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Contents of a core library in continuing medical education: a Delphi study.

INTRODUCTION: In developing their professional competence, those who are interested in the practice of continuing medical education (CME) should recognize the knowledge base that defines their field. This study systematically identifies and organizes a list of books and journals comprising a core library (100 books/15 journals) for CME professionals. METHODS: The Delphi method was applied to elicit and combine the judgments of a fifty member panel considered knowledgeable about the CME field. The panelists participated in three iterations of the survey to first identify and then rank order nominated works. Separate ranked lists were created for books and journals. RESULTS: Forty-four participants completed the study (88% response rate). 268 books and 34 journals were identified. Mean ratings ranged from 4.78 (high) to 1.50 (low). DISCUSSION: The results of the study reflect the panel's judgment. The list is not definitive; instead, it describes what a select group of individuals knowledgeable about the CME field considered important. The list should therefore be seen as a general guide and a resource to facilitate decision-making, not as a prescription for creating a library.

Delphi Technique↗

Is chiropractic evidence based? A pilot study.

OBJECTIVE: To calculate the proportion of care delivered in a chiropractic practice supported by good-quality clinical trials. DESIGN: Retrospective survey. METHODS: Data were collected from patient files relating to 180 consecutive patient visits in a suburban chiropractic practice in northern Spain. Each patient's presenting complaint was paired with the chiropractor's chosen primary intervention. Based on a literature review (Medline, Mantis, and nonautomated searches of local medical libraries), each presenting complaint-primary intervention pairing was categorized according to the level of supporting evidence as follows: Category I, intervention based on good quality clinical trial evidence; Category II, intervention based on poor-quality or no clinical trial evidence. To distinguish between good- and poor-quality clinical trials, studies were critically appraised and assigned quality scores. RESULTS: Of the 180 cases surveyed, 123 (68.3%) (95% CI, 61.5%-75.1%) were based on clinical trials of good methodologic quality (Category I). Only 57 (31.7%) (95% CI, 24.9%-38.5%) of the cases were based on poor-quality or no clinical trial evidence (Category II). CONCLUSIONS: When patients were used as the denominator, the majority of cases in a chiropractic practice were cared for with interventions based on evidence from good-quality, randomized clinical trials. When compared to the many other studies of similar design that have evaluated the extent to which different medical specialties are evidence based, chiropractic practice was found to have the highest proportion of care (68.3%) supported by good-quality experimental evidence.

Chiropractic↗

Molecular evidence for a uniform microbial community in sponges from different oceans.

Sponges (class Porifera) are evolutionarily ancient metazoans that populate the tropical oceans in great abundances but also occur in temperate regions and even in freshwater. Sponges contain large numbers of bacteria that are embedded within the animal matrix. The phylogeny of these bacteria and the evolutionary age of the interaction are virtually unknown. In order to provide insights into the species richness of the microbial community of sponges, we performed a comprehensive diversity survey based on 190 sponge-derived 16S ribosomal DNA (rDNA) sequences. The sponges Aplysina aerophoba and Theonella swinhoei were chosen for construction of the bacterial 16S rDNA library because they are taxonomically distantly related and they populate nonoverlapping geographic regions. In both sponges, a uniform microbial community was discovered whose phylogenetic signature is distinctly different from that of marine plankton or marine sediments. Altogether 14 monophyletic, sponge-specific sequence clusters were identified that belong to at least seven different bacterial divisions. By definition, the sequences of each cluster are more closely related to each other than to a sequence from nonsponge sources. These monophyletic clusters comprise 70% of all publicly available sponge-derived 16S rDNA sequences, reflecting the generality of the observed phenomenon. This shared microbial fraction represents the smallest common denominator of the sponges investigated in this study. Bacteria that are exclusively found in certain host species or that occur only transiently would have been missed. A picture emerges where sponges can be viewed as highly concentrated reservoirs of so far uncultured and elusive marine microorganisms.

Animals↗

A gerontological cohort study of aged twins: the Osaka University Aged Twin Registry.

We describe subject recruitment and research results from the Osaka University Aged Twin Registry (OUATR). The research focus of OUATR is the genetic and environmental contributions to physical-cognitive-mental aging which we examined in Japanese twins in later adulthood. Within this large-scale registry (12,000 pairs) of oriental twins born between 1900 and 1935, approximately 10% of participants are MZ twins reared apart from early childhood. Two hundred and fifty pairs have had comprehensive medical examinations, including various blood chemical panels, lymphocyte subtests, WAIS (Wechsler Adult Intelligence Scale), and urine analysis. The future foci of this study are primarily on longevity, decline of cognitive functions with aging, bio-physiological functions, lifestyle and behavior genetics, and psycho-spiritual functions.

