Search PubMed⌕ Search

Biomedical subjects

K A McKibbon

Publications and source records attributed to K A McKibbon.

At least 19 recordsLinked to original sources
PubMed2006

Lost in publication: Half of all renal practice evidence is published in non-renal journals.

Physicians often scan a select number of journals to keep up to date with practice evidence for patients with kidney conditions. This raises the question of where relevant studies are published. We performed a bibliometric analysis using 195 renal systematic reviews. Each review used a comprehensive method to identify all primary studies for a focused clinical question relevant to patient care. We compiled all the primary studies included in these reviews, and considered where each study was published. Of the 2779 studies, 1351 (49%) were published in the top 20 journals. Predictably, this list included Transplantation Proceedings (5.9% of studies), Kidney International (5.3%), American Journal of Kidney Diseases (4.7%), Nephrology Dialysis Transplantation (4.3%), Transplantation (4.2%), and Journal of the American Society of Nephrology (2.4%). Ten non-renal journals were also on this list, including New England Journal of Medicine (2.4%), Lancet (2.3%), and Diabetes Care (2.2%). The remaining 1428 (51%) studies were published across other 446 journals. When the disciplines of all journals were considered, 59 were classified as renal or transplant journals (42% of articles). Other specialties included general and internal medicine (16%), endocrinology (diabetes) and metabolism (6.5%), surgery (6.2%), cardiovascular diseases (6.1%), pediatrics (4.3%), and radiology (3.3%). About half of all renal practice evidence is published in non-renal journals. Browsing the top journals is important. However, relevant studies are also scattered across a large range of journals that may not be routinely scanned by busy physicians, and keeping up with this literature requires other continuing education strategies.

Evidence-Based Medicine↗
PubMed2001

Posing clinical questions: framing the question for scientific inquiry.

Much of nursing practice is (and always has been) based on information generated through inquiry. Finding the best answers quickly and effectively for the questions that arise in the clinical setting facilitates care, increases nursing efficiency, and improves patient outcome and satisfaction. Posing clinical questions also can help nurses identify and fill in gaps in knowledge, keep up with advances in clinical practice, and strengthen interactions with their peers, team members, and patients and their families. Formulating clinical questions that lead to sound, evidence-based answers to resolve clinical problems or direct patient-care decisions takes time and practice. The information in this article will assist nurses to develop the skill of framing clinical questions efficiently and effectively.

Decision Making↗
PubMed2001

Enhancing retrieval of best evidence for health care from bibliographic databases: calibration of the hand search of the literature.

BACKGROUND: Medical practitioners have unmet information needs. Health care research dissemination suffers from both "supply" and "demand" problems. One possible solution is to develop methodologic search filters ("hedges") to improve the retrieval of clinically relevant and scientifically sound study reports from bibliographic databases. To develop and test such filters a hand search of the literature was required to determine directly which articles should be retrieved, and which not retrieved. OBJECTIVE: To determine the extent to which 6 research associates can agree on the classification of articles according to explicit research criteria when hand searching the literature. DESIGN: Blinded, inter-rater reliability study. SETTING: Health Information Research Unit, McMaster University, Hamilton, Ontario, Canada. PARTICIPANTS: 6 research associates with extensive training and experience in research methods for health care research. MAIN OUTCOME MEASURE: Inter-rater reliability measured using the kappa statistic for multiple raters. RESULTS: After one year of intensive calibration exercises research staff were able to attain a level of agreement at least 80% greater than that expected by chance (kappa statistic) for all classes of articles. CONCLUSION: With extensive training multiple raters are able to attain a high level of agreement when classifying articles in a hand search of the literature.

Databases, Bibliographic↗
PubMed2000

Interventions for helping patients to follow prescriptions for medications.

