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PubMed1996

The introduction of evidence-based medicine as a component of daily practice.

Evidence-based medicine is an increasingly important concept in continuing medical education and medical school curricula. To cope with the rapid evolution of medicine, physicians need to remain abreast of the many new therapies and diagnostic tools that affect their practices. Unfortunately, along with the many changes there is also a surplus of relevant written material. Physicians are unable to read all of this information due to time constraints. Instead, they must choose information efficiently. Tools are needed to facilitate this process. Over a two-month period, a demonstration model was carried out at the Ottawa General Hospital to encourage faculty, residents, and students to incorporate evidence-based medicine into their daily practice. A study was conducted to investigate the level and type of information required by these individuals in a clinical setting. A literature searching service was introduced six months after the formal introduction of evidence-based medicine in the Department of Medicine. The logistics of and recommendations for providing such a service are presented in this paper.

Decision Making, Computer-Assisted↗
PubMed1999

Library residencies and internships as indicators of success: evidence from three programs.

This paper discusses post-master's degree internships in three very different organizations; the University of Illinois at Chicago, the National Library of Medicine, and the Library of Congress. It discusses the internships using several questions. Do the programs serve as a recruitment strategy? Do the programs develop key competencies needed by the participant or organization? Do the programs develop leaders and managers? Is acceptance into a program an indicator of future career success? A survey was mailed to 520 persons who had completed internships in one of the three programs. There was a 49.8% response rate. Responses to fifty-four questions were tabulated and analyzed for each program and for the total group. The results confirm the value of internships to the career of participants.

Adult↗
PubMed2004

Medical faculty's use of print and electronic journals: changes over time and in comparison with scientists.

OBJECTIVES: The objectives are to determine how medical faculty members use scholarly journals, whether print or electronic journals are read more, whether there is a pattern among types of users, and what similarities and differences there are between the use of journals by medical faculty and faculty in other disciplines. METHODS: Medical faculty of the University of Tennessee Health Science Center (UTHSC) multi-campus system were surveyed, and their responses estimated using critical incident technique to characterize the different aspects of their use of print and electronic journals. RESULTS: Medical faculty read a great deal, especially compared to scientists. The most frequently reported principal purpose of reading is to support their primary research (30% of reading). The majority of reading comes from recently published articles, mostly from personal subscriptions. Medical faculty continue to rely on print journals (approximately 70% of readings) versus electronic journals. Age of faculty does not appear to influence the choice of print or electronic format. Medical faculty read more articles than others on average and need information digested and verified in a way to save them time. Convenience and currency are highly valued attributes. CONCLUSIONS: It can be asserted that librarians and publishers must find ways to provide the attributes of convenience and currency and match the portability of personal subscriptions in an electronic journal format for medical faculty.

Adult↗
PubMed2002

Cognitive engineering of film library transition from film medium to digital environment in a Texas teaching hospital.

Digital imaging technology promises efficient, economical, and fast service for patient care, but the challenges are great in the transition from film to a filmless (digital) environment. This change has a significant impact on the film library's personnel (film librarians) who play a leading roles in storage, classification, and retrieval of images. The objectives of this project were to study film library errors and the usability of a physical computerized system that could not be changed, while developing an intervention to reduce errors and test the usability of the intervention. Cognitive and human factors analysis were used to evaluate human-computer interaction. A workflow analysis was performed to understand the film and digital imaging processes. User and task analyses were applied to account for all behaviors involved in interaction with the system. A heuristic evaluation was used to probe the usability issues in the picture archiving and communication systems (PACS) modules. Simplified paper-based instructions were designed to familiarize the film librarians with the digital system. A usability survey evaluated the effectiveness of the instruction. The user and task analyses indicated that different users faced challenges based on their computer literacy, education, roles, and frequency of use of diagnostic imaging. The workflow analysis showed that the approaches to using the digital library differ among the various departments. The heuristic evaluation of the PACS modules showed the human-computer interface to have usability issues that prevented easy operation. Simplified instructions were designed for operation of the modules. Usability surveys conducted before and after revision of the instructions showed that performance improved. Cognitive and human factor analysis can help film librarians and other users adapt to the filmless system. Use of cognitive science tools will aid in successful transition of the film library from a film environment to a digital environment.

Cognitive Science↗
PubMed2006

Development of a recombinant indirect ELISA for the diagnosis of Theileria sp. (China) infection in small ruminants.

