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PubMed2003

BEME Guide no 3: systematic searching for evidence in medical education--Part 1: Sources of information.

Searching for evidence to inform best practice in medical education is a complex undertaking. With very few information sources dedicated to medical education itself, one is forced to consult a wide range of often enormous sources--and these are dedicated to either medicine or education, making a medical education search all the more challenging. This guide provides a comprehensive overview of relevant information sources and methods (including bibliographic databases, grey literature, hand searching and the Internet) and describes when they should be consulted. The process of constructing a search is explained: identifying and combining core concepts, using Boolean algebra and search syntax, limiting results sets, and making best use of databases' controlled vocabularies. This process is illustrated with images from search screens and is followed by numerous examples designed to reinforce skills and concepts covered. The guide has been developed from the ongoing experience gained from the systematic searches conducted for the Best Evidence Medical Education Collaboration, and concludes by looking ahead to initiatives that will shape future searching for medical education evidence.

Benchmarking↗
PubMed2001

Information for surgical patients: implications of the World Wide Web.

OBJECTIVE: To sample the amount and scope of information available on the internet about three common surgical conditions, identify the sources, and to examine the relevance of the web to the surgical community. DESIGN: Internet search. SETTING: General hospital, Republic of Ireland. MATERIAL: Three arbitrarily chosen conditions were sought--varicose veins, inguinal hernia, and gallstones. Four commonly used search engines--Yahoo, Altavista, Excite and Lycos, were used to search worldwide, and then sites restricted to the UK and Republic of Ireland. MAIN OUTCOME MEASURES: Quality and quantity of information available. RESULTS: All four search engines retrieved patient-orientated information on the three conditions. The sites accessed from the web page matches generally presented a comprehensive summary of the condition including aetiology, risk factors and clinical features, but gave variable amounts of information on treatment options, surgical complications, comparisons between treatments, and expected outcomes. Online health magazines provided most of the information sites. CONCLUSION: The internet offers easily-accessible patient-orientated information. Surgeons should make more use of it to satisfy patients' increasing need for information.

Cholelithiasis↗
PubMed2001

The impact of medical informatics on the confidence of rural physicians caring for patients with chronic hepatitis C viral infections.

OBJECTIVE: The purpose of the present study was to determine whether CD-based medical informatics enhances rural physicians' confidence in the management of patients with chronic hepatitis C viral infections. METHODS: A total of 385 Canadian rural physicians were mailed a CD-based medical software programme that outlines all aspects of HCV care including diagnosis, counselling, treatment and follow-up. Accompanying the CD was a brief questionnaire that addressed physicians' confidence in the following areas: (i) identifying HCV patients in their practice; (ii) laboratory use and interpretation; (iii) patient counselling; (iv) selection of candidates for treatment; (v) sharing treatment delivery; and (vi) providing follow-up. Three months thereafter, the same questionnaire was repeated. RESULTS: Of the 385 mailings, 59 (15%) physicians returned the initial questionnaire and 57 (15%) the follow-up questionnaire. Twenty-five (44%) respondents indicated they had used the CD. Baseline physician confidence was low in three of the six areas addressed. At follow-up, in addition to now being confident in all areas, CD users were significantly more confident than those who had not used the CD. Increases in physician confidence for CD users were approximately 150-300% in the six areas addressed. The value assigned the CD programme was 8/10. CONCLUSION: The results of this study indicate that: (i) rural physicians are uncomfortable in dealing with many aspects of HCV management; (ii) CD-ROM-based medical informatics can significantly enhance rural physicians' confidence in these areas; (iii) approximately 50% of physicians will employ CD-ROM-based medical informatics in their offices; and (iv) physician level of satisfaction with such programmes is high.

Attitude of Health Personnel↗
PubMed2003

Specialized medical search-engines are no better than general search-engines in sourcing consumer information about androgen deficiency.

BACKGROUND: The Internet provides consumers with access to online health information; however, identifying relevant and valid information can be problematic. Our objectives were firstly to investigate the efficiency of search-engines, and then to assess the quality of online information pertaining to androgen deficiency in the ageing male (ADAM). METHODS: Keyword searches were performed on nine search-engines (four general and five medical) to identify website information regarding ADAM. Search-engine efficiency was compared by percentage of relevant websites obtained via each search-engine. The quality of information published on each website was assessed using the DISCERN rating tool. RESULTS: Of 4927 websites searched, 47 (1.44%) and 10 (0.60%) relevant websites were identified by general and medical search-engines respectively. The overall quality of online information on ADAM was poor. The quality of websites retrieved using medical search-engines did not differ significantly from those retrieved by general search-engines. CONCLUSION: Despite the poor quality of online information relating to ADAM, it is evident that medical search-engines are no better than general search-engines in sourcing consumer information relevant to ADAM.

Androgens↗
PubMed1996

A novel approach to data collection in a case-control study of cancer and occupational exposures.

