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PubMed2004

Current status of pharmacist-operated drug information centers in the United States.

PURPOSE: Pharmacist-operated drug information centers (DICs) in the United States and Puerto Rico were surveyed, and the results were compared with those of similar surveys conducted over the past 30 years. METHODS: In January 2003, surveys were mailed to 151 institutions that were thought to have an organized DIC, defined as a center that regularly accepts a broad scope of requests from health care professionals, regardless of the location or affiliation of those professionals. The survey covered such topics as affiliations, staffing, services, resources, quality assurance, involvement in education, and funding. RESULTS: One hundred nineteen DICs responded (79%), of which 81 met the criteria. Hospitals and medical centers and colleges and schools of pharmacy continued to be the most commonly reported affiliations. The number of DICs declined in the past decade, and the number of DIC pharmacists and other personnel was the lowest reported in the past 30 years. Drug information pharmacists appeared to be better trained than in the past, and a larger percentage had advanced degrees. Services provided by DICs remained consistent with previous findings, except for greater participation in the training and education of pharmacy students and residents. The resource most commonly reported by DICs as useful was Micromedex Healthcare Series, followed by MEDLINE and AHFS Drug Information. The percentage of DICs with formal quality assurance programs did not change significantly in the past decade. Funding sources and fee-for-service activities remained the same. CONCLUSION: The number of DICs has declined steadily since 1986, and the number of drug information pharmacists is at its lowest in 30 years. DIC services continue to be comprehensive. Only half of the DICs surveyed had a formal quality assurance program.

Drug Information Services↗
PubMed2004

Negative subtraction hybridization: an efficient method to isolate large numbers of condition-specific cDNAs.

BACKGROUND: The construction of cDNA libraries is a useful tool to understand gene expression in organisms under different conditions, but random sequencing of unbiased cDNA collections is laborious and can give rise to redundant EST collections. We aimed to isolate cDNAs of messages induced by switching Aspergillus nidulans from growth on glucose to growth on selected polysaccharides. Approximately 4,700 contigs from 12,320 ESTs were already available from a cDNA library representing transcripts isolated from glucose-grown A. nidulans during asexual development. Our goals were to expand the cDNA collection without repeated sequencing of previously identified ESTs and to find as many transcripts as possible that are specifically induced in complex polysaccharide metabolism. RESULTS: We have devised a Negative Subtraction Hybridization (NSH) method and tested it in A. nidulans. NSH entails screening a plasmid library made from cDNAs prepared from cells grown under a selected physiological condition with labeled cDNA probes prepared from another physiological condition. Plasmids with inserts that failed to hybridize to cDNA probes through two rounds of screening (i.e. negatives) indicate that they are transcripts present at low concentration in the labeled probe pool. Thus, these transcripts will be predominantly condition-specific, along with some rare transcripts. In a screen for transcripts induced by switching the carbon source from glucose to 12 selected polysaccharides, 3,532 negatives were isolated from approximately 100,000 surveyed colonies using this method. Negative clones were end-sequenced and assembled into 2,039 contigs, of which 1,722 were not present in the previously characterized glucose-grown cDNA library. Single-channel microarray hybridization experiments confirmed that the majority of the negatives represented genes that were differentially induced by a switch from growth in glucose to one or more of the polysaccharides. CONCLUSIONS: The Negative Subtraction Hybridization method described here has several practical benefits. This method can be used to screen any existing cDNA library, including full-length and pooled libraries, and does not rely on PCR or sequence information. In addition, NSH is a cost-effective method for the isolation of novel, full-length cDNAs for differentially expressed transcripts or enrichment of rare transcripts.

Aspergillus nidulans↗
PubMed1997

Promoting library services to qualified nurses: towards a market-led approach.

