Electronic Library For Health Research Articles

Cardiovascular disease and diabetes in patients with African or Asian background.

Population groups of different ancestry appear to have varying prevalence of diabetes, different risks of developing cardiovascular disease and different responses to certain drugs that are used for these conditions. We wished to review the literature in this field. We have performed searches in several databases for systematic review articles published from the year 2000 onwards, and supplemented these with articles from reference lists, our own literature archives and a pyramid search in the Norwegian Electronic Health Library database. Altogether 37 articles were included. With regard to diagnosed diabetes, the prevalence of coronary heart disease and stroke varies among groups of South Asian, East Asian, African and European ancestry. In patients of South Asian ancestry, the risk of coronary heart disease appears to be twice that of Europeans, and the disease occurs 5–10 years earlier. The prevalence of stroke is especially high in persons of African ancestry. Risk factors such as dyslipidemia and hypertension are distributed differently among these groups. The therapeutic response to drugs such as beta blockers, ACE inhibitors and various statins differs; for example, statin doses in Asians may often be halved in relation to those used for Caucasians, and ACE inhibitors are not recommended as monotherapy for hypertension in persons of African ancestry. These differences are partly attributable to variations in genetic disposition. The findings are clinically significant – better insight in this field enables optimal tailoring of treatment for each patient, with more rapid achievement of goals and reduced risk of adverse effects. The recommendations given in this article are consistent with and complement the Directorate of Health’s revised guidelines for the treatment of diabetes.

Examining the use of an open digital health library for professionals.

BackgroundThe Norwegian Electronic Health Library (The Library) is a website for health personnel. Most of the content is also open to the public. Usage statistics have risen sharply in the years 2010-2013.ObjectiveWe wanted to find out whether the rise was caused by health personnel, the general public, or other factors.MethodsSince we lacked direct information, we had to use proxy data to shed light on our questions. We applied mixed methods (database of registered users, user survey, usage statistics, and statistics from suppliers), and triangulated between them.ResultsHealth personnel were our largest user group, but The Library was also accessed by students, patients, and other groups. Content in Norwegian was preferred to English language content. Concise, practical information was preferred to more comprehensive information. Patient leaflets were the most popular information type. Mobile phone visits differed from personal computer visits both in terms of time of day and what kind of information was viewed.ConclusionsThe Library was used mostly by health personnel, as intended, but our data are inconclusive regarding a possible change in user groups. There was a large degree of consistency in results when using different investigation methods. The survey points toward health personnel being the largest user group, and the usage statistics show that patient leaflets are the most popular content, being viewed by both health personnel and patients.

On the advantages of negotiation

This article offers a partial response to and personal reflection on Kjell Tjensvoll’s March 2011 article on the benefits of the procurement process to the Norwegian Electronic Health Library. It considers Tjensvoll’s assertions on the basis of the author’s own experience of licensing, negotiation and procurement with the UK’s academic library consortium, JISC Collections, over the last decade. It argues that whilst there are undoubtedly benefits to be had from tender processes, there are also a number of potential pitfalls and unintended consequences and questions whether a procurement exercise is always the most appropriate way to go about licensing unique electronic resources. It is further suggested that for essential procurements at the consortia level a well-structured negotiation can deliver superior results more finely attuned to the needs of the consortium.

National licensing for the Norwegian Electronic Health Library

The Norwegian Electronic Health Library (NEHL) is a national online library service for Norwegian health care personnel.Through the NEHL portal (www.helsebiblioteket.no), users have access to approximately 2,500 medical journals, bibliographic indexes, point-of-care reference tools and other medical information resources.The service is funded by the Norwegian government, and consequently must comply with laws and regulation concerning public acquisitions, which are more or less the same all over the European Union. Norwegian laws were recently changed in order to be more in harmony with the EU.The regulations state when public tenders should be used, and also describe in detail how a tender should be organized and what kind of process to use for different kinds of products and/or projects. During the first half of 2009 a decision was made to acquire a point-of-care reference tool for Norwegian physicians. As a result of the tender process NEHL acquired national licences for BMJ Best Practice and UpToDate.

Linfedema: métodos de medición y criterios diagnósticos

Objective To review and update the existing knowledge regarding the different methods of measurement of lymphedema and diagnostic criteria, these being very debated issues in international societies of lymphology. Search strategy Original articles were searched for in major databases: Clearinghouse National Guidelines, Guidelines Finder of the National electronic Library for Health of Britannic NHS, Cochrane Central Register of Controlled Trials, Web of Knowledge and MEDLINE (1996–2009), and the most relevant monographs on Lymphedema. Study selection The relevance of the articles was evaluated by initial reading of the title and abstract and the full text of those considered relevant was analyzed. Data The main aspect of the diagnosis and assessment of lymphedema is the measurement of the size of the limb that can be done by circumference measurement or by direct or indirect volumetry. Other methods assess physical or mechanical properties of tissues.

