Abstract: A Review of: McGowan, Jessie, William Hogg, Craig Campbell, and Margo Rowan. “Just-in-Time Information Improved Decision-Making in Primary Care: A Randomized Controlled Trial.” PLoS ONE 3.11 (2008): e3785. 10 Mar 2009 Objectives – To determine whether a point-of-care librarian consultation service for primary care practitioners (PCPs) improves the quality of PCPs’ decision-making; saves PCPs time; reduces the number of point-of-care questions that go unanswered due to time constraints; and is cost-effective. Overall PCP satisfaction with the service was also assessed. Design – Randomized controlled trial. Setting – Four Family Health Networks (FHNs) and 14 Family Health Groups (FHGs) in Ontario, Canada. These represent new models for primary care service delivery in Ontario. Subjects – PCPs working within the selected FHNs and FHGs. The majority of these were physicians, but the sample also contained one resident, one nurse, and four nurse-practitioners. Methods – Subjects were trained in the use of a Web-based query form or mobile device to submit their point-of-care questions electronically. They were also trained in query formulation using PICO (patient, intervention, comparison, and outcome). Allocation was concealed by an independent company hired to manage data for the project. Participants were not randomized; rather the questions were randomized using a random-number generator. To ensure blinding of the librarians, all questions submitted were answered by a librarian. Answers to questions in the intervention group were relayed by a third party to the practitioner within minutes. Answers to the questions in the control group were not communicated to the physician. Blinding of the PCP subjects was not possible, as they either received or did not receive an answer. Subjects were asked to respond to a questionnaire 24 hours after submitting their question. If the question was in the control group, subjects were asked to indicate whether they had let the question remain unanswered or pursued an answer on their own. In order to assess cognitive impact of both librarian-provided information and self-sought information, respondents were asked to rate information on a scale from high positive to negative impact on decision making. Two linear regression models were run on the data, with participant response time as the dependent variable in the first model, and librarian response time as the dependent variable in the second. Main Results – The service received a total of 1,889 questions, of which 472 (25%) were randomized to the control group, and 1,417 (75%) to the intervention group. Analysis run on both groups found that the types and complexity of questions were similar between the two groups, as was librarian response time. Questions were rated for complexity (the rating scale is included in the article), and most (85%) had a Level 1 complexity rating, meaning there was only one concept listed for each PICO element. The primary outcome measure was the amount of time required to answer the question. Average librarian time to respond to questions was 13.68 minutes per question. Average PCP time to find answers to their own questions was 20.29 minutes; however, subjects only attempted to answer 40.5% of control-group questions themselves. Cost-effectiveness analysis was run on these times, and the authors found that the average per-question salary cost for a librarian to answer these questions (based on 15 minutes per question) was $7.15, while average salary cost for a PCP to spend 15 minutes searching for information ranged from $20.75 to $27.69. The results of the questionnaire indicated a significant positive impact of the information on clinician decision-making. Approximately 60% of the questions in the control group went unanswered, whereas all of the questions in the intervention group were answered. Of the questions answered by the information service, 63.7% of the answers were rated by participants as having a high positive impact on decision-making, versus 14.9% of answers to questions in the control group that practitioners sought out themselves. Seventeen percent of the answers were rated as having a moderate positive impact in the intervention group, versus 5.9% in the control group. Only 7.8% of answers in the intervention group were rated as having no impact, versus 24.8% of answers in the control group. A negative impact (where practitioners found too much or too little information or information that they disagreed with or felt was harmful) was found for 7.7% of librarian-provided answers, compared with 44.9% of practitioner-sought answers. Satisfaction was very high, according to the exit satisfaction survey, with 86% agreeing that the service had a positive impact on decision-making, and 83% stating that relevant answers were provided in an appropriate time frame. Most participants (72%) would consider using such a service, and 33% indicated they would be willing to pay for this type of service. Conclusion – A point-of-care reference service, in which librarians answer primary care practitioners’ questions within minutes, has a very positive impact on clinical decision making and a high rate of client satisfaction. This system saves PCPs time, which may allow them to spend more time with patients. In supporting good clinical decision making, the service may also decrease the need for referrals and further tests. The service is cost-effective, as librarians find better quality information than practitioners, and they do it faster, on a lower per-hour salary.

