G-

Patient Care (476)*

          Used the most appropriate diagnostic test (34)

               Used a previously unknown or unavailable
diagnostic test or procedure (6)

    Identification of a new technique for measuring diastolic
blood flow (carotid ultrasonography) enabled physician to
recommend that this test be ordered to investigate (and
eventually rule out) possible arterial problem (internal carotid
aneurism) without risky, painful, and expensive arteriogram. 
(034901)

    Information on antiphospholipid antibodies, anticoagulation
therapy for patients with this life-threatening condition, and
how to obtain the necessary laboratory test enabled physician to
confirm suspected diagnosis of this problem in a young stroke
victim and to place her on anticoagulant medication. (Patient is
still in hospital with a fair prognosis.)  (010801)

               Used the most sensitive and specific diagnostic
test(s) or workup for suspected condition (12)

    Information indicating a high false-negative rate of
ultrasound for common duct gallstones and that GGT was the most
helpful blood test for this problem led physician to request
immediate GGT on patient with a negative ultrasound scan but one
blood test suggestive of such gallstones, which resulted in the
diagnosis, subsequently confirmed by other tests.  (Stone
detached itself prior to surgery and patient is fine.)  (011404)

*Number in parentheses are the numbers of incidents classified in
each category


    Absence of information on any new measures for
differentiating between schizophrenia and organic brain disease
resulted in psychologist's continued use of Bender Gestalt test
as a diagnostic measure, even though there is a controversy over
its validity, in patients for whom he is called in as a
consultant.  (I) (U08702)

               Performed or interpreted diagnostic test properly
(9)

    Information giving the radiographic appearance of otitis
externa enabled pathologist to decide that image was indicative
of a tumor rather than otitis externa and to request further
imaging to confirm this diagnosis.  (Patient would have had
surgery if diagnosis was confirmed.)  (038303)

    Pathologist had patient with thymoma cells in the pleural
fluid who had an inconclusive biopsy.  Information from cell
marker studies on the differing cell patterns of benign and
malignant cells enabled the pathologist to discern that the
biopsied cells were malignant, after which the clinicians decided
to treat the patient's breathing problems and to treat the
patient with radiation and chemotherapy.  (Patient's current
status and prognosis were unknown to the pathologist.)  (039901)

               Evaluated new laboratory test for adoption (3)

                   Information on the specifics of a method to
measure xanthine oxidase in the serum, to assess the degree of
hypoxia in newborns who were asphyxiated at birth and then
resuscitated, enabled the physician to choose a more accurate
test that hospital laboratory could offer.  (U13903)

                   Information on the specificity of the beta
2-microglobulin test to evaluate the condition of AIDS patients
enabled clinic staff to decide to not use the microglobulin test
to evaluate patients with AIDS.  (074503)
               Identified most appropriate test and where it
could be performed (4)

    Information on the specifics of a diagnostic technique
(radionuclide lymphangiography) and on lymph edema enabled
physician to adopt this technique at his institution to examine
cases of edema and to provide clinicians with rough parameters
for evaluation -- diagnosis of lymph vs. vascular causes of edema
and for monitoring and post-op follow-up in, e.g., lymphovenous
anastomosis procedures.  (040002)

                   Information about clues for diagnosing
ectopic pregnancies and about additional tests such as
colocentesis and endovaginal ultrasound to fine-tune the
diagnosis enabled physician to diagnose one ectopic pregnancy
that he might have missed otherwise and to reduce his anxiety. 
(016301)

          Recognized and properly diagnosed a medical problem or
condition (104) 

               Recognized existence of an abnormal or normal
condition (15)

                    Determined that an observed condition was
within the normal range (1)

                        Identification of information on the
range of benign myoclonus in the newborn convinced the physician
that the baby he observed in the hospital who jerked in response
to touch, had episodes of apnea, and had a familial history of
the same condition did not have a life-threatening condition but
was within the normal range. (058001)

                    Determined that problem was a recognized
clinical entity (12)

                        Information obtained validated
physician's hypothesis that he was dealing with and appropriately
treating a legitimate clinical entity (thyroid abscess) in
patient with polyarteritis nodosa who had developed sepsis after
a consulting M.D. thought he had experienced a thyroid
hemorrhage, and it also identified treatments that had been used
by others.  (T02001)

                        Information obtained on depression,
treatment of depression, and client safety confirmed that the
plan that the physician had formulated was correct and allowed
him to treat patient in a more confident manner.  (024501)

                    Determined that proper diagnosis required
referral to a(nother) specialist (2)

                        Information on blepharospasm
(involuntary blinking of the eyelid) and the fact that it can be
aggravated by psychological factors convinced the psychiatrist to
refer his patient, who was a referral from the Workman's
Compensation insurance company, to a neuro-ophthalmologist for
further evaluation and testing.  (U17202)

                        Lack of confirming information that
thrombophlebitis was a side effect of the anticonvulsant Tegretol
led physician to go to the drug company for information (which
confirmed the side effect) and to withdraw use of all medications
and to treat patient's thrombophlebitis.  (I) (U08603)

               Arrived at a differential diagnosis (89)

                    Identified the diagnostic and prognostic
implications of specific history, physical exam, or test results
(10)

                        Pathologist examining supposed "wart"
that he concluded was malignant used information he obtained on
classification, treatment, and prognosis of that type of skin
cancer (polypoid melanoma) to alert and inform the surgeon, who
the pathologist believed may not have been familiar with the
problem and its treatment.  (034001)

                        Data indicating that patients with a
certain unusual pattern of tumor markers for myeloid leukemia had
a very poor chance for long-term cure provided the basis for
physician's decision to proceed with a bone marrow transplant for
a patient who exhibited this pattern, and led to a decision by
the hospital tumor board to test for these tumor markers in all
children who have a similar presentation.  (Patient is waiting
for a transplant.)  (059902)

                    Considered possible diagnoses that would
otherwise have been overlooked (6)

                        Information indicating that upper lobe
bullous disease could be caused by several conditions other than
emphysema or cysts (notably tuberculosis, ankylosing spondylitis,
pneumocystis pneumonia, and IV drug use) led physician to
consider these diagnoses in a young patient who didn't describe a
history of drug use.  Physician also now suggests these
differential diagnoses to physicians referring patients with this
problem. (029101)

                        Two case reports of headache and
migraine-like visual phenomena related to lead exposure were the
basis for physician's confirmation of lead exposure as the cause
of patient's having these unusual symptoms.  Physician
recommended classic treatment for lead exposure, which is
chelation therapy.  (Patient received chelation therapy and her
symptoms cleared in about 3 weeks.)  (048103)
                    Eliminated or was helped in eliminating a
possible diagnosis/cause of a medical problem (17)

                        Failure to find any reports of
exercise-induced pancreatitis helped physician rule this out as a
cause of pancreatitis in an adolescent patient who collapsed
during a foot race.  Having ruled out other causes as well
(infections, gallstones, alcoholism), physician treated patient
by withholding food until pancreas could rest and was able to
allow patient to resume racing with no recurrence of
inflammation.  (011401)
                        Absence of information supporting a
relationship between optic symptoms and exposure to an herbicide
(2,4-D) led consulting physician to conclude that 2,4-D exposure
was probably not the cause of optic neuritis in a patient, and to
advise clinician to treat the neuritis as another type of
problem, such as multiple sclerosis.  (Patient received local
treatment with cortisone and recovered with no decreased vision.) 
(048101)

                    Reached a diagnosis by resolving apparently
conflicting laboratory results, physical exam findings, or
history (6)

                        Information confirmed physician's
hypothesis that patient's hematuria was due to taking Quaaludes
and enabled him to advise patient that hematuria would go away if
she stopped taking the drug, which appears to have occurred. 
(021201)

                        Information indicating that positive
radiological findings had been previously observed in at least
two cases of bone marrow disease resolved apparently inconsistent
radiological and histological findings and made it easier to
diagnose bone marrow disease.  (034003)

                    Arrived at a diagnosis despite impossibility
of obtaining the classical diagnostic information (2)

                        Information indicating that Down's
syndrome has been observed to be associated with leukemia in
newborns increased pathologist's confidence in the diagnosis of
Down's syndrome at autopsy on a stillbirth based on evidence of
congenital leukemia, even though no cells could be cultured for a
chromosome study, and enabled appropriate counseling of the
parents.  (036103)

                        Lack of case reports in the literature
of other examples of chronic lymphocytic leukemia in very young
children, did not allow the physician to confirm the diagnosis in
his patient.  Treatment was unaffected as patient later developed
other definitive symptoms and physician was doing a retrospective
analysis.  (I) (065802)

                    Avoided a premature or unjustifiable
diagnostic conclusion (14)

                        Absence of comparable case reports in
literature of flexeril overdose in children told physician he was
facing an unusual situation and helped avoid a premature
conclusion about the cause of child's neurological problems. 
(T01301)

                        Determination that there was only a
single report that a particular pattern in bone scans was
associated with Paget's disease, and that there was no
further information on the pattern's specificity for the
diagnosis, helped keep physician from being too dogmatic about
the specificity of a similar pattern he had observed for Paget's
as opposed to bone metastases.  (040001)

               g.   Confirmed the suspected cause of a diagnosed
medical problem (27)

                        Information on the description of
capsular leiomyomas confirmed physician's suspected diagnosis in
a patient where this unusual kidney tumor was discovered after
surgery for another, larger tumor.  In fact, the tumor was benign
and no further therapy was needed.  (U11502)

                        Information about the incidence of
bilaterality of seminomas (primary germ cell tumors of the
testes) confirmed pathologist's belief that patient's
presentation, after 10 years, with a second separate seminoma on
the other side was a second primary lesion, not a metastasis. 
This meant that the urologist would follow-up patients with a
single lesion up to 10 years and that the treatment plan for this
particular patient would be altered to reduce the amount of
radiotherapy since the field had not been irradiated before. 
(U06901)

                        Lack of information about mortality
statistics for specific types of meningitis with different
etiologic agents left pathologist with unanswered questions
about the cause of death for a patient seen in autopsy because he
could never obtain any culture confirmation of a specific virus. 
(I) (U06902)

               h.   Confirmed a casual clinical observation about
the possible association of particular signs/symptoms, leading to
adoption of diagnostic procedures to identify appropriate
management in such instances (7)

                        Information indicating that there is a
linkage between thyroid problems and depression, and that lithium
for bipolar depression can depress thyroid function, confirmed
physician's casual clinical observations and led him to begin to
test thyroid function more carefully in depressed patients and to
treat both the depression and any thyroid problems
simultaneously. (010403)

