Biomedical subjects

Lori J Toedter

Publications and source records attributed to Lori J Toedter.

4 recordsLinked to original sources

PubMed2005

Zero-based print journal collection development in a community teaching hospital library: planning for the future.

OBJECTIVES: The paper describes and evaluates the success of a zero-based collection development approach to print serials in a community teaching hospital. METHODS: The authors first assessed the environmental factors that would determine future needs of the medical library and its customers. Liaisons to various departments and constituencies were substantially involved in the data-gathering phase. Using newly defined collection parameters, a list of journals to consider was compiled and each journal was categorized justifying its inclusion. Any title not having a strong fit in at least one category was eliminated from further consideration. RESULTS: Overall, 21 subscriptions were cancelled and 34 were added. Despite a 15% increase in total subscription costs, mostly due to normal annual journal price increases, the average cost per journal went down from $344 to $327. Journal usage went up over 30%, interlibrary loan lending went down 25%, and borrowing went up 20%. CONCLUSION: As resources available to libraries decline, it becomes critical that collections and services are continually and systematically reviewed with a view to keeping them aligned with the mission of the organization, needs of the customers, and emerging trends. Zero-based collection development can be a valuable tool in bringing a print journal collection into closer alignment with the needs of library customers.

Budgets↗

PubMed2004

Training surgeons to do evidence-based surgery: a collaborative approach.

BACKGROUND: Three of the Accreditation Council for Graduate Medical Education general competencies contain specific wording indicating that trainees must learn how to locate, appraise, and integrate the best information from the literature into their patient care practices. What is less clear is how to best translate evidence-based concepts into the workday of the resident, fellow, or attending surgeon. In this article we describe our use of the assignment-based training program we developed to ensure that our trainees can actually do what is required to practice evidence-based operations. STUDY DESIGN: Our collaborative program draws on the expertise of an attending surgeon, a medical librarian, and a research coordinator. The curriculum is designed so that all residents in our program develop and refine their evidence-based surgery skills in a context relating to their clinical practice. They are given a practice-related clinical question and are asked to demonstrate their competence in finding the best available evidence to answer it. This involves restating the question as a well-formulated clinical question, doing a focused literature search, critically appraising the results to find the best evidence, and integrating the information into practice, if appropriate. Search assignments are evaluated using a structured form and additional training is designed based on the results. Another question is then assigned to assess improvement. RESULTS: Residents' performance on a first assignment showed specific weaknesses in use of textwords and limiters. Performance was strongly related to a resident's ability to obtain the best evidence in answer to a clinical question (p = 0.011). Substantial improvement was shown on a second assignment after additional training. CONCLUSIONS: Our hands-on, performance-based program allows us to document trainees' progress in developing skills that will allow them to efficiently locate the best evidence available to inform their patient care decisions.

Curriculum↗

PubMed2003

The impact of ectopic pregnancy: a 16-year follow-up study.

Ectopic pregnancy is a potentially life-threatening event that represents the loss of a pregnancy and also may have longer-term consequences for fertility. Despite this triple threat to a woman's well-being, almost no systematic research exists on the psychological impact of ectopic pregnancy. We sought to reinterview 18 women who had been interviewed 2 months following an ectopic pregnancy as part of a longitudinal study of pregnancy loss 16 years previously. Thirteen of these women responded to questions about the long-term impact of the ectopic pregnancy on their lives in the intervening years. For many of the women, the ectopic pregnancy was a traumatic experience that impaired their fertility, strained their marriages, and led to a crisis of faith. Yet, despite the trauma of the event, overall the women found ways to interpret it positively and to use it as a source of meaning in their lives.

Adaptation, Psychological↗

PubMedDate not supplied

Ruptured abdominal aortic aneurysm and quality of life.

This study was undertaken to examine the community hospital experience in managing ruptured abdominal aortic aneurysm, and to assess the quality of life in survivors of the abdominal aortic aneurysm procedure. Study parameters included a retrospective chart review with prospective follow-up at a 369-bed, university-affiliated, community teaching hospital. Eighty-one consecutive patients undergoing surgery for ruptured abdominal aortic aneurysm between 1991 and 2000 were included. Main outcome measures included mortality and quality of life, as assessed by the SF-36 health survey. The overall perioperative mortality rate was 34.6%, significantly less (p < 0.005) than the 50% mortality rate reported in the literature. Predictor variables significantly related to mortality were age (p < 0.002), preoperative creatinine (p < 0.026), use of suprarenal clamp (p < 0.0001), acute renal failure (p < 0.0001), myocardial infarction (p < 0.0001), respiratory failure (p < 0.0001), and tobacco use (p < 0.05). Multiple regression analysis found that three predictor variables--myocardial infarction, respiratory failure, and use of a suprarenal clamp--predicted 25% of the variability in mortality (p < 0.0001). The quality-of-life analyses showed that the majority of the patients for whom follow-up data could be obtained (n = 26), reported the same or better quality of life compared to SF-36 norms for age-matched individuals. Results from this community hospital sample suggest that ruptured abdominal aortic aneurysm repair can be accomplished in this setting with an acceptable survival rate, and subsequent quality of life that meets or exceeds that of an age-matched sample.

Age Factors↗