Lessons learned: year-by-year improvement of a required information competency course.

At the Ohio State University, a health sciences librarian is the co-instructor in a required information competencies course for first-year undergraduate students in the Honors Biomedical Science Major. This article discusses the creation and development of the credit-bearing, in-person course from the curriculum planning phase in 2005 to present. Improvements to the course are described by year. Student feedback, student performance, and reflection by the co-instructors influenced the course improvements, including changes in content, delivery, student feedback mechanisms, and assessment of student learning. The course teaches students to access, organize, read, and analyze the biomedical research literature.

Information literacy skills of occupational therapy graduates: promoting evidence-based practice in the MOT curriculum.

Are Master of Occupational Therapy (MOT) graduates more successful than BS graduates in accessing and analyzing research literature? This retrospective cohort study used a survey sent to Ohio State University MOT graduates, asking why they need information for their practice, what types of information they seek, and how they search for and use it. Results suggest that the MOT program has fostered higher-level skills than did the BS program in independent writing, a greater focus on evidence-based practice, and the use of bibliographic databases. The MOT graduates report high confidence in their ability to apply research to practice and high satisfaction with the lifelong learning skills they learned. The survey findings support the importance of collaboration between Occupational Therapy faculty and medical librarians in developing MOT educational programs.

Credibility of a meta-analysis: evidence-based practice concerning soy intake and breast cancer risk in premenopausal women.

PURPOSE: To report the findings from a critical appraisal concerning the credibility of a meta-analysis (M-A) about the role of dietary soy intake in reducing breast cancer risk. The use of an evidence-based, advanced nursing practice framework was used to appraise the M-A. APPROACH: The clinical question was developed from a problem that could be encountered in clinical practice. For premenopausal women, does the use of high dietary soy intake reduce the future risk of breast cancer compared with low dietary soy intake? A search of electronic databases yielded one M-A, which was selected to answer the question. FRAMEWORK: A framework was developed from various authors' work and used to appraise the M-A and guide implementation of the evidence-based practice (EBP) process. CONCLUSIONS: The findings of the M-A were not deemed credible because of deficient information regarding the target population and outcome variable, lack of confounder control, unclear inclusion and exclusion criteria of the sample, and invalid methods of data abstraction. Because the findings were not credible, they were deemed not to be clinically applicable. Therefore, a high soy diet would not necessarily be recommended.

Concepts in clinical scholarship. Research literature in occupational therapy, 2001-2005.

One method to determine trends in occupational therapy research is to survey the literature published in occupational therapy journals. This study describes the types and topics of articles published in five prominent occupational therapy journals over a 5-year span. Feature articles published between 2001 and 2005 were analyzed to determine the types of articles and research and subject areas. The percentage of research articles published between 2001 and 2005 increased from 65% to 78% of all articles published and is higher than previous reports. More than 70% of the research articles used designs that substantially contribute to the evidence base for occupational therapy (defined by Kielhofner, Hammel, Finlayson, Helfrich, & Taylor [2004] as correlational-comparison, experimental, qualitative, and meta-analysis). Of the research articles, 60% addressed pediatric, physical disability, and rehabilitation topics. The 5-year period showed a trend of increasing frequency of geriatric and pediatric topics in research reports. Scholars should emphasize research designs that build the evidence for occupational therapy approaches and practices and focus on research topics of highest value to society.

Antioxidant status and hearing function in noise-exposed workers.

The cellular antioxidant system appears to protect cochlear hair cells from oxidative stress due to noise and aging. The role of individual metabolic variables remains poorly understood, however. We examined the role of a number of metabolic factors on human cochlear function in noise-exposed individuals. In 58 factory workers we measured audiometry and distortion product otoacoustic emissions prior to a workshift. Simultaneously we measured levels of vitamin E, vitamin C, and polymorphism status for two metabolic genes related to glutathione S-transferase function (GSTM1 and GSTT1). Age and total noise exposure were predictive of hearing status. Vitamin E levels were negatively correlated with hearing function, and this effect was partly explained by an increase in vitamin E levels with age. No effect was found for vitamin C. Individuals possessing the GSTM1 gene had significantly better high frequency otoacoustic emissions compared to GSTM1 null individuals. The protective effect of GSTM1 was present even after adjusting for age, race, sex, and years of noise exposure. GSTT1 did not exhibit a similarly protective effect. While the cross-sectional nature of the study precludes drawing conclusions about causation, these data suggest that GSTM1, an antioxidant enzyme which is found in the mammalian cochlea, may play a protective role in humans against hair cell damage due to noise or aging.

A validation of self-reported substance use with biochemical testing among patients presenting to the emergency department seeking treatment for backache, headache, and toothache.

