Showing papers in "Bulletin of The Medical Library Association in 1996"

Telemedicine: history, applications, and impact on librarianship.

Abstract: This paper traces the uses of telecommunications in health care from the Civil War era to the present. Topics include the National Aeronautics and Space Administration's involvement in the origins of current telemedicine systems and the impact of television. Applications of telemedicine discussed include remote consultation and diagnosis, specialty clinical care (including examples from anesthesia, dermatology, cardiology, psychiatry, radiology, critical care, and oncology), and others (including examples of patient education, home monitoring, and continuing education). The concluding section highlights how telemedicine affects health sciences librarianship, beginning with the development of online computerized literature searching. This section also discusses the medical resources available to health sciences librarians as a result of the Internet.

Consumer health information demand and delivery: implications for libraries.

Abstract: Consumers are increasingly interested in information that will help them manage their own health and that of their families. Managed care and other health providers see consumer health information as one tool to help improve patient satisfaction and reduce costs. There is a huge and varied supply of such information, provided through myriad sources. This article summarizes findings from a preliminary assessment of consumer health information demand and delivery supported by the U.S. Department of Health and Human Services. It highlights patterns of consumer interest and supply sources, identifies problems that confront those looking for information, and suggests a role for libraries as providers and interpreters of health information. The last publicly released general study on consumer health information was commissioned by General Mills in 1979. In the sixteen years since then, the scope of consumer health information has become huge and diverse; with increased responsibility for health, consumers have developed both broad interests and very specific needs. The Department of Health and Human Services commissioned a preliminary assessment of consumer health information demand and delivery to lay the foundation for a more comprehensive understanding of the issues. This article highlights some of the key findings that suggest a role for libraries as consumer health information providers and interpreters.

The changing face of health information and health information work: a conceptual framework.

Abstract: The purpose of this paper is to examine the changes in health information and health information work using a conceptual framework and to consider the implication of these changes for health sciences librarians. The notion of what constitutes information depends heavily on the perspective of those defining the term. In the health care domain, numerous established concepts of information exist, many clustering around disciplines and professions. Various information professions-for example, health sciences librarians, information-systems managers, and medical-records administrators--have differing core concepts of information. Although these established concepts of information may seem immutable, they are cultural facts and can and do change. Global networking and changes in health care delivery are just two of many environmental forces that are changing the way the health domain views health information and the way it values the patterns and practices traditionally associated with established types of information and information professions. As new concepts of information arise, the possibility for new expert work surrounding information also arises. Andrew Abbott's systems theory of professions, adapted to the health domain, suggests that some forms of established expert information work may diminish while new types may arise and that both established and new information professions will struggle with each other for official sanction, or jurisdiction, to perform new expert work. This competitive struggle is likely to produce a new balance of information work and roles among the information professions. The specialty areas of library and information science, the heartland of our knowledge base, are as relevant in the electronic environment as in the print environment. Our profession's challenge now is to redefine and communicate our jurisdictional place in the emerging health information environment.

Information and research needs of acute-care clinical nurses.

Abstract: The majority of nurses surveyed used the library on a regular but limited basis to obtain information needed in caring for or making decisions about their patients. A minority indicated that the libraries in their own institutions totally met their information needs. In fact, only 4% depended on the library to stay abreast of new information and developments in the field. Many of the nurses had their own journal subscriptions, which could account in part for the limited use of libraries and the popularity of the professional journal as the key information source. This finding correlates with the research of Binger and Huntsman, who found that 95% of staff development educators relied on professional journal literature to keep up with current information in the field, and only 45% regularly monitored indexing-and-abstracting services. The present study also revealed that nurses seek information from colleagues more than from any other source, supporting the findings of Corcoran-Perry and Graves. Further research is necessary to clarify why nurses use libraries on a limited basis. It appears, as Bunyan and Lutz contend, that a more aggressive approach to marketing the library to nurses is needed. Further research should include an assessment of how the library can meet the information needs of nurses for both research and patient care. Options to be considered include offering library orientation sessions for new staff nurses, providing current-awareness services by circulating photocopied table-of-contents pages, sending out reviews of new monographs, inviting nurses to submit search requests on a topic, scheduling seminars and workshops that teach CD-ROM and online search strategies, and providing information about electronic databases covering topics related to nursing. Information on databases may be particularly important in light of the present study's finding that databases available in CD-ROM format are consulted very little. Nursing education programs should be expanded to include curricula bibliographic sessions where the librarian, in cooperation with the teaching faculty, visits the classroom to explain all pertinent information sources or invites the class to the library for hands-on demonstration and practice. Nurses who gain working knowledge of the tools that open the doors to retrieval of research findings and who have information about new innovations in medicine and medical technology have superior chances for success in their chosen profession.

