Information needs of clinical teams: analysis of questions received by the Clinical Informatics Consult Service.

OBJECTIVES: To examine the types of questions received by Clinical Informatics Consult Service (CICS) librarians from clinicians on rounds and to analyze the number of clearly differentiated viewpoints provided in response. DESIGN: Questions were retrieved from an internal database, the CICS Knowledge Base, and analyzed for redundancy by subject analysis. The unique questions were classified into ten categories by subject. Treatment-related questions were analyzed for the number of viewpoints represented in the librarian's response. RESULTS: The CICS Knowledge Base contained 476 unique questions and 71 redundant questions. Among the unique queries, the top two categories accounted for 67%: treatment (36%) and disease description (31%). Within the treatment-related subset, 138 questions (59%) required representation of more than one viewpoint in the librarian's response. DISCUSSION: Questions generated by clinicians frequently require comprehensive, critical appraisal of the medical literature, a need that can be filled by librarians trained in such techniques. This study demonstrates that many questions require representation of more than one viewpoint to answer completely. Moreover, the redundancy rate underscores the need for resources like the CICS Knowledge Base. By critically analyzing the medical literature, CICS librarians are providing a time-saving and valuable service for clinicians and charting new territory for librarians.

The Patient Informatics Consult Service (PICS): an approach for a patient-centered service.

The Patient Informatics Consult Service (PICS) at the Eskind Biomedical Library at Vanderbilt University Medical Center (VUMC) provides patients with consumer-friendly information by using an information prescription mechanism. Clinicians refer patients to the PICS by completing the prescription and noting the patient's condition and any relevant factors. In response, PICS librarians critically appraise and summarize consumer-friendly materials into a targeted information report. Copies of the report are given to both patient and clinician, thus facilitating doctor-patient communication and closing the clinician-librarian feedback loop. Moreover, the prescription form also circumvents many of the usual barriers for patients in locating information, namely, patients' unfamiliarity with medical terminology and lack of knowledge of authoritative sources. PICS librarians capture the time and expertise put into these reports by creating Web-based pathfinders on prescription topics. Pathfinders contain librarian-created disease overviews and links to authoritative resources and seek to minimize the consumer's exposure to unreliable information. Pathfinders also adhere to strict guidelines that act as a model for locating, appraising, and summarizing information for consumers. These mechanisms--the information prescription, research reports, and pathfinders--serve as steps toward the long-term goal of full integration of consumer health information into patient care at VUMC.

Effect of luminance on the relation between accommodation and convergence.

When luminance is lowered, both vergence and accommodation tend to shift toward different and individually characteristic resting postures, commonly referred to as dark-vergence and dark-focus. In order to determine the luminance level at which these two mechanisms correspond to a target distance, subjects viewed a light spot 0.4 mm in diameter, corresponding to 1.4 to 2.7 min arc, located at the individually determined dark-focus position. As the luminance of a binocularly viewed spot increased, accommodation did not change significantly from the target distance. However, fusional vergence gradually shifted from the dark-vergence to the target position. The critical luminance level at which the 2 responses were coupled for the 12 observers ranged from 0.01 to 0.45 cd/m2, with distinct individual differences. In a second experiment, the target was positioned at distances different from the dark-focus and luminance was set at 0.5 and 1.0 log unit higher than the subject's critical luminance level. At lower luminance levels, mononuclear focus tended to remain at the individual dark-focus, whereas the binocular focus tended to correspond to the target distance. These differences can be attributed to vergence accommodation. Previous studies on night myopia reported that a negative correction based on one-half of the individual dark focus was superior to a full dark-focus correction. The present results suggest that this difference is due to vergence accommodation and that the optimum correction for night myopia depends, in part, on the critical luminance level for activation of fusional vergence.

Age differences in peripheral refractive error.

Refractive error was measured at 0 degrees to 40 degrees temporal to fixation in 10 young adults (M age = 26 years) and 10 older adults (M age = 63 years). Older adults exhibited a greater amount of sphere (i.e., overall) error, but no more so in the periphery than in the fovea. Although age differences were small, younger adults were found to exhibit more peripheral astigmatism than the older adults. Discrepancies between obtained results and those of Millodot (1985) may be attributed to the relationship between peripheral astigmatism and presenting refractive status. Alternatively, a two-mechanism model of age-related change in lens curvature is capable of accounting for across-study outcome differences. Recommendations are made concerning optimal viewing conditions for the study of age differences in visual perceptual processes.

Role of vergence accommodation in correcting for night myopia.

Although the dark-focus or resting position of accommodation provides a parsimonious interpretation of the anomalous myopias, in correcting for night myopia the role of vergence accommodation must be considered. Both contrast sensitivity (CS) and accommodation were determined for monocular and binocular observation without and with optical corrections based on the individual dark-focus. The data suggest that the availability of a stimulus for vergence accommodation may modify the magnitude of an optical correction for night myopia.