BACKGROUND BACKGROUND: Efforts to assist patients with adherence to prescribed, self-administered medications might improve the benefits and efficiency of health care. OBJECTIVES OBJECTIVE: To update an ongoing review summarising the results of randomised controlled trials (RCTs) of interventions to help patients follow prescriptions for medications, focusing on trials that measured both adherence and clinical outcomes. SEARCH STRATEGY: Computerised searches to July 1998 in MEDLINE, CINAHL, The Cochrane Library, International Pharmaceutical Abstracts (IPA), PsychInfo, Sociofile, and HSTAR; bibliographies in articles on patient adherence; articles in the reviewers' personal collections; and contact with authors. SELECTION CRITERIA: Articles were selected if they reported an unconfounded RCT of an intervention to improve adherence with prescribed medications, measuring both medication adherence and treatment outcome, with at least 80% follow-up of each group studied and, for long-term treatments, at least six months follow-up for studies with positive initial findings. DATA COLLECTION AND ANALYSIS: Information on study design features, interventions and controls, and findings were extracted by one reviewer (PM) and a research assistant and confirmed by two of the other reviewers. The studies were too disparate to warrant meta-analysis. MAIN RESULTS: For short-term treatments, one study, of counselling and written information, showed an effect on adherence and clinical outcome. Ten of 19 interventions for long-term treatments reported in 17 RCTs were associated with improvements in adherence, but only nine interventions led to improvements in treatment outcomes. Almost all of the interventions that were effective for long-term care were complex, including combinations of more convenient care, information, counselling, reminders, self-monitoring, reinforcement, family therapy, and other forms of additional supervision or attention. Even the most effective interventions did not lead to large improvements in adherence and treatment outcomes. Two studies showed that telling patients about adverse effects of treatment did not affect their adherence. REVIEWER'S CONCLUSIONS: The full benefits of medications cannot be realised at currently achievable levels of adherence. Current methods of improving adherence for chronic health problems are mostly complex and not very effective. More studies of innovative approaches to assist patients to follow medication prescriptions are needed.

Drug Prescriptions↗
PubMed1998

Evidence-based practice.

Evidence-based practice (EBP) is spreading in popularity in many health care disciplines. One of its main features is the reliance on the partnership among hard scientific evidence, clinical expertise, and individual patient needs and choices. Librarians play an important role in the spread of EBP because of the importance of identifying and retrieving appropriate literature from various sources for use in making health care decisions. This article gives an overview of how to search for therapy, diagnosis, etiology, and prognosis both for original studies and secondary publications such as systematic reviews, meta-analyses, and clinical practice guidelines. Understanding how this research is done, how it is indexed, and how to retrieve the clinical evidence are an important set of skills that librarians can provide for clinicians interested in EBP.

Evidence-Based Medicine↗
PubMed1997

Canadian physicians' attitudes about and preferences regarding clinical practice guidelines.

OBJECTIVE: To assess Canadian physicians' confidence in, attitudes about and preferences regarding clinical practice guidelines. DESIGN: Cross-sectional, self-administered mailed survey. PARTICIPANTS: Stratified random sample of 3000 Canadian physicians; 1878 (62.6%) responded. SETTING: Canada. OUTCOME MEASURES: Physicians' use of various information sources; familiarity with and confidence in guidelines; attitudes about guidelines and their effect on medical care; rating of importance of guidelines and other sources of information in clinical decision-making; rating of importance of various considerations in deciding whether to adopt a set of guidelines; and rating of usefulness of different formats for presenting guidelines. MAIN RESULTS: In all, 52% of the respondents reported using guidelines at least monthly, substantially less frequently than traditional information sources. Most of the respondents expressed confidence in guidelines issued by various physician organizations, but 51% to 77% were not confident in guidelines issued by federal or provincial health ministries or by health insurance plans. The respondents were generally positive about guidelines (e.g., over 50% strongly agreed that they are a convenient source of advice and good educational tools); however, 22% to 26% had concerns about loss of autonomy, the rigidity of guidelines and decreased satisfaction with medical practice. Endorsement by respected colleagues or major organizations was identified as very important by 78% and 62% of the respondents respectively in deciding whether to adopt a set of guidelines in their practice. User friendliness of the guidelines format was thought to be very important by 62%; short pamphlets, manuals summarizing a number of guidelines, journal articles and pocket cards summarizing guidelines were the preferred formats (identified as most useful by 50% to 62% of the respondents). CONCLUSIONS: Canadian physicians, although generally positive about guidelines and confident in those developed by clinicians, have not yet integrated the use of guidelines into their practices to a large extent. Our results suggest that respected organizations and opinion leaders should be involved in the development of guidelines and that the acceptability of any proposed format and medium for guidelines presentation should be pretested.

