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Muscat DM, Patel P, Reid S, Hoffmann T, Albarqouni L, Trevena L. Content analysis of clinical questions from Australian general practice which are prioritised for answering: identifying common question types and perceived knowledge gaps. BMJ Evid Based Med 2020; 25:15-21. [PMID: 31235528 PMCID: PMC7029252 DOI: 10.1136/bmjebm-2019-111210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2019] [Indexed: 12/29/2022]
Abstract
Perceived knowledge gaps in general practice are not well documented but must be understood to ensure relevant and timely evidence for busy general practitioners (GPs) which reflects their diverse and changing needs. The aim of this study was to classify the types of questions submitted by Australian GPs to an evidence-based practice information service using established and inductive coding systems. We analysed 126 clinical questions submitted by 53 Australian GPs over a 1.5-year period. Questions were coded using the International Classification of Primary Care (ICPC-2 PLUS) and Ely and colleagues' generic questions taxonomy by two independent coders. Inductive qualitative content analysis was also used to identify perceived knowledge gaps. Treatment (71%), diagnosis (15%) and epidemiology (9%) were the most common categories of questions. Using the ICPC-2 classification, questions were most commonly coded to the endocrine/metabolic and nutritional chapter heading, followed by general and unspecified, digestive and musculoskeletal. Seventy per cent of all questions related to the need to stay up-to-date with the evidence, or be informed about new tests or treatments (including complementary and alternative therapies). These findings suggest that current guideline formats for common clinical problems may not meet the knowledge demands of GPs and there is gap in access to evidence updates on new tests, treatments and complementary and alternative therapies. Better systems for 'pulling' real-time questions from GPs could better inform the 'push' of more relevant and timely evidence for use in the clinical encounter.
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Affiliation(s)
- Danielle Marie Muscat
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- ASK-GP Centre for Research Excellence, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Pinika Patel
- ASK-GP Centre for Research Excellence, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sharon Reid
- ASK-GP Centre for Research Excellence, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tammy Hoffmann
- ASK-GP Centre for Research Excellence, Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Loai Albarqouni
- ASK-GP Centre for Research Excellence, Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Lyndal Trevena
- ASK-GP Centre for Research Excellence, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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McKeown S, Konrad SL, McTavish J, Boyce E. Evaluation of hospital staff's perceived quality of librarian-mediated literature searching services. J Med Libr Assoc 2017; 105:120-131. [PMID: 28377674 PMCID: PMC5370602 DOI: 10.5195/jmla.2017.201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective The research evaluated the perceived quality of librarian-mediated literature searching services at one of Canada’s largest acute care teaching hospitals for the purpose of continuous quality improvement and investigation of relationships between variables that can impact user satisfaction. Methods An online survey was constructed using evidence-based methodologies. A systematic sample of staff and physicians requesting literature searches at London Health Sciences Centre were invited to participate in the study over a one-year period. Data analyses included descriptive statistics of closed-ended questions and coding of open-ended questions. Results A range of staff including clinicians, researchers, educators, leaders, and analysts submitted a total of 137 surveys, representing a response rate of 71%. Staff requested literature searches for the following “primary” purposes: research or publication (34%), teaching or training (20%), informing a policy or standard practice (16%), patient care (15%), and “other” purposes (15%). While the majority of staff (76%) submitted search requests using methods of written communication, including email and search request forms, staff using methods of verbal communication, including face-to-face and telephone conversations, were significantly more likely to be extremely satisfied with the librarian’s interpretation of the search request (p=0.004) and to rate the perceived quality of the search results as excellent (p=0.005). In most cases, librarians followed up with staff to clarify the details of their search requests (72%), and these staff were significantly more likely to be extremely satisfied with the librarian’s interpretation of the search request (p=0.002). Conclusions Our results demonstrate the limitations of written communication in the context of librarian-mediated literature searching and suggest a multifaceted approach to quality improvement efforts.
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Ho GJ, Liew SM, Ng CJ, Hisham Shunmugam R, Glasziou P. Development of a Search Strategy for an Evidence Based Retrieval Service. PLoS One 2016; 11:e0167170. [PMID: 27935993 PMCID: PMC5147858 DOI: 10.1371/journal.pone.0167170] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 11/09/2016] [Indexed: 11/18/2022] Open
Abstract
Background Physicians are often encouraged to locate answers for their clinical queries via an evidence-based literature search approach. The methods used are often not clearly specified. Inappropriate search strategies, time constraint and contradictory information complicate evidence retrieval. Aims Our study aimed to develop a search strategy to answer clinical queries among physicians in a primary care setting Methods Six clinical questions of different medical conditions seen in primary care were formulated. A series of experimental searches to answer each question was conducted on 3 commonly advocated medical databases. We compared search results from a PICO (patients, intervention, comparison, outcome) framework for questions using different combinations of PICO elements. We also compared outcomes from doing searches using text words, Medical Subject Headings (MeSH), or a combination of both. All searches were documented using screenshots and saved search strategies. Results Answers to all 6 questions using the PICO framework were found. A higher number of systematic reviews were obtained using a 2 PICO element search compared to a 4 element search. A more optimal choice of search is a combination of both text words and MeSH terms. Despite searching using the Systematic Review filter, many non-systematic reviews or narrative reviews were found in PubMed. There was poor overlap between outcomes of searches using different databases. The duration of search and screening for the 6 questions ranged from 1 to 4 hours. Conclusion This strategy has been shown to be feasible and can provide evidence to doctors’ clinical questions. It has the potential to be incorporated into an interventional study to determine the impact of an online evidence retrieval system.
