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Teaching pathology in the 21st century. An experimental automated curriculum delivery system for basic pathology.

In late 1984, the "General Professional Education of the Physician" (GPEP) report recommended, among other things, that medical curricula be revised to rely less on lectures and more on independent study and problem solving. We seem to have anticipated, in 1980, the findings of the GPEP panel by formulating and starting to test the hypothesis that certain "core" information in medical curricula can be as effectively delivered by technology-based self-study means as by lecture or formal laboratory. We began, at that time, to prepare a series of self-study materials using, at first, videotape and then computer-controlled optical videodiscs. The content area selected for study was basic microscopic pathology. The series was planned to cover the following areas of study: cellular alterations and adaptations, cell injury, acute inflammation, chronic inflammation and wound healing, cellular accumulations, circulatory disturbances, necrosis, and neoplasia. All are intended to provide learning experiences in basic pathology. The first two programs were released for testing in 1983 as a two-sided videodisc accompanied by computer-driven pretests, study modules, and posttests that used Apple computers and Pioneer (DiscoVision) videodisc players. An MS DOS (eg, IBM) version of the computer programs was released in 1984. The first two programs are now used in 57 US, Canadian, European, and Philippine health professions schools, and over 1300 student and faculty evaluations have been received. Student and faculty evaluations of these first two programs were very positive, and, as a result, the others are in production and will be completed in 1988. Only when a critical mass of curriculum is available can we really test our stated hypothesis. In the meantime, it is worthwhile to report the evaluation of the first two programs.

Audiovisual Aids↗

MEDLARS II: a review.

The MEDLARS II effort, as it was developed until June 1971, is reviewed in terms of the overall planning process. How MEDLARS I was approached by NLM is discussed first and its objectives used for comparison. Certain technical, managerial, and intellectual aspects are outlined as types of problems encountered in designing MEDLARS II. While improvement upon the MEDLARS I seemed to be the main reason for planning a MEDLARS II, objectives became blurred and divergent as the project went along. The complexities of creating a central computerized data base of health sciences bibliographic information and library functional activities for nationwide use were underappreciated and remain a challenge to NLM.

Computers↗

Comparison of fixed-fee Grateful Med database use and searching success rates given the continued availability of MEDLINE in other formats.

This study compared in-house Grateful Med database use and searching success rates for four-month periods at four sites of the Library of the Health Sciences of the University of Illinois at Chicago. Data were collected from Grateful Med workstation uselogs and analyzed. Database use patterns and searching success rates were fairly consistent across the four sites. Though MEDLINE was available in other formats and use in these other formats remained high, 65.48% of all Grateful Med searching was done by using MEDLINE, and an additional 21.34% was done by using the MEDLINE Backfiles. In-house use patterns were similar to the overall use pattern for the University of Illinois, with the exception of MEDLINE Backfiles. Overall, 54.30% of searches were successful.

CD-ROM↗

Implications of planning for regional libraries: our underlying philosophy.

The National Library of Medicine Extramural Program in administering the Medical Library Assistance Act of 1965 has developed the following specific program objectives: provide financial assistance for improving biomedical libraries; encourage and assist the establishment and functioning of a responsive national biomedical information network by strengthening present biomedical libraries and their interlibrary relationships; and assure that the biomedical library network is linked to related science information systems. The ultimate goal is to develop the role of the library as a full learning resource center for education, research, and service. The regional library program aims to augment present capability of existing medical libraries so that information can be made available more extensively and more rapidly. Comprehensive and thorough advanced planning is a basic element in the development of regional medical libraries.

Libraries, Medical↗

The availability of research journals in South African academic medical libraries.

Biomedical researchers depend on the journals of science as a primary source of information. The spiralling cost of journals threatens the ability of libraries to provide their users' information needs. In this study the availability of a representative sample of journals used by South African biomedical researchers was determined at each of the seven medical faculty libraries. The application of a standardised document delivery test is described and the results are interpreted in terms of: (i) the capability index, which includes material obtainable through inter-library loans; and (ii) an availability index, or measure of the probability that a user will find an item without delay in his/her own library. The current status of availability of biomedical journals was found to be high at all the libraries; indeed, the scores compare favourably with results obtained at academic libraries overseas. There is, however, real concern that the financial crisis in tertiary education will cause the situation to deteriorate. Repetition of this test is recommended to monitor the (probably declining) level of journal availability. The information would support efforts to rationalise and subsequently strengthen academic medical libraries' collective holdings as a strategic national resource.

Costs and Cost Analysis↗

Planning serials cancellations and cooperative collection development in the health sciences: methodology and background information.

In an era of steady-state budgets many research and academic libraries must cancel a significant number of current serials to maintain acquisitions of monographs. Thus paper reviews several techniques that have been used or that are of potential use in a rational selection of titles for cancellation. The context of the proposed methodology involves a network of libraries rather than an individual library. The methodology was tested with specific health sciences serial titles held by University of California libraries and resource libraries in NLM Region XI. As a test for the proposed methodology, background data were collected on 600 current foreign language serial titles included in SERLINE and held by at least one of the libraries in the networks of interest. Price, major secondary service coverage with productivity/impact factors, extent of holdings, and average number of recorded circulations per year in several of the libraries were recorded for each title. With the use of several different rules, estimates were made of the subscription savings that might be realized. It seems feasible to extend the same methodology to other groups of serial titles.

