The value of library and information services in patient care: results of a multisite study

Impact of high-quality, mixed-domain data on the performance of medical language models

OBJECTIVE

To optimize the training strategy of large language models for medical applications, focusing on creating clinically relevant systems that efficiently integrate into healthcare settings, while ensuring high standards of accuracy and reliability.

MATERIALS AND METHODS

We curated a comprehensive collection of high-quality, domain-specific data and used it to train several models, each with different subsets of this data. These models were rigorously evaluated against standard medical benchmarks, such as the USMLE, to measure their performance. Furthermore, for a thorough effectiveness assessment, they were compared with other state-of-the-art medical models of comparable size.

RESULTS

The models trained with a mix of high-quality, domain-specific, and general data showed superior performance over those trained on larger, less clinically relevant datasets (P < .001). Our 7-billion-parameter model Med5 scores 60.5% on MedQA, outperforming the previous best of 49.3% from comparable models, and becomes the first of its size to achieve a passing score on the USMLE. Additionally, this model retained its proficiency in general domain tasks, comparable to state-of-the-art general domain models of similar size.

DISCUSSION

Our findings underscore the importance of integrating high-quality, domain-specific data in training large language models for medical purposes. The balanced approach between specialized and general data significantly enhances the model's clinical relevance and performance.

CONCLUSION

This study sets a new standard in medical language models, proving that a strategically trained, smaller model can outperform larger ones in clinical relevance and general proficiency, highlighting the importance of data quality and expert curation in generative artificial intelligence for healthcare applications.

The medical librarian's roles in the patient education process: A scoping review protocol

BACKGROUND

The presence of medical librarians in the patient education team can greatly facilitate the patient education process. Expanding the role of medical librarians in patient education and using them in this process requires understanding the roles and services they can provide. This scoping review aims to identify different traditional and modern services and roles that medical librarians provide specifically in the patient education process.

MATERIALS AND METHODS

A scoping review protocol is reported, according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement and guided by The Joanna Briggs Institute. PubMed, Scopus, Web of Science, and LISTA (Library, Information Science & Technology Abstracts) will be searched. A grey literature search and hand-searching of citations and reference lists of the included studies will also be undertaken. Studies with their full text are not available and are in languages other than English will be excluded. Two independent reviewers will screen titles/abstracts and full text of retrieved articles and eligibility disagreements within a pair will resolve by discussion or a third reviewer. Data charting will be done in accordance with the data extraction tool made in Excel. Findings will be presented as a narrative summary supported by tables and diagrams.

CONCLUSIONS

Identifying the different services that medical librarians provide in the patient education process leads medical librarians to inform about the different services they can provide in the patient education process and to expand their roles as well as policymakers and hospital managers to be aware of these roles and use medical librarians in the patient education process appropriately. It also helps the general public and patients to learn about the services that medical librarians can provide them in this process.

The evolution of our profession and association from 1998-2023: reflections from four Medical Library Association leaders

On the occasion of the Medical Library Association's 125th Anniversary, four librarian leaders with a combined 105 years of engagement in MLA collaborated to reflect on the changes in our profession and our association. We draw on an examination of the last 25 years of the MLA Janet Doe Lectures, our own personal histories, and scholarship we produced for MLA publications and presentations. We offer this compilation as an invitation for readers to reflect on their experiences of changes within the profession, inspiration to engage in the issues around our place in society, and a source for additional exploration into researching and learning from our collective history.

Integrating Medical Librarians in Evidence-Based Medical Practice in Africa: A Survey of Current Practices and Challenges

Librarians' involvement in Evidence-Based Medical Practice (EBMP) has been widely reported from the Global North. The cross-sectional study designed a survey to investigate how African medical librarians integrate into EBMP. The respondents comprised medical librarians from 12 African countries. Findings revealed that African medical librarians are mostly involved in EBMP activities related to resource use, management, and evidence dissemination. The leading EBMP tools reportedly used or promoted by the librarians include UpToDate and Cochrane Library, while the leading challenges encountered in offering support for EBMP are related to skill deficiency, poor funding, and poor internet connectivity.

The historical development and current landscape of health library standards: A critical review

BACKGROUND

Since the emergence of the first health library standards, a large body of literature has been published in this field, most often focusing on a particular standard, or set of standards. In the case of literature reviews, they have been usually partial and integrated into a broader study.

OBJECTIVE

Identify and analyse national health library standards developed in different countries worldwide over the past 70 years, tracing their historical development and current status.

METHOD

A comprehensive search of published literature was conducted in Scopus, Web of Science, Medline, LISA, and Google Scholar up to May 2023. The reference lists and citations of retrieved papers were reviewed. After screening and eligibility, a total of 112 papers were included in the final selection.

RESULTS

More than 40 national hospital library standards published by a group of Anglo-Saxon and European countries were identified. In a chronological approach, the standards have been arranged by decades, from the 1950s to the present day, and the context of their appearance, their main contributions, and the relationships between them have been analysed. The major trends that have marked their evolution and development over time have also been established.

CONCLUSION

Standards have a key role to play in the important challenge facing health libraries today to demonstrate the high impact and value of their services in the functioning of their organisations and in improving patient care.

Integrating Medical Librarians Into Infectious Disease Rounding Teams: Survey Results From a Pilot Implementation Study

Medical librarians participating as infectious disease rounding team members add value by facilitating knowledge acquisition and dissemination and by improving clinical decision making. This pilot study implementing medical librarians on infectious disease rounding teams was a well-received and beneficial intervention to study participants.

Modeling the Adoption of 5760 Clinical Studies Into Practice Across 5 Surgical Specialties

INTRODUCTION

No studies exist that explore the factors that influence the process of synthesizing new knowledge into perioperative standards of care and the operating room. We sought to model the adoption of clinical research into surgical practice and identify modifiable factors influencing the latency of this translation.