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Affiliation(s)
- Gah Juan Ho
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Su May Liew
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ranita Hisham Shunmugam
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Paul Glasziou
- Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
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Amundstuen Reppe L, Lydersen S, Schjøtt J, Damkier P, Rolighed Christensen H, Peter Kampmann J, Böttiger Y, Spigset O. Relationship Between Time Consumption and Quality of Responses to Drug-related Queries: A Study From Seven Drug Information Centers in Scandinavia. Clin Ther 2016; 38:1738-49. [PMID: 27368118 DOI: 10.1016/j.clinthera.2016.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/26/2016] [Accepted: 05/26/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE The aims of this study were to assess the quality of responses produced by drug information centers (DICs) in Scandinavia, and to study the association between time consumption processing queries and the quality of the responses. METHODS We posed six identical drug-related queries to seven DICs in Scandinavia, and the time consumption required for processing them was estimated. Clinical pharmacologists (internal experts) and general practitioners (external experts) reviewed responses individually. We used mixed model linear regression analyses to study the associations between time consumption on one hand and the summarized quality scores and the overall impression of the responses on the other hand. FINDINGS Both expert groups generally assessed the quality of the responses as "satisfactory" to "good." A few responses were criticized for being poorly synthesized and less relevant, of which none were quality-assured using co-signatures. For external experts, an increase in time consumption was statistically significantly associated with a decrease in common quality score (change in score, -0.20 per hour of work; 95% CI, -0.33 to -0.06; P = 0.004), and overall impression (change in score, -0.05 per hour of work; 95% CI, -0.08 to -0.01; P = 0.005). No such associations were found for the internal experts' assessment. IMPLICATIONS To our knowledge, this is the first study of the association between time consumption and quality of responses to drug-related queries in DICs. The quality of responses were in general good, but time consumption and quality were only weakly associated in this setting.
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Affiliation(s)
- Linda Amundstuen Reppe
- Faculty of Health Sciences, Nord University, Steinkjer, Norway; Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway; Regional Medicines Information and Pharmacovigilance Center (Midt-Norge), St. Olavs Hospital, Trondheim, Norway.
| | - Stian Lydersen
- Regional Center for Child and Youth Mental Health and Child Welfare-Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jan Schjøtt
- Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway; Regional Medicines Information and Pharmacovigilance Center (Vest), Haukeland University Hospital, Bergen, Norway
| | - Per Damkier
- Department of Clinical Chemistry & Pharmacology, Odense University Hospital, Odense, Denmark
| | - Hanne Rolighed Christensen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Jens Peter Kampmann
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Ylva Böttiger
- Clinical Pharmacology, Department of Drug Research, Linköping University, Linköping, Sweden
| | - Olav Spigset
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway; Regional Medicines Information and Pharmacovigilance Center (Midt-Norge), St. Olavs Hospital, Trondheim, Norway
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Formative evaluation of a patient-specific clinical knowledge summarization tool. Int J Med Inform 2015; 86:126-34. [PMID: 26612774 DOI: 10.1016/j.ijmedinf.2015.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/16/2015] [Accepted: 11/08/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To iteratively design a prototype of a computerized clinical knowledge summarization (CKS) tool aimed at helping clinicians finding answers to their clinical questions; and to conduct a formative assessment of the usability, usefulness, efficiency, and impact of the CKS prototype on physicians' perceived decision quality compared with standard search of UpToDate and PubMed. MATERIALS AND METHODS Mixed-methods observations of the interactions of 10 physicians with the CKS prototype vs. standard search in an effort to solve clinical problems posed as case vignettes. RESULTS The CKS tool automatically summarizes patient-specific and actionable clinical recommendations from PubMed (high quality randomized controlled trials and systematic reviews) and UpToDate. Two thirds of the study participants completed 15 out of 17 usability tasks. The median time to task completion was less than 10s for 12 of the 17 tasks. The difference in search time between the CKS and standard search was not significant (median=4.9 vs. 4.5m in). Physician's perceived decision quality was significantly higher with the CKS than with manual search (mean=16.6 vs. 14.4; p=0.036). CONCLUSIONS The CKS prototype was well-accepted by physicians both in terms of usability and usefulness. Physicians perceived better decision quality with the CKS prototype compared to standard search of PubMed and UpToDate within a similar search time. Due to the formative nature of this study and a small sample size, conclusions regarding efficiency and efficacy are exploratory.
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Friesen C, Lê ML, Cooke C, Raynard M. Analysis of a librarian-mediated literature search service. Med Ref Serv Q 2015; 34:29-46. [PMID: 25611439 DOI: 10.1080/02763869.2015.986782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Librarian-mediated literature searching is a key service provided at medical libraries. This analysis outlines ten years of data on 19,248 literature searches and describes information on the volume and frequency of search requests, time spent per search, databases used, and professional designations of the patron requestors. Combined with information on best practices for expert searching and evaluations of similar services, these findings were used to form recommendations on the improvement and standardization of a literature search service at a large health library system.
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Affiliation(s)
- Carol Friesen
- a Neil John Maclean Health Sciences Library, University of Manitoba , Winnipeg , Manitoba , Canada
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A cost-consequences analysis of a primary care librarian question and answering service. PLoS One 2012; 7:e33837. [PMID: 22442727 PMCID: PMC3307768 DOI: 10.1371/journal.pone.0033837] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 02/17/2012] [Indexed: 12/02/2022] Open
Abstract
Background Cost consequences analysis was completed from randomized controlled trial (RCT) data for the Just-in-time (JIT) librarian consultation service in primary care that ran from October 2005 to April 2006. The service was aimed at providing answers to clinical questions arising during the clinical encounter while the patient waits. Cost saving and cost avoidance were also analyzed. The data comes from eighty-eight primary care providers in the Ottawa area working in Family Health Networks (FHNs) and Family Health Groups (FHGs). Methods We conducted a cost consequences analysis based on data from the JIT project [1]. We also estimated the potential economic benefit of JIT librarian consultation service to the health care system. Results The results show that the cost per question for the JIT service was $38.20. The cost could be as low as $5.70 per question for a regular service. Nationally, if this service was implemented and if family physicians saw additional patients when the JIT service saved them time, up to 61,100 extra patients could be seen annually. A conservative estimate of the cost savings and cost avoidance per question for JIT was $11.55. Conclusions The cost per question, if the librarian service was used at full capacity, is quite low. Financial savings to the health care system might exceed the cost of the service. Saving physician's time during their day could potentially lead to better access to family physicians by patients. Implementing a librarian consultation service can happen quickly as the time required to train professional librarians to do this service is short.
