Info.Rx Cases: Clinical queries, various

Thursday, September 23, 2010

Clinical queries, various

Lately the Clinical Medical Librarianship (CML) component of the service has been giving me a lot of interesting opportunities to support practice at the clinic. Often clinicians are faced with conflicting evidence, or their patients read something in the news and they need to be able to respond (Check out What Your Patient Reads, developed by the University of Manitoba Health Sciences Libraries).

I thought I would share a few of the topics I've worked on recently that go beyond the usual 5 min clinical question:

Evidence for and against PSA screening for prostate cancer. I put together a fairly extensive annotated bibliography which I would be happy to share with anyone who contacts me. Included in the bibliography:
- Incidence/mortality statistics for Canada & US
- Most recent studies & guidelines 2006-2010 (International)
- Decision aids and evidence to support their use
Evidence to support, or dispute, what has been in the news lately re: calcium supplements and heart disease:
- Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis BMJ July 2010, doi:10.1136/bmj.c3691
- Systematic Review: Vitamin D and Cardiometabolic Outcomes Annals of Internal Medicine May 2010
- Systematic review: Vitamin D and calcium supplementation in prevention of cardiovascular events. Ann Intern Med. 2010 Mar 2;152(5):315-23.
- Vitamin D and calcium: a systematic review of health outcomes. Evid Rep Technol Assess (Full Rep). 2009 Aug;(183):1-420.
- Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial BMJ Jan 2008, doi: 10.1136/bmj.39440.525752.BE
Association between accutane & ulcerative colitis?
- Isotretinoin use and the risk of inflammatory bowel disease: a case-control study Am J Gastroenterol. 2010 Sep
- Isotretinoin and intestinal inflammation: what gastroenterologists need to know Review, Gut 2009, doi:10.1136/gut.2008.170530
- Isotretinoin is not associated with inflammatory bowel disease: a population-based case-control study Am J Gastroenterol Nov 2009
- A causal association between isotretinoin and inflammatory bowel disease has yet to be established Review, Am J Gastroenterol Oct 2009,
- Possible association between isotretinoin and inflammatory bowel disease Am J Gastroenterol July 2006

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About Info.Rx

Update:

In the fall of 2008 a Clinical Medical Librarianship component was added to the service. The librarian now acts as a resident supervisor in the teaching rooms at the clinic one half-day per week, providing support for clinical decision-making in addition to continued support for patient education.

The service is based on an innovative InformationRx model first implemented in the UK (see: Early experience of the
contribution of an information specialist within a primary
healthcare team: a partnership venture between
library and healthcare services, doi: 10.1177/0961000604048915].

This model sees the information professional acting as a member of the health care team by providing informational/instructional support for patients/families and health professionals at point of care. Support for the service is provided by the main hospital library and is vital for ensuring long term sustainability.

The information professional is available 7 hrs per week to consult with patients/families that are in need of health information.

Health staff are encouraged to write InformationRx for patients which can then be filled by the information professional. Consultations with patients are treated as clinical encounters and are documented in the charts. The service has a clinic in the Centre's appointment scheduling software.

Patients and family members are welcome to drop in, or to submit questions by phone or email at their convenience. They can schedule appointments by contacting the information professional directly or by calling their team coordinator.

The library provides support by welcoming questions from patients and their families when the coordinator is not available. Herzl patients and families are able to borrow books from the Patient and Family Resource Centre's (PFRC) print collection, and a family medicine section has been created on the PFRC website which provides links to reliable and up-to-date consumer health resources.

About this blog

The Patient health Information Service at Herzl (H-PHIS) opened its doors in early July of this year (2007) and is in the early developmental stages. The challenges faced by myself (the service's coordinator), the staff, and the health care team at the HFPC are many and varied, as is to be expected when implementing a new and innovative service.

Perhaps the most unique aspect of the InfoRx model is the presence and participation of the information professional/librarian at point of care. This new and multidisciplinary approach presents a distinctive challenge. Health and support staff are not always clear on what knowledge and skills a librarian brings to the team. Conversely, I must be able to recognize and adapt to the needs and character of the community and of the setting itself.

This blog was created in response to some very astute and constructive criticism. After presenting to the residents at their weekly rounds, I was approached by one of the partners at the clinic who suggested that rather than introducing myself and the service and then explaining how to use it, it would have been more effective to present some cases illustrating what the service has to offer to the residents and to their patients. I see this as a perfect example of the kind of disconnect that can happen when two very different professions come together. In essence I had presented the way I would have to my own professional colleagues, but this was not the most appropriate approach given my audience.

After giving it some thought it occurred to me that it could be useful, both for myself and the rest of the team, for me to present a weekly case here, and talk about some of the challenges we are faced with and how these might best be resolved. Hopefully this will introduce some transparency to the InfoRx process.

This is meant to serve as a record of, and forum for discussion about, our challenges and successes. It is hopefully also an opportunity for other information professionals to be inspired by one example of what can be accomplished outside of the library setting.

Thursday, September 23, 2010

Clinical queries, various

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