Showing papers in "Bulletin of The Medical Library Association in 2000"

Medical Subject Headings (MeSH)

Abstract: In 1960, medical librarianship was on the cusp of a revolution. The first issue of the new Index Medicus series was published. On the horizon was a computerization project undertaken by the National Library of Medicine (NLM) to store and retrieve information. The Medical Literature Analysis and Retrieval System (MEDLARS) would speed the publication process for bibliographies such as Index Medicus, facilitate the expansion of coverage of the literature, and permit searches for individuals upon demand [1]. A new list of subject headings introduced in 1960 was the underpinning of the analysis and retrieval operation. This year marks the fortieth anniversary of the initial publication of Medical Subject Headings (MeSH) [2]. MeSH was a new and thoroughly revised version of lists of subject headings compiled by NLM for its bibliographies and cataloging [3]. Frank B. Rogers, NLM director, announced several innovations as he introduced MeSH in 1960. The adoption of a single subject authority list for both books and periodical articles is a departure from traditional practice. We take the view that subject cataloging and periodical indexing, as exemplified in the Index Medicus and in the NLM Catalog, are identical processes in their major dimensions. A single list can and should be used for both purposes. This has two major virtues: simplicity for users, in requiring familiarity with only a single scheme; and economy to the Library in the development and maintenance of a single scheme …. There is another departure from traditional practice represented in this list. This is the adoption of standard topical subheadings for cataloging books, as well as for indexing periodical articles …. The topical subheading is in effect a substitute for a phrase heading, and on the whole it is a preferable substitute …. The main heading-topical subheading combination is a pre-coordination of terms, reducing the problem of term permutation, which looms large in most manual retrieval systems in book form. [4] Three years later, the second edition of MeSH was distributed as part of the 1963 Index Medicus. Winifred Sewell described the changes made in anticipation of the introduction of MEDLARS to accommodate its use for both machine searching and publication. Though the number of subject headings in the second edition was a third greater than the number in the first edition, we followed the basic principles of assigning subject headings in medicine as set forth in the first edition. We are convinced of the value of using an identical authority list for the indexing of periodicals and the cataloging of books, and we regard subject headings as directional signals or vectors which, with other headings, serve to locate the essence of a particular paper or book in the universe of medical information. Rarely will a single subject heading encompass the total content of a citation. The advent of MEDLARS added two criteria to those used for earlier medical subject heading lists. By providing for much greater coverage and deeper indexing, it thus increased the need for specificity in descriptors. In addition it became possible not only to search for a single heading, … but also to include, in the search for that concept, all the specific terms that are comprehended in the meaning of the larger term …. This capability necessitated a delineation of all hierarchical relationships in the system. [5] Several major changes were made in response to these criteria. First, the terms in the list were sorted into broad categories, and categorized lists of terms were published to enable the user to find related terms. For headings that had attracted a large number of citations, more specific terms and precoordinated headings were introduced. The use of subheadings was discontinued, based on its effect on the printed Index Medicus (a decision that would later be reversed) [6, 7]. From its beginning, MeSH was intended to be a dynamic list, with procedures for recommending and examining the need for new headings [8–11]. The content of the vocabulary related to the usage of terms in the literature itself and evolved to meet new concepts in the field [12]. The use of the computer made revisions more practical and systematic, despite the difficulty in updating printed indexes and card catalogs. Forces today are pushing MeSH toward a new approach to organizing medical knowledge and information [13]. The non-mediated search requires simplification of MeSH by such means as eliminating most qualifiers and expanding entry terms and synonyms from natural language that map to subject headings. Translations of MeSH into other languages will also be linked to enable more efficient access for non-English speakers. An explosion of material, in all formats, to be organized has resulted from the Internet. This and the integration of other databases into MEDLINE increase the need to expand the coverage of MeSH and make it more universally approachable. The maintenance environment of MeSH will be the same as that of the Unified Medical Language System (UMLS) Metathesaurus to facilitate the import and export of terms. MeSH is evolving toward a concept-based system, rather than a term-based one. In this structure, the descriptor class, or set of related concepts, will include additional information about attributes of concepts and their relationship [14]. MeSH was a pioneering effort as a controlled vocabulary that was applied to early library computerization. Its impact on the organization and retrieval of health information has been enormous. In a broader sense, its alphabetical and hierarchical structures have been recognized as models for other thesauri [15, 16]. Even with advances in automation and resulting changes in the capabilities of indexing and searching, an important role remains for MeSH in organizing information in a way that provides precision and power in retrieval.

Evidence-based librarianship: an overview

Abstract: Objective: To demonstrate how the core characteristics of both evidencebased medicine (EBM) and evidence-based health care (EBHC) can be adapted to health sciences librarianship. Method: Narrative review essay involving development of a conceptual framework. The author describes the central features of EBM and EBHC. Following each description of a central feature, the author then suggests ways that this feature applies to health sciences librarianship. Results: First, the decision-making processes of EBM and EBHC are compatible with health sciences librarianship. Second, the EBM and EBHC values of favoring rigorously produced scientific evidence in decision making are congruent with the core values of librarianship. Third, the hierarchical levels of evidence can be applied to librarianship with some modifications. Library researchers currently favor descriptive-survey and case-study methods over systematic reviews, randomized controlled trials, or other higher levels of evidence. The library literature nevertheless contains diverse examples of randomized controlled trials, controlled-comparison studies, and cohort studies conducted by health sciences librarians. Conclusions: Health sciences librarians are confronted with making many practical decisions. Evidence-based librarianship offers a decisionmaking framework, which integrates the best available research evidence. By employing this framework and the higher levels of research evidence it promotes, health sciences librarians can lay the foundation for more collaborative and scientific endeavors.

