Evidenced Based Diagnostics

Just as the harms and benefits of drugs needs to be evaluated, so do diagnostic tests. The article "Evidenced Based Diagnostics" describes how it is useful to mirror the phases used in drug research to create similar architecture for research into diagnostic tests.

According to this report, there is little consensus on systemizing the methods for assessing diagnostic tests. There is a need to fully evaluate diagnostic tests prior to them being used in clinical practice. Then once diagnostic tests are in place, there should be continous monitoring to evaluate effectiveness of the test.

Gluud C, Gluud LL. "Evidence based diagnostics" BMJ 2005;330:724-726 (26 March)

Ecstacy: The Club Drug

Ecstacy is know in Europe to be one of the most widely abused illegal drugs. It is fast becoming a problem here in the US with teenagers. Because of this, it is a drug that needs to be understood by all nurse professionals.

The most recent issue of Clinical Nurse Specialist has an article describes the pharmacology and the effects of the drug. Ecstasy for Intimacy: Potentially Fatal Choices for Adolescents and Young Adults

Other articles about ecstacy that you might find of interest include
Altered states: the clinical effects of Ecstasy
MDMA (Ecstasy) in the emergency department
Shedding new light on the safe club drug: methylenedioxymethamphetamine (ecstasy)-related fatalities.

The National Institute of Drug Abuse (NIDA) also has several web pages devoted to the topic.

New Guidelines

From the National Guidelines Clearinghouse:

The New York State Department of Health has recently released two guidelines:

• HIV in infants and children (February 2005)
• Screening for substance abuse (March 2005)

The National Guidelines Clearinghouse (NGC) is is a comprehensive database of evidence-based clinical practice guidelines and related documents. NGC's mission is to provide physicians, nurses, and other healthcare professionals "an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines and to further their dissemination, implementation and use. "

Key components of NGC include:

• Structured abstracts (summaries) about the guideline and its development
• Links to full-text guidelines, where available, and/or ordering information for print copies
• Palm-based PDA Downloads of the Complete NGC Summary for all guidelines represented in the database
• A Guideline Comparison utility that gives users the ability to generate side-by-side comparisons for any combination of two or more guidelines
• Unique guideline comparisons called Guideline Syntheses prepared by NGC staff, compare guidelines covering similar topics, highlighting areas of similarity and difference. NGC Guideline Syntheses often provide a comparison of guidelines developed in different countries, providing insight into commonalities and differences in international health practices.
  

Happy Easter ... Beware The Salmonella

The CDC warns against giving young children those cute little fluffy chicks or ducklings as gifts for Easter.

The birds shed harmful salmonella bacteria and children, and other high people with high risk conditions, are prone to becoming quite ill from being in contact with the birds. The bacteria is harbored in the chick's down, and children are apt to kiss the bird, or put fingers into mouths after cuddling them.

Signs of salmonella poisoning are diarrhea, fever, stomach pains, all of which occur about one to three days after ingesting the salmonella. Other symptoms are chills, nausea, headache, or generally feeling achy. So leave those cute little birds in the pet store, and buy a stuffed animal instead.

[Of course you already knew that reptiles and turtles are renown for salmonella poisonings in children.]

www.grayace.com/dex/bunny.html

Chocolate

Well I have never heard of chocolate being "administered", so now I have heard everything!

In a study published recently it was determined that cocoa ingestion not only decreases blood pressure, but also improves insulin sensitivity in healthy people. It was shown that dark chocolate, but not white chocolate, has the potential to decrease fasting insulin and glucose concentrations. It seems that the flavanols in the dark chocolate are responsible. Flavanols are a class of flavanoids richly represented in cocoa beans. Whereas white chocolate contains only the cocoa butter.

One of the study's conclusions is that although the study was sound, "obviously, large trials are needed to confirm these protective actions of dark chocolate..."

For those of you wishing to volunteer for the trial - get in line behind me! Administer as much chocolate as you like Dr. G.!