A multidimensional evaluation of a nursing information-literacy program.

Abstract: The goal of an information-literacy program is to develop student skills in locating, evaluating, and applying information for use in critical thinking and problem solving. This paper describes a multidimensional evaluation process for determining nursing students' growth in cognitive and affective domains. Results indicate improvement in student skills as a result of a nursing information-literacy program. Multidimensional evaluation produces a well-rounded picture of student progress based on formal measurement as well as informal feedback. Developing new educational programs can be a time-consuming challenge. It is important, when expending so much effort, to ensure that the goals of the new program are achieved and benefits to students demonstrated. A multidimensional approach to evaluation can help to accomplish those ends. In 1988, The University of Northern Colorado School of Nursing began working with a librarian to integrate an information-literacy component, entitled Pathways to Information Literacy, into the curriculum. This article describes the program and discusses how a multidimensional evaluation process was used to assess program effectiveness. The evaluation process not only helped to measure the effectiveness of the program but also allowed the instructors to use several different approaches to evaluation.

Information retrieval patterns and needs among practicing general surgeons: a statewide experience.

Abstract: Information retrieval has progressed from a reliance on traditional print sources to the modern era of computer databases and online networks. Surgeons, many from remote areas not served by professional medical libraries, must develop and maintain skills in information retrieval and management in both electronic and standard formats. One hundred thirty-three New Mexico general surgeons were surveyed to identify their information-seeking patterns in five areas: retrieval purposes, retrieval sources, barriers to access, techniques used, and continuing education needs. Ninety-nine (74.4%) surgeons responded to the survey. Ninety-five percent utilize professional meetings, the medical literature, and physician colleagues as information sources. Only 17% utilize the outreach services of the state's only medical school library. Common retrieval barriers were practice demands (71%), isolation from medical schools (30%), computer illiteracy (28%), and rural environment (25%). Continuing education topics related to information management would be valuable to 61% of the surgeons. Sixty-nine percent believe their current ability to access biomedical information is adequate, despite most frequently accessing their personal libraries for information related to decision-making or patient management. These data suggest that, despite significant information needs, surgeons have not embraced newer forms of information retrieval. It is imperative that surgeons acquire and maintain modern information retrieval skills as a means of remaining up-to-date in their profession. Professional surgical organizations and medical librarians should collaborate on these continuing education ventures.

Comparing and using assessments of the value of information to clinical decision-making.

Abstract: This paper discusses the Value project, which assessed the value to clinical decision-making of information supplied by National Health Service (NHS) library and information services. The project not only showed how health libraries in the United Kingdom help clinicians in decision-making but also provided quality assurance guidelines for these libraries to help make their information services more effective. The paper reviews methods and results used in previous studies of the value of health libraries, noting that methodological differences appear to affect the results. The paper also discusses aspects of user involvement, categories of clinical decision-making, the value of information to present and future clinical decisions, and the combination of quantitative and qualitative assessments of value, as applied to the Value project and the studies reviewed. The Value project also demonstrated that the value placed on information depends in part on the career stage of the physician. The paper outlines the structure of the quality assurance tool kit, which is based on the findings and methods used in the Value project.

Identifying a core set of medical informatics serials: an analysis using the MEDLINE database.

Abstract: A study was undertaken to test the hypothesis that a core set of medical informatics serials could be identified by using standard bibliometric techniques. All journal articles indexed by the National Library of Medicine between 1990 and 1994 were included. Articles were identified by using the "MEDICAL INFORMATICS" Medical Subject Heading (MeSH) term. Each serial title containing articles was then ranked according to (1) the total number of medical informatics journal articles indexed and (2) the percentage of medical informatics journal articles indexed. Twenty-eight serials had more than 100 articles indexed under the "MEDICAL INFORMATICS" MeSH term. Thirty serials had more than 40% of their articles indexed under the "MEDICAL INFORMATICS" MESH term. A "core" set of fourteen serials had 100 or more medical informatics articles indexed, including more than 70% of all articles they published. The methodology described provides librarians with another tool to use in the difficult task of journal selection. The set of "core" serials identified provides librarians with a ranked list of serials, based on which a medical informatics collection can be developed.