MEDLINEplus: building and maintaining the National Library of Medicine's consumer health Web service

Abstract: MEDLINEplus is a Web-based consumer health information resource, made available by the National Library of Medicine (NLM). MEDLINEplus has been designed to provide consumers with a well-organized, selective Web site facilitating access to reliable full-text health information. In addition to full-text resources, MEDLINEplus directs consumers to dictionaries, organizations, directories, libraries, and clearinghouses for answers to health questions. For each health topic, MEDLINEplus includes a preformulated MEDLINE search created by librarians. The site has been designed to match consumer language to medical terminology. NLM has used advances in database and Web technologies to build and maintain MEDLINEplus, allowing health sciences librarians to contribute remotely to the resource. This article describes the development and implementation of MEDLINEplus, its supporting technology, and plans for future development.

Information needs of rural health professionals: a review of the literature.

Abstract: This review analyzes the existing research on the information needs of rural health professionals and relates it to the broader information-needs literature to establish whether the information needs of rural health professionals differ from those of other health professionals. The analysis of these studies indicates that rural health practitioners appear to have the same basic needs for patient-care information as their urban counterparts, and that both groups rely on colleagues and personal libraries as their main sources of information. Rural practitioners, however, tend to make less use of journals and online databases and ask fewer clinical questions; a difference that correlates with geographic and demographic factors. Rural practitioners experience pronounced barriers to information access including lack of time, isolation, inadequate library access, lack of equipment, lack of skills, costs, and inadequate Internet infrastructure. Outreach efforts to this group of underserved health professionals must be sustained to achieve equity in information access and to change information-seeking behaviors.

Public library consumer health information pilot project: results of a National Library of Medicine evaluation

Abstract: In October 1998, the National Library of Medicine (NLM) launched a pilot project to learn about the role of public libraries in providing health information to the public and to generate information that would assist NLM and the National Network of Libraries of Medicine (NN/LM) in learning how best to work with public libraries in the future. Three regional medical libraries (RMLs), eight resource libraries, and forty-one public libraries or library systems from nine states and the District of Columbia were selected for participation. The pilot project included an evaluation component that was carried out in parallel with project implementation. The evaluation ran through September 1999. The results of the evaluation indicated that participating public librarians were enthusiastic about the training and information materials provided as part of the project and that many public libraries used the materials and conducted their own outreach to local communities and groups. Most libraries applied the modest funds to purchase additional Internet-accessible computers and/or upgrade their health-reference materials. However, few of the participating public libraries had health information centers (although health information was perceived as a top-ten or top-five topic of interest to patrons). Also, the project generated only minimal usage of NLM's consumer health database, known as MEDLINEplus, from the premises of the monitored libraries (patron usage from home or office locations was not tracked). The evaluation results suggested a balanced follow-up by NLM and the NN/LM, with a few carefully selected national activities, complemented by a package of targeted activities that, as of January 2000, are being planned, developed, or implemented. The results also highlighted the importance of building an evaluation component into projects like this one from the outset, to assure that objectives were met and that evaluative information was available on a timely basis, as was the case here.

Focus Groups for Libraries and Librarians.

Abstract: The focus group interview is a research method used to elicit qualitative data in order to understand people's ideas, feelings, perceptions, and beliefs. A moderator—leading a small group of six to ten people who share common experiences, characteristics, or knowledge—uses a carefully prepared script to ask open-ended questions. The questions and focus group method are designed to draw out the participants' thoughts through the interaction and free expression of ideas, rather than forcing those participants to respond to the researcher's way of thinking. Focus groups were first used by marketing organizations as a way of gathering opinions from consumers about products and services. Social scientists discovered the usefulness of the method during the 1960s, and today focus group interviews have become a recognized part of research projects, especially in the health care field. The technique is used to understand attitudes and behaviors regarding a wide variety of health-related issues, especially in the development of successful patient health education programs and interventions. By understanding the perceptions, beliefs, and motivations of patients, educators can tailor programs to meet the needs of the clients as well as improve the success rates of interventions. Because focus groups have proven successful in evaluating services, their use has become an important research tool for librarians. While usage has been predominantly in college and academic libraries, the technique has also been used in school, state, public, and special (law, medical, and corporate) libraries. Investigated topics include assessment of collections, continuing education needs of staff, effects of organizational change on staff, patterns of Internet use by patrons, strategic planning, patron evaluation of library services, information-seeking behavior of patrons, reactions of patrons to new services, and evaluation of instructional programs. Librarians themselves have been the subjects of focus groups organized by publishers and vendors seeking to understand the library market and need for new products. Glitz highlights the strengths and weaknesses of this research method for the library setting. Benefits include a simple and flexible methodology, low cost, ability to use in-house staff, and easily understood results; disadvantages may lie in the reliability of the participants' perceptions, personality conflicts, controlling or inept moderators, and small sample sizes in the groups. Selection criteria for choosing a professional or layperson moderator are nicely detailed, as are necessary qualifications, skills, and characteristics. The planning and implementation of a focus group—including identification of the problem or question to be researched, formulation of questions, selection of moderator and participants, and final analysis of data—are nicely covered. The importance of developing appropriate, open-ended questions to encourage discussion is emphasized through examples of phrasing, terminology, and effective (versus ineffective) questions. Concrete tips for moderators on setting room ambiance, building rapport, encouraging discussion, focusing the discussion, and closing the group are excellent. The final steps of analyzing, reporting, and using the results through debriefing, transcribing tapes or notes, categorizing the garnered information, and reviewing and analyzing the categories for interpretation are delineated. Case studies of two focus group projects, one at an academic library and the other at a small hospital library, illustrate the concepts presented in previous chapters. Focus groups hold great potential for all librarians interested in evaluating their facilities' services and resources. While more complete information on the process can be found in The Focus Group Kit (Sage Publications, 1998), Glitz provides an excellent basic user's manual specifically for librarians.

