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PubMed2004

Clinical librarianship in the UK: temporary trend or permanent profession? Part II: present challenges and future opportunities.

BACKGROUND: This article is the second part of a two-part series reporting a study of the role of the Clinical Librarian (CL) in the UK. METHODS: A qualitative method of semi-structured interviews was used to explore in-depth the role of the CL. The interviews provided a rich source of data and give insight into this new and emerging role as practised in the National Health Service (NHS). Similarities and differences are examined between the CL population and reported within themes, specifically: personal qualities and skills required, training for the CLs, marketing the CL service, working in the clinical environment, monitoring and evaluation and the acceptance of the CL in the NHS. RESULTS: A common understanding of the skills and knowledge required to undertake the CL role was shared by the respondents. However, practice differed as this was often dictated by local circumstances. The study confirmed the need for the CLs to work with clinical colleagues in the clinical setting to enhance patient care. CONCLUSION: The importance of using best evidence to support patient care is a message that is slowly becoming the norm in the NHS and the CL role in this practice is demonstrated by this study.

Clinical Medicine↗
PubMed2006

Map of dermatology: 'first-impression' user feedback and agenda for further development.

BACKGROUND: Map of Dermatology (http://healthcybermap.org/dermap/) is a free web resource that enables users to search for images of skin conditions by body region and morphology rather than by condition name, which is much more useful and natural in answering questions about unknown clinical presentations/diagnoses, especially for non-specialists. OBJECTIVES AND METHODS: This paper presents responses received from twelve users, including specialist dermatologists, non-specialists (some with interests in health informatics), and lay persons, who provided their 'first-impression' feedback on Map of Dermatology by responding to a very short e-mail questionnaire covering service usefulness and interface usability. The paper also provides a brief review of the gaps in current online dermatology information service provision in general. RESULTS: The overall user feedback received was very positive. An exploratory discussion of the arguments and possibilities for radically improving Map of Dermatology to produce 'the ultimate web-based dermatology diagnostic tool' is also provided, together with some desiderata and preliminary 'design and feature specifications' for such a tool based on users' suggestions, the gaps highlighted in other existing online dermatology tools, and the author's own reflections and experience. CONCLUSIONS: When successfully developed, the proposed tool is expected to have significant potential for efficiently and effectively addressing many of the currently unmet educational needs of clinicians.

Atlases as Topic↗
PubMed1996

Molecular diversity of soil and marine 16S rRNA gene sequences related to beta-subgroup ammonia-oxidizing bacteria.

We have conducted a preliminary phylogenetic survey of ammonia-oxidizing beta-proteobacteria, using 16S rRNA gene libraries prepared by selective PCR and DNA from acid and neutral soils and polluted and nonpolluted marine sediments. Enrichment cultures were established from samples and analyzed by PCR. Analysis of 111 partial sequences of c. 300 bases revealed that the environmental sequences formed seven clusters, four of which are novel, within the phylogenetic radiation defined by cultured autotrophic ammonia oxidizers. Longer sequences from 13 cluster representatives support their phylogenetic positions relative to cultured taxa. These data suggest that known taxa may not be representative of the ammonia-oxidizing beta-proteobacteria in our samples. Our data provide further evidence that molecular and culture-based enrichment methods can select for different community members. Most enrichments contained novel Nitrosomonas-like sequences whereas novel Nitrosospira-like sequences were more common from gene libraries of soils and marine sediments. This is the first evidence for the occurrence of Nitrosospira-like strains in marine samples. Clear differences between the sequences of soil and marine sediment libraries were detected. Comparison of 16S rRNA sequences from polluted and nonpolluted sediments provided no strong evidence that the community composition was determined by the degree of pollution. Soil clone sequences fell into four clusters, each containing sequences from acid and neutral soils in varying proportions. Our data suggest that some related strains may be present in both samples, but further work is needed to resolve whether there is selection due to pH for particular sequence types.

Ammonia↗
PubMed2004

New perspective on uncultured bacterial phylogenetic division OP11.

