F-

I. Patient care (494)*

 Diagnosis and etiology (203)

 To utilize diagnostic tests and procedures (54)

 To help select an appropriate test(s) to
diagnose some condition or establish a differential diagnosis
(17)

 Had patient with symptoms that could have been chronic
granulomatous disease and wanted information on appropriate test
to detect this enzyme defect in white blood cells (P20802)

 Had patient with symptoms and unusual Doppler study which
suggested internal carotid aneurysm near cavernous sinus and
wanted information on appropriate Doppler velocity flow
measurement test to dissect out whether patient had aneurysm or
not (034901)

 To help apply a (new) diagnostic procedure
correctly (9)

 Had patient with suspected angiomyolipoma and was looking
for specific article on doing and interpreting CT scan of renal
mass (P10501)

 Had several patients with symptoms of lower abdominal pain
who ended up with unexpected ectopic pregnancies and was
looking for the diagnostic clues for ectopic pregnancy;
wanted information on doing and interpreting colocentesis and
endovaginal ultrasound (016301)

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

 To evaluate test sensitivity/specificity (4)

 Had patient with possible carcinoid syndrome, who when
tested had a high value of acetic acid in the urine, and wanted
information on any chemical interferences with the test
that could produce these results (077801)

 Had patient with suspected Paget's disease, and needed
information on "3-dot sign" on the bone scan being specific for
Paget's disease, as a colleague had told him; wanted information
on how specific it was to Paget's disease versus bone metastasis
(040001)

 To help interpret test/diagnostic procedure results
correctly (24)

To determine whether test/procedure results were within normal
limits (8)

 Had patient with observed levels of chlorophenol, an
environmental toxin, in tissue; wanted information on normal
levels for this toxin in human tissue and whether such levels
had been established (P11902)

 Had a patient with suspected biliary tract disease and
wanted to know whether ultrasoundimage of duct showed pathology
or was within normal limits for the patient's age (038302)

 To better understand relationship of
test/procedure results to particular diagnoses (16)

 Had patient with suspected gallstones--blood tests and liver
tests were consistent with this Dx, but ultrasound was not--and
wanted information on false negative rates for ultrasound and
specificity of blood tests (011404)

 Had request from another physician who wanted to know
whether there was anything in the literature to suggest that the
size of a renal tumor, when discovered, was related to kind
of tumor (P10503)

 To establish a differential diagnosis (149)

 To help establish diagnosis for presenting
symptoms (73)

 To suggest a possible diagnosis and
etiology (12)

 Had pediatric patient with symptoms of granulomatous
hepatitis and bone marrow failure and wanted review articles on
disease that would fit that combination of symptoms (I) (02102)

 Had young patient with symptoms which appeared like multiple
strokes and wanted information on the cause of the strokes;
needed information on specific collagen vascular disease which
might be the cause (060701)

 To obtain evidence to support/disprove a
hypothesized diagnosis (25)

 Had patient with uncommon symptoms of bilateral, localized
swelling of the eyes and wanted case reports or other information
to suggest a probable diagnosis (P11001)

 Had patient with symptoms that might have arisen from
exposure to a particular substance (e.g., joint swelling possibly
associated with wound from the thorn of a particular shrub) and
wanted to know whether the substance was known to cause such
symptoms (P11901)

 Had several patients with multiple miscarriages early on in
their pregnancy, and wanted evidence of whether luteal phase
defect was a true diagnostic entity. (16302)

 To differentiate between two
hypothesized diagnoses or disease variants (11)

 Had number of cases reported of measles (physician works for
state health department) which had blood tests done that did not
confirm measles and needed information on rash-type diseases such
as those caused by parvoviruses and how to diagnose them (I)
(045302)
  Was evaluating radiographic image and wanted to know if
image was more consistent with otitis external or a tumor
(038303)

 To identify or evaluate possible
alternative diagnoses when most common diagnosis has been ruled
out or is doubtful (2)

 Had patient with symptoms of headache and neck pain which
most likely indicated a brain tumor, and needed information to
confirm that symptoms could also be caused by high cervical spine
disease (I) (060702)

 Had pediatric patient with lesion of the mesentery 2-3 years
after a liver transplant that looked like a leiomyosarcoma but it
was unusual because this type of tumor is usually in adults;
physician was looking for information on other secondary tumors
that can occur in transplant patients who are immunosuppressed
(067701)

To help interpret symptoms or physical findings which appear
inconsistent with probable diagnosis (8)

 Had several pediatric patients with abdominal
lymphadenopathies that looked like progressive transformation
germinal centers and needed any reports of presentation in the
abdomen because this is highly unusual (I) (065801)

 Had neonatal patient with symptoms of myoclonus including
jerking to touch and apnea which appeared life-threatening (while
most literature suggests it is benign) and needed information on
the range of benign neonatal myoclonus (058001)

 To determine or better understand the
cause of a diagnosed condition (15)

 Had patient who had lost her baby at term through massive
abruptio placentae and needed information to understand the
etiology of such an occurrence (039601)

 Had patient with diffuse hair loss and needed information to
understand the etiology of diffuse alopecia; was not able to
obtain any references on etiology of the condition and had to
get the information from a textbook (I) (032001)

 To diagnose cause of new symptom(s)/change of
condition in patient(s) under treatment (76)

 To obtain evidence to support/disprove
hypothesis that new/additional symptoms are part of
known/preexisting medical problem (17)

 Had patient in emergency room in extreme cardiogenic and
anaphylactic shock and suspected the cause to be the homeopathic
medicine she took for poison ivy; needed information on
myocardial depression secondary to anaphylaxis rather than a
separate problem (039602)

 Had patient with severe intestinal problems and extreme
depression and needed information on depression caused by the
physical problems (as well as information on chronic pain
management) (U07403)

 To obtain evidence to support/disprove
hypothesis that observed symptoms are due to a medication side
effect (25)

 Had patient with leukopenia who was on several new cardiac
drugs and wanted to know if any of those drugs has been
implicated in leukopenia (032401)

 Physician and colleagues thought they were seeing
extrapyramidal reactions as side effects of antipsychotic drugs
being administered to their AIDS patients and wanted to know
whether these side effects had been observed by others (P20601)

 Had patient who appeared to be experiencing an severe skin
reaction to mitomycin-C, a chemotherapy agent being administered
via catheter to the bladder, and wanted to know if similar
reactions had been seen in other patients (P31103)

 To suggest other (non-drug related)
iatrogenic causes that might underlie observed problem (13)

 Had a number of pediatric burn patients who were having
electrolyte problems that seemed to become more acute after
hydrotherapy and wanted to know if anything about the
hydrotherapy could be causing the imbalance (P30201)

 Had penicillium mold show up in cultures taken
intraoperatively during heart valve surgery and wanted to know if
the mold could cause postoperative infection and where it was
coming from in the hospital environment (P21201)

 To determine whether two conditions
previously had been observed to be associated and due to a common
cause (21)

 Was consulting on a patient with an unusual combination of
symptoms--acute episodic hypertension and hyperparathyroidism;
needed any reports of previous observations of this presentation,
the diagnosis and treatment (U16201)

 Had newborn patient with congenital heart defect and absent
fibula and needed information on any reports of this combination
of birth defects (I) (U02002)

