JMLA article

Brief moment of shameless self promotion :-) - a paper based on my MPH thesis in included in this month's JMLA -

Jerome RN, Giuse BN, Rosenbloom ST, Arbogast PG. Exploring clinician adoption of a novel evidence request feature in an electronic medical record system. J Med Libr Assoc. 2008 January; 96(1): 34–41. The abstract:

Objective: The research evaluated strategies for facilitating physician adoption of an evidence-based medicine literature request feature recently integrated into an existing electronic medical record (EMR) system.

Methods: This prospective study explored use of the service by 137 primary care physicians by using service usage statistics and focus group and survey components. The frequency of physicians' requests for literature via the EMR during a 10-month period was examined to explore the impact of several enhanced communication strategies launched mid-way through the observation period. A focus group and a 25-item survey explored physicians' experiences with the service.

Results: There was no detectable difference in the proportion of physicians utilizing the service after implementation of the customized communication strategies (11% in each time period, P=1.0, McNemar's test). Forty-eight physicians (35%) responded to the survey. Respondents who had used the service (n=19) indicated that information provided through the service was highly relevant to clinical practice (mean rating 4.6, scale 1 “not relevant”–5 “highly relevant”), and most (n=15) reported sharing the information with colleagues.

Conclusion: The enhanced communication strategies, though well received, did not significantly affect use of the service. However, physicians noted the relevance and utility of librarian-summarized evidence from the literature, highlighting the potential benefits of providing expert librarian services in clinical workflow.

A common health language

The newsletter ADVANCE for Health Information Management Professionals has a really nice brief article on health literacy, "Dream of a Common Health Language" by Shawn Proctor. The article a few simple but striking examples from the world of respiratory therapy to illustrate signs and potential implications of low health literacy.

For Mari Jones, RRT, FNP, AE-C, the predicament hit home when she found her college-educated father struggling to understand his doctor's instructions. He had returned home knowing he should stop taking one of three medications. But he was unclear as to which one. He didn't want to admit he didn't understand.

The article mentions The Newest Vital Sign, a health literacy test that Pfizer makes freely available and the NN/LM health literacy page.

Epigenomics initiative

Today, the NIH announced a new initiative focused on developing the field of epigenomics in the US.

What is epigenomics, you ask?

The press release defines the field:

Epigenetics focuses on processes that regulate how and when certain genes are turned on and turned off, while epigenomics pertains to analysis of epigenetic changes across many genes in a cell or entire organism.

Epigenetic processes control normal growth and development. Diet and exposure to environmental chemicals throughout all stages of human development among other factors can cause epigenetic changes that may turn on or turn off certain genes. Changes in genes that would normally protect against a disease, as a result, could make people more susceptible to developing that disease later in life. Researchers also believe some epigenetic changes can be passed on from generation to generation.

And an example might help:

...epigenetics may help explain how some people are predisposed to certain illnesses such as cardiovascular disease, diabetes and hypertension. Several studies have documented that children born to mothers who did not get adequate nutrition during pregnancy were more likely to develop type 2 diabetes and coronary heart disease later in life. The theory is that epigenetic changes occur in genes that regulate sugar absorption and metabolism during fetal development that allow for survival with little food, but when encountered with an environment where food was plentiful these changes led to development of diabetes. (See scientific illustration of how epigenetic mechanisms can affect health at http://nihroadmap.nih.gov/epigenomics/epigeneticmechanisms.asp .)

More on epigenomics and epigenetics:
- NIH Roadmap: Epigenomics
- Biology Online: Introduction - from genome to epigenome - this intro notes "
The term ‘epigenetics’ was first introduced by Conrad Waddington in the 1940s to describe ‘the interactions of genes with their environment, which bring the phenotype into being’"
- the Human Epigenome Project

Ethics committees

AMNews, the weekly newsletter of the American Medical Association, this week considers the role of the hospital ethics committee, including potential limitations and barriers to ethics consultation by physicians.

The article mentions the VA initiative to transform the ethics committee model, coordinated by the VA's National Center for Ethics in Health Care. The IntegratedEthics initiative began rolling out to all VA medical centers in May 2007 and their web site includes a wealth of training information and other tools, including Ethics Consultation: Responding to Ethics Questions in Health Care, a primer for ethics consultants.

The Nintendo Wii and virtual surgery

From New Scientist -- A Wii warm-up hones surgical skills -- an excerpt:

You might think it a bad idea for trainee surgeons to play games on the Nintendo Wii when they should be studying, but it might be time well spent.

Kanav Kahol and Marshall Smith of the Banner Good Samaritan Medical Center in Phoenix, Arizona, have found that surgical residents performed better during simulated surgery after playing on the Wii console. They put it down to the console's
novel "Wiimote" control system, which allows players to direct on-screen action using a wireless wand that detects acceleration in three dimensions.

Now they are designing Wii software that will accurately simulate surgical procedures. A training platform based on the console, which costs about $250, might be more practical for trainee surgeons in the developing world than traditional virtual training tools, which typically cost a great deal more.

To test how the Wii affected surgical skill, the researchers asked eight trainee doctors to play it for an hour before performing a virtual surgery. They used a training tool called ProMIS, which simulates a patient's body in 3D and tracks the surgeon's movements as they operate. They fed the movements to an algorithm which scores the virtual surgeon on a range of factors. Wii-playing residents scored 48 per cent higher on tool control and performance than those without the Wii warm-up.

(More on virtual surgery in this past post and on the Clinical Cases blog - virtual knee and hip replacement)

Visiting the emergency room

CNN's Empowered Patient feature today focuses on five things not to do in the ER (more discussion of each of the items in the article:

1. Don't forget to call your doctor on the way to the ER

2. Don't use an ambulance unless you really need it

3. Don't be quiet

4. Don't get angry, and don't lie

5. Don't forget the phone

Disease origins

Tara at Aetiology has a great discussion of research to figure out where syphilis came from.

An octopus and his best friend

A heartwarming (maybe just to me...) story about an octopus and his favorite toy, a Mr Potato Head, via Zooillogix.

Scary and cute at the same time

Public Health Response to a Rabid Kitten --- Four States, 2007 in the CDC's MMWR this week gives a great, narrative discussion of the discovery and investigation of rabies exposure via a rabies-infected kitten -- public health epidemiology in action.

Of course, it's also sad that the kitten was ill (had already been euthanized before the suspicion of rabies) and a good reminder why rescued animals should really be quarantined from other animals and humans until a full veterinarian exam, even if they initially look well - though domestic animal rabies is not nearly as common as it used to be, animals that have spent any time in "the wild" might have been exposed to illnesses through contact with other animals (this kitten had a raccoon-variant rabies infection).

Some vets will give reduced rates for rescued animals - call your local veterinarians to find out if they offer assistance or can recommend other services in your area. The American Animal Hospital Association, the accrediting group for animal hospitals in the US and Canada, has a directory of vets that you can search by zip code.

It's also a good reminder to spay/neuter pets that you don't plan to breed - the ASPCA has an online directory of low-cost providers for this service.