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Finding evidence-based answers to clinical questions online.

You can find evidence-based answers to clinical questions quickly by searching online medical databases. The key is to be selective, on the basis of the type of information you need. Online textbooks, consensus guidelines systematic reviews, and MEDLINE are all available.

Directories as Topic↗

Influence of the Digital Anatomist Foundational Model on traditional representations of anatomical concepts.

A principled and logical representation of the structure of the human body has led to conflicts with traditional representations of the same knowledge by anatomy textbooks. The examples which illustrate resolution of these conflicts suggest that stricter requirements must be met for semantic consistency, expressivity and specificity by knowledge sources intended to support inference than by textbooks and term lists. These next-generation resources should influence traditional concept representation, rather than be constrained by convention.

Anatomy↗

NRP 2006: What you should know.

In spring 2006, the American Academy of Pediatrics (AAP) and the American Heart Association (AHA) will introduce revised materials for the Neonatal Resuscitation Program (NRP). These revisions affect the practice of neonatal resuscitation as well as the administrative components of the NRP. This article cannot address every program revision. Instead, it summarizes what prompted the program changes and then introduces the reader to guideline revisions that affect practice, as well as to changes in NRP tools and resources. The fifth edition of the Textbook of Neonatal Resuscitation is currently in press. The AAP granted permission to use material from the forthcoming edition in this article.

Algorithms↗

The conceptualisation of health and disease in veterinary medicine.

BACKGROUND: The concept of health, as well as the concept of disease, is central in veterinary medicine. However, the definitions "health" and "disease" are not generally acknowledged by veterinarians. The aim of this study was to examine how the concepts "health" and "disease" are defined in veterinary textbooks. METHODS: Veterinary textbooks in several disciplines were investigated, but only textbooks with explicit definitions of the concepts were selected for examination. RESULTS: Eighty out of the 500 relevant books within veterinary medicine were written for non-veterinarians. Eight percent of the books had an explicit definition of health and/or disease. More frequently, textbooks written for non veterinarians did have definitions of health or disease, compared to textbooks written for professionals. A division of health definitions in five different categories was suggested, namely: 1. Health as normality, 2. Health as biological function, 3. Health as homeostasis, 4. Health as physical and psychological well-being and 5. Health as productivity including reproduction. CONCLUSION: Few veterinary textbooks had any health or disease definition at all. Furthermore, explicit definitions of health stated by the authors seemed to have little impact on how health and disease are handled within the profession. Veterinary medicine would probably gain from theoretical discussions about health and disease.

Disease↗

Information-seeking strategies and differences among primary care physicians.

Differences in the sources of information that physicians utilize in their practice have several implications for the quality of care delivered and the dissemination of medical information. In order to examine the extent of differences in information preferences in primary care settings, 98 general internal medicine physicians and 73 family physicians were asked to indicate which of six alternative information sources they relied on most when faced with difficult medical problems. The alternatives were: journals, textbooks, informal consultations with colleagues, consultations with community specialists, consultations with outside specialists, and transfer of the patient to another physician. The results indicated that primary care internists have a greater preference for consulting the medical literature, while family physicians more often rely on colleagues and specialists as sources of information. These differences suggest that the focus of information dissemination through journals or textbooks may be more effective for internists, while colleagues or "educationally influential" physicians in the community may be more effective vehicles for information dissemination to family physicians.

Choice Behavior↗

Not committing barbarisms: Sherrington and the synapse, 1897.

The word synapse first appeared in 1897, in the seventh edition of Michael Foster's Textbook of Physiology. Foster was assisted in writing the volume on the nervous system by Charles Sherrington, who can be credited with developing and advocating the physiological concept of a synapse. The word itself however, was derived by a Cambridge classicist, Arthur Verrall.

History, 19th Century↗

Medical textbook summarization and guided navigation using statistical sentence extraction.

We present a method for automated medical textbook and encyclopedia summarization. Using statistical sentence extraction and semantic relationships, we extract sentences from text returned as part of an existing textbook search (similar to a book index). Our system guides users to the information they desire by summarizing the content of each relevant chapter or section returned in the search. The summary is tailored to contain sentences that specifically address the user's search terms. Our clustering method selects sentences that contain concepts specifically addressing the context of the query term in each of the returned sections. Our method examines conceptual relationships from the UMLS and selects clusters of concepts using Expectation Maximization (EM). Sentences associated with the concept clusters are shown to the user. We evaluated whether our extracted summary provides a suitable answer to the user's question.

Abstracting and Indexing↗

Religion and spirituality defined according to current use in nursing literature.

The nursing literature published from 1963 to 1989 was screened for definitions to distinguish the concept of religion from that of spirituality. Following concept analysis procedures, definitions were selected from journal articles and textbooks and the key words in the definitions were listed in order of frequency. In definitions of religion, six words appeared most frequently--system, beliefs, organized, person, worship, practices; in definitions of spirituality, nine words appeared most frequently--personal, life, principle, animator, being, God (god), quality, relationship, transcendent. Only the word person(al) appeared on both lists. Using these two lists, the words (defining attributes) that appeared most frequently were formed as consensus definitions. It was concluded that spirituality is currently the broader term and may subsume aspects of religion. If these concepts are not clearly defined, the care related to personal life principles, relationships, and transcendent experiences may be confused with care for personal beliefs and worship practices.

Holistic Health↗

A definition of prosthetic dentistry.