This article summarizes a research project carried out with the nursing staff of South Buckinghamshire NHS Trust. A 'community profile' looked at nurses' use of library and information services for patient care purposes and found that only a small portion of all categories of qualified staff were library users. A postal questionnaire was used to investigate why nurses sought information, what they used it for, where they obtained it from and how valuable they perceived it to be. The results shown that personal and departmental collections were used quite frequently and the information was widely disseminated by the nurses to patients and their families, to colleagues and to students. The overall message from the survey was that the information obtained is valued highly and is used for various important purposes in health care delivery, such as educating patients and their families and revising treatment plans. However, nurses have difficulty in accessing libraries, which are judged to contain the most accurate, reliable and up-to-date information. The data from the community profile and questionnaire were further analysed using soft systems methodology, in order to identify problems in the traditional model of information delivery to nurses via conventional library and information service. These were then investigated further and a series of recommendations for action drawn up.

Data Collection↗
PubMed2007

Visiting hours policies in New England intensive care units: strategies for improvement.

OBJECTIVE: Dying patients often feel isolated and alone, and restricted visiting hours in the intensive care unit (ICU) has been shown to increase anxiety and dissatisfaction in both critically ill patients and their families. Unrestricted visiting has been identified as a top-ten need by families of patients in the ICU. Because emotional distress experienced by patients and families may persist well beyond the ICU stay, an open visiting policy, by meeting the needs of patients and families, may improve the quality of end-of-life care in the ICU. This two-part study included a survey to determine the visiting hours policies of New England-area hospital ICUs, and nursing focus groups to describe challenges and barriers that nursing staff working in an open ICU have experienced and to provide solutions that will facilitate implementation of an open visiting hours policy. DESIGN: Two-part study: survey and focus groups. SETTING: ICUs in New England and one medical ICU in a tertiary care hospital. SUBJECTS: Registered nurses employed in medical ICUs. INTERVENTIONS: Adult ICUs in the six New England states were located using a library listing of all regional hospitals. A telephone questionnaire interview was used to ascertain visiting hours policies in each ICU. Six focus-group sessions were conducted with nursing staff who work in an urban, northeastern ICU with 8 yrs of experience with an unrestricted visiting hours policy. MEASUREMENTS AND MAIN RESULTS: A total of 171 hospitals completed the questionnaire (96%). From all ICUs surveyed, 62 (32%) had unrestricted, open visiting hours. Out of these, 57 (92%) were medical ICUs or mixed medical/surgical ICUs. Nursing staff identified three major areas of concern with an open visiting hours policy: space, conflict, and burden. Strategies for resolution that are either employed or advocated by nursing staff are described. CONCLUSIONS: The majority of ICUs in New England have restricted visiting hours. Only one third of ICUs have open visiting policies. Nursing concerns with an unrestricted ICU were identified and solutions were offered that may provide guidance for other ICUs considering adopting an open visiting hours policy.

Focus Groups↗
PubMed2003

Pathophysiology of priapism: dysregulatory erection physiology thesis.

PURPOSE: While a modest amount of medical literature has been written on the topic of priapism, reports heretofore have focused predominantly on diagnostic and management related aspects of the disorder, providing meager information in regard to its pathophysiology. Accordingly the intent of this review was to explore the etiological and pathogenic factors involved in priapism. MATERIALS AND METHODS: The review entailed an overview of traditional and modern concepts that have been applied to the pathophysiology of priapism and an evaluation of assorted observational and experimental data relating to this field of study. The basic exercise consisted of a literature search using the National Library of Medicine PubMed Services, index referencing provided through the Historical Collection of the Institute of Medicine of The Johns Hopkins University and a survey of abstract proceedings from national meetings relevant to priapism. RESULTS: Insight into the pathophysiology of priapism was derived from a synthesis of evolutionary clinical experiences, mythical beliefs, clinical variants and scientific advances associated with the field of priapism. The results can be summarized. 1) Clinicopathological manifestations of priapism support its basic classification into low flow (ischemic) and high flow (nonischemic) hemodynamic categories, commonly attributed to venous outflow occlusion and unregulated arterial overflow of the penis, respectively. 2) Factual information is insufficient to substantiate etiological roles for urethral infection, bladder distention, failed ejaculation, satyriasis and sleep apnea in priapism. 3) Features of the variant forms of priapism invoke changes in nervous system control of erection and penile vascular homeostasis as having pathogenic roles in the disorder. 4) Clinical therapeutic and basic science investigative studies have revealed various effector mechanisms of the erectile tissue response that may act in dysregulated fashion to subserve priapism. CONCLUSIONS: This exercise suggested that, while priapism is commonly defined in terms of adverse mechanical contexts affecting penile circulation, it may also be viewed at least in some situations as an unbalanced erectile response involving derangements in possibly diverse systems of regulatory control. An integrative scientific approach that encompasses tissular, cellular and molecular levels of investigation may allow further understanding of the pathophysiology of the disorder. Ongoing elucidation of this pathophysiology can be expected to promote the development of new priapism therapies.