 Had stillborn infant, at autopsy, who had a presumptive
diagnosis of Down's syndrome but also was found to have abnormal
cells in blood vessels which suggested congenital leukemia;
needed to know if there was a link between the two conditions.
(036103)

 Treatment and prognosis (253)

 To obtain general information to support choice of
treatment and determine prognosis for a presenting condition (90)

 To identify any treatment options for a known
condition (17)

 Had pediatric patient with an abnormal CAT scan of the head
which resulted in a diagnosis of cystic hygromas and needed
information on any treatment options for the condition (I)
(U12801)

 Had patient with a rare condition, an aspergilloma, or
fungus ball, in the left maxillary sinus and needed information
on any recommended therapies for the condition (U09401)

 To obtain evidence to support/reject use of
given treatment option (31)

 Had patient with a complicated hernia of the esophagus and
upper stomach--paraesophageal hernia--and needed confirmation on
whether to perform a fundus wrap in addition to repairing the
hernia (U11801)

 Had patient with hydrocephalus and needed information
providing technical descriptions of third ventriculostomy
procedure for internal treatment of the condition and the
results, in order to decide if the procedure was worth doing (I)
(U01201)

 Had several patients with recurrent primary carcinoma of the
peritoneum, and needed information on the use of intraperitoneal
chemotherapy as a possible treatment for this condition.
(U05602)

 To evaluate the relative merits of two drugs
or procedures for a particular medical problem (11)

 Wanted to inform own practice and that of colleagues by
comparing two drugs or procedures on a specific criterion (e.g.,
success rates for angioplasty vs. surgery to treat femoral artery
disease) (040502)

 Nurse had patient for whom surgeon recommended using a
permacath for long-term TPN (total parenteral nutrition). Nurse
understood permacath was appropriate for dialysis, but that
Groshong catheter was more appropriate for TPN, and wanted
information on patient outcomes with Groshong catheter for TPN to
support her position (U11202)

 To evaluate a treatment prescribed by a prior
or referring physician (8)

 Had a former patient who returned for a second opinion on
bypass surgery and wanted to provide an unbiased perspective on
indications for this procedure (P12402)

 Had patient, transferring from a physician in another city,
who was taking gangcyclovir for cytomegalovirus and wanted
information about this drug (040102)

 To determine the necessity/advisability of
surgery versus observation/medical treatment for a particular
condition (8)

 Had patient with small adrenal mass where another physician
recommended removal; needed recent reviews on the issue of
removal of the mass versus evaluation over time (068502)

 Had patient with thyroid nodules which the referring
physician recommended be removed; physician suggested treatment
with thyroid suppressant and needed recent literature to support
his position (U16202)

 To determine the need for treatment (e.g.
radiation or chemotherapy) in addition to surgery (4)

 Had patient with a chordoma in sacral area who had been
treated surgically, but tumor had not been totally excised.
Physician needed information on whether radiation therapy
would be useful in this situation (070301)

 Had female patient in late twenties with a very large
acoustic neuroma which had grown onto her brainstem and could not
be completely surgically removed, and needed information on
whether to recommend radiation therapy (070302)

 To determine what is the appropriate
treatment in the presence of a second disease/condition in the
patient (11)

 Had a number of patients who were hypertensive, as well as
having asthma or some reactive airway problem, and beta blockers
were contraindicated. Physician had recalled that
angiotensin-converting enzyme inhibitors might be a candidate to
treat hypertension and wanted information on the action of this
group of drugs on patients who have asthma (022601)

 Had patient with psoriatic arthritis who also had underlying
liver disease, so the usual treatment with methotrexate was
contraindicated. Patient's dermatologist recommended a Vitamin A
compound and respondent was not familiar with this treatment and
needed information on its use in these circumstances (023501)

 To obtain information on the clinical course and
general management of a relatively rare disease/condition(51)

 To determine the course and general
management of a condition unfamiliar to practitioner (25)

 Had a series of patients who showed symptoms of contact
dermatitis because of an allergy to nickel, and wanted to know
how to manage the patients, including any cross-sensitivity to
other compounds such as chemicals used in formulating ointments
(066001)

 Had a patient with pigment deposits in the retina as a
consequence of having taken canthaxanthine, an oral "suntanning"
medication, and wanted to know prognosis for visual deterioration
and for cosmetic appearance of the eye (P30101)

 Had patients with chronic systemic candidiasis and needed
information on the management of this condition with which he had
limited prior experience. (069103)

 To determine the clinical course, prognosis,
and general management of a specific neoplasm (19)

 Had patient who previously had surgery and radiation therapy
for prostate cancer, which now had metastasized to the orbit of
the eye with a loss of vision, and needed to know how rare this
is and what is the treatment and prognosis (034201)

 Had patient who had been previously diagnosed as
schizophrenic, who was now pregnant, and whom the psychiatrist
initially misdiagnosed as cured because of a lack of symptoms,
and wanted any reports of estrogen as an antipsychotic drug or
cases where pregnant schizophrenics appeared cured (064802)

 To determine the potential impact of
pregnancy on preexisting medical problem (7)

 Had a patient with a history of malignant melanoma who was
now pregnant; wanted to know if pregnancy would have any
influence on the course of the disease (P31101)
  Had a patient who had lupus anticoagulant and was pregnant;
wanted to know what was the current state of therapy of
management of these patients during pregnancy. (059904)

 To obtain information on the impact of a medical
problem on the management of another condition or problem (16)

 To determine impact of condition and/or its
treatment on general management of primary care (2)

 Had a new pediatric patient with William's syndrome and
wanted to know general features of the syndrome (P10102)

 Had a general practice patient who was also being treated
for IGa deficiency by a pulmonologist (using gamma globulin) and
wanted general information about the condition and its treatment
(010401)

 To determine impact of condition and/or its
treatment on pregnancy and appropriate management during
pregnancy and delivery (8)

 Had patient with diabetes insipidus who was now pregnant;
needed information about the use of medication during pregnancy
and problems encountered during delivery (U13601)

 Had patient with relatively rare condition--thrombocythemia,
an elevated platelet count, who was about to get married and was
concerned about the possibility of pregnancy.
Physician wanted to know the impact of the condition on pregnancy
management (U08001)

 To determine implications of condition or its
treatment for anesthesia management (3)

 Had to administer anesthesia to a patient with an unusual
disease or condition (Sandhoff's disease) and wanted to know
implications for anesthesia management (P20502)

 Had patient diagnosed with neuroleptic malignant syndrome
who was to undergo surgery, and wanted to know everything about
the disease and how to manage the patient anesthetically (P10804)
 To determine impact of condition and/or its
treatment on the potential outcome of surgery (3)

 Had a patient with diabetes and gallstones and wanted to
know current mortality rates for such patients and whether early
surgical removal of stones was still recommended (P21203)

 Had patient with Von Willebrand's syndrome, an hereditary
bleeding disorder, who was scheduled for urologic surgery; needed
to know how to manage the condition during and after surgery
(032002)

 To obtain information on the proper use of one or
more specific treatment options known to the physician for a
specific condition (22)

 To determine whether there were any known
guidelines for applying treatment in an unusual situation (2)

 Had a patient who had had blood accidentally injected into
spinal canal during epidural anesthesia and wanted to know what
should be done for the patient (011301)

 Surgeon was unable to plug the renal vein into the iliac
vein during kidney transplant operation because the vena cava was
totally occluded, so he plugged the renal vein into the portal
vein. He subsequently wanted to know if this had ever been done
before (T04101)