METHODS

We created a data set comprised of all UpToDate articles between 2011 and 2020, sampled at 3-mo intervals, to explore how research is incorporated at the point-of-care (POC)-studying 5760 new references from 204 journals across five surgical specialties, compared to all uncited articles published during the same interval. UpToDate authors serve as specialty curators of the vast surgical literature, with an audience of more than a million clinicians in over 180 countries across 3200 institutions. Unlike society guidelines, UpToDate also provides the necessary granularity to quantify the time in bringing research to the bedside. Our main outcomes are citation rates and time-to-citation, split by specialty, journal, article type, and topics. We also model the influence of impact factor, geography, and funding and, finally, propose new impact indices to help with prioritizing surgical literature.

RESULTS

We highlight variation in adoption of clinical research by specialty. We show, despite representing a lower quality of evidence, surgical case reports are one of the most cited article types. Furthermore, most clinical trials (94%-100%) in surgical journals are never incorporated into POC reference lists. While few, pragmatic trials were the most likely to be cited of any article type in any surgical specialty (40%). Journal impact factor did not correlate with time-to-citation or proportion of articles cited in three of five surgical specialties, suggesting differences in how specialties synthesize/value research from specialty journals. Our two metrics, the Clinical Relevancy and Immediacy Indices, were defined to capture this impact/relevance to surgical practice. Of the five surgical subspecialties, gynecology references were >5-fold more likely to get cited, had a larger fraction of higher quality evidence incorporated, and demonstrated more success with POC adoption of practice guidelines. We also quantified the cost of translating research to surgical practice per specialty and generated maps that highlight institutions successful in translating research to the POC. The higher expenditure of National Institutes of Health funding in gynecology may reflect the cost of higher quality research per citation.

CONCLUSIONS

Understanding translational latency is the first step to exposing blocks that slow the adoption of research into everyday surgical practice and to understanding why increasing research funding has not yielded comparative gains in surgical outcomes. Our approach reveals new methods to monitoring the efficiency of research investments and evaluating the efficacy of policies influencing the translation of research to surgical practice.

The impact of libraries and informationists on patient and population care: a mixed-methods study

Objective

While several studies have examined the effectiveness of librarian interactions with clinicians and impact of librarians on patient care, no studies have explored a library's effects on population care. The goal of this study was to investigate the library's impact on both patient and population care.

Methods

Using a sequential exploratory mixed-methods design, we first interviewed a small set of clinicians and researchers active in patient and population care. Based on the themes that we discovered through coding the interviews, we created a survey that was sent to faculty in the health sciences and the health system.

Results

We collected data from a representative sample of our population. We discovered that all respondents value the library and informationists, using our services most for teaching, publishing, presenting, and professional development.

Conclusion

We now have data to support our value to our population and to show where we can do more work to improve the use of our services. Our study shows the value of doing a mixed-methods sequential exploration in which themes that are important to our user community were identified prior to launching a large-scale survey.

Assessment of Library Services in Pediatric Hospitals in the United States and Canada

This study reports on a 2022 survey of pediatric hospital librarians in the U.S. and Canada to assess the status of staffing, resources, and services in their libraries. The report compares the data against the MLA Hospital Library Caucus Standards (2022) and the Canadian Hospital Library Association Standards (2020). The report also provides a comparison of the libraries' rankings using the Regional U.S. News & World Report Best Children's Hospitals and Magnet status. This approach is intended to determine how librarians and library services at hospitals that are recognized by the above programs differ from those that are not recognized.

Validation of a generic impact survey for use by health library services indicates the reliability of the questionnaire

BACKGROUND

A validated generic impact questionnaire can demonstrate how individual and groups of health libraries contribute to continuing education and patient care outcomes.

OBJECTIVES

To validate an existing generic questionnaire for Knowledge for Healthcare, England by examining: (1) internal reliability; (2) content validity; and (3) suggest revisions.

METHODS

Methods used included Cronbach's alpha test, simple data mining of patterns among a data set of 187 questionnaire responses and checking respondents' interpretation of questions.

RESULTS

Cronbach's alpha was 0.776 (acceptable internal reliability). The patterns of responses indicated that respondents' interpretations of the questions were highly plausible, and consistent. The meaning of 'research' varied among different occupational groups, but overall, respondents could identify relevant personal and service impacts. However, users were confused about the terms that libraries use to describe some services.

DISCUSSION

The analysis indicated that the questionnaire worked well for the two types of personal services (literature/evidence searches and training/e-learning) frequently cited on the responses. Further research may be required for library assessment of the impact of other services such as digital resource services.

CONCLUSIONS

The generic questionnaire is a reliable way of assessing the impact of health library and knowledge services, both individually and collectively.

[Point-of-care information in GP practices: Results of a survey among German GP specialists and GP trainees]

BACKGROUND

Specific questions often arise in the context of consultations regarding, for example, diagnostics and therapeutic management. This case-specific search for information is referred to as point-of-care information. In recent years, it has been influenced by an increase in digitalization and by the development of medical expert systems providing information for medical professionals. Data on the search behavior of German general practitioners (GPs) using digital media for obtaining point-of-care information have so far not been available. The aims of this study were to describe occasion-related point-of-care information as a function of the continuing education status and to identify requirements for online research platforms.

METHODS

In a cross-sectional survey, 829 GP specialists (FÄ) and 475 physicians in training (ÄiW) were invited to answer a self-developed, partially standardized questionnaire.

RESULTS

In total, 356 questionnaires were returned (response rate: 27%). Of these, 241 (68%) were answered by FÄ and 110 (31%) by ÄiW; five participants did not provide information on their specialist status. 66% of the FÄ and 89% of the ÄiW look up information every day. 46% of the FÄ and 73% of the ÄiW use their smartphone for this purpose. Both groups most often search for medical content (94%) and for information on medications (84%). Medical expert systems are more often used by ÄiW than by FÄ; 59% of the FÄ and 82% of the ÄiW are willing to pay a fee for these services. A quick overview and relevance of information were perceived as important criteria for good information sources.

