On-line search strategies of third year medical students: perception vs fact

The curriculum at the University of New Mexico School of Medicine has evolved with a high priority on problem-based and life-long learning. As the information pool enlarges, a greater emphasis must be placed on the ability of physicians to access the biomedical literature following residency training. To foster information retrieval skills, our medical school has included on the ability of physicians to access the biomedical literature following residency training. To foster information retrieval skills, our medical school has included on-line searching instruction since 1987. On-line classes are taught by experienced medical librarians during the second month of the first year curriculum. After receiving training, students are assigned a code via Grateful Med software. The purpose of the study was to measure the long-term effectiveness of this training approach and to determine the students' ability to formulate a search strategy and run a search to answer clinical questions at the third year level. During the 1990-1991 school year, all third year students were asked to use Grateful Med to answer two questions related to surgical patient care and to complete a questionnaire showing how they use Grateful Med and how they view their training. The students' searches were compared to "gold standard" searches run by an experienced medical librarian. Nineteen percent of all searches resulted in zero retrieval, and the remainder missed 74-100% of the gold standard available citations. Additional instruction shortly after on-line training could identify problem areas (poor search behavior) and information retrieval skills should be integrated and encouraged in all levels of the curriculum.     

Information-seeking behavior of health sciences faculty: the impact of new information technologies

This paper reports on an ongoing investigation into health sciences faculty's information-seeking behavior, including their use of new information technologies. A survey was administered to all faculty in medicine, nursing, and pharmacy at the University of Illinois at Chicago. It was similar to one administered to the same population in 1991. The survey asked about faculty's use of electronic resources, documented any shift from the use of print to electronic formats, and measured the utilization of library training. The response rate was 48.5% for medicine faculty, 45.0% for nursing, and 62.5% for pharmacy. The study found that use of the print Index Medicus among faculty was in transition: While 30.5% continued to use the print resources, 68.0% of faculty accessed MEDLINE through electronic means. Faculty preferred accessing electronic databases from their offices to doing so from the library. Health sciences faculty used a wide variety of databases, in addition to MEDLINE, to fill their information needs. Most faculty did not take advantage of either in-house or electronic training sessions offered by librarians. The study concluded that the training preferences of faculty need to be further explored.     

Advance directives: the emerging body of research

BACKGROUND: With the passage of the Patient Self-Determination Act in 1990, new procedures and documents became available for planning end-of-life care. These new procedures and documents are now being examined scientifically. OBJECTIVE: To review existing research on the use of advance directives. DATA SOURCES: Computer search using Grateful Med software from the National Library of Medicine with MEDLINE and BIOETHICSLINE databases. STUDY SELECTION: Studies that showed an emerging consensus or reported vastly differing results were selected. Selected studies examined these specific areas: demographic data on patients with advance directives, completion rates, capacity to complete, patients' preferences, stability of patients' decisions over time, treatment choices, proxy decision makers, treatment provided, and cost. RESULTS: The body of important research about advance directives is growing. A profile of their clinical utility is emerging. CONCLUSIONS: The research done so far can stimulate future research and can begin to suggest possible changes in practice. However, the body of research is not yet large enough or well controlled enough to answer conclusively many of the questions about planning of end-of-life care.     

Use of a multi-application computer workstation in a clinical setting

The goal of this study was to assess the usage frequency, user satisfaction, and quality of literature searchers for a multi-application computer workstation in a university-based general medicine clinic. A computer with medical literature searching, textbook searching, and a decision-support program was deployed in the workroom of the clinic and made available for routine use. Data were collected for ten months. More than three quarters of the study participants used the computer, with use increasing by level of medical training. Despite physicians' known preferences for nonjournal sources of information, literature searching was the application used most frequently, followed by textbooks and decision support. The literature searches were replicated by experienced clinician and librarian searchers using first full MEDLINE and then text-word-only searching, to compare the quantities of relevant references retrieved. Novice searchers retrieved a larger number of relevant references than did the experienced searchers, but they also retrieved more nonrelevant references. For both groups of experienced searchers, the full MEDLINE feature set conferred little benefit over searching with only text words. These searching results call into question the value of traditional searching methods for both novice and experienced physicians.     

