How doctors make use of online, point-of-care clinical decision support systems: a case study of UpToDate©.

BACKGROUND: Online point-of-care evidence-based information tools are becoming increasingly popular. OBJECTIVES: To discover how doctors actually use one such tool - UpToDate - in clinical practice. METHODS: An online survey was distributed to doctors at healthcare organisations in the north-west of England which subscribed to UpToDate. Some survey questions asked for quantifiable data (e.g. demographic details), whilst other questions were open-ended and sought examples of clinical scenarios and actual point-of-care use of UpToDate. Open-ended responses were then analysed into emerging themes. RESULTS: The open-ended responses include evidence illustrating a large variety of clinical scenarios in which the use of UpToDate influenced clinical practice. CONCLUSIONS: These results show how just one point-of-care tool is used in a variety of ways that benefit the patient, the doctor and the healthcare organisation. Direct quotations reported will provide compelling evidence for librarians to present to senior managers who may be unsure of the value of point-of-care tools in clinical practice.

The impact of information skills training on independent literature searching activity and requests for mediated literature searches.

BACKGROUND: Most NHS library services routinely offer both mediated searches and information skills training sessions to their users. We analyse the impact of these two services on the amount of literature searching demonstrated by users of hospital- based library services in the north-west of England. METHODS: Data for (1) mediated literature searches, (2) number of library users attending information skills training sessions, (3) amount of library staff time devoted to information skills training, and (4) number of Athens-authenticated log-ins to databases were obtained from statistical returns for 2007, and analysed for significant correlations. RESULTS: There was evidence of quite strong correlations between the two measures of training activity and the number of mediated literature searches performed by library staff. There was weaker evidence of correlation between training activity and total literature searching activity. DISCUSSION: Attending training sessions may make some library users aware of the difficulty of complex literature searches and actually reduce their confidence to perform their own complex searches independently. The relationships between information skills training, mediated literature searches, and independent literature searching activity remain complex.

Interlending and document supply trends in NHS North West health libraries 2003/2004 to 2006/2007.

BACKGROUND: The Library and Information for Health Network North West (LIHNN) represents health libraries in Cheshire, Cumbria, Greater Manchester, Isle of Man, Lancashire, Merseyside and Wirral. LIHNN members take part in a regional co-operative network supporting interlending and document supply. METHODS: Data were analysed over a 4-year period to identify trends and patterns. In addition, a literature review was conducted to compare trends seen in NHS libraries to those trends seen in other sectors and in other countries. RESULTS/TRENDS: Between 2003/2004 and 2006/2007 there was a significant drop in document supply activity reported by NHS North West libraries from 59 321 to 37 134 copies, representing a fall of 37.4%. During the same period, lending between libraries stayed constant. DISCUSSION: The NHS supplies a significant number of documents to its users and it is investigating a number of options to increase efficiencies. The observed fall in document supply activity has been reported in several sectors and has been attributed to a number of cofactors. Although the fall in document supply activity is expected to continue, a critical mass of information is likely to remain behind subscription barriers and this, in turn, will necessitate supply from external sources.

Interactions between rail and road safety in Great Britain.

This paper discusses the results of an investigation into ways in which the safety risks of travel on road and rail interact with each other in Great Britain, other than through physical contact such as at level crossings. The two main foci of the paper are: (1) an analysis of the 'whole journey' risks of journeys for which the national rail system is the main mode, but which also include stages by other transport modes to provide access to the railway system; and (2) an analysis of the effect on safety risk of inter-modal transfers between rail and road. On (1), walking to and from stations was estimated to account on average for 65% of the overall door-to-door risk of being killed on rail journeys; the rail system itself accounts for 21% of the risk, and other access modes account for the remaining 14%. The average distance walked to and from stations is 0.9 km per rail journey, and this walking accounts for 5% of all walking nationally. On (2), it was found that increasing rail fares to fund railway safety measures may lead passengers to switch from rail to car, but for most sensible rail safety measures, the additional risks from such diversions are small compared with the intended rail safety benefits. However, for high-cost rail safety measures funded by passengers, the additional risks from diversions may be of the same order as the intended safety benefits. The last section of the paper explores the effects of variations in the casualty rates of rail users as pedestrians and car users, because their road risks may be different from those of all road users. Such variations could alter the detailed conclusions of the paper, but the scale of such effects appears to be modest.

The mineral nature of asbestos.

Fibrous minerals are common in nature but asbestiform minerals are rare. The unique mineralogical characteristic common to all the asbestos minerals is their morphologic form (or habit of crystallization) as polyfilamentous fiber bundles. The individual fibrils within the bundles have a tendency to be very long with a narrow range of diameters and grow with their long fiber axis in parallel orientation to the bundle length. The asbestiform habit imparts to the asbestos minerals sufficient flexibility and tensile strength so that most can be woven into cloth. In the past application has focused on their ability to insulate against the transfer of heat. However, these minerals possess other properties which make them useful in many industrial applications.

A review of carcinogenicity studies of asbestos and non-asbestos tremolite and other amphiboles.

