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Study of the Information Dissemination Service--Health Sciences Library, State University of New York at Buffalo.

The Information Dissemination Service at the Health Sciences Library, State University of New York at Buffalo, was established June 1970 through a three-year grant from the Lakes Area Regional Medical Program, Inc. Analysis of two samples of user request forms yielded results which significantly substantiate findings in prior biomedical literature utilization studies. The findings demonstrate comparable utilization patterns by user group, age of material, journal titles, language, time to process request, source of reference, and size of institution.

Books

The dissemination of new medical information.

Dissemination of new medical information to the practicing physician is a complex and often faulty process. To examine the magnitude of this problem, we surveyed primary care physicians to determine their knowledge of the results of the cooperative trial of photocoagulation in diabetic retinopathy. Despite the acknowledge relevance to their practice, only 28% (38/137) of family physicians and 46% (42/91) of internists were aware of the study results (P less than .001). Respondents were asked to manage two patient problems involving diabetic retinopathy. Only 33% (75/229) handled both correctly, although the retinopathy photocoagulation study had been published 18 months earlier. These findings indicate that results from clinical trials may not be disseminated to practicing physicians and, therefore, not incorporated into practice. Greater attention should be directed toward making findings from clinical trials available to practitioners.

Diabetic Retinopathy

Comparison of media for dissemination of information about cancer in rural communities.

A study was done in Orangeburg County, South Carolina, to compare the effectiveness of the various mass media--television, radio, and newspaper--for the dissemination of educational material about cancer. Effectiveness of these media in reaching certain subpopulations defined by race, sex, income, and population density was also examined. The newspaper was found to be generally more effective than other media. This superiority held for almost all subpopulations. Furthermore, it was found that certain subpopulations differed from others in the extent to which they were reached by a particular medium.

Adult

Drug information centres: new role for pharmacists?

In the last few decades there has been a great increase in the number of new drugs available for general use. In consequence, drug information centres have been developed, particularly in U.S.A., to disseminate information on the uses, toxicity and cost of these drugs. Such centres have been slower to appear in the United Kingdom, with the exception of certain specialised centres, e.g. Poisons Information Bureaux. The present report describes the development of a drug information centre in Glasgow and gives preliminary data on its use during the last year. It is proposed that such centres provide a valuable aid in encouraging rational drug use particularly in hospitals. The centres may be run by a variety of interested personnel but in our view the professional group most likely to fill this role adequately is hospital pharmacists.

Drug Information Services

The drug lag: an interpretive review of the literature.

This articel reviews the literature pertinent to the "drug lag" issue, in order to evaluate the evidence underlying the thesis that the U.S. has suffered from a slow-down in the rate and timing of new drug introductions, to the detriment of patients, because of the stricter requirements since 1962 regarding proof of safety and efficacy for new drugs. Comparing the post-1962 record in the U.S. with (a) the U.S. record before 1962 and (b) the post-1962 record in other, mainly Western European, countries, the weight of evidence and argument falls on the side of those who see a lag existing in the U.S. Other evidence, more subjective, supports the view that this lag imposes net positive costs on U.S. patients. However, it is not clear that the 1962 Drug Act is the sole, or even the main, cause of the lag. Instead, the drug information system and its inefficiencies emerge as the fundamental reason for the existence of a lag; hence, changes in the administration of the law by the Food and Drug Administration and greater efficiency by companies in supporting New Drug Applications can help close the gap, but probably only in minor degree. The solution to the lag problem lies in formulating and implementing a drug information system that quickly and accurately gathers, interprets, and disseminates information on the positive and negative effects of newly introduced drugs; with such a system, protection of drug users from undue risk is compatible with a greater rate and more rapid appearance of new drug discoveries.

Drug Industry

The regional drug information service: a factor in health care?