                        Information on psychogenic polydipsia in
psychotic patients helped psychiatrist realize that polydipsia
among psychotic patients is quite prevalent nationally, not
merely a local problem, and led psychiatrist to institute
procedures to restrict fluid intake on the wards and set up a
schedule to monitor electrolyte levels.  (U08602)

          Developed an appropriate treatment plan (216)

               Confirmed the appropriateness of therapy selected
to treat a particular problem (24)

                    Confirmed that the original treatment plan
was correct (10)

                        Information indicating that the only
treatment for severe myasthenia gravis was steroids and/or Imuran
along with acetylcholine drugs made the physician feel confident
that his original treatment plan for his patient was correct. 
(U02802)

                        Lack of information on World Health
Organization guidelines for the administration of BCG vaccine for
tuberculosis prevention at birth to all third world children did
not allow physician to provide the guidelines to persons who
wanted to provide the vaccine for villages in Mexico.  Physician
later obtained WHO guidelines at a conference and found out from
a Mexican physician that the guidelines were being used and
the vaccine was being provided.  (I) (011402)

                    Confirmed efficacy of usual treatment after
exploring alternatives (8)

                        Information on what detoxification
protocols were in use (for benzodiazepine addiction), and the
fact that there were none that could reduce the time required,
resolved controversy in institution regarding time required by
protocol currently being used.  (033601)

         Information obtained about new vaccines being developed
in other countries and vaccine failures made the family practice
physician more confident that he should prescribe the standard
treatment (HDCV vaccine) rather than continue what had been
started in a foreign country for patient who had begun rabies
immunization in Mexico and then returned to the U.S. (045301)

                    Obtained support for proposed treatment of
rare/unusual condition (4)

                        Information obtained on the use of
intravenous IGG and steroids to treat neutropenia, which is a
rare and life-threatening condition, supported the physician's
decision to use this treatment, which he had only heard about
anecdotally, on his patient with the condition.  (040801)

                        Information obtained on the use of
cyclosporine and other unusual treatments for aplastic anemia, a
rather rare and serious disease, helped physician learn that
nothing more could be done for the patient.  Physician put the
patient on GM355 protocol because all other protocols were
anecdotal.  (011401)
                    Decided against a proposed therapy for lack
of supporting evidence (2)

                        Evidence that there is a lack of
understanding about extreme proteinuria, except that patients
usually die within 5 months, and a lack of evidence that AZT
treatment would help this kidney problem, led physician to decide
not to use AZT to treat patient with extreme proteinuria and HIV
infection.  (Patient has stayed alive for 2 1/2 years in spite of
proteinuria.)  (039603)

                        Advice obtained from the literature to
not use any nerve block for temporomandibular joint (TMJ) pain
helped anesthesiologist decide to continue with oral pain
medications, psychological counseling, and tricyclic
antidepressants rather than initiate use of any nerve block
(044803)

               Identified, evaluated, and chose an alternative to
own approach to treatment of a problem (35)

                    Identified and implemented a new
(state-of-the-art) treatment regimen (5)

                        Information in a Swiss journal
indicating that there was a new treatment for aplastic
anemia--high-dose antithymocyte globulin and high-dose
prednisone--convinced the physician to plan to use it on his
patient.  (P10301)

                        Physician was unable to retrieve the
latest information on diagnosis and treatment of
thrombocytopenia, a bleeding disorder, but was able to treat
patient.  (I) (045202)


                    Identified other treatment options among
which to choose (12)

                        Information about lack of expected
benefits from use of a pain control technique (transcutaneous
electrical nerve stimulation) and use of the technique for acute
postoperative pain was provided by anesthesiologist to a
colleague who had requested information describing the technique
and its uses.  (Anesthesiologist is unsure if colleague has begun
use of the technique.)  (044802)

                        Consistent reports recommending the
removal of an infected pacemaker confirmed physician's decision
not to use antibiotic treatment for a patient with an infected
pacemaker but to remove the pacemaker and implant a new one. 
(065502)

                    Changed the management of a common condition
(2)

                        Information obtained by surgeon on
current trends in rehabilitation after total hip replacement,
which recommended a posterior surgical approach and a six-week
recovery period before full weight-bearing ambulation, caused him
to institute these new methods with his patients.  (066303)

    Information suggesting the use of inhalation treatment with
bronchodilators for emergency treatment of children with asthma,
as well as use of steroids with this population, resulted in
physician changing his management of these patients when they
present in the E.R.  (U14401)


                    Confirmed the efficacy of a more conservative
therapeutic approach (7)

                        Information obtained by a physician that
adrenal masses could be evaluated over time, rather than
surgically removed, supported the physician's conservative
approach in controversy with another physician.  The patient was
evaluated biochemically and surgery was avoided.  (068502)

                        Information obtained about treating
shoulder-hand syndrome in stroke patients reinforced physical
therapist's position that immobilization with a sling was not the
first choice and that a gentle range of motion and positioning
was preferable.  (U14601)

                    Chose to implement a more aggressive
therapeutic approach (2)

                        Identification of a more aggressive
treatment regimen for advanced colon cancer (cisplatin for 5 days
and intra-arterial mitoxantrone) allowed the physician to show
the printout to the patient and family to confirm that this was
the best treatment available.  Family felt no need to seek other
opinions and the patient accepted the therapy.  (U19401)

                        Identification of intensive antibiotic
injections around the eye as a treatment for pseudomonas
scleritis, a rare infection usually resulting in the loss of
the eye, helped ophthalmologist choose this more aggressive
treatment for patient and improve the patient's vision. (030101)


                    Chose an appropriate alternative treatment
for a rare, unusual condition (7)

                        Identification of evidence that
supported the physician's view that his patient should have a
colectomy allowed the physician to make a treatment
recommendation to a patient with a unique presentation of
multiple colonic polyps.  The type of polyps and their
distribution was so unusual that, prior to the search, the
physician was not certain, from his knowledge or his textbooks,
of the appropriate treatment.  (U00902)

                        Identification of the best therapy
involving surgery and chemotherapy helped gynecological
oncologist choose best therapeutic solution for patient
with rare variety of ovarian carcinoma.  (047001)

               Adjusted the proposed therapy to improve
effectiveness (11)

                    Chose the appropriate dosage of a drug that
had previously been selected (2)

                        Information on the correct dosage of
mitotane and OPDDD to treat adrenocortical cancer (not commonly
used drugs) was used to treat patient with this disease. 
(019401)

                        Information about the proper dosage of
fentanyl for use as an anesthetic in surgery involving premature
infants confirmed the appropriate choice of dosage of drug used
by the anesthesiologist for child requiring surgery to close
ductus arteriosus.  (033802)


                    Identified a new route of administration for
a known drug (6)

                        Identification of a different route for
administering Ivermectines allowed a veterinarian to better treat
ear mites in cats.  Instead of the old tedious and usually
unsuccessful method of applying the medication topically, he
found evidence for injecting the drug, so the animal is treated
once and is cured of the problem.  (043401)

                        Information about combining sodium
bicarbonate with a xylocaine in the same solution to reduce the
pain associated with giving the local anesthetic enabled
pharmacist to answer physician's question, which then allowed
physician to make the treatment less painful for the patient. 
(059701)

                    Chose a different dosage/regimen to yield a
better response (3)

                        Information obtained on a different
treatment regimen convinced the physician to change the way he
treated a patient with chronic scrotal and lower-extremity edema
caused by treatment for a bladder tumor 10 years before.  From
the literature on female patients with similar symptoms after
radical pelvic surgery, physician learned that, by giving a
low-dose nightly antibiotic (until the symptoms disappeared)
instead of high doses for only a week, he could alleviate the
patient's problems.  (U15104)

                        Information about how non-steroidal
anti-inflammatory drugs prolong the bleeding times associated
with coumadin treatment led physician to do a more detailed
history-taking of patients who were to have vascular bypass
surgery or resection for aneurysms and to manage their
coagulopathy with less coumadin.  (U11901)

               Selected a treatment plan appropriate to condition
of individual patient (51)

                    Chose therapy appropriate to patient's age
(13)

    Information on guidelines for length of antibiotic use led
physician to continue treatment for an infant with salmonella
gastroenteritis bacteremia longer than he otherwise would have
and increased physician's certainty that what he was doing was
current therapy. (012101)

    Successful retrieval of an article that physician had
previously read about treatment of herpes zoster with acyclovir,
which described results for treatment of patients who were older
than current 30-year-old patient, led physician to decide against
use of acyclovir for this patient and to prescribe prednisone
instead.  (011403)

                    Chose therapy appropriate to pregnant patient
(8)

    Information on the likelihood of a recurrence of thrombosis
in a current or subsequent pregnancy, how long and how
intensively to keep patient on heparin therapy, and absence of
evidence of any attempts to use clot dissolvers during pregnancy
led physician to decide against thrombolytic therapy during
pregnancy and to more fully heparinize pregnant Hodgkin's
patient, who had a venous thrombosis due to an indwelling
catheter, between than during her pregnancies.  (011202)

    Data that indicated that treatment of seizures with valproic
acid is associated with a 1% incidence of fetal anomalies
confirmed physician's suspicion that the drug should not be
used to treat a pregnant patient with seizures.  Physician
stopped valproic acid and switched patient to Dilantin.  (011201) 


                    Chose appropriate therapy in light of
patient's previous history (12)

    Descriptions of clinical trials of low-molecular-weight
heparin derivatives that can be substituted for heparin, and of
sources for obtaining these derivatives, enabled physician
consulting to a surgeon with a patient with a life-threatening
allergic reaction to heparin to advise the surgeon on how to use
these heparin derivatives and where to obtain them.  (Bone
marrow service also was able to establish a route for obtaining
these derivatives within 10-12 hours.)  (059901)

    Information indicating that gamma globulin is
contraindicated in patients with low IGa levels, as opposed to
those who are IGa absent, enabled primary care physician to
convince pulmonary specialist to take patient off this
preparation and simply treat patient's underlying respiratory
infection problems, thus decreasing the patient's risk of
crossmatch problems were the patient to ever require surgery. (It
also resulted in patient having her children tested for
this possibly hereditary disorder.) (010401)

                    Chose appropriate therapy in light of a
concurrent medical problem (12)                  

                        Information on existence of a new
short-term, non-steroidal treatment strategy for managing
arthritis (T-cell globulin fractions), of which physician had
been unaware, enabled physician to obtain and use the medication,
which allowed earlier surgery on a bleeding ulcer caused by the
steroids a patient had been taking, and allowed an earlier switch
to the more effective non-steroidal treatment of choice for the
patient (methotrexate) (010901)
               
         Information about connections between skin changes from
psoriasis (arthritic changes) enabled physician to conclude that
there may be a relationship between severe acne and lower back
and joint pains and to treat both conditions with corticosteroids
(U03901)

