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Developing methods for systematic reviewing in health services delivery and organization: an example from a review of access to health care for people with learning disabilities. Part 2. Evaluation of the literature--a practical guide.

OBJECTIVES: To develop methods to facilitate the 'systematic' review of evidence from a range of methodologies on diffuse or 'soft' topics, as exemplified by 'access to health care'. DATA SOURCES: Twenty-eight bibliographic databases, research registers, organizational websites or library catalogues. Reference lists from identified studies. Contact with experts and service users. Current awareness and contents alerting services in the area of learning disabilities. REVIEW METHODS: Inclusion criteria were English language literature from 1980 onwards, relating to people with learning disabilities of any age and all study designs. The main criteria for assessment was relevance to Guillifords' model of access to health care which was adapted to the circumstances of people with learning disabilities. Selected studies were evaluated for scientific rigour then data was extracted and the results synthesized. Quality assessment was by an initial set of 'generic' quality indicators. This enabled further evidence selection before evaluation of findings according to specific criteria for qualitative, quantitative or mixed-method studies. RESULTS: Eighty-two studies were fully evaluated. Five studies were rated 'highly rigorous', 22 'rigorous', 46 'less rigorous' and nine 'poor' papers were retained as the sole evidence covering aspects of the guiding model. The majority of studies were quantitative but used only descriptive statistics. Most evidence lacked methodological detail, which often lowered final quality ratings. CONCLUSIONS: The application of a consistent structure to quality evaluation can facilitate data appraisal, extraction and synthesis across a range of methodologies in diffuse or 'soft' topics. Synthesis can be facilitated further by using software, such as the microsoft 'access' database, for managing information.

Adult↗

Online medical books: their availability and an assessment of how health sciences libraries provide access on their public Websites.

OBJECTIVE: The objective of this study was to determine the number and topical range of available online medical books and to assess how health sciences libraries were providing access to these resources on their public Websites. METHOD: The collection-based evaluative technique of list checking was used to assess the number and topical range of online medical books of the six largest publishers. Publisher inventory lists were downloaded over a two-day period (May 16-17, 2004). Titles were counted and compared with the 2003 Brandon/Hill list. A sample of health sciences libraries was subsequently derived by consulting the 2004 "Top Medical Schools-Research" in U.S. News & World Report. Bibliographic and bibliothecal access methods were evaluated based on an inspection of the publicly available Websites of the sample libraries. RESULTS: Of 318 currently published online medical books, 151 (47%) were Brandon/Hill titles covering 42 of 59 Brandon/Hill topics (71%). These 151 titles represented 22% (N = 672) of the Brandon/Hill list, which further broke down as 52 minimal core, 41 initial purchase, and 58 other recommended Brandon/Hill titles. These numbers represented 50%, 28%, and 12%, respectively, of all Brandon/Hill titles corresponding to those categories. In terms of bibliographic access, 20 of 21 of sampled libraries created catalog records for their online medical books, 1 of which also provided analytical access at the chapter level, and none provided access at the chapter section level. Of the 21 libraries, 19 had library Website search engines that provided title-level access and 4 provided access at the chapter level and none that at the chapter section level. For bibliothecal access, 19 of 21 libraries provided title-level access to medical books, 8 of which provided classified and alphabetic arrangements, 1 provided a classified arrangement only, and 10 provided an alphabetic arrangement only. No library provided a bibliothecal arrangement for medical book chapters or chapter sections. CONCLUSIONS: This study shows that the number and topical range of online medical books is reaching a point where collection-level consideration is warranted to facilitate efficient use and to prevent the problem of split files. However, the results also show that few efforts are underway on the publicly available Websites of the surveyed health sciences libraries to provide the analytical access necessary to meet the structural needs of clinical information seekers.

Access to Information↗

The lod score method.

The lod score method originated in a seminal article by Newton Morton in 1955. The method is broadly concerned with issues of power and the posterior probability of linkage, ensuring that a reported linkage has a high probability of being a true linkage. In addition, the method is sequential, so that pedigrees or lod curves may be combined from published reports to pool data for analysis. This approach has been remarkably successful for 50 years in identifying disease genes for Mendelian disorders. After discussing these issues, we consider the situation for complex disorders, where the maximum lod score (MLS) statistic shares some of the advantages of the traditional lod score approach but is limited by unknown power and the lack of sharing of the primary data needed to optimally combine analytic results. We may still learn from the lod score method as we explore new methods in molecular biology and genetic analysis to utilize the complete human DNA sequence and the cataloging of all human genes.