 To identify information that could prevent
procedural mishaps (3)

 Had a patient in whom the indwelling Hickman catheter broke,
leaving a fragment lodged in lung, and wanted to know how this
happened and how to prevent it in the future (029103)

 Generally interested in new ideas for preventing aspiration
as a consequence of anesthesia in a child with a full stomach (I)
(P11702)

 To evaluate potential side effects of a
treatment (11)

 Was asked to consult on patient with osteoporosis and a
history of breast cancer and wanted to know risk of reactivating
cancer if osteoporosis was treated with estrogen therapy (015602)

 Had patient admitted to emergency room with snakebite and
wanted current information on the trend toward or away from
recommending universal use of antivenin because of the high rate
of anaphylaxis and delayed allergic reaction to the antivenin
(U04602)

To obtain information on possible new uses of a known treatment
(6)

 Had veterinary patients who were treated for a wide variety
of parasites with a group of parasiticides called Ivermectines
and wanted to know if there were other uses of these agents of
which he was unaware (043401)

 Had patient with asthma for whom the physician prescribed
Robinul in a nebulizer every 6 hours. Pharmacist only knew of
its use as an oral antispasmodic and wanted to identify articles
where Robinul had been used by inhalation for asthma (059703)

 To obtain information on new or alternative
treatments for a specific condition (65)

 To evaluate a promising new treatment or
variation not readily available in the U.S. (4)

 Had patient with Hodgkin's disease who relapsed while on IV
chemotherapy (ABVD) and wanted to know more about oral therapy
using CEP protocol, which includes prednimustine, an
investigational drug which is only generally available in Europe,
or through NCI on a compassionate basis (037402)

 Had pediatric patient who had ethylene glycol poisoning
(swallowed antifreeze) and wanted information on the use of
4-methyl pyrazole in treating the condition, since it has
been used although it had not yet been licensed for use in the
U.S. for this purpose (066701)

 To obtain information on a treatment with
which physician is not familiar (40)

 To determine if treatment is appropriate
alternative for specific patient (24)

 Had pediatric patient who was a near-drowning victim who
required mechanical ventilation for a long time and had recurrent
pneumothorax which kept him in the hospital longer than expected
and wanted to know if sclerosing the lungs would be worthwhile
procedure to perform on the child and what were the risks and
benefits (T07001)

 Had pediatric patient with myoclonus which he wanted to
treat with a drug that increases serotonin and seemed to work in
similar cases. Since drug was experimental, wanted to know if
another drug, fluoxetine, which modifies brain serotonin in
adults, has been used in children and its safety (035403)

 Had patient with unusual hemangioma because it was limited
to the pinna and was quite aggressive, and physician wanted to
know if resection would be preferable rather than usual
treatments of observation only or argon laser treatment (057102)

 To determine if treatment would be of use to
future patients (16)

 In order to treat future pediatric patients appropriately,
physician wanted to know proper dosage for Fentanyl which is a
potent narcotic used as an anesthetic agent for surgery in
premature infants, since the search was done after the surgery
had been completed on his current patient (033802)

 Had heard about use of calcitonin to treat osteoporosis and
needed information that showed that it worked, practical
information on how to do the therapy, and possible problems,
to determine whether to prescribe it for future patients with
osteoporosis (P11502)

 To evaluate possible alternative treatments when the
standard treatments are not working or are causing unacceptable
side effects (21)

 Had patient with severe rheumatoid arthritis who was on
every non-steroidal pain medication, but was breaking through
with her pain and could not be treated with methotrexate because
of a bleeding ulcer; wanted to know if there were any new
medications or new treatment strategies for the pain (010901)

 Had patient with substantial groin eczema of long standing
duration and wanted to know if there was another treatment for
eczema that might help him (I) (041802)

  Had patient with heparin-induced
thrombocytopenia, which developed into a life-threatoning
allergic reaction to heparin, and needed to locate an
experimental low-molecular weight heparin derivative to possibly
use as an alternative (059901)

To obtain information on monitoring procedures and techniques (3)

 Had a patient whose reattached hand was not doing well and
wanted to apply a new monitoring technique, pulse oximetry, to
evaluate whether further surgery was necessary (P30202)

 Had many trauma cases in which fluid replacement was an
issue and was interested in determining most predictive indirect
measures of blood volume to guide fluid replacement decisions
(P11703)

 To obtain prognostic information (4)

 Had patient with bullous pemphigoid, a rare,
life-threatening skin disease, and wanted better prognostic
information than was found in textbooks to address the family's
concerns (I)(071602)

 Had six-month old patient with complete neuroblastoma lesion
of the upper thoracic spine and needed the most recent prognostic
information for children on the relationship between the length
of the interval between symptoms, surgery, and the recovery of
function. (066202)

 To locate specialist for referral (2)

 Had patient with back pain for 6-8 months which was
diagnosed as a rare endothelial cell sarcoma next to her sacrum
who was treated with radiation and needed to know who was
performing limb-sparing surgery to refer the patient to avoid
hindquarter amputation (034905)

 Had patient with pancreatic cancer who was on chemotherapy
and was going to a southern state for the winter, and needed to
refer the patient to an oncologist. (040802)

 Maintain an effective physician-patient relationship
(19)

 To provide information to patient so he/she could
make informed choices (7)

 Had a patient with non-Hodgkin's lymphoma; wanted to provide
her with copies of review articles on the disease (P12403)

 Had a patient with glioblastoma who had received radiation.
Nurse-practitioner wanted information to help patient cope with
condition and make decision on whether to have experimental
surgery (I) (U03702)

 To advise patient(s) considering participation in
a clinical trial (1)

 Had several patients with HIV infection and wanted to advise
them on merits of joining a clinical trial using isoprinosene
(040101)

 To advise a friend, colleague, or family member on
a disease, condition, or treatment outside the physician's
specialty (11)

 Was contacted by a friend to provide general information on
the prognosis and treatment of a disease (sarcoid) newly
diagnosed in a family member (P11704)

 Specialist in internal medicine had family member with
nasopharyngeal cancer and needed to know the latest prognostic
information on 5-year survival rates and different treatments to
provide guidance to the family (047901)

 Prevent Disease (13)

 To obtain information on health maintenance and
primary prevention strategies and resources (6)

 Was planning to create a booklet that respondent and
colleagues could use as a reference for patient education; wanted
current information on change strategies and recommended
behaviors re cholesterol intake, smoking, exercise, weight
control (010902)

 Physician who conducts community talks on the relationship
between diet and cancer and recommends nutritional counseling to
breast cancer patients after surgery needed the latest research
on diet and the development of breast cancer (U19702)

 To obtain information pertinent to evaluating life
style or environmental risk factors (4)

 Received an inquiry from an individual who was worried about
industrial exposure to styrene and wanted information on toxic
effects and recommended safety precautions (P30901)

 Physician's wife was a medical student who was exposed to
formaldehyde and phenol in anatomy class and was pregnant, and
physician wanted to know if there were any data which suggested
that there were teratogenic effects of inhalation of phenol
(T07601)

 To obtain information to improve effect of
hospital environment on patient (3)

 Nursing staff was considering limiting parent visitation in
neonatal ICU to make it easier for the staff to get their work
done and needed to know if anyone has studied the impact on
parents of having a child in intensive care and how parents adapt
to the stress and anxiety of such a situation (U09101)