Linfedema: diagnóstico diferencial y pruebas complementarias

Objective To review and update the existing knowledge regarding the differential diagnosis of lymphedema and the necessary complementary tests and to present a simplified algorithm for the diagnosis. Search strategy A search was made of the original articles in the major databases: Clearinghouse National Guidelines, Guidelines Finder of the National electronic Library for Health of Britannic NHS, Cochrane Central Register of Controlled Trials, Web of Knowledge and MEDLINE (1996–2009), and for the most relevant monographs on lymphedema. Articles selection The relevance of the articles was evaluated by initial reading of the title and abstract and the full text of those considered relevant was analyzed. Data Lower limb edema may appear due to multiple causes and may be difficult to diagnose adequately. Systemic causes such as hypoalbuminemia, congestive heart failure, kidney failure, nephrotic syndrome and advanced liver disease need to be ruled out. Local causes such as lymphedema, phleboedema and lipedema are more difficult to diagnose.

Wiring a nation: putting knowledge into action

Wiring a nation: putting knowledge into action

Conflict of Interest in Science Communication: More than a Financial IssueReport from Esteve Foundation Discussion Group, April 2009

A systematic review and meta-analysis suggests that around 2% of scientists admit to have falsified research at least once (1). Up to 33% admit other questionable practices such as plagiarism, duplicate publication, undisclosed changes in pre-research protocols or dubious ethical behavior (1). There can be no doubt that discovered cases of research and publication misconduct represent a tip of an iceberg and many cases go unreported (2). Experienced biomedical journal editors are aware of a “rogues’ gallery” of major fraudsters, such as Schoen, Hwang, Sudbo, Poehlman, Singh, and Chandra (3-8). Much more common are the less dramatic, because more subtle but probably more dangerous, examples; these are more dangerous because they remain undiscovered so may feed into meta-analyses and guidelines. A seminar organized by the Esteve Foundation, held in Sitges in April 2009, concentrated on conflicts of interest (COI, sometimes also referred to as Competing Interests, CI), which underlie so much research and publication misconduct. All attendants of the meeting agreed that there were many sources of COI in the general process of scientific communication (Figure 1). The meeting was mainly focused on non-financial COI. Three introductory presentations highlighted some of the topics related to COI in the contemporary scientific publishing enterprise. Figure 1 Main protagonists in the process of scientific communication among which conflict of interest may arise. Dr Virginia Barbour, editor of PLoS Medicine, raised the following issues: - Does past or present employment with industry prejudice authors and researchers? - Journal policies on competing interests are often unclear or ambiguous even though the problem is common and consumes a disproportionate amount of editors’ time. - It is difficult to persuade academic institutions and individual researchers to comply with accepted definitions of misconduct. - Editors and publishers have not got to grips with non-financial conflicts. - There is uncertainty and inconsistency about sanctions for misconduct. Magne Nylenna, editor-in-chief of the Norwegian Electronic Health Library, raised the following issues: - Good practice vs misconduct is not a matter of black and white. There are shades of gray. - Of greatest significance is the researcher’s/author’s intent – and that may be difficult to determine. - Extreme cases are probably unpreventable so, as in preventive medicine generally, attention to the whole population is likely to have a better outcome than concentrating on outliers. - Simple guidelines are more useful than detailed, lengthy protocol - Everyone concerned merits training. Ana Marusic, co-editor in chief of the Croatian Medical Journal, addressed the specificities of small journals: - There are particular problems for small journals whose editors are likely to be academics, not full time medical journalists. - There is special risk from “scientific inbreeding” (the tradition of having tenure in the same institution where one trained). - In post-communist countries the concept that it is praiseworthy to cheat the government may be extended to other perceived authorities. - There needs to be a clear definition of when and how an article is retracted and what should be the consequences thereof.

A case study: planning a statewide information resource for health professionals: an evidence-based approach

What is the best approach for implementing a statewide electronic health library (eHL) to serve all health professionals in Minnesota? The research took place at the University of Minnesota Health Sciences Libraries. In January 2008, the authors began planning a statewide eHL for health professionals following the five-step process for evidence-based librarianship: formulating the question, finding the best evidence, appraising the evidence, assessing costs and benefits, and evaluating the effectiveness of resulting actions. The authors identified best practices for developing a statewide eHL for health professionals relating to audience or population served, information resources, technology and access, funding model, and implementation and sustainability. They were compared to the mission of the eHL project to drive strategic directions by developing recommendations. EBL can guide the planning process for a statewide eHL, but findings must be tailored to the local environment to address information needs and ensure long-term sustainability.