Grassi D et al. "Short term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons." American Journal of Clinical Nutrition, Vol. 81, No. 3, 611-614, March 2005

YSN Library - March 28 - April 1

Here is the schedule for when I will be at YSN for this week.
Questions, comments, concerns? .... please email me
janene.batten@yale.edu

Monday 3/28
11:30-5:00

Tuesday 3/29
2:00-5:00
Class: 2:00-3:00 Intro to Entrez
Class: 3:00-4:00 RefWorks Basics

Wednesday 3/30
8:30 - 12:00

Thursday 3/31
8:30 - 12:00 (Charlie's covering)

Friday 4/1
Call Medical Library for assistance - 737-4065

Working Mothers and Mother-Child Relationships

As a working mother I am always torn between the positive impact of modeling successful behavior to two young girls, and the negative fall-out of not being there whenever they need me. I struggle with it less as they grow older, and have realized the joy that the various caregivers they have bring to their lives.

An article in the month's issue of Child Development is a study that deals with mother-child relationships in relation to the time mothers actually spend with their children. Heard it all before? This study is different in that it deals with mothers with infants - babies and toddlers, a much younger group than have been studied before.

"Employed mothers of infants spent less time on average with their infants than did nonemployed mothers, but the difference was much smaller than would be expected based on the amount of time that mothers spent at work." Significant findings of this reseach were that although employed mothers spent less time caring for their infant, they reallocated their leisure and housework time at home to allow more time with their infant, and it usually was in a more social interaction - talking, singing, playing.

The article reflects much of what is inherently known by most of us. But for me, many of the findings reinforced for me the positive benefits of me working. One in particular is: "We also found that mothers who spent more time at work provided slightly higher quality home environments, even though they did not have more education or better psychological adjustment. Employment may contribute some positive benefits to the family environment because of the income it generates or the intellectual and social stimulation it provides for the mother." [my italics]

I can relate - our home enviroment is all the more richer for me working. I love what I do, and my children can feel it.

Huston A. and Rosenkrantz Aronson S. "Mothers' Time With Infant and Time in Employment as Predictors of MotherChild Relationships and Children's Early Development" Child Development Volume 76 Issue 2 Page 467 - March 2005.

Skin and Wound Care Documentation

After the last post, I decided to look at what the topics were in the Jan-Feb 2005 issue of Skin and Wound Care.

I came across an article by Cathy Thomas Hess, discussing skin and wound care documentation. The process these days may include digital images and other computerized documentation. At the end of the article there is a neat Top 20 Strategies for effective skin and wound care documentation. It's worth the read!

Pressure Ulcers: Nutrition Tree

I don't have to tell you that nutrition is a big part of helping people to become well again after illness. In the Nov-Dec issue of Skin and Wound Care there is a very short article that included a nutrition decision tree to be used with someone who has pressure ulcers.

It's worth taking a quick look. Nutrition: a key link in clinical decision trees.

AACN Nursing School Data Released

TheAACN released results of a survey conducted in 559 nursing schools across the US, and it's territories last week.

Findings show an increase in nursing degree program enrollments (14.1% over the previous year). However, "more than 32,000 qualified applications were turned away from baccalaureate and graduate nursing programs". Applicants were often turned away due to faculty shortages, and other resource constraints. Those included "29,425 from entry-level baccalaureate programs; 422 from RN-to-Baccalaureate programs; 2,748 from master's programs; and 202 from doctoral programs".

This has a direct impact on future nursing educators, as students who go on to get higher degrees begin as baccalaureate students. This is particularly so if the desired qualification for faculty is the doctorial degree.

The AACN survey found that the number of graduates from masters programs increased 6.9% (669 students), and the number that graduated from doctorial programs was 2% (8 students). A program that is gaining momentum is the baccalaureate to doctorial program, accelerating the study course of potential younger faculty.

Results were collected on what AACN called "accelerated nursing programs". This program is defined as one that accepts students with prior degrees wanting to get nursing degrees (YSN GEPN). The number of program graduates in this course almost doubled from the previous year.

For more on the summary of this survey, see the AACN news release.

The X Chromosome

It's all over the news. Yes, scientists have sequenced the X chromosome. Quite a breakthough.

The X chromosome is reported to be linked to more than 300 diseases. Also, this greater understanding of the gene sequence will allow scientists to find genetic reasons for why the sexes are different, beyond XX and XY. There is even thought that the Y chromosome may be on it's way out, over time having lost most of its genes! As a bit of a comparison the X chromosome has 1,098 genes while the Y has less than 80 genes. But, according to David Page at MIT (and a leader in the chromosome field) there is no real fear that the Y will fade away altogether.