                    Chose the correct regimen for multiple
disorders (6)

                        Case reports of treatment of patients
with temporal arteritis and scleroderma with steroids, which is
the standard treatment for temporal arteritis alone, provided
basis for physician's decision to treat a patient with this rare
and life-threatening combination of diseases with steroids. 
(031203)

                        The very limited number of reports of
other cases of two concurrent diseases (myeloproliferative
disease and chronic lymphocytic leukemia) led physician to elect
to proceed with his planned treatment of both diseases.  This
also enabled him to tell patient that condition was rare but not
unique. (038704)

               Minimized risks of treatment (60)

                    Determined whether there was evidence of risk
or side effect associated with planned treatment (20)
                    
    No information was obtained suggesting a high probability
that cyclosporine would cause a thrombosis in the renal artery
after a kidney transplant.  Physician was then able to
tell the family that it was unlikely to happen again in a patient
who had lost a transplanted kidney once because the renal artery
clotted off.  (029502)

                        Rheumatologist found references on
methotrexate therapy for cancer patients at 50 times the dose
being given to an arthritis patient who had developed acute
hepatitis, in which the drug was reported to cause hepatitis, but
without liver damage, and the effect disappeared within a few
days.  He reported to the patient's general practitioner that the
hepatitis was probably not caused by the methotrexate and that
other causes should be explored.  (052604)

    Evidence that the use of angiotensin-converting enzyme
inhibitors might actually make asthma worse or cause it in
borderline asthmatics convinced physician that these drugs would
not be an appropriate alternative to beta blockers for treatment
of asthmatic patients who were also hypertensive.  (022601)
               
Selected therapy that would minimize potential side
effects/risk/other adverse effects of treatment (15)
               
    Data provided in the literature by the inventor of a blood
filter for pulmonary emboli, indicating that it caused chronic
obstruction of the vena cava in a significant proportion of
patients, was basis for physician's decision not to insert the
device in a pregnant patient as a substitute for heparin therapy
for suspected pulmonary emboli.  Decision was made to stop
heparin during C-section and start heparin again after bleeding
stopped.  (015601)   

                        Identification of a surgical specialist
who could excise an endothelial sarcoma near the sacrum but spare
the associated limb by performing a bone replacement enabled
physician to refer patient with this sarcoma to the specialist,
who performed surgery after patient had several rounds of
chemotherapy.  (034905)
               
                    Provided treatment for anticipated or
potential problem (8)
          
    Failure to locate reference to an article physician had seen
in pediatric journal prevented physician from obtaining an
expert's comment on the article and obtaining his opinion of the
feeding position for an infant (bottle propping) in order to
reduce accumulation of fluid in the middle ear and risk of serous
otitis media. (I) (012601)

                        Information on a particular tumor
(pheochromocytoma), medications that could exacerbate it, and the
best pharmacological preparation of the patient before surgery
helped physician to diagnose the problem, begin to prepare
patient sooner than he otherwise could have, and helped keep the
patient out of trouble. (Also, authenticity of information via
MEDLINE helped convince physician's colleagues that this approach
was warranted.)  (035001)
          
               Identified ineffective or risky treatments for a
medical problem (includes fads, notions, homeopathic remedies,
etc.) (17)
     
    Information stating that fish oil can be an allergic
provoker of migraine headaches led physician to discount
anecdotal reports that fish oil could be used as a treatment for
migraine, and to decide not to use it as a treatment for himself
or patients.  (051802)
                        General information about kidney stones
and about specific therapies for them, including the
recommendation to avoid drinking large quantities of milk, led
psychoanalyst who was searching for information and guidance
about his own condition to stop drinking large quantities of
milk, to decide against invasive therapies, and to feel relieved
that he was more in control due to a better understanding of his
condition. (038401)
          
               Determined limits of own capacity to manage
patient's problem and need for specialized care (35) 

                    Identified appropriate treatment for a rare
condition that the physician (specialist) had not previously
treated (10)

                        Identification of a chemotherapy regimen
that had been relatively more successful in a previous trial with
a small number of patients enabled physician to initiate
treatment of a rare cancer (invasive thymoma)  that he had not
previously treated.  (034601)

                        Information indicating that the most
successful treatment for cancer that had metastasized to the
orbit of the eye was DES therapy enabled physician to choose this
therapy for patient as a sequel to previously-treated prostate
cancer.  (034201)

                    Determined the need to seek further
information from another source (8)

                        Inability of dentist to obtain any
information about treatment of an unusual lower jaw tumor
(intrabony neurofibroma of the mandible) resulted in
dentist having to locate this information in the most recent
issue of a journal he receives. Dentist then used the recommended
treatment for his patient.  (I) (032703)

                        Determination that there were no
previous reports of such an occurrence led physician to seek
advice from neurosurgeons on how to manage patient with blood in
the intrathecal/subdural space due to inadvertent injection in
the course of an epidural blood patch. (Physician elected to
observe and not treat.)  (011301)

                    Made a decision that patient should be
referred to specialist for management (12) 

                        Information on the characteristics of
craniofacial anomalies and lissencephalies reported, showing no
established relationship between them, led physician to diagnose
craniofacial anomaly of unknown type in a child with an unusual
presentation of craniosynostosis and to refer the patient to a
craniofacial center. (018201)

                        Because no information about
chemotherapy protocols suitable for a metastasized advanced
bladder cancer could be found, physician decided to transfer
patient with this condition to a tertiary care center.  (Patient
was transferred; outcome unknown.)  (014401)

                    Identified and used new procedure that
surgeon had not previously used (5) 

                        Recent literature on treatment of a
hemangiopericytoma gave physician a clue on how to proceed with
resection of the tumor and much of the septum and fix it with a
prosthesis, and will enable him to use radiotherapy on it if
there is too much intracranial spread.  (030601)
                        Information found was not specific
enough for a physician to undertake a third ventriculostomy for
internal treatment of a patient with hydrocephalus.  The
physician had not performed the procedure before and did not find
enough information to give him support that the benefits would
outweigh the length and risk of surgery.  Instead the patient was
treated with the standard shunting procedure.  (I) (U01201)
     
          Implemented treatment plan (67)

               Instituted prompt treatment of problem (8)

                    Began treatment earlier than would otherwise
have been possible (3)
     
                   Identification of information on the current
recommendations for treatment of chancroid in the emergency room
allowed the physician to rapidly set up a policy for treatment of
the condition in response to an epidemic of chancroid in women
presenting in the E.R. of his hospital and to pass along the
policy rapidly to the E.R. personnel.  (T00702)

    Information on the potential toxic effects of exposure to a
chemical (a polymer of diisocyanate) involved in the production
of carbonless paper resulted in the workers at the end of the
production line being required to wear respirators, as well as
more careful monitoring of the ambient air on the production line
by industrial hygiene personnel.  (034902)

                    Chose the correct priority for treatment(s)
in an emergency situation (5)

                        Discovery of two articles on a similar
situation was key to physician's decision to concentrate on
reversing anaphylaxis in critically ill patient, rather than
attempting primary treatment of concurrent cardiac failure, and
was probably critical to the patient's survival.  (039602)

                        Discovery of articles verified
oncologist's suspicion that etoposide was the drug of choice as a
salvage regimen to treat a patient who had a germ cell cancer
that had not responded to the standard treatment, but that if the
tumor was still growing at the time of the last etoposide
treatment, then the prognosis was poor.  Physician contacted a
colleague at NCI to identify more experimental treatments. 
(057201)

               Provided appropriate monitoring of patient's
condition (12)

                    Identified early symptoms indicative of a
recurrence or exacerbation of a problem (4)

                        Absence of indications that there were
any new techniques for serodiagnosis, plus information reviewing
the potential complications of Behcet's syndrome, reinforced
physician's diagnostic procedures, enabled him to educate
patient, and will decrease the likelihood of complications by
alerting both to  symptoms earlier than they otherwise would have
been detected.  (036301)

    Information obtained by physician assistant on two specific
tests--prothrombin time and partial prothromboplastin time--for
disseminated intravascular coagulation (DIC), which is an
infrequent complication of orthopedic surgery, resulted in the
institution of monitoring techniques to detect DIC earlier and
informed physician assistant on how frequently the tests should
be performed.  (T00802)
                    Determined the appropriate method and
frequency of monitoring for potential side effects of treatment
(8)

                        Information on a drug used to treat
rheumatoid arthritis (methotrexate) suggested a range of points
to monitor for potential liver damage, but indicated there was no
clear consensus on optimal frequency of monitoring or dose at
which a biopsy should be done.  This encouraged physician to
begin prescribing methotrexate to several patients and guided him
in formulating instructions to patients about schedules for
follow-ups to monitor side effects.  (011102)

                        Case reports of other occurrences of
breakage and fragmentation of indwelling central venous (Hickman)
catheters, and descriptions of mechanism involved, was used by
physician who observed such breakage in one patient to institute
a monitoring procedure to check for signs of breakage in other
patients and to accumulate data on percent breakage in such
patients in his institution for possible publication.   (029103)

               Evaluated and revised treatment plan as needed
(47)

                    Identified a promising new treatment or
variation when other options had proven ineffective (16)

                        Information covering all current
treatment regimens for lymphoblastic lymphoma enabled physician
to choose and initiate an aggressive treatment with a better
prognosis (CHOP followed by a round of another chemotherapeutic
agent) for a patient with this rare cancer.   (040201)
                        Identification of a promising
chemotherapy protocol for metastatic thyroid cancer (adriamycin
and cis-platinum), not previously known to the physician, gave
the physician an additional option to try for a disease for which
there was no standard treatment.  (049903)

                    Utilized a promising therapeutic agent not
readily available in U.S. (3)

                        Information of the identity of companies
distributing a particular chemotherapy agent in Europe
(prednimustine) enabled physician to obtain this drug
in the U.S. and use it to treat a Hodgkin's patient who had
relapsed while on another therapy.  (037402)

    Information obtained by pediatric fellow on the use of
4-methyl pyrazole, a drug which has been used for treatment of
ethylene glycol poisoning but has not yet been licensed in the
U.S., will result in his possibly recommending this treatment for
this type of poisoning next time he is consulted.  (066701)

                    Chose a new treatment option when necessary,
taking into account contraindications due to patient's condition
(8) 
                        Identification of two potential
chemotherapies for Hodgkin's disease that are not too toxic for
patients who have been heavily pretreated has given physician and
patient an option that may be helpful and not too disruptive to
the life of a Hodgkin's patient with an incurable condition. 
(037401)

                        Information about chronic pain
associated with intestinal problems and medications to manage
chronic pain (tricyclic antidepressants), allowed social
worker to provide the information to patient and physician, so
both could understand the condition better and the physician
could prescribe the tricyclics (U07403)