 Nurse was concerned about the effects of the neonatal
intensive care environment on the infants in the unit and needed
to know what were the effects of the environmental deprivation
caused by bright lights, beeping sounds, and lack of day-night
sequence (U09102)

 Discharge responsibilities to patients and third-party
payors (6)

 To identify information to support or deny
reimbursement for treatment or procedure by insurance carrier (4)

 Insurance company had ceased defining as "functional" breast
reduction to reduce pain associated with extremely large breasts,
and physician wanted literature on pain relief from reduction
mammoplasty to support a claim (U06202)
  Had patient with multiple myelomas for ten years who had
been treated with all standard therapies and now was being
treated with hemi-body radiation, but the insurance company
refused to pay for the procedure because they contended it was
experimental and needed evidence from the literature for such
treatment (060401)

 To determine whether patient is entitled to
benefits (2)

 Had patient who was diagnosed with blepharospasm and asked
for compensation because they claimed it was a work-caused
problem. Physician needed to find out about causes and
aggravating factors of the condition to determine whether the
patient was entitled to benefits (U17202)

 Had patient, who was now deceased, who had sustained a skull
fracture falling off a truck in the course of employment, and the
widow wanted the Workmen's Compensation benefits. Physician
needed information on neurologic injury or deterioration
generally, in order to support the widow's claim against the
insurance company. (010802)

II. Research (233)

 A. Research planning and execution (128)

 1. To determine whether a research area is viable
(50)

 To determine whether an important problem,
knowledge gap, or controversy exists (17)

 Was beginning research on a particular area (e.g., the
impact of thrombolytic therapy on people with bundle branch
blocks) and wanted to review if research had been done examining
the effects of thrombolytic therapy on bundle branch block
(000501)

 Had isolated a maternally-produced retinal binding protein
from the uterus of pigs and wanted to know whether any work had
been done on vitamin A deficiency or excess vitamin A influencing
embryonic survival to see where they should go with this retinal
binding protein (I) (013901)

 To determine whether a proposed study has
already been done (11)

 Was using a test on afferent pupillary defect and a visual
field test and wanted to find out whether anyone had compared the
two tests (028201)

 Was looking at the connections between colonic polyps and
both papilloma virus and skin tags and wanted to know if anyone
had published in the field or if this was a field that is open
for further research (047501)

 To determine whether any evidence exists that
would support the validity of a given hypothesis or feasibility
of an approach (22)

 Wanted to determine whether there was preliminary evidence
for the benefit of use of systemic retinoids for treatment of
psoriatic arthritis (P10603)

 Wanted to determine whether significant research questions
were unanswered related to homologous recombination in cancer
cells (P20901)

 Wanted to determine the feasibility of a research project
examining photoreleasable compounds. (T00603)

 2. To determine the specific target for a research
study so as to be the most productive (9)

 Was designing an experiment to stimulate the
tyrosine-hydroxylase gene expression of dopaminergic neurons and
needed recent publications by a particular investigator who does
work in this area since research team planned to use the same
methodology (T06401)

 Was using single photon emission computer tomography and
other tomographies to study patients with schizophrenia or
Huntington's chorea and wanted to stay abreast of what
others were doing to help specify interesting research questions
(P20602)

 To help formulate specific research questions (7)

 Was studying oncogene expression in pancreatic carcinomas
and wanted to know which, specifically, had already been
investigated and which appeared most promising for further study
(P20801)

 Had seen a patient with an emergency presentation of an
aortic aneurysm and wanted to know whether a connection between
aortic aneurysm and lung disease had been reported to assess
whether research was needed, because all the patients with aortic
aneurysm were also smokers (063101)

 To choose (more) appropriate
variables/factors/conditions for use in research design (21)

 To identify (more) appropriate variables to
be manipulated in an experiment (10)

  Needed to know the measured concentrations of sodium
inside heart cells in order to plan and interpret experiments (I)
(T02502)

  Had an interest in the pharmacokinetics and
pharmacodynamics of anesthesia using an animal model and wanted
to know how others dealt mathematically with effect measurement
data to assess every measurable effect of anesthesia (074401)

 To identify (more) appropriate factors to be
tested in an experiment (8)

 Was designing models to modify cancerogenesis response to
UV-radiation and needed treatments that modify the natural
history of UV-induced cancerous lesions (P10602)

 Was designing an administrative/personnel experiment on use
of child care as a recruitment/retention incentive for nurses
working at night and wanted to know what others had found out in
this area (P10202)

 To identify (more) appropriate variables or
measures to use in epidemiologic research (3)

 Was designing a study of the relationship between attitudes
toward food and eating disorders in China and wanted to know what
others had found on eating disorders in non-Western cultures
(017902)

 Was involved in a study on the expression of HLADR, a
histocompatibility antigen in non-hematolymphoid tumors, and
needed to know if there was any evidence in the literature
of the expression of HLADR in other neoplasms besides lymphomas
in order to assess whether HLADR could be a parameter to separate
interleukin-2 therapy-responders from non-responders (044602)

 To choose or effectively implement an appropriate
methodology (41)

 To identify an appropriate protocol (6)

 Was designing a new project in the area of Epstein-Barr
virus and lymphoma and wanted to update information on most
current protocols and techniques (P12202)

 Was developing an instrument to assess speech-language
development in children and wanted to know how similar
instruments had been scaled and validated (P10201)

 To identify an appropriate laboratory
technique (23)

 Was planning a research project to insert the gene that
codes for metallothianine into algae to create an alga that
removes contaminating metal ions from the environment and
wanted to know how to clone the metallothianine gene (046601)

 Was devising a research project to clone the ovalbumin gene
into a plasmid to produce plants with a higher protein content
and needed the gene sequence of the ovalbumin gene (046602)

 Was looking for the citation for a method for intraocular
lens implantation by a specific author for supervisor's research
and needed a specific type of implant method described by one
individual (I) (042202)

 To identify appropriate materials (12)

 Was studying the basic biology of asthma and the role of the
nervous system in the disease and needed information on
fluorescent dyes, Dye-I and Dye-O, which are taken up by
nerves and transported to the cell body, which dyes researcher
was considering using to study innervation of the respiratory
tract (061301)

 Was studying the action of butyrate, which gets metabolized
by the acyl-CoA-synthetase in the mitochondra into butyrate-CoA.
Renal physiologist did not want this reaction because he was
looking at volume regulation, not metabolism, and needed to
know if there was inhibitors of acyl-CoA synthetase which he
could use to stop the reaction (052401)

 B. Securing research funding or collaboration (34)

 1. To obtain background facts to include in a grant
proposal (13)

 Was preparing a grant application for a research study in a
particular area (e.g., glycoprotein T-200) and wanted to be sure
knew all relevant literature (013803)

 Was writing a proposal for preliminary studies of a
particular organelle (primary cilium) in cartilage cells and
wanted to review studies of these organelles in vestibular hair
cells (where they have been more extensively researched) in order
to clarify research questions and specific things to look for
(012001)

 2. To obtain information to justify the significance
or appropriateness of a proposed study (14)

 Was preparing a grant application and needed citations to
document an assertion concerning a specific protein in liver
tumor cell lines (041601)