Theileria sp. (China) causes severe limitations on the development of the livestock industry in the north-west of China. An enzyme-linked immunosorbent assay (ELISA) based on merozoite homogenate of the parasite for diagnosis of infection has been established; however, cross-reactivity with other small ruminant-infecting piroplasms could not be excluded. Thus, a prerequisite for epidemiological surveys and diagnosis was the establishment of a recombinant protein-based ELISA. To this end, serum from Theileria sp. (China)-infected sheep was used to screen a Theileria lestoquardi expression library, resulting in the identification of a specifically reacting clone with a high identity to the heat shock protein 70 (HSP70) of Theileria parva and Theileria annulata and thus named TlHSP70. An HSP70 homologue was also confirmed to be expressed by Theileria sp. (China) merozoites (TcHSP70). A part of the TlHSP70 protein, found to be conserved in TcHSP70, was recombinantly expressed and used to establish an ELISA. A total of 260 field serum samples tested resulted in a sensitivity and specificity of 94.3 and 89.5%, respectively, in comparison with the merozoite homogenate ELISA. The potentials of the application of the test in epidemiological surveys to map out the prevalence of the disease and for routine diagnostics are described.

Animals↗
PubMed1990

Computerized literature searching in the ambulatory setting using PaperChase.

PaperChase, a self-service computerized literature search (SSCLS) service, was compared to conventional resources for accessing recent medical information by assessing user attitudes, search costs, and number of searches performed. The study was designed as a randomized controlled trial using survey instruments before and after the intervention. Accounting of PaperChase searches was monitored electronically, and costs of librarian searches were provided by the hospital library. Participants included 57 physicians in several specialties who were members of a group practice located in a suburban ambulatory care center. Responses were received from 67%. The experimental group received free, unlimited access to PaperChase over a one-year period, while the control group used conventional resources (manually self-performed searches and computerized MEDLINE searches performed free-of-charge by hospital librarians). The study disclosed no change in attitude of either those employing computers or SSCLS. Attitude scores in the experimental group showed statistically significant worsening in preference for SSCLS over textbook use and the estimation of SSCLS utility in the outpatient setting. The cost of PaperChase compared favorably to literature searches done by librarians. The self-reported numbers of literature searches of all types increased in the experimental group. PaperChase searches changed physicians' perceptions of patient treatment and outcome in some cases. While computerized literature searches may have a role in the outpatient setting, other resources remain important. Although only certain physicians are interested in using this method, this study shows that PaperChase can be a cost-effective alternative to MEDLINE searches performed by hospital librarians.

Attitude of Health Personnel↗
PubMed1994

Characterization of a gene, pilU, required for twitching motility but not phage sensitivity in Pseudomonas aeruginosa.

Type 4 fimbriae (or pilli) are associated with a form of bacterial surface translocation known as twitching motility. Fimbriae are also associated with sensitivity to certain bacteriophages such as PO4. Transposon mutagenesis was used to generate a library of Pseudomonas aeruginosa mutants which lack the spreading-colony morphology characteristic of twitching motility. In four of these mutants the transposon was found to be located in the vicinity of the previously described pilT locus, but in only one case was it found to have inserted within the pilT coding sequence. Two twitching-motility mutants originally isolated by Bradley, K2.2, and PAO2001.2, which have been widely used in studies of P. aeruginosa fimbrial structure and expression, were also shown to affect pilT and to comprise a small deletion and a frameshift mutation, respectively. The other three transposon mutations were found to have occurred within a new gene located directly downstream of pilT. This gene, termed pilU, encodes a 382-amino-acid protein closely related to PilT and to other members of a family of putative nucleotide-binding proteins which are involved in the assembly of cell surface-associated complexes. Furthermore, the pilT and pilU genes appear to be independently expressed. Like pilT mutants, the pilU mutants were hyperfimbriate, but in neither case was this associated with an increase in transcription of the fimbrial subunit gene pilA. However, in contrast to pilT mutants, the pilU mutants had not also acquired resistance to infection by bacteriophage PO4. A broader survey showed differential patterns of sensitivity to various fimbrial-specific phages among the pilU mutants and other twitching-motility mutants in the transposon library. The fact that twitching motility is not obligatorily associated with phage sensitivity suggests that the latter may not be directly dependent upon fimbrial function but rather may be a consequence of some common factor(s) involved in their assembly or export pathways.

