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The contribution of hospital library information services to clinical care: a study in eight hospitals.

Hospital health sciences libraries represent, for the vast majority of health professionals, the most accessible source for library information and services. Most health professionals do not have available the specialized services of a clinical medical librarian, and rely instead upon general information services for their case-related information needs. The ability of the hospital library to meet these needs and the impact of the information on quality patient care have not been previously examined. A study was conducted in eight hospitals in the Chicago area as a quality assurance project. A total of 176 physicians, nurses, and other health professionals requested information from their hospital libraries related to a current case or clinical situation. They then assessed the quality of information received, its cognitive value, its contribution to patient care, and its impact on case management. Nearly two-thirds of the respondents asserted that they would definitely or probably handle their cases differently as a result of the information provided by the library. Almost all rated the libraries' performance and response highly. An overview of the context and purpose of the study, its methods, selected results, limitations, and conclusions are presented here, as is a review of selected earlier research.

Allied Health Personnel↗

Data withholding in genetics and the other life sciences: prevalences and predictors.

PURPOSE: To better understand the variety and prevalence of data withholding in genetics and the other life sciences and to explore factors associated with these behaviors. METHOD: In 2000, a sample of 2,893 geneticists and other life scientists (OLS) at the 100 most research-intensive universities in the United States were surveyed concerning data withholding and sharing. The instrument was developed and pretested in 1999. The two primary outcome measures were withholding in verbal exchanges with colleagues about unpublished research (verbal withholding) and withholding as part of the publishing process (publishing withholding). The independent variables related to the personal characteristics, research characteristics of faculty, and previous experience with data withholding. RESULTS: A total of 1,849 faculty responded (64%): 1,240 geneticists and 600 OLS. Forty-four percent of geneticists and 32% of OLS reported participating in any one of 13 forms of data withholding in the three previous years. Publishing withholding (geneticists 35%, OLS 25%) was more frequent than verbal withholding (geneticists 23%, OLS 12%). In multivariate analyses, male gender, participation in relationships with industry, mentors' discouraging data sharing, receipt of formal instruction in data sharing, and negative past experience with sharing were significantly associated with either verbal or publishing withholding among either geneticists or OLS. CONCLUSIONS: Data withholding is common in biomedical science, takes multiple forms, is influenced by a variety of characteristics of investigators and their training, and varies by field of science. Encouraging openness during the formative experiences of young investigators may be critical to increased data sharing, but the effects of formal training do not appear straightforward.

Access to Information↗

Library as place: results of a delphi study.

OBJECTIVE: An expert consensus on the future of the library as place was developed to assist health sciences librarians in designing new library spaces. METHOD: An expert panel of health sciences librarians, building consultants, architects, and information technologists was asked to reflect on the likelihood, desirability, timing, and impact on building design of more than seventy possible changes in the use of library space. RESULTS: An expert consensus predicted that the roles librarians play and the way libraries are used will substantially change. These changes come in response to changes in technology, scholarly communication, learning environments, and the health care economy. CONCLUSIONS: How health sciences library space is used will be far less consistent by 2015, as space becomes more tailored to institutional needs. However, the manner in which health sciences libraries develop and deliver services and collections will drastically change in the next decade. Libraries will continue to exist and will provide support for knowledge management and clinical trials, provide access to digital materials, and play a host of other roles that will enable libraries to emerge as institutional change agents.

Delphi Technique↗

Oligodendroglioma: pathology and molecular biology.

BACKGROUND: Recently, important new information has become available concerning the histologic recognition and molecular biology of oligodendrogliomas. This information, in turn, impacts the way neurosurgeons diagnose and treat patients with these tumors. The purpose of this paper is to review the pathology and basic science of oligodendroglioma, highlighting these developments. METHODS: Information for this review was obtained by a Medline search using the term "oligodendroglioma," and limiting the results to articles dealing with pathology. Chapters from standard textbooks were also used, and bibliographies were checked for additional key articles contributing to the understanding of the pathobiology of this disease. RESULTS: On histologic examination, oligodendrogliomas must be differentiated from tumors including the fibrillary astrocytoma, clear cell ependymoma, central neurocytoma, and dysembryoplastic neuroepithelial tumor (DNT). There is no specific immunocytochemical marker allowing for the recognition of human oligodendroglial tumor cells. A current simplified grading scheme separates these tumors into low grade (WHO grade II) and anaplastic (WHO grade III) oligodendrogliomas. New molecular and genetic markers may aid in grading oligodendrogliomas and identifying patients with a better prognosis or response to chemotherapy. Markers studied include Ki-67, PCNA, EGFr, VEGF, platelet-derived growth factor, p16, p18, p53, bcl-2, COX-1, and chromosomal deletions. The combination of allelic losses on chromosomes 1p and 19q has been statistically associated with a longer recurrence-free survival after chemotherapy. CONCLUSIONS: A patient with an oligodendroglioma may at times still present a diagnostic challenge for the neuropathologist. Yet making an accurate diagnosis is essential, since the clinical course and optimal therapeutic approach differs from that of other gliomas. In the near future, molecular characterization of oligodendrogliomas is expected to play an even greater clinical role.