Organisms belonging to the OP11 candidate phylogenetic division of Bacteria have been detected only in rRNA-based sequence surveys of environmental samples. Preliminary studies indicated that such organisms represented by the sequences are abundant and widespread in nature and highly diverse phylogenetically. In order to document more thoroughly the phylogenetic breadth and environmental distribution of this diverse group of organisms, we conducted further molecular analyses on environmental DNAs. Using PCR techniques and primers directed toward each of the five described subdivisions of OP11, we surveyed 17 environmental DNAs and analyzed rRNA gene sequences in 27 clonal libraries from 14 environments. Ninety-nine new and unique sequences were determined completely, and approximately 200 additional clones were subjected to partial sequencing. Extensive phylogenetic comparisons of the new sequences to those representing other bacterial divisions further resolved the phylogeny of the bacterial candidate division OP11 and identified two new candidate bacterial divisions, OP11-derived 1 (OD1) and Sulphur River 1 (SR1). The widespread environmental distribution of representatives of the bacterial divisions OD1, OP11, and SR1 suggests potentially conspicuous biogeochemical roles for these organisms in their respective environments. The information on environmental distribution offers clues for attempts to culture landmark representatives of these novel bacterial divisions, and the sequences are specific molecular signatures that provide for their identification in other contexts.

Bacteria↗
PubMed2006

Microeukaryote community patterns along an O2/H2S gradient in a supersulfidic anoxic fjord (Framvaren, Norway).

To resolve the fine-scale architecture of anoxic protistan communities, we conducted a cultivation-independent 18S rRNA survey in the superanoxic Framvaren Fjord in Norway. We generated three clone libraries along the steep O(2)/H(2)S gradient, using the multiple-primer approach. Of 1,100 clones analyzed, 753 proved to be high-quality protistan target sequences. These sequences were grouped into 92 phylotypes, which displayed high protistan diversity in the fjord (17 major eukaryotic phyla). Only a few were closely related to known taxa. Several sequences were dissimilar to all previously described sequences and occupied a basal position in the inferred phylogenies, suggesting that the sequences recovered were derived from novel, deeply divergent eukaryotes. We detected sequence clades with evolutionary importance (for example, clades in the euglenozoa) and clades that seem to be specifically adapted to anoxic environments, challenging the hypothesis that the global dispersal of protists is uniform. Moreover, with the detection of clones affiliated with jakobid flagellates, we present evidence that primitive descendants of early eukaryotes are present in this anoxic environment. To estimate sample coverage and phylotype richness, we used parametric and nonparametric statistical methods. The results show that although our data set is one of the largest published inventories, our sample missed a substantial proportion of the protistan diversity. Nevertheless, statistical and phylogenetic analyses of the three libraries revealed the fine-scale architecture of anoxic protistan communities, which may exhibit adaptation to different environmental conditions along the O(2)/H(2)S gradient.

Anaerobiosis↗
PubMedDate not supplied

Organizational factors that influence information technology diffusion in academic health sciences centers.

OBJECTIVE: To identify the organizational factors which influence the diffusion of end user online literature searching, the computer-based patient record, and electronic mail systems in academic health sciences centers in the United States. DESIGN: A total of 1335 individuals working in informatics and library areas at 67 academic health sciences centers in the U.S. were surveyed. Multivariate techniques were used to evaluate the relationship between the set of six organizational factors and two measures of innovation diffusion. MEASUREMENTS: A Guttman-like scale was developed to measure infusion, or depth or sophistication, of each of the three innovations at each institution. Diffusion was measured by a question previously developed for another study. Six independent variables were measured via five formerly developed scales and one new one. RESULTS: The overall response rate was 41%. The set of organizational variables produced significant results in the diffusion of each of the three innovations, with individual variables influencing diffusion to varying degrees. The same set produced significant results in relation to infusion only for online searching. There was little or no correlation between infusion and diffusion for each innovation. CONCLUSION: Organizational attributes are important predictors for diffusion of information technology innovations. Individual variables differ in their effect on each innovation. The set of attributes seems less able to predict infusion. It is recommended that both infusion and diffusion be measured in future studies because there is little relation between them. It is further recommended that individuals charged with implementing information technology in the health sciences receive training in managing organizational issues.

Academic Medical Centers↗
PubMed2006

A web-based library consult service for evidence-based medicine: Technical development.

BACKGROUND: Incorporating evidence based medicine (EBM) into clinical practice requires clinicians to learn to efficiently gain access to clinical evidence and effectively appraise its validity. Even using current electronic systems, selecting literature-based data to solve a single patient-related problem can require more time than practicing physicians or residents can spare. Clinical librarians, as informationists, are uniquely suited to assist physicians in this endeavor. RESULTS: To improve support for evidence-based practice, we have developed a web-based EBM library consult service application (LCS). Librarians use the LCS system to provide full text evidence-based literature with critical appraisal in response to a clinical question asked by a remote physician. LCS uses an entirely Free/Open Source Software platform and will be released under a Free Software license. In the first year of the LCS project, the software was successfully developed and a reference implementation put into active use. Two years of evaluation of the clinical, educational, and attitudinal impact on physician-users and librarian staff are underway, and expected to lead to refinement and wide dissemination of the system. CONCLUSION: A web-based EBM library consult model may provide a useful way for informationists to assist clinicians, and is feasible to implement.