Greece, Ancient↗
PubMed2003

Arabidopsis genes involved in acyl lipid metabolism. A 2003 census of the candidates, a study of the distribution of expressed sequence tags in organs, and a web-based database.

The genome of Arabidopsis has been searched for sequences of genes involved in acyl lipid metabolism. Over 600 encoded proteins have been identified, cataloged, and classified according to predicted function, subcellular location, and alternative splicing. At least one-third of these proteins were previously annotated as "unknown function" or with functions unrelated to acyl lipid metabolism; therefore, this study has improved the annotation of over 200 genes. In particular, annotation of the lipolytic enzyme group (at least 110 members total) has been improved by the critical examination of the biochemical literature and the sequences of the numerous proteins annotated as "lipases." In addition, expressed sequence tag (EST) data have been surveyed, and more than 3,700 ESTs associated with the genes were cataloged. Statistical analysis of the number of ESTs associated with specific cDNA libraries has allowed calculation of probabilities of differential expression between different organs. More than 130 genes have been identified with a statistical probability > 0.95 of preferential expression in seed, leaf, root, or flower. All the data are available as a Web-based database, the Arabidopsis Lipid Gene database (http://www.plantbiology.msu.edu/lipids/genesurvey/index.htm). The combination of the data of the Lipid Gene Catalog and the EST analysis can be used to gain insights into differential expression of gene family members and sets of pathway-specific genes, which in turn will guide studies to understand specific functions of individual genes.

Acylation↗
PubMed1996

Molecular microbial diversity of an agricultural soil in Wisconsin.

A culture-independent survey of the soil microbial diversity in a clover-grass pasture in southern Wisconsin was conducted by sequence analysis of a universal clone library of genes coding for small-subunit rRNA (rDNA). A rapid and efficient method for extraction of DNA from soils which resulted in highly purified DNA with minimal shearing was developed. Universal small-subunit-rRNA primers were used to amplify DNA extracted from the pasture soil. The PCR products were cloned into pGEM-T, and either hypervariable or conserved regions were sequenced. The relationships of 124 sequences to those of cultured organisms of known phylogeny were determined. Of the 124 clones sequenced, 98.4% were from the domain Bacteria. Two of the rDNA sequences were derived from eukaryotic organelles. Two of the 124 sequences were of nuclear origin, one being fungal and the other a plant sequence. No sequences of the domain Archaea were found. Within the domain, Bacteria, three kingdoms were highly represented: the Proteobacteria (16.1%), the Cytophaga-Flexibacter-Bacteroides group (21.8%), and the low G+C-content gram-positive group (21.8%). Some kingdoms, such as the Thermotogales, the green nonsulfur group, Fusobacteria, and the Spirochaetes, were absent. A large number of the sequences (39.4%) were distributed among several clades that are not among the major taxa described by Olsen et al. (G.J. Olsen, C.R. Woese, and R. Overbeek, J. Bacteriol., 176:1-6, 1994). From the alignments of the sequence data, distance matrices were calculated to display the enormous microbial diversity found in this soil in two ways, as phylogenetic trees and as multidimensional-scaling plots.

Australia↗
PubMed2005

Continuing education as a catalyst for inter-professional collaboration.

Do nurses have access to the tools and resources they need for evidence-based practice? Are librarians prepared to work with nurses to provide access to appropriate resources and services, and teach the needed information literacy skills? The authors work with professional library and nursing organizations to present interdisciplinary continuing education to improve the information literacy of nurses and the ability of librarians to provide resources and services that meet nurses' information needs. This article reviews behavioral and practice changes reported by nurses and librarian participants in symposia on evidence-based nursing in March 2001 and May 2003.

