Impact of anesthesia on transcranial electric motor evoked potential monitoring during spine surgery: a review of the literature.

OBJECT: Transcranial motor evoked potential (TcMEP) monitoring is frequently used in complex spinal surgeries to prevent neurological injury. Anesthesia, however, can significantly affect the reliability of TcMEP monitoring. Understanding the impact of various anesthetic agents on neurophysiological monitoring is therefore essential. METHODS: A literature search of the National Library of Medicine database was conducted to identify articles pertaining to anesthesia and TcMEP monitoring during spine surgery. Twenty studies were selected and reviewed. RESULTS: Inhalational anesthetics and neuromuscular blockade have been shown to limit the ability of TcMEP monitoring to detect significant changes. Hypothermia can also negatively affect monitoring. Opioids, however, have little influence on TcMEPs. Total intravenous anesthesia regimens can minimize the need for inhalational anesthetics. CONCLUSIONS: In general, selecting the appropriate anesthetic regimen with maintenance of a stable concentration of inhalational or intravenous anesthetics optimizes TcMEP monitoring.

Making sense of autoimmune and rheumatic disorders at the reference desk.

This paper discusses concepts and terminology of some aspects of the autoimmune and rheumatic disorders as related to medical reference work. Details of anatomic, biochemical, and pathologic processes are not discussed. Knowledge of the specific terminology involved in this area may help to ensure a good approach to developing prudent strategies for database searching of the medical literature and, therefore, is reviewed. MeSH thesaurus terms are shown and textword synonyms are presented that provide tools for thorough searching techniques. Commonly used medical jargon as well as older terminology for this area is also explained. Examples of specific search strategies are illustrated.

Information needs in primary care: a survey of rural and nonrural primary care physicians.

OBJECTIVE: To compare the self-reported information needs of rural and nonrural primary care physicians. DESIGN AND PARTICIPANTS: Mail survey of active non-academic primary care physicians. DATA COLLECTION: A 60 item questionnaire regarding 1) demographic and practice setting data; 2) medical information needs; 3) medical knowledge resource availability and use; and 4) physician information seeking behavior. MAIN RESULTS: The response rate was higher among rural than non-rural physicians (55% vs. 42%, p< 0.001) and among Family Physicians than others (Family Medicine 53%, Internal Medicine 43%, Pediatrics 48%, p=0.015.) Rural physicians reported working more hours per week (45.3 vs. 42.7, p=0.033,) and seeing more patients per day (24.6 vs. 22.3, p=0.005) than their nonrural counterparts. Both groups reported a median of about 1 question for every 10 patients they see, with great variance among responses. Both groups reported pursuing answers to about 57% of their questions, and finding answers to about 70% of those they pursue. Knowledge resource preferences of the two groups were similar. Both groups reported frequent use of consultants, drug compendia, colleagues, and textbooks, and little use of library- or computer-based sources. Compared to nonrural physicians, rural physicians reported less frequent use of consultants, colleagues, librarians, and bound journals. These differences were small, and paralleled differences in availability. The two groups had equal access to textbooks and drug compendia, but for rural physicians, other resources were locally available significantly less often. CONCLUSIONS: Rural and nonrural primary care physicians reported equal information needs, similar information seeking, and similar resource preferences. Rural physicians reported less access to some information resources, but little difference in use of resources. Further studies are needed to determine how these differences impact rural practitioners and their patients.

The use of information technology in improving medical performance. Part III. Patient-support tools.

Despite the proliferation of computer-based resources for patients, usefulness has been limited to date. Already, 17,000 biomedical Internet sites exist, and patients are increasingly finding support and knowledge on the Internet, but the accuracy of the information found is highly variable and difficult for patients to assess. Patients have also found value in electronic communication with physicians, although relatively few physicians routinely use email to communicate with patients on a regular basis. Nonetheless, patient-focused information technologies potentially will have profound effects on medical care. With advancing sophistication of technology, patients will increasingly be able to compare and choose doctors using the Internet and to access information that allows them to monitor and regulate the quality of their own care. Further, technologies will likely be developed to allow patients to increasingly manage their own care -- whether they are patients with chronic illnesses such as diabetes or congestive heart failure who use customized software to adjust drug dosages and other treatments or patients with such common illnesses as headache or gastrointestinal infection who access self-management programs that may even write prescriptions for them. Thoughtful analysis and policy development will be critical for ensuring that the benefits are maximized and potential harm minimized. Specific areas include assessing the effects on outcomes and the characteristics of patients and technologies that succeed with self-management, and developing policies regarding liability for Web-based medical transactions and the privacy of information provided to physicians by email and via interactive Web sites.

Information retrieval patterns and needs among practicing general surgeons: a statewide experience.