PURPOSE: A more precise and up-to-date definition of prosthetic dentistry is warranted. The aim of the present review is to present a new core definition of the discipline on the basis of a discussion of existing definitions. MATERIALS AND METHODS: Clinical textbooks in prosthetic dentistry and dental implantology, as well as medical and dental glossaries were reviewed. RESULTS: Two main categories of definitions of prosthetic dentistry were identified: first, definitions that emphasized the technologic aspects of the discipline, i.e., the fabrication of prostheses; and second, definitions that incorporated some reference to the objectives or aims of prosthetic treatment, i.e., the restoration of one or more aspects of oral function. Slightly more than half of the citations contained such aim-related references, and this aspect tended to be most pronounced in recent publications. CONCLUSION: The following definition is ventured: prosthodontics is the discipline of dentistry concerned with the consequences of congenital absence or acquired loss of oral tissues and with the methods for and assessment whether more good than harm is done by inserting artificial devices made from alloplastic materials.

Humans↗

Academic performance and comparative effectiveness of computer- and textbook-based self-instruction.

We intended to clarify the influence of student academic ability on the effectiveness of CAI, using data of a study to assess the effectiveness of a new type of CAI software, cyberPatient (CP), at Kochi Medical School (KMS). A total of 59 third-year students were randomly assigned to four groups: Group-1 used a textbook for self-instruction, Group-2 used CP, Group-3 used both types of learning materials, and Group-4 did not learn. Learning performance was evaluated by multiple-choice examination and OSCE. In order to clarify the influence of students' academic ability on the effectiveness of CAI, statistical analyses were conducted, assigning students as either high or medium or low performance students. High performance students from Group-1, -2 and -3 did not differ significantly in test performance after self-instruction. However, low performance students in Group-1 scored significantly lower than those in Group-2 and -3. All students in Group-2 and -3 reported that CP stimulated willingness to learn and assisted understanding. The present analysis suggested that effectiveness of CAI might be associated with the academic ability of students.

Computer-Assisted Instruction↗

Neurologic examination in stroke rehabilitation: adequacy of its description in clinical textbooks.

Medical textbooks were reviewed to establish how well they presented those aspects of examination of the nervous system which are important in stroke rehabilitation. In addition, information was sought concerning such factors as the presence of instructions for the examiner and patient, grading and interpretation of results, and the importance of observer variation which can influence results of periodic neurologic examination of stroke patients. Study results demonstrated that the description of the neurologic examination which should be used in stroke rehabilitation was often incomplete and poorly defined. Material provided little interpretation for the physical signs which might be found. Factors which might influence results of periodic examination of the nervous system in stroke patients received little attention. There is an urgent need to develop a standardized form of clinical examination to meet the needs of practitioners who assess neurologic status in stroke rehabilitation.

Books↗

Methods in informatics: using data derived from a systematic review of health care texts to develop a concept map for use in the neonatal intensive care setting.

A qualitative systematic review of textbooks and clinical guidelines identified assessment criteria for initiation of nipple feeds in premature infants cared for in the neonatal intensive care unit (NICU) setting. Using a structured method for text source selection and data extraction, 43 health care texts were systematically reviewed yielding 153 separate statements related to assessing premature infants' feeding readiness. Following this procedure, a pile sort method was conducted wherein an expert neonatal nurse practitioner (NNP) grouped the statements according to similarity in meaning. Ten piles of terms emerged from this process. Each pile was "named," depicting discrete components used when assessing premature infants' readiness for nipple feeding. Using these public data and the private knowledge of the NNP informant, a concept map was constructed to illustrate a framework for decision support development and to examine the map's usefulness for structuring knowledge that will provide input to an intelligent decision support system.

Computational Biology↗

The Edwin Smith Surgical Papyrus.

The Edwin Smith Surgical Papyrus is undoubtedly one of the most significant medical texts ever discovered. It is of particular interest to neurosurgeons because of its specific references to ancient neurosurgical cases and is the first written record of many terms of neurosurgical interest. This review describes the colorful and controversial history of the Edwin Smith Papyrus and gives translations of four cases of neurosurgical interest.

Archaeology↗

Content of care by independent midwives: assistance with pain in labor and birth.

The proliferation of alternative health care systems in the United States raises numerous policy issues involving (1) those providing and receiving alternative services and (2) the established medical care system. This paper identifies some of these issues by examining an alternative system of independent (lay) midwifery and, in particular, midwifery approaches to pain during uncomplicated labor and birth. The paper summarizes medical care system approaches to pain in labor and birth: leading textbooks, prevailing topics in the journal literature, and empirical research reports are consistent in giving primary emphasis to analgesic and anesthetic drugs, accepting childbirth preparation, and questioning the efficacy of other approaches. The practices of independent midwives working in metropolitan areas of Utah are strikingly different. The midwives, who oppose any use of conventional obstetric pain medications, have a diverse repertoire of alternative approaches, including prenatal preparation, various physical manipulations, hydrotherapy, administration of herbs and nutritive substances, breathing and relaxation techniques, and psychological techniques. The midwives emphasize responsiveness to the needs of a particular woman at a particular time. They enhance and mobilize the resources of the mother and her support network for therapeutic ends. Their work emphasizes innovation and exploration. Relative to medical practices, midwifery practices seem to involve low iatrogenic risks, to be cost-effective, and to be appreciated by those seeking empowerment and minimal intervention in childbirth. It is recommended that these practices be formally evaluated for safety, efficacy, consumer acceptability, cost-effectiveness, and their potential for favorable impact on the practice of medical obstetrics.

Adult↗