DISCUSSION

German GPs frequently search for occasion-related information. There are generation-related differences regarding, among other things, the use of and the receptiveness to fee-based expert systems. The clarity of presentation and the relevance of the information provided are important requirements of effective information platforms.

CONCLUSION

The quick search for evidence-based information relevant to clinical practice presents a challenge, particularly in broad-range specialties such as general medicine. Web-based sources are becoming increasingly popular in this regard - a trend likely to intensify in future generations of physicians. This offers great potential for medical expert systems and app-based access to best-practice guidelines. These formats should be further developed in collaboration with scientific professional societies.

Comparing the Use of DynaMed and UpToDate by Physician Trainees in Clinical Decision-Making: A Randomized Crossover Trial

BACKGROUND

Costs vary substantially among electronic medical knowledge resources used for clinical decision support, warranting periodic assessment of institution-wide adoption.

OBJECTIVES

To compare two medical knowledge resources, UpToDate and DynaMed Plus, regarding accuracy and time required to answer standardized clinical questions and user experience.

METHODS

A crossover trial design was used, wherein physicians were randomized to first use one of the two medical knowledge resources to answer six standardized questions. Following use of each resource, they were surveyed regarding their user experience. The percentage of accurate answers and time required to answer each question were recorded. The surveys assessed ease of use, enjoyment using the resource, quality of information, and ability to assess level of evidence. Tests of carry-over effects were performed. Themes were identified within open-ended survey comments regarding overall user experience.

RESULTS

Among 26 participating physicians, accuracy of answers differed by 4 percentage points or less. For all but one question, there were no significant differences in the time required for completion. Most participants felt both resources were easy to use, contained high quality of information, and enabled assessment of the level of evidence. A greater proportion of participants endorsed enjoyment of use with UpToDate (23/26, 88%) compared with DynaMed Plus (16/26, 62%). Themes from open-ended comments included interface/information presentation, coverage of clinical topics, search functions, and utility for clinical decision-making. The majority (59%) of open-ended comments expressed an overall preference for UpToDate, compared with 19% preferring DynaMed Plus.

CONCLUSION

DynaMed Plus is noninferior to UpToDate with respect to ability to achieve accurate answers, time required for answering clinical questions, ease of use, quality of information, and ability to assess level of evidence. However, user experience was more positive with UpToDate. Future studies of electronic medical knowledge resources should continue to emphasize evaluation of usability and user experience.

Critical incident technique helps determine how health library and information services influence clinical decision making and patient care: A literature review

BACKGROUND

The Critical incident technique (CIT) has been used for decades in the assessment of the impact of library and information services on patient care and clinical decision making.

OBJECTIVES

The purpose of this article is to identify and review the studies that have used CIT approach to assess the impact of library and information services on patient care and clinical decision making.

METHODS

Related articles were searched in the information resources of Web of Science, PubMed, Embase, Scopus, Google Scholar and LISTA.

RESULTS

From among 1346 articles obtained, 22 met the inclusion criteria. The analysis of the articles indicated that CIT has been used for various purposes such as assessing the information value, assessing the information resources and librarians in their clinical practice and decision making, examining information-seeking behaviour and analysing cost- benefits.

DISCUSSION

Critical incident technique is a flexible approach for libraries and information services, based on individuals' experiences of finding and using information to help resolve a perceived problem.

CONCLUSIONS

The studies identified in this review offer a variety of methods for using CIT that other libraries might consider for their own impact studies.

The Never-Ending Evolutionary Saga of Assessing and Demonstrating the Value of Information Services in a Biomedical Library

Demonstrating added value can be very challenging, yet it is becoming important in academic libraries. The current literature primarily discusses citation analysis and usage reports to demonstrate return on investment for collections or impact on scholarly activity. However, value is not only in our collections but also in the library staff who support the institutional mission. Vanderbilt University's Annette and Irwin Eskind Family Biomedical Library and Learning Center has been experimenting with several methods to supplement the collections data with services performed by the staff. This article discusses the project's four phases as part of the goal to strategically demonstrate the biomedical library's added value to the university and medical center.

Identifying gaps in consumer health library collections: a retrospective review

Background:

The objective of this study was to determine if search request forms, which are used when a patron's request for information cannot be fulfilled at the time of contact with the library team, can be used to identify gaps in consumer health library collections.

Case Presentation:

Search request forms were collected from 2013 to 2020 and analyzed independently by two reviewers. Search request forms were included if they were complete and contained a record of how the request was fulfilled. Descriptive statistics were used to summarize patron characteristics. Search request forms were iteratively coded to identify themes in the data and determine if resources provided to patrons could be found within the library collection. The study team subsequently reviewed search request forms to determine reasons for identified gaps. Two hundred and forty-nine search request forms were analyzed. Six main content themes were identified: 1) understanding the cancer diagnosis, 2) cancer treatments, 3) understanding disease prognosis, 4) support during and after treatment, 5) natural health products and therapeutic effects in oncology, and 6) research literature. The majority of patrons were patients (53%). Over half (60%) of the submitted search request forms reflected collection gaps, and many (16%) contained queries for information about rare cancer diagnoses. The main reason that queries could not be satisfied was that there was limited consumer health information on the requested topics (53%).

Conclusions:

Search request forms are a useful resource for assessing gaps in consumer health library collections.

UK survey demonstrates a wide range of impacts attributable to clinical librarian services

OBJECTIVE

To understand the impact of the UK Clinical Librarian (CL) workforce and benchmark the results against a study undertaken in the North West region of the English National Health Service (NHS).

METHODS

An online survey was distributed by CLs to their service users regarding literature searches that had been carried out on their behalf in the 6 months from April to October 2017. Interviews were later carried out in person with selected respondents to the questionnaires.

RESULTS

CLs across the UK contribute to a wide range of outcomes, with 41% of search requests contributing to the choice of intervention, and 41% also to the advice offered by the clinician requester to a patient or their carer. These results are in line with the previous work undertaken in the North West.

DISCUSSION

CLs provide diverse services to clinical teams. They support the continuing professional development and personal research needs of team members, service development needs of organisations, and the information provided contributes to improved quality and safety of patient care.

