-ROM (MEDLINE) databases and foreign magazines are widely consulted. Respondents judged the library collection as fair. The study recommends that the existing medical libraries and information centers in Nigeria be well stocked for the retraining of librarians in modern information technology.     

Exploring e-readers to support clinical medical education: two case studies

Question:

Can e-readers loaded with medical textbooks and other relevant material benefit medical students, residents, and preceptors in clinical settings?

Settings:

The settings are North Carolina community clinics served by Duke University Medical Center and St. Joseph''s Hospital in Bryan, Texas, and Scott and White Memorial Hospital in Temple, Texas.

Methods:

Duke University: Twenty second-year medical students and fourteen family medicine clerkship preceptors used Kindle e-readers in clinics during eight months of rotations. Students and preceptors provided feedback through an anonymous online survey. Texas A&M University: Nine fourth-year medical students in an elective compared medical textbooks in print, online, and on a Kindle. Six residents at a local hospital completed an anonymous online survey after a three-week loan of a Kindle loaded with medical textbooks.

Results:

The e-reader''s major advantages in clinical settings are portability and searchability. The selected e-reader''s limitations include connection speed, navigation, and display. User preferences varied, but online resources were preferred. Participants suggested additional uses for Kindles in medical education.

Conclusions:

The selected e-reader''s limitations may be resolved with further development of the device. Investigation of other e-readers is needed. Criteria for evaluating e-readers in clinical settings should include portability, searchability, speed, navigation, and display. Research comparing e-readers and mobile devices in clinical education is also warranted.     

A Study of the Impact of Medical Libraries on Clinical Decision-Making in Nigeria University Teaching Hospitals

This study is aimed at examining the impact of an institution's medical library on the clinical decision-making of medical officers in two Nigerian University Teaching Hospitals. Medical information sources consulted by medical officers in Nigeria University teaching hospitals were examined. The results of the study revealed that the information provided by the library was appropriate to their clinical decisions. Medics rely mostly on their institution's library and personal data collections for information. Information is sought for the purposes of managing patients, evaluating new drugs, and support for the diagnosis of ailments. Scientific and technical journals, Index Medicus, Excerpta Medical, CD-ROM (MEDLINE) databases and foreign magazines are widely consulted. Respondents judged the library collection as fair. The study recommends that the existing medical libraries and information centers in Nigeria be well stocked for the retraining of librarians in modern information technology.     

基于循证医学本体论的临床元数据设计方法研究

临床实践中产生的海量临床信息是临床研究与临床实践最直接的证据,是医学领域不可或缺的、亟待科学挖掘的宝贵资源。基于循证医学本体论的临床元数据可用于临床元数据语言的需求体系设计、语义结构体系设计及语法结构体系设计,从而可以达成对各种异构的临床诊疗信息的科学整合与深度挖掘以及共享利用。     

临床医学研究论文中的真实性问题探讨

从随机对照试验描述错误、临床资料数据缺失、临床数据虚报3个方面对临床医学研究论文中存在的真实性问题进行了总结、分析,并为编辑审读临床稿件提供一些建议。     

Problem Knowledge Couplers: reengineering evidence-based medicine through interdisciplinary development, decision support, and research.

The rapid growth of medical knowledge is creating a demand for new ways of providing information in support of evidence-based medical practice. Problem Knowledge Couplers are a clinical decision support software tool that offer a new approach to this growing problem. Couplers are developed through a collaboration among clinicians, informaticians, and librarians. They recognize that functionality must be predicated upon combining unique patient information, gleaned through relevant structured question sets, with the appropriate knowledge found in the world's peer-reviewed medical literature. Two pilot studies indicate that couplers can meet the gold standards of decision making within both a primary care and a specialty practice. Issues remain about how to best integrate Problem Knowledge Couplers into clinical practice and whether large-scale outcomes research will support the findings of pilot studies. However, Problem Knowledge Couplers represent a promising approach that might portend a new model for health care delivery in the next millennium.     

Integrating knowledge resources at the point of care: opportunities for librarians.

Health sciences librarians at the University of Washington (UW) are partners in the evolution of Internet-based clinical information systems for two medical centers, University of Washington Medical Center and Harborview Medical Center, as well as the UW Primary Care Network clinics. Librarians lead information resource and systems development projects and play a variety of roles including facilitator, publisher, integrator, and educator. These efforts have been coordinated with parallel development efforts by the Integrated Advanced Information Management Systems (IAIMS) clinical informatics group in developing electronic medical record systems and clinical decision support tools. The outcome is MINDscape, a very heavily used Web view of the patient medical record with tightly integrated knowledge resources as well as numerous Web-accessible information resources and tools. The goal of this article is to provide a case study of librarian involvement in institutional information systems development at UW and to illustrate the variety of roles that librarians can assume in hospital settings.     

A multidisciplinary approach to information and critical appraisal instruction

The formulation of clinical decisions based on evidence requires the ability to locate information and evaluate it critically. A ten-week critical appraisal course for third-year medical students, taught cooperatively by library and Department of Medicine faculty, integrates education in the selection, evaluation, and application of information to patient care. The course is distinctive in that information management skills are taught by a multidisciplinary team in a problem-based format as part of the compulsory medical curriculum. Medical faculty provided instruction in reading and evaluating research methodology, as well as statistical analyses in published reports, using clinical scenarios and related journal articles at weekly sessions. Library faculty provided instruction in locating pertinent research on a sample clinical problem using standard printed and computerized indexes and local library resources, and presented criteria for selecting the most useful and significant works from those retrieved. Library faculty also met individually with students to provide instruction in online literature searching. Based on formal evaluation and informal feedback, the course was well received; it effectively presents the literature search as an integral part of critical appraisal of the medical literature and of the clinical decision-making process.     