Information retrieval has progressed from a reliance on traditional print sources to the modern era of computer databases and online networks. Surgeons, many from remote areas not served by professional medical libraries, must develop and maintain skills in information retrieval and management in both electronic and standard formats. One hundred thirty-three New Mexico general surgeons were surveyed to identify their information-seeking patterns in five areas: retrieval purposes, retrieval sources, barriers to access, techniques used, and continuing education needs. Ninety-nine (74.4%) surgeons responded to the survey. Ninety-five percent utilize professional meetings, the medical literature, and physician colleagues as information sources. Only 17% utilize the outreach services of the state's only medical school library. Common retrieval barriers were practice demands (71%), isolation from medical schools (30%), computer illiteracy (28%), and rural environment (25%). Continuing education topics related to information management would be valuable to 61% of the surgeons. Sixty-nine percent believe their current ability to access biomedical information is adequate, despite most frequently accessing their personal libraries for information related to decision-making or patient management. These data suggest that, despite significant information needs, surgeons have not embraced newer forms of information retrieval. It is imperative that surgeons acquire and maintain modern information retrieval skills as a means of remaining up-to-date in their profession. Professional surgical organizations and medical librarians should collaborate on these continuing education ventures.

Comparison of fixed-fee Grateful Med database use and searching success rates given the continued availability of MEDLINE in other formats.

This study compared in-house Grateful Med database use and searching success rates for four-month periods at four sites of the Library of the Health Sciences of the University of Illinois at Chicago. Data were collected from Grateful Med workstation uselogs and analyzed. Database use patterns and searching success rates were fairly consistent across the four sites. Though MEDLINE was available in other formats and use in these other formats remained high, 65.48% of all Grateful Med searching was done by using MEDLINE, and an additional 21.34% was done by using the MEDLINE Backfiles. In-house use patterns were similar to the overall use pattern for the University of Illinois, with the exception of MEDLINE Backfiles. Overall, 54.30% of searches were successful.

Dental hygienists' information seeking and computer application behavior.

A questionnaire requesting information on information seeking, critical analysis, and computer applications was returned in 1992 by 136 of 197 (69 percent) currently licensed dental hygienists residing in Alaska, Delaware, and Idaho. The most common sources used for professional development and information retrieval were continuing education courses, discussions with colleagues, and journals. The respondents' own experience, credibility of the journal, and discussions with colleagues were the most frequent methods used to evaluate professional information. Many hygienists owned or had access to a computer, yet they rarely conducted online database searches to obtain professional information. The computer was primarily used to perform business functions rather than for clinical applications in these dental hygienists' employment settings. The majority of these hygienists were interested in attending related continuing education courses and indicated that computer skills should be part of dental hygiene curricula.

Apreciación crítica de la literatura médica

El siguiente es el resumen del simposio que sobre el tema se llevó a cabo en el VII Congreso de Exalumnos de Medicina de la Universidad nacional de Colombia (AEXMUN). El artículo consta de tres partes : la primera introductoria escrita por G. Gómez sobre cómo y por qué evaluar críticamente la literatura biomédica, basado en los artículos y en el libro que sobre el tema han publicado docentes de la Universidad McMaster (1,2), la segunda sobre el ánalisis de exámenes diagnósticos por H. Gaitán, la tercera sobre análisis de estuduios sobre tratamientos, por R. Pardo.

An analysis of the hypertension journals.

There are now at least nine medical journals which are exclusively related to the topic of hypertension, of which two started publication in 1992. We have conducted an analysis of the impact of these journals in the published body of medical research into hypertension as well as the reports published in 1993 by the hypertension management 'guidelines' committees in the UK, USA, New Zealand, Canada and the WHO. Finally an analysis was conducted of the contents of the four established hypertension journals (Hypertension, Journal of Hypertension, Journal of Human Hypertension and American Journal of Hypertension) in 1992 in relation to the country of origin of the papers and the topics covered. Only 19% of all the hypertension papers listed in Index Medicus in 1992 were from the four established journals and only 12.6% of papers quoted in the 'guidelines' reports were from these journals. Most papers, and particularly the important ones, tend to be published in the weekly or monthly general medical journals. In the contents of the four journals, Hypertension and Journal of Hypertension tended to take more papers devoted to basic science than the Journal of Human Hypertension and American Journal of Hypertension which favoured more clinically relevant papers. American papers tended to go to American journals while European and Japanese papers appeared in all journals, although the Japanese bias towards basic science meant that their contributions also appeared in the two basic science orientated journals.(ABSTRACT TRUNCATED AT 250 WORDS)

Trends in the use of DOCLINE and the OCLC ILL subsystem 1986-1992.

An examination of interlibrary loan statistics from 1986 through 1992 at the Health Sciences Library (HSL), State University of New York at Buffalo, revealed that the numbers of requests received via DOCLINE increased steadily over this period. Meanwhile, the numbers of requests received via OCLC rose from 1986 to 1989 but then declined steadily from 1989 to 1992. To understand and interpret these trends, a survey of various libraries that obtain material from HSL was conducted to collect data on their use of DOCLINE and OCLC. Analysis of the data confirmed that the use of DOCLINE was on the increase, especially in health sciences libraries, and that in some of these libraries requests for documents via OCLC were on the decline. The ratio of requests via DOCLINE versus OCLC ranged from 2:1 to 5:1. In the non-health sciences libraries that request from HSL, use of DOCLINE is minimal compared to that of OCLC.