Adenosine Triphosphatases↗
PubMed1996

Patients' expectations of information provided at cancer hospitals in Japan.

In order to survey patients' views on disease and treatment information that should be provided at hospitals, an anonymous self-administered questionnaire was distributed to patients at Aichi Cancer Center Hospital in 1995. All eligible first-visit outpatients (97 persons), randomly selected revisit outpatients (99 persons; about one in ten refused), and all except six eligible inpatients in good condition at discharge (97 persons) responded. Out of 293 patients (115 males, 174 females and 4 unspecified), 74% answered that they wanted to be informed of their diagnosis irrespective of circumstances, 20% answered that they would want to be informed only in certain circumstances, and 2% did not want to be informed at all. There were no significant differences in response among the three sources of patients. Inpatients wanted more (81%) to be explained about recommended therapy than either first-visit outpatients (67%) or revisit outpatients (67%). The majority considered that about a 30-minute explanation was needed using pamphlet-like written materials or video. When asked what information was needed when choosing a cancer hospital, 71% specified information on the specialty of the hospital, 57% the content of the care provided, 23% the name and specialty of the doctors, 20% the waiting period before scheduled admission, 13% the average admission period, 11% the number of patients with the same disease, 10% the waiting time at the outpatient clinic, 6% the meal menu, and 4% the number of private wards. Forty-three percent wanted an information service covering all hospitals in the region through an information center. The results revealed that patients at this cancer hospital required information on their disease, treatment, and hospital specialty.

Adult↗
PubMed2005

Undertaking an information-needs analysis of the emergency-care physician to inform the role of the clinical librarian: a Greek perspective.

AIM OF STUDY: The primary focus of this pilot study was to gain a better understanding of the information needs of emergency-care clinicians. The secondary focus was to compare the traditional current practice of information provision within other emergency departments in Greek hospitals, with the new model of clinical librarianship (CL). RATIONALE: Clinical staff in the emergency department deal with a variety of cases, they have no time to visit the library, but need information instantly in their place of work. Clinical decision making in the emergency department setting frequently requires the clinician to obtain additional sources of information and clinical librarians may facilitate this. STUDY DESIGN: The present study focused on two professional groups: medical librarians (group A) and clinicians (consultants, senior registrars, registrars, nurses (group B), working in the emergency departments of two Greek hospitals. The study was organized through a questionnaire survey and some in-depth interviews. RESULTS: This study showed that, for 100% of the clinicians in daily practice, the main information needs arise while treating patients, and that information would help in making patient-care decisions. Clinicians made little use of hospital libraries because they are usually under tremendous time pressure. The main outcome of the study was the use of a clinical librarian as an information provider. Clinical librarians supply information to assist decisions, based on this model. This extends the librarian's role in evidence-based medicine, giving much stronger attention to the relevant evidence in clinical practice. CONCLUSIONS: Nowadays, health services are facing organizational change. The introduction of new technology, and rapid growth of medical knowledge creates a demand for new ways of providing information. Clinical librarian programmes may deliver patients specific information in a timely manner. The mission of the clinical librarian is to facilitate access to quality information which is necessary for improving health, and to act as an informationist in the emergency department.

Emergency Medicine↗
PubMed2004

Content-based image retrieval for large biomedical image archives.

Content-Based Image Retrieval (CBIR) has been a topic of research interest for nearly a decade. Approaches to date use image features for describing content. A survey of the literature shows that progress has been limited to prototype systems that make gross assumptions and approximations. Additionally, research attention has been largely focused on stock image collections. Advances in medical imaging have led to growth in large image collections. At the Lister Hill National Center for Biomedical Communication, an R&D division of the National Library of Medicine, we are conducting research on CBIR for biomedical images. We maintain an archive of over 17,000 digitized x-rays of the cervical and lumbar spine from the second National Health and Nutrition Examination Survey (NHANES II). In addition, we are developing an archive of a large number of digitized 35 mm color slides of the uterine cervix. Our research focuses on developing techniques for hybrid text/image query-retrieval from the survey text and image data. In this paper we present the challenges in developing CBIR of biomedical images and results from our research efforts.

Archives↗
PubMed2002

Capturing users' experiences of participating in cancer trials.

