Sidelines 15 (2)

Centre for Reviews and Dissemination

University of York

Web: http://www.york.ac.uk/inst/crd

The Sidelines abstracts in this issue of Inform comprise a wide ranging mix of research and opinion on the impact of ICT on patients, healthcare professionals, and publishing. In addition there are abstracts on the reporting of research evidence, search filters and public health indicators.

Bubela TM, Caufield TA. (2004) “Do the print media "hype" genetic research? A comparison of newspaper stories and peer-reviewed research papers”, CMAJ, vol. 170, pp. 1399-1407.

The public gets most of its information about genetic research from the media. This article reports a study that examined the accuracy and nature of media coverage of genetic research. The authors searched news databases to retrieve newspaper articles reporting gene discoveries and associated technologies published in scientific journals. These articles were then categorised in terms of whether their claims about genetic news were moderately to highly exaggerated, slightly exaggerated or not exaggerated. The study found that only 11% of the newspaper articles were categorised as having moderately to highly exaggerated claims. The majority had no claims (63%) or slightly exaggerated claims (26%). Overall, therefore, most newspapers in this survey appeared to accurately convey the results of genetic research and reflect the claims of the scientific journal articles from which they were derived.

Haynes RB & Wilczynski NL, for the Hedges Team. (2004) “Optimal search strategies for retrieving scientifically strong studies of diagnosis from Medline: analytical survey”, BMJ, vol. 328, pp .1040-2.

This article describes the development of an optimal search strategy for retrieving methodologically sound studies on the diagnosis of health disorders from MEDLINE.

The authors hand-searched 161 journals in 2000 to identify articles on diagnostic tests. 49,028 articles were included in the analysis. 778 articles were classified as original studies evaluating a diagnosis question, and 147 of these met the methodological criteria. These were treated as the 'gold standard' of articles against which electronic MEDLINE searches were tested.

A comprehensive set of possible search terms was created using MeSH and text words. This study documents the search terms and combinations of terms with the best sensitivity, specificity, accuracy and balance of sensitivity/specificity for retrieving high quality studies of diagnostic tests from MEDLINE.  Optimal sensitivity was reached by the following search string: 'sensitiv$.mp OR diagnos$.mp. or di.fs.'. Optimal specificity (and accuracy) was reached by the search term 'specificity.tw.' This outperforms a previous study by the same authors published in 1994.  

Ring F, Jones M. NHS Direct usage in a GP population of children under 5 years: is NHS Direct used by people with the greatest health need? Br J Gen Pract 2004;54(500):211-3.

This cross-sectional, postal questionnaire-based study looks at the usage of NHS Direct, comparing the socio-economic, demographic and health status characteristics of users and non-users. The objective was to establish “whether NHS Direct is being used by people with the greatest need for healthcare services”. The participants chosen to represent the general population were parents or guardians of children aged between 0 and 5. This group is more likely to be registered with a GP than other age groups and to be high users of all health services.

The authors suggest that usage of NHS Direct for information about children of 5 years and under is high. However, ethnic minority groups and those whose first language is not English, low socio-economic groups and those with established ill health are not using the service. The conclusions should be treated with caution as the authors report a low response rate and the over-representation of ‘non-whites’, suggesting that their findings may not apply to the UK as a whole.

Schroter S, Barratt H, & Smith J. (2004) “Authors’ perceptions of electronic publishing: two cross sectional surveys”, BMJ, vol. 328, no. 7452, pp. 1350-3.

With current innovations in electronic publishing, the BMJ decided to consult its authors about different approaches to publishing research articles and its current practice of publishing abridged versions of research articles in the printed journal and the full version on the web at bmj.com.

Two cross sectional surveys were used to ascertain authors’ views. The first asked authors who had experienced ELPS (electronic long, paper short) what aspects of ELPS they liked or disliked, to describe any problems encountered and to compare the readability of short papers to full papers. The second survey was sent to authors submitting research articles to the BMJ, who may not have experienced ELPS. It asked if authors knew about ELPS before the survey and what they liked and disliked about the idea. All authors were asked for their opinion about two other ways of publishing research articles: publishing unedited versions of papers on the web as soon as they are accepted for publication and publishing only abstracts in the printed journal and full articles on web.

The surveys found that 70 % of BMJ authors approve of its current practice (publishing condensed versions of research articles in paper and the full article on the web) with many highlighting the readability of the short version over the full. Authors dislike the idea of publishing only abstracts in the printed journal but are in favour of posting unedited versions of accepted articles on the Web site ahead of the printed version.

Reich V & Rosenthal S. (2004) “Preserving today's scientific record for tomorrow: LOCKSS marries age-old concepts of librarianship with modern technology”, BMJ, vol. 328, no. 7431, pp. 61-2.

