P13S05: Leg cramps
Bottom line: Information on leg cramps was used to modify the
management of the patient (stop the quinine treatment and reassess
regularly with the physician). There were no information-related patient health outcomes.
Level 1 outcome (situational relevance): On July 25, 2008, P13 did a search at work, by themselves, before an
encounter with the patient. P13 retrieved one information hit about Quinine sulphate. The reported search objectives were: to address a clinical question,
to share information with a patient or caregiver and to exchange information
with other health professionals. “She was a
patient [a woman in her eighties] that had been
on quinine for quite a number of years for nocturnal leg cramps. She was taking
it more regularly during the winter months, because she tends to get more leg
cramps during the winter, but in the summer, she doesn't get as many leg
cramps, so [...] she sorts of goes off the therapy slightly,
and waits until she does have an episode, and then she might take it for a few
days in a row…and then she'll come off it and wait… and she may not need it
again for another week or so. [...] I guess my clinical question was "is
quinine effective for nocturnal leg cramps?", because I wasn’t necessarily
convinced. [...] I was discussing with the patient, you know,
you know about the effects of quinine and [...] if there was any question as to whether it
might be effective for her still, or whether she might qualify for just a time
without it…and that she'd be reassessed every so often, as she'd been on it for
quite some years. [...] Afterwards, I felt that it would be useful
information to share with the physician in terms of seeing whether [...] she [the patient] should continue
with the treatment.” According to P13, e-Therapeutics+ was the only source
for information, and the found information was relevant.
Level 2 outcome (cognitive impact): One hit was associated with a report of positive cognitive impact (see table). Regarding practice
improvement, P13 stated: “[My practice will be changed and improved
because] I probably would be reluctant to try
quinine, I would probably try one of the other treatment options that are
suggested further in that topic area. [...] For the patients who are already on quinine,
it [the learned information] may affect my recommendation in terms of
reassessing treatment or assessing, you know, side effects, and things like
that.”
Retrieved
information hit:
1) e-Therapeutics+ (CIRT): Therapeutics tab – Keyword: Muscle cramps – Management of nocturnal leg cramps – Table 1–
Highlight (P13S05H01)
Level 3 outcome
(information use): Information on Quinine sulfate was
retrieved, and used to modify the management of the patient (information used
as presented in e-Therapeutics+). “[...] Well, [I was hoping] at least to try
to modify the management. [...] [When] discussing it [to stop the quinine treatment and reassess
with the physician regularly] with the patient, the patient was very much
reluctant to stop the medication or to go on a trial without it for any period
of time.”
Level 4 outcome (patient health): Regarding patient
health, P13 did not associate the information with any health outcomes.
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Share information Exchange information |
Practice improved Learned something |
Manage differently |
No outcome |