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The Art and Science of Searching Medline to Answer Clinical Questions: Finding the Right Number of Articles
APRIL 2000, VOL 7 1, NO 4
REVIEWS
RESEARCH REVIEWS
PA TlENT SATISFACTION WITH AN OUTPATIENT ENDOSCOPIC SERVICE J Sincock, S V Dunn, L Pretty Gastroenterology Nursing Vol22 (SeptemberlOctober1999) 193-198
T
he increasing demand for patient involvement in health care and hospital accreditation has driven hospital managers to evaluate patient satisfaction with the health care venue. Research regarding patient satisfaction and outcomes has been performed in the United States, Canada, and the United Kingdom; however, relatively little literature exists regarding patient satisfaction with outpatient endoscopic services. Purpose. The purpose of this study was to explore patient satisfaction with endoscopic services and factors influencing patients’ perceptions. Methods. During a one-month period, 151 males and 77 females undergoing elective outpatient procedures-including diagnostic and therapeutic interventions, such as liver biopsy, sigmoidoscopy, bronchoscopy, upper endoscopy, and colonoscopy procedures-were surveyed. Ten (6.6%) patients were undergoing more than one procedure. Sixty-five (43%) patients were between 61 and 80 years of age. Patients undergoing inpatient procedures and patients admitted to acute emergency areas were not included in the study. A multidisciplinary team comprising RNs, ancillary staff members, and a rotating roster of consultants worked in the unit. A 14-item, open-ended and
closed-ended questionnaire was mailed to patients one week after the date of their procedure. This timing enabled patients to reflect on their experience but still recall the procedure. Questions focused on patient comfort and instructions and information patients received. Results. Patient perceptions of the endoscopy services were sought for preoperative, intraoperative, and postoperative time frames. During the preoperative phase, responses indicated that 136 (93.8%) patients received written instructions regarding their appointment, and 122 (91.7%) received written patient information before their procedure. One hundred and thirty (88%) patients perceived the time between arriving at the unit and entering the OR to be no more than 30 minutes. The time between entering the OR and beginning the procedure was perceived to be more than 30 minutes by 105 (85%) patients. During the procedures, 119 (85.6%) patients who received sedation medication claimed to have remained comfortable throughout the procedure. Women were significantly more likely than men to experience discomfort during their procedure. No statistically significant differences were found related to discomfort among age groups. One hundred twenty-seven (85.2%) patients thought their recovery time was appropriate. Postoperative instructions provided by RNs were understood by 140 (95.9%) patients, and 139 (93.9%) patients stated their privacy was considered at all times. Discussion. This study found patients have an overall high level of satisfaction with the 901 AORN JOURNAL
endoscopy services provided. This study enables multidisciplinary team members to recognize aspects of services, such as information or instructions, waiting times, and comfort levels of patients undergoing endoscopy procedures, that are paramount to the enhancement of patient care. This study offers perioperative nurses an opportunity to reflect on their practice and evaluate their care and working relationships with other health care professionals. Collaboration with patients undergoing endoscopic services enhances quality outcomes. ROSIE, LEE CALVIN RN, DNS NURSINGRESEARCH COMMITTEE
THE ART AND SCIENCE OF SEARCHING MEDLINE TO ANSWER CLINICAL QUESTIONS: FINDING THE RIGHT NUMBER OF ARTICLES J J Allison et a1 International Journal of Technology Assessment in Health Care VoE15 (Spring 1999) 281 -296
I
nformation retrieval is essential for the improvement of patient care, education, and research, and MEDLINE is an excellent means of finding needed information. Maintained by the United States National Library of Medicine, MEDLINE is offered free of charge to the public on the Internet. As with all technologies, MEDLINE is only as useful as the user is knowledgeable of it. Four major barriers to an effective and efficient search on MEDLINE are failure to begin with a wellbuilt clinical question, failure to use the medical
APRIL 2000, VOL 71, NO 4
subject heading (MeSH) indexing system (ie, a controlled database indexing language developed to manage the imprecision of variations in medical jargon), failure to leverage the important relationship between recall and precision, and R failure to apply proper limits to the search. Clinical question. A well-constructed clinical question is the foundation of an effective search. The three essential elements of a search pertaining to clinical questions are patient, intervention, and outcome.
MeSH indexing system. Using MeSH descriptors facilitates an effective MEDLINE search. Each MeSH descriptor relates to one medical concept, and all MeSH terms are included within a hierarchy, portrayed by the MeSH tree. The MeSH tree begins with the broadest concepts at the highest level and progressively branches into more narrow concepts. For example, the subject of cardiovascular disease branches to heart disease, which branches to arrhythmias, congestive heart failure, and myocardial ischemia. Myocardial ischemia then branches to coronary artery disease and myocardial infarction. Articles are indexed by their most specific terms; therefore, an article indexed under myocardial infarction, for example, will not appear by using the MeSH heading of cardiovascular disease. The explode feature is extremely useful because it retrieves all articles indexed at or below a given level.
