188 research outputs found

    Heath Network Clinicians Use and Need for Clinical Information Sources: Results of a Survey

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    The Dana Medical Library, part of the University of Libraries system, with the support of the University of Vermont Health Network, assessed the needs of UVM Health Network clinicians for evidence-based clinical resources such as: medical databases, journal articles, topic summaries, or electronic/print textbooks. Results are compiled and discussed

    Effect of a Clinical Evidence Technology on Patient Skin Disease Outcomes in Primary Care: A Cluster-Randomized Controlled Trial

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    Objective: Providers’ use of clinical evidence technologies (CETs) improves their diagnosis and treatment decisions. Despite these benefits, few studies have evaluated the impact of CETs on patient outcomes. Investigators evaluated the effect of one CET, VisualDx, on skin problem outcomes in primary care. Methods: The cluster-randomized controlled pragmatic trial was set in outpatient clinics at an academic medical center in the Northeast. Participants were Primary Care Providers (PCPs) and adult patients seen for skin problems. The intervention was VisualDx as used by PCPs. Outcomes were patient-reported time from index clinic visit to problem resolution, and the number of follow-up visits to any provider for the same problem. PCPs assigned to intervention agreed to use VisualDx as their primary evidence source for skin problems. Control group PCPs agreed not to use VisualDx. Investigators collected outcome data from patients by phone at 30 day intervals. Cox proportional hazards models assessed time to resolution. Wilcoxon-rank sum tests and logistic regression compared return appointments. Results: Thirty-two PCPs and 433 patients participated. In proportional hazards modelling adjusted for provider clusters, the days from index visit to skin problem resolution were similar in both groups (HR 0.92; CI 0.70, 1.21 P= 0.54). Patient follow-up appointments did not differ significantly between groups (OR 1.26 95% CI 0.94, 1.70 P =0.29). Conclusion: This pragmatic trial tested the effectiveness of VisualDx on patient reported skin disease outcomes in a generalizable clinical setting. There was no difference in skin problem resolution or number of follow-up visits when PCPs used VisualDx

    Clinical Evidence Technologies and Patient Care

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    ABSTRACT Clinical evidence technologies (CETs) are information sources derived from medical research literature that may assist health care providers in continued learning, decision-making, and patient care. Examples of CETs include: MEDLINE/PubMed and Cochrane Reviews, research journal literature, print and electronic medical texts, clinical topic summaries, guidelines, and interactive decision tools. Clinicians utilize CETs to find answers to questions that arise during patient care. However, it was unclear if CETs had a measurable impact on provider practice or patient outcomes. A literature review identified twenty-two articles evaluating CETs’ impact. Study designs included surveys, observational studies, randomized controlled trials and quasi-experimental methods. The review revealed mixed evidence of CET impact on provider-level outcomes such as improved diagnoses and treatments, and on patient level outcomes such as length of hospital stay and mortality. Additional research was needed to determine whether certain CETs or CET types have impact on patient care outcomes in clinically targeted areas. We conducted a cluster-randomized controlled trial (CRCT) to evaluate the effect of a dermatology-focused CET (VisualDx) when used by primary care providers. We found no difference in the patient skin disease outcomes of resolution of symptoms and return visits for the same problem in that trial. Thirty-two PCPs and 433 patients participated. In proportional hazards modelling adjusted for provider clusters, the time from index visit to skin problem resolution was similar in both groups (Hazard Ratio=0.92; 95% Confidence Interval (CI)=0.70, 1.21; P=0.54). Patient follow-up appointments did not differ significantly between groups (Odds Ratio=1.26; CI=0.94, 1.70; P=0.29). In a follow up mixed-methods study, we sought to understand why VisualDx did not make a difference. All CRCT provider participants were surveyed about their experience in the trial. VisualDx users (intervention arm) were interviewed about their experience using the CET. Ease of access and usefulness for patient communication facilitated successful use while irrelevant search results and use of other sources were barriers. Although PCPs reported benefits, they did not perceive the CET as useful often enough to motivate using it frequently or exclusively, thereby reducing the likelihood of it making a difference in the problem resolution and return appointment outcomes. There was no difference in skin problem resolution or number of follow-up visits when PCPs used VisualDx. PCPs did not perceive VisualDx as “useful” often enough for to use it frequently, or exclusively, thereby reducing the likelihood of this CET making a difference in patient-level outcomes

    Knowledge-based Information in Vermont Hospitals: A Survey of Library and Information Services in 2010

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    Introduction: This report contains the results of a 2010 survey of Vermont hospitals. The purpose of the survey was to provide a snapshot of the health sciences information services currently available to health care providers through Vermont hospitals. We proposed to determine the status of Vermont hospital libraries and the extent of medical information resources (knowledge-based information) available to health care professionals through the hospitals

    Health Research Associates: Dana Library Program Supporting the Information Needs of Small Hospitals & Public Health Agencies in Vermont

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    We will describe the purpose, methods, members and service changes, income-expense status, trends, and the value of this program

    Barriers and Facilitators to Use of a Clinical Evidence Technology for Management of Skin Problems in Primary Care: Insights from Mixed Methods