CONCLUSION

The survey confirms the findings of the earlier NW study. It demonstrates the impact of services based around literature searching on patient care.

Evolution-revolution-devolution: a short history of the provision of knowledge-based information services to Manitoba's health professionals

Since 1993, the University of Manitoba (UM), Winnipeg area hospitals, the Winnipeg Regional Health Authority (WRHA), and the Manitoba Health Department have engaged in a series of agreements that have changed access to knowledge-based information for health professionals. These agreements gradually transferred the management and delivery of library service from hospital libraries to the UM Libraries. This paper describes the historical evolution in health information access in Winnipeg, subsequent revolutionary changes that resulted in the Health Sciences Libraries Service Model, and the devolution of the model following serious challenges. Its rebirth as the WRHA Virtual Library is discussed with factors that may impact the new service model.

Addressing Disparities in Physician Access to Information in Support of Evidence-based Practice

The purpose of this study is to determine if Minnesota physicians have access to information resources needed to support evidence-based practice (EBP), which supports a culture of safety and patient-centered care. A survey was used to determine Minnesota physicians' need for, and access to, evidence-based clinical information. A total of 877 responses (6.4% response rate) were included in the data analysis. Participants spent 24 min daily seeking answers to clinical questions and averaged 4.41 questions per day that could not be immediately answered. Physicians reported high levels of information needs met (85.8%), though they reported limited access to drug resources, citation databases, systematic reviews, and full-text books and articles. Results also showed use of unreliable sources to support decision-making. A key finding was the extent to which workplace affiliation broadens disparities in information access. National and regional approaches can work to support EBP by reducing the information gap caused by workplace affiliation and other barriers. Further research should be done to identify partnerships, funding, infrastructure, and support to address these gaps.

Why are they not accessing it? User barriers to clinical information access

The Medical Library Association's InSight Initiative provides an open and collaborative environment for library and industry partners to discuss vexing problems and find solutions to better serve their users. The initiative's fifth summit, continuing work from the previous summit, focused on understanding how users discover and access information in the clinical environment. During the summit, participants were divided into working groups and encouraged to create a tangible product as a result of their discussions. At the end of the summit, participants established a framework for understanding users' pain points, discussed possible solutions to those points, and received feedback on their work from an End User Advisory Board comprising physicians, clinical researchers, and clinical faculty in biomedicine. In addition to the pain point framework, participants are developing MLA InSight Initiative Learning content with modules to educate librarians and publishers about critical aspects of user behavior. The 2020 Insight Initiative Fall Forum will serve as a virtual home for constructive dialogue between health sciences librarians and publishers on improving discovery and access to information.

A clinical librarian in a hospital critical care unit may generate a positive return on investment

BACKGROUND

Timely information provided by clinical librarians can contribute to outcomes such as improved patient care and time savings for hospital staff. What is unknown is the return on investment (ROI) of a clinical librarian on a critical care unit.

OBJECTIVE

The aim of this study was to assess the ROI, from the employer perspective, of placing a clinical librarian in a critical care unit in a large UK acute hospital.

METHODS

Using a mixed methods approach, ROI was estimated by comparing the total costs with the total monetised benefits of implementing the clinical librarian intervention. Total costs included salary and equipment costs. Total monetised benefits included time saving for hospital staff, support for professional development and improved patient care.

RESULTS

When total monetised benefits were compared with total costs, the 15-month clinical librarian intervention generated a positive ROI of £1.18-£3.03 for every £1 invested.

DISCUSSION

Using outcome measures derived from previous research, this novel study generated promising results indicative for commissioners seeking to improve patient care and deliver value for money. To improve generalisability, multisite studies using standardised ROI tools are recommended.

CONCLUSION

Employing a clinical librarian in a critical care unit can generate a positive ROI.

How searching under time pressure impacts clinical decision making

Objective:

Clinicians encounter many questions during patient encounters that they cannot answer. While search systems (e.g., PubMed) can help clinicians find answers, clinicians are typically busy and report that they often do not have sufficient time to use such systems. The objective of this study was to assess the impact of time pressure on clinical decisions made with the use of a medical literature search system.

Design:

In stage 1, 109 final-year medical students and practicing clinicians were presented with 16 clinical questions that they had to answer using their own knowledge. In stage 2, the participants were provided with a search system, similar to PubMed, to help them to answer the same 16 questions, and time pressure was simulated by limiting the participant's search time to 3, 6, or 9 minutes per question.

Results:

Under low time pressure, the correct answer rate significantly improved by 32% when the participants used the search system, whereas under high time pressure, this improvement was only 6%. Also, under high time pressure, participants reported significantly lower confidence in the answers, higher perception of task difficulty, and higher stress levels.

Conclusions:

For clinicians and health care organizations operating in increasingly time-pressured environments, literature search systems become less effective at supporting accurate clinical decisions. For medical search system developers, this study indicates that system designs that provide faster information retrieval and analysis, rather than traditional document search, may provide more effective alternatives.

Leveraging Survey Results in Support of a Library Renovation: A Case Study

The Health Sciences Library (HSL) at Stony Brook University along with the School of Medicine were motivated to make improvements in seating and hours based on survey results from an LCME self-study. Preparation for the site visit from the Liaison Committee for Medical Education helped to garner resources and support for this initiative. To meet the evolving needs of the HSL patrons, librarians completed an overdue collection assessment project which allowed for 142 new seats, including newly designed spaces and furnishings. Ongoing assessment of the redesigned space will be conducted to evaluate success and areas for continued improvement.

What we talk about when we talk about medical librarianship: an analysis of Medical Library Association annual meeting abstracts, 2001-2019

Objective:

This study seeks to gain initial insight into what is talked about and whose voices are heard at Medical Library Association (MLA) annual meetings.