                    Insured that all possible treatment options
were explored in the case of a seriously disabling or
life-threatening condition (19)

                        Case reports of patients that had done
well with just long term antibiotic therapy enabled physician to
successfully treat a post-surgical bone infection (pudendal
osteomyelitis) without further surgical intervention.  (035102)

                        Identification of the best therapy
(intravenous miconazole) for a brain abscess due to a very rare
fungus, based on a limited number of previous case reports, was
critical to the physician being able to institute the correct
treatment, without which the patient would have died.  (035002)

                    Determined nature and extent of others'
previous experience with own improvised therapy (1)

                        Information was obtained which
identified that a highly unusual procedure which the surgeon had
improvised had been reported one other time in the literature. 
When the surgeon was unable to plug the renal vein into the iliac
vein of the patient, he plugged it into the portal vein.  It was
helpful to the physician to know the operation had been done
before (only once), but since the operation was not too
successful (the kidney clotted off two days later), the physician
decided not to write up the case. (T04101)


          Maintained an effective physician-patient relationship
(46)

               Provided explanation of condition to patient or
family (44)

                    Relieved patient or family anxiety (30)

                        Information indicating that the effect
of pregnancy on malignant melanoma is not well understood, but
appears to depend on how advanced the case is, enabled physician
to provide the best available answers and reassure newly pregnant
patient.  Patient had had a malignancy several years previous and
had become highly anxious after discovering a suspicious lesion
(which proved not to be a melanoma).  (P31101)

                        Information indicating that Thorotrast,
an X-ray contrast medium, removed from the market fifteen years
earlier, caused reactive thickening of meninges and produced
neuritis allowed physician to explain the cause of the condition
to patient and to explain that nothing can be done except to use
painkillers to help the neuritis. (033301)

                        Lack of information on prognosis of a
rare skin disease (bullous pemphigoid) characterized by bullous
lesions and skin necrosis, prevented physician from answering
patient's family's questions promptly and necessitated calls to
academic medical centers to obtain the answers.  (I) (071602)

                    Improved patient or family cooperation (3)

                        Data that indicated that the 5-year
survival rate for nasopharyngeal cancer varied from 20 to 90%
depending on the type and stage of the tumor guided physician to
counsel members of his family to be realistic about the prognosis
for another family member with this cancer and to advise them
that the patient needed to be vigilant about follow-ups instead
of assuming that the cancer was cured.  (047901)  

                        Studies showing that morbidity and
mortality were lower for vaginal birth after Caesarean than for
repeated Caesareans convinced the physician to explain the
alternatives to his patients and advise them to request a vaginal
delivery after Caesarean, since the hospital was recommending
repeat C-section (U02402)

                    Involved patient or family in treatment
decision (11)

                        Information on the types of associated
birth defects enabled physician to counsel parents of a child
with a chromosome deletion that child would have mild mental
retardation and should be enrolled in a infant stimulation
program. (015001)

                        Information recommending vaginal
delivery after Caesarean (VDAC), the appropriate monitoring
techniques, and patients who should be ruled out, made rural
physician more accepting of the new practice but led him to
suggest to patients who want VDAC that they will be referred to
an urban clinic or hospital with the appropriate emergency
equipment (016303)

               Insured continuity of care for patient moving or
traveling outside area (2) 

                   Information obtained by a physician with a
pancreatic cancer patient undergoing chemotherapy permitted him
to recommend a specialist to continue her care in city to which
she was moving for the winter.  (040802)
                   Information on chemotherapy and immunologic
protocols and persons performing limb-sparing surgery for
soft-tissue sarcomas permitted oncologist to recommend the only
specialist performing limb-sparing surgery to a patient with an
endothelial cell sarcoma.  Patient was treated by that
specialist, had the sarcoma removed, and is now walking. (034905)

          Provided assistance in modifying patients' health
behaviors (4)

    Failure to obtain information on effective interventions and
educational resources to help patients stop smoking, reduce
cholesterol, and increase exercise prevented physician from
preparing a booklet for other doctors in his office to help them
answer patients' questions and assist patients in making changes
in health risk behaviors.  (I) (010902)

    Information obtained by endocrinologist showing that
lowering cholesterol lowers the incidence of heart disease but
does not lower the death rate from the disease, coupled with his
discussions with experts in the field who also lacked proof of
the benefits of lowering cholesterol, has significantly affected
his patient care.  Physician does not say that he has evidence
that it matters if they lower their cholesterol; he says that he
believes that there are benefits.  (U06302)

          Discharged responsibilities with respect to patient and
third-party payors (5)

    Determination that there was only one, inconclusive report
of a low blood count resulting from any of the chemicals to which
the patient was exposed on his job led physician to conclude that
patient's work environment was safe, to deny support for
workman's compensation claim, and to institute typical therapy
for idiopathic thrombocytopenic purpura. (038703)

    Information indicating that remission of a particular kidney
disease (membrano-proliferative glomerulonephritis) is rare and
that it normally recurs supported physician's decision not to
certify to patient's insurance company that patient, who had been
in remission for several years, no longer had the disease, as had
been requested by patient's mother. (040203)

Research (239)

          Formulated a research problem or hypothesis (64)

               Determined whether research area was viable (12) 

    Researcher who knew that rheumatoid arthritis, which is
hereditary, is identified with HLA type 27 hypothesized that
there might also be a relationship between atherosclerosis and
HLA-typing.  He thought this might be worth pursuing as a
research project, but when he couldn't find anything in the
literature relating atherosclerosis and HLA-typing, he decided
not to pursue it further (053701)

    Research team of molecular biologists working in large
animal studies had isolated maternally-produced retinal-binding
proteins in pig uteruses.  These proteins were not fully
loaded, and team was interested in exploring whether loading
status influences embryonic survival.  To substantiate the
viability of this research idea, they were looking for evidence
in the literature that Vitamin A deficiency or excess influences
embryonic survival.  They found nothing in MEDLINE but are still
searching other data bases that are more focused on large
animal research (I) (013901)

               Found an entre into a previously refractory
research area (9)

                   Researcher had been interested in
insulin-like growth factors and the role they might play on the
lining of the uterus (decidua) during pregnancy, but didn't
really know where to go with this idea and hadn't been able to
find anything in the literature. MEDLINE search suggested these
binding proteins may be made by the decidua and also gave
indications of the experimental conditions under which others had
been able to find them.  Respondent was able to formulate a
research plan and develop a successful research program. 
(046802)

    An article in a German journal revealing the same
interaction between drugs that modulate calcium channels and
tinnitus in humans that researcher had seen in his animal
model encouraged him to pursue the research (because so little
had been done in this area) and to move on to the next stage
using calcium channel modulators on his animal model to
see the influence of different drugs.  (074801)

               Determined whether a problem of interest had been
adequately investigated or resolved (41) 

                    Determined area was wide open for new
research (15)

    Public health researcher found little information in the
literature on an association between colonic polyps and either
papilloma virus or skin tags (an association which he thought he
had observed in his patients), and he was encouraged to look
further at cases in own hospital to see if solid evidence of an
association could be found (047501)

    Absence of controlled studies comparing brachial artery
placement with other arterial line placements convinced
pediatrician in intensive care unit to set up a research protocol
to investigate the issue further.  (U13402)

Identified a gap in existing knowledge open to new research (26)

    While working on biochemical effects of radiation,
researcher had obtained preliminary evidence that calcium played
a role in induction of cell death by radiation.  Information
discovered on work by a previously unknown researcher led to
articles which confirmed and explicated this phenomenon. 
Researcher subsequently modified research plan to build on other
researcher's work instead of repeating it. (056803)

    While designing a study on preterm infant feeding behavior
by bottle, physician found most articles were dated and
descriptive of older methods; newer techniques such as pulse
oximetry were not mentioned.  He decided to replicate data from
older studies, confirm their results, and conduct his study after
finding the information he needed on pulse oximetry. (U11001)

    After obtaining no evidence of research studies that dealt
specifically with the relationship between cocaine and myocardial
infarct, only case reports, cardiologist decided to design a
protocol and conduct a study to determine if there is such a
relationship.  (T00102)

               Contacted colleagues to generate ideas (2)

    An article with list of books which identified researchers
in his field of interest allowed dentist to contact these
individuals to obtain more information and names of other
people to contact.  (078102)

          Sought research funding or collaboration (37)

               Enhanced credibility by demonstrating full command
of current state of the science in study area (17)

    Information from both classic and current articles in
research area (e.g., wound healing, immunosuppression) provided a
broader context for researcher's own work and helped him prepare
a credible background section for grant proposal. (049102)

    After reviewing literature on food attitudes and eating
disorders in non-Western cultures (which was practically
non-existent), respondent had the information base necessary
to establish credibility with Chinese colleagues and set up own
survey during trip to China (017902)

               Justified the significance and/or appropriateness
of a proposed research study (11)

    Results of large-scale surveys of atherosclerosis in
childhood (from the literature) were used in grant proposal by
respondent to underscore the significance of researcher's own
proposed survey of pediatricians' attitudes and behaviors
vis-a-vis early prevention of adult cardiovascular disease in
their patients.  (060501)

    In the course of his work, researcher found that compounds
that increase the CGMP inside the cell cause the cells to
differentiate in the HL-60 cell line.  Review of the literature
to see if this had already been reported in other cell lines
revealed that it had not been and encouraged him to write grant
proposal and proceed with research.  (045802)

Evaluated potential for collaboration with other researchers (6)

    Researcher had attended a professional meeting and met 12
investigators from different countries, all working in
respondent's field of molecular cloning and amino acid
sequences.  Reviews of the published works of each of these
individuals helped him determine their value as potential
collaborators and generally guided further interactions with
them.  (013902)

    Before meeting with a potential collaborator, pharmacologist
obtained a complete list of that neuroscientist's publications
since graduate school, and developed a complete picture of the
individual's interests and other collaborative work on which to
base his decision. (074402)


Secured review by most appropriate funding agency or agency
component (3)

    Based on review of published work of study section members,
researcher confirmed that agency component to which grant had
been submitted had the orientation (carbohydrate analysis rather
than molecular biology) necessary for an appropriate review
(013802)

    Based on review of appropriate literature on control of
fatty acid utilization and the different approaches that could be
used to study the topic, member of study section determined
feasibility of each approach, presented in the grant applications
he was reviewing and whether the methodology was precise enough
to answer the questions proposed, in an area with which he was
somewhat familiar. (074202)

          Planned and executed the investigation (68)

               Formulated specific research questions (7) 