A library-based bioinformatics services program

Abstract: Support for molecular biology researchers has been limited to traditional library resources and services in most academic health sciences libraries. The University of Washington Health Sciences Libraries have been providing specialized services to this user community since 1995. The library recruited a Ph.D. biologist to assess the molecular biological information needs of researchers and design strategies to enhance library resources and services. A survey of laboratory research groups identified areas of greatest need and led to the development of a three-pronged program: consultation, education, and resource development. Outcomes of this program include bioinformatics consultation services, library-based and graduate level courses, networking of sequence analysis tools, and a biological research Web site. Bioinformatics clients are drawn from diverse departments and include clinical researchers in need of tools that are not readily available outside of basic sciences laboratories. Evaluation and usage statistics indicate that researchers, regardless of departmental affiliation or position, require support to access molecular biology and genetics resources. Centralizing such services in the library is a natural synergy of interests and enhances the provision of traditional library resources. Successful implementation of a library-based bioinformatics program requires both subject-specific and library and information technology expertise.

Clarifying the abstracts of systematic literature reviews

Abstract: Background: There is a small body of research on improving the clarity of abstracts in general that is relevant to improving the clarity of abstracts of systematic reviews. Objectives: To summarize this earlier research and indicate its implications for writing the abstracts of systematic reviews. Method: Literature review with commentary on three main features affecting the clarity of abstracts: their language, structure, and typographical presentation. Conclusions: The abstracts of systematic reviews should be easier to read than the abstracts of medical research articles, as they are targeted at a wider audience. The aims, methods, results, and conclusions of systematic reviews need to be presented in a consistent way to help search and retrieval. The typographic detailing of the abstracts (type-sizes, spacing, and weights) should be planned to help, rather than confuse, the reader.

AIDS in Haiti: a bibliometric analysis.

Abstract: Objectives: In Haiti, AIDS has become the leading cause of death in sexually active adults. Increasingly, AIDS has become a disease of women and children. Previous bibliometric studies have shown the emergence of Haiti as a leading country in the production of AIDS literature in the Latin American and Caribbean regions. No information exists, however, regarding the type of publications produced, the collaboration patterns used, or the subject content analysis of this production. The purpose of this study was to gain insight into the construction of this literature production. Methods: A bibliometric analysis regarding Haitian AIDS research was conducted in the AIDSLINE database for the period 1980 to 1998. An attempt was made to identify the patterns of the growth in AIDS literature, as well as the types of documents published, authorship, institutional affiliations of authors, and subject content. Results: Results indicated that most documents were published in periodicals. The International Conference on AIDS obtained the highest frequency. The United States, Haiti, and Canada were the main productive countries. Conclusions: While nearly 40% of the records corresponded to ethnology-related articles, HIV infections, sex behavior, pregnancy, and substance-related disorders headed the Medical Subject Headings (MeSH) found. Main aspects of AIDS papers focused on epidemiology, complications, and trends issues.

Structuring the pre-search reference interview: a useful technique for handling clinical questions.

Abstract: Objectives: To explore whether structuring a literature search request form according to an evidence-based medicine (EBM) anatomy elicits more information, improves precision of search results, and is acceptable to participating librarians. Methods: Multicenter before-and-after study involved six different libraries. Data from 195 minimally structured forms collected over four months (Phase 1) were compared with data from 185 EBM-structured forms collected over a further four-month period following a brief training intervention (Phase 2). Survey of librarians' attitudes toward using the EBM-structured forms was conducted early during Phase 2. Results: 380 request forms, EBM-structured and minimally structured, were analyzed using SPSS. A statistically significant Pearson correlation was found between use of the EBM-structured form and complexity of the search strategy (P = 0.002). The correlation between clinical requests handled by the EBM-structured form and fewer items retrieved was also statistically significant (P = 0.028). However, librarians rated minimally structured forms more highly than EBM-structured forms against all dimensions except informativeness. Conclusions: Although use of the EBM-structured forms is associated with more precise searches and more detailed search strategies, considerable work remains on making these forms acceptable to both librarians and users. Nevertheless, with increased familiarity and improved training, information retrieval benefits could be translated into more effective search practice.

Web-based Distance Continuing Education: A New Way of Thinking for Students and Instructors

Abstract: As people have more difficulty taking time away from work to attend conferences and workshops, the idea of offering courses via the Web has become more desirable. Addressing a need voiced by Medical Library Association membership, the authors developed a Web-based continuing-education course on the subject of the librarian's role in evidence-based medicine. The aim of the course was to provide medical librarians with a well-constructed, content-rich learning experience available to them at their convenience via the Web. This paper includes a discussion of the considerations that need to be taken into account when developing Web-based courses, the issues that arise when the information delivery changes from face-to-face to online, the changing role of the instructor, and the pros and cons of offering Web-based versus traditional courses. The results of the beta test and future plans for the course are also discussed.