Abstracting and Indexing↗

Strengthening the links between health sciences information users and providers.

In 1994, the Hospital Library Service Program of the Central New York Library Resources Council conducted a study to evaluate the usefulness, impacts, and potential services of eleven hospital libraries in a four-county area in New York State; determine the degree to which the libraries comply with Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standard IM.9.2; and provide recommendations for improved services in the member libraries. Two research instruments were used: a survey for hospital-based health sciences professionals and a survey for hospital-based information providers. Results from the two surveys were compared to determine if users' needs were being filled, and to develop plans for improved information services and products. Fourteen recommendations are made that, if implemented, will support the creation of user-defined information products, enhance the library's profile within the hospital, and exploit resource sharing to reduce costs and enhance coordination.

Computer Communication Networks↗

Non-science majors gain valuable insight studying clinical trials literature: an evidence-based medicine library assignment.

When faced with a diagnosis, it is empowering to be able to assess the evidence of treatment effectiveness and safety. To teach this skill to non-science majors, we assigned the "Responsible Patienthood Project" (RPP). For the RPP, students studied an array of disease and treatment literature: the final product of their work was a poster presentation, in which they did an in-depth analysis of one primary article, thus encouraging critical evaluation of experimental design, methods, and conclusions. Post-RPP, there was a 35% decrease in the student perception that they would unquestioningly accept a recommended treatment for a hypothetical diagnosis, and a 40% increase in the perception that they would consult a combination of resources, including primary articles. We recommend this project based on our results that suggest 1) non-science majors are able to successfully access and assess primary scientific literature, 2) students felt empowered by the RPP, and 3) skills in information gathering, via library instruction, may serve as a particularly helpful lifelong learning tool.

Clinical Trials as Topic↗

Rural GRATEFUL MED outreach: project results, impact, and future needs.

The Library of the Health Sciences-Peoria (LHS-Peoria), located at a regional site of the University of Illinois College of Medicine, conducted an eighteen-month GRATEFUL MED outreach project funded by the National Library of Medicine. The project was designed to enhance information services for health professionals at eight underserved rural hospitals in west central Illinois. One hundred rural health professionals, mainly nonphysicians, received GRATEFUL MED training at these hospitals; LHS delivered more than 350 documents to the trainees. In this paper, investigators describe the project and its goals and discuss results and their evaluation, from both individual and institutional perspectives. Outcome is examined in the context of future outreach plans, both at LHS and elsewhere.

Computer Communication Networks↗

[The Library of Medicine of Córdoba, witness and protagonist of knowledge from the end of the 19th Century to the beginning of 21st Century].

In the nineteenth century, was founded the Medicine's Library of the National University Faculty of Medicine, center of knowledge, new ideas and teaching. The history library sector hold the valuable inheritance that represent the collection of Teachers Doctors, Pablo Mirizzi, Temístocles Castellano, Pedro Ara, José F. Verna, Juan Martín Allende located with the books and thesis of the XIX century and beginning of XX century. In 1986 it integrates the National Health Science Information Network and also, the Latino American and the Caribbean Health Science Information Network. The health libraries are in front of a new paradigm. The technologies of information and communication require new methods for administration of the information's resources and services, to answer the society information needs in the knowledge age. The traditional and virtual library is one unit that complement sources in different supports, electronic publications and interactive networks. It is the nexus between the scientific inheritance and the society, and it's mission is: Give local and virtual information's services and management the information's resources, basis of the knowledge society, support of teaching, investigation and extension of the Medical Sciences Faculty of the Córdoba National University.

Academic Medical Centers↗

Group-based parent-training programmes for improving emotional and behavioural adjustment in 0-3 year old children.