Genetic Linkage↗

The vertical file enters the electronic age.

Vertical files are revered institutions in many libraries. The reference staff at the Spencer S. Eccles Health Sciences Library at the University of Utah automated their vertical file and made the information in it accessible via the Library's Integrated Library System. Medical Subject Headings (MeSH) were applied to vertical files and simple records leading to them were entered in the Library's online catalog. Electronic access to the vertical file increases the availability of concepts too new to be in medical books and permits the Library to meet the needs of lay patrons searching for basic information on popular health care topics.

Academic Medical Centers↗

The concept of race in Health Services Research: 1966 to 1990.

OBJECTIVE: This study examined ways in which race/ethnicity has been conceptualized and used in the health services research literature as published in Health Services Research (HSR). DATA SOURCE: All articles published in HSR from its inception in 1966 to 1990. STUDY DESIGN: The analyses were restricted to U.S.-based empirical research on humans or in which human population characteristics are described. This study identifies the terms used for race and/or ethnicity, the frequency with which they occur, and the purposes for which they are utilized. PRINCIPAL FINDINGS: The study documents that race/ethnicity is widely used in the health services literature to stratify or adjust results and to describe the sample or population of the study. Terms used for race are seldom defined and race is frequently employed in a routine and uncritical manner to represent ill-defined social and cultural factors. CONCLUSIONS: Researchers and practitioners must give more careful attention to the conceptualization and measurement of race. An understanding of racial/ethnic differences in patterns of health service utilization will require efforts to catalog and quantify the specific social and cultural factors that are differentially distributed by racial and ethnic status.

Ethnicity↗

Contraindications for superficial heat and therapeutic ultrasound: do sources agree?

OBJECTIVES: To determine the amount of agreement among general rehabilitation sources for both superficial heating and therapeutic ultrasound contraindications. DATA SOURCES: English-language textbook and peer-reviewed journal sources, from January 1992 to July 2002. Searches of computerized databases (HealthSTAR, CINAHL, MEDLINE, Embase) as well as Library of Congress Online Catalogs, Books in Print, and AcqWeb's Directory of Publishers and Venders. DATA SELECTION: Sources were excluded if they (1) were published before 1992, (2) failed to address general rehabilitation audiences, or (3) were identified as a researcher's related publication with similar information on the topic. DATA EXTRACTION: Type and number of contraindications, type of audience, year of publication, number of references, rationales, and alternative treatment strategies. DATA SYNTHESIS: Eighteen superficial heat and 20 ultrasound sources identified anywhere from 5 to 22 and 9 to 36 contraindications/precautions, respectively. Agreement among sources was generally high but ranged from 11% to 95%, with lower agreement noted for pregnancy, metal implants, edema, skin integrity, and cognitive/communicative concerns. Seventy-two percent of superficial heat sources and 25% of ultrasound sources failed to reference at least 1 contraindication claim. CONCLUSIONS: Agreement among contraindication sources was generally good for both superficial heat and therapeutic ultrasound. Sources varied with regard to the number of contraindications, references, and rationales cited. Greater reliance on objective data and standardized classification systems may serve to develop more uniform guidelines for superficial heat and therapeutic ultrasound.

Contraindications↗

[The German Ophthalmology Society in the internet. Resources and interest].

OBJECTIVE: The German Ophthalmologic Society is rising to the challenges of the information age by offering comprehensive information resources online. METHODS: The society's board decided on the development of an Internet website in October 1996. Since February 1997, the website has been available under the Internet address www.dog.org. The amount of information offered has been growing fast during the following 12 months. RESULTS: On its website, the DOG offers information about itself, membership, further education, and a catalog of important addresses, patient information, official recommendations, and the program and abstracts of the annual sessions. The ICD10-aug was integrated into the website as a database application. A discussion group is reserved for ophthalmologists who can use this platform to share ideas and discuss clinical topics. CONCLUSIONS: The website of the DOG consists of over 4,900 files that represent the activities of the society. The website's access log indicates steady interest in the information offered. Over 53,000 users visited the DOG website. The discussion group is used by 71 members from 10 countries (all numbers as of 9/98).

Germany↗