Integrating knowledge-based resources into the electronic health record: history, current status, and role of librarians

Satisfying clinical information needs remains a major challenge in medicine, underscored by recent studies showing high medical error rates and suboptimal physician adherence to evidence-based practice guidelines. Advanced clinical decision support systems can improve practitioner performance and patient outcomes. Similarly, integrating online information resources into electronic health records (EHRs) shows great potential for positively impacting health care quality. This paper explores the evolution and current status of knowledge-based resource linkages within EHRs, including the benefits and drawbacks, as well as the important role librarians can play in this process.     

Growth in biomedical publications and scientific institutions in the Emirates (1998–2004): an Arabian renaissance?

OBJECTIVES: The United Arab Emirates is witnessing a rapid development in population and infrastructure, leading to an expansion in the educational field and the health care system, including universities, hospitals and research institutes. One potential outcome of this development is an increase in biomedical research publications. This was examined in this study. METHOD: Searches were made of three databases; PubMed, Current Contents and embase. All records from these databases related to the Emirates were downloaded and cross-referenced. Duplications were removed as well as erroneous records. A total of 1369 publications during 1998-2004 were obtained. RESULTS: Analysis of these records revealed that the Faculty of Medicine and Health Sciences, located at the federal University, was responsible for 48% of all biomedical publications. All hospitals together accounted for 24%, while other universities and other research institutes accounted for 13 and 14% respectively. Further analysis revealed that there had been no further growth in the number of publications since 1998. This is in contrast to the increasing number of institutions that have been set up in the 1998-2004 period; from 29 to 112. CONCLUSION: The Emirates are witnessing a rapid development in universities, colleges, hospitals and research centres. The ratio of publications, as yet, has not kept up with this development. The enormous growth in institutes, however, may, in time, herald an Arabian renaissance in scientific activity and related publications.     

Evaluating the impact of library user training programmes across Thames Valley Strategic Health Authority in the UK

BACKGROUND: This study was undertaken to provide evidence that library outreach projects in the NHS in the Thames Valley Strategic Health Authority area were effective and could justify continued funding. Objectives: The object was to assess whether information literacy skills training taken up by health professionals impacts on their confidence and skills in using electronic sources of health information. METHOD: A total of 487 health professionals taking up training on a voluntary basis were assessed by completing a self-assessment questionnaire prior to and after training to establish their information literacy skills and confidence levels. Of these, 223 trainees (46%) also returned 6-week follow-up questionnaires. RESULTS: Results showed that 464 trainees (95%) intended to apply what they had learnt in a variety of ways; use of specific resources greatly increased after training and confidence in using them increased substantially. Use of search techniques increased considerably overall, whereas use of Google decreased. CONCLUSIONS: The major findings of this research are that training health-care personnel in the use of electronic resources impacts positively on their information literacy skills and confidence, and that the information available to them is considered to have potential value across health-care practice.     

Developing a database of behavioural medicine interventions

OBJECTIVE: To describe the development of the Cochrane Behavioral Medicine Field database of interventions and its contribution to the knowledge base of this field. METHODS: A list of behavioural medicine interventions was solicited from content experts. The resulting list of index terms was used to generate a comprehensive search strategy to retrieve relevant records, and a thesaurus of terms with which to index them. The records are included in a register. A subset of records have been coded for study design, health condition, intervention, study participants, setting and provider and made available in a public online database. RESULTS: The Cochrane Behavioral Medicine Field database consists of over 3500 records of systematic reviews, meta-analyses and randomized controlled trials for public educational use. CONCLUSIONS: The register provides a comprehensive listing of studies relating to behavioural medicine interventions. The public online database enables easy access to the evidence base and provides enhanced details of the studies included on it. These databases are a valuable resource for the behavioural medicine community. Other fields are encouraged to duplicate these methods in the design of content-specific databases.     

Strategies for incorporating cultural competence into childbirth education curriculum

Cultural competence affects all interactions with prospective parents and families. Childbirth educators need to assess their own cultural competence, beginning with an understanding of their own background and how it affects interactions with families. The purpose of this article is to enhance the incorporation of cultural competency, cultural awareness, and cultural sensitivity into the childbirth education curricula. Methods for enhancing cultural competence in a multicultural global society are discussed. Strategies are also presented to address the challenges of assessing parents and families of diverse cultures and their beliefs, traditions, and special needs in the plan of care.     

Providing Bottom-Up Support to Middle School Science Teachers’ Reform Efforts in Using Inquiry-Based Kits

Middle grades science teachers need professional support in practice as they implement new inquiry-based science. Professional development schools can provide this bottom-up support through connecting preservice and inservice teacher education programs in classroom practice. In this study, coteaching arrangements with secondary science education majors provided additional teachers in the classroom to support a materials-rich curriculum and the needed associated pedagogies. Science education majors provided needed assistance in troubleshooting difficulties with the new curriculum. They also provided needed content knowledge to support inquiry, along with creating moments and space for teachers to reflect on inquiry practice. Ongoing assistance by preservice teachers allowed inservice teachers to progress from logistical concerns in implementing kit curriculum to concerns regarding student learning and the supporting professional development.

Temporal integration in Pavlovian appetitive conditioning in rats

We used an appetitive sensory preconditioning procedure to investigate temporal integration in rats in two experiments. In Phase 1, rats were presented with simultaneous compound trials on which a 10-sec conditioned stimulus (CS) X was embedded within a 60-sec CS A. In Group Early, CS X occurred during the early portion of CS A, whereas in Group Late, CS X occurred during the latter portion of CS A. In Phase 2, CS X was paired simultaneously with sucrose. On a subsequent test with CS A, the rate of magazine entries peaked during the early portions of the stimulus in Group Early and during the latter portions of the stimulus in Group Late (Experiments 1 and 2). Similar response peaks were not observed on tests with a control stimulus that had been presented in compound with a stimulus that did not signal reward (Experiment 2).     

Flavor-evaluative conditioning is unaffected by contingency knowledge during training with color-flavor compounds

In two experiments, participants inspected and drank a series of drinks, half of which contained sugar and half unpalatable Tween20 (tween). Each sugar and tween drink had a particular flavor and color. Following this training, the flavors of the sugar drinks were assigned higher hedonic evaluations than were those of the tween drinks, even though the participants did not reliably report which flavors had been present in the sugar and tween drinks during training. Moreover, the evaluative conditioning of the flavors was unaffected by whether or not the colors alone had been pretrained to predict the presence of sugar or tween in the drinks. In accord with Baeyens, Eelen, van den Bergh, and Crombez (1990), we conclude that flavor-evaluative conditioning is not mediated by contingency learning.     

Maintenance of responding when reinforcement becomes delayed

In four experiments with rats, we examined the persistence of behavior when reinforcement was switched from immediate to delayed. In Experiment 1, lever pressing elicited by instrumental training with immediate reinforcement continued when a 20-sec delay of reinforcement was introduced (easy-to-hard condition), whereas when the delay condition was introduced from the start (hard-to-hard condition), responding remained low throughout. A similar result was obtained in Experiment 2, in which lever pressing was elicited by a classical conditioning (autoshaping) procedure. In Experiment 3, rats initially trained with delayed reinforcement continued to respond at a low rate when switched to immediate reinforcement (hard-to-easy condition). By measuring magazine entry (goal tracking) as well as lever pressing (sign tracking) in Experiment 4, we confirmed that such transfer effects at least partly involve the persistence of whatever type of behavior was initially dominant.