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Abstract
BACKGROUND This is an update of a Cochrane Review first published in The Cochrane Library in Issue 3, 2004 and previously updated in 2007 and 2009.Motion sickness, the discomfort experienced when perceived motion disturbs the organs of balance, may include symptoms such as nausea, vomiting, pallor, cold sweats, hypersalivation, hyperventilation and headaches. The control and prevention of these symptoms has included pharmacological, behavioural and complementary therapies. Although scopolamine (hyoscine) has been used in the treatment and prevention of motion sickness for decades, there have been no systematic reviews of its effectiveness. OBJECTIVES To assess the effectiveness of scopolamine versus no therapy, placebo, other drugs, behavioural and complementary therapy or two or more of the above therapies in combination for motion sickness in persons (both adults and children) without known vestibular, visual or central nervous system pathology. SEARCH STRATEGY We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 14 April 2011. SELECTION CRITERIA All parallel-arm, randomised controlled trials (RCTs) focusing on scopolamine versus no therapy, placebo, other drugs, behavioural and complementary therapy or two or more of the above therapies in combination. We considered outcomes relating to the prevention of onset or treatment of clinically-defined motion sickness, task ability and psychological tests, changes in physiological parameters and adverse effects. DATA COLLECTION AND ANALYSIS Two authors independently extracted data from the studies using standardised forms. We assessed study quality. We expressed dichotomous data as odds ratio (OR) and calculated a pooled OR using the random-effects model. MAIN RESULTS Of 35 studies considered potentially relevant, 14 studies enrolling 1025 subjects met the entry criteria. Scopolamine was administered via transdermal patches, tablets or capsules, oral solutions or intravenously. Scopolamine was compared against placebo, calcium channel antagonists, antihistamine, methscopolamine or a combination of scopolamine and ephedrine. Studies were generally small in size and of varying quality.Scopolamine was more effective than placebo in the prevention of symptoms. Comparisons between scopolamine and other agents were few and suggested that scopolamine was superior (versus methscopolamine) or equivalent (versus antihistamines) as a preventative agent. Evidence comparing scopolamine to cinnarizine or combinations of scopolamine and ephedrine is equivocal or minimal.Although sample sizes were small, scopolamine was no more likely to induce drowsiness, blurring of vision or dizziness compared to other agents. Dry mouth was more likely with scopolamine than with methscopolamine or cinnarizine.No studies were available relating to the therapeutic effectiveness of scopolamine in the management of established symptoms of motion sickness. AUTHORS' CONCLUSIONS The use of scopolamine versus placebo in preventing motion sickness has been shown to be effective. No conclusions can be made on the comparative effectiveness of scopolamine and other agents such as antihistamines and calcium channel antagonists. In addition, we identified no randomised controlled trials that examined the effectiveness of scopolamine in the treatment of established symptoms of motion sickness.
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Affiliation(s)
- Anneliese Spinks
- Griffith UniversitySchool of MedicineUniversity DriveMeadowbrookQueenslandAustralia4031
| | - Jason Wasiak
- Monash University, Alfred HospitalVictorian Adult Burns Service and School of Public Health and Preventative MedicineCommercial RoadPrahranMelbourneVictoriaAustralia3181
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McGowan J, Hogg W, Rader T, Salzwedel D, Worster D, Cogo E, Rowan M. A rapid evidence-based service by librarians provided information to answer primary care clinical questions. Health Info Libr J 2010; 27:11-21. [DOI: 10.1111/j.1471-1842.2009.00861.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Piccoliori G, Kostner S, Abholz HH. [EBM Service: evidence-based answers provided by general practitioners to questions asked by general practitioners--a project from South Tyrol/Italy]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2010; 104:132-137. [PMID: 20441021 DOI: 10.1016/j.zefq.2009.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
General practices also require more and more evidence-based decision-making. But knowledge is increasing rapidly and guidelines produced to help doctors to find answers to their problems seem to exclude a number of problems that are important in general practices. Here we report on the introduction and activities of an EbM Service provided by general practitioners to answer questions of their colleagues. The aim is to give EBM answers, but also, in doing so, to teach the application of EBM and--in the long run--to enable the users themselves to find EBM answers. The provision of EBM answers is fairly pragmatic: after using the service the inquiring physician should be better informed, i.e., have more evidence-based information, but sometimes this need not be the "ultimate truth" that experts might deliver. EBM answers are published both on the homepage of the College of General Practitioners and in their journal. It took quite a while to implement this service, and the number of those using it has increased slowly but constantly.