A two-year experience teaching computer literacy to first-year medical students using skill-based cohorts.

Abstract: Because it is widely accepted that providing information online will play a major role in both the teaching and practice of medicine in the near future, a short formal course of instruction in computer skills was proposed for the incoming class of students entering medical school at the State University of New York at Stony Brook. The syllabus was developed on the basis of a set of expected outcomes, which was accepted by the dean of medicine and the curriculum committee for classes beginning in the fall of 1997. Prior to their arrival, students were asked to complete a self-assessment survey designed to elucidate their initial skill base; the returned surveys showed students to have computer skills ranging from complete novice to that of a systems engineer. The classes were taught during the first three weeks of the semester to groups of students separated on the basis of their knowledge of and comfort with computers. Areas covered included computer basics, e-mail management, MEDLINE, and Internet search tools. Each student received seven hours of hands-on training followed by a test. The syllabus and emphasis of the classes were tailored to the initial skill base but the final test was given at the same level to all students. Student participation, test scores, and course evaluations indicated that this noncredit program was successful in achieving an acceptable level of comfort in using a computer for almost all of the student body.

Providing health information to the general public: a survey of current practices in academic health sciences libraries.

Abstract: A questionnaire was mailed to 148 publicly and privately supported academic health sciences libraries affiliated with Association of American Medical Colleges (AAMC)–accredited medical schools in the United States and Canada to determine level of access and services provided to the general public For purposes of this study, “general public” was defined as nonaffiliated students or health care professionals, attorneys and other nonhealth-related professionals, patients from affiliated or other hospitals or clinics, and general consumers One hundred five (71%) libraries responded Results showed 98% of publicly supported libraries and 88% of privately supported libraries provided access to some or all of the general public Publicly supported libraries saw greater numbers of public patrons, often provided more services, and were more likely to circulate materials from their collections than were privately supported libraries A significant number of academic health sciences libraries housed a collection of consumer-oriented materials and many provided some level of document delivery service, usually for a fee Most allowed the public to use some or all library computers Results of this study indicated that academic health sciences libraries played a significant role in serving the information-seeking public and suggested a need to develop written policies or guidelines covering the services that will be provided to minimize the impact of this service on primary clientele

Mapping the literature of cytotechnology

Abstract: The major purpose of this study was to identify and assess indexing coverage of core journals in cytotechnology. It was part of a larger project sponsored by the Nursing and Allied Health Resources Section of the Medical Library Association to map the literature of allied health. Three representative journals in cytotechnology were selected and subjected to citation analysis to determine what journals, other publication types, and years were cited and how often. Bradford's Law of Scattering was applied to the resulting list of cited journals to identify core titles in the discipline, and five indexes were searched to assess coverage of these core titles. Results indicated that the cytotechnology journal literature had a small core but wide dispersion: one third of the 21,021 journal citations appeared in only 3 titles; another third appeared in an additional 26 titles; the remaining third were scattered in 1,069 different titles. Science Citation Index Expanded rated highest in indexing coverage of the core titles, followed by MEDLINE, EMBASE/Excerpta Medica, HealthSTAR, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The study's results also showed that journals were the predominantly cited format and that citing authors relied strongly on more recent literature.

Informationists and librarians.

