EBM and Clinical Support Librarians@UCHC

A blog for medical students, faculty and librarians about their use of evidence based medicine, clinical literature, Web 2.0, sources and search strategies

Category Archives: Epidemiology/Public Health

Instruction, Information Seeking Behaviors, Clinical Evidence: Teaching with EBM Databases

This has been a busy month. The final first-year PBL class will be wrapping up, as the semester ends on Friday, Dec 18 2009.

On Monday, I taught an evidence-based medicine class for 28 third-year medical students (which I’ve done since 2001).  It is part of a week-long curriculum that all third-years attend as regular breaks from their clerkship rotation schedules.  They come back to the Health Center (for “Home Week”).

This 90-minute course represents a real opportunity for a librarian to connect with advanced students who are already savvy users of the medical literature.  They have completed two years of basic science and human systems curriculum, and have participated in four semesters of problem-based learning.  Each has passed the USMLE Step 1.  By this point in their graduate education, they are dedicated users of PubMed and Up to Date.

The location is one of the large classrooms equipped with computers, or students use their own laptops so that everyone gets to use a resource together.  Sometimes it gets pretty loud in that room!  The instructional challenge is to keep the content fast-paced and interesting enough for these experienced searchers while introducing (and convincing them to test out) some new clinical resources and search techniques.

Utilizing a PICO strategy (Patient or Problem-Intervention-Comparison of Treatments-Outcome) is briefly discussed.  The first half of the class is devoted to locating and applying MeSH headings and subheadings for effective search strategies and showing them ways to use the Clinical Queries search engine.  The student are asked to register for their own MyNCBI account in order to begin to organize their searches or create collections of documents in the future.

Always I ask this group if any are currently searching the SCOPUS database in addition to PubMed.  Their response?  Most are not, and that surprises me a bit.  However, once they view the links to online reference lists and “cited reference searching” capability in SCOPUS*, I’d venture a guess that 100% of this group will be using it from that day forward!  It is a database that generates instant loyalty for most users.  

Other EBM resources covered briefly are the five segments and uses of Cochrane Library, ACP Journal Club, JAMA Evidence-Guide to the Medical Literature (a digital subscription resource), and the classic BMJ series on How to Read a Paper (open access).  Ideally I end up with sufficient time to demonstrate using the TRIP (Turning Research Into Practice) clinical search engine.

The LibGuide used for the class is linked here.

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During their clerkship year, third-year students favor putting as many of the subscription resources as are available onto their PDAs.  Having drug-interactions databases, clinical DDx or algorithm calculators and a disease photo-atlas in their coat pocket comes in very handy (no pun intended) as they travel to different hospitals for their clinical rotations.

PDA resources popular with this group include Lexi-DrugsDynaMed and Diagnosaurus (which is free).

Two of the databases that I featured in the EBM class this week were ACP-PIER (American College of Physicians-Physicians Information & Education Resource) which UCHC library subscribes to via Stat!Ref, and Essential Evidence Plus (EEP) from Wiley-Blackwell.

Here’s a screenshot from EEP:

Image credit: http://www.essentialevidenceplus.com/content/eee – All rights reserved – Copyright 2009

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A press release from the company, issued Dec 14 2009, describes their new ‘point of care’ product:

Wiley-Blackwell today announced the launch of Essential Evidence (EE), a new product for PDAs which has been added to its online evidence-based, peer-reviewed subscription Essential Evidence Plus, a source which provides access to: Practice Guidelines, Decision Support Tools, History and Physical Exam Calculators, Diagnostic Test Calculators, the Derm Expert, ICD-9 Lookup Tool, Patient Education Handouts, links to Cochrane Systematic Reviews, and 950+ high quality photographs. Essential Evidence Plus links to Daily POEMs (Patient Oriented Evidence that Matters).