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Rinnerberger A, Grafinger M, Melchardt T, Sönnichsen A. [Implementation of evidence based medicine in primary care]. Wien Med Wochenschr 2009; 159:207-10. [PMID: 19412696 DOI: 10.1007/s10354-009-0673-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Accepted: 12/29/2008] [Indexed: 11/24/2022]
Abstract
The particular situation of primary care - i.e. decentralized setting, comprehensive medical care, and limited access to continuous medical education - makes it difficult to implement evidence-based medicine into daily practice. Therefore, the Institute of General Practice of the Paracelsus University (PMU) in Salzburg and Actavis GmbH Austria developed "REM" (Rechercheservice evidenzbasierte Medizin). This is a web-based enquiry service offered mainly to GPs who can submit questions arising in daily practice which are answered by the service according to current best evidence. In 8.5 months 176 physicians registered to participate. A total of 31 submitted at least one question. In total, REM processed 134 questions. The number of physicians registered and the frequency of enquiries show that REM can facilitate the implementation of evidence-based medicine in primary care. Nonetheless, only a small proportion of the physicians registered actually made use of the service. Improvements are necessary to promote interest in this new way of continuous medical education.
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Affiliation(s)
- Andreas Rinnerberger
- Institut für Allgemein-, Familien- und Präventivmedizin, Paracelsus Medizinische Privatuniversität, Salzburg, Osterreich.
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McGowan J, Hogg W, Campbell C, Rowan M. Just-in-time information improved decision-making in primary care: a randomized controlled trial. PLoS One 2008; 3:e3785. [PMID: 19023446 PMCID: PMC2583045 DOI: 10.1371/journal.pone.0003785] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Accepted: 10/28/2008] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The "Just-in-time Information" (JIT) librarian consultation service was designed to provide rapid information to answer primary care clinical questions during patient hours. This study evaluated whether information provided by librarians to answer clinical questions positively impacted time, decision-making, cost savings and satisfaction. METHODS AND FINDING A randomized controlled trial (RCT) was conducted between October 2005 and April 2006. A total of 1,889 questions were sent to the service by 88 participants. The object of the randomization was a clinical question. Each participant had clinical questions randomly allocated to both intervention (librarian information) and control (no librarian information) groups. Participants were trained to send clinical questions via a hand-held device. The impact of the information provided by the service (or not provided by the service), additional resources and time required for both groups was assessed using a survey sent 24 hours after a question was submitted. The average time for JIT librarians to respond to all questions was 13.68 minutes/question (95% CI, 13.38 to 13.98). The average time for participants to respond their control questions was 20.29 minutes/question (95% CI, 18.72 to 21.86). Using an impact assessment scale rating cognitive impact, participants rated 62.9% of information provided to intervention group questions as having a highly positive cognitive impact. They rated 14.8% of their own answers to control question as having a highly positive cognitive impact, 44.9% has having a negative cognitive impact, and 24.8% with no cognitive impact at all. In an exit survey measuring satisfaction, 86% (62/72 responses) of participants scored the service as having a positive impact on care and 72% (52/72) indicated that they would use the service frequently if it were continued. CONCLUSIONS In this study, providing timely information to clinical questions had a highly positive impact on decision-making and a high approval rating from participants. Using a librarian to respond to clinical questions may allow primary care professionals to have more time in their day, thus potentially increasing patient access to care. Such services may reduce costs through decreasing the need for referrals, further tests, and other courses of action. TRIAL REGISTRATION Controlled-Trials.com ISRCTN96823810.
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Affiliation(s)
- Jessie McGowan
- Faculty of Family Medicine, University of Ottawa, Ottawa, Canada.
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Norlin C, Sharp AL, Firth SD. Unanswered questions prompted during pediatric primary care visits. ACTA ACUST UNITED AC 2007; 7:396-400. [PMID: 17870649 DOI: 10.1016/j.ambp.2007.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2006] [Revised: 05/26/2007] [Accepted: 05/30/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To identify the frequency, types, and perceived importance of questions prompted during primary care visits for which pediatricians have no ready answer; to characterize pediatricians' responses to them; and to determine how questions prompted while caring for children with special health care needs (CSHCN) and children without special needs (Cw/oSN) differ. METHODS Patient visits with 35 general pediatricians were observed. Parents completed a CSHCN screener. Physicians provided details about their unanswered questions and their pursuit of answers. RESULTS Of 890 observed visits, 170 (19.1%) prompted unanswered questions, of which 60.1% were deemed important or very important. Physicians intended to pursue answers to 49.7% of the questions but actually pursued answers for only 27.5%, citing lack of time and inadequate information resources as barriers. One hundred sixty-seven (18.8%) visits were with CSHCN. Unanswered questions arose more often with CSHCN than with Cw/oSN (28.7% vs 16.9%; odds ratio 1.98; 95% confidence interval, 1.32-2.97), particularly during well visits (34.6% vs 14.9%; odds ratio 3.24; 95% confidence interval, 1.59-6.39). CSHCN prompted more diagnosis and treatment questions than Cw/oSN. Questions prompted by CSHCN were ranked as more important but were no more likely to be pursued than those prompted by Cw/oSN. CONCLUSIONS Unanswered questions arise during nearly 20% of pediatric primary care visits. Visits with CSHCN, particularly well visits, generate more questions than those with Cw/oSN. Answers are pursued for few unanswered questions, both overall and for CSHCN. Potential strategies to overcome barriers to answering questions include scheduling more time or more visits for CSHCN.
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Affiliation(s)
- Chuck Norlin
- Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA.
