How much effort is needed to keep up with the literature relevant for primary care?

OBJECTIVES: Medicine must keep current with the research literature, and keeping current requires continuously updating the clinical knowledge base (i.e., references that provide answers to clinical questions). The authors estimated the volume of medical literature potentially relevant to primary care published in a month and the time required for physicians trained in medical epidemiology to evaluate it for updating a clinical knowledge base. METHODS: We included journals listed in five primary care journal review services (ACP Journal Club, DynaMed, Evidence-Based Practice, Journal Watch, and QuickScan Reviews). Finding little overlap, we added the 2001 "Brandon/Hill Selected List of Print Books and Journals for the Small Medical Library." We counted articles (including letters, editorials, and other commentaries) published in March 2002, using bibliographic software where possible and hand counting when necessary. For journals not published in March 2002, we reviewed the nearest issue. Five primary care physicians independently evaluated fifty randomly selected articles and timed the process. RESULTS: The combined list contained 341 currently active journals with 8,265 articles. Adjusting for publication frequency, we estimate 7,287 articles are published monthly in this set of journals. Physicians trained in epidemiology would take an estimated 627.5 hours per month to evaluate these articles. CONCLUSIONS: To provide practicing clinicians with the best current evidence, more comprehensive and systematic literature surveillance efforts are needed.     

Determination of continuing medical education needs of clinicians from a literature search study, Part I. The study.

Continuing medical education is an area of current concern to health sciences librarians. A comprehensive study of literature searches requested by physicians and by fourth-year medical students serving their five-week preceptorship with a rural physician was conducted: (1) to determine if there is any pattern to the requests received so that areas of study for continuing medical education can be ascertained; and (2) to determine whether there is any appreciable difference in nature and complexity between those searches requested by clinicians and those requested by medical student preceptees. Literature search requests were examined in terms of individual MeSH subjects, subcategories, and categories for each subject covered in every search. This analysis has demonstrated that assessing the clinical problems of practicing physicians may be one method of determining needed continuing medical education topics.     

Changes in learning-resource use across physicians' learning episodes

INTRODUCTION: This study explores the numbers of learning resources physicians use at each stage in self-directed learning episodes addressing general problems. MATERIALS AND METHODS: A survey of a statewide random sample of doctors estimated the number of resources used at each stage in solving various general problems. RESULTS: The 50% response rate for faculty allowed generalization of findings to the population of these physicians; the rate for nonfaculty physicians was too low to allow generalization. Faculty findings showed (1) broader resource use in learning about diseases than diagnosis or therapeutics (2) comparable numbers of resources used in deciding whether to take on the learning problem and learning the required skills and knowledge, (3) greater numbers of resources selected to evaluate the problem and to learn the required skills and knowledge than to gain experience with the newly learned skills and knowledge, and (4) support for assertions that doctors value learning resources that are accessible, applicable, familiar, and time effective. DISCUSSION: The findings were interpreted in light of theory describing physicians' self-directed learning episodes, and implications are presented for physicians-in-training, physicians, and medical librarians.     

A study of clinical questions posed by hospital clinicians.

OBJECTIVE: This article presents the results of complementary research studies on the behaviors of hospital clinicians in asking clinical questions and the relationship between asking of questions, outcome of information searches, and success in problem solving. METHODS: Triangulation in research methods--a combination of mailed questionnaires, interviews, and a randomized controlled study--was employed to provide complementary views of the research problems under study. RESULTS: The survey and interviews found that clinical problems (concerned mainly with therapy and equipment or technology) were expressed as statements rather than questions (average number of concepts = 1.7), that only slightly more than half (higher for doctors) of problems could be solved, and that the majority of clinical questions were not well formed. An educational workshop however improved clinicians' formulation of questions, but the use of structured prompting was found to improve building of hypotheses in the doctors' group without training. The workshop also improved satisfaction with the obtained information and success in problem solving. Nonetheless, for both the experimental and control groups, more structured and complete questions or statements did not mean higher success rates in problem solving or higher satisfaction with obtained information. CONCLUSION: The triangulation methods have gathered complementary evidence to reject the hypothesis that building well-structured clinical questions would mean higher satisfaction with obtained information and higher success in problem solving.     

The role of expert searching in the Family Physicians' Inquiries Network (FPIN).

