Gurpreet K. Rana

A controlled comparison study of the efficacy of training medical students in evidence-based medicine literature searching skills.

Purpose Many educational programs seek to develop skills in evidence-based medicine (EBM). The authors examined the efficacy of teaching the EBM skill of efficiently searching the research literature. They compared students who received brief training in EBM searching skills with those who did not, and assessed the quality of literature searching one month after that training. Method The authors used a nonrandomized control group study design to quantify the impact of a single, brief (two-hour) instructional intervention on EBM-based techniques for searching Medline for evidence related to a clinical problem provided to the students. Ninety-two fourth-year medical students (34 intervention, 58 control) at the University of Michigan participated in a four-week EBM elective between 2001 and 2003. The authors conducted a preintervention assessment of searching skills, followed by a repeat assessment one month after the intervention. Search quality was judged by medical librarians using a structured clinical scenario and scoring algorithm. Results Data for 30 intervention and 40 control students could be analyzed. Intervention students had fewer search errors and correspondingly higher quality searches than did control students. The educational intervention accounted for approximately 8% of the variance in both of these outcomes. The most common search errors were a lack of Medical Subject Headings (MeSH) explosion, missing MeSH terms, lack of appropriate limits, failure to search for best evidence, and inappropriate combination of all search concepts. Conclusions This study provides evidence that a single, brief training session can have a marked beneficial effect on the quality of subsequent, short-term EBM literature searching performance outcomes.

Mobile Health Devices as Tools for Worldwide Cardiovascular Risk Reduction and Disease Management

We examined evidence on whether mobile health (mHealth) tools, including interactive voice response calls, short message service, or text messaging, and smartphones, can improve lifestyle behaviors and management related to cardiovascular diseases throughout the world. We conducted a state-of-the-art review and literature synthesis of peer-reviewed and gray literature published since 2004. The review prioritized randomized trials and studies focused on cardiovascular diseases and risk factors, but included other reports when they represented the best available evidence. The search emphasized reports on the potential benefits of mHealth interventions implemented in low- and middle-income countries. Interactive voice response and short message service interventions can improve cardiovascular preventive care in developed countries by addressing risk factors including weight, smoking, and physical activity. Interactive voice response and short message service–based interventions for cardiovascular disease management also have shown benefits with respect to hypertension management, hospital readmissions, and diabetic glycemic control. Multimodal interventions including Web-based communication with clinicians and mHealth-enabled clinical monitoring with feedback also have shown benefits. The evidence regarding the potential benefits of interventions using smartphones and social media is still developing. Studies of mHealth interventions have been conducted in >30 low- and middle-income countries, and evidence to date suggests that programs are feasible and may improve medication adherence and disease outcomes. Emerging evidence suggests that mHealth interventions may improve cardiovascular-related lifestyle behaviors and disease management. Next-generation mHealth programs developed worldwide should be based on evidence-based behavioral theories and incorporate advances in artificial intelligence for adapting systems automatically to patients’ unique and changing needs.

Information Technology and Cancer Prevention

Information technology is rapidly advancing and making its way into many primary care settings. The technology may provide the means to increase the delivery of cancer preventive services. The aim of this systematic review is to examine the literature on information technology impacts on the delivery of cancer preventive services in primary care offices. Thirty studies met our selection criteria. Technology interventions studied to date have been limited to some type of reminder to either patients or providers. Patient reminders have been mailed before appointments, mailed unrelated to an appointment, mailed after a missed appointment, or given at the time of an appointment. Telephone call interventions have not used technology to automate the calls. Provider interventions have been primarily computer‐generated reminders at the time of an appointment. However, there has been limited use of computer‐generated audits, feedback, or report cards. The effectiveness of information technology on increasing cancer screening was modest at best. The full potential of information technology to unload the provider‐patient face‐to‐face encounter has not been examined. There is critical need to study these new technologic approaches to understand the impact and acceptance by providers and patients.

Complement Activation in Emergency Department Patients With Severe Sepsis

OBJECTIVES This study assessed the extent and mechanism of complement activation in community-acquired sepsis at presentation to the emergency department (ED) and following 24 hours of quantitative resuscitation. METHODS A prospective pilot study of patients with severe sepsis and healthy controls was conducted among individuals presenting to a tertiary care ED. Resuscitation, including antibiotics and therapies to normalize central venous and mean arterial pressure (MAP) and central venous oxygenation, was performed on all patients. Serum levels of Factor Bb (alternative pathway), C4d (classical and mannose-binding lectin [MBL] pathway), C3, C3a, and C5a were determined at presentation and 24 hours later among patients. RESULTS Twenty patients and 10 healthy volunteer controls were enrolled. Compared to volunteers, all proteins measured were abnormally higher among septic patients (C4d 3.5-fold; Factor Bb 6.1-fold; C3 0.8-fold; C3a 11.6-fold; C5a 1.8-fold). Elevations in C5a were most strongly correlated with alternative pathway activation. Surprisingly, a slight but significant inverse relationship between illness severity (by sequential organ failure assessment [SOFA] score) and C5a levels at presentation was noted. Twenty-four hours of structured resuscitation did not, on average, affect any of the mediators studied. CONCLUSIONS Patients with community-acquired sepsis have extensive complement activation, particularly of the alternative pathway, at the time of presentation that was not significantly reversed by 24 hours of aggressive resuscitation.