The break though was published in Nature this week. The report is not for the faint-hearted, but if you like genetics, you're going to really enjoy the read. I myself enjoyed the NPR report, it's easier for the layperson to grasp!

Now that it's been discovered, I am not sure what to do with myself next week. ;)

YSN Library - March 21 - March 25

Here is the schedule for when I will be at YSN for this week.
Questions, comments, concerns? .... please email me
janene.batten@yale.edu

Monday 3/21
8:30-5:00
Class: 3:00-4:00 Library 101

Tuesday 3/22
2:00-5:00

Wednesday 3/23
8:30 - 5:00

Thursday 3/24
See me in Medical Library for assistance - 737-2964

Friday 3/25
University Holiday

Neonatal Survival Series

"3 million out of 4 million neonatal deaths could be saved each year by the implementation of low-tec and low-cost interventions ... 99% of deaths in the first month of life (the neonatal period) occur in developing countries--yet virtually all published research on neonatal health concerns the 1% of neonatal deaths in the developed world."

The Lancet is publishing a series focusing on the health of newborns in underdeveloped areas around the globe.

This landmark series, published over the next few weeks in The Lancet addresses a major gap in the knowledge about causes of neonatal death and interventions of that could prevent it. According to the authors, this is an issue that is largely ignored by global health policy.

The first article, addresses the statistics of neonatal mortality, and the causes. The second paper, discusses cost effect methods of prevention. The third article covers issues of the lack of trained health care providers and lack of infrastructure which contribute to high mortality. The fourth article maps out a global strategy to reduce deaths.

In addition The Lancet is also publishing three original research articles relevant to neonatal health: a Brazilian study, a Nepalese study, and a study from Bangladesh.

It is an issue that can cause a stir in even the hardest of hearts. The Editors are welcoming feedback ... email webeditor@lancet.com

"Celebrate Nursing" Awareness Bracelets

In the style that we have become accustomed to (thanks to Lance Armstrong), the PA State Nurses Association has apricot colored awareness bracelets that can be ordered to celebrate National Nurses Week (May 6-12).

If you are looking for other Nursing Week memorabilia, ANA has a supplier of a variety of other products that can be purchased to show your support for the occasion.

Folk Remedies in Children

I wsa scanning the contects of the March issue of Pediatrics and came across this electronic article.

"The use of folk remedies among children in an urban black community: remedies for fever, colic, and teething."

The study was to identify folk remedies used to treat fever, colic, and teething in black children in Detroit, Michigan. The subjects were all patients of the pediatric clinic at Children's Hospital in Michigan. It has previously been reported that the use of folk remedies is prevalent among the black population because of lack of access to health care, language or cultural barriers, socioeconomic status, or mistrust of physicians. One major reason is because it is culturally traditional, being passed from one generation to the next, and patients see the remedies as being effective.

The article defines folk remedies as "herbs, food products, or household items that are recommended by members of the lay community". Black folk medicine is a combination of African and Native American traditional medicine from as long ago as the European colonization of the south eastern coast of North America. It came to be known as "rootwork" because many of the medicines came from plant roots.

Participants in the study were more likely to use both folk remedies and the pediatric clinic for their child's health care. The study also pointed out that at times, in keeping with patient's tradition, medical personnel were likely to recommend harmless folk remedies to patients.

The article talks about the motivations behind why caregivers use folk remedies. But on the other hand, it is worthy of note that folk remedies are rarely discussed with care providers, for fear of disapproval or misunderstanding that use of such remedies may lead to Social Services intervention. Most of the remedies discussed in the article are harmless to the child, but there is a list of those that can be potentially harmful.

As you have already gleaned, the point of the article is that certain segments of the population use folk remedies and it is important that clinicians be aware of what is being used. There needs to be detailed medical history taken so that families can be aware of what will, and will not be, potentially harmful. All prescribed and non-prescribed medications and procedures need to be noted. Allowing open discussion will pave the way for a better relationship between caregiver and clinical staff.

Footnote: If you haven't read The Spirit Catches You and You Fall Down (Anne Fadiman), I recommend you put it on your summer reading list. It is a beautifully written book that explores just this topic, the interation between the Hmong community and Western medicine. You can even borrow it from the Yale Library.

Hints and Tips

Have you been looking for tips to use RefWorks, or Ovid, or some other resource?
Do you want to do a tutorial for one of the research applications that you use all the time?

The Medical Library has a web page devoted to just that. You can click around and get how tos and tips galore.