If you are sceptical about your ability to provide long-term access to materials published on the Web, an initiative from Stanford University Libraries might provide you with a solution. The BMJ reports on the LOCKSS (Lots Of Copies Keeps Stuff Safe) project that aims to provide librarians with an inexpensive, practical solution to digital preservation.

Working like a search engine, software crawls the Web sites of those journals to which a library subscribes and collects the content locally, creating ‘persistent digital caches’. This provides librarians with an easy way of running web caches. Content is collected into the cache as new issues of the journals are published and content is served to readers from either the publisher or from the cache. The contents of the cache are preserved for posterity by never flushing it.

Over fifty publishers of academic journals, including the BMJ, support the project and beta testing of the LOCKSS system is currently being completed at 80 libraries worldwide.

Stiell A, Forster AJ, Stiell IG, & van Walraven C. (2003) “Prevalence of information gaps in the emergency department and the effect on patient outcomes”, CMAJ, vol.  169, no. 10, pp. 1023-8.

Access to and availability of information in patients’ records is particularly important for healthcare practitioners working in accident and emergency departments. This Canadian study investigates how often potentially useful information is unavailable to hospital staff and what impact this has on the treatment of patients. It found that in almost one third of cases some information was not available and, as the missing information was often the patient history and test results, this was considered to be essential for patient care. In addition, the length of time spent in the emergency department tended to be longer for patients whose records were incomplete. The authors conclude that an electronic patient records system would improve patient care.

Christensen H, Griffiths KM, & Jorm AF. (2004) “Delivering interventions for depression by using the Internet: randomised controlled trial”, BMJ, vol.  328, no. 7434, pp. 265.

Could the Internet be an effective way to reduce the symptoms of depression in a community-based population? This RCT used two Web sites, one offering cognitive behaviour therapy and one offering evidence-based information on depression and its treatment, to evaluate this approach. The researchers found that both Web sites were equally effective in reducing symptoms and increasing knowledge of depression and its effective treatment. The authors suggest that the Internet could be a powerful tool in the delivery of public health interventions.

Balas EA, Krishna S, Kretschmer RA, Cheek TR, Lobach DF, & Austin Boren S. (2004) “Computerized knowledge management in diabetes care”, Med Care, vol. 42, pp. 610-21.

Getting evidence into practice has long been an issue in evidence-based medicine. The authors present examples of the long delays in the application of scientific achievements in diabetes care. They hypothesise that better knowledge management may be the solution to the discrepancy between what is known and what is done. They examine the value of computerised knowledge management in diabetes care through a systematic review of randomised controlled trials.

44 unique clinical trials were included in the review. The trials fell into 3 categories. 9 studies evaluated the use of computer-generated information during clinician-patient consultations. 25 studies explored participants using glucose measurements at home and transmitting data electronically to clinicians. Finally, 10 studies evaluated the impact of computerised education.

Overall compliance with recommended diabetes care procedures and guidelines was higher in the group of physicians prompted by computer-generated information. There was also significant improvement in glycated haemoglobin for those patients with glucose measurements at home and a significant improvement in outcomes was also seen with those participants receiving computerised education.

The authors note that not all outcomes measured saw a significant improvement in the intervention groups and that there is probably an element of positive publication bias in the papers identified. Despite these caveats they suggest that, for diabetes, computerised knowledge management can lead to improved care. Further research, however, is recommended on the long-term effects, the cost and satisfaction with care associated with these interventions.

Robine J, Jagger C, & Euro-REVES Group. (2003) “Creating a coherent set of indicators to monitor health across Europe”, Eur J Pub Health vol. 13, pp. 6-14.

This paper outlines the methods used and the lessons learned in developing a set of recommended instruments for calculating health expectancies to be used in European surveys. This work began in 1998 under the European Health Monitoring Programme and has included a detailed analysis of the current health survey instruments in Europe together with a review of past research. Previous efforts to standardise techniques to allow comparisons between countries have been unsuccessful due to lack of validation and a lack of implementation guidelines and follow-up. Consequently many countries have made alterations to the instruments with little awareness of the implications.

Recommendations about specific instruments in this paper, however, are based on past research. The relevance of the indicators to policy and guidelines for implementation are made. The next step for the researchers, however, is to recommend further instruments with validation to ensure equivalence in questions between countries.

Scheck McAlearney A, Schweikhart SB, & Medow MA. (2004) “Doctors’ experience with handheld computers in clinical practice: qualitative study”, BMJ, vol. 328, pp. 1162-5.

The article reports a qualitative study of 54 US doctors’ use of handheld computers in clinical practice. The study design was eight 60-90 minute focus groups comprising doctors who did and did not use handheld computers.

