Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Reblog] What happens to medicine when it has no heroes?

What happens to medicine when it has no heroes?.

From the 4th December 2013 KevinMD article  by  |

A few years ago, a medical journal piece about electronic medical records with built-in decision support announced that the days of super-physicians and master diagnosticians were over.

Being a doctor isn’t very glamorous anymore, and being a good one seems rather obsolete with so many guidelines and protocols telling us what to do.

A hundred years ago, William Osler, a practicing physician, had single-handedly written the leading textbook of medicine, reformed medical education, helped create and chaired Johns Hopkins and become the chair of medicine at Oxford.

Today, it is virtually necessary to be a researcher to teach at a university, let alone chair a medical school. The only other way to advance in medicine is to go into administration. Leaders in medicine are not chosen for their mastery of clinical practice, but for their managerial or business acumen.

The culture of clinical excellence has few heroes in our time. Pharmaceutical companies sometimes speak of “thought leaders” on the local level, which is more often than not only their way of building momentum for their drug sales through promoting early adoption of new medicines. Doctors today practice on a level playing field, where we are considered interchangeable providers in large organizations and insurance networks. Media doctors don’t earn their position based on clinical mastery, but rather their communication and self promotion skills.

What happens to medicine when it has no heroes? Who defends the ideals of a profession that is becoming commoditized? What keeps new physicians striving for clinical excellence with only numerical quality metrics and policy adherence as yardsticks? How are the deeper qualities of doctoring preserved for new generations of doctors, and how are they kept in focus with all the distractions of today’s health care environment — because people still worry and suffer; they are more than bodies with diseases or abnormal test results.

Every day, doctors on the front lines treat two dozen fellow human beings with every imaginable condition. How do we carry on, with only our own ideals as beacons in the fog, if we are left to ourself to defend our higher purpose, without champions, mentors, or heroes?

“A Country Doctor” is a family physician who blogs at A Country Doctor Writes:.

December 16, 2013 Posted by | health care | , , , | Leave a comment

UK Centre for Reviews and Dissemination (CRD) announces new partnership with PubMed Health

https://i1.wp.com/www.nlm.nih.gov/pubs/techbull/so11/graphics/pm_health_fig1.gifCRD announces new partnership with PubMed Health.

From the 9 December press release (at Eureka News Alert)CRD announces new partnership with PubMed Health

A new partnership between the Centre for Reviews and Dissemination (CRD) at the University of York and PubMed Health is launched today.

PubMed Health is a new online service provided by the National Center for Biotechnology Information (NCBI) at the US National Library of Medicine (NLM) – the world’s largest medical library. The service provides summaries and full text of selected systematic reviews and also provides information for consumers and clinicians based on those reviews

Systematic reviews are widely recognised as reliable sources of information about the effects of healthcare interventions. But as with individual research studies, they can be hard to find, may have flaws and can be difficult to interpret.

Since 1994, CRD has been producing and maintaining DARE, a database which uniquely provides access to over 11,000 abstracts of quality assessed and critically appraised systematic reviews. The database has become a key resource for health professionals and policy makers as it provides its users with a ‘bottom line’ on the overall validity and reliability of each review.

The new partnership involves CRD providing DARE content to PubMed Health.

Deputy Director of CRD Dr Amanda Sowden said: “CRD aims to produce and disseminate high quality evidence to inform health care decision making in the UK and internationally. Our partnership with PubMed Health is an exciting and prestigious development that will help give our database content truly global reach.”

 

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and…from the NLM (US National Library of Medicine’s December Technical Bulletin)

Update — PubMed Health December 2011 Release

With its December release, PubMed® Health grows to over 18,000 systematic reviews and health technology assessments in the last 10 years. With the inclusion of the Database of Reviews of Effects (DARE) from the Centre for Reviews and Dissemination in England, PubMed Health is getting close to comprehensive coverage of reliable systematic reviews on clinical effectiveness.

Other new features and content additions in this release include:

  • Evidence-based, regularly updated information on cancer for consumers and health professionals from the National Cancer Institute (NCI®) Physician Data Query (PDQ®) database.
  • Two full-text books under “Understanding research results” from the “Understand clinical effectiveness” tab:
    Irwig L, et al. Smart Health Choices: Making Sense of Health Advice. London: Hammersmith Press; 2008. Available from: http://www.ncbi.nlm.nih.gov/books/NBK63638/

    Evans I, et al. Testing Treatments: Better Research for Better Healthcare. 2nd edition. London: Pinter & Martin; 2011. Available from: http://www.ncbi.nlm.nih.gov/books/NBK66204/
  • Simplified and broadened — display of medical encyclopedia search results.