Growth patterns in the National Library of Medicine's serials collection and in Index Medicus journals, 1966-1985.

Data from the National Library of Medicine (NLM) automated Master Serials System and its MEDLINE database were used to chart the growth of NLM's serials collection and of the journals indexed in Index Medicus from 1966 to 1985. The number of live serial titles in the subset of NLM's collection examined increased 30% in the twenty years. The average number of articles per Index Medicus journal increased 56%. The average number of articles in U.S. Index Medicus journals grew more rapidly than the average number in journals published elsewhere. The NLM data provide clear evidence that the years from 1966 to 1985 saw a substantial increase in the percentage of the biomedical serial literature published in English. The period from 1966 to 1985 saw substantial but uneven growth in the number of serial titles in the NLM collection and in the average number of articles in Index Medicus journals. Although data on the number of articles published in Index Medicus journals is unlikely to reflect the number of articles in other journals, the pattern of growth in the number of serials held by NLM probably reflects trends in the universe of all biomedical serials.

User interactions with the PDQ cancer information system.

Searches by end users and intermediaries on the online PDQ (Physician Data Query) cancer information system were observed. With the National Library of Medicine (NLM) menu-based interface, end users (physicians) averaged fewer steps per question, while with the BRS command-drive interface, intermediaries appeared to be more efficient. Cancer Information Service (CIS) searchers, who have more PDQ experience than end users or intermediaries, made greater use of command stacking to anticipate menu selections. Retrieval was more complete in the NLM system, where both the menus and predefined print formats assisted the searchers.

CD-ROM MEDLINE use and users: information transfer in the clinical setting.

Effective delivery of biomedical information to health professionals depends on the availability of systems that are compatible with the information-seeking patterns of health professionals. MEDLINE is a major source of biomedical information, but has been available primarily through libraries via telecommunications networks. The recent availability of MEDLINE on CD-ROM has made it possible to provide MEDLINE directly to clinicians without the associated problems of telecommunications and online use charges. The MEDLINE on CD-ROM Evaluation Forum sponsored by the National Library of Medicine reported on clinicians' use of CD-ROM MEDLINE at seven different clinical settings. This article summarizes the findings from these sites and places them in the context of current understanding of information-seeking behaviors of health professionals. Key issues in the design and development of information technologies in the clinical setting are also articulated.

Monitoring patron use of CD-ROM databases using SignIn-Stat.

SignIn-Stat, a PC-based, menu-driven program, collects information from users of the library's public access computer systems. It was used to collect patron use data for the library's four CD-ROM workstations for the period September 1987 to April 1988 and to survey users for the period December 1987 to March 1988. During the sample period, 5,909 CD-ROM uses were recorded. MEDLINE was the most heavily used database, followed by PsycLIT and Micromedex CCIS. Students accounted for 61% of the use, while faculty, residents, and staff were responsible for 31%. Graduate students had the highest rate of use per student. Nineteen percent of use was by patrons who had never used CD-ROMs before, while 37% was by patrons who had used CD-ROMs ten or more times. Residents were the least experienced user group, while graduate students and faculty were the most experienced.

Online access to MEDLINE in clinical settings. A study of use and usefulness.

STUDY OBJECTIVE: We introduced self-service access to the medical literature database, MEDLINE, into clinical settings to assess the frequency, patterns, purposes, and success of use. DESIGN: Longitudinal descriptive study. SETTING: Inpatient and outpatient services of a university medical center. PARTICIPANTS: All trainees and attending staff working at the service sites were invited to participate; 158 (84%) did so. INTERVENTIONS: Free online access was provided to MEDLINE through GRATEFUL MED software. Participants were offered a 2-hour introduction to online searching and 2 hours of free search time. MEASUREMENTS AND MAIN RESULTS: For each search, a computer program requested identification of the user and the question to be addressed. Search transactions were recorded automatically. Interviews were conducted after a random sample of searches, and search questions were given to more expert searchers to run for comparison with the original. Eighty-one percent of participants did searches on study computers, at a mean rate of 2.7 searches per month. On comparison searches, participants retrieved 55% of the number of relevant articles retrieved by reference librarians (P = 0.024) and 50% more irrelevant articles (P less than 0.001). Forty-seven percent of searches on patient problems affected clinical decisions, but often on scanty information. CONCLUSIONS: MEDLINE searching from clinical settings is feasible with brief training and affects clinical decisions. However, inexperienced searchers miss many relevant citations and search inefficiently. Further studies are needed to assess the impact of searching on physician performance and patient care.