Most regional health authorities throughout the United Kingdom have established drug information units to provide health service staff with a wide range of information about drugs and drug use. The units, which are staffed by drug information pharmacists, provide their service mainly by answering inquiries, although some disseminate information more positively through lectures and bulletins.An analysis of inquiries received by regional information units during 1976 showed that most were submitted by hospital doctors or pharmacists; comparatively few were received from general practitioners. Topics of inquiry included adverse effects of drugs, source of supply and identification, current treatment, dosage, route, precautions, and pharmaceutical problems such as stability or formulation of drug preparations. A more detailed analysis of the inquiries received by the North-western Regional Drug Information Service at Manchester over three years showed that the number of inquiries gradually increased and that more were received from general practitioners after a programme of lectures had been introduced to tell them about the service. The North-western service also received more requests from hospital pharmacists than other units, though many originated from clinicians.The regional drug information units consulted widely with clinical and other specialists in answering questions, but about a quarter of all inquiries were pharmaceutical, relating to stability and incompatibility. A multidisciplinary approach therefore seems necessary to provide a comprehensive and advisory drug information service.

Community Health Services

The future role of communications in psychopharmacological research and practice.

1. Communication of psychopharmacologic data is seen as a system whose structure should be determined by efficient information dissemination. Suggestions are made to improve the efficiency. 2. The author suggests ways to improve information accessibility for auxiliary medical personnel, medical personnel and for basic researchers. 3. The International Reference Centre for Information on Psychotropic Drugs is discussed with reference to a weakness in its function and corrective suggestions.

Communication

Donors and nondonors: communication and information.

Donors and nondonors from six states were surveyed to determine differences in: 1) socioeconomic and demographic characteristics, 2) knowledge about blood donation, 3) access to information about donating, and 4) motivation to donate. The findings indicate that the present donor pool consists largely of socioeconomically advancing young adults. There was little difference between donors' and nondonors' knowledge of the donating process and access to mass media-disseminated information about blood donation. Nondonors receive more information about donating from friends than do donors and interpersonal influence is an effective means of donor recruitment. The use of motivators other than humanitarianism may also be useful for inducing volunteer donations. Nondonors do lack knowledge about the location of local collection facilities. The present sample is socioeconomically and demographically representative of the U.S. adult population. As such, it provides information useful for developing effective donor recruitment strategies.

Blood Banks

Cultural perceptions and nutritional disorders: a Jamaican case study.

This case study brings out differences in the way protein-calorie malnutrition (PCM) in Jamaica is regarded by women who use medical services, women who do not, indigenous health practitioners, and trained health workers. The study reveals that women who utilize modern health clinics are able to identify appropriate techniques for reducing a child's susceptibility to PCM. But women who rely on indigenous medical services, as well as the actual providers of such services, frequently misdiagnose PCM as a "marasmi cold" and treat it as such. This treatment often involves actions which decrease the child's resistance to nutrition-related disorders. Both groups of women, and also the indigenous practitioners, provided more information about marasmus than about kwashiorkor, and often identified the latter as a form of robust good health. All of the mothers believed that improper prenatal and postnatal care would increase a child's susceptibility marasmus, although some mothers did not associate the condition with nutritional deficiency. These and other findings are used to recommend ways of organizing and disseminating information about PCM to the public at large. Such educational efforts should emphasize that food is a prime etiological and therapeutic factor, and that the quality and quantity of foods influence a child's susceptibility to PCM. Education programs, however, need not attempt to change indigenous practices which are neutral or harmless; ideas about PCM which parallel rather than conflict with traditional beliefs may stand the best chance of altering PCM incidence. It is also recommended that influential family members and native practitioners such as the nana be enlisted as local sources in the effort to provide health information about PCM.

Attitude to Health

Profile: the voluntary council for handicapped children.