Activities of Daily Living↗

The Swedish Young Male Twins Register: a resource for studying risk factors for cardiovascular disease and insulin resistance.

A new Swedish twin register was created in 1998. All male twins born in Sweden 1973-1979 were identified in the Swedish Medical Birth Register. 3566 twins (1783 pairs) who were alive and residents of Sweden in 1997 were included in the new register. Data on birthweight, birthlength, gestational age, and so forth, were obtained from the Medical Birth Register. Record linkage was effected with the Military Service Conscription Register for the years 1991-1999. Anthropometrical data and information on blood pressure were obtained from this latter source. In 1998 a questionnaire was mailed to all twins in the register. Questions were posed about zygosity, socioeconomic conditions, lifestyle factors (physical activity, smoking habits, etc.), body shape and body size. Complete responses were obtained from 2654 twins (1327 pairs). In 2002 the cohort is being followed-up by a more extensive mailed questionnaire. Data will be collected about socioeconomic conditions, lifestyle, eating behaviour (TFEQ), body size and body shape. In the next few years genomic DNA will also be collected from buccal mucosa (using brush techniques).

Adult↗

Twins early development study (TEDS): a multivariate, longitudinal genetic investigation of language, cognition and behavior problems in childhood.

The Twins Early Development Study (TEDS) focuses on the early development of the three most common psychological problems in childhood: communication disorders, mild mental impairment and behavior problems. The TEDS twins were assessed longitudinally at 2, 3, 4 and 7 years of age in order to investigate genetic and environmental contributions to change and continuity in language and cognitive development; it is multivariate in order to examine the origins of comorbidity; and it uses a large sample in order to study abnormal development in the context of normal development. The twins were identified from birth records of twins born in the UK in 1994-96. More than 15,000 pairs of twins have been enrolled in TEDS and the participating families are representative of the UK. The measures at 2, 3 and 4 years are administered by parents. At 7 years, children are assessed for language and cognitive development using telephone testing, parents and children are interviewed about behavior problems, and teachers also assess behavior problems as well as academic achievement. One set of findings is that the same genes largely contribute to both language and cognitive problems and the same genes affect normal and abnormal development, a result that suggests that general impairment may be a better target for genetic research than specific language impairment independent of nonverbal cognitive problems. DNA has been obtained so far for more than 4000 pairs and is being used initially in molecular genetic studies of language problems and hyperactivity.

Birth Certificates↗

Information-seeking behavior of nursing students and clinical nurses: implications for health sciences librarians.

OBJECTIVES: This research was conducted to provide new insights on clinical nurses' and nursing students' current use of health resources and libraries and deterrents to their retrieval of electronic clinical information, exploring implications from these findings for health sciences librarians. METHODS: Questionnaires, interviews, and observations were used to collect data from twenty-five nursing students and twenty-five clinical nurses. RESULTS: Nursing students and clinical nurses were most likely to rely on colleagues and books for medical information, while other resources they frequently cited included personal digital assistants, electronic journals and books, and drug representatives. Significantly more nursing students than clinical nurses used online databases, including CINAHL and PubMed, to locate health information, and nursing students were more likely than clinical nurses to report performing a database search at least one to five times a week. CONCLUSIONS AND RECOMMENDATIONS: Nursing students made more use of all available resources and were better trained than clinical nurses, but both groups lacked database-searching skills. Participants were eager for more patient care information, more database training, and better computer skills; therefore, health sciences librarians have the opportunity to meet the nurses' information needs and improve nurses' clinical information-seeking behavior.

Adult↗

Building a Database of Data Sets for Health Services Research.

The Database of Data Sets (DB/DS) for Health Services Research will be an online searchable directory of data sets which are available, often with restrictions and confidentiality safeguards, for use by health care researchers. The DB/DS project is aimed at a wide audience, and intends to include a very broad range of health care data sets, ranging from state hospital discharge data bases, to national registries and health survey data sets, to institutional clinical databases. The intended users are the same community of researchers, policy-makers, administrators and practitioners who are served by the National Library of Medicine's current bibliographic databases. This paper describes a pilot phase of the DB/DS project in which the issues involved in creating such a database were explored with an initial set of 20 representative data sets.