Computer Literacy↗
PubMed1998

A hypermedia tool to support the interaction between radiologists and clinicians.

In this work we discuss problems related to the radiological reporting process and attempt to identify the ones which emerge during clinician-radiologist communication. We propose a hyper-reporting system, which allows the clinician to share the knowledge and critical factors that prompt the radiologist's diagnostic hypothesis during the discussion of results. This is possible by creating hypermedia links among different elements: reporting text, images, comments and the graphic models library. These elements make radiological knowledge explicit and clarify to the clinician the logical-diagnostic path traveled by the radiologist. A questionnaire, a survey of clinicians' and radiologists' needs allowed us to define some aspects of a hypermedia demo interface. Finally, we describe an example of a working session with the use of a few explanatory cards.

Attitude to Computers↗
PubMed2002

Use of focus groups in a library's strategic planning process.

The use of focus groups to determine patron satisfaction with library resources and services is extensive and well established. This article demonstrates how focus groups can also be used to help shape the future direction of a library as part of the strategic planning process. By responding to questions about their long-term library and information needs, focus group participants at the University of Texas Southwestern Medical Center at Dallas Library contributed an abundance of qualitative patron data that was previously lacking from this process. The selection and recruitment of these patrons is discussed along with the line of questioning used in the various focus group sessions. Of special interest is the way the authors utilized these sessions to mobilize and involve the staff in creating the library's strategic plan. This was accomplished not only by having staff members participate in one of the sessions but also by sharing the project's major findings with them and instructing them in how these findings related to the library's future. The authors' experience demonstrates that focus groups are an effective strategic planning tool for libraries and emphasizes the need to share information broadly, if active involvement of the staff is desired in both the development and implementation of the library's strategic plan.

Consumer Behavior↗
PubMed2004

Evaluating the effectiveness of clinical medical librarian programs: a systematic review of the literature.

OBJECTIVE: This study was undertaken to determine if a systematic review of the evidence from thirty years of literature evaluating clinical medical librarian (CML) programs could help clarify the effectiveness of this outreach service model. METHODS: A descriptive review of the CML literature describes the general characteristics of these services as they have been implemented, primarily in teaching-hospital settings. Comprehensive searches for CML studies using quantitative or qualitative evaluation methods were conducted in the medical, allied health, librarianship, and social sciences literature. FINDINGS: Thirty-five studies published between 1974 and 2001 met the review criteria. Most (30) evaluated single, active programs and used descriptive research methods (e.g., use statistics or surveys/questionnaires). A weighted average of 89% of users in twelve studies found CML services useful and of high quality, and 65% of users in another overlapping, but not identical, twelve studies said these services contributed to improved patient care. CONCLUSIONS: The total amount of research evidence for CML program effectiveness is not great and most of it is descriptive rather than comparative or analytically qualitative. Standards are needed to consistently evaluate CML or informationist programs in the future. A carefully structured multiprogram study including three to five of the best current programs is needed to define the true value of these services.

Clinical Medicine↗
PubMed1999

Adoption of Internet technology by UK postgraduate centres: a questionnaire survey.

A survey of UK postgraduate centres during September 1997 found that almost 60% were connected to the Internet, but librarians were still the largest user group, few had more than one access point and support to users was limited. Significant progress was made during the following 18 months--by April 1999 all but one of the remaining sites had Internet access in either the postgraduate centre or in a separate library. Lack of funds and decisive policy were stated to be the most common reasons for delay in connecting. The Internet was rated highly as source of the latest research information and support for evidence-based medicine and continuing education. Expansion of the role of librarians to include assistance with sophisticated searches seemed a logical move to the majority, yet the survey suggests that a significant investment in time and money will be required to support the use of the Internet in continuing medical education in the broadest sense. It is likely that the traditional boundaries between IT departments, libraries and user groups will need to be redrawn if the technology is to be exploited effectively.

Data Collection↗
PubMed1997

Ethics and the GMC core curriculum: a survey of resources in UK medical schools.