OBJECTIVE: This article describes the contributions of medical librarians, as members of the Family Physicians' Inquiries Network (FPIN), to the creation of a database of clinical questions and answers that allows family physicians to practice evidence-based medicine using high-quality information at the point of care. The medical librarians have contributed their evidence-based search expertise and knowledge of information systems that support the processes and output of the consortium. METHODS: Since its inception, librarians have been included as valued members of the FPIN community. FPIN recognizes the search expertise of librarians, and each FPIN librarian must meet qualifications demonstrating appropriate experience and training in evidence-based medicine. The consortium works collaboratively to produce the Clinical Inquiries series published in family medicine publications. RESULTS: Over 170 Clinical Inquiries have appeared in Journal of Family Practice (JFP) and American Family Physician (AFP). Surveys have shown that this series has become the most widely read part of the JFP Website. As a result, FPIN has formalized specific librarian roles that have helped build the organizational infrastructure. CONCLUSIONS: All of the activities of the consortium are highly collaborative, and the librarian community reflects that. The FPIN librarians are valuable and equal contributors to the process of creating, updating, and maintaining high-quality clinical information for practicing primary care physicians. Of particular value is the skill of expert searching that the librarians bring to FPIN's products.     

Intergroup,Interpersonal, and Intercultural Nature of Patient–Provider Communication: A Comparison of IMG and USMG Physicians

Using communication accommodation theory as a framework, this study explores and compares communication patterns of international medical graduate (IMG) physicians and United States medical graduate (USMG) physicians in intergroup, interpersonal, and intercultural context. Given that every fourth doctor practicing medicine in the U.S. is an internationally trained physician (AMA-IMG, 2010) an examination of the influence on patient-provider communication involving IMG physician and comparison with USMG physician is warranted. In a national survey of IMG and USMG physicians, the participants self-reported their perceptions of communication behaviors they used during a medical interaction. Although no difference was found between IMG and USMG physicians use of communication accommodation strategies during medical interaction, IMG physicians reported practicing significantly more relational communication than their U.S. counterparts. USMG physicians reported greater difficulty in communication owing to differences in culture than IMG physicians. Implication of findings for patient-centered communication, patient-physician relationship, and communication skills training is discussed.     

PIER- evidence-base medicine from ACP

PIER has been available directly to physicians from the American College of Physicians (ACP) for some time, but it has only recently become available to libraries via the STAT!Ref suite of electronic resources. PIER is designed specifically for the practicing internist, and it offers a uniform search structure that is meant to be searched the way physicians work through their medical cases, going from diagnosis to treatment. All of the information content in PIER is evidence-based and consists of clinical practice guidelines and recommendations.     

The Influence of Medical Orientation on Perceived Physician Credibility

This study assessed whether two medical orientations of physicians—biomedical vs biopsychosocial—influenced individuals’ perceptions of physician credibility. Participants read a vignette describing a physician communicating either a predominantly biomedical or a predominantly biopsychosocial orientation and then completed the Measure of Source Credibility in reference to the physician. Results indicate that physicians who display a biopsychosocial orientation were rated higher in perceived competence, character, and caring. Future researchers should address various effects of the medical context on physician credibility and how patients’ preferences regarding physicians’ medical orientation influence choice of and communication with physicians, patient satisfaction, and compliance.     

Factors associated with successful answering of clinical questions using an information retrieval system

OBJECTIVES: Despite the growing use of online databases by clinicians, there has been very little research documenting how effectively they are used. This study assessed the ability of medical and nurse-practitioner students to answer clinical questions using an information retrieval system. It also attempted to identify the demographic, experience, cognitive, personality, search mechanics, and user-satisfaction factors associated with successful use of a retrieval system. METHODS: Twenty-nine students completed questionnaires of clinical and computer experience as well as tests of cognitive abilities and personality type. They were then administered three clinical questions to answer in a medical library setting using the MEDLINE database and electronic and print full-text resources. RESULTS: Medical students were able to answer more questions correctly than nurse-practitioner students before and after searching, but both had comparable improvements in the number of correct questions before and after searching. Successful ability to answer questions was also associated with having experience in literature searching and higher standardized test-score percentiles. CONCLUSIONS: Medical and nurse-practitioner students obtained comparable benefits in the ability to answer clinical questions from use of the information retrieval system. Future research must examine strategies that improve successful search and retrieval of clinical questions posed by clinicians in practice.     

医学知识发现中的医学概念及语义关系特征研究

为了研究医学知识创新对知识组织系统的需求特点,本文收集了医学科研课题中具有一定创新意义的内容,并基于MeSH词表和UMLS,探索了医学知识创新在概念及其语义关系层面的表达特征,分析了医学知识组织工具在医学知识创新的概念表达及语义表述中的作用,从医学知识发现与创新的角度,探讨了知识组织工具的发展方向.本文发现,医学研究中常见的语义关系是有限的,UMLS的54种语义关系的研究价值各有不同.而现有的知识组织工具不能完全适应医学知识创新对概念及其关系描述的需求.     

A specialized information center. The clinical neurology information center.