 Had observed a relationship between growth hormone and
obesity--obese people secrete less growth hormone than non-obese
individuals--and needed to determine whether this relationship
was causative or a secondary factor so that he could prepare a
grant proposal (077802)

 3. To provide justification for some aspect of a
proposed research design or methodology (including submission to
FDA for investigational drug)(3)

 Was preparing a grant proposal and wanted specific evidence
from the literature to support a point concerning the expression
of a cytoskeleton protein, 4.1, in the cell lines hepatoma G2 and
hepatoma 3B (041601)

 Was submitting an application to the FDA to use a new
nuclear medicine technique for white blood cell labeling and
needed specific references that documented procedures and
outcomes of the labeling technique (062802)

 4. To identify information to evaluate potential for
collaboration with other researchers (3)

 Was deciding whether or not to collaborate with other
investigators contacted at an international meeting and needed
information on their research projects of the past three to
four years (013902)

 Was planning to introduce papilloma virus protein,
synthesized by a possible collaborator, into fibroblast cells to
determine whether or not it would metastasize the cells
and wanted to make certain that he had not overlooked any of the
prospective collaborator's publications (025202)

 5. To identify the expertise/interests of potential
reviewers in order to decide on the agency component from which
to seek funding(1)

 Was preparing a grant application for glycoprotein research
and wanted to identify a funding agency where at least one
reviewer on the study section would have an orientation
towards molecular biology and carbohydrate analysis (013802)

 C. Performing analysis of published information (8)

 1. To perform an analysis of previously published
research findings (5)

 Had research in progress on polyethylene as a component of
total-joint-replacement prostheses and wanted to know more about
normal joint wear and types of failures that could occur with
prostheses (045401)

 Was preparing an epidemiological study of chest wall
recurrences of breast carcinoma in women who had adjunct
chemotherapy, but no radiation until the recurrence, versus those
who had it immediately after surgery, and needed information from
previous studies (I) (044301)

 2. To perform an analysis of medical views or
opinions (1)

 Was doing a project on rise of biophysical, high-technology
medicine in 20th century and wanted to contrast views of
physicians and medical historians (048901)

 3. To perform an analysis of research methods (2)

 Was involved in a research project evaluating different
diagnostic tests for patients with pneumocystis pneumonia, and
wanted information on the sensitivity and specificity of the
tests as a measure of their accuracy to diagnose pneumocystis
(014001)

 Was looking at negative clinical trials for patients with
cystic fibrosis for the past 10 years and needed to find all of
the studies where there was no difference between two therapies,
in order to look at the sample size to do a power analysis.
(033401)

 D. Interpreting research findings (23)

 1. To help refine a theory or model so that it can
encompass new findings (5)

 Was attempting to determine whether a protein that binds
zinc fit the zinc fingers model of binding and needed examples
from the literature of zinc finger proteins (073103)

 Had hypothesized that calcium and calcium channel modulators
play a more significant role in the auditory system than was
thought and needed to identify and review other research on
calcium channels and the auditory system which was applicable to
his work (074801)

 2. To help understand the significance of certain
research findings (10)

 Had cloned a gene (transin) that turned out to be
differentially expressed during tumor formation and had done some
DNA sequence analysis and found that transin gene was similar
to stromelysin, so needed to find out more about substrate
specificity of stromelysin (P21501)

 Had found that in cleft palate children who had a breathing
impairment, the impairment had a profound effect on the mode of
distributing air between the mouth and nose, while in non-cleft
children the mode of distributing air was not related to the
impairment, and needed to know the incidence of breathing
impairment and a definition of impairment, in order to understand
the significance of their findings (078101)

 3. To help interpret unusual findings (8)

 Had discovered a protein, p-21, which is an expression of
the ras oncogene from immunohistochemical studies of brain
tissues of patients with Jakob-Creutzfeldt disease and
scrapie, and wanted to know whether an association existed
between the expression of the ras oncogene and the diseases
(046901)
  Had discovered an interaction between dimethylsulfate and
guanine residues which caused reverse transcriptase to stop in a
method to transform messenger RNA in vivo and needed information
about the chemical interactions between nucleic acids and
dimethyl sulfate (056601)

 E. Preparing research reports (37)

 1. To determine whether results are sufficiently
novel and should be published (4)

 Had just discovered that butanol stabilizes the enzyme alpha
glucosidase and wanted to know if there were other reports of
butanol protecting an enzyme from deterioration (017701)

 Had seen angiogenesis, the growth of blood vessels, in
endothelial cells in tissue culture and needed information on
angiogenesis in tissue to determine whether or not system
was unique and should be reported (021901)

 2. To place own findings in context of most recent
research and opinion (33)

 a. To review all current and significant work in
own field (21)

 Was preparing paper on own research on steroid binding
proteins in plasma and wanted to review most recent literature in
field to place findings in context (049301)

 Was preparing a manuscript on progesterone receptors and
binding and needed other recent papers on this topic to ensure
that no related papers had been overlooked (072601)

 Was preparing a report on the results of testing the
efficacy of vaccines for the feline leukemia virus and wanted new
articles on immunity to and molecular biology of the leukemia
virus (071502)

 b. To obtain specific citation(s) for work to be
referenced in report of own findings(12)

 Was preparing a manuscript on research findings and needed a
specific reference on relationship between T-200 and fodrin to
include in article (013801)
  Was preparing a paper on own research and needed a paper
which referenced some unpublished observations about DNA bending
which researcher wanted to use for background in his paper.
(018101)

 Evaluating research proposals or requests for approval
of new drugs/devices (3)

 To assist in study section review(1)

 Was evaluating grant applications for a metabolism study
section on an area of fatty acid binding proteins which was
unfamiliar and needed to find out whether or not a connection
existed between biological regulation and the amount of protein
isolated (074202)

 To assist in review of investigational drug
application (2)

 Was reviewing a request of an investigator to receive an
exemption to use an experimental treatment for breast cancer,
when it was only approved for leukemia, and needed to find doses
that were used and whether the drug was safe or not (049901)

 Was reviewing application to FDA for approval of a new drug
for treatment of breast cancer, and needed to find all clinical
studies of this drug to make sure there were not selective
omissions of any negative studies (049902)

III. Teaching (231)

 A. Instruction in the basic medical sciences (5)

 1. To prepare a lecture for undergraduate college
science course (1)

  Wanted background information for a
undergraduate class on Drosophila homeobox including current
references and state-of-the-art information on the Drosophila
homeobox (050701)

 2. To prepare a lecture for medical school course in
basic medical sciences (1)

  Was preparing a lecture on axonal transport
for a basic medical sciences course and wanted information on
recent developments in the area of the mechanisms of moving
biochemicals up and down the axons (058602)

 To prepare a lecture for graduate student seminar
(1)

  Was preparing a seminar for graduate students
on colony stimulating factors and needed information on each of
the six subclasses in cells and their effects (013903)

 To provide students with bibliographic materials
to aid them in preparing a paper or thesis (2)

  Wanted to find references by other groups in
the last two years on cardiac assist devices in animal models for
a graduate student's bibliography for her master's thesis
(P10805)

 Wanted to obtain review articles on tuberculose meningitis
for a third year medical student to aid him in writing a paper on
the topic for his oncology service rotation (060403)

 B. Practical instruction in a clinical setting (10)

 1. To obtain supplemental information pertinent to
the care of patients on the teaching services (4)

  Had asked resident to give a talk on the
condition of a multiple myeloma patient seen on rounds and wanted
to be able to elaborate on resident's talk
(P12404)