The introduction of evidence-based medicine as a component of daily practice.

Abstract: Evidence-based medicine is an increasingly important concept in continuing medical education and medical school curricula. To cope with the rapid evolution of medicine, physicians need to remain abreast of the many new therapies and diagnostic tools that affect their practices. Unfortunately, along with the many changes there is also a surplus of relevant written material. Physicians are unable to read all of this information due to time constraints. Instead, they must choose information efficiently. Tools are needed to facilitate this process. Over a two-month period, a demonstration model was carried out at the Ottawa General Hospital to encourage faculty, residents, and students to incorporate evidence-based medicine into their daily practice. A study was conducted to investigate the level and type of information required by these individuals in a clinical setting. A literature searching service was introduced six months after the formal introduction of evidence-based medicine in the Department of Medicine. The logistics of and recommendations for providing such a service are presented in this paper.

Integrating health sciences librarians into biomedicine.

Abstract: Vanderbilt University Medical Center (VUMC) developed a model training program to prepare current and future health sciences librarians for roles that are integrated into the diverse fabric of the health care professions. As a complement to the traditional and theoretical aspects of a librarian's education, this mixture of supplemental coursework and intensive practical training emphasizes active management of information, problem-solving skills, learning in context, and direct participation in research, while providing the opportunity for advanced academic pursuits. The practical training will take place under the auspices of an established Integrated Advanced Information Management Systems (IAIMS) library that is fully integrated with the Health Center Information Management Unit and Academic Biomedical Informatics Unit. During the planning phase, investigators are analyzing the model's aims and requirements, concentrating on (a) refining the current understanding of the roles health sciences librarians occupy; (b) developing educational strategies that prepare librarians to fulfill expanded roles; and (c) planning for an evaluation process that will support iterative revision and refinement of the model.

An electronic consumer health library: NetWellness.

Abstract: NetWellness is a community-based, consumer-defined grant program supporting the delivery of electronic health information to rural residents of southern Ohio and urban and suburban communities in the Greater Cincinnati tri-state region. NetWellness is a collaboratively developed and publicly and privately funded demonstration project. Information is delivered via ISDN, standard dial, dedicated network connections, and the Internet. TriState Online (Greater Cincinnati's Free-Net) and other southern Ohio Free-Nets are key access points in the larger project communities. The other access points are more than forty workstations distributed at public sites throughout the project's primary geographical area. Design strengths and limitations, training initiatives, technical issues, and the project's impact on medical librarianship are examined in this paper. Also discussed are ways of determining community needs and interest, building political alliances, finding and developing funding sources, and overcoming technical obstacles. NetWellness's Internet address is: http:@www.netwellness.org.

Public empowerment through accessible health information.

Abstract: The Public Library Association (PLA) is developing plans for cooperative consumer health information services. Foremost for developing this program is the need for partnerships with health agencies and mechanisms to attract grant funding. The proposed project will expand the role of public librarians to address the health information queries they receive effectively. The project plans include the use of new technologies for delivery of health information, and the provision of tools, training, and resources.

Information-seeking behavior of health professionals in Hong Kong: a survey of thirty-seven hospitals.

Abstract: Shortly after the establishment of Hong Kong's Hospital Authority (HA) in 1990, ten library service networks supported by the Library Information Systems (HALIS) were established to pool resources. A survey was undertaken to investigate the information-seeking behavior of health professionals working in thirty-seven public hospitals, examine their information needs, assess user satisfaction with and the impact of library services (including HALIS), and examine why hospital libraries sometimes fail to meet user needs. The findings revealed disparate use patterns among different groups of health professionals and confirmed that medical staff were most satisfied with the library collections and services. The nurses and hospital executives were found to be underserved. They needed information not only for work-related reasons but also to support self-study and development. The new HALIS service was neither well known nor widely used, especially among nurses. The findings provided valuable measures of performance for comparing different hospitals and assessing changes over time. Survey results also highlighted areas in which improvements are needed, such as collection enhancement, promotion and user training, and assessment of the impact of library service on patient care. Subsequent developments in these directions have led to increased awareness and use of library services and confirmed the direction of strategic plans for growth.

A comparison of authors publishing in two groups of U.S. medical journals.