The history, philosophy, and methodology of a unique specialized medical information center are reported. The Clinical Neurology Information Center is an educational information service (giving its audience information which can be the basis for formulating their own questions) rather than an instructional information service (giving information in reply to questions). Clinical, as well as basic neuroscience, information is culled by professional neurologists from 855 medical periodicals. The essence of each article is summarized in a single sentence ("terse conclusions") or a bibliographic reference only is given; this material is published every two weeks in the Concise Clinical Neurology Review (CCNR). The format of the CCNR is such that the reader should be able to scan a very large amount of current literature by investing only twenty to thirty minutes every two weeks. The values of this system as well as some of its problems are discussed.     

The evolving role of the librarian in evidence-based medicine.

Librarians' participation in evidence-based medicine (EBM) is rooted in past practices, most notably in clinical medical librarianship. EBM extends the librarians' role beyond identification of the literature to involvement in practicing and teaching quality filtering and critical appraisal of the literature. These activities require librarians to acquire new knowledge and develop new skills. A professional development program for librarians at the Library of the Health Sciences (LHS) at the University of Illinois at Chicago (UIC) is described. The program's goals are to increase librarians' skills and support the EBM curricular initiative at the UIC College of Medicine (COM). The unique program has been a collaborative effort of the LHS and the COM. The locally developed classes provide librarians with instruction in clinical study designs, statistical concepts, and critical appraisal of the literature. Other interventions such as an EBM round table are also described. The programs' success is measured by librarians' growing involvement in EBM medical curricula, journal clubs, and morning reports. Additionally, librarians gained competence in new skills and professional satisfaction from working collegially with COM students, residents, and faculty.     

面向劣构问题求解的知识管理系统及其构建

首先介绍组织中大量存在的劣构问题的求解现状和存在的问题;其次,在分析面向特定领域劣构问题求解的知识管理系统研究和应用情况的基础上,研究劣构问题的特点及其求解过程,建立一般性劣构问题求解的过程模型,讨论劣构问题求解过程中的知识结构和信息结构,并提出其知识管理系统的设计和实现方式;最后给出系统应用实例。     

Bibliometric aspects of medical information in Arab countries

This paper discusses the current state and development of health and biomedical literature in Arab countries. The study concentrates on the Arabic sources of medical articles, and surveys and analyzes the size of the literature and its development in the past 100 years. Two aspects of these sources are covered: the Arab medical information sources published within the Arab region, and those published outside the region. This includes the quantity of material available within and outside the Arab region. The size of the Arab medical literature indicates that it is worthy of collection. Treatment of the Arab medical literature, a pressing and urgent issue, is needed to assist in the research and development of an Arab medical infrastructure.     

The impact of the hospital library on clinical decision making: the Rochester study.

In these times of economic constraint, libraries of all types are under increasing pressure to evaluate their services. Hospital libraries face a particular challenge because the goals of the health care system demand that the relevance of library services to patient care be determined. The hospital librarians in Rochester, New York, responded to this challenge by developing a research project that explored the impact of library services on clinical decision making. A systematically sampled group of 448 physicians in the Rochester area agreed to participate in the study between September 1990 and March 1991. The physicians were asked to request some information related to a current clinical case and then to evaluate its impact on the care of their patients. Senior medical staff or administrators acted as study facilitators in each of the fifteen participating hospitals. As a result of the information provided by the library, 80% of the 208 physicians who returned their questionnaires said that they probably or definitely handled some aspect of patient care differently than they would have handled it otherwise. Changes in the following specific aspects of care were reported by the physicians: diagnosis (29%), choice of tests (51%), choice of drugs (45%), reduced length of hospital stay (19%), and advice given to the patient (72%). Physicians also said that the information provided by the library contributed to their ability to avoid the following: hospital admission (12%), patient mortality (19%), hospital-acquired infection (8%), surgery (21%), and additional tests or procedures (49%). The physicians rated the information provided by the library more highly than that provided by other information sources such as diagnostic imaging, lab tests, and discussions with colleagues. In addition to confirming earlier research findings that information provided by hospital libraries is perceived by physicians as having a significant impact on clinical decision making, the results increase our store of scientific knowledge about the specific nature and extent of the impact of information provided by the hospital library.     

The medical library: its function in a clinical pharmacy program

Because of the many demands currently being made upon physicians, a Clinical Pharmacy Training Program has been established to assist them in a patient-oriented program of drug therapy. This program provides clinical training for students in the College of Pharmacy, North Dakota State University, and for our local hospital pharmacy interns and residents. Our Medical Library enters into this program by providing training in medical literature resources to students and staff involved in this program. Cooperation between the Medical Service, Pharmacy Service and Library Service, serves to promote our Medical Library as the resource and reference center at this hospital.     

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.