Abstract: Perhaps it's an omen. While in Vancouver for MLA/CHLA/ABSC 2000, Carolyn Lipscomb and I talked about possible themes for her history column in this issue of the Bulletin of the Medical Library Association. We settled on clinical medical librarianship (CML), a topic that has been the subject of numerous papers over the last thirty years and would, therefore, provide a suitable subject for the column. We had no idea that Frank Davidoff and Valerie Florance were putting the finishing touches to an editorial for the Annals of Internal Medicine that will almost certainly bring discussions of clinical librarianship to a new level of intensity [1]. You need to read it. Librarians will quibble over the term “informationist.” It has an awkward and contrived sound, but as a rhetorical device, designed to get our attention, it certainly does the trick. Some have been quick to reply that what Davidoff and Florance describe is what librarians already do; we do not need another bit of jargon to make it glitzy. The fact is, the work they are describing is not what librarians already do. It should be. The singular addition that Davidoff and Florance make to the development of clinical librarianship is to insist on more specialized clinical training than health sciences librarians typically have, even those who participate in clinical librarian programs. Shortly after the editorial appeared, Patricia Fortin, who works as a clinical librarian in Canada, made this comment on MEDLIB-L; although I could do summaries of the literature for some of the questions I receive and/or identify, I would not feel entirely comfortable doing this without more of a clinical background, statistical knowledge, and/or very well-honed critical appraisal skills. This is because what I write could greatly impact patient care. [2] This is the crux of the matter. Clinical librarianship programs have attempted to extend the helping role of the librarian to the patient's bedside, but they have not essentially altered that role. The librarian's sphere remains that of understanding the question, searching the literature, providing targeted information—clinical judgments are left to the physicians. Perhaps this is as it should be. But Davidoff and Florance think something more is necessary. They are suggesting that the relationship between the information-management expert and the other members of the health care team needs a significant shift. They point out that CML programs “have remained largely outside the mainstream of clinical practice.” They argue that now is the time to move them into the mainstream. What is required to do this? Davidoff and Florance advance two primary causes for the failure of clinical librarianship to “take root and flourish.” Money is always a problem, of course. Clinical librarianship programs have always been viewed as ancillary, as extras, as things to be done if we can find the funding—not as critical services that should be funded first. Davidoff and Florance also point to the “physician's ambivalence about needing help,” and they argue that “it's time to face up to the fact that physicians can't, and shouldn't, try to do all or even most medical information retrieval themselves.” Perhaps there is another reason—an ambivalence on the part of librarians to take on the outlined role. I am reminded of the controversy that still accompanies the notion of quality filtering. While many of our colleagues have adopted and adapted quality filtering as an integral part of the work that they do, many others are repelled by the notion, believing that to make the sorts of required judgments takes one beyond the boundaries of good librarianship. I imagine that the notion of taking an even more active filtering role would be that much more appalling to those who take this view. Perhaps they will agree that whatever these informationists are, they should not be called librarians. But librarians are exactly what they are. Librarians playing a role that very few of us have played so far, to be sure, but fundamentally, librarians doing the core work that librarians have always done: making sure that people have the information they need, where they need it, when they need it, and in the format in which they find it most useful. Twelve issues ago, in the October 1997 issue of the Bulletin, Nunzia Giuse prefigured Davidoff and Florance, arguing in an editorial that the future of medical librarianship lay in moving into the clinical realm [3]. She identified the lack of adequate preparation for librarians as the most important element limiting the success of CML programs. She identified a number of specific things that should be done. Librarians should “assimilate the culture,” “seek instruction in the techniques of clinical trials,” “study … evidence-based medicine,” and receive “mentored instruction and practice in searching, retrieving, filtering, and summarizing information.” These elements, and the others mentioned in her editorial are, indeed, absolutely critical. But in the end, Giuse's better-prepared (and more successful) clinical librarian is still a library-based librarian. The program is developed in the library; the training is managed through the library; the funding is provided by the library. Davidoff and Florance take the concept a very substantial step further. In their view, the informationist takes part in a nationally recognized standard curriculum, has appropriate training and accreditation, and will “answer directly to clinical directors and chiefs of staff, and their services [will] be paid for directly, as is done for other health care providers.” This model is clinic driven, not library driven. Nine months after her editorial appeared, Giuse and her colleagues published an article describing the Vanderbilt CML program [4]. In comparing it with the informationist piece, I am struck by the fact that it lists “caseworkers, nutritionists[, and] pharmacists” as models for the role that clinical librarians can play, while Davidoff and Florance point out that physicians do not “perform their own clinical chemistries, electrocardiography, computed tomography and the like.” The former models are still one step removed from the patient, providing services that support the caregivers. The latter models are hands-on. This difference may just be a coincidence, an accident in the writing of the two pieces, but it does serve to emphasize that the informationist described by Davidoff and Florance is not a librarian with additional training in or exposure to clinical situations. This informationist is a true hybrid—still a librarian, but one steeped in the clinic in a substantially new way. There is something else that strikes me when I look at the literature. Almost all of the articles that have been written about clinical librarianship over the years stress that good clinical librarian programs are essential for the survival and growth of librarianship. Davidoff and Florance's piece is not concerned with the survival of our profession. It is concerned with the survival of patients. I do not know if the development of informationists is good or bad for our profession; but as a librarian, I know that doing something that will enable clinicians to make better judgments based on better use of published information is definitely going to be good for patients. And when I get to the heart of it, I seem to recall that is why I became a medical librarian. What should our association be doing about this? We should be right out in front in responding to Davidoff and Florance's challenge. They call for the development of a “national program, modeled on the experience of clinical librarianship, to train, credential, and pay for the services of information specialists.” Clearly, we need to play a central role in this development. Obvious partners include the Association of American Medical Colleges, the American Hospital Association, the library schools, and the National Library of Medicine. The Medical Library Association has an opportunity to take the lead in reaching out to potential partners to begin the discussions and the planning that are necessary to see what sort of beneficial reality can be made out of the informationist concept. Three years have passed since Giuse sounded the call in these pages that to avoid moving into the clinical realm “is to deny our future in the information age.” Davidoff and Florance have now issued a challenge to “everyone involved in health care.” We should not let one more year go by before we respond to that challenge.

Providing consumer health information in the rural setting: Planetree Health Resource Center's approach.

Abstract: Both lifestyle and geography make the delivery of consumer health information in the rural setting unique The Planetree Health Resource Center in The Dalles, Oregon, has served the public in a rural setting for the past eight years It is a community-based consumer health library, affiliated with a small rural hospital, Mid-Columbia Medical Center One task of providing consumer health information in rural environments is to be in relationship with individuals in the community Integration into community life is very important for credibility and sustainability The resource center takes a proactive approach and employs several different outreach efforts to deepen its relationship with community members It also works hard to foster partnerships for improved health information delivery with other community organizations, including area schools This paper describes Planetree Health Resource Center's approach to rural outreach

Enabling, empowering, inspiring: research and mentorship through the years.

Abstract: The interrelationship between research and mentorship in an association such as the Medical Library Association (MLA) is revealed through the contributions of individuals and significant association activities in support of research. Research is vital to the well-being and ultimate survival of health sciences librarianship and is not an ivory tower academic activity. Mentorship plays a critical role in setting a standard and model for those individuals who want to be involved in research and, ultimately, for the preparation of the next generation of health sciences librarians. Research and mentorship are discussed in the context of personal experiences, scholarship, and problem solving in a practice environment. Through research and mentorship, we are enabled to enhance our services and programs, empowered to look beyond our own operations for information puzzles to be solved, and inspired to serve society by improving health.

