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Use and perceived benefits of handheld computer-based clinical references.

OBJECTIVE: Clinicians are increasingly using handheld computers (HC) during patient care. We sought to assess the role of HC-based clinical reference software in medical practice by conducting a survey and assessing actual usage behavior. DESIGN: During a 2-week period in February 2005, 3600 users of a HC-based clinical reference application were asked by e-mail to complete a survey and permit analysis of their usage patterns. The software includes a pharmacopeia, an infectious disease reference, a medical diagnostic and therapeutic reference and transmits medical alerts and other notifications during HC synchronizations. Software usage data were captured during HC synchronization for the 4 weeks prior to survey completion. MEASUREMENTS: Survey responses and software usage data. RESULTS: The survey response rate was 42% (n = 1501). Physicians reported using the clinical reference software for a mean of 4 years and 39% reported using the software during more than half of patient encounters. Physicians who synchronized their HC during the data collection period (n = 1249; 83%) used the pharmacopeia for unique drug lookups a mean of 6.3 times per day (SD 12.4). The majority of users (61%) believed that in the prior 4 weeks, use of the clinical reference prevented adverse drug events or medication errors 3 or more times. Physicians also believed that alerts and other notifications improved patient care if they were public health warnings (e.g. about influenza), new immunization guidelines or drug alert warnings (e.g. rofecoxib withdrawal). CONCLUSION: Current adopters of HC-based medical references use these tools frequently, and found them to improve patient care and be valuable in learning of recent alerts and warnings.

Adult↗

Platinum-based versus non-platinum-based chemotherapy in advanced non-small-cell lung cancer: a meta-analysis of the published literature.

PURPOSE: This meta-analysis was performed to compare the activity, efficacy and toxicity of platinum-based versus non-platinum-based chemotherapy in patients with advanced non-small-cell lung cancer. METHODS: Randomized phase II and III clinical trials comparing first-line palliative platinum-based chemotherapy with the same regimen without platinum or with platinum replaced by a nonplatinum agent were identified by electronic searches of Medline, Embase, and Cancerlit, and hand searches of relevant abstract books and reference lists. Response rates, 1-year survival, and toxicity were analyzed. Subgroups of trials using third-generation agents were compared. RESULTS: Thirty-seven assessable trials were identified including 7,633 patients. A 62% increase in the odds ratio (OR) for response was attributable to platinum-based therapy (OR, 1.62; 95% CI, 1.46 to 1.8; P < .0001). The 1-year survival rate was increased by 5% with platinum-based regimens (34% v 29%; OR, 1.21; 95% CI, 1.09 to 1.35; P = .0003). No statistically significant increase in 1-year survival was found when platinum therapies were compared to third-generation-based combination regimens (OR, 1.11; 95% CI, 0.96 to 1.28; P = .17). The toxicity of platinum-based regimens was significantly higher for hematologic toxicity, nephrotoxicity, and nausea and vomiting, but not for neurotoxicity, febrile neutropenia rate, or toxic death rate. CONCLUSION: Response is significantly higher with platinum-containing regimens. One-year survival was not significantly prolonged when platinum-based therapies were compared with third-generation-based combination regimens. Toxicity is generally higher for platinum-based regimens.

Antineoplastic Combined Chemotherapy Protocols↗

Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data.