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Spinks AB, Wasiak J, Villanueva EV, Bernath V. Scopolamine (hyoscine) for preventing and treating motion sickness. Cochrane Database Syst Rev 2007:CD002851. [PMID: 17636710 DOI: 10.1002/14651858.cd002851.pub3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Motion sickness - the discomfort experienced when perceived motion disturbs the organs of balance - may include symptoms such as nausea, vomiting, pallor, cold sweats, hypersalivation, hyperventilation and headaches. The control and prevention of these symptoms have included pharmacological, behavioural and complementary therapies. Although scopolamine (hyoscine) has been used in the treatment and prevention of motion sickness for decades, there have been no systematic reviews of its effectiveness. OBJECTIVES To assess the effectiveness of scopolamine versus no therapy, placebo, other drugs, behavioural and complementary therapy or two or more of the above therapies in combination for motion sickness in persons (both adults and children) without known vestibular, visual or central nervous system pathology. SEARCH STRATEGY The Cochrane Ear, Nose and Throat Disorders Group Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2007), MEDLINE (OVID, 1966 to May 2007), EMBASE (1974 to May 2007) CINAHL (OVID, 1982 to May 2007) and reference lists of retrieved studies were searched for relevant studies. No language restrictions were applied. The date of the last search was May 2007. SELECTION CRITERIA All parallel-arm, randomised controlled trials (RCTs) focusing on scopolamine versus no therapy, placebo, other drugs, behavioural and complementary therapy or two or more of the above therapies in combination were included. Outcomes relating to the prevention of onset or treatment of clinically-defined motion sickness, task ability and psychological tests, changes in physiological parameters and adverse effects were considered. DATA COLLECTION AND ANALYSIS Data from the studies were extracted independently by two authors using standardised forms. Study quality was assessed. Dichotomous data were expressed as odds ratio (OR) and a pooled OR was calculated using the random-effects model. MAIN RESULTS Of 35 studies considered potentially relevant, 14 studies enrolling 1025 subjects met the entry criteria. Scopolamine was administered via transdermal patches, tablets or capsules, oral solutions or intravenously. Scopolamine was compared against placebo, calcium channel antagonists, antihistamine, methscopolamine or a combination of scopolamine and ephedrine. Studies were generally small in size and of varying quality. Scopolamine was more effective than placebo in the prevention of symptoms. Comparisons between scopolamine and other agents were few and suggested that scopolamine was superior (versus methscopolamine) or equivalent (versus antihistamines) as a preventative agent. Evidence comparing scopolamine to cinnarizine or combinations of scopolamine and ephedrine is equivocal or minimal. Although sample sizes were small, scopolamine was no more likely to induce drowsiness, blurring of vision or dizziness compared to other agents. Dry mouth was more likely with scopolamine than with methscopolamine or cinnarizine. No studies were available relating to the therapeutic effectiveness of scopolamine in the management of established symptoms of motion sickness. AUTHORS' CONCLUSIONS The use of scopolamine versus placebo in preventing motion sickness has been shown to be effective. No conclusions can be made on the comparative effectiveness of scopolamine and other agents such as antihistamines and calcium channel antagonists. In addition, no randomised controlled trials were identified that examined the effectiveness of scopolamine in the treatment of established symptoms of motion sickness.
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Ely JW, Osheroff JA, Maviglia SM, Rosenbaum ME. Patient-care questions that physicians are unable to answer. J Am Med Inform Assoc 2007; 14:407-14. [PMID: 17460122 PMCID: PMC2244897 DOI: 10.1197/jamia.m2398] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To describe the characteristics of unanswered clinical questions and propose interventions that could improve the chance of finding answers. DESIGN In a previous study, investigators observed primary care physicians in their offices and recorded questions that arose during patient care. Questions that were pursued by the physician, but remained unanswered, were grouped into generic types. In the present study, investigators attempted to answer these questions and developed recommendations aimed at improving the success rate of finding answers. MEASUREMENTS Frequency of unanswered question types and recommendations to increase the chance of finding answers. RESULTS In an earlier study, 48 physicians asked 1062 questions during 192 half-day office observations. Physicians could not find answers to 237 (41%) of the 585 questions they pursued. The present study grouped the unanswered questions into 19 generic types. Three types accounted for 128 (54%) of the unanswered questions: (1) "Undiagnosed finding" questions asked about the management of abnormal clinical findings, such as symptoms, signs, and test results (What is the approach to finding X?); (2) "Conditional" questions contained qualifying conditions that were appended to otherwise simple questions (What is the management of X, given Y? where "given Y" is the qualifying condition that makes the question difficult.); and (3) "Compound" questions asked about the association between two highly specific elements (Can X cause Y?). The study identified strategies to improve clinical information retrieval, listed below. CONCLUSION To improve the chance of finding answers, physicians should change their search strategies by rephrasing their questions and searching more clinically oriented resources. Authors of clinical information resources should anticipate questions that may arise in practice, and clinical information systems should provide clearer and more explicit answers.
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Affiliation(s)
- John W Ely
- Department of Family Medicine, 01291-D PFP, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, Iowa 52242, USA.
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Krahn J, Sauerland S, Rixen D, Gregor S, Bouillon B, Neugebauer EAM. Applying evidence-based surgery in daily clinical routine: a feasibility study. Arch Orthop Trauma Surg 2006; 126:88-92. [PMID: 16402196 DOI: 10.1007/s00402-005-0095-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Indexed: 02/09/2023]
Abstract
BACKGROUND Although the word evidence-based medicine (EBM) has gained wide popularity, only a few studies have evaluated how EBM works in clinical practice. METHODS We have prospectively evaluated the feasibility of evidence-based trauma surgery. Orthopaedic trauma surgeons were asked to produce clinical questions related to the treatment of current patients. An informaticist searched the literature (Medline, Cochrane Library, practice guidelines and textbooks) and reported the findings on every following day. The study's main endpoints were the rate of questions for which relevant evidence (>level V) was available and the time necessary to find and critically appraise medical evidence. RESULTS In total, 44 EBM questions were formulated, mainly concerning treatment options. PubMed was searched for 39 questions, textbooks for 14, the Cochrane Library for 11, online guidelines for 9 and other sources were used for 4 questions. On average, 157 text items (three per questions) were identified as potentially relevant. Journal articles predominated (83%) over textbooks (10%). Sixty-eight percent of the questions (30 of 44) were answered, either on the basis level 1 (n=13 questions), level 2 (n=6), or level 4 evidence (n=14). Trying to answer a question required 53 min on average, split up between 39 min of database searches and 25 min of obtaining full text articles. In four cases, the evidence suggested a change in clinical management. The physicians were very appreciative of our project and found the provided evidence very helpful for their clinical decisions. CONCLUSIONS Time will be the main barrier against the introduction of clinical EBM. It is likely that clinicians reduce EBM to those situations where evidence is likely to be found. Although the impact of EBM on patient-care was limited, the concept of EBM was successfully implemented.