Recall versus precision. Culling irrelevant and poor-quality articles without eliminating
nd-of-life decisions have become more difficult with the advancement of medical technology. The ability to sustain life brings questions involving prolonged suffering, emotional stress, financial debilitation, and resource allocation. Ethics consultation often is used to facilitate decision making in such complex cases. This study sought to assess the effect of proactive ethics consultation on documented patient care communications and on decisions regarding high-risk patients in the intensive care unit (ICU). The authors hypothesized that proactive ethics consultation could be used as a process-oriented intervention for improving communication and decision making among physicians, patients, and health care team members. Methods. This prospective, controlled study analyzed the charts and documentation of 99 patients in the ICU treated with more than 96 hours of continuous mechanical ventilation. After discharge, data regarding patient age, gender, primary and secondary diagnoses, method of payment, admission and subsequent code status, patient acuity, length of stay, decisional capacity, advance directives, do-not-resuscitate orders, formal ethics conEDWINA A. MCCONNELL sultation, and consultation with RE(, PHD, FRCNA other health care professionals NURSINGRESEARCH COMMITTEE were collected by chart review. Three groups compared were a baseline group enrolled in A STUDY OF PROACTIVE ETHICS the study before establishment CONSULTATION FOR CRITICALLY of the hospital’s ethics consulAND TERMINALLY ILL PATIENTS tation service, WITH EXTENDED LENGTHS OF a control group in which ethics STAY consultation was the option of M D Dowdy, C Robestson, health care team members, and J A Bander. a treatment group in which the Critical Care Med ethics consultants intervened Vol26 (February 1998) proactively after patients had 252-259
highly relevant and quality articles is challenging. It is impossible to maximize both the recall (ie, the number of relevant articles retrieved versus the total number of relevant articles in the database) and precision (ie, the number of relevant articles retrieved versus the total number of articles retrieved) of a MEDLINE search; thus, it is important to leverage the relationship between the two factors. Techniques that can increase the recall or precision of a completed MEDLINE search include MeSH, text, Boolean, and mixed. For example, the Boolean operators or, and, and not make it possible to combine results of separate searches. Search limits. Applying search limits is an important, but not integral, part of the search strategy. For searches relating to clinical questions, applying common limits of human, English, and Abridged Index Medicus (AIM) helps remove unwanted documents. The AIM is a core set of 125 journals selected from the more than 3,900 journals that MEDLINE covers. Articles not in the AIM typically are useful for either specialized research topics or systematic reviews.
902 AORN JOURNAL
REVIEWS
RESEARCH REVIEWS
PA TlENT SATISFACTION WITH AN OUTPATIENT ENDOSCOPIC SERVICE J Sincock, S V Dunn, L Pretty Gastroenterology Nursing Vol22 (SeptemberlOctober1999) 193-198
T
he increasing demand for patient involvement in health care and hospital accreditation has driven hospital managers to evaluate patient satisfaction with the health care venue. Research regarding patient satisfaction and outcomes has been performed in the United States, Canada, and the United Kingdom; however, relatively little literature exists regarding patient satisfaction with outpatient endoscopic services. Purpose. The purpose of this study was to explore patient satisfaction with endoscopic services and factors influencing patients’ perceptions. Methods. During a one-month period, 151 males and 77 females undergoing elective outpatient procedures-including diagnostic and therapeutic interventions, such as liver biopsy, sigmoidoscopy, bronchoscopy, upper endoscopy, and colonoscopy procedures-were surveyed. Ten (6.6%) patients were undergoing more than one procedure. Sixty-five (43%) patients were between 61 and 80 years of age. Patients undergoing inpatient procedures and patients admitted to acute emergency areas were not included in the study. A multidisciplinary team comprising RNs, ancillary staff members, and a rotating roster of consultants worked in the unit. A 14-item, open-ended and
closed-ended questionnaire was mailed to patients one week after the date of their procedure. This timing enabled patients to reflect on their experience but still recall the procedure. Questions focused on patient comfort and instructions and information patients received. Results. Patient perceptions of the endoscopy services were sought for preoperative, intraoperative, and postoperative time frames. During the preoperative phase, responses indicated that 136 (93.8%) patients received written instructions regarding their appointment, and 122 (91.7%) received written patient information before their procedure. One hundred and thirty (88%) patients perceived the time between arriving at the unit and entering the OR to be no more than 30 minutes. The time between entering the OR and beginning the procedure was perceived to be more than 30 minutes by 105 (85%) patients. During the procedures, 119 (85.6%) patients who received sedation medication claimed to have remained comfortable throughout the procedure. Women were significantly more likely than men to experience discomfort during their procedure. No statistically significant differences were found related to discomfort among age groups. One hundred twenty-seven (85.2%) patients thought their recovery time was appropriate. Postoperative instructions provided by RNs were understood by 140 (95.9%) patients, and 139 (93.9%) patients stated their privacy was considered at all times. Discussion. This study found patients have an overall high level of satisfaction with the 901 AORN JOURNAL