BACKGROUND: Mental health problems in children are common. Research suggests that parenting has an important role to play in helping children to become well adjusted adults, and that the first few months and years of a child's life are especially important in establishing patterns of emotional, cognitive and social functioning which will in turn influence the child's future development and in particular, their mental health. Parenting programmes may therefore have a role to play in improving the mental health of infants and toddlers. OBJECTIVES: The objectives of this review are as follows: a) To establish whether group-based parenting programmes are effective in improving the mental health of children less than three years of age b) To assess the role of parenting programmes in the primary prevention of mental health problems SEARCH STRATEGY: A range of biomedical and social science databases were searched including MEDLINE, EMBASE, CINAHL, PsychLIT, Sociofile, Social Science Citation Index, ASSIA, the Cochrane Library including SPECTR, CENTRAL, National Research Register (NRR) and ERIC. SELECTION CRITERIA: Only randomised controlled trials were included and studies had to include at least one standardised instrument measuring some aspect of infant mental health. DATA COLLECTION AND ANALYSIS: The treatment effect for each outcome in each study was standardised by dividing the mean difference in post-intervention scores for the intervention and treatment group, by the pooled standard deviation, to obtain an effect size. The results for each outcome in each study have been presented with 95% confidence intervals. Where appropriate the results have been combined in a meta-analysis using a random effect model. MAIN RESULTS: A total of five studies were included in the review. The 5 included studies provided a total of 36 assessments of infant and toddler mental health including emotional and behavioural adjustment, and sleep patterns. All of the results apart from 6 showed positive findings favouring the intervention group. While some of findings were non-significant, most of the effect sizes were large and the wide confidence intervals crossing the zero that were obtained in a number of the studies, were very probably due to small sample sizes. There was sufficient data from four studies to combine the results in a meta-analysis. The results of the meta-analysis show a significant difference in children's emotional and behavioural adjustment favouring the intervention group. Overall, the limited follow-up data provide equivocal evidence concerning the maintenance of these effects over time. REVIEWER'S CONCLUSIONS: The results of this review suggest that parenting programmes can be effective in improving the mental health of infants and toddlers. There is, however, insufficient evidence to reach any firm conclusions regarding the role that such programmes might play in the primary prevention of mental health problems. Furthermore, there is insufficient evidence to know whether the short-term benefit of these programmes is maintained over time, and further research is required.

Child Development↗

Laxatives for the management of constipation in palliative care patients.

BACKGROUND: Constipation is a common problem for palliative care patients which can generate considerable suffering for patients due to both the unpleasant physical symptoms and psychological preoccupations that can arise. There is uncertainty about the 'best' management of constipation in palliative care patients and variation in practice between palliative care settings. OBJECTIVES: To determine the effectiveness of laxative administration for the management of constipation in palliative care patients, and the differential efficacy of the laxatives used to manage constipation. SEARCH STRATEGY: We searched The Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue four, 2005), MEDLINE (1966 to January 2005), EMBASE (1980 to January 2005), CANCERLIT, PUBMED, Science Citation Index, CINAHL, The Cochrane Library, SIGLE, NTIS, DHSS-DATA, Dissertation Abstracts, Index to Scientific and Technical Proceedings and NHS-NRR and reference lists of articles. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing laxatives for constipation in palliative care patients. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted patient-reported data measuring changes in stool frequency and ease of passing stools, using objective and validated scales. Tolerance or adverse effects of laxatives used were also sought. The appropriateness of synthesizing data from the controlled trials depended upon the clinical and statistical homogeneity of studies identified. If the controlled trials were homogeneous, a meta-analysis would be attempted. MAIN RESULTS: Four trials involving 280 people were included. Between these trials, the laxatives lactulose; senna; danthron combined with poloxamer (Co-danthramer); Misrakasneham; magnesium hydroxide combined with liquid paraffin (Milpar) were evaluated. All four trials included number and frequency of bowel movements and relative ease of defecation as part of the assessment of laxative efficacy. All of the laxatives demonstrated a limited level of efficacy, although a significant number of participants required rescue laxatives in each of the studies. The only significantly different treatments were in the trial where lactulose plus senna were more effective than danthron combined with poloxamer. Patient preference did not favour either treatment option. Other related systematic reviews have similarly identified that there is a lack of evidence to support the use of one laxative, or combination of laxatives, over another. AUTHORS' CONCLUSIONS: The treatment of constipation in palliative care is based on inadequate experimental evidence, such that there are insufficient RCT data. Recommendations for laxative use can be related to costs as much as to efficacy. There have been few comparative studies, equally there have been few direct comparisons between different classes of laxative and between different combinations of laxatives. There persists an uncertainty about the 'best' management of constipation in this group of patients.

Cathartics↗

Organizational factors that influence information technology diffusion in academic health sciences centers.

OBJECTIVE: To identify the organizational factors which influence the diffusion of end user online literature searching, the computer-based patient record, and electronic mail systems in academic health sciences centers in the United States. DESIGN: A total of 1335 individuals working in informatics and library areas at 67 academic health sciences centers in the U.S. were surveyed. Multivariate techniques were used to evaluate the relationship between the set of six organizational factors and two measures of innovation diffusion. MEASUREMENTS: A Guttman-like scale was developed to measure infusion, or depth or sophistication, of each of the three innovations at each institution. Diffusion was measured by a question previously developed for another study. Six independent variables were measured via five formerly developed scales and one new one. RESULTS: The overall response rate was 41%. The set of organizational variables produced significant results in the diffusion of each of the three innovations, with individual variables influencing diffusion to varying degrees. The same set produced significant results in relation to infusion only for online searching. There was little or no correlation between infusion and diffusion for each innovation. CONCLUSION: Organizational attributes are important predictors for diffusion of information technology innovations. Individual variables differ in their effect on each innovation. The set of attributes seems less able to predict infusion. It is recommended that both infusion and diffusion be measured in future studies because there is little relation between them. It is further recommended that individuals charged with implementing information technology in the health sciences receive training in managing organizational issues.

Academic Medical Centers↗