Methods:

Meeting abstracts were downloaded from the MLA website and converted to comma-separated values (CSV) format. Descriptive analysis in Python identified the number of presentations, disambiguated authors, author collaboration, institutional affiliation type, and geographic affiliation. Topics were generated using Mallet's Latent Dirichlet Allocation algorithm for topic modeling.

Results:

There were 5,781 presentations at MLA annual meetings from 2001–2019. Author disambiguation resulted in approximately 5,680 unique authors. One thousand ninety-three records included a hospital-related keyword in the author field, and 4,517 records included an academic-related keyword. There were 438 presentations with at least 1 international author. The topic model identified 16 topics in the MLA abstract corpus: events, electronic resources, publications, evidence-based practice, collections, academic instruction, librarian roles and relationships, technical systems, special collections, general instruction, literature searching, surveys, research support, community outreach, patient education, and library services.

Conclusions:

Academic librarians presented more frequently than hospital librarians, though more research should be done to determine if this discrepancy was disproportionate to hospital librarians' representation in MLA. Geographic affiliation was concentrated in the United States and appeared to be related to population density. Health sciences librarians in the early twenty-first century are spending more time at MLA annual meetings talking about communities, relationships, and visible services, and less time talking about library collections and operations. Further research will be needed to boost the participation of underrepresented members.

Barriers and facilitators to use of a clinical evidence technology in the management of skin problems in primary care: insights from mixed methods

Objective:

Few studies have examined the impact of a single clinical evidence technology (CET) on provider practice or patient outcomes from the provider's perspective. A previous cluster-randomized controlled trial with patient-reported data tested the effectiveness of a CET (i.e., VisualDx) in improving skin problem outcomes but found no significant effect. The objectives of this follow-up study were to identify barriers and facilitators to the use of the CET from the perspective of primary care providers (PCPs) and to identify reasons why the CET did not affect outcomes in the trial.

Methods:

Using a convergent mixed methods design, the authors had PCPs complete a post-trial survey and participate in interviews about using the CET for managing patients' skin problems. Data from both methods were integrated.

Results:

PCPs found the CET somewhat easy to use but only occasionally useful. Less experienced PCPs used the CET more frequently. Data from interviews revealed barriers and facilitators at four steps of evidence-based practice: clinical question recognition, information acquisition, appraisal of relevance, and application with patients. Facilitators included uncertainty in dermatology, intention for use, convenience of access, diagnosis and treatment support, and patient communication. Barriers included confidence in dermatology, preference for other sources, interface difficulties, presence of irrelevant information, and lack of decision impact.

Conclusion:

PCPs found the CET useful for diagnosis, treatment support, and patient communication. However, the barriers of interface difficulties, irrelevant search results, and preferred use of other sources limited its positive impact on patient skin problem management.

Assessing return on investment in health libraries requires lateral thinking

This study considers the status of trends in value and impact research in health libraries and discusses how return on investment approaches such as social value analysis could be used. It uses an example, based on the Health Education England evaluation framework for health library and knowledge services, to outline how a theory of change can be developed. Health libraries now work more closely with health care staff and researchers in co-creating value and impact for improving patient care. Therefore, collection of data to assess social value should be drawn not only from performance data already collected by libraries, but also data collection by and for the health care organisation on evaluation of care quality and professional competence.

The tenth Janet Doe Lecture, a forty-year perspective: still relevant after all these years

Erich Meyerhoff was an academic health sciences librarian and a distinguished member of the Medical Library Association when he was invited to present the Janet Doe Lecture in 1977. His lecture on the state of the association is considered one of the finest Doe lectures and is still relevant more than forty years later, not only from an historical perspective, but also for his projections for the future and his prescient comments about the future of hospital librarianship and the important role of women in the association. Key 1977 Doe lecture topics are reviewed and updated in the context of the current health sciences library environment.

Twelve tips for undertaking a focused systematic review in medical education

The exponential growth of the systematic review methodology within health has been mirrored within medical education, allowing large numbers of publications on a topic to be synthesized to guide researchers and teachers. The robust, transparent and reproducible search methodologies employed offer scholarly rigor. The scope and scale of many reviews in education have only been matched by the size of the commitment needed to complete them and occasional lack of utility of reports. As such, we have noticed a growth in reviews across journals in the field that have questions that are more focused in scope. The authors propose 12 tips for performing a focused review in the right settings for the right reasons and discuss why such "focused reviews" may be more beneficial in those circumstances. Focused reviews allow researchers to formulate answers to specific local issues that have explicit utility of findings. Such reviews are equipped to identify what works for specific groups in specific circumstances and even question how and why this may occur. An additional impact of a focused approach can be a rapid turnaround. This article explains the purpose and benefits of focused review and provides guidance on how to produce them.

Impact of pharmacy medicine information service advice on clinician and patient outcomes: an overview

BACKGROUND

Pharmacy-led medicine information (MI) services are available in many countries to support clinicians and patients make decisions on use of medicines.

OBJECTIVES

To establish what impact, if any, pharmacy-led MI services have on clinician and patient outcomes.

METHODS

All published works indexed in Embase or PubMed, meeting this review's inclusion and exclusion criteria, that wholly or partially attempted to measure the effects of MI advice were retrieved and assessed.

RESULTS

Twenty studies were reviewed. Five broad themes were identified describing study findings, three were specific to clinicians: their views on the effect MI answers had; actions they took; and influence on their decision making. A fourth theme centred on patient utilisation of advice, and the fifth on 'process measures' attempting to determine MI worth.

DISCUSSION

Studies report on positive patient outcomes as a direct result of MI advice. Clinicians and patients acted upon the advice provided. Clinicians also reported using MI advice as a 'safety net', to check, reassure or confirm what to do. MI advice also demonstrated economic worth, although these studies are old.

CONCLUSION

MI Service advice appears to affect clinician and patient outcomes. However, study design limitations require findings be viewed cautiously.