And don't forget, Jan is regularly adding tips to her blog as well.

Really Really Old and Rare Midwifery Book

Exciting news! The Medical Library recently purchased a 1609 first edition book on midwifery written in the 16th century.

The book, Observations diverses sur la sterilité, perte de fruict, foecondité, accouchements, et maladies des femmes, et enfants nouveaux naiz, was written (in French) by Louise Bourgeois (1563-1636). Bourgeois was midwife to the royal court in France. She delivered six children to Marie de Medici, wife of King Henry IV. Her book was the first of its kind, advancing the practice of French midwifery, and earning great respect among male physicians and barber-surgeons of the time.

The first edition was further expanded in 1617, 1626, and 1634. The book had such profound authority in its time that it was translated into German, Dutch, and English, and remained influential throughout the 17th century and into the 18th century.

I am not sure how many copies there are throughout the world, but there seems to be about only 10 of the 1609 edition listed in WorldCat. The copy that the Library owns is in extremely good condition, although without its original cover. (It has a cover, but not the original). An article by Professor Dunn gives translations of parts of the text that you might find very interesting. There are also other translations from other editions (I found them on the web, wouldn't Louise be amazed!) that you might find fascinating.

This book, and other old and rare items, are not on show for general viewing or browsing. But should anyone wish to see any of the rare collections that we have, it can be arranged.

YSN Library March 14 - March 18

Here is the schedule for when I will be at YSN for this week.
Questions, comments, concerns? .... please email me
janene.batten@yale.edu

Monday 3/14
8:30-5:00

Tuesday 3/15
3:30-5:00

Wednesday 3/16
8:30 - 5:00
Class: 5:15-6:15 Advanced Searching Techniques

Thursday 3/17
See me in Medical Library for assistance - 737-2964
Class: 3:00-4:00 Refworks Basics

Friday 3/18
See me in Medical Library for assistance - 737-2964
Class: 12:30-1:30 Ovid Refresher

Health Affairs - March '05 issue

The March issue of Health Affairs is dedicated to the topic of racial disparities. Click the table of contents to see articles about racial and ethnic health disparities.

Electronic Books

For those of you that didn't know, the Library keeps a very large collection of electronic books. In recent times, statistics have shown that there is greater use of titles in electronic form than the same book in paper.

The electronic collections come from Ovid, MDConsult, National Academy Press, and StatRef.

A complete list of nursing title is found on the Nursing Library website under the Book link. Click the Nursing link to get titles devoted to nursing. Otherwise just browse the entire electronic book collection.

Body Piercing

Body piercing has been around for many years now. However, there is very little medical literature written about people who get intimate body piercings. There is a dearth in the nursing literature in particular.

This well researched and written article is a study that offers insights into why people would choose to do it, and most importantly the health issues of intimate body piercings. This kind of research helps health care providers better understand their patients, and therefore be more sensitive to patient needs and health care.

See the full article, in the March issue of Journal of Advanced Nursing (49(5): 474) "Self-reported characteristics of women and men with intimate body piercings."

Patient Safety Awareness Week

It's Patient Safety Week (March 6-12, 2005).

The theme this year is

Ask, Listen & Learn
Effective Communication: The Patient Safety Tool of Choice

In other words, care providers should listen to what their patients are saying, speak in easy to understand language when talking with patients, and include the patient as a partner in their care.

Asthma in Pregnant Women: Guideline update

Updated federal guidelines on managing asthma in pregnant women, including information on new medications and safety, are available from the National Heart, Lung, and Blood Institute.

According to the MedPage I downloaded from Epocrates, these are the first new guidelines in more than a decade from the National Asthma Education and Prevention Program. Key recommendations include:

• Albuterol should be used as a quick-relief medication to treat asthma symptoms, and pregnant women with asthma should have this medication available at all times.
• Pregnant women with persistent asthma need daily medication, preferably inhaled corticosteroids. Alternative daily medications are leukotriene receptor antagonists, cromolyn, or theophylline.
• For severe asthma, oral corticosteroids may be needed. The safety of oral corticosteroids in pregnant women is still unclear, but severe, uncontrolled asthma is associated with increased maternal and fetal mortality.
• Pregnant women with persistent asthma should have their asthma monitored monthly.

The full report (as well as a quick guide and evidence tables) can be found on the National Heart Blood Lung Institute website.