Antibodies, Antinuclear↗

Establishing a culture of care, conscience, and responsibility: addressing the improvement of scientific discovery and animal welfare through science-based performance standards.

Science-based performance standards offer a viable means of reducing regulatory burden while ensuring that research animal welfare and high-quality research data are realized. Unlike rigid regulations, science-based performance standards evolve as new information becomes available, thereby allowing new discoveries to be implemented in a timely manner and in a way that more effectively benefits the animals and the science. The implementation of performance standards requires a well-coordinated institutional team composed of the administration, research staff, the institutional animal care and use committee, professional and technical animal care personnel, occupational health and safety staff, and physical plant staff. This animal program team is best supported in an institutional environment that reflects a culture of care, compliance, and responsibility. In such a culture, the professional judgment exercised by the team is well grounded in meeting the diverse needs of the program's customers, who include the animals, the researchers, and research stakeholders such as the public. The institutional culture of care, compliance, and responsibility fosters workplace integrity, an ethics-based decision-making paradigm, sound understanding of institutional expectations through good communication and clear lines of authority, the hiring and retention of trained and well-qualified individuals, and a system for continuous development and improvement of the program.

Animal Care Committees↗

Qualitative studies. Their role in medical research.

OBJECTIVE: To define qualitative research in terms of its philosophical roots, the questions it addresses, its methods and analyses, and the type of results it can offer. DATA SOURCES: MEDLINE and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched for the years January 1985 to April 1998. The search strategy consisted of "textword" terms that searched in the "title" field of both databases. Qualitative research and evaluation textbooks in health and the social sciences were also used. QUALITY OF EVIDENCE: The information on qualitative research is based on the most recent and valid evidence from the health and social science fields. MAIN MESSAGE: Qualitative research seeks to understand and interpret personal experience to explain social phenomena, including those related to health. It can address questions that quantitative research cannot, such as why people do not adhere to a treatment regimen or why a certain health care intervention is successful. It uses many methods of data collection, including participant observation, case studies, and interviews, and numerous approaches to data analysis that range from the quasistatistical to the intuitive and inductive. CONCLUSIONS: Qualitative research, a form of research completely different from quantitative research, can provide important insights into health-related phenomena and can enrich further research inquiries.

Data Collection↗

Risk management in chemical safety: some general observations relating to the state of the art.

Risk management for chemical safety begins with judgement and produces arbitrary regulations. In between, technical risk assessment has value in clarifying the behaviour of particular chemical risk systems. Risk quantification can be useful in some cases and quite misleading in others. In no case can it alone be the decisive factor. In the public's perception, chemicals are feared most for potential insidious exposure in the general environment. Risk management then must deal with high system uncertainty and information heavily influenced by value judgements. The technical contribution to risk assessment is reduced, in real terms, as the decision-making scenario expands with its increasing exposure to system 'noise', interference and misinformation. Improved communication in the system requires the use of simplified language. The suitability of risk estimation methodologies must be assessed in terms of general comprehensibility in the management for chemical safety will remain, perhaps always, more of an art than a science, concerned with an interplay of information that can be 'rationalised' with other information that defies such rationalisation.

Communication↗

An interdisciplinary course in the basic sciences for senior medical and PhD students.

Integrating clinical and basic sciences throughout the medical school curriculum has become a major objective of various innovations in medical education. While early clinical exposure has evolved as an efficient means of introducing clinical studies in the preclinical years, interdisciplinary integration of basic sciences during the clinical years remains a challenge. The authors describe their three years of experience with an interdisciplinary course designed to demonstrate the continuum of medical information from the clinic to the basic sciences. In this course, sixth-year medical students are required to choose one of three to four different one-week programs, each of which requires them to conduct an in-depth investigation of a defined clinical topic. Program coordinators are encouraged to work in clinician-basic scientist teams and to use a variety of teaching methods, with an emphasis on tutored individual and group learning based on critical readings of original papers. Coordinators are also encouraged to enable graduate research students to participate. From 1998 to 2000, students participated in nine programs, seven of which were coordinated by interdisciplinary teams. Several clinical and basic science disciplines were represented in each program, and various teaching methods were used. Graduate students participated in two of the programs. Evaluation of the programs (a debriefing discussion as well as short written evaluations) indicated moderate to good achievement of the course objectives.

