ABSTRACT
To synthesize findings from previous studies assessing information needs of primary care patients on the Internet and other information sources in a primary care setting. A systematic review of studies was conducted with a comprehensive search in multiple databases including OVID MEDLINE, CINAHL, and Scopus. The most common information needs among patients were information about an illness or medical condition and treatment methods, while the most common information sources were the Internet and patients' physicians. Overall, patients tend to prefer the Internet for the ease of access to information, while they trust their physicians more for their clinical expertise and experience. Barriers to information access via the Internet include the following: socio-demographic variables such as age, ethnicity, income, education, and occupation; information search skills; and reliability of health information. CONCLUSION: Further research is warranted to assess how to create accurate and reliable health information sources for both Internet and non-Internet users.
Subject(s)
Information Seeking Behavior , Information Storage and Retrieval/standards , Patient-Centered Care/methods , Access to Information/psychology , Humans , Internet , Patient-Centered Care/standards , Physician-Patient Relations , Primary Health Care/methods , Primary Health Care/standardsABSTRACT
More than 1.5 million adults live in US nursing homes, and approximately 30% of individuals in the United States will die with a nursing home as their last place of residence. Physicians play a pivotal role in the rehabilitation, complex medical care, and end-of-life care of this frail and vulnerable population. The reasons for admission are multifactorial and a comprehensive care plan based on the Minimum Data Set guides the multidisciplinary nursing home team in the care of the patient and provides assessments of the quality of care provided. Using the cases of 2 patients with different experiences, we describe the physician's role in planning for admission, participating as a team member in the ongoing assessment and care in the nursing home, and guiding care at the end of life. The increasing population of older adults has also promoted community-based and residential alternatives to traditional nursing homes. The future of long-term care will include additional challenges and rich innovations in services and options for older adults.
Subject(s)
Nursing Homes , Patient Care Team , Patient Care , Physician's Role , Aged , Female , Frail Elderly , Humans , Male , Patient Admission , Patient Care Planning , Risk Factors , Terminal CareABSTRACT
OBJECTIVE: To systematically examine current evidence pertaining to information needs of informal caregivers of older adults with chronic health conditions. METHODS: Structured search of MEDLINE, MEDLINE IN-PROCESS, CINAHL, and PsycINFO databases to identify studies of caregiver information needs, followed by data extraction and syntheses. RESULTS: The 62 articles that met the stated inclusion criteria highlighted extensive needs among informal caregivers for practical, accessible, timely information. CONCLUSION: The identified information needs of informal caregivers can inform organizations and agencies that seek to provide disease and illness-related information. PRACTICE IMPLICATIONS: Existing evidence supports the implementation of a health information delivery system designed to meet the needs of informal caregivers of older adults with chronic health conditions.
Subject(s)
Caregivers/psychology , Consumer Health Information , Needs Assessment , Adult , Aged , Aged, 80 and over , Caregivers/education , Chronic Disease , Family , Female , Health Services Needs and Demand , Humans , Information Services , Male , Middle Aged , Social SupportABSTRACT
Obesity independently increases the risk of developing diabetes 10-fold compared with that for patients who are normal weight. Overweight patients with impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) should be given counseling on weight loss of 5% to 10% of body weight as well as on increasing physical activity to at least 150 min/wk to prevent progression to diabetes. American Diabetes Association (ADA) recommends screening patients older than 45 years with a body mass index (BMI) greater than or equal to 25 for diabetes with fasting glucose every 3 years. Testing should be considered at a younger age or performed more frequently for those who are overweight and have 1 or more risk factors for diabetes.
Subject(s)
Diabetes Mellitus, Type 2/complications , Metabolic Syndrome/complications , Obesity/complications , Body Mass Index , Body Weights and Measures , Cardiovascular Diseases/etiology , Cardiovascular Diseases/physiopathology , Diabetes Mellitus, Type 2/prevention & control , Humans , Inflammation/physiopathology , Metabolic Syndrome/prevention & control , Prediabetic State , Prevalence , Risk FactorsABSTRACT
Because of their significant dependence on others for their care, nursing home residents are potentially vulnerable to abuse and/or neglect. The topic of elder mistreatment, whether in the nursing home or other living environments, received little attention from clinicians and researchers until the past 2 decades. Original research is now emerging that sheds light on the scope of the problem and the challenges to timely prevention, identification, and management. Practitioners may use this information to recognize and change factors associated with a higher likelihood of nursing home mistreatment.