  Wanted information on whether ativam could be
effectively administered intramuscularly to control seizures in
order to supplement his existing knowledge about treatment of
seizures (I) (035404)

 2. To provide reference tools for students,
residents, or faculty (6)

 To provide students or residents with
selected references or reference list (5)

  Wanted to share a particular paper on
the malposition of catheter tips with residents to aid them in
reading a film of a patient with a chest tube (029102)

  Wanted background articles on the
ethical issues behind the Harvard criterion for brain death to
prepare residents for taking the general internal medicine
section of the MKSAP-7 Medical Board Exam (038803)
 To construct a special-purpose literature
data base to provide students or residents immediate access to
information on clinical questions (1)

  Wanted to create a customized data base
to aid residents in searching the journals in the anesthesia
department library by downloading appropriate MEDLINE entries to
a hypercard file (P10806)

 C. Continuing and inservice education of practitioners
(29)

 1. To obtain information to update practicing
physicians on new diagnostic techniques or treatment modalities
(18)

  Was teaching physicians and technologists
from all over the world and needed information on the indications
for testing for carotid vascular ultrasound (T06501)

  Needed clinical data on use of Beta-HCG as a
tumor monitor and also as a monitor of stage of pregnancy for a
teaching presentation at clinical pathology conference (U18301)

 2. To obtain information to provide inservice
education to non-physician health professionals and
para-professionals (11)

  Was going to be co-teaching and coordinating
a class on pain management for nurses and needed literature from
the past two years on assessment, narcotics and
nonpharmacological treatments such as hypnosis (U05301)

  Was preparing a class for nurses on blood
administration and needed a search of recent literature to find
articles on the physiology relating to blood administration and
autologous donations (U05302)

 D. Didactic instruction of residents or faculty in a
hospital, medical center, or other educational setting (63)

 1. To supplement presentation of article in
residents' journal club (5)

  Wanted to review two major recent studies on
use of Levine or peritovenous shunts in treatment of ascites for
journal club (P10403)

  Was preparing for a lecture for journal club
presenting an historical view of vasculitis and needed
information on diagnosing vasculitis--the tests and the
order in which to use them (052603)

 2. To prepare a presentation for a regularly
scheduled teaching conference for residents (6)

  Was searching for data for a regularly
scheduled teaching conference on the effectiveness of various
bronchodilators to treat asthma, especially concentrating on
aerosolized beta-agonists (T01801)

  Was preparing to teach residents and needed
information on intraventricular hemorrhages in the delivery of
babies--blood in the ventricle of the brain of neonates as the
result of birth trauma (I) (U02101)

 3. To prepare for case or clinical conference (10)

 a. To develop presentation concerning a specific
case (7)

  Was preparing for a clinical conference
on a patient with rhabdomyolysis the breakdown of muscle tissue,
and needed information on the natural history of the condition,
what is felt to be the cause, and the typical outcome (041602)

  Was preparing to present data at a
conference and was looking for the treatment for a patient who
previously had several heart catheterizations, after a transplant
and was now in rejection (T07501)

 b. To provide input on specific issue at
department conference (3)

  Was searching for information for a
staff meeting on the effects of lead on the function of the brain
and where in the brain the effect occurs (U08103)

  Was going to a noon conference at local
hospital to discuss primary management of prostate cancer, and
wanted to find more information on whether to recommend no
treatment (observation only) or surgery and radiation (069703)

 4. To prepare a special clinical lecture, symposium,
or grand rounds presentation for faculty, residents, and other
health professionals (33)

 a. To develop content of clinical lecture,
symposium, or grand rounds for residents, faculty, or students
(28)

 Was preparing presentation on chemotherapy of cervical
cancer to his division and wanted general information on the
chemotherapy of cervical cancer and the relationship of
cervical cancer to viral infections (036901)

  Was preparing presentation and wanted to
know when most research on Crohn's disease and ulcerative colitis
had been done (P10402)

  Was preparing a talk on sarcoidosis for
grand rounds and wanted general reviews of sarcoidosis, including
pathophysiology and any reports of abdominal lymphadenopathy
(045803)

 b. To assemble visual materials to present in
clinical lecture or symposium (3)

  Was preparing overheads for a
presentation on thrombolylic therapy and needed specific
statistics on the comparison of the efficacy of streptokinase and
TPA so that he could present the most current data (P20201)

 Was preparing a talk on keratinization of hair follicle
epidermis and wanted pictures of hair follicle epidermis
(016401)

 To locate a specific article or prepare a
bibliography to distribute at clinical lecture (2)

  Had given a talk to a group of
paramedics and nurses on oximetry in pre-hospital settings and
had handed out an article for distribution and now needed to
locate it because participants had asked for a copy (U13001)

  Was preparing to do a seminar on the use
of lasers and wanted to be sure there was not any information on
an application of lasers that he was not aware of (069601)

 Presentation of a comprehensive review at a
professional meeting (9)

  Was preparing a professional talk on
transfusions in malignancy and patient survival to give to a
national group of physicians on blood systems and wanted
background information on the effects of transfusion on survival
rates in patients with malignancies (077501)

  Was preparing to moderate a symposium on
medical liability issues for pathologists and attorneys, and
needed to know the specific problems that can arise that lead to
litigation or some kind of poor outcome for patient or
pathologist (067706)

 E. Providing health and safety information to community
and lay public (8)

 1. To develop a lecture/course on health or safety
for lay group (6)

  Was doing child safety programs for various
community groups and needed updated information on various
aspects of safety including burns, bicycles, water, playgrounds,
etc. (010502)

 Was preparing a talk for a consumers group on children of
the survivors of the Holocaust and needed literature on the topic
(024502)

 2. To answer inquiry from lay public (1)

  Received a call from the national office of
[youth organization] as to the correct treatment for fire ant
bites, so that they could put it into their manual, and needed to
find a specific treatment, if one existed, rather than
symptomatic treatment (T05802)

 3. To present technical information to other
pharmaceutical salespeople(1)

  Was preparing to give a two-hour presentation
on arthritis and [drug] to his fellow drug salespeople at their
sales meeting and needed information on arthritis and [drug]
(054101)

 F. Preparing a written communication on a clinical topic
(articles, book chapters, reviews, etc.) (116)

 1. To determine whether a disease presentation seen
or treatment/procedure used by the physician was sufficiently
unique to warrant a written communication (15)

  Was considering writing a paper about
treatment the respondent was using use of cimetidine to protect
the small intestine and wanted to know whether it was already in
the literature (P12001)

  Saw a patient who was in O.R. for
electroconvulsive shock therapy for major depressive episodes,
who also had uremia. Physician had been unable to produce a
seizure and wanted any evidence in the literature of uremia
decreasing seizure activity to write the case up because it was
such an unusual event (U12502)

 2. To obtain an overview of topic area to support
preparation of a paper, book chapter, etc. (55)

 To obtain comprehensive information on a
topic to include in a written communication (30)

  Was preparing a review article on the
role of the nurse-consultant in pediatric oncology and wanted all
significant and current references (037602)

  Was preparing a book chapter solar
urticaria and wanted all significant and current references
(P10605)

  Was asked to write a chapter of a
textbook on lead poisoning due to retained fragments of material
such as bullet fragments (missiles)after having previously
published an experimental study, and was looking for more
complete information on lead poisoning or intoxication and trauma