BACKGROUND: In community and hospital-based case-control studies, the occupational data collected in interviews are usually limited to responses to general questions asked of all study subjects. A procedure is described in which more detailed information can be collected in an efficient, standardized and systematic way. METHODS: A generic work history is initially collected from all subjects using a computer-assisted interview. The work history includes job title, type of business, job activities, materials and chemicals, and tools and equipment used. After responses are entered into the computer by the interviewer, the computer searches a synonym file to identify possible job-specific modules relevant to the reported job. The modules are detailed questionnaires that address specific jobs administered after obtaining the generic work history. The modules are used to ask questions about the work environment; sources of exposure; factors affecting the movement of the agent from the source to the subject, such as local exhaust ventilation; and individual and job characteristics. After the interview is completed, the work history and responses to the modules are sent electronically to an industrial hygienist who reviews the information using a custom-designed software package. Where ambiguities or contradictions occur in information reported by the respondent, or for jobs for which no module had been developed, the industrial hygienist generates up to 10 additional questions per job. These questions are sent back to the interviewer for administration of a short, second interview. CONCLUSIONS: These procedures, which are being successfully implemented in an on-going case-control study of brain tumours, should improve disease risk estimates over those derived from more traditional approaches to exposure assessment.

Brain Neoplasms↗
PubMed1999

What lessons can be learned for cancer registration quality assurance from data users? Skin cancer as an example.

BACKGROUND: In cancer registration, data cleaning (i.e. amendments made by data users to datasets released by registries) is potentially informative for quality assurance, but generally underreported. AIM: To assess the scope for learning lessons about cancer registration quality assurance from a data user (using skin cancer as the example). METHODS: The main design features were: (i) A descriptive study identifying, qualitatively and quantitatively, the breadth, depth, and impact of quality assurance issues raised by a user cleaning Merseyside and Cheshire Cancer Registry skin cancer data. Errors were rectified and pitfalls for interpretation were identified. (ii) A nested validation of morphology and site coding on random samples of cutaneous malignant melanomas, basal cell carcinomas (BCC), and squamous cell carcinomas. The 33132-record dataset comprised: all registered skin lesions, except metastases; most recorded variables (about patient, lesion, treatment, outcome); for Merseyside and Cheshire residents diagnosed 1970-1991. RESULTS: (i) Ineligible cases represented 0.3% (97/33132), and were detected best by morphology checks. Most quality assurance issues identified related to local custom and practice, staff training, and computerization, being particularly illustrated by problematic BCC registration practice (e.g. records written over unchallenged by range checks; and idiosyncratic use of variables). (ii) Post-cleaning, morphology coding errors were minimal in the random samples. CONCLUSION: There is great scope for data users to contribute to cancer registration quality assurance. Ultimately, the study dataset appeared fit for epidemiological analysis and important quality assurance messages emerged. Shared explicit standard guidelines for data preparation and validation are needed by users, whose insights could and should be better recognized by cancer registries.

Adult↗
PubMed2003

Health technology assessment: history and demand.

Health technology assessment (HTA)--the provision to decision makers of information on the value of treatments and tests--has come of age in the last two decades. But it has deep roots in health care, with notable landmarks in (1) the mid eighteenth-century development of empiricism, (2) the twentieth century interest in outcomes and variation in health care, and (3) the pioneering work of Archie Cochrane and others in the 1970s. Three main forces have driven the recent developments of HTA: a combination of concerns about the adoption of unproven technologies, rising costs, and an inexorable rise in consumer expectations. The HTA response, essentially initiatives supporting the provision of reliable synthesised research information on the effects and costs of health technologies, have been well supported in the United Kingdom and internationally. We can be sure that HTA is here to stay.

Cost-Benefit Analysis↗
PubMed1986

Forensic diagnosis coding and retrieval by microcomputer.

A system is described for coding of anatomic--including forensic--pathologic diagnoses from necropsy cases using a microcomputer. The SNOMED software from the College of American Pathologists is utilized. RAM-disk software is employed to enhance the speed of operation of the system. The microcomputer can be operated by clerical staff versed in medical terminology. Speed of entry and retrieval, with minimal manual interaction, is an important aspect of operation. Equipment and storage costs are minimal.

Forensic Medicine↗
PubMed1999

Mapping variation in brain structure and function: implications for rehabilitation.

The recognition of structural and functional variability of the human brain promoted the development of a system to organize and analyze the rapidly growing body of knowledge acquired among diverse disciplines. The Human Brain Project (HBP) was initiated and has evolved as a means of establishing an information infrastructure through tools related to the emerging science of neuroinformatics. This article will briefly describe the implications that such an endeavor has for the field of traumatic brain injury (TBI) rehabilitation.

Brain↗
PubMed1997

"Just-in-time" clinical information.

The just-in-time (JIT) model originated in the manufacturing industry as a way to manage parts inventories process so that specific components could be made available at the appropriate times (that is, "just in time"). This JIT model can be applied to the management of clinical information inventories, so that clinicians can have more immediate access to the most current and relevant information at the time they most need it--when making clinical care decisions. The authors discuss traditional modes of managing clinical information, and then describe how a new, JIT model may be developed and implemented. They describe three modes of clinician-information interactions that a JIT model might employ, the scope of information that may be made available in a JIT model (global information or local, case-specific information), and the challenges posed by the implementation of such an information-access model. Finally, they discuss how JIT information access may change how physicians practice medicine, various ways JIT information may be delivered, and concerns about the trustworthiness of electronically published and accessed information resources.

Clinical Competence↗