Abstract: This study compared the editorial peer review experiences of authors who published in two groups of indexed U.S. medical journals. The study tested the hypothesis that after one journal rejects a manuscript an author selects a less well-known journal for submission. Group One journals were defined as those indexed in 1992 MEDLINE that satisfied several additional qualitative measures; Group Two journals were indexed in the 1992 MEDLINE only. Surveys were sent to the first authors of 616 randomly selected articles, and 479 surveys were returned, for a response rate of 78.1%. A total of 20.8% of Group One and 15.7% of Group Two articles previously had been rejected. Group One authors were more likely to select a journal for its prestige and article quality, while Group Two authors were more likely to have been invited to submit the manuscript. More than 60% of both groups felt the peer review had offered constructive suggestions, but that it had changed article conclusions less than 3% of the time. Both groups thought the review process only marginally improved content, organization, or statistical analysis, or clarified conclusions. Between 3% and 15% of all authors received considerable conflicting advice from different reviewers. Authors from both groups differed as to their reasons for journal selection, their connections with the publishing journal, and patterns of resubmission after rejection.

Consumer health information partnerships: the health science library and multitype library system.

Abstract: The University of Illinois Library of the Health Sciences at Rockford (LHS-Rockford) long has honored a commitment to serving the health information needs of the greater Rockford community Utilization data collected over the past five years indicate that approximately 50% of reference transactions involve persons not affiliated with the university In early 1994, LHS-Rockford submitted a proposal to the Northern Illinois Library System (NILS), a multitype system spanning twelve counties in northwestern Illinois, asking to serve as a resource library for improving medical and health information services provided by the 138 NILS member libraries The NILS funded this pilot project as part of an effort to implement a new strategic plan, which encouraged member libraries to form networks to provide reference back-up service LHS-Rockford acquired InfoTrac's Health Reference Center, a consumer health information database, and set up a dedicated workstation near the information and circulation desk Referral guidelines were established and the project was promoted among NILS member libraries Activities were documented in order to track project success in terms of referrals and outcomes The demonstration project was very successful, and it proves public consumers seeking health information can benefit greatly from this type of cooperative arrangement

Networking Consumer Health Information: Bringing the Patient into the Medical Information Loop

Abstract: The Library of the Health Sciences at the University of Illinois at Chicago obtained a grant from the Illinois State Library to implement a statewide demonstration project that would provide consumer health information (CHI) using InfoTrac's Health Reference Center CD-ROM database. The goals of the project were to cooperate with targeted public libraries and clinics in providing CHI at the earliest point of need ; to provide access to the database via a dial-up network server and a toll-free telephone number ; and to work with targeted sites on database training, core CHI reference sources, and referral procedures. This paper provides background information about the project ; describes the major systems and technical issues encountered ; and discusses the outcomes, impact, and envisioned enhancements.

Beyond relevance--characteristics of key papers for clinicians: an exploratory study in an academic setting.

Abstract: OBJECTIVE: The purpose of this study was to determine what factors beyond relevance influence a clinician's decision to choose to read one journal article over another in satisfying an information need. DESIGN: Seventeen health care providers were interviewed and then surveyed regarding the characteristics of key articles (those they would not want to miss). On a Likert scale, the clinicians graded forty-two characteristics for importance in the decision process. Relevance was assumed and not at issue. SETTING: The study took place in an academic health science center. SUBJECTS: The subjects were seventeen clinicians, all with patient care responsibilities. There were four internists, four surgeons, three family practitioners, three pediatricians, two psychiatrists, and one clinical psychologist. RESULTS: Factors beyond relevance that most often influenced the decision process pertained to methodological rigor, authors and their institutional affiliations, document types, and population studied. CONCLUSIONS: Among the clinicians surveyed, factors beyond topicality influenced judgments as to what constitutes an important article. The emphasis respondents gave to certain attributes is echoed in other published work and highlights the need for more intensive investigation of these non-subject indicators as search parameters. Improved searching capabilities might well lead to a significant reduction in the clinician's information overload.

Where should the pharmacy researcher look first ? comparing International Pharmaceutical Abstracts and MEDLINE

Abstract: This study compared the usefulness of various CD-ROM versions of International Pharmaceutical Abstracts (IPA) and MEDLINE for pharmacy research. Journal coverage as well as the strengths and weaknesses of database structure and contents were considered. The journals indexed in each database were compared to those identified in a survey of the research journals most important to University of Maryland at Baltimore pharmacy faculty and in a similar North Carolina study rating pharmacy journals. In addition, indexed journals were checked against the Institute for Scientific Information's most recent list of high-impact journals in pharmacology and pharmacy. Searches representing a variety of topics relevant to pharmacy were conducted in both databases, and the number and relevance of citations located were analyzed. Results showed that IPA indexed a greater number of pharmacy titles, but that MEDLINE indexed more pharmacy journals designated in studies as significant to the field. There was little overlap in coverage between the two databases. MEDLINE produced larger retrievals for the majority of questions, but many citations retrieved in IPA did not appear in MEDLINE.