EE for PDAs is a topic-oriented clinical resource tool designed to help clinicians to effectively make diagnoses, chart treatment plans, and determine prognoses.  EE can be searched via the web or loaded onto a handheld computer (Pocket PC or Palm OS). EE currently features 700 structured medical topics and approximately 100 more are in development and will be added to the site soon…”

Text Source: http://www.essentialevidenceplus.com/articles/EE_Launch_12.09.pdf – All rights reserved – Copyright 2009

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And that’s my final formal class for 2009!

( Happy! )

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* How did we (i.e., those of us in academic-health science libraries) function without SCOPUS?  It’s like thinking about the days before cell phones – a time dimly remembered, difficult to recall… sort of like pre-historic times.

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News, Medical Research, UCHC Faculty: Immune Levels + Holiday Stress? Not Beneficial

If you ever thought the stress of seeing your extended family over the holidays was slowly killing you—the bad news: a new research report in the December 2009 print issue of Journal of Leukocyte Biology shows that you might be right. Here’s the good news: results from the same study might lead to entirely new treatments that help keep autoimmune diseases like lupus, arthritis, and eczema under control. “

Text credit: Press Release from Eurekalert (Nov 30 2009)

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Recently published research by scientists from UCHC examine the effects of psychological stress on the human immune system.  The paper was published this month in the Journal of Leukocyte Biolology – Vol. 86: 1275 (Dec 2009); the abstract is available to read here: http://www.jleukbio.org/cgi/content/abstract/86/6/1275.

The citation found on PubMed can be viewed here.

News, Data on Health Care, Global Demographics: OECD Health at a Glance 2009

Organisation of Economic Co-operation & Development (OECD) published its’ fifth annual edition of Health at a Glance 2009 – OECD Indicators on Dec 8 2009.

The full report is available in English or French language; anyone may read the “web book” online, at no cost, on the OECD Statistics page.*

Here is how the organization describes the scope of this report:

Health at a Glance 2009 provides the latest comparable data on different aspects of the performance of health systems in OECD countries. It provides striking evidence of large variations across countries in the costs, activities and results of health systems. Key indicators provide information on health status, the determinants of health, health care activities and health expenditure and financing in OECD countries… 

This edition also contains new chapters on the health workforce and on access to care, an important policy objective in all OECD countries. The chapter on quality of care has been extended to include a set of indicators on the quality of care for chronic conditions. ”

Text source: http://www.oecdilibrary.org/oecd/content/book/health_glance-2009-en – All rights reserved – Copyright 2009

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The 89-page report shows data from 30 countries on the following measures:

  • Health Status
  • Non-Medical Determinants of Health
  • Health Workforce
  • Health Care Activities
  • Quality of Care
  • Access to Care
  • Health Expenditures & Financing

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Data from the section on Health Expenditure per Capita reveal that…

The United States continues to outspend all other OECD countries by a wide margin. In 2007, spending on health goods and services per person in the United States rose to USD $7,290 (Figure 7.1.1) – almost two and a half times the average of all OECD countries. “

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Another highly useful publication from OECD is the annnual OECD Factbook 2009: Economic, Environmental and Social Statistics.

These countries are OECD members: Australia, Austria, Belgium, Canada, Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Japan, Korea, Luxembourg, Mexico, the Netherlands, New Zealand, Norway, Poland, Portugal, Slovak Republic, Spain, Sweden, Switzerland, Turkey, United Kingdom, United States.

* Not all OECD publications are available online, or for free download.

News: Warning against a Phishing Scam from CDC

On Dec 1 2009, the Centers for Disease Control  & Prevention issued a general alert to citizens of the United States regarding a “phishing” scam that was discovered recently.  This type of announcement is rather unusual.

Following is a screenshot of the official CDC page which addresses this potential security hazard:

Image Credit: http://www.cdc.gov/hoaxes_rumors.html – All rights reserved – Copyright 2009


News, Global Health, Public Health: Today is World AIDS Day

Today is World AIDS Day 2009

33.4 million people in the world are living with AIDS

Image Credit: http://UNAIDS.org – All rights reserved – Copyright 2009

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Following is a brief list of statistical or factual sources for HIV/AIDS information:

  • The UNAIDS.org (Joint United Nations Programme on HIV/AIDS) website offers a variety of factual and global epidemiological reports found on their Knowledge Center page.   Also see the 72-page 2008 UNAIDS Annual Report, available to download at no cost.