医学期刊组织开展多中心临床研究初探

当前我国医学期刊优秀稿件数量下降、刊载论文学术质量滑坡.如何吸引更多高质量的原创性论文是医学期刊急需解决的一大问题.作者尝试组织开展多中心临床研究项目,旨在通过开展多中心、前瞻性、大样本、随机对照研究,不仅起到了引领学术发展的作用,而且为期刊组织到高质量的论文,有助于提升期刊的质量和水平,进一步增强期刊的影响力.     

The MAClinical Workstation Project at Georgetown University

The intent of the MAClinical Workstation Project is to develop computer workstations for medical students of the sort they will use in future medical practice. The idea is to instill information query habits in the daily clinical activities of these young physicians-in-training. The Georgetown University Medical Center Library spearheads the project in conjunction with the School of Medicine. The library handles technical support, including software development, user training, equipment maintenance, and network installations. The project began in 1988 with nine Macintosh computers; today thirty machines are distributed throughout the Georgetown University Hospital conference rooms, faculty and resident offices, and at four affliated hospitals. The Macintosh computers are connected to the medical center's local area network (LAN) with access to the Integrated Academic Information Management System (IAIMS) and Library Information System (LIS) databases. The MAClinical workstations serve multiple educational purposes in the clinical setting. Primarily, students gain experience in medical informatics by using a variety of software systems installed at the stations: the H&P Writer, a history and physical system written in the C programming language, can be used by students to prepare the admission record on patients they examine; also, students can keep patient records, check findings against a diagnostic system, look up drugs and treatment protocols, develop medical sketches, and find additional information when needed in the medical literature.     

我国检验医学研究论文计量分析

利用清华同方的《中国知识资源总库》,检索1983-2012年来发表的检验医学相关文献并进行统计分析发现,我国检验医学研究论文数量呈快速增长态势,检验医学、临床检验、检验科等是检验医学研究的主关键词,临床医学、医药卫生方针政策与法律法规研究和医学教育与医学边缘学科是检验医学研究最主的学科领域。     

医学科技期刊服务基层医务工作者的实践——以《中国心脏起搏与心电生理杂志》为例

基层医务工作者是直接与广大人民群众接触,提供预防、医疗、保健、康复服务的人员。提高基层医务工作者的专业素养及救治能力,才能真正贯彻和落实我国的新医改政策。医学期刊在此方面可以开展一些工作——面向基层读者、作者进行选题策划,栏目建设,通过线上线下的宣传扩大发行、增加与读者的互动;组织适合基层医务工作者的学术活动以及科研思维与写作投稿宣讲活动;举办面向基层的科普宣传、义诊活动。通过这些实践整体更新和提高基层医务工作者的理论知识、临床诊治的专业技能,提高为基层群众服务的医疗能力和水平。     

后疫情时期医学图书馆医务人员信息素养培育研究

本文通过剖析信息素养的概念和内涵,总结了信息素养的本质和发展规律;从医疗服务模式的转变、临床诊疗和科研创新要求以及医学图书馆发展3个方面阐述了现阶段医学图书馆助力提升医务人员信息素养的重要性,指出了目前医务人员信息素养存在的问题,重点探讨了医学图书馆助力提升医务人员信息素养的途径,以期为后疫情时期制定相应的策略和措施提供理论指导和科学依据。     

The hospital library and the enterprise portal

At Exempla Healthcare, the medical librarians and the e-Business staff are creating an enterprise information portal where medical reference is targeted, easily accessible, and supported by the medical librarians. A team approach has been essential. The e-Business department has worked for nine months coordinating technical challenges required to support personalization, targeted communications, and a single access point for clinical patient data. Exempla medical librarians have been involved in the definition and design of information access needs from the very beginning. The Clinicians Portal was the first developed, with other customizations to follow. Many challenges remain, but by definition, a portal is designed to be flexible and adapt to the changing needs of the enterprise it supports.     

Medical journals and effective dissemination of health research

Clinical medical journals have not been effective in meeting the information needs of practitioners and bridging the gap between clinical research and practice. The slow adoption of results of clinical research is at least partly due to the failure of clinical journals to disseminate information in a way that would motivate practitioners to change practice. Although implementation is primarily a local process, medical journals are in a unique position to advance implementation by modifying their focus and adjusting their contents. Strategies that may be useful include publication of pre‐appraised evidence summaries and ‘clinical bottom‐lines’ and giving importance to systematic reviews and large evaluative research articles as they represent higher levels of evidence and have greater potential to change practice. Clinical journals should encourage researchers to consider how and by whom the findings will be used and provide information on implications for implementation such as possible strategies that may work, cost‐effectiveness, side‐effects and potential barriers to implementation. Medical journal publishers should explore ways to cooperate so that findings of landmark clinical trials could be shared thus reducing the ‘scatter’ of medical information. Electronic media offers numerous advantages such as quick accessibility and linking of information, and medical journals should capitalize on such innovations. There is a paradigm shift in health care practice as evidence is consciously and explicitly incorporated into individual patient care. Medical journals need to change to reflect this change in practice and provide practitioners with valid and relevant information.