Library instruction in the medical school curriculum: a survey of medical college libraries.

Abstract: Future physicians must learn to cope with continuing changes in access to medical information. New instructional techniques, such as problem-based learning, emphasize the importance of research skills to medical students. To investigate the feasibility of establishing library instruction as a required part of the East Tennessee State University College of Medicine curriculum for undergraduates, the university's medical library surveyed 123 medical school libraries to determine the level of instruction offered by other academic medical libraries. The survey asked whether formal instruction was offered or required, and which courses were taught at each level of undergraduate training. Analysis of the fifty-five responses revealed that 75% offered formal library instruction, and that 49% of these respondents (36% of the total sample) required all students to take such courses. The courses offered most often were library tours, online catalog instruction, and MEDLINE-on-CD-ROM classes. Overall, thirty-three different course titles were offered by responding libraries. The majority of classes involved second- and third-year students. The survey responses reveal the prevalence of required library instruction in medical school curricula, and a broad-scale commitment to the development of lifelong learning skills among future health professionals.

The patients' library movement: an overview of early efforts in the United States to establish organized libraries for hospital patients.

Abstract: The patients' library movement in the United States, a dynamic, cohesive drive begun and sustained by librarians and physicians, strove to promote placement of organized libraries for patients in hospitals. It took shape in the early years of this century, evolving from its proponents' deeply held conviction that books and reading foster the rehabilitation of sick people. The American Library Association's World War I service to hospitalized military personnel dramatically reinforced the conviction; the post-World War I institution of public library extension services to general hospitals explicitly reflected it. Enormous energy was infused into the patients' library movement. Throughout the first half of this century, there were sustained efforts not only to establish organized libraries for hospitalized people but also to expand and systematically study bibliotherapy and to shape patients' librarianship as a professional specialty. The movement's achievements include the establishment of patients' library committees within national and international associations; impetus for development of academic programs to train patients' librarians; and publication, from 1944 through 1970, of successive sets of standards for hospital patients' libraries. The first of these remain the first standards written and issued by a professional library association for a hospital library.

Clinical extracts of biomedical literature for patient-centered problem solving.

Abstract: This paper reports on a four-part qualitative research project aimed at designing an online document surrogate tailored to the needs of physicians seeking biomedical literature for use in clinical problem solving. The clinical extract, designed in collaboration with three practicing physicians, combines traditional elements of the MEDLINE record (e.g., title, author, source, abstract) with new elements (e.g., table captions, text headings, case profiles) suggested by the physicians. Specifications for the prototype clinical extract were developed through a series of relevance-scoring exercises and semi-structured interviews. For six clinical questions, three physicians assessed the applicability of selected articles and their document surrogates, articulating relevance criteria and reasons for their judgments. A prototype clinical extract based on their suggestions was developed, tested, evaluated, and revised. The final version includes content and format aids to make the extract easy to use. The goals, methods, and outcomes of the research study are summarized, and a template of the final design is provided.

SPIRS, WinSPIRS, and OVID: a comparison of three MEDLINE-on-CD-ROM interfaces.

Abstract: Three MEDLINE-on-CD-ROM interfaces are compared: SPIRS (version 3.11) and WinSPIRS (version 1.0) from SilverPlatter and OVID (version 3.0, DOS and Windows interfaces) from CD Plus Technologies. Though the database is the same, there are substantial differences among the interfaces in the way these data are presented and can be searched. These different approaches are discussed, and a detailed comparative table is included. It is obvious that all three interfaces are quite good yet none of them is perfect; each has desirable and unfortunate features. Together, they offer an enormous range of possibilities. Users would benefit if most of the better features (e.g., easy menu, free-text retrieval, pre-exploded thesaurus terms) were implemented in future versions of these interfaces and if system operators were given greater latitude to determine the system defaults appropriate to their specific situations and customers.

Transforming the present--discovering the future: the University of Pittsburgh's NLM grant on education and training of health sciences librarians.