  • CDC staff collects a wide variety of epidemiological statistics about HIV/AIDS in the United State.  One useful page is a link to factual data for individual U.S. states…. as an example,  click here to view the latest HIV/AIDS data for the state of Connecticut.   For other HIV/AIDS state data, also see this site from CDC.
  • This site, HIV Reality (from the UK), has a group of interviews with people living with AIDS.
  • An excellent subscription resource available for UCHC library users, GIDEON (Global Infectious Diseases and Epidemiology Online Network) provides an impressive list of HIV/AIDS related statistical sources for countries worldwide.  Here is a link to a FAQ-handout on using GIDEON handout.

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Finally, knowing one’s own HIV status is essential information.  At HIVTest.org an interactive list of local testing or counseling resources from U.S. healthcare agencies can be assembled (by zipcode).  The pop-up list will show which agencies will test for free.

A screenshot below (from HIVTest.org page) shows a list of current testing recommendations for those who are sexually active:

Image Credit: HIVTest.org – All rights reserved – Copyright 2009

News, Public Health, Public Service: H1N1 Fact Page from Ebsco

This year, Ebsco Publishing has created an evidence-based medicine source for current factual diagnostic or treatment information for H1N1 influenza virus, written for clinicians, nurses and the general public.

This site is open to anyone in the world to access, at no cost.  Following is a brief description found on the front page of Ebsco Publishing Influenza Evidence-Based Information Portal:

Due to Pandemic H1N1 Influenza (formerly known as Swine Flu) and concerns about the 2009/2010 flu season, the EBSCO Publishing Medical and Nursing editors of DynaMed, Nursing Reference Center™ (NRC) and Patient Education Reference Center™ (PERC) have made key influenza information from these resources freely available to health care providers worldwide. The information is designed to inform patients and their families, and provide information to clinicians to help them with H1N1 diagnosis and H1N1 treatment by making up-to-date diagnosis and treatment information availableThis site includes more than 50 evidence-based topics including patient education information in 17 languages.”

Source/ text credit: http://www.ebscohost.com/flu/ – All rights reserved – Copyright 2009
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As shown in this screenshot below, there are sections written for clinicians, nurses and patients.

Photo credit: http://www.ebscohost.com/flu/ – All rights reserved – Copyright 2009
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If you treat patients who speak Arabic, French, German, Hindi, Chinese (traditional or simplified), Japanese, Italian, Korean, Portuguese, Russian, Spanish, Farsi, Polish, Tagalog, Vietnamese (or English), this is an excellent free resource – bookmark it!

Thanks to Ebsco for producing this EBM influenza page.

News, Public Health, Epidemiology, Tobacco: Great American Smokeout 2009, and another Reason to Quit

Today, Nov 19 2009 is designated by the American Cancer Society as…

The Great American Smokeout

Image credit: Courtesy of American Cancer Society – All rights reserved – Copyright 2009

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There are many excellent reasons for quitting smoking.  A new international study announced this week presents a novel (and compelling) reason to stop using tobacco once and for all.

Dr. Amy Sapkota, PhD, MPH, is an assistant professor for the School of Public Health at University of Maryland with a joint appointment at Maryland Institute for Applied Environmental Health.  She describes her research as  “… utilizing metagenomic methods to understand total bacterial biodiversity in cigarettes, smokeless tobacco products and environmental tobacco smoke“.

In 2007, Dr. Sapkota and two microbial biologists at the Ecole Centrale de Lyon, Sibel Berger and Timothy M. Vogel, sampled tobacco taken from four commercial brands of American cigarettes for evidence of bacterial contamination, using DNA microarray analysis techniques.