Randomized controlled trials are accepted to be the research design of choice to evaluate the effectiveness of health care interventions and are commonly used to evaluate cancer treatments. There are concerns, however, that levels of recruitment to trials are often much lower than anticipated, particularly in cancer trials. Several research methods have been used to collect aspects of users' experiences of participating in cancer trials. Perhaps the most common method has been through measures of outcome and the impact of treatments on quality of life (QoL), using standardized schedules to capture physical, social and psychological health. In some areas of cancer, individual patient testimonies illuminate particular issues or narratives. Another body of research has grown around issues of user involvement in trials, including surveys of recruitment and participation, as well as investigations of patient preferences and experiences of participation. We searched MEDLINE and the Cochrane Trials Library from 1995 to 2001 for relevant publications. In this article, we review the literature in these areas and examine whether users' experiences of participating in cancer trials can be used to assist in the design or conduct of trials.

Female↗
PubMed2003

Novel Proteorhodopsin variants from the Mediterranean and Red Seas.

Proteorhodopsins, ubiquitous retinylidene photoactive proton pumps, were recently found in the widespread uncultured SAR86 bacterial group in oceanic surface waters. To survey proteorhodopsin diversity, new degenerate sets of proteorhodopsin primers were designed based on a genomic proteorhodopsin gene sequence originating from an Antarctic fosmid library. New proteorhodopsin variants were identified in Red Sea samples that were most similar to the original green-light absorbing proteorhodopsins found in Monterey Bay California. Unlike green-absorbing proteorhodopsins however, these new variants contained a glutamine residue at position 105, the same site recently shown to control spectral tuning in naturally occurring proteorhodopsins. Different proteorhodopsin variants were also found in the Mediterranean Sea. These proteorhodopsins formed new and distinctive proteorhodopsin groups. Phylogenetic analyses show that some of the new variants were very different from previously characterized proteorhodopsins, and formed the deepest branching groups found so far among marine proteorhodopsins. The existence of these varied proteorhodopsin sequences suggests that this class of proteins has undergone substantial evolution. These variants could represent functionally divergent paralogous genes, derived from the same or similar species, or orthologous proteorhodopsins that are distributed amongst divergent planktonic microbial taxa.

Amino Acid Sequence↗
PubMed1975

Reflections on fifty years of publications on the history of general biology and special embryology.

The publications of fifty years (1925-1974) of the histroy of biology and embryology are surveyed. In America, the earliest background for work during this period was provided by the collectors, mainly physicians, of books into extensive private libraries. The collectors, for instance Osler, Cushing, and Fulton in this country and Geoffrey Keynes abroad, became expert technical bibliographers during the early part of the half-century under consideration. High standards for medical, thus biological history, insofar as these fields overlap, were also set earlier by Sudhoff's Institut für Geschichte der Medizin in Leipzig, and American historical studies benefited when Sigerist came from Leipzig to Baltimore in the early 1930's. Textbooks of medical history are omitted from discussion here, but a number of more or less general histories of biology published within the specified period are briefly evaluated. The discussion next turns to histories of embryology, general and special. Recent monographs on the classical embryologists, Wolff and von Baer, are enumerated, as are a number of biographies and autobiographies of important embryologists published here or abroad during our half-century. Then general histories of embryology are discussed, and finally some specialized ones. Needham, Roger, and Adelmann are singled out as the most important contributors to the history of embryology, in the West, during the period covered. Few of the contributors to the history of biology and medicine during the years of 1925 through 1974 were trained as historians while students. It is concluded that the History of Science Society has performed an important contribution in professionalizing the history of biology and embryology, but it is pointed out that a great new challenge faces it in the necessity to counteract anti-historical and anti-intellectual moods and movements of today.

Bibliographies as Topic↗
PubMedDate not supplied

DNA sequence and expression analysis of root-knot nematode-elicited giant cell transcripts.

Fifty-eight cDNA clones isolated from a library of transcripts exhibiting up regulation in tomato root giant cells induced by infection with the parasitic nematode Meloidogyne incognita were characterized. A survey of plant tissues identified 31 transcripts present in tissues other than root, including actively dividing and expanding tissues and mature leaf tissues. The identities of approximately 20% of the giant cell transcripts were inferred from DNA sequence data; they include sequences encoding a plasmalemma proton ATPase, a putative Myb-type transcription factor, and the largest subunit of RNA polymerase II.

Amino Acid Sequence↗
PubMed2006

Effect of pH on isolation and distribution of members of subdivision 1 of the phylum Acidobacteria occurring in soil.