A multicenter clinical trial of PerioGard in distinguishing between diseased and healthy periodontal sites. (I). Study design, methodology and therapeutic outcome

We designed and performed a multicenter clinical trial to determine the relationship between measurements of the level of the enzyme aspartate aminotransferase (AST) in gingival crevicular fluid (GCF) to other measures used to detect periodontal disease and monitor outcome of treatment, including pocket depth and gingival inflammation. 32 periodontitis patients were enrolled at the University of Washington, Seattle, 30 at the University of Florida, Gainesville, and 34 at the University of Illinois, Chicago. 10 periodontally normal control subjects were enrolled at each location. 8 diseased and 4 healthy sites were designated for study in each patient and 8 healthy sites designated in each control subject. Measures of disease included pocket depth, severity of gingival inflammation, and GCF volume. AST levels were measured using the PerioGard test kit. Clinical measurements were made and GCF samples harvested and tested 2x before and 2x after therapy consisting of scaling and root planing under local anesthetic. Specific design and other issues are discussed, including selection of patients and control subjects, sample size, selection of experimental test sites, methods for assessment of diseased and therapeutic improvement, harvesting of GCF and selection of appropriate biostatistical methods for data analysis. Demographics of the patient populations at the 3 locations are reported. As expected, therapy induced only negligible changes in the measures of disease at healthy sites in control subjects, and relatively minor improvement in healthy sites in patients. In contrast, statistically significant improvement relative to pretreatment baseline status in all 3 measures of disease was observed for diseased sites at all 3 study locations with all p-values less than 0.0002. The magnitude of improvement was comparable to that reported previously by others. The % of PerioGard-positive sites decreased significantly between the screening baseline and both post-treatment visits for patients at all 3 locations, with p values of 0.0001 to <0.0008.     

The initiation of a calcium signal in Xenopus oocytes

Clinical and radiographic healing observations were categorized into four patterns: rapid, typical, delayed, and adverse. While considerable overlap of characteristics was noted between the categories, singular factors or combinations of factors enabled pattern identification. The factor primarily associated with the rapid healing pattern was the appearance of bone in the former defect adjacent to the membrane at removal. In contrast, the adverse healing pattern depicted surface necrosis or loss of tissue height at membrane removal. One hundred random sites were evaluated, revealing 13% rapid healing patterns, 76% typical healing patterns, 8% delayed healing patterns, and 3% adverse healing patterns. With favorable patient compliance with oral hygiene and follow-up care, the rapid and typical healing patterns became clinically successful cases. The level of clinical success varied with the delayed healing pattern; the adverse pattern failed to achieve the therapeutic objective.     

Metastatic follicular thyroid carcinoma to the mandible: a case report and review of the literature

OBJECTIVES: To describe the patterns of protective equipment use by in-line skaters in Winnipeg, Manitoba and nearby rural communities. METHODS: In-line skaters were observed for three months in 1996 at 190 urban and 30 rural sites selected using a formal sampling scheme. Age, gender, protective equipment use, skating companions, correct helmet use, and use of headphones were recorded. RESULTS: Altogether 123 in-line skaters were observed at 61 sites, including one rural site. No skaters were observed at the remaining sites. There were 37 adults and 86 children; 56% were male. Helmet use was 12.2% (95% confidence interval (CI) = 6.4% to 18.0%), wrist guard use was 16.3% (95% CI = 9.7% to 22.8%), knee pad use was 9.8% (95% CI = 5.2% to 16.4%), and elbow pad use was 7.3% (95% CI = 3.4% to 13.4%). Children were more likely to wear a helmet than teens 12-19 years of age (relative risk (RR) = 30, 95% CI = 4.01 to 225). Adults were more likely to wear wrist guards than children (RR = 4.32, 95% CI = 1.87 to 9.94). No gender differences were found. Incorrect helmet use was documented in four skaters; three skaters were wearing headphones. CONCLUSIONS: Low rates of protective equipment use were documented in our region, significantly lower than those reported in the literature. Barriers to equipment use are not known, and should be examined by further study. In-line skating safety programs should be developed, promoted, and evaluated. Teens should be targeted for future preventive efforts.     