Clinicians tended to use handheld computers for point of care assistance e.g. drug information, clinical guidelines, decision aids and patient education. They were also used for patient information including tracking clinical results, and for administrative functions such as electronic prescribing, coding and tracking schedules. Some doctors found them useful for medical education and used their handheld computers for presentations, photographs, diagrams and lecture notes. Generally clinicians used handheld computers on their own initiation, buying devices based on recommendations or personal preferences. Clinicians were satisfied with their hand held computers and identified additional benefits such as improving productivity and patient interaction.

Barriers to use centred on the computer itself, information security, over-reliance, and potential changes to practice. Handhelds were perceived to be no greater threat to the security of patient information than paper-based systems. A few doctors were concerned that handheld computers would have a negative effect on clinical practice and could encourage an over-reliance on them or that keen users might continuously gather data without improving patient care. All doctors agreed that handheld computers were destined to become critical because of their potential to improve patient safety and the quality of care.

Zipperer L. (2004) “Clinicians, librarians and patient safety: opportunities for partnership”,  Quality and Safety Health Care, vol. 13, pp. 218-222.

The author suggests that librarians could improve the safety of medical care by greater participation in patient safety initiatives. In the US there is concern that there is no official requirement for hospitals to have a library, although information management is seen as vital. With the growth of the Internet and free access to Medline in the US, librarians are striving to develop roles as informationists – an extension of the role of clinical librarian.

Case studies from around the world demonstrate the need for librarians to be involved in systematic reviews and the delivery of evidence based medicine. Research demonstrates that information identified by librarians has modified current and future clinical activities and the absence of information can lead to harm.

Due to their working environment librarians are well positioned to build bridges between clinicians and administrators and to act as “knowledge brokers”.  Librarians also have a role to play in providing training in quality filtering, critical analysis of literature and targeted searching techniques. 

The report concludes that librarians can contribute to enhancing patient safety through local partnering and global change projects coupled with professional motivation. It states that following these suggestions the healthcare and library communities “could foster the research, creative ideas and partnerships needed to involve the information profession more completely in improving patient safety”.

Jada AR & Delamothe T. (2004) “What next for electronic communication and healthcare?” BMJ, vol.  328, pp. 1143-1150.

The editorial in this issue contains several short articles on the impact of information technology on healthcare.

Humber M. describes the National Programme for Information Technology which aims to streamline healthcare by giving all patients a basic healthcare record, ensuring instant access to patient information. Humber stresses that the programme’s success depends not only on the reliability of the technology but also on its successful implementation, which in turn depends on the full involvement of all stakeholders.

N M Lorenzi in ‘Beyond the gadgets’, discusses the human issues involved in the implementation of a new information system. She uses the trans-theoretical model of change, which charts the stages individuals go through in a process of change and suggests strategies for overcoming issues at each stage.

D J Klass, in ‘Will e-learning improve clinical judgement?’, suggests that the increased availability of medical information as a result of improvements in technology will not necessarily lead to an improvement of clinical judgements by doctors. Klass asserts that the only known way to teach judgement (as opposed to transferring knowledge) is through working collaborations such as observed traineeships.

T Ferguson draws five conclusions about the emerging population of patients who use the Internet as a health resource, in ‘The first generation of e-patients’. The conclusions are:

1. The benefits of the Internet have been underestimated and the risks over-estimated.

2. Online support groups have become an important resource for patients.

3. When clinicians respond negatively to patients who have found information online it damages the doctor/patient relationship.

4. The way we conduct research into Internet resources needs to change, to start to evaluate the ways the resources are used.

5. To understand the world of the e-patient, a paradigm shift in the way we think about the patient’s place in healthcare needs to occur.

Finally D Gustafson and J Wyatt discuss the evaluation of e-health systems and services. They recommend that evaluation should move beyond testimonials and usage reports and suggest that the amount and type of evaluation required will depend on the needs of the user, the potential benefits the resource can provide and the potential damage it can do.

Green CJ, Kazanjian A, & Helmer D. (2004) “Informing, advising or persuading? An assessment of bone mineral density testing information from consumer health Web sites”, International Journal of Technology Assessment, vol. 20, no. 2, pp. 156-166.

Increased access to healthcare information on the Internet should enable patients to have greater participation in healthcare decisions. However, this will only lead to improvements in health if the information they use is accurate. This article describes a study to assess the quality of content on consumer health Web sites (CHWSs) about bone-mineral density (BMD) testing. The study used Health Technology Assessments (HTAs) as a comparison. The authors found that CHWSs, which were often funded by companies with a commercial interest in promoting BMD testing, generally overstated both the benefits of BMD testing and the risks associated with having a low BMD. The HTA reports, on the other hand, contained more scientifically rigorous information and their findings may be of use to consumers. Unfortunately, whilst these reports are publicly available, they are not as readily accessible to consumers as the CHWs.

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This page was last updated on: 6 October 2005