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    Background: A previous cluster-randomized controlled trial tested the effectiveness of a clinical evidence technology (CET), VisualDx, for skin problems seen by Primary Care Providers (PCPs). Based on patient report, there was no effect on time to problem resolution or return appointments. Objective: To explain, from the provider perspective, why the CET did not make a difference in the clinical trial and to identify barriers and facilitators to use. Methods: Mixed methods study design. Providers from both arms completed a survey about their use of VisualDx and information-seeking during and after the trial. Active arm providers participated in interviews to explore their opinions and experiences using VisualDx. Behavioral steps of the evidence-based medicine (EBM) paradigm informed the 6 step model. Results: PCPs found VisualDx easy to use (median 3 on a 1-4 scale), but found it only somewhat useful (median 2 on a 1-4 scale). PCPs with fewer years in practice used it more often and found it easier to use. Interviews identified facilitators and barriers to using VisualDx. Facilitators included diagnostic uncertainty, positive attitude, easy access, utility for diagnosis and therapy decisions, and utility for patient communication. Barriers included confidence in dermatology, preference for other sources, interface difficulty, and retrieval of irrelevant diagnoses and images. Some PCPs reported positive impacts on patient treatment and fewer referrals; others saw no difference. PCPs found VisualDx easy to access, but some found the interface difficult to use. They found it useful and relevant at times, but also frustrating and time-consuming. They used other sources in addition to, or instead of, VisualDx. Conclusion: PCPs did not perceive VisualDx as “useful” often enough for them to use it frequently or exclusively, thereby reducing the likelihood of its making a difference in patient-level outcomes such as problem resolution and return appointments

    Barriers and Facilitators to Use of a Clinical Evidence Technology in the Management of Skin Problems in Primary Care: Insights from Mixed Methods

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    Objective: Few studies have examined the impact of a single clinical evidence technology (CET) on provider practice or patient outcomes from the provider’s perspective. A previous cluster-randomized controlled trial with patient-reported data tested the effectiveness of a CET (i.e., VisualDx) in improving skin problem outcomes but found no significant effect. The objectives of this follow-up study were to identify barriers and facilitators to the use of the CET from the perspective of primary care providers (PCPs) and to identify reasons why the CET did not affect outcomes in the trial. Methods: Using a convergent mixed methods design, PCPs completed a post-trial survey and participated in interviews about using the CET for the management of patients’ skin problems. Data from both methods were integrated. Results: PCPs found the CET somewhat easy to use but only occasionally useful. Less experienced PCPs used the CET more frequently. Data from interviews revealed barriers and facilitators at four steps of evidence-based practice: clinical question recognition, information acquisition, appraisal of relevance, and application with patients. Facilitators included uncertainty in dermatology, intention for use, convenience of access, diagnosis and treatment support, and patient communication. Barriers included confidence in dermatology, preference for other sources, interface difficulties, presence of irrelevant information, and lack of decision impact. Conclusion: PCPs found the CET useful for diagnosis, treatment support, and patient communication. However, the barriers of interface difficulties, irrelevant search results, and preferred use of other sources limited its positive impact on patient skin problem management

    Implementing the information prescription protocol in a family medicine practice: a case study.

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    QUESTION: Can an information prescription protocol be successfully integrated into a family medicine practice seeking to enhance patient education and self-management? SETTING: Milton Family Practice, an outpatient clinic and resident teaching site of the University of Vermont and Fletcher Allen Health Care, is located in a semirural area fifteen miles from main campus. OBJECTIVES: The objectives were to increase physicians\u27 knowledge and use of information prescriptions, sustain integration of information prescription use, and increase physicians\u27 ability to provide patient education information. METHODS: Methods used were promotion of the National Library of Medicine\u27s Information Rx, physician instruction, installation of patient and provider workstations, and a collaborative approach to practice integration. MAIN RESULTS: A post-intervention survey showed increased physician knowledge and use of the Information Rx protocol. Support procedures were integrated at the practice. CONCLUSIONS: Sustainable integration of Information Rx in a primary care clinic requires not only promotion and education, but also attention to clinic organization and procedures

    The Nitrate Time Bomb (NTB) Model: a simple but effective method to investigate the impacts of historical nitrate loading on long-term groundwater nitrate concentrations

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    Nitrate water pollution, which remains an international problem, can cause long-term environmental damage and threaten both the economy and human health. Agricultural land is the major source of nitrate water pollution. It can take decades for nitrate leached from the soil to discharge into freshwaters. However, this nitrate time lag in the groundwater system has generally been ignored within the water resource management in many countries including the UK. We present a nitrate time bomb (NTB) model to modelling nitrate processes in the groundwater system. Whilst NTB contains simplified conceptual models, it can represent the major nitrate and hydrogeological processes in the groundwater system at both national and catchment scales, such as spatio-temporal nitrate loading, low-permeability superficial deposits, dual-porosity unsaturated zones and nitrate dilution in aquifers. The NTB model has been successfully used to simulate annual nitrate concentrations from 1925 to 2150 in the major aquifers in Great Britain and four local aquifer zones in the Eden Catchment, England. Monte Carlo simulations were undertaken to analyse parameter sensitivity and calibrate the model using observed datasets. These results help decision makers to understand how the historical nitrate loading from agricultural land affects the evolution of groundwater quality due to the nitrate time lag in the groundwater system. This NTB approach will be particularly valuable to evaluate the long-term impact and timescale of land management scenarios and programmes of measures introduced to help deliver water quality compliance. This model requires relatively modest parameterisation and is readily transferable to other areas
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