Health care, information needs, and outreach: Reaching Ohio's rural citizens

Abstract: As a rural state, Ohio has a vital interest in addressing rural health and information needs. NetWellness is a Web-based consumer health information service that focuses on the needs of the residents of Ohio. Health sciences faculty from the state's three Carnegie Research I universities—University of Cincinnati, Case Western Reserve University, and The Ohio State University—create and evaluate content and provide Ask an Expert service to all visitors. Through partnerships at the state and local levels, involving public, private, commercial, and noncommercial organizations, NetWellness has grown from a regional demonstration project in 1995 to a key statewide service. Collaboration with public libraries, complemented by alliances with kindergarten through twelfth grade agencies, makes NetWellness Ohio's essential health information resource.

Stop Talking Start Doing! Attracting People of Color to the Library Profession.

Abstract: Library administrators, human resources personnel, and librarians serious about diversifying their library's professional workforce should read this book. Stop Talking Start Doing! is a practical guide to finding, nurturing, and retaining a diversified workforce for all libraries. The library and information science professions must position themselves for the changing demographics occurring in our society. The populations served by our nation's libraries have enlarged and expanded, and this change must be addressed in staffing needs. In chapter one, “The Browning of America,” Reese and Hawkins use statistics to show that in the year 2000, minorities will make up approximately one-third of the United States population. This number will steadily increase during the twenty-first century. However, minorities—including African Americans, Hispanics, Asians, and Native American—currently make up only 10% of new library school graduates and less than 12% of the total number of librarians working in academic, public, and health sciences libraries. This book demonstrates the importance of having a racially and ethnically diverse workforce in the library profession, and it recommends strategies for recruitment. The authors note, “We must develop a strategic plan of recruitment with objectives and activities that will include marketing the profession in such a manner that it piques the interests of our minority population, beginning with our minority youth population (junior and senior high school students) through undergraduate and graduate level students” (p. 42). One of the marketing techniques discussed in the book is the use of ethnic minority library professionals to promote career opportunities available in the library and information science profession through advertising campaigns, video presentations, and career fairs. Schools of library and information science must realize how critical it is to adopt a comprehensive program to recruit, fund, and train underrepresented racial and ethnic groups in their programs. This book contains information from the 1997 Association for Library and Information Science Education Statistical Report that represents in chart format the need for more participation by ethnic minorities as students and as faculty members. The American Library Association, through its affiliated ethnic caucuses, has made significant contributions concerning issues involving ethnic minority participation in the library and information science profession. Other professional library organizations, including the Medical Library Association, should also be encouraged to undertake an effort to attract ethnic minorities to the profession. Formal mentoring initiatives, such as the one offered to Clark Atlanta University School of Library and Information Studies students through the Special Libraries Association (SLA) Georgia Chapter Mentor Program, provide an excellent means of support for individual minority students. This program offers students opportunities for enhancement, enrichment, and encouragement by forming partnerships with members of the Georgia Chapter of SLA. This reviewer currently participates in this program and finds it both satisfying and rewarding. Reese and Hawkins give examples of electronic mentoring programs already in progress. Stop Talking Start Doing! uses a combination of personal experiences, interviews, commentary, suggested strategies, and statistics to encourage readers to become a part of the solution to the problem of a lack of minorities in the library profession. The book makes for enjoyable reading and will serve as a resource for those individuals interested in creating a diverse workplace. It is recommended for library directors, library school deans, and personnel recruiters to help them understand the crucial role they can play in attracting people of color to the library and information science professions. To further emphasize the importance of diversity awareness for library administrators, the Journal of Library Administration has devoted an entire issue to the theme, “Managing Multiculturalism and Diversity in the Library: Principles and Issues for Administrators,” edited by Mark Winston [1]. The manner in which the profession embarks upon this challenge should be of significant importance to all library professionals across the nation.

The rise and fall of the medical mediated searcher

Abstract: The relationship between the development of mediated online literature searching and the recruitment of medical librarians to fill positions as online searchers was investigated. The history of database searching by medical librarians was outlined and a content analysis of thirty-five years of job advertisements in MLA News from 1961 through 1996 was summarized. Advertisements for online searchers were examined to test the hypothesis that the growth of mediated online searching was reflected in the recruitment of librarians to fill positions as mediated online searchers in medical libraries. The advent of end-user searching was also traced to determine how this trend affected the demand for mediated online searching and job availability of online searchers. Job advertisements were analyzed to determine what skills were in demand as end-user searching replaced mediated online searching as the norm in medical libraries. Finally, the trend away from mediated online searching to support of other library services was placed in the context of new roles for medical librarians.

Monograph use at an academic health sciences library: the first three years of shelf life.

Abstract: Objective: To study the circulation of monographs during the first three years of shelf life at an academic health sciences library. Method: A record was kept of monographs added to the circulating collection from mid-1994 to mid-1995. After three years, each monograph was located and the number of times it circulated during the first, second, and third year of shelf life determined by counting checkout stamps on the circulation slip. Results: Of the 1,958 monographs studied, 1,674 had complete data for the first three years of shelf life. Of those 1,674 titles, 81.48% circulated at least once. A total of 7,659 circulations were recorded; 38.69% occurred in the first year of shelf life, 32.37% in the second year, and 28.95% in the third year. The data did not fit the well-known 80/20 rule. Instead, approximately 38% of monographs accounted for 80% of circulation. A small percentage, 2.21%, of monographs accounted for a substantial percentage of circulation, 21.84%. Conclusions: A large percentage of the monographs circulated and use did not decline sharply with age within the first three years of shelf life, indicating a high demand for monographs at this academic health sciences library. These results, combined with the findings of earlier studies, suggested two possibilities. First, academic health sciences libraries might exhibit use of a higher percentage of monograph acquisitions than other types of libraries; or, second, a low monograph-to-user ratio might result in a higher percentage of monographs being used. Perhaps both factors contributed to the results found in this study. Further investigation would be needed to determine the extent to which library type and monograph-to-user ratio influenced monograph use.