Recruitment of CBP/p300 by the IFN beta enhanceosome is required for synergistic activation of transcription

The widespread use of computers and the Internet have made searching the medical literature easier and more accessible to most physicians. The National Library of Medicine (NLM) maintains MEDLINE, a comprehensive, cross-referenced database of citations to the medical literature covering 1966 to the present. The NLM maintains several other literature databases that are also available online. In 1996, the NLM began providing free, unlimited access to MEDLINE to all Americans over the World Wide Web. This article discusses how to perform effective and efficient literature searches using MEDLINE and other databases.     

Evaluation of Multidimensional Transport through a Field-Scale Compacted Soil Liner

A field-scale compacted soil liner was constructed at the University of Illinois at Urbana-Champaign by the U.S. Environmental Protection Agency (USEPA) and Illinois State Geological Survey in 1988 to investigate chemical transport rates through low permeability compacted clay liners (CCLs). Four tracers (bromide and three benzoic acid tracers) were each added to one of four large ring infiltrometers (LRIs) while tritium was added to the pond water (excluding the infiltrometers). Results from the long-term transport of Br? from the localized source zone of LRI are presented in this paper. Core samples were taken radially outward from the center of the Br? LRI and concentration depth profiles were obtained. Transport properties were evaluated using an axially symmetric transport model. Results indicate that (1) transport was diffusion controlled; (2) transport due to advection was negligible and well within the regulatory limits of ksat ? 1×10?7?cm/s; (3) diffusion rates in the horizontal and vertical directions were the same; and (4) small positioning errors due to compression during soil sampling did not affect the best fit advection and diffusion values. The best-fit diffusion coefficient for bromide was equal to the molecular diffusion coefficient multiplied by a tortuosity factor of 0.27, which is within 8% of the tortuosity factor (0.25) found in a related study where tritium transport through the same liner was evaluated. This suggests that the governing mechanisms for the transport of tritium and bromide through the CCL were similar. These results are significant because they address transport through a composite liner from a localized source zone which occurs when defects or punctures in the geomembrane of a composite system are present.     

Studies of the orientations of fracture surfaces produced in austenitic stainless steels by stress-corrosion cracking and hydrogen embrittlement

Orientation studies have been made on several different austenitic stainless steels, using photogrammetric and electron channeling techniques. The fracture facets produced by SCC in boiling aqueous MgCl₂ (155 °C) were large and relatively flat in the case of type 310 steels, and the fracture plane was found to be at or near {100}. The transgranular stress-corrosion fractures in type 304 steels were more complex, and there was considerably more scatter in the orientation determinations. However, the orientations of the fracture facets in these steels were clearly not {100}, but fell into two distributions, one near {211} and the other near {110}. Electron diffraction studies from the fracture surfaces indicated the presence of α′ and martensites in the type 304 but not in the type 310 cases; the possibility that this was responsible for the differences in fracture planes is discussed. Studies were also made of a type 304 specimen which had failed by SCC at 289 °C. No martensitic phases were detected at the fracture surfaces in this case, and the fracture facets were large and flat, similar to those for type 310. Cleavage-like fracture surfaces were also produced in type 304 steels by hydrogen embrittlement, using both gaseous hydrogen and cathodic charging, but the facets were too small for precise orientation determination. Formerly with the Department of Metallurgy, University of Illinois at Urbana-Champaign. Formerly with the Department of Metallurgy, University of Illinois at Urbana-Champaign. Formerly Professor of Metallurgy, University of Illinois.     

