What is known and objective: Although non-steroidal anti-inflammatory drugs (NSAIDs) have been studied in randomized, controlled trials and meta-analyses in an effort to determine their cardiovascular (CV) risks, no consensus has been reached. These studies continue to raise questions, including whether cyclooxygenase-2 (COX-2) selectivity plays a role in conferring CV risk. We performed a meta-analysis of current literature to determine whether COX-2 selectivity leads to an increased CV risk. Methods: We utilized randomized, controlled trials and prospective cohort studies. We selected eight NSAIDs based on popularity and COX selectivity and conducted a search of the MEDLINE, EMBASE, and Cochrane databases. Primary endpoints included any myocardial infarction (MI), any stroke, CV death, and a combination of all three (composite CV outcomes). Twenty-six studies were found that met inclusion and exclusion criteria. Comparisons were made between all included drugs, against placebo, and against non-selective NSAIDs (nsNSAIDs). Drugs were also compared against COX-2 selective inhibitors (COXIBs) with and without inclusion of rofecoxib. Results and discussion: Incidence of MI was increased by rofecoxib in all comparison categories [all NSAIDs (OR: 1·811, 95% CI: 1·379–2·378), placebo (OR: 1·655: 95% CI: 1·029–2·661), nsNSAIDs (OR: 2·155, 95% CI: 1·146–4·053), and COXIBs (OR: 1·800, 95% CI: 1·217–2·662)], but was decreased by celecoxib and naproxen in the COXIB comparison [(OR: 0·583, 95% CI: 0·396–0·857) and (OR: 0·609, 95% CI: 0·375–0·989, respectively]. Incidence of stroke was increased by rofecoxib in comparisons with all NSAIDs and other COXIBs [(OR: 1·488, 95% CI: 1·027–2·155) and (OR: 1·933, 95% CI: 1·052–3·549), respectively]. Incidence of stroke was decreased by celecoxib when compared with all NSAIDs, nsNSAIDs, and COXIBs [(OR: 0·603, 95% CI: 0·410–0·887), (OR: 0·517, 95% CI: 0·287–0·929), and (OR: 0·509, 95% CI: 0·280–0·925), respectively]. No NSAID reached statistical significance in regard to CV death. Incidence of the composite endpoint was increased by rofecoxib when compared against all NSAIDs, placebo, and other COXIBs [(OR: 1·612, 95% CI: 1·313–1·981), (OR: 1·572, 95% CI: 1·123–2·201) and (OR: 1·838, 95% CI: 1·323–2·554), respectively]. Incidence of composite endpoint was decreased by celecoxib in the all NSAIDs and COXIBs comparisons [(OR: 0·805, 95% CI: 0·658–0·986) and (OR: 0·557, 95% CI: 0.404–0.767), respectively]. When rofecoxib was removed from the COXIBs group, no difference was found with any comparison, suggesting rofecoxib skewed the data. What is new and conclusion: This instead of the meta-analysis suggests that COX-2 selectivity may not play a role in the CV risk of NSAIDs. Rofecoxib was the only drug to demonstrate harm and skewed the data of the COX-2 selective group.

Background: Cancer is a leading cause of death around the world and often is a chronic long term disease. This calls for an expanded workforce to include non-traditional health care providers. Objective: To determine effectiveness of a cancer information training project with clergy from selected rural Appalachian areas to improve comfort and willingness to work as part of the cancer health care team. Methods: Clergy were trained in the consumer health database of the National Library of Medicine MedlinePlus.gov. Exercises were required that were done using an iPad tablet with an online curriculum. They were also taught how to do a population health assessment of their particular area and develop a health ministry for their church. Results: Three key elements were confirmed that would enable replication of the pilot: access to medlineplus, programmed learning modules using mobile technology such as iPads, and staff support including librarians and medical staff. With these key elements, the cancer project is potentially replicable with other groups beyond clergy. Conclusion: about population health, built on new awareness and topical health knowledge, and using new skills to identify relevant information and library resources, could open minds and enhance community support for preventive and medical interventions.