Databases, Factual↗

STRONGYLID COINFECTIONS IN SYMPATRIC CHIMPANZEES AND GORILLAS FROM THE REPUBLIC OF THE CONGO REVEALED BY FECAL METAGENOMICS.

Soil-transmitted strongylid nematodes are common intestinal parasites of African great apes, yet most surveys have relied on microscopy or targeted PCR assays that are limited in taxonomic breadth and comparability across hosts. I reanalyzed 46 publicly available shotgun fecal metagenomes from sympatric central chimpanzees (Pan troglodytes troglodytes; n = 18) and western lowland gorillas (Gorilla gorilla gorilla; n = 28) in the Goualougo Triangle, Nouabalé-Ndoki National Park, Republic of the Congo, to test whether host species structures genus-level strongylid community composition and relative read signal. Non-host reads were classified against a custom strongylid-focused database targeting 4 genera repeatedly reported from African apes: Ancylostoma, Necator, Oesophagostomum, and Trichostrongylus. All 4 focal genera were detected in every library under baseline filtering, and multi-genus detection remained robust under increasingly stringent read-count thresholds. However, host species differed strongly in community composition. Chimpanzee libraries had relatively even genus-level profiles, whereas gorilla libraries were consistently Necator-dominated. Gorillas also had substantially higher relative strongylid read abundance. The results show that shotgun metagenomic reanalysis can recover host-structured strongylid community signals from wildlife samples and can complement targeted parasitological surveys in conservation and One Health surveillance.

Animals↗

Information needs in primary care: a survey of rural and nonrural primary care physicians.

OBJECTIVE: To compare the self-reported information needs of rural and nonrural primary care physicians. DESIGN AND PARTICIPANTS: Mail survey of active non-academic primary care physicians. DATA COLLECTION: A 60 item questionnaire regarding 1) demographic and practice setting data; 2) medical information needs; 3) medical knowledge resource availability and use; and 4) physician information seeking behavior. MAIN RESULTS: The response rate was higher among rural than non-rural physicians (55% vs. 42%, p< 0.001) and among Family Physicians than others (Family Medicine 53%, Internal Medicine 43%, Pediatrics 48%, p=0.015.) Rural physicians reported working more hours per week (45.3 vs. 42.7, p=0.033,) and seeing more patients per day (24.6 vs. 22.3, p=0.005) than their nonrural counterparts. Both groups reported a median of about 1 question for every 10 patients they see, with great variance among responses. Both groups reported pursuing answers to about 57% of their questions, and finding answers to about 70% of those they pursue. Knowledge resource preferences of the two groups were similar. Both groups reported frequent use of consultants, drug compendia, colleagues, and textbooks, and little use of library- or computer-based sources. Compared to nonrural physicians, rural physicians reported less frequent use of consultants, colleagues, librarians, and bound journals. These differences were small, and paralleled differences in availability. The two groups had equal access to textbooks and drug compendia, but for rural physicians, other resources were locally available significantly less often. CONCLUSIONS: Rural and nonrural primary care physicians reported equal information needs, similar information seeking, and similar resource preferences. Rural physicians reported less access to some information resources, but little difference in use of resources. Further studies are needed to determine how these differences impact rural practitioners and their patients.

Data Collection↗

Excerpta Medica abstracting journals: a case study of costs to medical school libraries.

A cost comparison study was made of Excerpta Medica's abstracting journals, based upon actual costs to a library. Unit costs were determined for six sections of EM as compared with six corresponding abstract journals. On average, EM sections were found to be 138% more costly than corresponding abstract journals. The effects of splitting of EM journal titles were also analyzed. This practice increases the price of a total subscription to EM and makes comprehensive information retrieval more difficult. A survey of medical school librarians as users of EM points to dissatisfaction with its increasing price, particularly when it results from title splitting.

Abstracting and Indexing↗

The management of health library outreach services: evaluation and reflection on lessons learned on the VIVOS project.

PURPOSE: The aim of the VIVOS project was to develop and evaluate methodologies, i.e., sets of methods, for determining the value and impact of "virtual outreach" information services in the health sector in the UK. METHODS: Five different projects were recruited initially, with another two added later. Methods were largely qualitative, with over 130 interviews conducted among health professionals, complemented by postal questionnaire surveys. RESULTS: Identified factors that affect the successful roll-out and continued development of the projects included the need for help-desk type services to provide sustained support for new users to the services. CONCLUSIONS: Follow-up of the projects eighteen months after the end of the VIVOS project revealed that the long-term impacts for the participating library managers included the benefits of using evidence on service outcomes, enhanced recognition locally, and greater confidence in evaluation.