Attitude of Health Personnel↗
PubMed1997

Locating and appraising systematic reviews.

Several methods can be used to identify systematic reviews. These include bibliographic databases, such as MEDLINE, Best Evidence, and the Cochrane Library. In the future, the Cochrane Library could become the source of choice for systematic reviews because it provides the full text for Cochrane reviews and citations to many other systematic reviews. Moreover, the Library is growing rapidly and becoming more readily available, and its searching capabilities are being improved with each update. Although Best Evidence contains fewer systematic reviews than the Cochrane Library, it is specifically designed for practicing internists and primary care physicians and includes systematic reviews on diagnosis, cause, prognosis, and quality improvement. At present, however, MEDLINE and other bibliographic databases are probably the most up-to-date and readily available sources of systematic reviews. Systematic reviews are a powerful and useful way to assemble evidence; however, just because a review has been done using systematic review methods does not guarantee that its results are credible. Regardless of the source, all systematic reviews (like all types of research evidence) require critical appraisal to determine their validity and to establish whether and how they will be useful in practice.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1996

Systematic review of randomised trials of interventions to assist patients to follow prescriptions for medications.

BACKGROUND: Low adherence of patients to prescribed, self-administered medical interventions is ubiquitous. Low adherence limits the benefits of current medical care. Efforts to assist patients to follow treatments might improve the efficiency of care and substantially enhance benefits. Our objective was to summarise the results of randomised controlled trials (RCTs) of interventions to help patients follow prescriptions for medications. METHODS: A previous systematic review was updated through computerised searches in Medline, International Pharmaceutical Abstracts, Psychinfo, and HSTAR online databases; bibliographies in articles on patient adherence; articles in the reviewers' personal collections; and contact with authors. Articles were judged of interest if they reported original data concerning an unconfounded RCT of an intervention to improve adherence with prescribed medications, with one or more measure of medication adherence, one or more measure of treatment outcome, at least 80% follow-up of each group studied, and, for long-term treatments, at least 6 months of follow-up for studies with positive initial findings. Information on study design features, interventions and controls, and findings were extracted by one reviewer (RK) and checked by the other two reviewers. FINDINGS: 1,553 relevant citations and abstracts were screened, 252 full text articles were reviewed in detail, and 13 RCTs met all criteria. The studies were too disparate in clinical problems, adherence interventions, measures and reporting of adherence, and the clinical outcomes studied to warrant meta-analysis. Seven of 15 interventions were associated with improvements in adherence and six interventions led to improvements in treatment outcomes. For short-term treatments, one study showed an effect on adherence and outcome of counselling and written information. The interventions that were effective for long-term care were complex, including various combinations of more convenient care, information, counselling, reminders, self-monitoring, reinforcement, family therapy, and other forms of additional supervision or attention. Even the most effective interventions did not lead to substantial improvements in adherence. INTERPRETATION: Although adherence and treatment outcomes can be improved by certain-usually complex-interventions, full benefits of medications cannot be realised at currently achievable levels of adherence. It is time that additional efforts be directed towards developing and testing innovative approaches to assist patients to follow treatment prescriptions.

Drug Therapy↗
PubMed1995

The quality and impact of MEDLINE searches performed by end users.

Evidence suggests that MEDLINE is becoming an important clinical tool that can improve the care and health of patients. Efforts to improve the quality and impact of end-user searching are needed and ongoing. End users are completing many MEDLINE searches. They appreciate and value training along with feedback on their searching techniques. Practice, is however, the biggest single factor in improving the quality of searching. Key roles for the library in end-user searching include, providing the most effective MEDLINE access possible to the maximum number of users, and providing training that includes feedback and practice opportunities. System-wide advances in structured abstracts, indexing, system design, informatics research and the literature itself will make searching easier and more effective in the future. More important than the quality of search results per se is the impact that end-user searches have on patient care and patient outcomes. Growing evidence shows that both patient care and patient outcomes are improved by end-user searches.