Health information services: Engaging women in cervical cancer screening awareness in Nigeria

Around the world, a woman dies of cervical cancer every two minutes. In Nigeria, it is the second leading cause of cancer deaths, which could be avoided with proper access to health information. This mixed methods study, which employs a questionnaire, interviews, observations and discussion, examined women’s awareness on cervical cancer, screening status, sources, attitude and willingness, factors deterring them from being screened, and lessons learnt. Screening was done using visual inspection with acetic acid (VIA). The study involved two librarians, two medical doctors, a pharmacist and a laboratory scientist: 90 women participated in the cervical screening exercise in non-standard settings – an e-library and a cathedral. It was discovered that 90% of the women had never been screened. Thus, if the women are not sensitized on cervical cancer they may never go for screening and more casualties will be recorded. The paper concludes with recommendations and a call to action for all, especially librarians.

[Computer-assisted diagnosis of rare diseases]

To establish a comprehensive diagnosis is by far the most challenging task in a physician's daily routine. Especially rare diseases place high demands on differential diagnosis, caused by the high number of around 8000 diseases and their clinical variability. No clinician can be aware of all the different entities and memorizing them all is impossible and inefficient. Specific diagnostic decision-supported systems provide better results than standard search engines in this context. The systems FindZebra, Phenomizer, Orphanet, and Isabel are presented here concisely with their advantages and limitations. An outlook is given to social media usage and big data technologies. Due to the high number of initial misdiagnoses and long periods of time until a confirmatory diagnosis is reached, these tools might be promising in practice to improve the diagnosis of rare diseases.

Effect of a clinical evidence technology on patient skin disease outcomes in primary care: a cluster-randomized controlled trial

Objective

Providers' use of clinical evidence technologies (CETs) improves their diagnosis and treatment decisions. Despite these benefits, few studies have evaluated the impact of CETs on patient outcomes. The investigators evaluated the effect of one CET, VisualDx, on skin problem outcomes in primary care.

Methods

A cluster-randomized controlled pragmatic trial was conducted in outpatient clinics at an academic medical center in the northeastern United States. Participants were primary care providers (PCPs) and their adult patients seen for skin problems. The intervention was VisualDx, as used by PCPs. Outcomes were patient-reported time from index clinic visit to problem resolution, and the number of follow-up visits to any provider for the same problem. PCPs who were randomly assigned to the intervention agreed to use VisualDx as their primary evidence source for skin problems. Control group PCPs agreed not to use VisualDx. Investigators collected outcome data from patients by phone at thirty-day intervals. Cox proportional hazards models assessed time to resolution. Wilcoxon-rank sum tests and logistic regression compared the need for return appointments.

Results

Thirty-two PCPs and 433 patients participated. In proportional hazards modelling adjusted for provider clusters, the time from index visit to skin problem resolution was similar in both groups (hazard ratio=0.92; 95% confidence interval [CI]=0.70, 1.21; p=0.54). Patient follow-up appointments did not differ significantly between groups (odds ratio=1.26; CI=0.94, 1.70; p=0.29).

Conclusion

This pragmatic trial tested the effectiveness of VisualDx on patient-reported skin disease outcomes in a generalizable clinical setting. There was no difference in skin problem resolution or number of follow-up visits when PCPs used VisualDx.

Developing a generic tool to routinely measure the impact of health libraries

BACKGROUND

Health libraries contribute to many activities of a health care organisation. Impact assessment needs to capture that range of contributions.

OBJECTIVES

To develop and pilot a generic impact questionnaire that: (1) could be used routinely across all English NHS libraries; (2) built on previous impact surveys; and (3) was reliable and robust.

METHODS

This collaborative project involved: (1) literature search; (2) analysis of current best practice and baseline survey of use of current tools and requirements; (3) drafting and piloting the questionnaire; and (4) analysis of the results, revision and plans for roll out.

FINDINGS

The framework selected was the International Standard Methods And Procedures For Assessing The Impact Of Libraries (ISO 16439). The baseline survey (n = 136 library managers) showed that existing tools were not used, and impact assessment was variable. The generic questionnaire developed used a Critical Incident Technique. Analysis of the findings (n = 214 health staff and students), plus comparisons with previous impact studies indicated that the questionnaire should capture the impact for all types of health libraries.

CONCLUSIONS

The collaborative project successfully piloted a generic impact questionnaire that, subject to further validation, should apply to many types of health library and information services.

Librarians collaborating to teach evidence-based practice: exploring partnerships with professional organizations

Objective

The study sought to determine if librarians are collaborating with nurses and professional nursing organizations to teach evidence-based practice (EBP) continuing education courses, workshop, classes, or other training activities.

Methods

A 15-question survey was sent to 1,845 members of the Medical Library Association through email.

Results

The survey was completed by 201 consenting respondents. Some respondents (37) reported having experience teaching continuing education in collaboration with professional health care organizations and 8 respondents, more specifically, reported having experience teaching EBP continuing education courses, workshops, classes, or other training activities in collaboration with professional nursing organizations.

Conclusions

The survey results demonstrate that librarians are teaching continuing education classes or workshops in collaboration with professional health care organizations and reveal that there are a small number of librarians collaborating with professional nursing organizations to teach EBP continuing education courses, workshops, classes, or other training activities.

Clinical usefulness of library and information services in Japan: The detailed use and value of information in clinical settings

OBJECTIVES

Considering that there is a lack of evidence regarding the contribution of library and information services to evidence-based medicine in actual clinical practice in Japan, the purpose of the study is to explore the current status of use and value of library and information services in clinical settings to examine the usefulness of information in implementing evidence-based medicine (EBM) into practice.

METHODS

A Web-based survey was conducted at seven sites (hospitals with 300-1,200 beds) and interviews conducted at five sites to investigate information behavior among health professionals (physicians, residents, and nurses) in 2016, replicating the Value Study carried out in the United States in 2010 and 2011. Using a critical incident technique, respondents answered questions about their information topics, information resources used, search location, access points, and evaluation of the information.