Community-Institutional Relations↗

Definition and detection of alarms in critical care.

Critical care medicine has developed enormously in complexity and even more so in cost over the past twenty years. There has been evidence of remarkable progress in improved outcomes from some conditions, particularly when severely ill patients are treated in well equipped and well managed intensive care units (ICU) which have clear directorship and comprehensive management guidelines and protocols (Zimmermann et al., Crit Care Med 1993; 21:1443-1451). Nevertheless, for some conditions such as severe acute respiratory failure and multiple organ failure, there is considerable debate as to whether there has been any improvement at all (Lee et al., Thorax 1994; 49:596-597. Artigas et al., Adult respiratory distress syndrome, Churchill Livingstone, Edinbugh, London, Madrid, Melbourne, New York, Tokyo, pp. 509-525). Developments in signal processing and monitoring and recording technology have resulted in a vast increase in the quantity of data that is available to clinicians trying to manage critically ill patients (Price, Bailliere's Clin Anaesthesiol 1987; 1:533-556) but there is little evidence that this apparent gain has lead to better clinical decisions or earlier warning of significant instability. One of the tasks of the European Union sponsored IMPROVE group was to attempt to identify significant downward trends in vital parameters sufficiently early to allow clinical intervention to be potent and effective and ultimately improve patient outcome from a wide range of life threatening conditions. The first stage of this task was to define examples of such life threatening deterioration and conduct a survey in representative intensive care units of the incidence of these conditions and the subsequent patient outcomes. This is a preliminary task, the next stage being the gathering of "real time' data from critically ill patients for 24-h sample periods to probe for deteriorating trends and to compile a comprehensive annotated data library of physiological data as a rich resource for future adaptations in signal processing technology and clinical decision support.

Bacterial Infections↗

Phylogenetic diversity of ultraplankton plastid small-subunit rRNA genes recovered in environmental nucleic acid samples from the Pacific and Atlantic coasts of the United States.

The scope of marine phytoplankton diversity is uncertain in many respects because, like bacteria, these organisms sometimes lack defining morphological characteristics and can be a challenge to grow in culture. Here, we report the recovery of phylogenetically diverse plastid small-subunit (SSU) rRNA gene (rDNA) clones from natural plankton populations collected in the Pacific Ocean off the mouth of Yaquina Bay, Oreg. (OCS clones), and from the eastern continental shelf of the United States off Cape Hatteras, N.C. (OM clones). SSU rRNA gene clone libraries were prepared by amplifying rDNAs from nucleic acids isolated from plankton samples and cloning them into plasmid vectors. The PCR primers used for amplification reactions were designed to be specific for bacterial SSU rRNA genes; however, plastid genes have a common phylogenetic origin with bacteria and were common in both SSU rRNA gene clone libraries. A combination of restriction fragment length polymorphism analyses, nucleic acid sequencing, and taxon-specific oligonucleotide probe hybridizations revealed that 54 of the 116 OCS gene clones were of plastid origin. Collectively, clones from the OCS and OM libraries formed at least eight unique lineages within the plastid radiation, including gene lineages related to the classes Bacillariophyceae, Cryptophyceae, Prymnesiophyceae, Chrysophyceae, and Prasinophyceae; for a number of unique clones, no close phylogenetic neighbors could be identified with confidence. Only a group of two OCS rRNA gene clones showed close identity to the plastid SSU rRNA gene sequence of a cultured organism [Emiliania huxleyi (Lohmann) Hay and Mohler; 99.8% similar]. The remaining clones could not be identified to the genus or species level. Although cryptic species are not as prevalent among phytoplankton as they are among their bacterial counterparts, this genetic survey nonetheless uncovered significant new information about phytoplankton diversity.

Animals↗

Fibroblast growth factors share binding sites in heparan sulphate.

HS (heparan sulphate) proteoglycans bind secreted signalling proteins, including FGFs (fibroblast growth factors) through their HS side chains. Such chains contain a wealth of differentially sulphated saccharide epitopes. Whereas specific HS structures are commonly believed to modulate FGF-binding and activity, selective binding of defined HS epitopes to FGFs has generally not been demonstrated. In the present paper, we have identified a series of sulphated HS octasaccharide epitopes, derived from authentic HS or from biosynthetic libraries that bind with graded affinities to FGF4, FGF7 and FGF8b. These HS species, along with previously identified oligosaccharides that interact with FGF1 and FGF2, constitute the first comprehensive survey of FGF-binding HS epitopes based on carbohydrate sequence analysis. Unexpectedly, our results demonstrate that selective modulation of FGF activity cannot be explained in terms of binding of individual FGFs to specific HS target epitopes. Instead, different FGFs bind to identical HS epitopes with similar relative affinities and low selectivity, such that the strength of these interactions increases with increasing saccharide charge density. We conclude that FGFs show extensive sharing of binding sites in HS. This conclusion challenges the current notion of specificity in HS-FGF interactions, and instead suggests that a set of common HS motifs mediates cellular targeting of different FGFs.