Experimental animal studies comparing asbestos and non-asbestos varieties of tremolite indicate tremolite asbestos is markedly more carcinogenic. By direct analogy, the differences in carcinogenicity between tremolite asbestos and non-asbestos prismatic tremolite should be the same for the other types of amphibole that also crystallize in the asbestos and non-asbestos habits. The earliest of the experiment animal studies, done more than 25 years ago, have design limitations by modern standards including the use of injection or surgical implantation as the route of administration rather than the more relevant route of inhalation. However, the differences in the carcinogenicity of amphibole asbestos and non-asbestos amphiboles are sufficiently large to be clearly discernable even with the study limitations. Together with later studies on these and related minerals, there is strong evidence of a much lower hazard associated with the shorter, thicker fibers of the non-asbestos amphiboles, than is found for the asbestos analogues of the same mineral. It is possible that the non-asbestos amphiboles are no more hazardous than other silicate minerals widely considered nuisance dusts.

Journal usage in NHS hospitals: a comparison report of total usage at an acute NHS Trust and a specialist NHS Trust in the North West of England.

BACKGROUND: Health care libraries spend a large amount of their non-pay budgets on the purchase of scientific, technical and medical journals. In a typical hospital library in the National Health Service (NHS) North West Strategic Health Authority (SHA), this can represent between 80 and 90% of the collection development budget. METHODS AND RESULTS: Data were collected from 1 December 2005 to 30 November 2006 using COUNTER-generated usage statistics obtained from publishers' administration tools. Between the two trusts included in the study, 93 376 full-text article downloads were recorded; of these, 15 952 or 17.1% articles were downloaded from national core content journals via Proquest. Photocopies made by users for their own use were recorded whenever this data were available. CONCLUSIONS: NHS staff at the sites included in this study recorded a high volume of journal usage. There was a marked difference in usage patterns between the acute and specialist trusts in the study. The journals provided by national core content represented a much higher proportion of total usage at the acute trust (29.9%) compared with the specialist cancer trust (4.5%). This study supports the view that the local purchasing of journal titles is an important component of the overall journal-based information provision to NHS staff.

Otoprotective effects of dexamethasone in the management of pneumococcal meningitis: an animal study.

OBJECTIVE: To determine whether treating pneumococcal meningitis with a combined antibiotic and steroid regime will prevent cochlear damage, a common pneumococcal meningitis side effect. STUDY DESIGN: Prospective animal study. METHODS: Gerbils were randomly assigned to three experimental groups. Animals in group 1 received intrathecal saline injections. Animals in groups 2 and 3 received intrathecal injections of Streptococcus pneumoniae to induce meningitis. Group 2 was treated for 7 days with intraperitoneal penicillin injections (48,000 units). Animals from group 3 received intraperitoneal dexamethasone (0.5 mg/kg) injections for 4 days in addition to 7 days of intraperitoneal penicillin. Three months after the meningitis was induced, the animals' cochlear functions were determined using auditory brainstem responses (ABRs). After measuring cochlear function, the animals were sacrificed for cochlear histopathology. Spiral ganglion cell densities at Rosenthal's canal were determined. RESULTS: ABR thresholds were significantly elevated in animals from group 2 when compared with the animals in groups 1 and 3 (P < .05). ABR thresholds for animals from group 3 and group 1 were similar (P > .05). Damage of cochlear structures was detected in animals from group 2. The degree of the damage varied: one animal in group 2 had no identifiable hair cells and pillar cells and showed damage of the tectorial membrane. Spiral ganglion density in the basal turn was significantly less in animals from group 2 when compared with controls (P < .05). Although spiral ganglion cell density was less in the dexamethasone-treated group (group 3) when compared with group 1 (control group), but greater than observed in animals treated with antibiotics only (group 2), the differences were statistically not significant (P > .5). Nuclear diameters of the spiral ganglion cells decreased on average from 7.24 +/- 0.48 microm (group 1) to 6.28 +/- 0.76 microm (group 3, animals that received dexamethasone) to 5.57 +/- 0.82 microm (group 2, animals that received antibiotics only). Differences were significant (P < .05). Differences in stria vascularis thickness were not significant among the animals. CONCLUSION: Dexamethasone has a protective effect on the cochlea when given together with antibiotics in the treatment of pneumococcal meningitis.

Cochlear preservation after meningitis: an animal model confirmation of adjunctive steroid therapy.

OBJECTIVE/HYPOTHESIS: The objective of the present study was to determine whether treating pneumococcal meningitis with a combined antibiotic and steroid regime will prevent cochlear damage, a common pneumococcal meningitis side effect. STUDY DESIGN: This was a prospective animal study. METHODS: Gerbils were randomly assigned to three experimental groups. Animals in group 1, the control animals, received intrathecal saline injections. Animals in groups 2 and 3 received intrathecal injections of Streptococcus pneumoniae to induce meningitis. Although group 2 solely was treated for 7 days with intraperitoneal penicillin injections (48,0000 units), group 3 received, in addition to the antibiotic for 4 days, 0.5 mg/kg intraperitoneal dexamethasone injections. Three months after the meningitis was induced, the animals' cochlear function was determined using auditory brainstem responses (ABRs). Fifteen frequencies were tested, five octaves at three steps per octave between 2 and 50 kHz. RESULTS: ABR thresholds were significantly elevated only in group 2. When compared with group 1, ABR thresholds were 19 dB higher (P<.05). Frequencies at the low-frequency end of the hearing range were affected more than the midfrequencies. Animals that received dexamethasone had 2-dB higher thresholds than the control group (P>.05). CONCLUSIONS: Dexamethasone therapy in conjunction with antibiotic therapy preserves cochlear function in cases of S. pneumoniae meningitis in the Mongolian gerbil model.