Subject(s)
Elder Abuse/diagnosis , Elder Abuse/prevention & control , Nursing Homes , Aged , Attitude of Health Personnel , Drinking Behavior , Feeding Behavior , Financial Management , Health Personnel/education , Human Rights Abuses , Humans , Job Satisfaction , Patient Advocacy , Patient Rights , Personnel Turnover , Pressure Ulcer/etiology , Pressure Ulcer/prevention & control , Professional-Patient Relations , Quality Assurance, Health Care , Risk Factors , Sex Offenses , Wounds and Injuries/diagnosisABSTRACT
Cyclo-oxygenase-2 (COX-2) selective nonsteroidal anti-inflammatory drugs (NSAIDs) are as effective as acetaminophen and nonselective NSAIDs in treating of osteoarthritis, and are equally effective in reducing pain and inflammation and improving of joint function for patients with rheumatoid arthritis, when compared with nonselective NSAIDs. The COX-2 selective NSAIDs also have a better gastrointestinal safety profile in short-term (6-12 month) treatment (strength of recommendation [SOR]: A, based on meta-analysis of randomized controlled trials with patient-oriented outcomes). However, with recent growing concern of the cardiovascular safety of COX-2 selective NSAIDs, it is imperative to select appropriate patients by considering benefit vs risks, which include serious gastrointestinal bleeding, history of intolerance to nonselective NSAID, cardiovascular disease or associated risks, renal disease, patient's preference, and cost.
Subject(s)
Arthritis, Rheumatoid/drug therapy , Cyclooxygenase 2 Inhibitors/therapeutic use , Gastrointestinal Hemorrhage/prevention & control , Osteoarthritis/drug therapy , Anti-Ulcer Agents/administration & dosage , Cyclooxygenase 2 Inhibitors/administration & dosage , Cyclooxygenase 2 Inhibitors/adverse effects , Drug Therapy, Combination , Humans , Risk AssessmentABSTRACT
Scant evidence exists for the best duration of steroid therapy for contact dermatitis due to plants (rhus). Review articles recommend 10 to 21 days of treatment with topical or oral corticosteroids for moderate to severe contact dermatitis due to plants (strength of recommendation [SOR]: C, based on review articles). The primary reason given for the duration of 2 to 3 weeks is to prevent rebound dermatitis.
Subject(s)
Dermatitis, Contact/drug therapy , Glucocorticoids/therapeutic use , Drug Administration Routes , Drug Administration Schedule , Glucocorticoids/administration & dosage , Humans , Practice Guidelines as Topic , Time Factors , Treatment OutcomeABSTRACT
OBJECTIVE: This article describes the contributions of medical librarians, as members of the Family Physicians' Inquiries Network (FPIN), to the creation of a database of clinical questions and answers that allows family physicians to practice evidence-based medicine using high-quality information at the point of care. The medical librarians have contributed their evidence-based search expertise and knowledge of information systems that support the processes and output of the consortium. METHODS: Since its inception, librarians have been included as valued members of the FPIN community. FPIN recognizes the search expertise of librarians, and each FPIN librarian must meet qualifications demonstrating appropriate experience and training in evidence-based medicine. The consortium works collaboratively to produce the Clinical Inquiries series published in family medicine publications. RESULTS: Over 170 Clinical Inquiries have appeared in Journal of Family Practice (JFP) and American Family Physician (AFP). Surveys have shown that this series has become the most widely read part of the JFP Website. As a result, FPIN has formalized specific librarian roles that have helped build the organizational infrastructure. CONCLUSIONS: All of the activities of the consortium are highly collaborative, and the librarian community reflects that. The FPIN librarians are valuable and equal contributors to the process of creating, updating, and maintaining high-quality clinical information for practicing primary care physicians. Of particular value is the skill of expert searching that the librarians bring to FPIN's products.
Subject(s)
Family Practice/standards , Information Storage and Retrieval/standards , Librarians , Libraries, Medical/organization & administration , Library Services/organization & administration , Professional Role , Databases as Topic/standards , Evidence-Based Medicine/standards , Family Practice/education , Humans , Interdisciplinary Communication , Libraries, Medical/standards , Library Services/standards , United StatesABSTRACT
The Colorado Health Outcomes (COHO) Department of the School of Medicine at the University of Colorado Health Sciences Center (UCHSC) coordinates the Rocky Mountain Evidence-Based Health Care (EBHC) Workshop, which has been held annually since 1999. The goals of the workshop include helping participants-physicians, pharmacists, health care policy makers, journalists and librarians-learn and apply skills for critically appraising medical research literature and for effective use of evidence-based information resources. Participants are encouraged to share ideas and to plan local services and instruction for those working in clinical settings. Each year, librarians from UCHSC Denison Memorial Library participate as faculty by teaching searching skills (PubMed, Cochrane Library, ACP Journal Club, etc.), providing support to small groups, and staffing two computer labs. In 2002, Denison Library received a National Network of Libraries of Medicine (NN/LM) MidContinental Region Impact Award to fund the attendance of three health sciences librarians from the MidContinental Region, an academic education librarian, a clinical medical librarian, and a department librarian. In this paper, the participating librarians share the lessons they learned about how health care practitioners approach evidence-based practice. The participating librarians also share how they incorporated these lessons into their support of evidence-based practice related to teaching about evidence-based resources, assisting health care practitioners with developing answerable questions, enhancing the clinician-librarian partnership, and assisting practitioners in selecting evidence-based resources for quick answers to clinical questions.