                   Information was gathered for a clinical study
of the incidence of ruptured aortic aneurysm which included
demographic data (age groups in which it occurs, sex, etc.) and
associated diseases.  This allowed physician to work up a
research protocol to study his accumulated experience with this
problem over the past five years.  (U00502)

                   Information was obtained on pathogenesis of
ultraviolet carcinomas which provided researcher with ideas of
possible test models to study treatments to modify
ultraviolet-induced cancerous lesions.  (P10602)

               Identified important variables and control
conditions (10)

                        Researcher working in reproductive
endocrinology wanted to investigate a group of compounds called
lipocortins, focusing on whether these compounds are secreted or
produced by the placent.  Information about the chemistry and
molecular biology of these compounds and their biological effect 
helped researcher conceptualize the experiments and to get
suggestions as to appropriate protocols (e.g., doses, exposure
times, etc.) (046801)
 
                        Physician researcher noted clinical
problems among certain patients using experimental total-joint
prosthetics made of polyethylene.  Used retrospective case study
of own population combined with a review of literature on
clinical and theoretical studies of these types of prosthetics to
isolate precisely what failures might occur and what clinical and
other factor were related to these types of failures.  Used
results to help guide search for better prosthetic joint material 
(045401)

               Selected appropriate protocols and techniques (38)
                    Confirmed safety of proposed research
protocol (1)

    Researcher was planning a study of the use of low dose
aspirin to prevent fetal growth retardation in patients with
abnormal umbilical artery blood flow used information from
review of prior research to confirm that the side effects of the
proposed protocol would be within acceptable limits for mother
and baby (060802)

                    Identified or developed a protocol,
technique, or tool that rendered the research technically
feasible (23)

    Renal biologist needed an inhibitor of acyl-CoA synthetase
so as to distinguish between the effects of volume regulation and
beta oxidation on butyrate.  MEDLINE search turned up Japanese
investigators who had isolated an appropriate inhibitor and
compound was obtained directly from them for use in the
researcher's experiments (052401)
    Researcher was unable to identify a review article
describing the methodology for synthesizing Schiff bases and
subsequently had to review Chemical Abstracts by hand to get
the information before proceeding with research (I) (046603)

    Researcher used information on the properties and sequence
of the ovalbumin gene, as well as information on the techniques
for isolating and utilizing the gene, to help devise methods for
cloning the gene into a plasmid and thence transforming plants to
increase their nutritional value (046602)

                    Identified or developed best protocol or
technique based on comparison of alternatives (14)

    Researcher was not able to obtain information on how
photoreleasable compounds are made and what they are used for. 
Consequently he was unable to decide whether these compounds
would be useful in his own research and had to select a different
method to try to reach research goals. (I) (T00603)

    Researcher obtained several review articles which indicated
that the cytobrush was the best method for cervical cancer
screening, and researcher could design his protocol to study
cervical cancer screening.  (034501)

               Modified planned procedures when warranted (13)

                    Incorporated a method, technique or equipment
to solve a central problem in the investigation (3)

    Researcher had evidence from enzymatic treatment that there
were different kinds of carbohydrates on androgen-binding
proteins, but had been unable to define the specific
carbohydrates because the enzymatic procedures that could
separate the sugars also denatured the protein and interfered
with radioactive tracing.  Information from the literature on
seriolectin chromatography allowed the researcher to fractionate
the glycoproteins and separate the different classes of sugars
without denaturing the protein, so that the research proceed
(049302)

    Researcher obtained the specific physiological procedures
for measuring radionucleotide-labelled transfer across the
blood-brain barrier, which helped him enter a new area of
research which has subsequently expanded to account for a major
research area in his laboratory.  (P21101)

Substituted a method, technique or equipment giving better
results than the one in current use (10)

    Researcher's prior method of SDS page electrophoresis, using
saponin, was destroying the proteins in erythrocyte membranes and
frustrating efforts to measure the erythrocytes.  Information
from a MEDLINE search turned up two new alternate methods, and
researcher switched to one which uses the SDS itself to lyse the
cells.  The research was then able to proceed (058301)

    Information on methods using DNA probes to localize
chromosomes within the nucleus of the lymphocyte cell allowed
researcher to enhance his own techniques in various ways, e.g.,
by adopting a different solution for removing nonspecific
staining from slides (044502)
 Executed secondary or meta-analysis of published data or
research (13)

               Performed meta-analysis to evaluate adequacy of
existing research (11)

    Researcher analyzed sample sizes of published negative
clinical trials of treatments for cystic fibrosis during the past
10 years, concluded that most did not have the statistical power
to confirm null findings, and wrote paper advocating more
multicenter trials to increase power (033401)

    In context of a research paper for M.P.H. program, emergency
medicine physician analyzed published data on trauma mortality
before and after the introduction of specialized trauma centers
and concluded that these centers had done little to influence
overall mortality rates (028401) 

               Analyzed attitudes and opinions as evidenced in
published papers (1) 

    Doctoral student writing a dissertation on the rise in
biophysical, high-technology medicine in the 20th century,
particularly the artificial heart.  Review of medical literature
allowed him to incorporate attitudes of clinicians as well as
non-physician commentators and to demonstrate that conflict over
the ethical quality and overall efficacy of these devices
exists within medicine as well as elsewhere.  (048901)

          Interpreted and reported results (57)

               Developed an interpretation of research findings
(16)

                    Identified a mechanism that would explain
unusual or puzzling results (6) 

                        Information on the base levels of
glutathione peroxidase in leukocytes allowed physician researcher
to explain why there was an unexpected increase in glutathione
peroxidase in the lungs when they were experimentally implanted
after being treated with a preservative fluid to keep them viable
longer.  Since it was too soon for enzyme induction to occur, the
rise had to be due to an influx of cells into the lung. (044402)

    Physician/biochemist unearthed a little known paper that
described an alternate reaction of guanine methyl sulfate that
blocks in vitro DNA synthesis by undergoing further degradation,
and thus explained the unusual result their lab obtained where
dimethyl sulfate interacted with guanine residues to cause
inactivation of reverse transcriptase.  (065501)

Identified a model or theory that fit experimental findings (4) 

                        Information on the rolling circle model
for plasmid replication allowed the researcher to explain how his
PE194 plasmid replicates and makes bacteria resistant to
erythromycin, and provided some new directions for his research
to take without repeating other experiments which the researcher
believed were done incorrectly. (056603)

    Information on a model of peptide metabolism and
elimination, was used by a pharmacologist to interpret data that
had been gathered from rats and monkeys on the peptide in
question, in his role as consultant to a pharmaceutical firm that
is planning to use the peptide as a drug.  (019001)

                    Developed or refined theory so that it would
encompass new findings (3) 

    Information from the literature on the role of specific
catalases in oxidative reactions involved in the process of
differentiation, in conjunction with researcher's own findings,
allowed the researcher to publish a paper advancing the theory of
the role of oxidative reactions in development.  (028702)

    Information that the zinc-binding protein that the
biochemist was studying did not fit with  the zinc fingers model
of binding caused him to alter his model for zinc binding of the
protein and try to come up with an alternative model.  (073103)

                    Analyzed methodology in order to interpret
research findings (3)

    Scientist found a relevant and well done study in the
literature which helped him extend his knowledge of drug movement
through the body to model the movement of antibodies (a much
larger molecule).  He then used this information to interpret
data from a study of two antibodies against breast cancer, and
particularly to derive pharmacokinetic parameters from data on
antibody blood levels as a function of time after administration.
(019002)

    Information obtained by research psychiatrist on other
studies utilizing non-psychosocial factors that can affect immune
system function was used to interpret his own research findings
on how long it takes HIV-positive individuals to develop
full-blown AIDS, and also to integrate this information into the
study in order to control for these non-psychosocial factors. 
(T07401)


               Determined the significance of research findings
(13) 

                    Determined that findings had not been
previously reported and should be published (5) 

                        Lack of information on the effects of
beta agonists on cytosolic calcium and and cyclic AMP and their
influence on glycolysis in the heart, convinced the cardiologist
researcher that his specific study had not been performed
previously and that the article he was writing presented some new
ideas about the efficiency of heart function when glucose is
being utilized.  (T02501)

                        Failure to obtain information on
angiogenesis in tissue culture made the researcher question
whether he should write up the results of the system he developed
using endothelial cells in tissue culture as a model for the
growth of endothelial cells on vessel prostheses in surgery,
because he didn't know if the system had been reported before,
and resulted in a delay in publication.  (I) (021901)

                    Determined that findings contradicted
prevailing opinion and should be reported (3) 

                        Information on the successful use of
Verapamil, a calcium channel blocker, to treat patients with
tardive dyskinesia conflicted with the negative results obtained
by an osteopath researcher who had conducted a single blind-ABA
design study and convinced him to write up his results as a
negative study.  (U12503)

    Published information indicating a better outcome with donor
blood transfusions prior to transplant compared to treatment with
cyclosporine reinforced nephrologist/immunologist researcher's
decision to publish his conflicting experimental results which
indicated a better outcome with cyclosporine than with blood
transfusion.  (T07802)

                    Determined that findings were worthy of
further investigation (5) 
     
    Information that showed a direct action of insulin-like
growth factors on growth hormone in the pituitary of the rat,
plus articles by the same author on gene and protein regulation,
supported validity of researcher's decision to continue
exploration of role of IGFs in regulating growth hormone rather
than the converse. (033501)

    While no information was found on increased rates of suicide
among new settlers, information on increased suicide rates among
immigrants, and the symptoms of early risk (boredom, alcoholism,
and argumentative behavior) convinced researcher to propose a
follow-up study on the high rates of suicide among settlers in
the wet zone of [country] focusing on the symptoms of early risk. 
(U08802)
 
               Prepared report of research (28) 

                    Cited corroborating evidence from other
studies in report of research findings (11)

                             Information from an English journal
revealing that Russian researchers had obtained chemical evidence
of attachments for carbohydrates on steroid binding sites
supported researcher's findings from enzymatic studies and
produced a more authoritative discussion of his data in a
research paper (049301)

    Lack of information on the length of time it takes
neutrophil cells to move from inside to outside of blood vessels,
did not provide the pulmonary diseases researcher with desired
evidence needed to corroborate his findings on the change in the
adherence of neutrophils in the respiratory tract as they move
from inside to outside of blood vessels during airway
inflammation.  (I)  (061303)

                    Provided relevant context of other research
in which to discuss methods and results in research report (10)

                             Information in two previously
unknown articles on changes in renal function with aging and the
relationship between renal and cardiac function was incorporated
into paper reporting on researcher's own study of how renal
changes predict changes in cardiac function (T00602)

    Information describing other examples of proteins with
O-linked glycosylation allowed the researcher to tell a more
complete story in the introduction to a paper on the
glycosylation of the peptide fiber protein, which is an
adenovirus of the cell receptor, involved in the initial
process of infection.  (073102)