Abstract: Objectives – To determine which strategies were most effective for encouraging general practitioners (GPs) to sign up for free access to an online evidence based information resource; and to determine whether those who accepted the offer differed in their sociodemographic characteristics from those who did not. Design – Descriptive marketing research study. Setting – Australia’s public healthcare system. Subjects – 14,000 general practitioners (GPs) from all regions of Australia. Methods – Subjects were randomly selected by Medicare Australia from its list of GPs that bill it for services. Medicare Australia had 18,262 doctors it deemed eligible; 14,000 of these were selected for a stratified random sample. Subjects were randomized to one of 7 groups of 2,000 each. Each group received a different letter offering two years of free access to BMJ Clinical Evidence, an evidence based online information tool. Randomization was done electronically, and the seven groups were stratified by age group, gender, and location. The interventions given to each group differed as follows: • Group 1: Received a letter offering 2 years of free access, with no further demands on the recipient. Evidence Based Library and Information Practice 2010, 5.4 84 • Group 2: Received a letter offering 2 years of free access, but on the condition that they complete an initial questionnaire and another one at 12 months, as well as allowing the publisher to provide de-personalized usage data to the researchers. • Group 3: Same as Group 2, but with the additional offer of an online tutorial to assist them with using the resource. • Group 4: Same as Group 2, but with an additional pamphlet with positive testimonials about the resource from Australian medical opinion leaders. • Group 5: Same as Group 2, but with an additional offer of professional development credits towards their required annual totals. • Group 6: Same as Group 2, but with an additional offer to be entered to win a prize of $500 towards registration at a conference of the winner’s choice. • Group 7: A combination of the above interventions. The group received the opinion leaders’ pamphlet, the online tutorial, and eligibility for professional development points. The online survey and usage data from Groups 2 through 7 was to be analyzed as part of a companion study, and is not reported in this article. To protect the privacy of individual subjects, Medicare Australia mailed out the offers and provided the authors with anonymized data, in table format, on response status by intervention group and by the following sociodemographic variables: age, gender, geographic remoteness as determined by the Accessibility/Remoteness Index of Australia (ARIA), country of graduation, and years since graduation. Baseline characteristics were compared between the intervention groups, and then response rates were also compared between intervention groups and between the above-mentioned variables to see whether any of these variables affected the likelihood of practitioners being interested in an online evidence based tool. All comparisons were done using a chi-square test. Main Results – Overall, 2,105 subjects returned their acceptance forms, out of the total sample of 14,000 (15%). The true acceptance rate was 12.5%, however, when adjusted for the number of subjects in Groups 2 through 7 who went on to complete the online questionnaire. There was a statistically significant difference in response rates between the seven groups, with the greatest acceptance rate (27%) coming from Group 1 (who received only the letter of offer, with no experimental demands). The other groups averaged a response rate of 10% collectively, with the lowest rates (8.0% and 8.5% respectively) from Group 5 (offer of professional development points) and Group 7 (combination of interventions). The large sample size offered adequate power to detect differences in characteristics between responders and non-responders. The study found that responders were more likely to be younger, male, recent graduates, and practising in less remote locations. Among responders, there were no statistically significant differences in most of these characteristics among the seven groups, with the exception of time since graduation, which varied somewhat. Conclusion – The authors conclude that funding of access to free online resources for large groups of practitioners may not be cost-effective if calculations of cost are based on total eligible populations rather than on the number of practitioners who may be interested. They also conclude that the low response rates generated by their offer indicate a need to find ways to increase GPs’ interest in using online evidence based tools and in accessing best practice evidence. Further research into how to achieve behaviour change among practitioners may be needed.

Abstract: Objective – Online library guides can serve as resources for students and researchers conducting systematic literature reviews. There is a need to develop learner-centered library guides to build capacity for systematic review skills. The objective of this study was to explore the content of existing systematic review library guides at research universities. Methods – We conducted a content analysis of systematic review library guides from English-speaking universities. We identified 18 institutions for inclusion using a Scopus search to find the institutions with the highest number of systematic review publications. We conducted a content analysis of those institutions’ library guides, coding for the types of resources included, and the stage of the systematic review process to which they referred. A chi-square test was used to determine whether the differences in distribution of the resource types within each systematic review stage were statistically significant. Results – The most common type of resource was informational in content. Only 24% of the content analysed was educational. The most common stage of the systematic review process was conducting searches. The chi-square test revealed significant differences for seven of the nine systematic review stages. Conclusion – We found that many library guides were heavily informational and lacking in instructional and skills focused content. There is a significant opportunity for librarians to turn their systematic review guides into practical learning tools through the development and assessment of online instructional tools to support student and researcher learning.

Abstract: There is ongoing debate regarding potential associations between restrictions of antimicrobial use and prevalence of antimicrobial resistance (AMR) in bacteria. Objectives To summarize the effects of interventions reducing antimicrobial use in food-producing animals on the prevalence of AMR genes (ARGs) in bacteria from animals and humans. Methods We published a full systematic review of restrictions of antimicrobials in food-producing animals and their associations with AMR in bacteria. Herein, we focus on studies reporting on the association between restricted antimicrobial use and prevalence of ARGs. We used multilevel mixed-effects models and a semi-quantitative approach based on forest plots to summarize findings from studies. Results A positive effect of intervention [reduction in prevalence or number of ARGs in group(s) with restricted antimicrobial use] was reported from 29 studies for at least one ARG. We detected significant associations between a ban on avoparcin and diminished presence of the vanA gene in samples from animals and humans, whereas for the mecA gene, studies agreed on a positive effect of intervention in samples only from animals. Comparisons involving mcr-1, blaCTX-M, aadA2, vat(E), sul2, dfrA5, dfrA13, tet(E) and tet(P) indicated a reduced prevalence of genes in intervention groups. Conversely, no effects were detected for β-lactamases other than blaCTX-M and the remaining tet genes. Conclusions The available body of scientific evidence supported that restricted use of antimicrobials in food animals was associated with an either lower or equal presence of ARGs in bacteria, with effects dependent on ARG, host species and restricted drug.