PURPOSE: This systematic review and meta-analysis were performed to assess the efficacy and tolerability of chemotherapy in patients with advanced gastric cancer. METHODS: Randomized phase II and III clinical trials on first-line chemotherapy in advanced gastric cancer were identified by electronic searches of Medline, Embase, the Cochrane Controlled Trials Register, and Cancerlit; hand searches of relevant abstract books and reference lists; and contact to experts. Meta-analysis was performed using the fixed-effect model. Overall survival, reported as hazard ratio (HR) with 95% CI, was the primary outcome measure. RESULTS: Analysis of chemotherapy versus best supportive care (HR = 0.39; 95% CI, 0.28 to 0.52) and combination versus single agent, mainly fluorouracil (FU) -based chemotherapy (HR = 0.83; 95% CI = 0.74 to 0.93) showed significant overall survival benefits in favor of chemotherapy and combination chemotherapy, respectively. In addition, comparisons of FU/cisplatin-containing regimens with versus without anthracyclines (HR = 0.77; 95% CI, 0.62 to 0.95) and FU/anthracycline-containing combinations with versus without cisplatin (HR = 0.83; 95% CI, 0.76 to 0.91) both demonstrated a significant survival benefit for the three-drug combination. Comparing irinotecan-containing versus nonirinotecan-containing combinations (mainly FU/cisplatin) resulted in a nonsignificant survival benefit in favor of the irinotecan-containing regimens (HR = 0.88; 95% CI, 0.73 to 1.06), but they have never been compared against a three-drug combination. CONCLUSION: Best survival results are achieved with three-drug regimens containing FU, an anthracycline, and cisplatin. Among these, regimens including FU as bolus exhibit a higher rate of toxic deaths than regimens using a continuous infusion of FU, such as epirubicin, cisplatin, and continuous-infusion FU.

Antineoplastic Combined Chemotherapy Protocols↗

Teratological research using in vitro systems. II. Rodent limb bud culture system.

This review represents a compilation of information related to the rodent limb bud culture system from approximately 80 publications after 1969 and conversations with workers in the field. Most of these papers and book chapters refer exclusively to studies with the mouse limb bud. Sections in this review include historical review, end point measurements, activating systems, types of compounds studied and dose response, reproducibility, statistical analysis, equipment and personnel requirements, mechanisms, and summary.

Animals↗

Science in the court.

Explore the source record for details and available documents.

Environmental Pollutants↗

The information sources used by community nurse prescribers.

A purposive sample of 22 community nurse prescribers and five prescribing leads were interviewed to determine how nurses both access and assess the reliability of pharmacological information. Prescribers used both printed material and other professionals to obtain pharmacological information. The most commonly mentioned sources of printed material were journals and the British National Formulary. Other people that nurses obtained information from included pharmaceutical company representatives, community pharmacists, nurse specialists, colleagues, and GPs. Nurses described the attributes that they associated with reliable information (previous vetting, up-to-date and used by other healthcare professionals) and unreliable information (produced by those with a vested interest). Much of the pharmacological information supporting prescribers is aimed at doctors and may not be accessible for nurse prescribers. Organizations seeking to influence evidence-based practice should consider the method of communication in addition to the message.

Community Health Nursing↗

Sources of salary statistics for health care professionals.

Salary statistics for various health care professions are much in demand, yet finding them is not always an easy task. This article provides an annotated list of selected sources of salary statistics for medicine, dentistry, nursing, pharmacy, occupational therapy, and physical therapy. Emphasis is placed on sources which are published regularly. Strategies for finding additional sources of salary statistics are also discussed.

Data Collection↗

A successful cross-training experience of reference service at UCLA.

This paper describes a successful cross-training and reference librarian exchange experience involving two librarians at UCLA, one based at the Louise M. Darling Biomedical Library and the other based at the College Library, which primarily serves undergraduates. The experience has increased the reference skills and expertise of both librarians by introducing them to new sets of reference tools and databases, and has broadened their network of colleagues within the UCLA Library system. The participating libraries have also benefited from the exchange, and the program is expanding to include other UCLA libraries.

Inservice Training↗

Locating grey literature on communication disorders.