Creating a charter of collaboration for international university partnerships: the Elmina Declaration for Human Resources for Health.

The potential of international academic partnerships to build global capacity is critical in efforts to improve health in poorer countries. Academic collaborations, however, are challenged by distance, communication issues, cultural differences, and historical context. The Collaborative Health Alliance for Reshaping Training, Education, and Research project (funded by the Bill and Melinda Gates Foundation and implemented through academic medicine and public health and governmental institutions in Michigan and Ghana) took a prospective approach to address these issues. The project had four objectives: to create a “charter for collaboration” (CFC), to improve data-driven policy making, to enhance health care provider education, and to increase research capacity. The goal of the CFC was to establish principles to guide the course of the technical work. All participants participated at an initial conference in Elmina, Ghana. Nine months later, the CFC had been revised and adopted. A qualitative investigation of the CFC’s effects identified three themes: the CFC’s unique value, the influence of the process of creating the CFC on patterns of communication, and the creation of a context for research and collaboration. Creating the CFC established a context in which implementing technical interventions became an opportunity for dialogue and developing a mutually beneficial partnership. To increase the likelihood that research results would be translated into policy reforms, the CFC made explicit the opportunities, potential problems, and institutional barriers to be overcome. The process of creating a CFC and the resulting document define a new standard in academic and governmental partnerships.

A validated search assessment tool: assessing practice-based learning and improvement in a residency program

OBJECTIVE The objective of this study was to validate an assessment instrument for MEDLINE search strategies at an academic medical center. METHOD Two approaches were used to investigate if the search assessment tool could capture performance differences in search strategy construction. First, data from an evaluation of MEDLINE searches from a pediatric residents longitudinal assessment were investigated. Second, a cross-section of search strategies from residents in one incoming class was compared with strategies of residents graduating a year later. MEDLINE search strategies formulated by faculty who had been identified as having search expertise were used as a gold standard comparison. Participants were presented with a clinical scenario and asked to identify the search question and conduct a MEDLINE search. Two librarians rated the blinded search strategies. RESULTS Search strategy scores were significantly higher for residents who received training than the comparison group with no training. There was no significant difference in search strategy scores between senior residents who received training and faculty experts. CONCLUSION The results provide evidence for the validity of the instrument to evaluate MEDLINE search strategies. This assessment tool can measure improvements in information-seeking skills and provide data to fulfill Accreditation Council for Graduate Medical Education competencies.

One Institution's Experience in Transforming the Health Sciences Library of the Future

Recognizing a need to be more relevant to its constituents, and aligned with institutional priorities, the Taubman Health Sciences Library redefined its mission, roles, and space. This transformation facilitated innovative, team-based collaborations within the health sciences community and the addition of new roles and responsibilities in academic and clinical engagement, research and informatics, enabling technologies, community outreach, and global health. Library space is being redesigned, and a branch library dedicated to interdisciplinary partnerships has been established. Information gained from this experience will be useful to other libraries faced with budget, resource, and staffing challenges and will offer practical ideas for becoming more integrated into the academic, research, and clinical work of the health sciences enterprise.

Librarian Integration in a Four-Year Medical School Curriculum: A Timeline

The Taubman Health Sciences Library (THL) is integrated in all four years of the University of Michigan Medical School (UMMS) curriculum. Information resources are introduced at strategic points throughout the curriculum so that students receive training at times when they are most likely to need the resource. Most of the core instruction sessions are taught in teams that consist of librarians and UMMS faculty, which provides unique learning opportunities for students. This article describes each THL instruction activity in the four-year undergraduate UMMS curriculum and provides commentary on the overall effectiveness of this integrated approach to instruction.

Diabetes Prevention Interventions in Latin American Countries: a Scoping Review.

Public policies, population health initiatives, and targeted behavioral change interventions for individuals at risk for developing diabetes are all essential for diabetes prevention in Latin American countries (LACs). This scoping review examines (1) the current evidence on diabetes prevention policies and interventions in LACs to identify components of effective diabetes prevention models in those countries and (2) effective diabetes prevention interventions targeting Latino populations in the USA to explore possible lessons from these interventions for LACs. Diabetes prevention programs in LACs evaluated to date consist of short-term health professional-led face-to-face behavioral counseling sessions. Intervention components of US-based programs for Latinos that might benefit diabetes prevention programs in Latin America include (1) deployment of community health workers (“promotoras”) for diabetes screening and delivery of lifestyle modification programs, (2) multiple modes of program delivery beyond face-to-face sessions, (3) information technology to automate and enhance program delivery, (4) leveraging of pre-existing familial relationships to engage in and sustain lifestyle modifications, and (5) innovative environmental change strategies such as collaborations with local food stores and markets to promote healthy behaviors.

Mlibrary: Concepts for Redefining Reference

ABSTRACT Readily available reference services have been a key component of the University of Michigan Librarys (MLibrary) success in supporting and advancing campus research, teaching, and learning. An examination of the evolution of our reference services over the past 10 years suggests strategies and innovative approaches that may well inform future service directions. The purpose of this article is to capture the University of Michigan experience as a way to better understand this evolution and, in doing so, to offer critical concepts to consider when thinking about the development of current and future reference services.