 To identify current information to update own
state of knowledge (25)

  Was writing an article on B-cell
lymphoma which was a case report of particular patient who had
the life-threatening condition which presented in the skin and
needed recent information on the natural history of B-cell
lymphoma when it was presented in the skin (028703)
  Was writing a paper on coronary spasms
and needed up-to-date, current information to write the paper on
the relationship between myocardial infarction and coronary spasm
(T00101)

 Was writing a chapter on echocardiography for description of
ventricular inflow anomalies and needed the most recent
references on these anomalies (028301)

 3. To obtain specific data pertinent to the
preparation of a written communication (40)

 a. To obtain specific references to support case
report on own clinical observations (7)

  Was preparing a paper on the use of
magnetic resonance imaging (MRI) to diagnose venous thrombosis in
pregnant women and was looking for background information on
venous thrombosis in pregnancy, and any other reports of similar
use of MRI (T02101)

  Was writing a paper after conducting a
twelve year follow-up of a patient with ameloblastoma who had
been treated unconventionally with radiotherapy and wanted
information on other pertinent literature that had been published
about the use of this treatment for ameloblastoma (032702)

 b. To obtain information to answer a specific
question arising in the process of preparing an article or book
(33)

  Was preparing a paper on campylobacter
pylori which is a causative agent of chronic gastritis and needed
to find cytology procedures--brushings or washings of the gastric
mucosa--that could be used to identify the agent (041502)

  Was writing a book chapter on anesthesia
management of aortic and carotid artery surgery and was looking
for information on anesthetic or surgical complications or
different anesthetic techniques (I) (P10803)

  Was preparing a brief essay on sleep
studies in rheumatoid arthritis for a dictionary of the rheumatic
diseases and wanted to identify all reports of sleep studies in
rheumatic diseases as well as general information on what
constitutes a modern sleep study (P21401)
 4. To obtain proper bibliographic citations for
previously identified articles (6)

  Was preparing a paper or presentation
and needed proper bibliographic citation for an article to be
included in the bibliography or footnotes (P30702)

  Was writing an article on gastric
freezing, which was abandoned after a couple of years because of
the complication that patients bled again after a year and was
looking for the specific original articles advocating gastric
freezing and subsequent articles denouncing it (077901)

IV. Learning (81)

 A. Furthering own formal education (15)

 1. To obtain information pertinent to preparing paper
or other report for graduate coursework (11)

  Was exploring issues of chemical
dependency in health professionals for a thesis and wanted
information on how different professional organizations and
government entities are handling impaired professionals (P11103)

  Was preparing a thesis on developing a
measurement tool to assess parents' adjustment to apnea
monitoring and needed to know what was already in the literature
on sudden infant death syndrome, apnea monitoring, and parents'
perceptions of home apnea monitoring (U11002)

 2. To obtain information on areas of research
interest of individual or laboratory being considered as location
for fellowship or sabbatical (4)

  Was planning to do a post-doctoral
fellowship and wanted to know if an investigator had a
biochemical orientation and studied areas he was interested in,
including cytoskeleton and regulation of cell cycle control,
before interviewing for the position (051001)

  Was preparing to interview for
fellowship and wanted to find out what a researcher, who was
investigating neuronal development, had published in the
past five years and identify his scientific approaches (051002)
 B. Furthering own or other's continuing education (34)

 1. To keep up to date in own primary area(s) of
expertise (18)

  Was working in the same field as an
individual from France and had not seen any recent papers; wanted
to find any new papers by him, as well as investigate whether the
investigator had changed fields (025203)

  Was researching virulence factors of
Neisseria gonorrhea and needed the most recent papers to update
his literature file (02701)

 2. To evaluate or demonstrate potential of Grateful
Med to search literature (6)

 Resident had patient with blood coagulation problem due to
protein C deficiency and faculty member wanted to find an article
on the topic that he didn't have in his files, as well as to show
the resident how quickly he could gain access to information on
an unusual clinical problem (070001)

  Had patient with intracranial bleed, on
teaching service, and wanted to show residents value of MEDLINE
to obtain information when colleagues were unavailable (I)
(047902)

 3. To prepare for attending a professional conference
(3)

  Was preparing a poster presentation and
needed information from the abstract of a specific article on the
effects of estrogen on glucocorticoid receptor synthesis in the
pituitary (P16001)

  Was preparing for conference on
cholesteatoma (tumor-like masses) and wanted to review every
title in the medical literature on the topic as the pertained to
the CNS and Otology (039502)

 4. To develop or maintain own database in area of
interest (7)

  Was researching anaphylatoxins and
needed general information on an analog of the anaphylatoxin C3a
(C5a), which plays a major role in the inflammatory response and
neutrophil behavior, to build a citation index on own computer
(075702)
  Was working on RNA splicing and wanted
to develop own database on RNA processing to put all references
on Reference Manager program (051401)

C. Satisfying own curiosity or personal interest (32)

 1. To learn more about some clinical problem of
current interest (16)

  Wanted more information about tumor
necrosis factor and its relationship to clinical disease and
needed a list of current articles and reviews to have a broader
knowledge base (T03303)

  Was asked about the pathologic features of
lymphoblastic lymphoma and needed to know its morphology and to
find out how it differs from other lymphomas to satisfy his
curiosity; recent references did not provide enough detail (I)
(067703)

 2. To obtain more complete information on a brief
item encountered casually (6)

  Wanted to review the work of a
researcher not previously known to the respondent (P10902)

  Had noted a reference at a talk about
work done on hemophilia and wanted to locate the author's article
(065704)

 3. To develop a more updated C.V. (3)

  Wanted to update references for own CV
(P10502)

  Was preparing CV for promotional
purposes and was missing some of own citations and needed all
citations on which he was an author (068603)

 4. To obtain information on research interests of
seminar speakers (7)

  Was arranging a chapter meeting of a
professional organization and needed to know which surgeons were
authorities in ambulatory surgery and who was familiar with the
newest developments (U11802)

  Was preparing for a visiting speaker and
wanted information on the speaker to circulate among staff and to
prepare an introduction (072802)
V. Administration (72)

 A. Standard setting (34)

 1. To obtain information pertinent to determining
optimal or most cost-effective treatment regimen (28)

 a. To develop or modify therapeutic protocols
(15)

 Was planning a protocol for treatment of premature labor and
wanted information on side effects of different beta agonists,
particularly terbutaline and aritradine, that are commonly used
in this situation (P10703)

 Was preparing to write a departmental protocol for
monitoring ototoxicity and needed to know current techniques to
detect ototoxicity sooner and the standard dosage regimens to
implement to avoid the problem (057101)

 b. To evaluate most efficacious pharmaceutical
agent (13)

 Was on hospital Policy and Therapeutics committee, setting
standards for emergency medicine, and wanted information on the
relative efficacy of streptokinase and TPA (P11301)
 Pharmacy was carrying both triamcinalone inhaler and
betamethazone inhaler in the hospital pharmacy and a member of
the Pharmacy and Therapeutics committee needed to evaluate which
was the more effective and which presented fewer side effects
(U06602)

 2. To obtain information pertinent to setting
standards for use of personnel (2)

 Quality Assurance Committee was questioning use of nurses to
triage x-rays and lab work and physician wanted to know what
other institutions were doing in this regard (P11302)