Binding Sites↗

Bibliography on AIDS-related bereavement and grief.

This annotated bibliography on AIDS-related bereavement and grief was compiled to address a steadily increasing population: survivors of persons who have died of AIDS. Bibliographical entries were located by searching printed indexes, including Cumulative Index to Nursing and Allied Health Literature, Hospital Literature Index, Index Medicus, International Nursing Index, Psychological Abstracts, Social Science Index, Social Work Abstracts, and Sociological Abstracts. Databases searched included ERIC (Department of Education), Med-Line (National Library of Medicine), and Psych-Lit (American Psychological Association). References cited at the end of each work were also checked. This bibliography includes publications of studies using the survey method of social research and the case-study approach. It also includes experiences of professionals personally affected by the loss of someone to AIDS, and informational articles and chapters. To be included in this bibliography the work must have dealt exclusively or largely with the topic of AIDS-related bereavement and grief, or it must have addressed some aspect of it not previously covered anywhere in the literature. The topic of AIDS-related bereavement and grief refers to the loss of someone to (or with, as is the case with suicide) Acquired Immune Deficiency Syndrome, and its psychological, emotional, physical, and social effects on the survivor(s). This bibliography does not include publications that deal with related topics such as thanatology, anticipatory grief and mourning, and mortality rates and trends. This work is meant to serve as a resource for professionals in a variety of fields (e.g., nursing, pastoral care, mental health, and social work) involved in social research, bereavement counseling, ministry, and group intervention. It can be useful as a literature search for students in a variety of disciplines and for the AIDS-bereaved themselves. The bibliography is accompanied by an overview of the current state of the literature and a summary of the areas still in need of research and publication.

Acquired Immunodeficiency Syndrome↗

Students evaluate MEDFILE, a preprinted medical literature filing system.

Medical professionals are highly dependent on personal libraries and reprint files as their sources for current information. A large population of practising doctors have poorly organized medical literature data bases in their professional environment. To expedite the development of a personal library data base by medical students, we created MEDFILE, a preprinted, cross-indexed file folder system for organizing the medical literature. This paper reports the results of two surveys performed in connection with the distribution of the MEDFILE system. One hundred per cent of the students who used MEDFILE found the system to be beneficial. Ninety-seven per cent felt their ability to find their personal literature improved by using MEDFILE, and 65% felt MEDFILE improved their clinical preparation. Of all surveyed recipients of the system, 96.8% felt MEDFILE would be useful in their future studies.

Attitude of Health Personnel↗

Expressed sequence tags (ESTs) and simple sequence repeat (SSR) markers from octoploid strawberry (Fragaria x ananassa).

BACKGROUND: Cultivated strawberry (Fragaria x ananassa) represents one of the most valued fruit crops in the United States. Despite its economic importance, the octoploid genome presents a formidable barrier to efficient study of genome structure and molecular mechanisms that underlie agriculturally-relevant traits. Many potentially fruitful research avenues, especially large-scale gene expression surveys and development of molecular genetic markers have been limited by a lack of sequence information in public databases. As a first step to remedy this discrepancy a cDNA library has been developed from salicylate-treated, whole-plant tissues and over 1800 expressed sequence tags (EST's) have been sequenced and analyzed. RESULTS: A putative unigene set of 1304 sequences--133 contigs and 1171 singlets--has been developed, and the transcripts have been functionally annotated. Homology searches indicate that 89.5% of sequences share significant similarity to known/putative proteins or Rosaceae ESTs. The ESTs have been functionally characterized and genes relevant to specific physiological processes of economic importance have been identified. A set of tools useful for SSR development and mapping is presented. CONCLUSION: Sequences derived from this effort may be used to speed gene discovery efforts in Fragaria and the Rosaceae in general and also open avenues of comparative mapping. This report represents a first step in expanding molecular-genetic analyses in strawberry and demonstrates how computational tools can be used to optimally mine a large body of useful information from a relatively small data set.

Chromosome Mapping↗