Addition of Over 12,000 Reviews from DARE

A new section in the “Contents” drop-down box on the homepage has been added for the DARE reviews (see Figure 1). This new content type rounds out PubMed Health’s coverage of systematic reviews on clinical effectiveness in the published biomedical literature, joining over 4,500 Cochrane reviews and hundreds of systematic reviews by health technology assessment agencies.

Screen capture of Contents drop-down box
Figure 1: Contents drop-down box.

DARE is a key database produced by the Centre for Reviews and Dissemination (CRD) and funded by England’s National Institute of Health Research. Information specialists at CRD regularly search an extensive group of electronic databases, supplemented by hand searching, to identify published systematic reviews that meet their set of scientific criteria.

For about half of the reviews that qualify for DARE, a CRD summary with critical appraisal of the scientific quality of the review is added. These may raise caveats about the reliability of the review, as in the example featured in Figure 2.

PubMed Health displays the title of the review and its citation (see #1 in Figure 2). For those reviews with a full CRD summary and appraisal, the conclusion is then displayed, followed by a link to the complete version (see #2 in Figure 2). This is followed by the abstract of the review itself, if one is included in PubMed (see #3 in Figure 2).

Screen capture of Example of a DARE review with CRD summary
Figure 2: Example of a DARE review with CRD summary.

Each PubMed Health record from DARE includes a link to an explanation of CRD’s process and assessment criteria.

Currently, DARE is added to weekly, and new records and summaries will appear shortly afterward in PubMed®Health. The records will not yet appear in PubMed.

Changes to Display of Search Results

DARE reviews are returned with all results, and can also be viewed under their own content type (see #1 in Figure 3).

Medical encyclopedia content has been simplified, with some content text also appearing (see #2 in Figure 3). Previously, only medical encyclopedia content for diseases and drugs were shown on the search results page. Relevant medical encyclopedia content for procedures and other types of searches now display.

The parallel “Clinical Queries” filter search for systematic reviews in PubMed remains (see #3 in Figure 3). This search continues to return results chronologically.

Screen capture of Search results
Figure 3: Search results.

NCI cancer information for patients and health professionals appears under the “For consumers” and “Clinical Guides” links, respectively.

Twitter followers can learn more about PubMed Health content and additions by following @PubMedHealth.

By Hilda Bastian
National Center for Biotechnology and Information

December 10, 2011 Posted by | Educational Resources (High School/Early College(, Finding Aids/Directories, Health Education (General Public), Librarian Resources, Professional Health Care Resources | , , , , , | Leave a comment

PubMed Health – A Growing Resource for Clinical Effectiveness Information

Screen capture of PubMed Health homepage.

From the November NLM Technical Bulletin article

PubMed Health — A Growing Resource for Clinical Effectiveness Information

PubMed® Health developed further as a resource for clinical effectiveness research with its August and September 2011 releases. Growing from around 200 items based on systematic reviews to over 5,000, PubMed Health has also begun a collection focused on helping people understand systematic reviews and their results. PubMed Health goals are: helping users find the evidence that could answer their questions about effects of health care and helping them understand what they find.

Making Systematic Reviews More Accessible
Systematic reviews that identify and interpret studies on the effects of health care form an essential research basis for informed decision-making. Systematic reviewing has been growing, especially with the advent of The Cochrane Collaboration and the increasing incorporation of this methodology in health technology assessment by public agencies and clinical practice guideline development.

Systematic reviews (including health technology assessments) are often lengthy and highly technical. Their evolution has been accompanied by a growth in knowledge translation activity. Along with traditional abstracts, various forms have been developed to help people use systematic reviews: executive and policymaker summaries, summaries or other forms for patients/consumers and summaries for clinicians.

However, these materials have been scattered widely on content providers’ Web sites without being collected centrally. Many of the systematic reviews undertaken by public health technology assessment agencies have also remained outside the National Library of Medicine® (NLM®) system. The PubMed Health initiative is gathering them together within a single searchable resource.

PubMed Health Content
PubMed Health contains systematic reviews and summaries of systematic reviews undertaken or updated in roughly the last ten years. The time limit is applied to publication date of around eight years, to allow for the time lag from the date of the evidence search. The cut-off currently is 2003.