PURPOSE: This study tests the validity of self-reported illicit substance use against biochemical testing among Emergency Department (ED) patients seeking treatment with narcotics for backache, headache, and toothache and to characterize patients who provide false reports. METHODS: Retrospective chart review comparing the self-reported drug use history obtained during an ED visit during a six-year period (1995-2001) with the results of a biochemical drug screen obtained the same day. RESULTS: 248 patients met screening criteria, 79 (32%) of whom tested positive for unclaimed "drugs of abuse." Patients with a history of "drug abuse" and chronic pain were significantly more likely to test positive for unclaimed drugs than were their counterparts (p=.05 and p<.0001, respectively). No significant difference was found in comparing those with and without multiple ED visits or those requesting a specific narcotic. CONCLUSION: Self-reported drug use is unreliable in this ED subpopulation. When this knowledge is critical for patient care, biochemical testing may be indicated.

Effectiveness of a practice-based, multimodal quality improvement intervention for gastroenteritis within a Medicaid managed care network.

OBJECTIVE: Acute gastroenteritis results in 220,000 hospitalizations yearly in the United States. The substantial geographic variation in gastroenteritis care, coupled with the evidence of effective treatment of dehydration in nonhospital settings, suggests that the majority of these hospitalizations are avoidable. We sought to decrease hospitalizations for gastroenteritis by using practice-based, multimodal quality improvement methods that target multiple care processes to make them consistent with evidence-based guidelines. METHODS: We used a controlled before/after study design to evaluate a quality improvement intervention in a 20-practice Medicaid network. All 20 practices participated in continuing education sessions; received free oral rehydration solution, patient education materials, and performance feedback; and participated in a follow-up conference call. Three practices were chosen to develop and pilot office-process changes. These practices formed interdisciplinary teams to develop and test changes and collaborated with project faculty and each other. They shared their learning with the other 17 practices via a conference call and toolkit. We compared before/after gastroenteritis hospital admissions for children <5 years old covered by Medicaid in the intervention practices with all other Medicaid recipients in North Carolina using claims data from 2000-2002. RESULTS: The 3 high-intensity practices all made numerous changes to care processes. Most of the 17 low-intensity practices reported changes in their gastroenteritis care processes. Gastroenteritis admission rates declined 45% in high-intensity practices and 44% in low-intensity practices during the study compared with 11% in the control practices. CONCLUSIONS: A practice-based, multimodal quality improvement intervention that targets multiple care processes on the basis of evidence-based guidelines lowered rates of gastroenteritis hospitalization in a Medicaid network. This approach could lower costs attributable to gastroenteritis for Medicaid programs.

Information literacy skills of occupational therapy graduates: a survey of learning outcomes.

OBJECTIVES: The purpose of this study is to assess whether recent graduates of the Ohio State University's Occupational Therapy division are applying information-seeking skills they learned as undergraduates, and to seek their advice on ways to improve information-literacy instruction for current and future occupational therapy students. METHOD: A survey was sent to a sample of graduates from 1995-2000. The results were entered into an SPSS database, and descriptive and inferential results were calculated to determine the information-seeking patterns of these recent graduates. RESULTS: A majority of the occupational therapy graduates who responded to the survey prefer to use information resources that are readily available to them, such as advice from their colleagues or supervisors (79%) and the Internet (69%), rather than the evidence available in the journal literature. Twenty-six percent (26%) of the graduates have searched MEDLINE or CINAHL at least once since they graduated. Formal library instruction sessions were considered useful by 42% of the graduates, and 22% of the graduates found informal contacts with librarians to be useful. CONCLUSIONS: Librarians and occupational therapy faculty must intensify their efforts to convey the importance of applying research information to patient care and inform students of ways to access this information after they graduate. In addition to teaching searching skills for MEDLINE and CINAHL, they must provide instruction on how to assess the quality of information they find on the Internet. Other findings suggest that occupational therapy practitioners need access to information systems in the clinical setting that synthesize the research in a way that is readily applicable to patient-care issues.

Patients' behavior at the time of injury: effect on nurses' perception of pain level and subsequent treatment.

This study examined whether nurses who currently provide direct patient care would perceive and treat pain differently in patients whose pain resulted from activities involving different levels of socially acceptable behavior. Clinical vignettes (differing only with respect to information provided about the patient's behavior at the time of injury) were randomly distributed to all medical/surgical, critical care, and emergency room nurses at this institution. Nurses were asked to record their perception of the patient's pain level and to indicate how much morphine should be given. Nurses (n = 167) did not differ significantly in their mean pain ratings (p =.86) or in the average amount of morphine (p =.80) given to the 2 patients. However, medical/surgical nurses indicated that they would give significantly less morphine to the patient who was presented as engaging in less socially acceptable behavior at the time of injury (p =.03). Overall, significantly more nurses correctly increased the next dose of morphine for the patient who was presented as having injured him or herself while participating in more socially acceptable behavior (p =.003). Thus, although the level of social acceptability of the patient's behavior at the time of injury did not significantly affect the average pain rating or morphine dose that the nurse would have reportedly given, there is evidence that the nurses would have been less aggressive in ensuring adequate pain treatment in the patient exhibiting less socially acceptable behavior.