Abstracting and Indexing↗
PubMed1995

Reasons for the loss of sensitivity and specificity of methodologic MeSH terms and textwords in MEDLINE.

OBJECTIVE: To determine the reasons for the loss of sensitivity and specificity of methodologic MeSH terms and textwords in MEDLINE for identifying sound clinical studies of the etiology, prognosis, diagnosis, prevention, or treatment of disorders in adult general medicine. DESIGN: Analytic survey of the information retrieval properties of methodologic MeSH terms and textwords selected to detect studies meeting basic methodologic criteria for direct clinical use in general adult medicine. MEASURES: Frequency of non-use and misuse of relevant methodologic MeSH terms and textwords among studies meeting and not meeting the basic criteria for clinical practice as determined by the manual review (the gold standard) of all articles in 10 internal and general medicine journals for 1986 and 1991. RESULTS: Loss of sensitivity due to the non-use of relevant methodologic terms among articles meeting basic methodologic criteria was more pronounced in the areas of diagnosis, prognosis, and etiology than treatment in 1991 and 1986. The use of relevant methodologic terms has improved from 1986 to 1991 in all areas except prognosis. Loss of specificity due to the use of relevant methodologic terms among articles not meeting basic methodologic criteria occurred most frequently in the areas of treatment and etiology. CONCLUSIONS: Although the appropriate use of methodologic MeSH and textwords has improved from 1986 to 1991 among studies meeting basic methodologic criteria for direct clinical use in general adult medicine much improvement is still needed in the areas of diagnosis, prognosis, and etiology. Improvement is needed in assigning the relevant methodologic index terms to studies that meet the methods criteria and in having the authors use the relevant methodologic textwords in the title or abstract. Some improvement is also needed in not using methodologic terms when the study clearly does not meet the methods criteria.

Abstracting and Indexing↗
PubMed1995

Preliminary assessment of the effect of more informative (structured) abstracts on citation retrieval from MEDLINE.

OBJECTIVE: To compare the recall and precision of citation retrieval from MEDLINE when searching in journals containing traditional abstracts with journals containing abstracts prepared according to the guidelines of more informative abstracts (MIAs) for clinical journal articles. DESIGN: Analytic survey of operating characteristics of MeSH terms and textwords selected to detect studies meeting basic methodological criteria for direct clinical use in general adult medicine in priority journals with and without MIAs. MEASURES: The sensitivity, specificity, and precision of search terms were determined by comparison with a manual review of all articles (the gold standard) in 10 internal and general medicine journals for 1986 and 1991. The performance of each search term was compared before and after the implementation of MIAs and in two journal sets with and without MIAs in 1991. RESULTS: The sensitivity of some terms increased with the use of MIAs and also increased by the same amount in journals with usual abstracts in 1991 compared to 1986. The use of MIAs had the greatest impact in the areas of etiology and prognosis. Many MeSH and textwords had comparable performance before and after the implementation of MIAs and between journals with and without MIAs in 1991. CONCLUSIONS: More informative abstracts improved the retrieval properties of some, but not all, textwords and medical subject headings. Further work may be needed to enhance the effects of MIAs on bibliographic retrieval.

Abstracting and Indexing↗
PubMed1994

Quantitative comparison of pre-explosions and subheadings with methodologic search terms in MEDLINE.