Following is an excerpt from a press release about the study results (Courtesy of Eurekalert, Nov 19 2009):

Fifteen different classes of bacteria and a broad range of potentially pathogenic organisms were detected in all cigarette samples.  Most notably, we detected Acinetobacter, Bacillus, Burkholderia, Clostridium, Klebsiella, Pseudomonas aeruginosa, and Serratia in ≥ 90% of all cigarette samples. Other pathogenic bacteria detected included Campylobacter, Enterococcus, Proteus, and Staphylococcus.   No significant variability in bacterial diversity was observed across the four different cigarette brands “.

Excerpt from press release at Eurekalert (Nov 19 2009) – All rights reserved – Copyright 2009

The title of the paper is “Human Pathogens Abundant in the Bacterial Metagenome of Cigarettes” and will be published in a forthcoming issue of the journal Environmental Health Perspectives (EHP)

It can be read online, at no cost, via this link from EHP.

News, Public Health, Epidemiology: Nutrition versus Food: Too Much or Not Enough?

This world is divided in many ways:  people who grew up around snow, people who have never even seen snow… left-handed knitters with curly hair versus balding right-handed crocheters, those who love the NY Yankees versus the Boston Red Sox, blue- or brown- or green-eyed people, cat-lovers versus dog-lovers, strict vegans versus fans of potatoes and red-meat. Those who can drive a car with 5-speed manual shift with gusto versus anyone who can’t.

There are more basic human divisions.  Those who have a great appetite and enjoy their food, including those with the means to buy (or store) all the food they could need or want.  Those with metabolic or systemic illnesses with access to lots of food but who lack the ability to chew or swallow or those who can eat but not digest their food.  Those who because of illness, medical interventions, depression or fate have lost their appetite, their sense of smell or taste, and subsequently, their interest in food.  Those in the world who, because of geographic region or socio-economic status, fail to grow up strong or thrive over the long-term due to inadequate food supplies during gestation, infancy or childhood.

Several big news item this week highlight the cumulative effects or outcomes produced by this essential element required by us all: nutrition over the lifespan (or, too much food, the wrong kind of food, food which has contaminants or toxins in it, or a general chronic scarcity of adequate nutrition).

In September 2009, The Obesity Society released a brief report on “Obesity Driving U.S. Healthcare to the Tipping Point” which recommended “four targeted interventions for effective healthcare reform”.  Below is an excerpt from the press release, which provides links to some troubling health statistics:

More than one-third of U.S. adults—over 72 million people—and 16 percent of U.S. children are now estimated to be overweight or obese.1 . Obesity and overweight are associated with several chronic health risks and conditions, including: diabetes, heart disease, stroke, hypertension, some types of cancer, sleep apnea, osteoarthritis, and gallbladder disease.2 . Furthermore, the medical costs of obesity are now estimated at more than $147 billion US dollars per year.3

Source Credit: The Obesity Society, at: http://www.obesity.org/news/pr_09082009.pdf – All rights reserved – Copyright 2009
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Contrast the troubling statistics cited above with a very different set of statistics released this month by the U.S. Department of Agriculture Economic Research Service (ERS) on the incidence of Household Food Security in the United States, 2008 (ERS Report #83).   Following is a table from this 66-page report (available online at no cost):

Image/Data: Link to http://www.ers.usda.gov/Briefing/FoodSecurity/insecurity_d.html – All rights reserved – Copyright 2009
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Next:  Published in mid-2009, a new report assesses a variety of public health measures or health outcomes for U.S. populations listed by state (including food availability and nutritional intake).  Produced cooperatively by staff from the American Public Health Association, Partnership for Prevention and the United Health Foundation, this is the 20th edition of  “America’s Health Rankings: A Call to Action for Individuals and Their Communities™”.  The 116-page report provides a historical and comprehensive view of the health of Americans, including annual rankings of each U.S. state or territory, based on data taken from 22 individual measures.  It is free, online, at this link.