Development of a Web-based faculty publications database.

Abstract: Founded in 1961, the University of Connecticut Health Center (UCHC) has been committed to exemplary teaching, patient care, and research. The Lyman Maynard Stowe Library is an integral part of UCHC, supporting the medical and dental education programs, clinical treatment programs, various graduate programs, and faculty research efforts. Each year, information services librarians collect UCHC faculty publication citation information for the office of assistant vice chancellor for research for statistical purposes. UCHC librarians capitalized upon the opportunity to use the journal publication data to provide a value-added service to the UCHC academic community. In 1999, these citations were combined with faculty information and formulated into the Web-based Faculty Publications Database.* This database currently contains journal publication citations of full-time faculty from 1996 to 1998 along with brief summaries of faculty members' professional information. Objectives in developing the Web-based Faculty Publications Database were to enhance communication between UCHC faculty, students, and the medical community by increasing awareness of faculty research; providing aid to students seeking a preceptor in their area of interest; increasing ease of access to faculty research for faculty, students, and other library users; and promoting UCHC research throughout the larger medical research community.

Expediting the transfer of evidence into practice: building clinical partnerships.

Abstract: A librarian/clinician partnership was fostered in one hospital through the formation of the Evidence-based Practice Committee, with an ulterior goal of facilitating the transfer of evidence into practice. The paper will describe barriers to evidence-based practice and outline the committee's strategies for overcoming these barriers, including the development and promotion of a Web-based guide to evidence-based practice specifically designed for clinicians (health professionals). Educational strategies for use of the Web-based guide will also be addressed. Advantages of this partnership are that the skills of librarians in meeting the needs of clinicians are maximized. The evidence-based practice skills of clinicians are honed and librarians make a valuable contribution to the knowledgebase of the clinical staff. The knowledge acquired through the partnership by both clinicians and librarians will increase the sophistication of the dialogue between the two groups and in turn will expedite the transfer of evidence into practice.

Applications of informatics in veterinary medicine.

Abstract: This study used the peer-reviewed biomedical literature to define the veterinary informatics knowledgebase and associated subspecialties, and assesses the level of activity in the field over the thirty-year period from 1966 through 1995. Grateful Med was used to search the MEDLINE bibliographic database for articles that shared one or more Medical Subject Headings (MeSH) keywords from the veterinary and medical informatics subject headings. Each of ninety-five MeSH medical informatics terms was assigned to one of twelve veterinary informatics subspecialties. The number of articles retrieved by each MeSH keyword and subspecialty was calculated. A total of 611 articles were retrieved, representing the contributions of 1,338 authors published in 153 journals. The field experienced slow growth over the twenty-year period from 1966 through 1985. In the following decade, the cumulative number of veterinary informatics articles almost tripled and the percentage of veterinary-related articles that included an informatics component increased almost two-and-one-half fold. Despite this recent growth, the number of veterinary-related articles with an informatics component has never exceeded 1% of either the veterinary or medical informatics literature over the past thirty years, and representation of veterinary subspecialties in the literature varied widely.

AHEC library services: from circuit rider to virtual librarian. Area Health Education Centers.

Abstract: The North Carolina Area Health Education Centers Library and Information Services (NC AHEC LIS) Network provides library outreach services to rural health care providers in all nine AHEC regions of North Carolina. Over the last twenty-five years, the AHEC and university-based librarians have collaborated to create a model program for support of community-based clinical education and information access for rural health care providers. Through several collaborative projects, they have supported Internet access for rural health clinics. The NC AHEC Digital Library—under development by NC AHEC, University of North Carolina at Chapel Hill, Duke University, East Carolina University, and Wake Forest University—will further extend access to electronic biomedical information and resources to health professionals in a statewide digital library.

Outreach to Public Health Professionals: Lessons Learned from a Collaborative Iowa Public Health Project

Abstract: In 1995, the National Library of Medicine (NLM) and the Public Health Service (PHS) recommended that special attention be given to the information needs of unaffiliated public health professionals. In response, the National Network of Libraries of Medicine (NN/LM) Greater Midwest Region initiated a collaborative outreach program for public health professionals working in rural east and central Iowa. Five public health agencies were provided equipment, training, and support for accessing the Internet. Key factors in the success of this project were: (1) the role of collaborating agencies in the implementation and ongoing success of information access outreach projects; (2) knowledge of the socio-cultural factors that influence the information-seeking habits of project participants (public health professionals); and (3) management of changing or varying technological infrastructures. Working with their funding, personnel from federal, state, and local governments enhanced the information-seeking skills of public health professionals in rural eastern and central Iowa communities.