 Was administering a public school district's health-related
programs and needed articles to defend against cutbacks in
nursing staff (I) (T00203)

 3. To obtain information on legal issues and
liability relative to a particular patient-care policy (1)

 Wanted to review national legislation and liability issues
related to failure to treat uninsured patients ("patient
dumping") (P11303)

 4. To obtain information on standards for precautions
staff should observe to avoid exposure to possibly harmful agents
(3)

 Was interested in possible teratogenic effects of ribovirin,
an aerosol antiviral agent, on pregnant nurses or on nurses
planning to become pregnant who are exposed to the drug
when treating patients, and wanted guidelines for protecting
health care workers from effects of ribovirin (053603)

 Was making recommendations to hospital staff about
appropriate precautions for dealing with patients who had
methicillin-resistant Staphylococcus aureus infections and
needed to know if the infection is airborne, to protect employees
from being exposed to the organism when they enter the patient's
room (U18501)

 B. Evaluation of care (13)

 1. To obtain information on national standards
against which to compare performance of own institution (7)

 Was performing an in-house audit of needle localizations
based on mammography and wanted information on national rates of
positive findings (malignancies) for this procedure (P12102)

 Was doing research on birthweight mortality statistics in
own institution and wanted national statistics against which to
compare local findings (011203)

 2. To obtain measures to assess quality assurance (3)

 Was keeping current in field of recreation therapy and
needed information on quality assurance and outcome assessment to
develop outcome measurements for patient satisfaction and goal
attainment (U03301)

 Had identified that their ambulatory care quality assurance
program needed upgrading and needed methodology and systems to
refine plan that would work in a busy, overburdened clinic
setting (U04001)
 3. To obtain information on possible sources of
infection (3)

 Had seen several cases of infection by Clostridium
difficile, an organism causing antibiotic-associated colitis, and
needed recent information about controlling the organism in
the hospital to develop quality control measures (U11302)

 Was consulting to determine apparent outbreak of an unusual
organism, Pseudomonas posimobilus, among bone marrow transplant
patients and needed to find out where it might be coming from in
the environment, whether it was a real or a pseudoinfection, and
whether clinical experience with previous infections had been
reported (035101)

 C. Planning of facilities and services (11)

 1. To obtain information on how to conduct strategic
planning (1)

 Was developing a strategic plan for the pharmacy department
and needed information on strategic planning techniques (044002)

 2. To obtain methods for hospital facility planning
(2)

 Was developing and planning health care for an international
agency and needed information on new methods and techniques to
help plan a new hospital in Latin America (053901)

 Were developing a proposal for a children's hospital for the
city service area and needed broad-based information on
children's hospitals and on services provided by them U09502)

 3. To help evaluate the rationale for a new facility
or service (8)

 Was contacted and given a grant to study whether or not HMO
should cover pancreatic transplants and needed to assess the
benefits and risks and the costs of the service (023602)

 Was presenting information about the education or retraining
of closed-head injured children and needed to know about a
technique called cognitive retraining and whether or not
it would be beneficial (T00202)

 D. Personnel administration (9)

 1. To help evaluate qualifications of a potential
employee or colleague (7)

 Was asked to look up publications of a candidate
interviewing for position of attending physician and needed a
list of articles published by the candidate to give to the
interviewer (049401)

 Was matching expertise of potential reviewers with faculty
members up for promotion or tenure for a promotion and tenure
process at a college and needed to know areas of expertise in
drug research of each potential reviewer (048502)

 2. To obtain information to resolve personnel safety
issues (2)

 Was writing a protocol to ensure the safety of nurses,
visitors, and the patient in the period following a surgical
implant of a radioisotope, when the patient is radioactive, and
needed information on techniques nurses could use to minimize
their exposure without compromising care (U19102)

 Was writing a paper on precautions health care workers need
to take with AIDS patients to protect themselves against
infection and wanted to know what percentage of patients who came
into the hospital not knowing if they were HIV-positive tested
positive for HIV (028402)

 E. Equipment purchase (5)

 1. To obtain information pertinent to decisions
regarding purchase of new equipment (5)

 Was considering purchase of a newer blood counting machine
and needed to know what the machine measures and what its utility
is (I) (030402)

 Was planning to go to the surgical staff with
recommendations for the use of devices to prevent postoperative
respiratory complications and needed to know which device to
recommend, how often it should be used, and who should administer
it (U04403)

VI. Other (40)

 A. Consultation to government agencies (7)

  Physician was presenting testimony before
congressional committee on appropriateness, quality, and
necessity of medical care related to Medicare beneficiaries, and
needed information on the impact on quality of care related to
prospective payment and DRGs (063001)

  Was consulting on the design of a nuclear
emergency response plan and wanted published reports of hospital
evacuation experiences in other nuclear and non-nuclear
emergencies (P20402)

 B. Medico-legal consultations (32)

 1. To help determine probable etiology of a contested
injury or condition (12)

  Physician was evaluating the viability of a
medico-legal suit which law firm was considering taking on and
wanted information on frequency of adverse affects from a vaccine
as well as differences between vaccines approved for use in Japan
and United States (P12501)

  In conjunction with an on-going law suit,
wanted information on whether and how trauma accelerates cancer
(P12502)

 2. To help determine whether prognosis for particular
condition was affected by delayed or incorrect diagnosis (5)

  Was consulting to a lawyer on a medical
liability case and needed outcomes and survival rates in
cryptococcus infection with proper diagnosis and early treatment
as compared with late diagnosis and treatment to make certain
that no support existed in the literature for the claim that the
outcome would be deleterious whether or not the disease was
treated early or late (021101)

  Was consulting on medical-legal cases related
to the issue of misdiagnosis of aneurysm and wanted clues for
early diagnosis, outcomes after correct diagnosis and proper
treatment, and statistics on survival to counter claims that
early diagnosis would not have made a difference (021102)

 3. To obtain information to determine the
appropriateness of care given (12)

  A physician was having a problem with other
physicians at his hospital because of a new technique he was
using for hiatus hernia surgery; another physician who was
assisting prepare the defense wanted information on most current
indications for surgery and surgical techniques (P12503)

  Dermatologist was consulting on alleged
malpractice in treatment of basal cell carcinoma and needed
information on established standard of care as of the date
of the contested event (1977), which predated the physician's own
training (019602)

 4. To obtain information to assess future risk of a
serious, life-threatening problem due to some agent (2)

  Was evaluating a case of a patient who had
been exposed to the sun on the job and had developed actinic
keratoses; needed information about the likelihood that actinic
keratoses will develop into skin cancer for purposes of providing
the worker's compensation company with accurate, up-to-date
information (027602)

  Physician was asked for information about a
reported fatal anaphylactic reaction to carbonless paper and
needed information about any type of toxicity to such paper for
and whether diisocyanate, which is converted to a monoisocyanite
and aerosolized at the end of the papermaking process, can lead
to a lethal reaction (034902)

 5. To obtain information to aid in resolving a
personal medico-legal matter (1)

  Had a court hearing scheduled and needed
background information about behavior patterns in vicious dogs to
resolve a personal problem with a vicious dog in the neighborhood
(I) (T00402)

 C. Personal business endeavors (1)

  Wanted information on anabolic steroid implants
for weight gain in cattle to aid in his business (I) (043403)