Chicago↗
PubMed2005

Participant perceptions of the influences of the NLM-sponsored Woods Hole medical informatics course.

This report provides an evaluation of the National Library of Medicine-sponsored Woods Hole Medical Informatics (WHMI) course and the extent to which the objectives of the program are achieved. Two studies were conducted to examine the participants' perceptions of both the short-term (spring 2002) and the long-term influences (1993 through 2002) on knowledge, skills, and behavior. Data were collected through the use of questionnaires, semistructured telephone interviews, and participant observation methods to provide both quantitative and qualitative assessment. The participants of the spring 2002 course considered the course to be an excellent opportunity to increase their knowledge and understanding of the field of medical informatics as well as to meet and interact with other professionals in the field to establish future collaborations. Past participants remained highly satisfied with their experience at Woods Hole and its influence on their professional careers and their involvement in a broad range of activities related to medical informatics. This group considered their knowledge and understanding of medical informatics to be of greater quality, had increased their networking with other professionals, and were more confident and motivated to work in the field. Many of the participants feel and show evidence of becoming effective agents of change in their institutions in the area of medical informatics, which is one of the objectives of the program.

Fellowships and Scholarships↗
PubMed2006

Comparison of students' performance in and satisfaction with a clinical pharmacokinetics course delivered live and by interactive videoconferencing.

OBJECTIVES: To compare students' performance in and course evaluations for a clinical pharmacokinetics course taught in a traditional classroom setting, and for the same course taught via interactive videoconferencing. METHODS: The course was taught in a traditional classroom setting to 38 students, and in asynchronous sessions via interactive videoconferencing to 75 students at a distant site. A course evaluation was administered to each group at the conclusion of the courses. RESULTS: The students in the live classroom setting had a higher mean final course grade of 90.7% compared to the mean final course grade (87.8%) of students in the interactive videoconferencing group (P = 0.024). The mean evaluation score for students in the videoconferencing class were higher than for students in the live classroom setting (4.73 vs. 4.58; P < 0.001). CONCLUSIONS: Students in both the classroom setting and interactive videoconferencing setting performed well and had a high overall perception of the course.

Choice Behavior↗
PubMedDate not supplied

Virtual microscopes in podiatric medical education.

In many medical schools, microscopes are being replaced as teaching tools by computers with software that emulates the use of a light microscope. This article chronicles the adoption of "virtual microscopes" by a podiatric medical school and presents the results of educational research on the effectiveness of this adoption in a histology course. If the trend toward virtual microscopy in education continues, many 21st-century physicians will not be trained to operate a light microscope. The replacement of old technologies by new is discussed. The fundamental question is whether all podiatric physicians should be trained in the use of a particular tool or only those who are likely to use it in their own practice.

Computer-Assisted Instruction↗
PubMed2001

Expert witness billing practices revisited: a pilot study of further data.

This pilot study follows up an earlier study of the strategies and rationales by which psychiatric expert witnesses bill for their time on a case. Questionnaires were answered by participants at a workshop at the Annual Meeting of the American Academy of Psychiatry and Law (AAPL). In this follow-up, additional novel billing issues were addressed, some subtler than in the original study. In addition, responses to one question supported the previous finding that experts billed more reasonably when a case was simple. Additional issues included use of fee agreements and returning an unpaid-for case. The implications of these findings are discussed.

Attitude of Health Personnel↗
PubMed1965

MEDICAL INTERLIBRARY LOAN PATTERNS.

During the academic year 1958/59, a survey was made of interlibrary loan requests originating at Columbia University Medical Library. A high percentage of requests came from a relatively few requesters. However, analysis based on "one-time" and "repeat" categories for the patron and his requests indicated a situation less extreme than "monopoly use by an elite group." Requests were classed by type, age, language, title, etc., and were also correlated with such variables as citation source, requester's academic status and experience, and estimated importance of material. The analysis aims to uncover patterns significant for cooperative planning. Did the repeat and one-time requester show distinctive characteristics and habits? Which materials attracted more repeat requests? Findings generally favored cooperation, at least for a library servicing nonstudent researchers. Unpredictability of researchers' needs was noted. Apart from specific findings, this paper offers methods for statistical analysis of interlibrary loans.

Data Collection↗
PubMed1992

Impact of end-user search training on pharmacy students: a four-year follow-up study.