OBJECTIVE: To compare the retrieval characteristics of subheadings with methodologic textwords and MeSH terms in MEDLINE for identifying sound clinical studies on the etiology, prognosis, diagnosis, prevention and treatment of disorders in general adult medicine. DESIGN: Analytic survey of the information retrieval properties of methodologic textwords, single methodologic MeSH terms, pre-explosions and subheadings selected to detect studies meeting basic methodologic criteria for direct clinical use in general adult medicine. MEASURES: The sensitivity, specificity, and precision of search terms were determined by comparing the citations retrieved by the search strategies in MEDLINE with that of a manual review (the gold standard) of all articles in 10 internal and general medicine journals for 1986 and 1991. RESULTS: For treatment and diagnosis in 1991, and treatment, diagnosis, and etiology in 1986, pre-explosions yielded the highest sensitivity, with typical absolute increases exceeding 15%. For etiology and prognosis in 1991, and prognosis in 1986, textwords or MeSH terms yielded the highest sensitivity. In all cases the increase in sensitivity was coupled with a loss in specificity and precision. CONCLUSIONS: Compared with searching with single methodologic textwords and subject headings, the detection of sound clinical studies on the diagnosis and treatment of disorders in general adult medicine was consistently enhanced by searching with pre-explosions, but at a price of decreased specificity and precision.

Abstracting and Indexing↗
PubMed1993

A program to enhance clinical use of MEDLINE. A randomized controlled trial.

OBJECTIVE: To determine if a preceptor and individualized feedback improves the performance of physicians in searching MEDLINE in clinical settings. DESIGN: Randomized controlled trial with 2 to 10 months follow-up. SETTING: A 300-bed teaching hospital. PARTICIPANTS: All 392 physicians and physicians-in-training from 6 major clinical departments were invited to participate if they made patient-care decisions during the study period; 79.4% agreed. INTERVENTIONS: All participants were given 2 hours of basic training, then randomized to a control group (no further intervention) or an intervention group in which each person chose a clinical preceptor experienced in MEDLINE searching and received individualized feedback from a study librarian on each of their 1st 10 searches. MAIN OUTCOME MEASURES: The number and proportion of relevant and irrelevant references retrieved for 1st, 4th, and 8th searches of participants were compared with independent librarian searches on the same topics. RESULTS: Intervention group members did not search more often than controls (5.9 searches per month versus 4.7, respectively; P = 0.26) and there were no significant differences in the quality of searches. Rather, search performance for both groups improved, with the average number of relevant references retrieved per search increasing from 4.5 to 7.4 (P < 0.01). The librarian retrieved more relevant citations than participants for the 1st search (P = 0.001) but not for the 4th (P = 0.60) or 8th (P = 0.76) searches. CONCLUSIONS: A program of assigning preceptors and providing feedback on individual searches did not enhance the quantity or quality of searches. Soon after a basic introduction to searching, however, clinicians in both groups improved their search performance.

Clinical Medicine↗
PubMed1993

Assessment of methodologic search filters in MEDLINE.

OBJECTIVE: To determine the retrieval characteristics of methodologic textwords and MeSH terms in MEDLINE for identifying methodologically sound studies on the etiology, prognosis, diagnosis, and prevention and treatment of disorders in general adult medicine. DESIGN: Comparison of methodologic search terms and phrases for the retrieval of citations in MEDLINE with a manual hand search of the literature (the gold standard) for 10 internal and general medicine journals for 1986 and 1991. MEASURES: Sensitivity (proportion of methodologically sound and correct topic studies retrieved) and specificity (proportion of unsound or wrong topic articles not retrieved) of the search strategies. RESULTS: The individual terms yielding the best sensitivity for 1991 by purpose category were: risk (tw) for etiology; exp cohort studies for prognosis; sensitivity (tw) for diagnosis; and clinical trial (pt) for treatment. The corresponding terms for 1986 were: risk (tw) for etiology; prognosis: (tw) for prognosis; sensitivity (tw) for diagnosis; and random: (tw) for treatment. CONCLUSIONS: The performance of methodologic MeSH terms and textwords varied greatly in MEDLINE and changed from 1986 to 1991. More complex search strategies may be required to optimize retrieval.

Information Storage and Retrieval↗
PubMed1992

Performance appraisal of online MEDLINE access routes.