OBJECTIVES: To study the resources available and resources needed for ethics teaching to medical students in UK medical schools as required by the new GMC core curriculum. DESIGN: A structured questionnaire was piloted and then circulated to deans of medical schools. SETTING: All UK medical schools. RESULTS: Eighteen out of 28 schools completed the questionnaire, the remainder either indicating that their arrangements were "under review" (4) or not responding (6). Among those responding: 1) library resources, including video and information technology were found to be fairly well developed; 2) many schools had a good supply of handouts and sample cases for teaching; 3) most had a written syllabus, and 4) two-thirds examined in the subject. However, many schools indicated that there was an urgent need for: 1) full-time teachers (most ethics teaching is still by part-time and voluntary staff); funding for books and journals, and 3) additional teaching materials (including further case vignettes, handouts and sample exam questions). CONCLUSIONS: There has been a considerable overall improvement in resources for medical ethics teaching since the time of the last national survey (The Pond Report). However, provision varies widely from medical school to medical school. The particular needs identified were for full-time teachers, library resources and teaching materials. Wider use of existing organisations concerned with medical ethics could help to meet these needs.

Curriculum↗
PubMed2004

Best paediatric evidence; is it accessible and used on-call?

BACKGROUND: Paediatricians wanting to use evidence based medicine (EBM) strategies, need to be able to track down and critically appraise evidence. This requires access to quality filtered resources (for example, Cochrane Library), bibliographic databases (for example, Medline), and paediatric journals. AIMS: To determine whether paediatricians have access to these resources when on-call and if they use them to answer clinical questions. METHOD: A telephone survey of paediatric and neonatal units was performed during November 2001. The "paediatrician-on-call" was asked whether they could access Medline, Cochrane, and paediatric journals, and if they used these when on-call. RESULTS: Paediatric trainees were available in 87 of the 97 units contacted. All except one had access to Medline; although only 56 (64%) could do this near their ward. Eighty had access to Cochrane. Thirteen (15%) could not gain access to their library out-of-hours. All except one department had local guidelines, with 71% having >15 guidelines. Access to any of the top seven "best evidence" paediatric journals varied from 64% to 100%. Only 26% of trainees had read the evidence based section of Archives of Disease of Childhood, Archimedes. Many trainees claimed to use guidelines when on-call (61; 70%), but few used Medline (14; 16%). CONCLUSIONS: Paediatric trainees mostly have access to facilities to help them to track down and critically appraise evidence. However, few of them have used it to help make clinical decisions when on-call. Many of the doctors contacted said they used local guidelines as their source of information on-call.

Child↗
PubMedDate not supplied

A library-site asthma education program for inner-city communities.

Asthma education programs are reportedly effective for children and adolescents. Urban and minority children continue to have poor asthma outcomes and limited access to asthma education programs. The purpose of this study was to determine whether a library-based asthma education program, the Columbus Ohio Partnership for Inner-City Asthma Education (COPICAE), offered to urban and minority children (with their parents) could improve asthma-related outcomes and reduce billing claims for asthma-related hospital visits. A prospective/observational study was conducted to evaluate asthma-related outcomes of 87 children who completed 6 hours of asthma education using telephone follow-up at 12 and 24 months with a scored Living With Asthma Survey (LWAS). Hospital billing claims for asthma as the primary diagnosis were compared over a 24-month period for 64 children who completed 6 hours of asthma education with an age and zip code match control. Two separate focus groups with Spanish-speaking and English-speaking parents who completed 6 hours of asthma education with their children obtained parental perspectives about the asthma education classes. LWAS follow-up data were obtained on 67% of the participants at year 1 and 43% at year 2. Compared to pre-intervention mean scores, there were decreases in scores to all LWAS items. Parents reported improvements in compliance with asthma medication use and overall control of their child's asthma. Parents also found the information from the asthma education classes to be "beneficial." Total asthma-related billing claims for children who completed 6 hours of asthma education decreased 63.2%, while those for age and zip code matched controls increased 0.7%. Inner-city and minority children (with their parents) who attended 6 hours of asthma education offered in a public library showed improvements in asthma-related outcomes over a 24-month period and decreased billing claims for asthma-related hospital visits. Parents found 6 hours of asthma education to be beneficial in gaining basic knowledge about asthma and improving their child's illness control and self-esteem in living with asthma.

Adolescent↗