There is a supplemental page from the report, about Costs of Obesity.  Data gathered in 2008 showed populations from the states of Colorado, Connecticut, Virginia, Massachusetts and Rhode Island were expected to incur the “lowest expenditures in Adult Obesity-Attributable Health Care Spending” over a ten-year reference range (a screenshot of Table 2 shown below):


Image/Data: Link to http://www.americashealthrankings.org/2009/spotlight/Cost.aspx – All rights reserved – Copyright 2009
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Finally:  a conference about global food security was held in Rome this week. The World Summit on Food Security was sponsored by the Food & Agriculture Organization (FAO) of the United Nations (Nov 16-19 2009).  One of the themes:  in 2009,  1 billion people worldwide live in a state of chronic hunger.

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For more information about available U.S. government programs about nutrition, food assistance programs (or links to other reports on U.S. food insecurity data), please visit this link on Nutrition.gov.

And if you’re of such a mind, please take the time this year to donate goods or volunteer to work at a local food bank or soup kitchen in advance of the up-coming holiday season.  There are so many families in need.

News, Public Service Announcements, Public Health: Hands Symphony and CPR Reminder

Here’s a wonderful public service announcement from

American Heart Association

Hands Symphony

AHAHandsSymphonyImage Source: http://handsonlycpr.org/symphony/ – All rights reserved – Copyright 2009

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This is an interactive visualization… choose the style of music, and click any pair of hands to create (or lessen) a full sound.  Each set of hands adds its’ own unique contribution to the ‘symphony’.

At the bottom of this page on the AHA website, there is a 1.3 minute video showing a demonstration of how to initiate and continue hands-only CPR while awaiting medical assistance.

Well-done public service announcement, American Heart Association!

News, Global Public Health, Health Disparities: 2009 Human Development Report from the United Nations

Despite progress in many areas over the last 25 years, the disparities in people’s well-being in rich and poor countries continue to be unacceptably wide, according to the Human Development Index (HDI) released today as part of the United Nation’s 2009 Human Development Report (HDR). This year’s HDI, a summary indicator of people’s well-being—combining measures of life expectancy, literacy, school enrollment and GDP per capita—was calculated for 182 countries and territories, the most extensive coverage ever.

Excerpt from a press release issued by United Nations Human Development Reports Office (Oct 5 2009)

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The latest Human Development Report by the United Nations was released on Oct 5 2009, presenting data gathered in 2007 from countries around the world. Begun in 1990, the series provides analysis of health, economic, demographic and quality of life indicators globally.  The current 229-page report is available for anyone to read or download, at no cost, at this link.

A 14-page HDR Executive Summary is the source of the three screenshots shown below:

UNHumanDevelopIndex2009

Next: An excerpt from a chart showing that Norway received the top spot out of 21 countries ranked for scores on the Health Development Index:

UNHumanDevelopment2009ReportTop21CountriesRanked

The score given to the United States declined to 13th place on the 2009 list.

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The screenshot below shows the countries with the lowest Human Development Index; Niger scored lowest in the rankings:

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UNHumanDevelopment2009ReportCountriesRankedLowest

Images – All above taken from 2009 HDR Executive Summary – http://www.undp.org/hdr2009.shtml – All rights reserved – Copyright 2009


For a list of related or archival HDR publications from the United Nations, click here.

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A couple of news stories of the day illustrate some of the background issues that may be contributing to the declining quality of life scores in the U.S.

Veteran family physician Deb Richter wrote a brief article entitled “Lack of Universal Health Care is a Mass Killer“, about the serious health consequences suffered by uninsured patients seen in her Vermont practice.  It was posted on The Progressive website on Oct 4 2009.

Guardian (UK) columnist Paul Harris wrote “Will California become America’s First Failed State?”(Sunday, Oct 4 2009 edition), examining a complex list of declining economic, public health, housing and quality of life management issues faced by residents (and elected government officials) living in the state of California.

An article from the Oct 6 2009 New York Times provides a brief description of how health care cost subsidies on a sliding scale for an estimated 46,000,000 people currently uninsured in the U.S. might operate.