Autosomal recessive omodysplasia: report of three additional cases

AIM: To determine the results of transluminal angioplasty in patients with Brescia-Cimino arteriovenous fistulae. PATIENTS AND METHODS: Thirty-one patients underwent transluminal angioplasty of 36 stenotic lesions related to Brescia-Cimino arteriovenous fistulae over a 5-year period. The lesions treated were characterized by review of pre-angioplasty fistulograms. Medical and radiological records were reviewed to assess medium-term patency of each patient's fistula. RESULTS: Angioplasty was performed successfully in 28 out of 31 patients initially (90% technical success rate). Duration of follow-up for the 31 patients ranged from 4 to 65 months (median = 34 months). At 6 months, seven patients required further surgical or endovascular intervention (18 patients remained event-free) and at 1 year, 10 patients required further endovascular or surgical intervention (14 patients remained event-free). Life-table analysis revealed primary patency rates of 77%, 64% and 39% at 6 months, 1 year and 2 years, respectively. At 6 months and 1 year, four and five patients, respectively, required surgical revision or closure of fistula. Secondary patency rates were 85%, 81% and 65% at 6 months, 1 year and 2 years, respectively. All patients with a primary patency at 2 years remained event-free during the follow-up period. CONCLUSIONS: Transluminal angioplasty is an effective treatment for stenoses developed in relation to Brescia-Cimino haemodialysis fistulae. Further endovascular procedures may be required, especially in the first 24 months, to preserve patency. These techniques extend the lifetime of fistulae, thereby preserving proximal venous access sites for future use. Our result is in broad agreement with results from other series.     

The rates of adhesion development and the effects of crystalloid solutions on adhesion development in pelvic surgery

OBJECTIVE: To document rates of adhesion development after abdomino-pelvic surgery, stratified by adhesion type, access method, and use of crystalloid solution instillates. DESIGN: Reports from a MEDLINE search (1/1/1966-12/18/1996) detailing rates of adhesion development and meeting the inclusion criteria were subjected to meta-analysis. SETTING: Meta-analysis. PATIENT(S): Patients undergoing abdomino-pelvic surgery. INTERVENTION(S): Intraperitoneal crystalloid solution instillates. MAIN OUTCOME MEASURE(S): Percentage adhesion-free outcome in patients ("patients") or surgical sites ("sites"). RESULT(S): Adhesion-free outcome (sites) was lowest for reformed (26.3% laparotomy; 14.3% laparoscopy), higher for de novo 1b (direct trauma) (45.2% laparotomy, 37.2% laparoscopy), and highest for de novo 1a (indirect trauma) adhesions (82.4% laparoscopy). Crystalloid solution instillates reduced adhesion-free outcome at sites (45.2% versus 20% de novo 1b adhesions in laparotomy) and in patients (43.5% versus 19.9% reformed, laparotomy; 71.7% versus 25% de novo 1b, laparoscopy). CONCLUSION(S): Adhesion-free outcome was lowest for reformed, higher for de novo 1b, and highest for de novo 1a adhesions. Surprisingly, it was lower in laparoscopy than in laparotomy for de novo 1b and reformed adhesions. Crystalloid instillates did not increase adhesion-free outcome. Although limited by the retrospective and heterogeneous nature of the data, these conclusions nonetheless provide a basis on which to formulate future hypotheses.     

Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age

Current knowledge regarding the basic epidemiology of fractures is largely limited to a few fracture sites, notably those of the hip and distal forearm. To clarify the patterns of incidence of limb fractures in the elderly, we used data from a 5% sample of the U.S. Medicare population over age 65 years during the years 1986-1990. We identified incident fractures of the proximal humerus, other parts of the humerus, proximal radius/ ulna, shaft of the radius/ulna, distal radius/ulna, pelvis, hip, other parts of the femur, patella, ankle, and other parts of the tibia/fibula from diagnoses and procedures coded on claims for inpatient services, outpatient facility use, and physician services. We used Poisson regression to investigate the relation between demographic factors and fracture risk at these sites. Fractures at the hip were the most common, accounting for 38% of the fractures identified. The proximal humerus, distal radius/ulna, and ankle also were common fracture sites. A pattern of rapidly rising rates with age was seen for fractures of the pelvis, hip, and other parts of the femur among women. Fractures distal to the elbow or knee, however, had, at most, modest increases in incidence with age over 65 years. For each of the fractures studied, women had higher rates than men of the same race, and whites generally had higher rates than blacks of the same gender. Gender-related differences in risk were larger among whites than among blacks, and racial differences in risk were more marked among women than among men.     

To Google or not to Google: Graduate students' use of the Internet to access personal information about clients.

The emergence of Internet search and social media sites now permits therapists to obtain a plethora of personal information about their clients online. These behaviors raise a number of ethical issues related to client privacy, self-determination, and informed consent. The purpose of this study is to examine student therapists' opinions and behaviors in regard to the use these websites to search for information about their clients. A national sample of 854 psychology doctoral students was surveyed in regard to their online activities, attitudes, and frequency of searching for client information online. Results showed that Internet usage is pervasive in this group, with the majority reporting daily use of search engine or social networking sites. Most participants reported that searching for information about clients online using search engines (66.9%) or social networking websites (76.8%) was “always” or “usually” unacceptable. Nevertheless, 97.8% of participants reported searching for at least one client's information using search engines in the past year; 94.4% reported searching for client information on social networking websites. Overall, student therapists reported searching for 16.5% of clients seen in the past year, using either search engine or social networking sites. The ethical and training implications of these results are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Simple constitutive equations for steel at high temperature

This work develops and investigates simple unified constitutive equations to model the mechanical behavior of plain carbon steel in the austenite temperature region for use in finite element stress analysis of processes such as continuous casting. Four different forms of constitutive relations are considered: constant structure, time-hardening, strain-hardening, and simultaneous time- and strain-hardening models. Each relation is judged on its ability to reproduce experimental data from both tensile and creep tests and its ability to exhibit reasonable behavior under complex loading conditions. Three of the equations appear suitable for small strain monotonic loading conditions for a wide range of low strain rates (10⁻³ to 10⁻⁶ s⁻¹), high temperatures (950 °C to 1400 °C), and varying carbon contents (0.005 to 1.54 wt pct C). Formerly Graduate Student, University of Illinois at Urbana-Champaign formerly Graduate Student, University of Illinois at Urbana-Champaign     

Acute leptin action on insulin blood level and liver insulin receptor in the rat

OBJECTIVE: Despite the proliferation of electronic information retrieval (IR) systems for physicians, their effectiveness has not been well assessed. The purpose of this review is to provide a conceptual framework and to apply the results of previous studies to this framework. DATA SOURCES: All sources of medical informatics and information science literature, including MEDLINE, along with bibliographies of textbooks in these areas, were searched from 1966 to January 1998. STUDY SELECTION: All articles presenting either classifications of evaluation studies or their results, with an emphasis on those studying use by physicians. DATA EXTRACTION: A framework for evaluation was developed, consisting of frequency of use, purpose of use, user satisfaction, searching utility, search failure, and outcomes. All studies were then assessed based on the framework. DATA SYNTHESIS: Due to the heterogeneity and simplistic study designs, no meta-analysis of studies could be done. General conclusions were drawn from data where appropriate. A total of 47 articles were found to include an evaluation component and were used to develop the framework. Of these, 21 articles met the inclusion criteria for 1 or more of the categories in the framework. Most use of IR systems by physicians still occurs with bibliographic rather than full-text databases. Overall use of IR systems occurs just 0.3 to 9 times per physician per month, whereas physicians have 2 unanswered questions for every 3 patients. CONCLUSIONS: Studies comparing IR systems with different searching features have not shown that advanced searching methods are significantly more effective than simple text word methods. Most searches retrieve only one fourth to one half of the relevant articles on a given topic and, once retrieved, little is known about how these articles are interpreted or applied. These studies imply that further research and development are needed to improve system utility and performance.     