This article provides an overview of selected Web-based resources containing grey literature in the area of communication disorders. It is geared to practitioners, researchers, students, and consumers seeking reliable, freely available scientific information. Grey (or gray) literature has been defined as "that which is produced on all levels of government, academics, business, and industry in print and electronic formats, but which is not controlled by commercial publishers."1 This paper reviews various general reference sources potentially containing grey literature on communication disorders. This review includes identification of the methods specialists in this field use to obtain this valuable, yet often overlooked, literature. Access points and search tools for identifying grey literature on communication disorders are recommended. Commercial databases containing grey literature are not included. Conclusions presented in this article are considered complementary to traditionally published information resources on communication disorders, such as scholarly journals, online databases, etc.

Academic Medical Centers↗

National survey of dietary supplement resources at drug information centers.

OBJECTIVE: To assess the resources drug information centers are currently using to respond to dietary supplement information requests and to determine the frequency with which drug information centers are used as sources of information on dietary supplements. DESIGN: Cross-sectional survey. SETTING: United States. PARTICIPANTS: 116 drug information centers. INTERVENTIONS: Mail survey that collected information on the use of drug information centers for dietary supplement information requests and the dietary supplement-specific resources available at and used in these centers. MAIN OUTCOMES MEASURES: Survey responses, evaluated using descriptive statistics. RESULTS: Drug information centers received a relatively small number of requests for information related to dietary supplements, and most such requests came from consumers. The centers had a number of resources available to assist in responding to those requests, with Facts and Comparisons' The Review of Natural Products and the print version of Natural Medicines Comprehensive Database being the resources most often at hand. The majority of respondents believed their centers were "usually able" to respond to the requests received. CONCLUSION: Drug information centers are often overlooked as sources of information about dietary supplements; however, centers have resources that are, by self-assessment, sufficient to respond to dietary supplement information requests. Great variation exists among centers in the resources available to address requests, with just two resources, the Review of Natural Products and the print version of Natural Medicines Comprehensive Database, available to more than three-fourths of the respondents.

Data Collection↗

Concordance of severity ratings provided in four drug interaction compendia.

OBJECTIVE: To evaluate the agreement among drug-drug interaction (DDI) compendia as to designation of interactions as having the greatest clinical importance ("major" DDIs). DESIGN: Cross-sectional, one-time evaluation. SETTING: United States in fall 2001. PARTICIPANTS: Not applicable. INTERVENTIONS: Major DDIs involving prescription medications likely to be dispensed in the community and ambulatory pharmacy settings were identified as listed in four compendia that provide specific, detailed information about DDIs (Drug Interaction Facts, Drug Interactions: Analysis and Management, Evaluations of Drug Interactions, and the MicroMedex DRUG-REAX program). MAIN OUTCOME MEASURE: Level of agreement between DDI compendia as assessed by the intraclass correlation coefficient (ICC). RESULTS: Overall, 406 major DDIs were listed in one or more of the four compendia. Only 9 (2.2%) of these major DDIs were listed in all four compendia; in fact, the majority of interactions were listed in only one compendium (291 DDIs, 71.7%), despite these interactions being considered of greatest clinical relevance by at least one compendium. The ICC among the compendia was -0.092, indicating low agreement on the classification of major DDIs. CONCLUSION: Little agreement exists among commonly used drug interaction COMPENDIA for DDIs that were classified in fall 2001 as having the highest clinical relevance and importance. A concerted effort to identify DDIs of the highest clinical importance is needed to design effective strategies to avoid and manage them.

Adverse Drug Reaction Reporting Systems↗

The remarkable vision of Robert Hooke (1635-1703): first observer of the microbial world.

Robert Hooke played important roles in the early development of the Royal Society of London. As Curator of Experiments of the Society, he became a pioneering microscopist, prolific inventor, astronomer, geologist, architect, and an effective surveyor of the City of London following the Great Fire of 1666. Hooke's Micrographia (1665) revealed the microscopic structures of numerous biological and inorganic objects and became an important source of information for later studies. Aside from the body of detailed observations reported and depicted in Micrographia, the Preface is in itself an extraordinary document that exhibits Hooke's fertile mind, philosophical insights, and rare ability to look into the future.

Animals↗