The Alfred Taubman Medical Library at the University of Michigan has offered instruction in online literature searching to third-year pharmacy students as a component of the course "Drug Information and Scientific Literature Evaluation" since 1983. In the spring of 1989, a follow-up study was conducted to assess the impact of instruction on four classes of graduates. Of a pool of 151 graduates, 90 (60%) responded to a mailed questionnaire on their use of information and computerized literature searching. The respondents were divided into four subgroups: end-user searchers, users of intermediaries, end users who used intermediaries, and those who did not use computerized literature search systems. Seventy-two percent of the respondents used some type of computerized literature searching, and 42% performed their own searches. The four subgroups differed in general computer use, familiarity with MEDLINE search terminology, information use, reasons for using or not using literature searching, and characteristics of searches (i.e., type, time frame, amount, and frequency). Training in end-user search systems appears to have had an impact on the continued use of computerized literature searching several years after the formal educational program.

Computer User Training↗
PubMed1991

Assessing and enhancing the value of the UMLS Knowledge Sources.

The goal of the UMLS Project is to give practitioners and researchers easy access to machine-readable information from diverse sources. Assessment of the first experimental versions of the UMLS Knowledge Sources is essential to measuring progress toward that goal and to identifying needed enhancements. As of July 30, 1991, copies of the first edition of the UMLS Knowledge Sources had been distributed to 143 individuals and institutions; 66 had provided initial feedback information. The information received indicates that the UMLS Knowledge Sources will undergo broad testing in the patient care, medical education, library service, and product development environments. Preliminary data support the hypothesis that expanded coverage of routine clinical concepts is needed. Key enhancements planned for 1992 and beyond include expanded coverage of ICD-9-CM and CPT.

National Library of Medicine (U.S.)↗
PubMed1988

Gene isolation with human T lymphocyte probes. Isolation of a gene that expresses an epitope recognized by T cells specific for Mycobacterium bovis BCG and pathogenic mycobacteria.

We have used human CD4+ T lymphocyte clones as primary probes to identify and isolate lambda gt11 rDNA clones that express epitopes recognized by T cells. The method that we describe here permits a direct survey of T cell epitope coding sequences in genomic DNA or cDNA libraries. A lambda gt11 library of Mycobacterium leprae DNA was screened with M. leprae-reactive human T cell clones as probes, allowing the isolation of a M. leprae DNA clone encoding the unidentified Ag. This DNA clone differs in restriction maps from those previously identified by antibody probes and encodes an epitope that is unique to vaccine strains of Mycobacterium bovis bacillus Calmette-Guérin and pathogenic mycobacteria. This method is generally applicable and should expedite the study of Ag and epitopes important to the T cell response in infections and in autoimmune diseases.

Antigens, Bacterial↗
PubMed1989

Analysis of Mycobacterium tuberculosis genoma and production of a recombinant protein containing specific B and T cell antigenic determinants--new approaches to second generation antituberculosis vaccines.

Tuberculosis is still a major health problem in almost all over the world. Thus, new directions in basic and applied research of tuberculosis are under investigation in several laboratories. In this paper, we provide recent data obtained in our laboratory with the recombinant DNA technology which allow a systematic survey of the microbial genome. Screening of the M. tuberculosis genomic DNA library in the phage lambda gt11 expression vector, using E. coli as surrogate host, has evidenced the possibility of producing recombinant M. tuberculosis proteins recognized by sera from tuberculosis patients and by specific monoclonal antibodies. Using this technology, we have isolated a recombinant protein (molecular weight 130 kilodaltons) which is identified by a murine monoclonal antibody recognizing a mycobacterial cell wall antigenic determinant present on a mycobacterial protein. This protein is only present on the mycobacterial species related to the tuberculosis complex (M. tuberculosis, M. bovis, M. africanum) and does not crossreact with nonpathogenic Mycobacteria. Since the immune response to mycobacterial infections is cell-mediated, the question arises about the use of M. tuberculosis-specific T lymphocytes to screen this gene bank. Thus, the recombinant mycobacterial protein isolated by antibodies has been then used to stimulate the proliferation of T lymphocytes from patients with tubercular pleuritis. This experiment indicates that the recombinant protein contains antigenic determinants recognized by T cells. Moreover, such protein is able to elicit delayed type hypersensitivity skin reaction in mice immunized or infected with M. tuberculosis and M. bovis. Finally, gene mapping and hybridization studies with native M. tuberculosis DNA confirme the mycobacterial nature of the recombinant DNA insert. Thus a good candidate for the prophylaxis and the immunodiagnosis of tuberculosis has been identified. The identification and selection of genes encoding antigenic determinants recognized by mycobacteria-specific T cells with protective functions will allow in the near future the construction by genetic engineering of recombinant vaccines effective in the control of this disease. This paper will briefly discuss the present strategy used in our laboratory to reach this goal.

Animals↗