                    Avoided omission of other relevant research
in report of research (7)

                             Identification of all the review
articles on the prognosis and treatment of polymyositis in the
past three years gave physician researcher a basis for comparison
with his own concepts and findings in paper on his research
(045702)

    Information on the isolation of the blastomycosis fungus
from a beaver dam or fishing hut, which is difficult to isolate
in the laboratory, allowed the veterinary researcher to include
all the relevant research in his paper on the evaluation of an
experimental drug for the treatment of this life-threatening
fungus pneumonia in dogs.  (071503)

Teaching (254)

          Provided instruction in the basic sciences (6)

               More effectively prepared lecture for
undergraduate college science course (1)

    Information was gathered for a lecture to university
undergraduates on the Drosophila homeobox (a DNA sequence in some
mutants), and the citations themselves were presented to
the class as handouts. (050701)

               More effectively prepared lecture for graduate
student seminar (2)

    Information obtained on axonal transport including recent
developments in the area of moving biochemicals along the axon,
gave the researcher the most current information to prepare a
lecture for graduate students. (058602)

                   Information obtained on the broad areas of
colony stimulating factors and the subclasses, gave the
researcher, who was not versed in the area, sufficient
information and key review articles to use in presenting the
seminar to graduate students. (013903)

               Provided students with bibliography to prepare
paper (3)

    Information obtained within 30 minutes on tuberculous
meningitis enabled a 3rd year medical student to begin to write
classroom paper on the topic. (060403)

    References were assembled, on cardiac assist devices in
animals, by a faculty member,which graduate student could use to
develop a bibliography of other people's results to compare with
her own. (P10805) 
          Provided clinical instruction (73)

               Supplemented own or resident's clinical teaching
on the wards (7) 

    Information was obtained to teach medical students who were
treating asthma patients, about asthma giving them general
information on the condition, new drug therapies and under
what conditions these drugs were recommended.  The information
also provided the physician with reassurance that his  new use of
steroids as a first-line medication was correct. (T04201)

    Information obtained on multiple myeloma-- the history of
the disease and previous therapies--was used by the physician to
augment a resident's talk in rounds about a particular
patient, thus underscoring the evolution of treatment of the
condition.  (P12404)

               Prepared educational resource for use by students,
residents, or faculty (12)

                    Provided students/residents with selected
references or a reference list (4) 

    An article obtained via MEDLINE that catalogued all the
malpositions which can occur with catheter placements was given
to residents by physician to aid them in reading the
malpositions on films and to serve as a reference when they go
into practice.  (029102)

    Articles obtained on the ethical issues behind the Harvard
criterion for brain death was used by a faculty member in as a
basis of discussion with his residents preparing for a section
of the MKSAP-7 board examination.  (038803)
          

          Provided students/residents with special-purpose
literature data base (1) 

    A database was developed consisting of all articles
appearing in the past several years in the most commonly used
journals in the anesthesia department library, which made
searching very easy for the residents and served as their
first-line reference tool.  (P10806)
          
          Prepared or assembled bibliography to supplement a
presentation (7)

    A list of citations to articles on the use of computers in
medical education, sorted by type of use, was distributed as a
reference to supplement family physician's talk on his own
uses of computers with information on what others are doing.
(041803)

    Physician researcher obtained all items in the bibliography
of a visiting researcher and was able to print it out directly,
in the correct (inverse chronological) order, an distribute it in
advance of the researcher's lecture. (052601)

               Prepared clinical lecture or graduate symposium
(13)

                    Developed content of talk (11) 

                        New information suggesting that the
various psychological problems experienced by women during
menopause are not necessarily related to any physiological
process corroborated what nurse already knew and gave a different
perspective on that aspect of women's health care that she could
use in a lecture to nurse practitioners on the menopause.
(T04002)

                        Rapid and inexpensive acquisition of a
series of articles giving information on the success rates in
treating optic nerve trauma by surgical or medical means greatly
facilitated neuro-ophthalmologist's preparation of a lecture on
this subject to colleagues. (031201)
     
               Assembled audiovisual materials (2)
     
    General information published in the last three years on
keratinization of hair follicle epidermis aided dermatologist in
preparing a talk on this subject and provided pictures to use
in the talk. (016401)

    An article on the arterialization of the dorsal vein of the
penis provided urologist with the figure he needed to reproduce
as a slide as part of his lecture presentation.  (063501)

               Prepared for case/clinical conference (8)

                    Augmented own information on case and
management (7)

                        Information in a review article giving
the newest information on antibodies which might be specific to
drug-induced lupus was obtained and used to supplement a case
conference on a patient with this condition.  (052602)

                        Failure to find information on what
cancer cells have receptors on their surface for colony
stimulating factors meant that hematologist/oncologist
could only conjecture that this might be happening in the patient
he was presenting at case conference whose lung cancer was
producing a factor that stimulated the production of eosinophils.
(I) (070502)


               Provided input on specific issues related to case
(1)
     
    Information obtained on the treatments used for cardiac
rejection by different transplant centers helped physician
present a clinical conference on a patient in rejection, to
educate the surgeons and the cardiologists as to the therapeutic
options and stepwise approach to care, and when they should think
about using various anti-rejection agents such as azathioprine,
cyclosporine and antilymphocytic globulin.  (T07501) 
     
          Prepared broad review for major professional
presentation (28)

                    Incorporated additional information in
presentation at grand rounds (13) 
     
    Failure to obtain information on clinical research on
peroxisomal disorder meant that physician had to re-search the
human literature in order to prepare an adequate review for a
grand round presentation on a patient with this condition.  (I)
(036401)

                        Identification of a broad review on the
subject of the renal manifestations of multiple myeloma provided
physician with sufficient information to address the common and
uncommon manifestations of renal diseases in multiple myeloma in
a grand rounds presentation. (T02302)
          
          Incorporated additional information in presentation at
teaching conference (7)
          
    Information indicating that antibiotics were indicated for
animal bites on the hands and feet, but that for all other bites
irrigation and debridement were more important allowed physician
to include this information in a teaching conference on animal
bites for medical students and residents (032501)

    New information on the use of aerosol bronchodilators in the
management of asthma in children was included by pediatrician in
a teaching conference he conducted.  He also changed the
management of his own patients, selecting an agent specific for
bronchodilation rather than an agent he was taught to use as a
intern, which had side effects such as increased heart rate. 
(T01801)

                    Incorporated additional information in
presentation at professional meeting (8) 

                        Comprehensive information on contact
lens complications enabled ophthalmologist to identify the
specific problems that lead to corneal ulcers and hence to focus
his talk (being given to a large group of practicing
ophthalmologists) on the most important issues in preventing this
problem -- aggressive treatment with injections, rather than just
treatment with drugs and loose follow-up.  (030102)

    Lack of useful new information on adolescent behavior and
homosexuality, prevented physician from presenting as complete an
address as he would have liked on the whole range of risk-taking
in adolescents. (I)  (021202)

               Supplemented discussion of article in journal club
(5) 
    Information on diagnosing vasculitis provided the physician
researcher with a complete bibliography from which he could
review the state of knowledge than he would have had using the
more limited paper he was reviewing for presentation in a journal
club. (052603)
    Information obtained for a journal club presentation on the
use of leading edge cultures on lesions such as cellulitis
suggested a larger number of positive cultures than the physician
was used to seeing in his hospital. Physician added article to
his reprint file and decided he would perform the procedure in
the appropriate patients since it would give more information.
(T04701)

          Provided inservice/continuing education to clinical
personnel (36)

               Provided education on diagnostic techniques (9) 

                   Information obtained in order to educate
physicians in the clinic on the indications for use of Doppler
ultrasound helped guide the physician in describing the most
current indications for the use of the technique. (038301)

                   Information obtained on the indications for
carotid vascular ultrasound testing and the indications for
referral allowed physician to present a class to other physicians
and technologists because he was able to be certain that his
information was clinically validated and that he was
disseminating the most current body of knowledge on the topic.
(T06501)
     
          Provided education on therapies (15)
     
    Specific data comparing the effectiveness of streptokinase
and TPA, and supporting the point that TPA is more effective,
were useful in preparing talks to be given by physician to small
satellite hospitals who were concerned about the high cost of
TPA.  (P20201)

    Specific information on the effects of various stimuli
(light and sound) and the effects of longer periods of quiet time
on growth rates, allowed nurse to prepare a program for other
neonatal intensive care nurses on the effects of the environment
on the newborns, making the nurses more sensitive to the
developmental, as well as physical, needs of the newborns. 
(U09102)

               Provided education on a disease entity (4) 

                   Information on the relationship between
papillomavirus and malignancy, including the increase in the
number of strains coinciding with the increase in cervical change
and premalignant lesions, as well as the informnation that laser
surgery will remove the lesions but not get rid of the virus,
convinced physician to inform his medical group that the viral
infection is not curable, that males need to be treated as well,
and that the whole field of OB-GYN needs to be alert to the
problem.  (062901)

                   Primary research articles on the etiologies,
diagnostic approach, and treatments for chronic cough in
children, including reactive airway, was used by the physician to
prepare talk on this subject to residents and doctors in the
community.  (067901)

          Provided education on a professional activity (8)
     
              Absence of relevant general information on how to
do nursing research and how to evaluate research in journals,
appropriate for people who are not knowledgeable about the
process, convinced the nurse not to give the nursing inservice
she had planned. (I) (U11003)

    Broad information on the ethical problems related to code
arrest situations, including the feelings of professionals trying
to resuscitate patients who did not want heroic measures taken,
allowed the nurse to include some of the opinions and research
surrounding this issue in her presentation to the code arrest
team.  (U11101)


          Provided education for inservice/continuing education
to community health care or public health personnel (3) 

    Information was obtained on the use of smokeless tobacco in
adults and children, and the health implications of its use,
which convinced physician to develop and present a program on the
epidemiology and the implications of its use. (043001)

    Information on the common types of vaginitis in
reproductive-aged women, and various treatments for the
condition, allowed nurse to assemble the most current information
for her lecture to public health nurses.  (T04001)

          Provided educational services to the community and lay
public (15)

               Developed and presented health education
lecture/course for lay community (7)

    Information was gathered on child safety (mode of
presentation at various ages, need for parent knowledge
assessment, and useful illustrations) which the nurse used to
refine the safety programs she presents to the community. 
(010502)

    Information on the value of humor, anecdotes, and use of
humor by nurses, as well as the names of critical workers in the
field, allowed hematologist to familiarize himself with the
entire field in a few days in order to prepare a seminar for the
public on the emotional aspects of cancer and laughter and
medicine.  (U19403) 