What is known and objective: Although non-steroidal anti-inflammatory drugs (NSAIDs) have been studied in randomized, controlled trials and meta-analyses in an effort to determine their cardiovascular (CV) risks, no consensus has been reached. These studies continue to raise questions, including whether cyclooxygenase-2 (COX-2) selectivity plays a role in conferring CV risk. We performed a meta-analysis of current literature to determine whether COX-2 selectivity leads to an increased CV risk. Methods: We utilized randomized, controlled trials and prospective cohort studies. We selected eight NSAIDs based on popularity and COX selectivity and conducted a search of the MEDLINE, EMBASE, and Cochrane databases. Primary endpoints included any myocardial infarction (MI), any stroke, CV death, and a combination of all three (composite CV outcomes). Twenty-six studies were found that met inclusion and exclusion criteria. Comparisons were made between all included drugs, against placebo, and against non-selective NSAIDs (nsNSAIDs). Drugs were also compared against COX-2 selective inhibitors (COXIBs) with and without inclusion of rofecoxib. Results and discussion: Incidence of MI was increased by rofecoxib in all comparison categories [all NSAIDs (OR: 1·811, 95% CI: 1·379-2·378), placebo (OR: 1·655: 95% CI: 1·029-2·661), nsNSAIDs (OR: 2·155, 95% CI: 1·146-4·053), and COXIBs (OR: 1·800, 95% CI: 1·217-2·662)], but was decreased by celecoxib and naproxen in the COXIB comparison [(OR: 0·583, 95% CI: 0·396-0·857) and (OR: 0·609, 95% CI: 0·375-0·989, respectively]. Incidence of stroke was increased by rofecoxib in comparisons with all NSAIDs and other COXIBs [(OR: 1·488, 95% CI: 1·027-2·155) and (OR: 1·933, 95% CI: 1·052-3·549), respectively]. Incidence of stroke was decreased by celecoxib when compared with all NSAIDs, nsNSAIDs, and COXIBs [(OR: 0·603, 95% CI: 0·410-0·887), (OR: 0·517, 95% CI: 0·287-0·929), and (OR: 0·509, 95% CI: 0·280-0·925), respectively]. No NSAID reached statistical significance in regard to CV death. Incidence of the composite endpoint was increased by rofecoxib when compared against all NSAIDs, placebo, and other COXIBs [(OR: 1·612, 95% CI: 1·313-1·981), (OR: 1·572, 95% CI: 1·123-2·201) and (OR: 1·838, 95% CI: 1·323-2·554), respectively]. Incidence of composite endpoint was decreased by celecoxib in the all NSAIDs and COXIBs comparisons [(OR: 0·805, 95% CI: 0·658-0·986) and (OR: 0·557, 95% CI: 0.404-0.767), respectively]. When rofecoxib was removed from the COXIBs group, no difference was found with any comparison, suggesting rofecoxib skewed the data. What is new and conclusion: This instead of the meta-analysis suggests that COX-2 selectivity may not play a role in the CV risk of NSAIDs. Rofecoxib was the only drug to demonstrate harm and skewed the data of the COX-2 selective group.

The aim of this thesis is to explore medical librarians information practice in a pedagogical context. The empirical material was produced by 6 semi-structured interviews at 5 different hospital libraries during April and March 2023. A practice-oriented approach was used by the theoretical lens of Social Practice by Shove, Pantzar and Watson. In the analysis it was thematised by the practice elements material, competences and meanings. The findings show that medical librarians informationpractice in a pedagogical context work with many different materials and have competences that are of importance for students, hospital staff and researchers. They adapt their teaching and guidance for the user and their level. The different meanings that the medical libraries user and organization put on the medical library and their services has an impact on their ability to reach more of their users and their development.

OBJECTIVE: The purpose of this study was to determine the association between baseline patient recovery expectations and outcomes following physical therapy care. METHODS: PubMed, CINAHL Complete, PEDro, SPORTDiscus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and PsycINFO were searched from inception to February 2021. Concepts represented in the search included physical therapy, patient expectations, patient outcomes, and their relevant synonyms. Two reviewers independently screened studies of article abstracts and full texts. Eligibility criteria included English language studies that evaluated adults seeking physical therapist intervention for any health condition where both patient outcome (recovery) expectations and functional or other outcome measures were reported. Methodologic standards were assessed using the Critical Appraisal Skills Program criteria. Data were extracted using a custom template for this review with planned descriptive reporting of results. Vote counting was used to measure reported outcomes. RESULTS: Twenty-one studies were included in this review, representing 4879 individuals. Studies were most commonly prospective cohort studies or secondary analyses of controlled trials. Varied expectation, outcome, and statistical measures that generally link patient recovery expectations with self-reported outcomes in musculoskeletal practice were used. CONCLUSION: Patient recovery expectations are commonly associated with patient outcomes in musculoskeletal physical therapy. IMPACT: Evidence supports measuring baseline patient expectations as part of a holistic examination process.