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Affiliation(s)
- Jan Krahn
- Institute for Research in Operative Medicine, Faculty of Medicine, University of Witten/Herdecke, Ostmerheimer Strasse 200, Cologne, Germany
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Grad RM, Pluye P, Meng Y, Segal B, Tamblyn R. Assessing the impact of clinical information-retrieval technology in a family practice residency. J Eval Clin Pract 2005; 11:576-86. [PMID: 16364111 DOI: 10.1111/j.1365-2753.2005.00594.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVE Evidence-based sources of information do not integrate self-assessment tools to assess the impact of a users' search for clinical information. We present a method to evaluate evidence-based sources of information, by systematically assessing the impact of searches for clinical information in everyday practice. METHODS We integrated an information management tool (InfoRetriever 2003) with an educational intervention in a cohort of 26 family medicine residents. An electronic impact assessment scale was used by these doctors to report the perceived impact of each item of information (each hit) retrieved on hand-held computer. We compared the types of impact associated with hits in two distinct categories: clinical decision support systems (CDSS) vs. clinical information-retrieval technology (CIRT). Information hits in CDSS were defined as any hit in the following InfoRetriever databases: Clinical Prediction Rules, History and Physical Exam diagnostic calculator and Diagnostic Test calculator. CIRT information hits were defined as any hit in: Abstracts of Cochrane Reviews, InfoPOEMs, evidence-based practice guideline summaries and the Griffith's 5 Minute Clinical Consult. RESULTS The impact assessment questionnaire was linked to 5160 information hits. 4946 impact assessment questionnaires were answered (95.9%), and 2495 contained reports of impact (48.4%). Reports of positive impact on doctors were most frequently in the areas of learning and practice improvement. In comparison to CDSS, CIRT hits were more frequently associated with learning and recall. CDSS hits were more frequently associated with reports of practice improvement. CONCLUSIONS Our new method permits systematic and comparative assessment of impact associated with distinct categories of information.
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Affiliation(s)
- Roland M Grad
- Herzl Family Practice Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada.
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Hannes K, Leys M, Vermeire E, Aertgeerts B, Buntinx F, Depoorter AM. Implementing evidence-based medicine in general practice: a focus group based study. BMC FAMILY PRACTICE 2005; 6:37. [PMID: 16153300 PMCID: PMC1253510 DOI: 10.1186/1471-2296-6-37] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2005] [Accepted: 09/09/2005] [Indexed: 11/10/2022]
Abstract
Background Over the past years concerns are rising about the use of Evidence-Based Medicine (EBM) in health care. The calls for an increase in the practice of EBM, seem to be obstructed by many barriers preventing the implementation of evidence-based thinking and acting in general practice. This study aims to explore the barriers of Flemish GPs (General Practitioners) to the implementation of EBM in routine clinical work and to identify possible strategies for integrating EBM in daily work. Methods We used a qualitative research strategy to gather and analyse data. We organised focus groups between September 2002 and April 2003. The focus group data were analysed using a combined strategy of 'between-case' analysis and 'grounded theory approach'. Thirty-one general practitioners participated in four focus groups. Purposeful sampling was used to recruit participants. Results A basic classification model documents the influencing factors and actors on a micro-, meso- as well as macro-level. Patients, colleagues, competences, logistics and time were identified on the micro-level (the GPs' individual practice), commercial and consumer organisations on the meso-level (institutions, organisations) and health care policy, media and specific characteristics of evidence on the macro-level (policy level and international scientific community). Existing barriers and possible strategies to overcome these barriers were described. Conclusion In order to implement EBM in routine general practice, an integrated approach on different levels needs to be developed.