Transarterial brachial plexus anesthesia for hand surgery: a retrospective analysis of 346 cases

STUDY OBJECTIVES: To study the safety and efficacy of the transarterial approach to brachial plexus block with 60 to 70 ml of local anesthetic solution, and to compare the success and complication rates of this block performed by experienced or inexperienced anesthesiologists. DESIGN: Retrospective analysis of 346 records of ASA physical status I-IV patients who underwent elective unilateral orthopedic upper limb surgery with transarterial plexus anesthesia. SETTING: University teaching hospital. MEASUREMENTS AND MAIN RESULTS: Blood pressure (BP) and heart rate were measured at 5-minute intervals. Analgesia was registered as successful, incomplete, or failed. Any patient complaints or adverse reactions were recorded. The first 60 ml of local anesthetic provided surgical analgesia to 64% of patients. With a supplemental 10 ml of anesthetic, the overall success rate was 94%, with only 19 of 346 patients requiring general anesthesia. Experience in performing the block increased the success rate from 90% to 98% (p < 0.001). Six patients experienced either nausea or a transient BP decrease that did not require medication. There was no record of toxic or other serious adverse reaction. CONCLUSIONS: Transarterial brachial plexus block administered with a 60 to 70 ml dose of local anesthetic provides surgical analgesia for hand surgery with an excellent success rate and without serious adverse effects.     

Advances in osseointegrated implants for dental and facial rehabilitation following major head and neck surgery

Osseointegrated implants can be used to facilitate retention stability and support for facial and intraoral prostheses used to restore head and neck defects. Preliminary studies indicate that in nonirradiated maxillectomy patients the success rates are about 75%. In the reconstructed mandible the results appear to be more favorable--over 90% for implants placed in free nonvascularized bone grafts and over 90% for free revascularized bone grafts. Similar high success rates have been observed for most sites used to support facial prostheses. Success rates for auricular sites exceed 95% and for floor of nose sites success rates exceed 90%. Success rates have been lower (77%) for implants placed in the frontal bone for retention of orbital prostheses. Success rates for irradiated bone sites have been lower and range from 60.4% in the maxilla to 68.6% in facial bone sites. Of greater concern is that most implants placed in irradiated sites are beginning to show signs of impending failure.     

Graduate student success in psychology.

Studied all graduate students who entered the Department of Psychology at the University of Illinois at Urbana-Champaign from 1965 through 1970 with respect to their success as graduate students. The predictors were the standard admission variables (e.g., Graduate Record Examination scores, undergraduate grades). The criteria included obtaining the doctorate, time taken to obtain the degree, and type and number of publications after the doctorate. As predicted, the standard ability variables correlated with early graduate school success criteria, such as 1st-year grades. In addition, peer ratings of need for achievement, conscientiousness, and commitment to psychology emerged as important predictors of later success. Sex differences were less than anticipated, although proportionally fewer women completed the degree than men. Data suggest the possibility of using a multiple-hurdles model for graduate school selection and retention, with the hurdles being defined throughout the student's career. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An aid in interpersonal relations and nursing]

This paper discusses user support in the context of a library-managed online database search service. Experience is drawn from the British Medical Association (BMA) Library's Free MEDLINE Service. More than 9,600 BMA members, who are largely unfamiliar with computer communications and database searching, have registered as users of the service. User support has played a significant role in the development of the service and has comprised four main aspects: an information pack, a help desk, online help, and MEDLINE courses. The paper includes an analysis of help desk usage statistics collected from January 1996 through June 1996, and highlights other relevant research. Plans for further service enhancements and their implications in terms of future user support are discussed.