endoscopy services provided. This study enables multidisciplinary team members to recognize aspects of services, such as information or instructions, waiting times, and comfort levels of patients undergoing endoscopy procedures, that are paramount to the enhancement of patient care. This study offers perioperative nurses an opportunity to reflect on their practice and evaluate their care and working relationships with other health care professionals. Collaboration with patients undergoing endoscopic services enhances quality outcomes. ROSIE, LEE CALVIN RN, DNS NURSINGRESEARCH COMMITTEE
THE ART AND SCIENCE OF SEARCHING MEDLINE TO ANSWER CLINICAL QUESTIONS: FINDING THE RIGHT NUMBER OF ARTICLES J J Allison et a1 International Journal of Technology Assessment in Health Care VoE15 (Spring 1999) 281 -296
I
nformation retrieval is essential for the improvement of patient care, education, and research, and MEDLINE is an excellent means of finding needed information. Maintained by the United States National Library of Medicine, MEDLINE is offered free of charge to the public on the Internet. As with all technologies, MEDLINE is only as useful as the user is knowledgeable of it. Four major barriers to an effective and efficient search on MEDLINE are failure to begin with a wellbuilt clinical question, failure to use the medical
APRIL 2000, VOL 71, NO 4
subject heading (MeSH) indexing system (ie, a controlled database indexing language developed to manage the imprecision of variations in medical jargon), failure to leverage the important relationship between recall and precision, and R failure to apply proper limits to the search. Clinical question. A well-constructed clinical question is the foundation of an effective search. The three essential elements of a search pertaining to clinical questions are patient, intervention, and outcome.
MeSH indexing system. Using MeSH descriptors facilitates an effective MEDLINE search. Each MeSH descriptor relates to one medical concept, and all MeSH terms are included within a hierarchy, portrayed by the MeSH tree. The MeSH tree begins with the broadest concepts at the highest level and progressively branches into more narrow concepts. For example, the subject of cardiovascular disease branches to heart disease, which branches to arrhythmias, congestive heart failure, and myocardial ischemia. Myocardial ischemia then branches to coronary artery disease and myocardial infarction. Articles are indexed by their most specific terms; therefore, an article indexed under myocardial infarction, for example, will not appear by using the MeSH heading of cardiovascular disease. The explode feature is extremely useful because it retrieves all articles indexed at or below a given level.
Recall versus precision. Culling irrelevant and poor-quality articles without eliminating
nd-of-life decisions have become more difficult with the advancement of medical technology. The ability to sustain life brings questions involving prolonged suffering, emotional stress, financial debilitation, and resource allocation. Ethics consultation often is used to facilitate decision making in such complex cases. This study sought to assess the effect of proactive ethics consultation on documented patient care communications and on decisions regarding high-risk patients in the intensive care unit (ICU). The authors hypothesized that proactive ethics consultation could be used as a process-oriented intervention for improving communication and decision making among physicians, patients, and health care team members. Methods. This prospective, controlled study analyzed the charts and documentation of 99 patients in the ICU treated with more than 96 hours of continuous mechanical ventilation. After discharge, data regarding patient age, gender, primary and secondary diagnoses, method of payment, admission and subsequent code status, patient acuity, length of stay, decisional capacity, advance directives, do-not-resuscitate orders, formal ethics conEDWINA A. MCCONNELL sultation, and consultation with RE(, PHD, FRCNA other health care professionals NURSINGRESEARCH COMMITTEE were collected by chart review. Three groups compared were a baseline group enrolled in A STUDY OF PROACTIVE ETHICS the study before establishment CONSULTATION FOR CRITICALLY of the hospital’s ethics consulAND TERMINALLY ILL PATIENTS tation service, WITH EXTENDED LENGTHS OF a control group in which ethics STAY consultation was the option of M D Dowdy, C Robestson, health care team members, and J A Bander. a treatment group in which the Critical Care Med ethics consultants intervened Vol26 (February 1998) proactively after patients had 252-259
highly relevant and quality articles is challenging. It is impossible to maximize both the recall (ie, the number of relevant articles retrieved versus the total number of relevant articles in the database) and precision (ie, the number of relevant articles retrieved versus the total number of articles retrieved) of a MEDLINE search; thus, it is important to leverage the relationship between the two factors. Techniques that can increase the recall or precision of a completed MEDLINE search include MeSH, text, Boolean, and mixed. For example, the Boolean operators or, and, and not make it possible to combine results of separate searches. Search limits. Applying search limits is an important, but not integral, part of the search strategy. For searches relating to clinical questions, applying common limits of human, English, and Abridged Index Medicus (AIM) helps remove unwanted documents. The AIM is a core set of 125 journals selected from the more than 3,900 journals that MEDLINE covers. Articles not in the AIM typically are useful for either specialized research topics or systematic reviews.
902 AORN JOURNAL