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Affiliation(s)
- Karin Hannes
- Belgian Centre for Evidence-Based Medicine-Belgian Branch of the Cochrane Collaboration, Kapucijnenvoer 33 blok J, 3000 Leuven, Belgium
| | - Marcus Leys
- Department of Medical Sociology Vrije Universiteit Brussel, Laerbeeklaan 103, 1090 Jette, Belgium
| | - Etienne Vermeire
- Belgian Centre for Evidence-Based Medicine-Belgian Branch of the Cochrane Collaboration, Kapucijnenvoer 33 blok J, 3000 Leuven, Belgium
- Department of General Practice, Universiteit Antwerpen, Universiteitsplein 1, 2610 Antwerpen, Belgium
| | - Bert Aertgeerts
- Belgian Centre for Evidence-Based Medicine-Belgian Branch of the Cochrane Collaboration, Kapucijnenvoer 33 blok J, 3000 Leuven, Belgium
- Academic Centre for General Practice, Katholieke Universiteit Leuven, Kapucijnenvoer 33 blok J, 3000 Leuven, Belgium
| | - Frank Buntinx
- Belgian Centre for Evidence-Based Medicine-Belgian Branch of the Cochrane Collaboration, Kapucijnenvoer 33 blok J, 3000 Leuven, Belgium
- Academic Centre for General Practice, Katholieke Universiteit Leuven, Kapucijnenvoer 33 blok J, 3000 Leuven, Belgium
| | - Anne-Marie Depoorter
- Department of Public Health, Vrije Universiteit Brussel, Laerbeeklaan 103, 1090 Jette, Belgium
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Pluye P, Grad RM, Dunikowski LG, Stephenson R. Impact of clinical information-retrieval technology on physicians: A literature review of quantitative, qualitative and mixed methods studies. Int J Med Inform 2005; 74:745-68. [PMID: 15996515 DOI: 10.1016/j.ijmedinf.2005.05.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2004] [Revised: 05/13/2005] [Accepted: 05/13/2005] [Indexed: 11/19/2022]
Abstract
PURPOSE This paper appraises empirical studies examining the impact of clinical information-retrieval technology on physicians and medical students. METHODS The world literature was reviewed up to February 2004. Two reviewers independently identified studies by scrutinising 3368 and 3249 references from bibliographic databases. Additional studies were retrieved by hand searches, and by searching ISI Web of Science for citations of articles. Six hundred and five paper-based articles were assessed for relevance. Of those, 40 (6.6%) were independently appraised by two reviewers for relevance and methodological quality. These articles were quantitative, qualitative or of mixed methods, and 26 (4.3%) were retained for further analysis. For each retained article, two teams used content analysis to review extracted textual material (quantitative results and qualitative findings). RESULTS Observational studies suggest that nearly one-third of searches using information-retrieval technology may have a positive impact on physicians. Two experimental and three laboratory studies do not reach consensus in support of a greater impact of this technology compared with other sources of information, notably printed educational material. Clinical information-retrieval technology may affect physicians, and further research is needed to examine its impact in everyday practice.
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Affiliation(s)
- Pierre Pluye
- Department of Social Studies of Medicine, McGill University, Montreal, Que., Canada H3A 1X1.
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Verhoeven AAH, Schuling J. Effect of an evidence-based answering service on GPs and their patients: a pilot study. Health Info Libr J 2004; 21 Suppl 2:27-35. [PMID: 15317573 DOI: 10.1111/j.1740-3324.2004.00524.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES For general practitioners (GPs), an important obstacle to practising evidence-based medicine is lack of time. An evidence-based answering service was developed that took over searching and appraisal of medical evidence from the GPs. GPs sent in questions, and the informationist formulated the answers. Our objectives were to find out if such an evidence-based answering service was feasible, including assessing the effect of the answers on GPs and their patients, as reported by the GPs. METHODS After attending a workshop on building well-formulated questions from daily practice, the GPs sent in questions to the informationist. The literature was searched, the relevant information was appraised, and the answers to the questions were formulated. With a questionnaire, the effect of the answers on the GP and the patient was assessed, as well as the perceived barriers to implementing the answers. RESULTS From 26 GPs, 61 questions were received. For 12% of questions, information was found with the highest evidence level, while for 36%, no information was found. However, for 89% of the questions for which no information could be found, the answer 'no information found' did have an effect on the GP concerned. In total, 81% of all the answers had an effect on the GP, and, according to the GP, 52% had an effect on the patient. Few barriers to implementing the evidence were perceived. Most of the answers were found in Pubmed/Medline, the Cochrane Library and Embase. CONCLUSIONS This study indicates that an evidence-based answering service can have an impact on GPs and their patients. Librarians can provide an evidence-based answering service for GPs and their patients. The evidence-based answering service for GPs in this study had an impact on 81% of the GPs and on 52% of their patients. Although for one-third of the questions no evidence-based answer was found, this message in itself had an impact on 89% of the GPs. An informationist as mediator between medical information and doctors can save doctors' time.
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Affiliation(s)
- Anita A H Verhoeven
- University Library and Department of General Practice, University of Groningen, Ant. Deusinglaan 1, 9713 AV Groningen, The Netherlands.
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Book Reviews. Aust N Z J Public Health 2004. [DOI: 10.1111/j.1467-842x.2004.tb00712.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Lucas BP, Evans AT, Reilly BM, Khodakov YV, Perumal K, Rohr LG, Akamah JA, Alausa TM, Smith CA, Smith JP. The impact of evidence on physicians' inpatient treatment decisions. J Gen Intern Med 2004; 19:402-9. [PMID: 15109337 PMCID: PMC1492243 DOI: 10.1111/j.1525-1497.2004.30306.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Previous studies have shown that most medical inpatients receive treatment supported by strong evidence (evidence-based treatment), but they have not assessed whether and how physicians actually use evidence when making their treatment decisions. We investigated whether physicians would change inpatient treatment if presented with the results of a literature search. DESIGN Before-after study. SETTING Large public teaching hospital. PARTICIPANTS Random sample of 146 inpatients cared for by 33 internal medicine attending physicians. INTERVENTIONS After physicians committed to a specific diagnosis and treatment plan, investigators performed standardized literature searches and provided the search results to the attending physicians. MEASUREMENTS AND MAIN RESULTS The primary study outcome was the number of patients whose attending physicians would change treatment due to the literature searches. These changes were evaluated by blinded peer review. A secondary outcome was the proportion of patients who received evidence-based treatment before and after the literature searches. Attending physicians changed treatment for 23 (18%) of 130 eligible patients (95% confidence interval, 12% to 24%) as a result of the literature searches. Overall, 86% of patients (112 of 130) received evidence-based treatments before the searches and 87% (113 of 130) after the searches. Changes were not related to whether patients were receiving evidence-based treatment before the search (P =.6). Panels of peer reviewers judged the quality of patient care as improved or maintained for 18 (78%) of the 23 patients with treatment changes. CONCLUSIONS Searching the literature could improve the treatment of many medical inpatients, including those already receiving evidence-based treatment.
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Affiliation(s)
- Brian P Lucas
- Department of Medicine, John H Stroger, Jr. Hospital of Cook County and Rush Medical College, Chicago, IL 60612, USA.
