The value and impact of information provided through library services for patient care: a systematic review

OBJECTIVE: An updated systematic review was carried out of research studies looking at the value and impact of library services on health outcomes for patients and time saved by health professionals. METHODS: A comprehensive systematic search was undertaken of the published literature to September 2003 in ERIC, LISA, MEDLINE, PREMEDLINE, EMBASE, the Cochrane Controlled Trials Register and Google. Some handsearching was carried out, reference lists were scanned and experts in the field were contacted. Twenty-eight research studies of professionally led libraries for health-care staff, including clinical librarian projects, met the inclusion criterion of at least one health or 'time saved' outcome. Papers were critically appraised using internationally accepted criteria. Data were extracted and results were summarised using a narrative format as the studies were heterogeneous and precluded a statistical analysis. RESULTS: There is evidence of impact from both traditional and clinical librarian services. The higher quality studies of traditional services measured impacts of 37-97% on general patient care, 10-31% on diagnosis, 20-51% on choice of tests, 27-45% on choice of therapy and 10-19% on reduced length of stay. Four studies of clinical librarian projects suggested that professionals saved time as a result of clinical librarian input, and two of these studies showed evidence of cost-effectiveness. However, the clinical librarian studies were generally smaller, with poorer quality standards. CONCLUSIONS: Research studies suggest that professionally led library services have an impact on health outcomes for patients and may lead to time savings for health-care professionals. The available studies vary greatly in quality but the better quality studies also suggest positive impacts. Good practice can be gathered from these studies to guide the development of a pragmatic survey for library services that includes the direct effects for patients among the outcome measures.     

Quantifying elbow extension and elbow hyperextension in cricket bowling: a case study of Jenny Gunn

In this study a method for determining elbow extension and elbow abduction for a cricket bowling delivery was developed and assessed for Jenny Gunn who has hypermobility in both elbows and whose bowling action has been repeatedly queried by umpires. Bowling is a dynamic activity which is assessed visually in real time in a cricket match by an umpire. When the legality of a bowler's action is questioned by an umpire a quantitative analysis is undertaken using a marker based motion analysis system. This method of quantifying elbow extension should agree with a visual assessment of when the arm is "straight" and should minimise the effects of marker movement. A set of six markers on the bowling arm were used to calculate elbow angles. Differences of up to 1° for elbow extension and up to 2° for elbow abduction were found when angles calculated from the marker set for static straight arm trials were compared with measurements taken by a chartered sports physiotherapist. In addition comparison of elbow extension angles at ball release calculated from the markers during bowling trials with those measured from high speed video also showed good agreement with mean differences of 0°±2°.     

Enlightenment and measurement - a way to improve health among high school students

Abstract This paper examines the effect of participating in a web-based health programme that promotes personal tracking of high school students' own measurements of a number of health-related parameters. Danish cross-sectional survey data were used to examine the effects of the health programme on various health measures. Both quantile regression models and standard ordinary least squares (OLS) models were used to explore the correlations between the students' participation in the health programme and their body mass index (BMI), body fat percentage, aerobic fitness, and well-being. Participation in the health programme increased BMI and aerobic fitness among students with a BMI or an aerobic fitness value ranging from the 25th percentile to the 75th percentile and reduced body fat percentage among students with the highest percentages of body fat. In addition, the health programme led to an increased feeling of wellbeing among students, especially those with high BMI levels and poor aerobic fitness. As the schools participated in the health programme on voluntary basis and at a financial cost to themselves, the positive effects of participation found can only be stated to be valid among students from committed schools.     

The lived experience of knowing in childbirth

Research on knowing in childbirth has largely been a quantitative process. The purpose of this study was to understand the ways first-time mothers learn about birth. A phenomenological approach, using a feminist view, was used to analyze two in-depth interviews and journals to understand nine first-time expectant mothers' experiences of knowing in childbirth. The findings demonstrated a range of knowledge that contributed to issues of control and conflict. The participants also described an increased dependency on their mothers and a lack of their own intuition contiguous to the birth process. These findings contribute understanding to how expectant mothers know birth, suggesting that their knowing does not diminish conflict surrounding the event and may even exacerbate it when not combined with learning skills to manage conflict. Childbirth educators may want to include instruction on negotiating power differential in relationships encountered during childbirth in order to strengthen a first-time mother's ability to receive the care she wants. Educators may also want to assess the expectant mother's view of birth and her expectations for birth. Schools of nursing should consider the inclusion of women-centered care curricula at both the undergraduate and graduate levels. The mothers' responses in this study clearly reveal that the politics surrounding birthing remain in place and must be removed in order to provide a supportive environment for normal birth.     

Correlates of sexual abuse and smoking among French adults

OBJECTIVE: The goal of this study was to examine the association between sexual abuse (SA) and initiation, cessation, and current cigarette smoking among a large representative adult population in France. METHOD: A random sample size of 12,256 adults (18-75 years of age) was interviewed by telephone concerning demographic variables, health practices and beliefs, and health status--for which SA and tobacco questions were included. Bivariate and multivariate analyses were conducted. RESULTS: Nearly 46% of SA survivors were current smokers compared to 34% of non-abused persons (p<.001). Survivors of SA consumed more cigarettes per day than non-abused individuals (14.5 vs. 12.4, p<.01). Survival analysis showed an increased risk of smoking initiation for respondents abused before 18 (adjusted relative hazard=1.55; p<.0001) with referent to the non-abused group. SA was not found to be a significant predictor of current smoking status among those who began smoking after the first incident of SA. Respondents who were not sexually abused were 1.8 times (95% CI, 1.12-2.99) more likely to quit smoking than people who began smoking after they were sexually abused. CONCLUSIONS: The early identification and treatment of sexually abused persons is critical to decrease smoking among adolescents and adults because of the association of SA with both smoking initiation and decreased cessation rates. It may be more difficult to detect an association between SA and current smoking due to the high rates of smoking and lower rates of quitting among the general French population.