Vitamin D Deficiency a Risk Factor for Cardiovascular Disease?

Lee JH, O'Keefe JH, Bell D, Hensrud DD, Holick MF.
Vitamin D deficiency an important, common, and easily treatable cardiovascular risk factor?
J Am Coll Cardiol. 2008 Dec 9;52(24):1949-56.

In this latest study to come out on vitamin D, the authors discuss the largely unrecognized problem of vitamin D deficiency in the general population and review the growing body of data from epidemiologic studies suggesting that low levels of 25-hydroxyvitamin D play an important role in the development of coronary risk factors and cardiovascular disease. They offer specific recommendations for monitoring and correction of vitamin D deficiency and maintenance of vitamin D levels for optimal health.

Just-in-time information improved decision-making in primary care: a randomized controlled trial.

McGowan J. Just-in-time information improved decision-making in primary care: a randomized controlled trial. PLoS ONE. 2008;3(11):e3785. Epub 2008 Nov 21. PMID: 19023446

The "Just-in-time Information" (JIT) librarian consultation service was designed to provide rapid information to answer primary care clinical questions during patient hours. This study evaluated whether information provided by librarians to answer clinical questions positively impacted time, decision-making, cost savings and satisfaction. METHODS AND FINDING: A randomized controlled trial (RCT) was conducted between October 2005 and April 2006. A total of 1,889 questions were sent to the service by 88 participants. The object of the randomization was a clinical question. Each participant had clinical questions randomly allocated to both intervention (librarian information) and control (no librarian information) groups. Participants were trained to send clinical questions via a hand-held device. The impact of the information provided by the service (or not provided by the service), additional resources and time required for both groups was assessed using a survey sent 24 hours after a question was submitted. The average time for JIT librarians to respond to all questions was 13.68 minutes/question (95% CI, 13.38 to 13.98). The average time for participants to respond their control questions was 20.29 minutes/question (95% CI, 18.72 to 21.86). Using an impact assessment scale rating cognitive impact, participants rated 62.9% of information provided to intervention group questions as having a highly positive cognitive impact. They rated 14.8% of their own answers to control question as having a highly positive cognitive impact, 44.9% has having a negative cognitive impact, and 24.8% with no cognitive impact at all. In an exit survey measuring satisfaction, 86% (62/72 responses) of participants scored the service as having a positive impact on care and 72% (52/72) indicated that they would use the service frequently if it were continued. CONCLUSIONS: In this study, providing timely information to clinical questions had a highly positive impact on decision-making and a high approval rating from participants. Using a librarian to respond to clinical questions may allow primary care professionals to have more time in their day, thus potentially increasing patient access to care. Such services may reduce costs through decreasing the need for referrals, further tests, and other courses of action.

Athletic tape, auriculotherapy, autovaccines...

What do athletic tape, droughts and nephrogenic fibrosing dermopathy have in common? They are all new MeSH terms for 2009!

While you know that medicine, clinical care and research are constantly evolving, you may not be aware that those Medical Subject Headings (or MeSH terms) that describe articles in the MEDLINE database also undergo changes and revisions every year. The National Library of Medicine, the agency that maintains MEDLINE and PubMed, analyzes MeSH every year to determine if new terms are needed and if old terms should be edited or retired.

While this reload of MeSH takes place, no new indexed citations are added to the MEDLINE database. For most people, this will have a limited impact: if you are a PubMed user, just be sure that you search using textwords in addition to MeSH terms (this is the default method when using the main search box); for Ovid users looking for the most current citations, be sure to search the in-process file (accessible from the change database link within Ovid) in addition to the MEDLINE file. Generally this process lasts just a few weeks in December.

If you have saved searches, you may want to check the new 2009 MeSH term list to determine if your strategy is still appropriate.

If you have any questions or would like assistance in evaluating a saved search, contact a reference librarian at 660-1100, mclref@mc.duke.edu, or via IM.

Resident Duty Hours: Enhancing Sleep, Supervision, and Safety

Medical residency in the United States aims to prepare recent medical school graduates to practice medicine independently. One fundamental requirement of resident education is in-depth, firsthand experience caring for patients. During the three to seven years of training, residents often work long hours with limited time off to catch up on their sleep. They can experience fatigue on the job, contributing to increased errors and accidents. However, many medical educators believe extensive duty hours are essential to provide residents with the educational experiences they need to become competent in diagnosing and treating patients.

Resident Duty Hours: Enhancing Sleep, Supervision, and Safety, a December 2008 report from the IOM, asserts that revisions to medical residents’ workloads and duty hours are necessary to better protect patients against fatigue-related errors and to enhance the learning environment for doctors in training. The report recommends that residency programs provide regular opportunities for sleep each day and each week during resident training. In addition, it recommends that the Accreditation Council for Graduate Medical Education provide better monitoring of duty hour limits and that residency review committees set guidelines for residents’ patient caseload. Patient handover procedures and supervision of residents should also be strengthened. Until these changes take place, residency programs are not providing what the next generation of doctors or their patients deserve. Link to report files.

NIH Launches New Site on Medical Research for Children

National Institutes of Health has created a new site Children & Clinical Studies to offer parents and health care providers an insider's guide to children's medical research.

Find out more on these topics:
Importance of Research In Kids
Why is research important, how is it different, safety and protections, are there benefits, your right to say no

Getting Started In a Study
Information on the research team, what you might need to ask, and what role kids play in participating

Once In a Study
Information on how studies affect the family and what kids think, what happens if you leave a study or what happens when it ends

Resources
Know what rights you have, where to find information, and terms that you may hear in a study

If you have other questions about clinical trials, call the Library at 660-1100.