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Book Reviews. Aust N Z J Public Health 2004. [DOI: 10.1111/j.1467-842x.2004.tb00492.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
BACKGROUND Motion sickness - the discomfort experienced when perceived motion disturbs the organs of balance - may include symptoms such as nausea, vomiting, pallor, cold sweats, hypersalivation, hyperventilation and headaches. The control and prevention of these symptoms have included pharmacological, behavioural and complementary therapies. Although scopolamine has been used in the treatment and prevention of motion sickness for decades, there have been no systematic reviews of its effectiveness. OBJECTIVES To assess the effectiveness of scopolamine versus no therapy, placebo, other drugs, behavioural and complementary therapy or two or more of the above therapies in combination for motion sickness in persons (both adults and children) without known vestibular, visual or central nervous system pathology. SEARCH STRATEGY The Cochrane Ear, Nose and Throat Disorders Group Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2003), MEDLINE (OVID, 1966 to March Week 1 2004), EMBASE (1974 to 2004) CINAHL (Ovid, 1982 to March Week 1 2004) and reference lists of retrieved studies were searched for relevant studies. No language restrictions were applied. SELECTION CRITERIA All parallel-arm, randomised controlled trials (RCTs) focusing on scopolamine versus no therapy, placebo, other drugs, behavioural and complementary therapy or two or more of the above therapies in combination were included. Outcomes relating to the prevention of onset or treatment of clinically-defined motion sickness, task ability and psychological tests, changes in physiological parameters and adverse effects were considered. DATA COLLECTION AND ANALYSIS Data from the studies were extracted independently by two authors using standardised forms. Study quality was assessed. Dichotomous data were expressed as odds ratio (OR) and a pooled OR was calculated using the random effects model. MAIN RESULTS Of 27 studies considered potentially relevant, 12 studies enrolling 901 subjects met the entry criteria. Scopolamine was administered via transdermal patches, tablets or capsules, oral solutions or intravenously. Scopolamine was compared against placebo, calcium channel antagonists, antihistamine, meth-scopolamine or a combination of scopolamine and ephedrine. Studies were generally small in size and of varying quality. Scopolamine was more effective than placebo in the prevention of symptoms. Comparisons between scopolamine and other agents were few and suggested that scopolamine was superior (versus meth-scopolamine) or equivalent (versus antihistamines) as a preventative agent. Evidence comparing scopolamine to cinnarizine or combinations of scopolamine and ephedrine is equivocal or minimal. Although sample sizes were small, scopolamine was no more likely to induce drowsiness, blurring of vision or dizziness compared to other agents. Dry mouth was more likely with scopolamine than with meth-scopolamine or cinnarizine. No studies were available relating to the therapeutic effectiveness of scopolamine in the management of established symptoms of motion sickness. REVIEWERS' CONCLUSIONS The use of scopolamine versus placebo in preventing motion sickness has been shown to be effective. No conclusions can be made on the comparative effectiveness of scopolamine and other agents such as antihistamines and calcium channel antagonists. In addition, no randomised controlled trials were identified that examined the effectiveness of scopolamine in the treatment of established symptoms of motion sickness.
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Forsetlund L, Talseth KO, Bradley P, Nordheim L, Bjørndal A. Many a slip between cup and lip. Process evaluation of a program to promote and support evidence-based public health practice. EVALUATION REVIEW 2003; 27:179-209. [PMID: 12703342 DOI: 10.1177/0193841x02250528] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The main aims of this study are to document whether an intervention for promoting evidence-based public health practice had been delivered as intended and to explore the reasons for its lack of impact. Process data from the implementation of the program and data from interviews with 40 public health physicians are analyzed. Although they expressed satisfaction with the service, the doctors experienced the program as rather irrelevant for their daily work. They did not perceive that they dealt with many issues relevant for the use of research information, and if they did, referring to research would not make any difference to the way others perceived their advice. There is a need to develop more overlying strategies for integrating evidence into decision making than addressing the individual level.
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Hitchins RN. Safety of hormone replacement therapy after mastectomy. Med J Aust 2002. [DOI: 10.5694/j.1326-5377.2002.tb04601.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Pain is a common problem, but unfortunately, it is one that is still notoriously neglected and poorly managed. Although it usually is not rated highly in public health statistics, it forms a substantial proportion of the everyday work of health care professionals, and thus remains a major public health burden. The first challenge in successful pain management is overcoming the ineffective learning processes most health care practitioners use to update their procedures and therapies in response to the latest research. The ready availability of over-the-counter analgesics means that much of the pain in the community is now self-medicated, and it is vital that they also have ready access to the latest evidence-based recommendations. Second, better methods are needed to tailor treatment to individual patients because differences in comorbidities, drug metabolism, or the nature and severity of disease processes lead to different responses from individual patients. Such tailoring should also account for differences in side-effect profiles of the various treatment options available. Finally, even if health practitioners are aware of the latest in clinical evidence and recommended practices, they may not be able to implement the most appropriate treatment because of legal or financial barriers. This article will to review these three challenges to the management of pain and discuss practical ways in which they may be handled to help reduce the burden of pain care in society.
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Affiliation(s)
- Paul Phillip Glasziou
- School of Population Health, Medical School, University of Queensland, Herston, Australia.
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Del Mar CB, Glasziou PP. EBM in action: Is laser treatment effective and safe for musculoskeletal pain? Med J Aust 2002. [DOI: 10.5694/j.1326-5377.2002.tb04367.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Chris B Del Mar
- Centre for General Practice, Medical School, University of Queensland, Herston, QLD
| | - Paul P Glasziou
- Centre for General Practice, Medical School, University of Queensland, Herston, QLD
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