New content incorporated in these releases include summaries from The Cochrane Collaboration and the National Health Service (NHS) National Institute for Health Research (NIHR) Health Technology Assessment Programme. There are also full text reviews from the U.S. Agency for Healthcare Research and Quality (AHRQ), the Drug Effectiveness Review Project (DERP) at Oregon Health & Science University (OHSU), England’s National Institute for Health and Clinical Excellence (NICE) guidelines program, and the Department of Veterans Affairs’ Evidence-based Synthesis Program. From NHS Choices comes “Behind the Headlines”, its educational service on the science behind the news. These new content providers join PubMed Health original consumer clinical effectiveness content for consumers content provided by AHRQ and the German Institute for Quality and Efficiency in Health Care (IQWiG).

The reviews and review summaries now in PubMed Health account for perhaps one-third of the good quality systematic reviews published by public agencies and journals worldwide. Most of the remainder can be found in PubMed “Clinical Queries” Systematic Reviews search which runs simultaneously with a PubMed Health search; those PubMed results are presented as links on the right-hand portion of the results page (see #3 in Figure 4).

Organization
The re-designed homepage (see Figure 1) includes four key sections:

  • Contents: a complete alphabetical listing of all titles, sorted by type of content.
  • Behind Headlines: the NHS guide to the science behind health stories in the news.
  • New & updated: content added in the last 60 days.
  • Featured reviews: high quality reviews on interesting topics are selected and featured here. “Previously featured reviews” are provided in an RSS feed to which people can subscribe.
  • Understanding clinical effectiveness: an explanation of clinical effectiveness research along with a section focusing on resources to help people understand systematic reviews and interpret the results.

Screen capture of PubMed Health homepage.
Figure 1: PubMed Health homepage.

A drop-down box under “Contents” (see Figure 2) shows the categories of information currently included in PubMed Health where these are available:

  • For consumers: includes consumer summaries of systematic reviews as well as consumer information based on systematic reviews.
  • Executive summaries: executive or policymaker summaries of systematic reviews.
  • Clinical guides: clinician summaries of systematic reviews as well as clinical practice guidelines that are based on a fully reported systematic review.
  • Full text reviews: systematic reviews with full texts, including PDF versions.
  • Medical encyclopedia: medical and drug information for consumers for supplementary background information.

PubMed Health includes content that is currently also cited in PubMed, and PubMed Health will systematically be building in links to these citations. However, there will be some time lag for many items between inclusion in PubMed Health and citation in PubMed. Consumer content from PubMed Health is currently not included in PubMed.

Screen capture of Contents drop-down box.
Figure 2: Contents drop-down box.

At the top right-hand corner (see Figure 3), “About PubMed Health” explains the Web site and the National Center Biotechnology Information, NLM, with a full listing of content providers. “Help” includes explanation of basic functions, along with suggested citations for PubMed Health content.

Screen capture of About PubMed Health and Help features.
Figure 3: About PubMed Health and Help features.

Searching
The primary search (see #1 in Figure 4) returns clinical effectiveness content by relevance, with the option of viewing all (default) or only specified content types. Relevant medical encyclopedia results are shown at the right (see #2 inFigure 4), with the results of the “Clinical Queries” filter search for systematic reviews in PubMed showing below those (see #3 in Figure 4). “Clinical Queries” returns results chronologically.

Screen capture of Search results.
Figure 4: Search results.

Additional Features
With medical encyclopedia content, PubMed Health has enhanced the display of anatomical images and given this popular feature a more prominent position. There are links from the medical encyclopedia diseases and conditions pages to MedlinePlus® content.

PubMed Health now features “Add this” sharing for e-mail and social media. Coming in the fall, PubMed Health will begin a Twitter feed, announcing new content providers and features, as well as featured content.

PubMed Health full address: http://www.ncbi.nlm.nih.gov/pubmedhealth/
Shortcut: http://www.pubmed.gov/health
Customer service contact: pmh-help@ncbi.nlm.nih.gov

By Hilda Bastian
National Center for Biotechnology Information

 


November 16, 2011 Posted by | Biomedical Research Resources, Educational Resources (Health Professionals), Educational Resources (High School/Early College(, Finding Aids/Directories, health care, Health Statistics, Librarian Resources, Professional Health Care Resources, Tutorials/Finding aids | , , , , , , , | Leave a comment

   

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