Practitioner Commentary on Toth B, Muir Gray JA, Fraser V, Ward R. National electronic Library for Health: progress and prospects. Health Libraries Review 2000, 17, 46–50*

Practitioner Commentary on Toth B, Muir Gray JA, Fraser V, Ward R. National electronic Library for Health: progress and prospects. <i>Health Libraries Review</i> 2000, 17, 46–50*

Analysis of the quality of clinical practice guidelines on established ischemic stroke

To catalogue and comparatively assess the quality of Clinical Practice Guidelines (CPG) for ischemic stroke taking into account format and development methodology. We performed a comprehensive, systematic bibliographic search of CPGs addressing the management of ischemic stroke. We designed a sensitive strategy, using methodological filters in the following databases: Medline, IME and Lilacs, National Guidelines Clearinghouse, National electronic Library for Health, NICE, Guidelines International Network (GIN), Canadian Medical Association Infobase, development groups such as Scottish Intercollegiate Guidelines Network (SIGN), New Zealand Guidelines Group (NZGG), Agency for Healthcare Research and Quality (AHRQ), Ministry of Health Singapore, Institute for Clinical Systems Improvement (ICSI); and scientific societies: American Heart Association, American Medical Association, Royal College of Physicians London. We included all CPGs published in English, French, Italian, Portuguese, or Spanish from 1999 to 2005 and excluded those CPGs whose scope was primary prevention and rehabilitation from ischemic stroke. Four researchers independently assessed the structure and methodologies followed in drafting the CPGs using the Changing Professional Practice (CPP) and Appraisal of Guidelines Research & Evaluation (AGREE) instruments. We retrieved 117 documents; following application of exclusion criteria, twenty-seven CPGs were appraised. With regard to methodological quality (using the AGREE instrument), the domains that scored highest were "Scope and purpose" and "Clarity and presentation." The lowest scoring domains were "Stakeholder involvement," "Rigor of development," and "Applicability." Most guidelines received an overall score of "would not recommend" (77.8 percent). Finally, based on the CPP instrument, most of the CPGs evaluated were aimed at secondary care and did not provide updating procedures. The overall quality of the CPGs published for ischemic stroke management did not have minimum methodological quality. Quality improvement has been observed in more recent CPGs and may be due to the publication of new tools such as the AGREE or CPP instruments, as well as international initiatives for CPG improvement.

Religião e espiritualidade no ensino e assistência de enfermagem

Estudo da interseção entre o discurso da enfermagem e os preceitos que albergam a religião/religiosidade e espiritualidade, e como se deu a incorporação e o reflexo desse discurso nas práticas assistenciais, no ensino e no delineamento da organização da profissão. Para revisão bibliográfica, utilizaram-se as bases de dados LILACS e BDENF, da Biblioteca Virtual de Saúde. Um total de 57 artigos completos, publicados entre 1957 e 2007, foram analisados à luz das idéias sobre " memória coletiva" , de Maurice Halbwachs. Verificou-se que há uma raiz religiosa com ramificações profundas na conformação da enfermagem brasileira. Esta configuração está tão imbricada na memória coletiva que, mesmo com a expansão de instituições que não se declaram religiosas, os pressupostos cristãos se mantêm presentes e com vitalidade.

Web intelligence analyses of digital libraries

Purpose – The purpose of this paper is to explore the use of LexiURL as a Web intelligence tool for collecting and analysing links to digital libraries, focusing specifically on the National electronic Library for Health (NeLH).Design/methodology/approach – The Web intelligence techniques in this study are a combination of link analysis (web structure mining), web server log file analysis (web usage mining), and text analysis (web content mining), utilizing the power of commercial search engines and drawing upon the information science fields of bibliometrics and webometrics. LexiURL is a computer program designed to calculate summary statistics for lists of links or URLs. Its output is a series of standard reports, for example listing and counting all of the different domain names in the data.Findings – Link data, when analysed together with user transaction log files (i.e. Web referring domains) can provide insights into who is using a digital library and when, and who could be using the digital library...

Web-based provision of information on infectious diseases: a systems study

The National electronic Library for Health (NeLH) is an Internet medical information resources portal, principally for healthcare professionals, within which the National electronic Library of Infection (NeLI) is one of NeLH Specialist Libraries providing evidence on infectious diseases. In this article, we describe a systems-based evaluation of NeLI based on a soft systems methodology. User feedback and other data for the analysis were obtained using online questionnaires. This evaluation, which is a pilot study aimed at demonstrating proof of concept, provided evidence for improving three systems that are crucial to effective NeLI provision. These are navigation of the site, quality and tagging of information provided by NeLI, and information regarding users and their usage of the system. On the basis of a soft systems analysis, an action plan was formulated identifying areas where improvement is needed. Actions for consideration included simplifying terminologies to improve the navigation, enhancing the provision of research assessments, quality tagging NeLI documents, provided by experts in the field, and attracting a broader cross-section of healthcare professional user.