               Provided information/advice to address inquiry
from lay public (6) 

    Physician received a request from the national headquarters
of a youth organization for information on the proper treatment
of fire ant bites to include in their manual.  After reviewing
the literature the physician was able to tell them that there is
no specific treatment to counteract the formic acid, and that
these bites can only be treated symptomatically. (T05802)

    Non-physician writing book for older consumers on
prescription drugs was able to incorporate hard evidence on the
increased incidence of falls due to dizziness in older people
taking benzodiazapines to support his thesis that there was a
correlation between the two, a thesis which previously had been
based only on his own common sense. (055301)        
     
          Provided technical information to pharmaceutical
salespeople (2)

    Information obtained from the literature  on the dosage
range for treating arthritis, onset of effect, the overall safety
and the lack of risk of neoplasia due to the use of one of his
company's products provided pharmaceutical salesperson with the
basis for a presentation at a sales meeting and made a favorable
impression on his supervisor, since an article he found had been
circulated by the company several years before but had been
forgotten. (054101)
     
Initiated an article or case report (33)

               Determined that own clinical observations or
approach was sufficiently novel or important to be worth
contributing to the literature (20)

    Physician who had patient with mucoepidermoid carcinoma of
the lacrimal gland determined that the number of previous case
reports was small enough that it was worth reporting on the
results of the biopsy and treatment (surgical removal) of this
potentially life-threatening lesion in this patient, for the
benefit of other pathologists and ophthalmologists. (052702)

    Information about current therapies for pheochromocytomas
will contribute to physician's decision on whether or not to
prepare a journal article based on several such cases seen in his
practice, since he found that there is little consensus on
whether to operate for this condition during pregnancy but that
others have addressed many of the concerns involved. (T02102)
          
Supplemented report on own clinical experience with supporting
information from others' experience or research findings (13)

    Information from case reports, literature reviews and
articles on metabolic effects enabled trauma surgeon to
incorporate a more complete information base in book chapter he
was preparing on lead intoxication from retained missiles (such
as bullets), rather than only information on the patients he had
personally treated. (T03001)

    Information from case reports and review articles enabled
physician doing 12-year follow-up of unconventional
(radiotherapy) treatment of a patient with ameloblastoma to
incorporate what had been done with this technique in the ensuing
time period. (032702)

          Prepared a current and authoritative review of a topic
in the form of an article, book, or book chapter (86)

               Easily and efficiently assembled information
necessary to preparation of a published review (10) 

    Information on how to evaluate risks of dental surgery in
patients with particular diagnoses and on whether or not to do
surgery decreased the time involved in dentist's preparation of a
paper on surgical risk assessment in the elderly.  (013401)
          
    Nurse preparing revisions of certain chapters in her
clinical textbooks was able to rapidly confirm and update her
information on how acute myocardial infarction, pulmonary
embolism, acute renal failure, and the nursing process are
related to behavioral modification, relaxation, or imagery
techniques. (T08101)
               Organized manuscript effectively (5) 

    Analysis of relevant recent literature provided pediatric
cardiologist with a basis for organizing a book chapter on the
use of echocardiography for description of ventricular inflow
anomalies, and also provided previously unknown information on
the high incidence of mitral valve prolapse in the "healthy"
population. (028301)

    Information on some cytochemistry staining techniques used
for the diagnosis of acute leukemia, which were new to him, as
well as complete citations for references used as background,
allowed physician to efficiently organize the material for his
book.  ((063302)

               Incorporated most recently published information
on topic (18)

    Information obtained on the epidemiology of senile dementia
from author he believed had been to be writing on this topic
enabled epidemiologist to incorporate this most recent
information into an introductory book on the epidemiology of
mental disorders. (042301)

    Information on the current surgical approach to trauma of
the genitourinary system was critical in enabling radiologist to
prepare a chapter for a book on the radiology of trauma that
would provide an emergency room doctor with accurate information
on x-ray approaches most helpful in treating such an injury.
(T03201)

               Incorporated information that insured that review
was comprehensive (28)

                    Incorporated complete set of references on
topic (20)

                        Failure to obtain relevant and useful
articles on the history of the concept of drug addiction,
including the failure to retrieve article of which the
pharmacist was already aware, meant that his attempt to write a
history of the concept, to parallel an existing history on the
concept of alcohol addiction, had to be temporarily suspended.
(I) (055303)

                        Failure to obtain key references on the
metabolism of bile acids, except for ones of which the biochemist
was already aware, meant that he could not prepare a book chapter
on this topic and a paper on a particular bile acid and metabolic
product without having a search run on an automated retrieval
system with a forward-searching capability. (I) (057501)

                        Recent information on the epidemiology
and treatment of Crohn's disease, ulcerative colitis, and
inflammatory bowel disease in articles previously unknown to
physician enabled the preparation of a more complete chapter of a
textbook on inflammatory bowel disease. (056901)

                    Incorporated most authoritative information
on topic (8)

    Lack of authoritative information describing the mechanism
behind bleeding (coagulation) disorders after head injury
resulted in the nurse only including studies in her
nursing journal review article describing types of patients,
severity of injuries, and likely abnormal lab studies seen with
patients exhibiting this complication.  (I)  (U05903)

    Relevant articles describing both clinical and basic
research studies, which provided evidence of sympathetic nervous
system involvement in arthritis, allowed neurophysiologist to
write a more authoritative section on this topic in a book
chapter and to propose specific mechanisms of involvement. 
(025403) 
               Incorporated specific information that s/he had
not previously known into review (17)

    Information from articles discussing different drugs that
are toxic to the kidney, including information of which he was
previously unaware indicating that indomethacin can
cause kidney damage to the fetus, was incorporated by pediatric
nephrologist in review article on such toxic drugs. (058502)

    Pediatrician writing chapter for a book on viral infections
in children was able to incorporate new information from articles
in a journal of whose existence s/he was previously unaware.
(028901)

               Incorporated current, accurate information on
topic that was somewhat outside own area of expertise (5) 

    Failure to obtain information on the pharmacologic effects
of drugs on gastric emptying in infants and children delayed
pediatric anesthesiologist in writing chapter on the anesthesia
management of GI surgery and caused concern that he was missing
something important related to gastric physiology, which is
outside his own specialty. (I) (031001)

    Clear information on the population of women who should be
targeted for grief counselling after giving birth by caesarian
section and the impact of breast feeding success or failure on
these women, allowed nutritionist to prepare an article on the
topic, which was outside of her field of expertise.  (U14502)

               (Unable to determine appropriate title to be given
to book in preparation) (1)

    Failure to obtain any titles of existing books on food
allergy via MEDLINE to help settle a disagreement between the
author (an allergist/immunologist), the book sponsor, and
the publisher on what the title of the author's book should be
led the physician to ask the medical librarian to run the search,
which she did, on CATLINE, and obtained many articles. (I) 
(070601)
     
          Responded to reviewer's comments on review article (2)

    Information suggesting that DTPA (a first cousin of
gadolinium EDTA) was more toxic than other less stable compounds
as a contrast agent in NMR imaging reinforced the feelings of
physical chemist that there is not a simplistic quantitative
correlation between stability and toxicity, as the reviewer of
his paper thought, and he was able to refute the reviewer's
comments with factual information.  (057801)

    Information which indicated that the only basic research
articles written on the topic of the interaction between
glutathione and copper to generate hydrogen peroxide and oxygen
radicals were theoretical discussions, rather than the
biochemist's experimental study, and he was able to refute the
reviewer's comment that his work was confirmatory.  (073401) 

          Carried out bibliographic analysis--determined trends
in numbers and types of publications on particular topic (2)

    Identification and topical analysis of 400-500 papers on the
subject of ritodrine tocolysis (drug therapy for inhibiting
premature labor) enabled physician to document the number of
papers published per year on this topic and on several specific
aspects of the topic for a paper on the national impact of
ritodrine  therapy. (T05501)

    Citations for 400 pertinent articles in the area of the
history of ethical dilemmas concerning neonatal infants published
between 1966 and 1986 were used by a nurse pursuing a Ph.D. to
develop a chart showing the number of references in each time
period and in different subject areas for review by her
dissertation committee.  (048401)


Learning (77)

          Furthered own formal education (16)

               Prepared paper or other report for graduate
coursework (10)

    Recent information on brain injuries due to trauma,
including less central information on facial injuries, added to
health sciences graduate student's knowledge of this field and
enabled the preparation of a more current book chapter on the
rehabilitation of patients with such injuries. (T01601)

    Information consisting of expert views and description of
current systems provided the basis upon which graduate student in
health services carried out a project to design the
specifications for a clinical-financial decision support system
to be used in the health care industry for a class project on
which he received an "A" grade. (T01502)

               Characterized research areas of individual or
laboratory being considered as location for fellowship (6)

    Out of curiosity about an area that was not covered even
three years ago when he was in medical school, physician carried
out a search on tumor necrosis factor and how it applies
to clinical disease. The large number of articles obtained
reinforced his decision to do a fellowship in a laboratory that
he found was doing research in that area and has also affected
his long term career plans. (T03303)

    Information indicating that a researcher on neuronal
development had previously used biochemical methods in his work
led biochemistry graduate student, who wanted to use the methods
with which he was familiar to study neuronal development, to
apply (successfully) for fellowship to be done in the
researcher's lab. (051002)
          Furthered own informal, continuing education (31)

               Kept up to date in own primary area(s) of
expertise (19)

    Pathologist working in area of child abuse and routinely
reviewing recent publications in related areas found information
validating own published assertions that there is no scientific
basis for the conclusion that serious brain injury can be caused
by shaking, thus providing a more solid basis for his further
writing, lectures, and court testimony. (T04301)

    Failure to obtain pertinent information on surgery of the GI
tract discouraged pediatric anesthesiologist from trying to keep
up with such information in the non-anesthesia as well as the
anesthesia literature.  (I) (031002)

               Evaluated or demonstrated potential of Grateful
Med to search literature (12)

    Review articles on an unusual blood coagulation problem due
to protein C deficiency provided the faculty member with an
opportunity to demonstrate to the resident the use of Grateful
Med to access information on an unusual clinical problem. 
(070001)

    Failure to retrieve any articles when he thought there
should be a large number of them discouraged physician from
pursuing use of Grateful Med because he didn't feel he had
time to sit down for a whole weekend and read the book to see
what he was doing wrong. (I) (030701)

          Satisfied own curiosity/personal interest in a
particular topic or phenomenon (30)

               Learned about some clinical problem of current
interest (13)

    Physician who was getting behind in reviewing Current
Contents obtained all of the information he wanted on Forcious
Erikson ocularomnis. (036403)

