A rapid evidence‐based service by librarians provided information to answer primary care clinical questions

Background: A librarian consultation service was offered to 88 primary care clinicians during office hours. This included a streamlined evidence‐based process to answer questions in fewer than 20 min. This included a contact centre accessed through a Web‐based platform and using hand‐held devices and computers with Web access. Librarians were given technical training in evidence‐based medicine, including how to summarise evidence. Objectives: To describe the process and lessons learned from developing and operating a rapid response librarian consultation service for primary care clinicians. Methods: Evaluation included librarian interviews and a clinician exit satisfaction survey. Results: Clinicians were positive about its impact on their clinical practice and decision making. The project revealed some important ‘lessons learned’ in the clinical use of hand‐held devices, knowledge translation and training for clinicians and librarians. Conclusions: The Just‐in‐Time Librarian Consultation Service showed that it was possible to provide evidence‐based answers to clinical questions in 15 min or less. The project overcame a number of barriers using innovative solutions. There are many opportunities to build on this experience for future joint projects of librarians and healthcare providers.     

Physical Therapy Management of a Patient on Portable Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation: A Case Report

Introduction

Although the life expectancy for patients with cystic fibrosis (CF) has increased dramatically in the preceding decades, often the final therapeutic option for patients with end-stage CF is lung transplantation. Prior to transplantation, patients with severe disease may require mechanical ventilation. Those refractory to mechanical ventilation may require extracorporeal membrane oxygenation (ECMO). The purpose of this case report is to describe the physical therapy management of a patient who received ECMO as a bridge to lung transplantation.

Case Presentation

A 16-year-old girl with severe acute respiratory failure due to a CF exacerbation eventually required ECMO to maintain adequate gas exchange. While on ECMO, she received physical therapy interventions ranging from therapeutic exercise, manual therapy, and integumentary protection techniques in addition to airway clearance techniques. Prior to her transplant, she was standing multiple times per day with moderate assistance, was sitting on the edge-of-bed, as well as taking steps to transfer to/from a chair. She successfully received a bilateral lung transplant after 8 days on ECMO.

Conclusion

Physical therapy interventions, including out-of-bed mobility, can be safely provided to patients on portable ECMO as a bridge to lung transplantation. These interventions were focused on preventing the negative sequelae of bed rest, increasing her strength and endurance, as well as improving her level of consciousness and psychological well being in preparation for lung transplantation.Key Words: extracorporeal membrane oxygenation, lung transplantation, physical therapy, exercise     

School improvement plans and student learning in Jamaica

A school improvement program that provided support to poor-performing schools on the basis of needs identified in a school improvement plan was implemented in 72 government schools in Jamaica, from 1998 to 2005. In this independent evaluation of the program, we use propensity score matching to create, post hoc, a control group of schools that were similar to program schools in the baseline year. By the final year of the program, we find that program schools had received more inputs to improve literacy and numeracy than control schools, and that some inputs associated with the program were correlated with improvements school average achievement: supplementary reading materials, additional training for reading resource teachers, and functioning computers. At the student level, however, we find no evidence that students enrolled in program schools achieved higher reading or math scores than those in control schools. We suggest three possible reasons for this: (a) the lack of sensitivity of the learning measures to improvements at the lower end of the scales; (b) the availability of program-like inputs in non-program schools, provided by other programs and donors; and (c) the growth in student enrollment in the program schools, which may have diluted the program effect for incoming students in upper grades. Schools with school improvement plans did not outperform comparable schools that did not have these plans.     

Health information resources: tradition and innovation in a medical school curriculum

Changes in LCME accreditation for medical colleges fostered the development of Health Information Resources, a required, for-credit course created by the Saint Louis University Health Sciences Center Library Reference Department for the first-year medical school curriculum. Six content areas were developed for inclusion in the syllabus: "Electronic Resources Survival Kit"; "Introduction to Problem Based Resources"; "Introduction to Literature Searching"; "MEDLINE Searching Hands-On/Publishing Pearls & Pitfalls"; "The World Wide Web and Patient Information"; and "Introduction to Electronic Mail." A combination of lectures, hands-on instruction, and active learning techniques were employed in the teaching of this class. Submission of a Health Information Resource Guide and a two-part final exam were required.     

Preliminary comparison of the performance of the National Library of Medicine's systematic review publication type and the sensitive clinical queries filter for systematic reviews in PubMed

Objective:The National Library of Medicine (NLM) inaugurated a “publication type” concept to facilitate searches for systematic reviews (SRs). On the other hand, clinical queries (CQs) are validated search strategies designed to retrieve scientifically sound, clinically relevant original and review articles from biomedical literature databases. We compared the retrieval performance of the SR publication type (SR[pt]) against the most sensitive CQ for systematic review articles (CQrs) in PubMed.Methods:We ran date-limited searches of SR[pt] and CQrs to compare the relative yield of articles and SRs, focusing on the differences in retrieval of SRs by SR[pt] but not CQrs (SR[pt] NOT CQrs) and CQrs NOT SR[pt]. Random samples of articles retrieved in each of these comparisons were examined for SRs until a consistent pattern became evident.Results:For SR[pt] NOT CQrs, the yield was relatively low in quantity but rich in quality, with 79% of the articles being SRs. For CQrs NOT SR[pt], the yield was high in quantity but low in quality, with only 8% being SRs. For CQrs AND SR[pt], the quality was highest, with 92% being SRs.Conclusions:We found that SR[pt] had high precision and specificity for SRs but low recall (sensitivity), whereas CQrs had much higher recall. SR[pt] OR CQrs added valid SRs to the CQrs yield at low cost (i.e., added few non-SRs). For searches that are intended to be exhaustive for SRs, SR[pt] can be added to existing sensitive search filters.