A study comparing centralized CD-ROM and decentralized intranet access to MEDLINE

Abstract: Objective: The purpose of this study was to evaluate the efficacy of a decentralized intranet access in each medical department as opposed to centralized unique MEDLINE access in the medical library. Design: A two-phase questionnaire to evaluate MEDLINE use was given to junior and senior physicians at Rouen University Hospital (RUH). Phase I (August–October 1996) corresponded to a time period when centralized access was the only means of access available and phase II (August–October 1997) to a time period following the introduction of decentralized intranet access. Results: A total of 168 physicians filled out at least one phase of the questionnaire, among whom 123 (73%) filled out both phases. Use of MEDLINE significantly increased in 1997 (average of 10.2 ± 1.1 searches in three months) versus 1996 (average of 4.9 ± 0.7 searches in three months, P < 0.0001). The aim of searches changed, becoming significantly more care oriented in phase II (P < 0.0001). The number of searches performed by the physicians alone increased (P < 0.0001) and searches performed by the librarian decreased (P < 0.0001) in phase II. The method of searches also changed, as searches by author (P < 0.0001), by journal (P = 0.0042), and by free word (P = 0.0027) increased in phase II. Knowledge of the following concepts of MEDLINE significantly increased: explosion (P < 0.0001), scope note (P < 0.0001), Abridged Index Medicus (AIM) journals (P < 0.0001), Medical Subject Headings (MeSH) qualifier (P < 0.0001), and focus (P < 0.0001). Conclusion: A decentralized intranet access to MEDLINE increased the number of searches and knowledge of this bibliographic database. MEDLINE intranet access modified the purpose and the methods of searching.

Library outreach: addressing Utah's "Digital Divide".

Abstract: A "Digital Divide" in information and technological literacy exists in Utah between small hospitals and clinics in rural areas and the larger health care institutions in the major urban area of the state. The goals of the outreach program of the Spencer S. Eccles Health Sciences Library at the University of Utah address solutions to this disparity in partnership with the National Network of Libraries of Medicine-- Midcontinental Region, the Utah Department of Health, and the Utah Area Health Education Centers. In a circuit-rider approach, an outreach librarian offers classes and demonstrations throughout the state that teach information-access skills to health professionals. Provision of traditional library services to unaffiliated health professionals is integrated into the library's daily workload as a component of the outreach program. The paper describes the history, methodology, administration, funding, impact, and results of the program.

The Amazing Internet Challenge: How Leading Projects Use Library Skills to Organize the Web.

Abstract: This collection describes twelve Internet virtual libraries selected by the editors for “their international reputation as leaders in the delivery of selective, quality resources” (p. v). The twelve are: (1) Agriculture Network Information Center/AgNIC, (2) Argus Clearinghouse/Argus, (3) Blue Web/n, (4) BUBL Information Service/BUBL, (5) Edinburgh Engineering Virtual Library/EEVL, (6) INFOMINE, (7) Internet Public Library/IPL, (8) Librarians' Index to the Internet/LII, (9) Mathematics Archives, (10) Organising Medical Networked Information/OMNI, (11) Scout Report Signpost, and (12) Social Science Information Gateway/SOSIG. Eight are based in the United States and four in the United Kingdom. The twelve cover a spectrum of information services covering both specialized and interdisciplinary subject areas. The purpose of this collection is to present these projects as “strategic examples of the possibilities inherent in online information” (p. v). It is designed to appeal to reference librarians, catalogers, systems librarians, and administrators by providing insight into the day-to-day workflows and the long-term plans of the twelve virtual libraries. A basic assumption of this presentation is that all virtual libraries share common concerns and challenges. Therefore, within its own scope, each project has defined “quality information” and “trusted sources” and determined selection criteria to create collection resources valuable to its users. Although some of the criteria will be the same as those used in the print world (e.g., author, content, audience, and scope), the ephemeral nature of the Internet resource requires that new criteria also be considered, such as design and accessibility, site permanence, site revision and updating provisions, and linkage accuracy. The virtual library faces these fundamental considerations as well as more complex challenges. How best to use the technology to present and deliver information to the end user? How best to present the collection through the user interface? How many access methods should be provided? These and other issues are faced by the project developers, and their decisions are based on the primary audience served. The funding source, in most cases, defines the primary audience … and so it goes with each project having addressed common issues faced by all. The editors have profiled each of the twelve virtual libraries in chapters that follow the same outline: (1) responsible persons, (2) mission statement, (3) funding source(s) and project budget, (4) target audiences, (5) collection description, (6) resource selection and evaluation, (7) software and hardware mechanics, (8) taxonomy of classification, (9) project strengths, (10) project weaknesses, (11) project time frames, (12) project future goals, and (13) vision statements for future resource location and description. While each project has responded to these profile questions in its own way, the format provides a common outline that underscores the unique and outstanding approaches that the individual projects have taken in working in an online environment. For those faced with the challenges of organizing information on the Internet, this book should provide much useful data on selection criteria, evaluation processes, funding and budget mechanisms, and software and hardware technology. The twelve virtual libraries described here have been called trailblazers. Those about to embark on a similar project will want to familiarize themselves with the collective experience presented by these twelve successful projects.

The evolution of rural outreach from Package Library to Grateful Med: introduction to the symposium

Abstract: Outreach is now a prevailing activity in health sciences libraries. As an introduction to a series of papers on current library outreach to rural communities, this paper traces the evolution of such activities by proponents in health sciences libraries from 1924 to 1992. Definitions of rural and outreach are followed by a consideration of the expanding audience groups. The evolution in approaches covers the package library and enhancements in extension service, library development, circuit librarianship, and self-service arrangements made possible by such programs as the Georgia Interactive Network (GaIN) and Grateful Med.