The thesis focuses on the profession of librarian and information professional in health care in the context of lifelong learning. The target group are professionals of information institutions in the network of public health information services in the Czech Republic. Content analysis of Czech and foreign materials and sociological quantitative research carried out by questionnaires in the Czech Republic's health information institutions are methods for analysing the needs of the librarian and information specialist in the health care sector in the Czech Republic. The output is a proposal of the concept of a lifelong professional education program called Competencies of the medical librarian for the performance of library and information activities. The lifelong education of medical librarians in connection with the concept of lifelong education of librarians in the Czech Republic is a process that will enable to gain necessary qualifications (professional knowledge and skills, general skills and soft skills) to perform this responsible and demanding profession.

在數位化的進程及環境中，圖書館已由對大眾一視同仁的服務演變成重視個體不同需求的服務，圖書館的服務也不再是齊頭式平等的服務。讀者個人的喜好及需求已漸融入到圖書館建置的各種服務項目中，也就是必須因人而異，以滿足使用者的資訊需求，就如同商業市場的機制一樣，唯有行銷與競爭才能使圖書館更具有持續力。 個人化為導向的資訊管理與資訊服務，正逐漸被人們所重視。為了真正滿足使用者的資訊需求，創造出實用的資訊價值，個人化資訊的服務系統強調「因人而異，各取所需」的資訊服務系統，而圖書館也從傳統大眾化式的服務走向分別式、個別化差異的服務模式。 本研究為了要能瞭解醫事人員，對於圖書館所提供的服務需求內容及需求程度，以文獻分析及網站內容分析以及問卷調查的方法對台北榮民總醫院醫事人員的基本背景資訊、網路使用行為，以及對圖書館的網站使用行為與個人化服務需求做一問卷調查。並利用交叉分析的方法，探討醫事人員身份、年齡、學歷與個人化服務需求相關度問題，歸納研究結果重點如下： 一、醫學圖書館在網站上建置個人化服務需求首先應重視個人化資訊環境的建立。 二、國外圖書館網站內容之分析是提供國內醫學圖書館個人化服務項目的參考指標。 三、醫事族群中因不同的身份、年齡、學歷對個人化資訊服務需求有所影響。 四、醫事人員應加強個人興趣檔的建置觀念，以強化醫學圖書館個人化服務功能的提昇。 五、圖書館在個人化服務系統中應規劃隱私權政策。 六、醫學圖書館對整體個人化資訊環境及資訊服務的需求有其必要性且是非常肯定的。 對研究結果提出建議如下： 國內醫學圖書館應儘快整合共同發展個人化服務的機制；對於個人化服務中群體屬性的差異要能持續的注意及改進；對使用者的調查研究由完全量的統計進展到質與量的交叉運用調查研究；圖書館應協助醫事人員建立正確的興趣檔觀念以強化個人化服務的功能；隱私權政策的制訂應多加宣導並於圖書館資訊政策時明訂；個人化服務應多加推廣與宣傳。 / In the progress and environment of digitalization, the library has transformed its service mode from satisfying general needs into catering for different individuals. The library is no longer a one-for-all service. The users' personal interests and needs have been integrated into all the services the library provided; that is, the service differs from person to person so as to meet the users' needs for information. Just like the commercial world, only with marketing and competition will the library last. The individual-oriented information management and service is gradually getting people's attention. To really satisfy the users' information needs and create practical information value, the individualized information service system emphasizes providing "tailor-made" service for different users. And such is a trend the modern library follows. This research is carried out to understand what the users of the medical library need and to what extent they need it, regarding the service the library offers. This research uses literature review, Internet content analysis, and questionnaire survey of the basic background information, Internet usage behavior, the library Internet usage behavior and the needs for personalized service of the medical staff of Taipei Veteran General Hospital. Meanwhile, it uses cross-analysis to find out the relationships between the medical staff's positions, ages, education, and the needs for personalized service. The results of the research are as follows: 1. The personalized service of the medical library on its website should put major emphasis on the establishment of personalized information environment. 2. The analysis of oversea library websites can provide the benchmark for the personalized service of our country's medical libraries. 3. There exists influence from the medical staff's positions, ages, education on the needs for personalized service. 4. Medical people should strengthen their concept of establishing personal interest profile to enhance the personalized service in the medical library. 5. Privacy policy should be taken into consideration in setting up the personalized service system. 6. The personalized information environment and service is essential to the medical library. The implications of the research: The local medical libraries should cooperate to develop the personalized service as soon as possible; they should pay attention to the differences among different groups of users; when doing the survey of users, quality research coupled with quantity research should be conducted instead of completely using quantitative statistics; the library should assist the medical people to establish correct concept of interest profiles to enhance personalized service; the privacy policy should be established and implemented; and finally, the users should be familiarized with the personalized service.