The pH strongly influenced the development of colonies by members of subdivision 1 of the phylum Acidobacteria on solid laboratory media. Significantly more colonies of this group formed at pH 5.5 than at pH 7.0. At pH 5.5, 7 to 8% of colonies that formed on plates that were incubated for 4 months were formed by subdivision 1 acidobacteria. These colonies were formed by bacteria that spanned almost the entire phylogenetic breadth of the subdivision, and there was considerable congruence between the diversity of this group as determined by the cultivation-based method and by surveying 16S rRNA genes in the same soil. Members of subdivision 1 acidobacteria therefore appear to be readily culturable. An analysis of published libraries of 16S rRNAs or 16S rRNA genes showed a very strong correlation between the abundance of subdivision 1 acidobacteria in soil bacterial communities and the soil pH. Subdivision 1 acidobacteria were most abundant in libraries from soils with pHs of <6, but rare or absent in libraries from soils with pHs of >6.5. This, together with the selective cultivation of members of the group on lower-pH media, indicates that growth of many members of subdivision 1 acidobacteria is favored by slightly to moderately acidic growth conditions.

Bacteria↗
PubMedDate not supplied

A practice-sponsored Web site to help patients pursue healthy behaviors: an ACORN study.

PURPOSE: We tested whether patients are more likely to pursue healthy behaviors (eg, physical activity, smoking cessation) if referred to a tailored Web site that provides valuable information for behavior change. METHODS: In a 9-month pre-post comparison with nonrandomized control practices, 6 family practices (4 intervention, 2 control) encouraged adults with unhealthy behaviors to visit the Web site. For patients from intervention practices, the Web site offered tailored health advice, a library of national and local resources, and printouts for clinicians. For patients from control practices, the Web site offered static information pages. Patient surveys assessed stage of change and health behaviors at baseline and follow-up (at 1 and 4 months), Web site use, and satisfaction. RESULTS: During the 9 months, 932 patients (4% of adults attending the practice) visited the Web site, and 273 completed the questionnaires. More than 50% wanted physician assistance with health behaviors. Stage of change advanced and health behaviors improved in both intervention and control groups. Intervention patients reported greater net improvements at 1 month, although the differences approached significance only for physical activity and readiness to change dietary fat intake. Patients expressed satisfaction with the Web site but wished it provided more detailed information and greater interactivity with clinicians. CONCLUSIONS: Clinicians face growing pressure to offer patients good information on health promotion and other health care topics. Referring patients to a well-designed Web site that offers access to the world's best information is an appealing alternative to offering handouts or impromptu advice. Interactive Web sites can facilitate behavior change and can interface with electronic health records. Determining whether referral to an informative Web site improves health outcomes is a methodological challenge, but the larger question is whether information alone is sufficient to promote behavior change. Web sites are more likely to be effective as part of a suite of tools that incorporate personal assistance.

Adult↗
PubMed2006

Functional cloning as a means to identify Leishmania genes involved in drug resistance.

Resistance to anti-leishmanial drugs is a mounting problem in high-endemicity regions of South Asia and, potentially, in the context of HIV-Leishmania coinfections in Southern Europe. The molecular basis for clinical drug resistance is still largely unknown. It is important, however, to identify all relevant drug resistance markers for further drug development and for epidemiological surveys. An elegant and powerful method to identify such drug resistance markers without bias is functional cloning, using cosmid-based genomic DNA libraries. This review discusses the merits and caveats of this approach.

Animals↗
PubMed1971

An investigation of the educational needs of health sciences library manpower. 3. Manpower supply and demand in health sciences libraries.

An investigation of the manpower requirements of health sciences libraries and of educational programs appropriate to these manpower needs was begun in March 1968. To date, 4,727 libraries have been identified as being used by 14,000 health sciences institutions and programs. Of this total, 2,628 are hospital libraries; 1,328 are health sciences libraries and collections located outside of hospitals; and 771 are academic or public libraries. Within these libraries some 14,938 persons are directly involved, either full- or part-time, in the delivery of health sciences library services. Of the total work force, 5,861 persons are employed in hospital libraries and 9,077 are employed in health sciences libraries and collections. The ratio between professional and nonprofessional employees is 1:2; professional and nonprofessional status was assigned by the chief librarian. Survey data indicate a 7 percent manpower shortage in positions classified as professional, and a 3 percent shortage in positions classified as nonprofessional.

Journal Article↗