RESULTS

Analysis from 598 valid responses (275 physicians, 55 residents, and 268 nurses) revealed the characteristics of information use and recognition of the value of information. Physicians and residents showed their information needs regarding clinical care using PubMed (80.4%, 65.5%), Ichushi-Web (61.8%, 63.6%), and UpToDate (40.4%, 65.5%). While physicians rely more on electronic journals (37.8%), residents use more hybrid resources including Japanese print books (38.2%) and online books (30.9% for Japanese, 32.7% for English) to confirm their knowledge. Nurses need more information close to patients and explore a wider variety of information resources such as Japanese print books (60.4%), Ichushi -Web (40.3%), Japanese online books (20.5%), and websites of academic organizations (19.0%). Although the overall recognition of the value of information was relatively modest, concrete changes in clinical practice were found in some areas. Environments with insufficient information and availability of electronic resources should be improved to increase the use of library and information services for implementing EBM.

Evaluating the impact of clinical librarians on clinical questions during inpatient rounds

Objective

The investigation sought to determine the effects of a clinical librarian (CL) on inpatient team clinical questioning quality and quantity, learner self-reported literature searching skills, and use of evidence-based medicine (EBM).

Methods

Clinical questioning was observed over 50 days of inpatient pediatric and internal medicine attending rounds. A CL was present for 25 days and absent for 25 days. Questioning was compared between groups. Question quality was assessed by a blinded evaluator, who used a rubric adapted from the Fresno Test of Competence in Evidence-Based Medicine. Team members were surveyed to assess perceived impacts of the CL on rounds.

Results

Rounds with a CL (CLR) were associated with significantly increased median number of questions asked (5 questions CLR vs. 3 NCLR; p<0.01) and answered (3 CLR vs. 2 NCLR; p<0.01) compared to rounds without a CL (NCLR). CLR were also associated with increased mean time spent asking (1.39 minutes CLR vs. 0.52 NCLR; p<0.01) and answering (2.15 minutes CLR vs. 1.05 NCLR; p=0.02) questions. Rounding time per patient was not significantly different between CLR and NCLR. Questions during CLR were 2 times higher in adapted Fresno Test quality than during NCLR (p<0.01). Select participants described how the CL's presence improved their EBM skills and care decisions.

Conclusions

Inpatient CLR were associated with more and improved clinical questioning and subjectively perceived to improve clinicians' EBM skills. CLs may directly affect patient care; further study is required to assess this. CLs on inpatient rounds may be an effective means for clinicians to learn and use EBM skills.

The Impact of Library Resources and Services on the Scholarly Activity of Medical Faculty and Residents

Librarians at an academic medical center library gathered data to determine if library services and resources impacted scholarly activity. A survey was developed and sent out to faculty and residents asking how they used the library during scholarly activity. Sixty-five faculty members and residents responded to the survey. The majority of respondents involved with scholarly activity use the library's services and resources. PubMed is the most frequently used database. The positive results show the library impacts the scholarly activity of medical faculty and residents.

Association between Search Behaviors and Disease Prevalence Rates at 18 U.S. Children's Hospitals

Background Usage of online resources by clinicians in training and practice can provide insight into knowledge gaps and inform development of decision support tools. Although online information seeking is often driven by encountered patient problems, the relationship between disease prevalence and search rate has not been previously characterized. Objective This article aimed to (1) identify topics frequently searched by pediatric clinicians using UpToDate (http://www.uptodate.com) and (2) explore the association between disease prevalence rate and search rate using data from the Pediatric Health Information System. Methods We identified the most common search queries and resources most frequently accessed on UpToDate for a cohort of 18 children's hospitals during calendar year 2012. We selected 64 of the most frequently searched diseases and matched ICD-9 data from the PHIS database during the same time period. Using linear regression, we explored the relationship between clinician query rate and disease prevalence rate. Results The hospital cohort submitted 1,228,138 search queries across 592,454 sessions. The majority of search sessions focused on a single search topic. We identified no consistent overall association between disease prevalence and search rates. Diseases where search rate was substantially higher than prevalence rate were often infectious or immune/rheumatologic conditions, involved potentially complex diagnosis or management, and carried risk of significant morbidity or mortality. None of the examined diseases showed a decrease in search rate associated with increased disease prevalence rates. Conclusion This is one of the first medical learning needs assessments to use large-scale, multisite data to identify topics of interest to pediatric clinicians, and to examine the relationship between disease prevalence and search rate for a set of pediatric diseases. Overall, disease search rate did not appear to be associated with hospital disease prevalence rates based on ICD-9 codes. However, some diseases were consistently searched at a higher rate than their prevalence rate; many of these diseases shared common features.

The new diagnostic team

The National Academy of Medicine (NAM) in the recently issued report Improving Diagnosis in Health Care outlined eight major recommendations to improve the quality and safety of diagnosis. The #1 recommendation was to improve teamwork in the diagnostic process. This is a major departure from the classical approach, where the physician is solely responsible for diagnosis. In the new, patient-centric vision, the core team encompasses the patient, the physician and the associated nursing staff, with each playing an active role in the process. The expanded diagnostic team includes pathologists, radiologists, allied health professionals, medical librarians, and others. We review the roles that each of these team members will need to assume, and suggest “first steps” that each new team member can take to achieve this new dynamic.

Tools for evidence-based vascular nursing practice: Achieving information literacy for lifelong learning

Information literacy is essential in facilitating evidence-based practice (EBP) activities. In vascular nursing, the implementation of EBP is of utmost importance. Best practice grounded in research evidence can contribute to improved patient care outcomes for individuals with vascular disease. The following paper discusses information literacy competencies for nurses to develop in the context of EBP, with an emphasis on formulating a clinical question and searching for evidence. Relevant health science information resources are described, including their value and purpose in the 6S model of evidence. Also discussed are practical and supportive solutions with proven effectiveness in ensuring nurses' success with EBP.

Big data application framework and its feasibility analysis in library

Purpose

The purpose of this study is to introduce the concept of big data and provide a comprehensive overview to readers to understand big data application framework in libraries.