    Physician interested in Alzheimer's disease determined that
there was not much in the literature regarding nootropic drugs -
drugs that might enhance the ability to think. (T05102)

               Obtained more complete information on a brief item
encountered in print or via casual comment or question (13)

    Information published over a 15 year period on the effects
of zinc on the retina, including information on retinal
degeneration and retinal atrophy, was given to ophthalmologist
who asked physician a question about this in passing. (033303)

    Information was obtained to answer a question posed by a
pharmacy student's preceptor on the role of neuroregulator
(serotonin and norepinephrine) levels in Alzheimer's disease
patients by using the information from abstracts on levels of the
two neuroregulators in the brain tissue of these patients.
(059702)

               Learned about treatment for a personal medical
problem (1)

    New references on the treatment of stomatitis, which
outlined new therapies to try, where previously there had been
none, gave physician some new information on his own medical
condition.  (P11501)

               Updated own curriculum vitae (3)

    Retrieval of citations to all of his own publications,
allowed pathologist to prepare a complete, updated CV for
promotional purposes.  (68603)


Administration (70)

Formulated a strategic planning process (2)

    Hospital had undertaken a strategic planning effort, and
individual responsible for pharmacy planning wanted to know more
about how to apply systems analysis and strategic planning
techniques.  Review of articles on strategic planning for nursing
and allied health services led to specific ideas on how to
conduct the internal analysis and how to work productively with
various groups in the planning process (044002)

    Information on the etiology of urinary tract infections was
used by a urologist to develop a plan for tracing the source of
urinary tract infections in these patients and to develop a
tracking system for monitoring the infections.  (066602)

          Addressed personnel matters (8)

               Evaluated qualifications of potential employees or
consultants (5)

    Individual responsible for interviewing an applicant for an
attending physician position used information on the candidate's
published work to explicate the individual's interests and areas
of concentration.  This information was then used to help
structure the interview process.  (049401)

    Administrator had to hire outside reviewers to assist with
promotion and tenure process for faculty members.  Published work
by potential reviewers to was used to identify their specific
areas of expertise and determine the most appropriate reviewers
for particular faculty members.  (048502)

               Resolved personnel safety issues (1)

    Information indicating that an individual with a chronic
health problem (hyperthyroidism) was still at risk for medication
side effects, even after a prolonged period on the drug, led
agency physician to refuse to grant the individual a waiver to
travel on an ocean-going vessel operated by the agency.  (031102)

               Determined personnel needs and utilization (2)

    Physician on Quality Assurance committee obtained
information on the use of nurses to triage X-rays and laboratory
work in the emergency room, in other hospitals, which he
used to help his committee determine where the hospital's policy
stood from a national perspective and helped support his
recommendation that the hospital implement these changes. 
(P11302)  

    Physician-administrator responsible for health-related
school programs wanted hard data on the cost-effectiveness of
school nurses to bolster arguments against cut-backs in this
category of personnel.  Was unable to locate articles with such
hard data and school district is consequently still struggling
with the problem of how to evaluate the need for school nurses.
(I)  (T00203)

          Established standards, policies, and procedures (44)

               Determined most appropriate therapeutic agent or
procedure (30)

                    Determined which agent or procedure was more
effective (19)

                             Physician was on clinic committee
responsible for establishing guidelines for treatment of uterine
fibroids.  Failure to turn up any large or long-term clinical
trials of the use of LHRH analogs for this condition led
physician to recommend that this treatment not be included in the
guidelines.  (019402)

    Pharmacist on a committee evaluating whether to add TPA to
hospital's formulary concluded, from information obtained, that
TPA is a good thrombolytic agent and should be added, but that it
should not be used with elderly patients or patients with
previous history of stroke because of an increased risk of
cerebral hemorrhage.  (U17501)

                    Determined which agent or procedure was safer
(6)

                             Physician team investigating
birthweight mortality statistics at own institution realized that
local mortality rates for given fetal weights were higher than
national rates reported in the literature and  they are in the
process of revising pregnancy management guidelines accordingly. 
(011203)

    Physician in an HMO was preparing protocols for home care
for children with acute infectious diseases. Based on information
obtained, he concluded that it was safe to transfer children home
who have been afebrile for 48 hours and included this criterion
in his protocol. Without the information, he would not have
gotten as good agreement on this aspect of the protocol from his
colleagues.  (051801)

                    Determined which agent or procedure was more
cost-effective (5)

                        Information obtained from reputable
journals that triamcinolone inhaler was superior to betamethazone
inhaler based upon solid, double-blind studies gave pharmacy and
therapeutics committee a clear answer as to which was better, and
saved money by removing betamethazone from the formulary, since
triamcinolone cost considerably less.  (U06602)

    Absence of information suggesting any inotropic (increased
heart activity) effects in humans of a particular beta adrenergic
agonist used in treatment of COPD and asthma, only in animals,
supported the data from the manufacturer and led pharmacist to
recommend to Pharmacy and Therapeutics committee that it replace
its current beta adrenergic agonist with the less expensive one
because it is at least as effective.  (U03201)

               Developed quality control measures (9)

                   Information on the transmission of
Clostridium difficile infections in the hospital setting through
improper handwashing and portable commodes enabled quality
control supervisor to educate staff and get their cooperation in
instituting more stringent cleanliness measures and controls with
compromised patients in the rehabilitation unit, where they had
encountered a number of cases of this infection.  (U11302)

    An article with diagrammatic instructions for urine
collection provided a clinical microbiologist with the
information necessary to develop such instructions for patients
with urinary tract infections which will form the basis of a
quality control study of urine contamination aimed at improving
patient management and therapy.  (U18201)

               Developed precautions to avoid exposure by staff
to possibly harmful agents (5)

                   Absence of information from any validated
study that there can be aerosol transmission of
methicillin-resistant Staphylococcus aureus  (there was only one
undocumented report) allowed nurse administrator to allay fears
of the staff that the organism is transmitted through the air,
but to emphasize through an inservice program that it is
transmitted by poor handwashing and by being splashed with
contaminated fluids.  Universal precautions on contact with
fluids were also instituted.  (U18501)
    Absence of clear information on human teratogenic effects of
Ribavirin, an aerosol antiviral agent, only of animal
teratogenicity, and suggestions that health care workers should
use barrier precautions (mask, gown and gloves) when
administering the drug, allowed the pharmacist to respond to a
question of a physician who had been given contradictory
information by a colleague. (U18502)

          Developed basis for establishment of a new facility or
service (12)

              Information on children's hospitals that were
based upon different financial models and on a system of patient
service reimbursement that was economically sound was useful to
hospital administrator in finalizing an approach and developing
the financial justification for opening a new children's
hospital.  (U09502)

    Lack of recent information on group therapy in adolescent
girls, including selection and therapy techniques, resulted in
social worker relying on information she had from conducting such
a group many years before in developing a new group for
adolescent girls who were withdrawn, depressed and had low
self-esteem.  (I)  (U10801)

          Evaluated efficacy of a governmental program (1)

    County health department employee thought proposed new state
regulations that would require all medical wastes to be treated
as hazardous wastes were unnecessary and would place an excessive
burden on local hospitals.  A review of the literature revealed
no objective evidence of spread of disease from solid hospital
wastes and, on this basis, the employee recommended modifications
in the proposed regulations.  (T04801)

          Performed editorial duties for a journal (1)

              Accurate citations for the relevant journal
articles allowed the editor of a veterinary journal to spot-check
references in manuscripts, tell the authors the mistakes that
were found and needed to be fixed, and resulted in more accurate
articles in his journal than in other journals.  (01071501)

          Made determinations on investigational drug application
(3)

              Information on white blood cell labeling with a
particular substance, including the procedure, its minimal side
effects, and instances of false positive and negative reports,
allowed physician to assemble the information to submit an
application to the FDA so that a group of patients could be
tested with this new nuclear medicine technique for assessing a
suspected abscess.  (01062802)

    A description of a number of patients who had received a
particular chemotherapy agent intrapleurally, with apparent
safety, convinced agency representative to approve request
of an investigator for an exemption to initiate a study to
evaluate the use of this drug for breast cancer, when it had only
been approved for leukemia.  (044901)

Consultation (35)

          Provided medico-legal consultation (32)

               Determined probable etiology of a contested
injury/condition (15)

    Patient who had sustained a skull injury in an industrial
accident several years earlier showed progressive neurological
deterioration and eventually died.  Rural physician who had
treated this patient for several years used information from the
literature to support Workman's Compensation claim vis-a-vis
probable cause of death (010802)

    Medical chemist consulting to a law firm representing a drug
company used information from the literature to advise that
aseptic femoral necrosis was a rare, but clearly documented, side
effect of corticosteroids (as the patient-plaintiff had claimed). 
(048503) 


               Determined whether prognosis for particular
condition was affected by an incorrect or delayed diagnosis (4)

    Neurologist consulting on legal cases involving misdiagnosis
of aneurysms needed information on outcome and survival under
conditions of early or late diagnosis.  Based on the literature,
respondent was able to assure plaintiffs' lawyer that delayed
diagnosis did negatively affect the chances for a satisfactory
outcome even though early diagnosis does not assure such an
outcome.  (021102)

    Neurologist consulting on a legal case involving
misdiagnosis of meningitis due to cryptococcus infection needed
information on whether prompt treatment decreased the likelihood
of brain damage.  Based on the literature, respondent was able to
assure plaintiff's lawyer that incidence of brain damage was low
(5-10%) when appropriate treatment with amphotericin B was
started early. (021101)

               Determined appropriateness of care given (13)

    Dermatologist consulting on alleged malpractice in treatment
of basal cell carcinoma needed information on established
standard of care as of the date of the contested event (1977),
which predated the dermatologist's own training.  Information
from the literature enabled the dermatologist to determine that
the treatment given (cryosurgery) was considered appropriate at
that time.  (019602) 

    Anesthesiologist was preparing to give expert testimony in
defense of the care given by a fellow anesthesiologist whose
patient had died after caesarian delivery.  The patient had
been suffering from severe toxemia and the respondent wanted to
strengthen his upcoming testimony with evidence that a pulmonary
embolism (one of the suspected causes of death) was a common and
potentially serious complication in toxemic patients.  (040501)


          Provided medical consultation to governmental agency
(3)

              Information on individual DRGs -- how they impact
on hospital remuneration and possibly impact care in various
services -- allowed physician to present complete and
well-documented testimony on the quality of care in the Peer
Review Organization program, which contracts with HCFA to review
Medicare.  (063001)

    Information on high rates of tuberculosis among prisons in
all states, and confirmation that his rate was similar to that in
other states, allowed family practitioner serving as state
director of TB control to focus on the general problem of TB in
prisons, rather than focusing on this state's particular
situation.  (045303)