OBJECTIVE: To compare the performance and cost of 11 online MEDLINE systems with MEDLINE at Elhill. DESIGN: Comparative study. SYSTEMS: Eleven online daytime systems commercially available in North America offering the MEDLINE database. MEASURES: Number of relevant citations, number of irrelevant citations, proportion of searches producing no relevant citations and cost per relevant citation were analyzed for each system. Relevance and cost for each system were compared with direct searching of MEDLINE through NLM for librarian and clinician search strategies for 18 clinical questions. The citations retrieved by both strategies were pooled and rated for relevance on a 7-point scale. RESULTS: Numbers of relevant and irrelevant citations and cost per relevant citation were higher for clinician searches than librarian searches, reflecting the higher total number of citations retrieved by the clinician approaches. A lower proportion of clinician searches produced no relevant citations than librarian searches. CONCLUSIONS: Eleven daytime MEDLINE systems performed similarly in terms of retrieval and cost within similar searching groups. Clinicians, however, tended to capture larger overall retrievals resulting in higher numbers of relevant and irrelevant citations than librarians.

CD-ROM↗
PubMed1992

Increases in knowledge and use of information technology by entering medical students at McMaster University in successive annual surveys.

OBJECTIVE: To determine self-reported microcomputer and information technology competency, access, and usage by entering medical students and their perceptions of the need for training in additional applications. DESIGN: Cross-sectional surveys of successive classes. SETTING: McMaster University Faculty of Health Sciences Medical Undergraduate Program, which has a 33-month, problem-based, self-directed learning curriculum and a high applicant-to-student ratio. PARTICIPANTS: Medical school classes entering in 1987, 1988, and 1989. Response rates were 80%, 90%, and 86% respectively. MEASURES: A self-report questionnaire was sent to each student, with up to two follow-up letters to prompt a response. RESULTS: There was a progressive rise in reported information technology access and use for the three years. For the classes starting in 1987, '88, and '89 respectively, computer access was 29%, 49%, and 49% (P < 0.002 for linear trend), and, among those with computer access, modem access was 17%, 29% and 50% (P = 0.012). Self-service MEDLINE use on CD-ROM at the Health Sciences Library was 65%, 75%, and 89% respectively (P < 0.001) for all respondents within the first few months of starting medical school. Over 50% of each class stated they would take courses, if available, on clinical applications software, office management, online searching, filing, and CD-ROM searching. CONCLUSIONS: Half of the most recent entering students already had access to a personal computer and most wished to learn computer applications that would assist them with patient management, and with information access and organization. Medical schools need to address which applications they will teach or make available and how to bring all students to acceptable competency in their use.

Computer Literacy↗
PubMed1991

Rapid evolution of microcomputer use in a faculty of health sciences.

OBJECTIVE: To assist with educational planning we surveyed health sciences faculty members in 1989 to determine their use of microcomputers, desire for further instruction and perceptions on what microcomputer services should be provided for students. The 1989 results were compared with those of a similar survey performed in 1986. DESIGN: A self-completed, mailed questionnaire, with up to three reminders. SETTING: Faculty of Health Sciences, McMaster University, Hamilton, Ont. PARTICIPANTS: All full-time (FT) and part-time (PT) faculty members were sent the questionnaire; over 80% of the FT and 65% of the PT faculty members responded in 1986 and in 1989. RESULTS: The proportions of faculty members who used microcomputers increased significantly over the 3 years, from 71% to 87% among FT members (p = 2.2 x 10(-8)) and from 48% to 69% among PT members (p = 4.9 x 10(-8)). There were significant increases in the use of many of the applications, especially database and filing uses (from 10% to 41% among FT members [p less than 1 x 10(-9)] and from 6% to 34% among PT members [p less than 1 x 10(-9)]) and on-line access to bibliographic databases (from 7% to 37% among FT members [p less than 1 x 10(-9)] and from 3% to 18% among PT members [p less than 1 x 10(-9)]. These changes occurred mainly through individual initiative and voluntary continuing education. CONCLUSIONS: The extraordinary rate of adoption of microcomputers attests to their perceived usefulness. Curriculum planners need to consider how the success of microcomputer applications can be evaluated objectively and how successful applications can be integrated into educational programs.

Attitude of Health Personnel↗