A voice for the UK care pathway community of practice

Critical path and process-mapping methodology was used in industry, particularly in the field of engineering from as early as the 1950s. In the 1980s, clinicians in the USA began to develop the pathway tool within managed care; they were re-defining the delivery of care and attempting to identify measurable outcomes. They were focusing on the patient rather than the system, but needed to demonstrate efficient processes in order to fulfill the requirements of the insurance industry. In the early 1990s the National Health Service (NHS) in the UK funded a patient-focused initiative to support organizational change. This resulted in the investigation and development of concepts such as pathways. In 1990, a team from the UK visited the USA to investigate the use of these pathways, or ‘Anticipated Recovery Pathways’ as they were then called. As a result of this visit, 12 pilot sites for pathways were set up in Northwest London in 1991–92. The West Midlands Pathway Development work also got underway. By 1994, the Anticipated Recovery Pathway had evolved into the Integrated Care Pathway (ICP) in the UK. ICPs were clinician led and driven, and had patients and locally agreed, best practice at their heart. In response to demand for a coordinated UK ICP users group, the National Pathways User Group (later re-named the National Pathways Association [NPA]) was set up in 1994. A popular and well-supported group, it finally folded in 2002, a casualty of the time required by volunteers to lead the group and administer its running. In 2002, at about the same time that the NPA folded, the National Electronic Library for Health (NeLH) Pathways Database was launched to enable the free sharing of ICPs and ICP projects across the UK. Since 1991, ICPs have been developed and implemented across all health care settings in the UK (acute, community, primary, mental health, private, independent, NHS). ICPs are now used all around the world including Africa, Australia, Belgium, Canada, Denmark, Germany, Hong Kong, Italy, the Netherlands, New Zealand, the UK, and the USA. However, the UK has formalized the systematic development, implementation and use of care pathways by embedding them in national policy, identifying them as the vehicle for implementation, demonstration/monitoring and evaluation of all health and social care policies, strategies, initiatives and agendas at the frontline.

Evaluation of the Current Knowledge and Awareness of the Integrated Care Pathway Tool in a Local Health Community

An integrated care pathway (ICP) identifies the patient's anticipated progress and ensures that any activities delivered by health- and social-care professionals are signed off, and that any variation from the intended practice is documented. Analysis of the variances from the ICP allows continuous assessment of process and outcomes against guidelines or standards. The objectives of this study were to establish the current knowledge and awareness of the ICP tool within the local health community, and to find out how it may be improved. A semi-structured questionnaire was sent to 15 representatives at a senior manager or director level in the local health community. A response rate of 67% was achieved. The questionnaire data were examined using ‘content analysis' and ‘constant comparison’ methodology. In all, 80% of the questionnaire respondents did not identify that the variance framework was an essential element of the ICP tool. A high number of questionnaire respondents identified some, but not the majority, of the benefits that the ICP tool can offer. A total of 60% of the respondents identified resources to assist in the development of ICPs. None of the respondents identified the National Electronic Library for Health (NeLH) as a main resource where guidance was available. However, 100% of the respondents stated that it would be beneficial if standardized national guidance were made available to support ICP development. In conclusion, this study demonstrated that there is variability in the current level of knowledge and awareness of the ICP tool. It is therefore recommended that national guidance be produced, which would provide a standard framework for National Health Services staff to follow when developing ICPs. It is also recommended that improved provision and distribution of information on how ICPs can be used can lead to effective quality improvement programmes.

The National Electronic Library for Health Controlled Clinical Trials website: a website about clinical trials for patients and the public

The National Electronic Library for Health Controlled Clinical Trials website: a website about clinical trials for patients and the public

National Electronic Library for Health—Mental Health Homepage

National Electronic Library for Health—Mental Health Homepage

Clinical trials

Are you involved in inviting patients to join clinical trials? The National electronic Library for Health (NeLH) has developed a website for people who are asked to take part, writes Ruth Williams.

What's on the web?

The NHS website www.informatics.nhs.uk with its NHS Information homepage is a useful starter site for people wanting to find out more about UK health informatics and forthcoming events. It has links to the National Electronic Library for Health, the Informatics Learning Network, and the NHS Information Authority. Affiliated to the University of Iowa, Virtual Hospital—a digital library of health information (www.vh.org/) is an American website providing information for patients, doctors, medical students, and health reporters. Patients can search for their …