Design/methodology/approach

The authors first used the text analysis and inductive analysis method to understand the concept of big data, summarize the challenges and opportunities of applying big data in libraries and further propose the big data application framework in libraries. Then they used questionnaire survey method to collect data from librarians to assess the feasibility of applying big data application framework in libraries.

Findings

The challenges of applying big data in libraries mainly include data accuracy, data reduction and compression, data confidentiality and security and big data processing system and technology. The opportunities of applying big data in libraries mainly include enrich the library database, enhance the skills of librarians, promote interlibrary loan service and provide personalized knowledge service. Big data application framework in libraries can be considered from five dimensions: human resource, literature resource, technology support, service innovation and infrastructure construction. Most libraries think that the big data application framework is feasible and tend to apply big data application framework. The main obstacles to prevent them from applying big data application framework is the human resource and information technology level.

Originality/value

This research offers several implications and practical solutions for libraries to apply big data application framework.

Examining the role of MEDLINE as a patient care information resource: an analysis of data from the Value of Libraries study

OBJECTIVE

This study analyzed data from a study on the value of libraries to understand the specific role that the MEDLINE database plays in relation to other information resources that are available to health care providers and its role in positively impacting patient care.

METHODS

A previous study on the use of health information resources for patient care obtained 16,122 responses from health care providers in 56 hospitals about how providers make decisions affecting patient care and the role of information resources in that process. Respondents indicated resources used in answering a specific clinical question from a list of 19 possible resources, including MEDLINE. Study data were examined using descriptive statistics and regression analysis to determine the number of information resources used and how they were used in combination with one another.

RESULTS

Health care professionals used 3.5 resources, on average, to aid in patient care. The 2 most frequently used resources were journals (print and online) and the MEDLINE database. Using a higher number of information resources was significantly associated with a higher probability of making changes to patient care and avoiding adverse events. MEDLINE was the most likely to be among consulted resources compared to any other information resource other than journals.

CONCLUSIONS

MEDLINE is a critical clinical care tool that health care professionals use to avoid adverse events, make changes to patient care, and answer clinical questions.

Effectiveness of a clinical knowledge support system for reducing diagnostic errors in outpatient care in Japan: A retrospective study

Clinical evidence has indicated the effectiveness of computer-based systems for preventing and reducing diagnostic errors. Our study aimed to evaluate the effectiveness of UpToDate, a computer-based clinical knowledge management system, for reducing diagnostic errors. We retrospectively identified 100 patients who visited an outpatient department in a community-based hospital from July 2014 to June 2015. Fifty patients (exposure group) were seen by UpToDate-equipped physicians and another 50 (control group) were seen by UpToDate-unequipped physicians. We extracted data on patient sex, age, primary diagnosis, and case difficulty that could potentially affect diagnostic outcomes. We compared the two groups regarding diagnostic error rate and performed logistic regression analysis to analyze the concurrent effects of various factors affecting diagnostic error. The diagnostic error rate was 2% in the exposure group, while the error rate was 24% in the control group. Multivariate logistic regression analysis showed that error rate reduction was significantly associated with exposure to UpToDate with an odds ratio of 15.21 (95% CI 1.86-124.36). Our results demonstrated the effectiveness of UpToDate for the prevention and reduction of diagnostic error.

Evaluating the Impact of Mediated Literature Searches at a Comprehensive Cancer Center

Research informationists at a comprehensive cancer center sought to evaluate the impact and value of mediated literature searches in support of their users' work activities. An assessment tool was identified in the literature and modified by the investigators to solicit feedback from library users and identify the major reason(s) why scientists and health care professionals request literature searches, how they use the resulting information, and the impact that the results may or may not have on their research or patient care/decision-making activities. Survey results were qualitatively analyzed, and future avenues of outreach and promotion of mediated literature search services were identified.

Surveying hospital nurses to discover educational needs and preferences

OBJECTIVE

The author investigated the educational needs of nurses in an American Nurses Credentialing Center Magnet hospital to determine topics of interest, instruction time and delivery preferences, and interest in a research information skills certificate provided by the library.

METHODS

A 9-question survey was distributed to 1,500 nursing staff of the hospital through email.

RESULTS

Surveys were completed by 865 respondents, which represented a response rate of 58%. The majority of respondents were registered nurses, licensed practical nurses, and paramedics (81%), and day-shift workers (65%). For education topics, nursing staff placed the highest priority on finding health-related mobile apps for professionals and developing evidence-based research skills. For mode of delivery, respondents expressed a preference for unit-based in-service, computer-based tutorials, and hands-on computer training. Most (70%) respondents expressed an interest in participating in a research information skills certificate program.

CONCLUSIONS

Our survey results reveal an avenue for reinvigorating and updating the library's educational program to match the needs of nursing staff and may offer valuable insight for other libraries seeking to do the same.

Evidence-based medicine for all: what we can learn from a programme providing free access to an online clinical resource to health workers in resource-limited settings

The rapidly changing landscape of medical knowledge and guidelines requires health professionals to have immediate access to current, reliable clinical resources. Access to evidence is instrumental in reducing diagnostic errors and generating better health outcomes. UpToDate, a leading evidence-based clinical resource is used extensively in the USA and other regions of the world and has been linked to lower mortality and length of stay in US hospitals. In 2009, the Global Health Delivery Project collaborated with UpToDate to provide free subscriptions to qualifying health workers in resource-limited settings. We evaluated the provision of UpToDate access to health workers by analysing their usage patterns. Since 2009, ∼2000 individual physicians and healthcare institutions from 116 countries have received free access to UpToDate through our programme. During 2013-2014, users logged into UpToDate ∼150 000 times; 61% of users logged in at least weekly; users in Africa were responsible for 54% of the total usage. Search patterns reflected local epidemiology with 'clinical manifestations of malaria' as the top search in Africa, and 'management of hepatitis B' as the top search in Asia. Our programme demonstrates that there are barriers to evidence-based clinical knowledge in resource-limited settings we can help remove. Some assumed barriers to its expansion (poor internet connectivity, lack of training and infrastructure) might pose less of a burden than subscription fees.