Submitted by Giselle Francisco de Vasconcellos (gfvasconcellos@hotmail.com) on 2015-03-27T14:05:56Z No. of bitstreams: 1 Dissertação_Giselle Vasconcellos.pdf: 818582 bytes, checksum: 515159ca176c2a4cc30f6d61b8b67ad4 (MD5) / Approved for entry into archive by GILSON ROCHA MIRANDA (gilson.miranda@fgv.br) on 2015-04-09T16:46:18Z (GMT) No. of bitstreams: 1 Dissertação_Giselle Vasconcellos.pdf: 818582 bytes, checksum: 515159ca176c2a4cc30f6d61b8b67ad4 (MD5) / Approved for entry into archive by Marcia Bacha (marcia.bacha@fgv.br) on 2015-04-14T17:52:48Z (GMT) No. of bitstreams: 1 Dissertação_Giselle Vasconcellos.pdf: 818582 bytes, checksum: 515159ca176c2a4cc30f6d61b8b67ad4 (MD5) / Made available in DSpace on 2015-04-14T17:52:59Z (GMT). No. of bitstreams: 1 Dissertação_Giselle Vasconcellos.pdf: 818582 bytes, checksum: 515159ca176c2a4cc30f6d61b8b67ad4 (MD5) Previous issue date: 2015-01-07 / This study was developed in a private hospital, in Rio de Janeiro, in order to demonstrate the value of a digital medical library, as a scientific support tool for health care practices adopted by physicians, that resulted in technical glosses and loss of revenue for the institution. Through integrative review methodology, clinical literature related to technical glosses, occurred in the period from january to september 2014, were collected and analyzed from the perspective of the conceptual model presented by Cochrane (LEFEBVRE et al., 2011), which identifies the level of scientific evidence and establishes the degree of recommendation for clinical practice. During the content analysis, considering the techniques proposed by Bardin (1977), the scientific evidences, that gives value to the health care practices, were identified, as proposed by the conceptual model. In addition, the cost of the glosses were included in the analysis of the results, reinforcing the trend of the study to validate the conceptual model that recommends evidence-based medical practice to generate more effective results and better cost / benefit in health. Based on the findings, the theoretical and practical implications are discussed, as well as suggestions for future studies on the subject. / Este estudo foi desenvolvido em um hospital privado, no Rio de Janeiro, com o intuito de demonstrar o valor de uma biblioteca médica digital, como ferramenta de suporte para fundamentação científica das condutas assistenciais adotadas pela equipe médica, que resultaram em glosas técnicas e perda de faturamento para a instituição. Para isso, por meio do método revisão integrativa, foi coletada a literatura clínica referente às glosas, ocorridas durante o período de janeiro a setembro de 2014, e analisada sob a perspectiva do modelo conceitual apresentado pela Cochrane (LEFEBVRE et al., 2011) que identifica o nível da evidência científica e estabelece o seu grau de recomendação para a prática clínica. Durante a análise de conteúdo, considerando as técnicas propostas por Bardin (1977), foram identificadas as evidências científicas que conferem valor à prática assistencial, conforme proposto pelo modelo conceitual. Além disso, o valor dos itens glosados foi incluído na análise dos resultados, reforçando a tendência do estudo para a validação do modelo conceitual que recomenda a prática clínica baseada em evidências científicas para geração de resultados mais efetivos e de melhor custo/benefício na saúde. Com base nos achados, são discutidas as implicações teóricas e práticas, assim como sugestões para futuros estudos sobre o tema.

Background: The East Tennessee State University Quillen College of Medicine Library has participated for several years in projects to provide rural clinicians with health information resources. Objectives: To determine whether a strategy of hand‐held devices with a best‐evidence point‐of‐care disease tool and a drug database paired with access to a medical library for full‐text articles and training to use the tools would be an affordable way to meet the information needs of rural underserved clinicians. Methods: This study is a mixed‐methods methodology. The first project was evaluated using a randomised controlled trial (RCT) methodology. The second was evaluated qualitatively using interviews and focus groups. Results: The quantitative findings discovered that clinicians equipped with a hand‐held device with evidence‐based software more frequently found answers to clinical questions, found answers more quickly, were more satisfied with information they found and use expensive resources such as continuing medical education, online databases and textbooks less than the group that did not have access to online technology. Qualitative results supported the quantitative findings. Conclusion: Librarians can implement a three‐pronged strategy of the secondary literature via a hand‐held, the primary literature via Loansome Doc and quality training to meet basic information needs of rural clinicians.