The Voluntary Council for Handicapped Children is an independently elected Council, established under the aegis of the National Children's Bureau in 1975. The Council arose from a recommendation in the Eileen Younghusband Working Party's report, Living with Handicap, in 1970. This major report draws attention to the gaps, overlaps and general lack of co-ordination and information about services for handicapped children. It recommended the creation of a genuinely multidisciplinary council to provide a forum for joint discussion and action, to offer a comprehensive advisory and information service covering all aspects of childhood disability. The Voluntary Council for Handicapped Children is unique in providing a comprehensive service for all categories of handicap, and for statutory and voluntary agencies. Parents and professionals can use the Council as a resource centre on an individual basis, although casework cannot be provided. The role of the Council is essentially that of a signpost to existing resources. It is, in effect, an advisory body collecting, evaluating and disseminating information, promoting study and discussion by organizations and individuals and seeking to identify gaps in present services.

Child

The controversy over change.

The full impact of twentieth century technology upon medical libraries was first felt in the late 1950s and early 1960s with the introduction of electronic automation into library methodology. During those years, often the aura of technology for the sake of technology prevailed, and medical librarians did little to inform themselves of capabilities, potentialities, and limitations in relation to cost-effective library usage of automation. Likewise, currently microforms and audiovisuals are frequently acquired for their own sake instead of for their capacity to transmit messages in the most effective and comprehensive way possible. Controversy has raged and still rages over the pros and cons of applying modern technology to library procedures and over the coexistence of the printed page with electronic media. New systems and methodologies, machine or manual, must realistically be evaluated in terms of increased service output by the library to its clientele. Regardless of technological sophistication, any machine that does not significantly contribute to that specific aim has no place in a library. The tradition of the medical librarian has always been to collect, organize, store, and disseminate information in the most efficient manner that the media of the times have had to offer.

Audiovisual Aids

Solid tumor models for the assessment of different treatment modalities: VIII. The scheduling of treatment for a chemotherapeutically resistant experimental solid tumor.

Single, large doses of adriamycin, cyclophosphamide and 5-fluorouracil (5-FU) have been compared to the same amount of drug given in divided doses daily over a 3 or 5 day period in a solid tumor model which metastasizes to the regional lymph nodes and lungs. No significant increase in life expectancy occurred following adriamycin or cyclophosphamide. However, a significant reduction in life expectancy occurred after 5 fractionated doses of 5-FU but not after the large single dose. The increase in mortality following fractionated doses of 5-FU is attributed to the prolongation of the onset of recovery of bone marrow. Tumor volume reduction following a single dose of each agent was equal to or greater than the fractionated doses. The results of these studies on this chemotherapeutically resistant solid tumor indicate that small daily fractionated doses of adriamycin, cyclophosphamide or 5-FU result in increased morbidity and mortality without therapeutic benefit in tumor control. The time sequence of recovery of the limiting organ of the host (i.e., bone marrow) is similar to the time sequence of recovery of the tumor. Large intermittent single doses of chemotherapeutic agents given following recovery of the host from a previous treatment would be expected to be less toxic to the host and equally effective in control of tumor growth. None of the 3 chemotherapeutic agents was successful in tumor eradication. Previous studies of this series have shown that the utilization of sequential chemotherapy combined with radiotherapy can be successfully used for eradication of another solid tumor which did not metastasize. A similar therapeutic strategy using sequential combined modality therapy should also be effective in the control of the primary H-4-II-E tumor as well as its metastatic dissemination. Information gained from these experimental studies should eventually provide information which should be helpful in the clinical management of chemotherapeutically resistant solid tumors in man.

Animals

Disease-surveillance and decision-making after the 1976 Guatemala earthquake.

In the first 3 weeks after the 1976 earthquake in Guatemala a system for collecting, analysing, and disseminating information of medical importance was instituted in the disaster area. Data on cases of selected diseases, number of available hospital beds, and medical supplies were collected, and reported epidemics were investigated. The system functioned well despite the limited numbers of trained personnel. Collection and analysis were quick enough for data to be used immediately in decision-making. No epidemics of communicable diseases were observed in the affected area. The number of dog bites in Guatemala City increased but no cases of rabies were reported. The success of the surveillance system in Guatemala suggests that immediate use of epidemiological methods should be an integral part of disaster relief.

Animals