Abstract: BACKGROUND: The University of Pittsburgh was awarded a grant by the National Library of Medicine to study the education and training needs of present and future medical librarians and health information specialists through a collaboration of the university's School of Information Sciences and Health Sciences Library System. Goals and objectives for the year-long project included (1) assessment of education and training needs of medical librarians, (2) development of a master of library science curriculum and an internship program that would prepare graduates to take leadership roles in medical librarianship or information management, (3) development of continuing education programs for medical librarians in different formats, and (4) development of targeted recruitment efforts to attract minority group members and individuals with undergraduate science majors. The importance of this project, present practice, and success factors for programs seeking excellence in the preparation of health sciences information professionals are reviewed. A needs assessment involving a national advisory panel and a follow-up study of individuals who have participated in previous specialized training programs in health sciences information, compared with a peer group of medical librarians who did not participate in such programs, is described. This paper presents the goals and objectives of the project, describes the methods used, and outlines a curriculum, continuing education initiatives, and recruitment activities.

"Current topics in health sciences librarianship": a pilot program for network-based lifelong learning.

Abstract: The long-term objective of this project is to make health sciences librarians more effective in their role by using emerging technologies to deliver timely continuing education (CE) programs to them regardless of their physical location. The goals of the one-year planning project at the William H. Welch Medical Library are to plan, implement, and evaluate a pilot CE program that includes (1) a three-day general-interest session organized in four tracks: Market Forces and Management, Information Technology and the Internet, Publishing and Copyright, and Education; (2) a one-day special topic session on the Informatics of the Human Genome Project; and (3) an electronic poster session in parallel with the general-interest session. The program will be offered in three simultaneous formats: (1) on-site, in a distance-learning classroom in Baltimore; (2) as a telecourse, in a similar classroom outside Washington, DC; and (3) online, via the World Wide Web. An electronic proceedings of the entire program will be published on the Web to serve as a continuously available CE resource for health sciences librarians. This paper gives an overview of the planning process, presents a status report on the programmatic and technical implementation of the pilot project at its midpoint, and discusses future directions for the program.

Medical problem attributes and information-seeking questions.

Abstract: This study was designed to explore the relationship between certain attributes of a diagnostic problem and a particular information-seeking question. Using case vignettes under experimental conditions, fifty residents in internal medicine and family practice informed the experimenter of the most important thing they would need to know to make a preliminary diagnosis. These data were classified nominally using a preexisting taxonomy. Significant results indicated that Quantification questions tend to be asked under urgent conditions and Verification questions tend to be asked when the least amount of information is presented. While the taxonomy used to classify the questions did not prove rich enough to describe information needs fully, results did suggest some consistency in question asking, a skill that could be developed further during medical education.

History of the Medical Library Association's credentialing program.

Abstract: Since the Medical Library Association (MLA) adopted the Code for the Training and Certification of Medical Librarians in 1949, MLA members have reviewed and revised the program regularly. This paper traces the history of MLA's professional recognition program to illustrate how the program has changed over time and to identify the issues that have surrounded it. These issues include the value of the program to individual members, cost to MLA, appropriate entry requirements, certification examinations, and recertification requirements. The development and operation of MLA's current credentialing program, the Academy of Health Information Professionals, is described in detail.

A journal use study: checkouts and in-house use.

Abstract: Journal use studies provide meaningful data to consider in shaping a library's journal collection. The University of California at Los Angeles (UCLA) Louise M. Darling Biomedical Library undertook such a study of 2,552 print subscription titles over one year, gathering data on circulation, in-house use, and interlibrary loan (ILL) use. Objectives focused on gathering practical data to support cancellation decisions and to determine whether reliable relationships of in-house to checkout use would emerge, upon which to base future decisions. Data were analyzed for all titles, for titles grouped by publication frequency, and for titles grouped by ten major subject headings. Results, to be interpreted within the limitations of this study and of use studies in general, showed in-house use to be higher than checkouts across all subjects and all publication frequencies-but in ratios too complex to be reduced to a single regression line. All use increases with increases in titles' frequency of publication. Even titles with few or no checkouts show some in-house use. Patterns of serial use differ among general subject disciplines.

Promotion of health information access via Grateful Med and Loansome Doc: why isn't it working?

Abstract: Information gathered from Grateful Med and Loansome Doc outreach projects, including one involving seven health centers in rural southwest Alabama, raises questions about the effectiveness of such programs. This paper presents a review of the literature on Grateful Med as well as of information access and usage behaviors of physicians, an overview of the Alabama project, and data from other projects. Analysis of the responses and observations of the researchers reveal some strategies for enhancing the outcomes of such projects and improving access to medical care literature by health care professionals at rural sites.