YSN Library March 7 - March 11

Here is the schedule for when I will be at YSN for this week.
Questions, comments, concerns? .... please email me
janene.batten@yale.edu

Monday 3/7
1:00-5:00
Class: 4:00-5:00 Ovid Medline

Tuesday 3/8
12:00-2:30
Class: 3:00-4:00 EndNote Basics

Wednesday 3/9
1:30 - 5:00

Thursday 3/10
See me in Medical Library for assistance - 737-2964
Class: 3:30-4:30 EndNote Advanced

Friday 3/11
At an off-site meeting. Call YML Info Desk for help 737-4065
Class: 10:00-11:00 Ovid Refresher

Developing Guidelines

Ever wondered how to develop a guideline?

The New Zealand Guidelines Group has a great site that gives insight and advice about everything you ever wanted to know about guidelines - from development to evaluation, and everything in between.

The links are on the top left hand corner of the site, and are not all that clear. But link around. I guarantee that you'll find something of interest.

In case you didn't know, the National Guidelines Clearinghouse is a brilliant source for tracking down any guideline that you might be interested in. The Clearinghouse even has a page devoted to listing all the Guidelines that are "in progress". They include guidelines from various Academys and Associations not only in the US, but from around the world. In other words ... I'll be watching that space!

Google Scholar

There is much discussion about the latest addition to the Google suite: Google Scholar (http://scholar.google.com).

What is it? It's a Google search that presents results specific to scholarly publications, including peer-reviewed materials. It has has opened up access to what is kind of "invisible" to most search engines. Neat concept huh! There may be some pluses to using it, but there are also some very concerning minuses. Read on.

Why would I use it?
Maybe because you have cabin fever. Maybe you yearn to get into the garden, but the ground is still too hard to dig so you have nothing better to do. No really, maybe it's because you are frustrated with not getting what you want when doing a Medline or CINAHL search.

All really good reasons to consider using this tool. But let me tell you some reasons to be wary of resorting to such a search.

Why wouldn't I use it?
Because the search process, and therefore the result set, is not focused enough to give you the specificity that your search demands. Sure you get hits, and in no time flat. (I did one on Diabetes and got "results of about 978,000 for diabetes in 0.04 seconds") .

In this day and age of medical liability we need to be sure that we are getting all of the research, and most particularly the right research to satisfy the question. Search terms need to be precise, and then results refined in order to get information that matches the question.

Also, with Google Scholar, there is no indication of relevancy of the hit list to your search. On the other hand, a directed search in a specific database such as CINAHL will yield very high relevancy to your question.

Lastly, there is no reasonable date sequence. My diabetes search pulled up (in this order) three 2004 articles, one 1997, then two 1993 articles, then back to 2001. And there was no way to bring the most recent hits to the top of the list. A Medline search can be limited by date, or minimally the search set comes back chronologically sorted.

As nursing professionals, I would like to suggest that if you have any concerns with getting just the right answer to your research question, that you talk to one of the many information professionals that you have available to you. If searching the literature is just not your thing, then we can help you with that. We can show you tricks, give you hints, guide you, or do it with you.

Most of all we are here to make you shine. Just Ask!

Children with Bipolar Disorder: Guidelines Released

A working group sponsored by the Child and Adolescent Bipolar Foundation have developed consensus guidelines for treating bipolar disorder in children. Guidelines are based on clinical study evidence, published case reports, and expert consensus.

Here is the link to the guidelines: Treatment Guidelines for Children and Adolescents With Bipolar Disorder, published in Journal of the American Academy of Child and Adolescent Psychiatry .

Health Literacy

A question was posed in a recent issue of the American journal of health system pharmacy. How does a pharmacist assist people in providing them with information that they can actually understand? The question may be specific, but the answer is valuable to all of us.

Being health literate is sometimes difficult for even the most educated among us. For the clinician it is difficult to know if our patient understands instructions about their care, discharge instructions, or drug dosage. People are often embarrassed to say that they do not understand.

The article Counseling patients with low health literacy give more insight into who is most at risk for having low health literacy, and how to overcome the problem.

The Medical Librarian's Association (MLA) has taken up this issue. There has been discussion about how Librarians can help practitioner with these challenges. The MLA website has a web page devoted to literacy standards of difference national organizations. If would like more information on health literacy just ask one of us in the Medical Library.