Curriculum↗

[How do physicians evaluate their medical school training. Retrospective survey of 4 groups of medical students 8-11 years after graduation].

A survey was conducted among 250 graduates of the Bobigny School of Medicine (University Paris-Nord) who had completed medical school from 1986 to 1989 in order to ascertain their opinion concerning the training received. Ninety former students (36%) responded. The mean age of the sample was 34 years; 46 women and 44 men. Most (88.9%) were practicing medicine, principally as general practitioners (61.8%). 81.6% felt they had been well prepared to practice medicine. The rate of satisfaction was higher in the area of fundamental science than in clinical science. The responders generally felt that teaching and validation methods should emphasize real situations. The main criticism concerning the curriculum was an insufficient degree of professionalism, particularly in fields currently of particular importance: epide miology, health economics, education, prevention, office management. Training was also considered to be insufficient in medical techniques, communication, priority decision making, team work, emergency care, organization of time and handling stress. The responders suggested that the future curriculum should focus more on information search, research methodology and computer science. The results of this survey collaborate findings of recent retrospective long-term analyses conducted in other European countries.

Education, Medical, Continuing↗

Implementation of organizational practices to protect information in health organizations.

In March of 1997, the National Research Council (NRC) of the National Academy of Sciences issued the report, "For the Record: Protecting Electronic Health Information." In its report, the Council recommended both technical and organizational practices to protect electronic health information. At the time the report was issued, Vanderbilt University Medical Center was deeply immersed in the development of organizational practices consistent with the Council's recommendations. We agreed that the recommended technical and organizational practices are important for protecting other information types in addition to health information, and that they suggest appropriate practices for non-electronic information, as well. In this paper, we focus on our process for developing and implementing the seven organizational practices recommended for immediate implementation.

Academic Medical Centers↗

The Louis Stokes Health Sciences Library: the Howard University move experience.

The Louis Stokes Health Sciences Library attributes its successful move to early planning and preparation. Professional literature on the subject as well as consultation with other experienced library personnel also proved beneficial. Utilizing these resources, the committees devised a strategy that supported the library's mission to provide excellent and complete information services for the advancement of health sciences. This paper describes the Howard University Health Sciences Library move experience and offers practical advice for planning a library move. We hope that the information shared will assist other libraries facing a similar challenge.

Diffusion of Innovation↗

Earthquake prediction: the interaction of public policy and science.

Earthquake prediction research has searched for both informational phenomena, those that provide information about earthquake hazards useful to the public, and causal phenomena, causally related to the physical processes governing failure on a fault, to improve our understanding of those processes. Neither informational nor causal phenomena are a subset of the other. I propose a classification of potential earthquake predictors of informational, causal, and predictive phenomena, where predictors are causal phenomena that provide more accurate assessments of the earthquake hazard than can be gotten from assuming a random distribution. Achieving higher, more accurate probabilities than a random distribution requires much more information about the precursor than just that it is causally related to the earthquake.

Journal Article↗

[Development of studies on problem of infectious arthritis at the Institute of RHeumatology, Russian Academy of Medical Sciences in 1970 to 1990].

The paper presents information on the studies on the elucidation of the etiopathogenetic role of Chlamydia and Yersinia infections in reactive arthritis, which have been made at the Institute in the past decades. Among them it mentions the first experiments and subsequent findings of detection of both Chlamydia and DNA in joint tissues in urogenic arthritis, those of identification of altered minor forms of this microbe in chronic types, which mimic in vitro persistent Chlamydia infection. The clinical experience gained by the Institute in treating Chlamydia-induced urogenic arthritis with high-dose antibiotics is reported. In addition to detailed studies of the clinical manifestations and outcomes of Yersinia-induced arthritis, long-term follow-ups have examined an association of clinical and serological manifestations with HLA B27 carriage; it is suggested that there is a partial similarity between this antigen and Yersinia antigens. Pronounced changes have been found in the mucosa of the intestine and its microflora in enterogenous reactive arthritis and a treatment with bifidum-containing drugs proposed. A variety of clinical and serological manifestations of Lyme borreliasis detected in the endemic areas of Russia is described. The specific features of rheumatological manifestations of this disease are comparable with those observed in the USA and Europe.

Academies and Institutes↗

Area health education centers and health science library services.

A study to determine the impact that the Area Health Education Center type of programs may have on health science libraries was conducted by the Extramural Programs, National Library of Medicine, in conjunction with a contract awarded by the Bureau of Health Manpower, Health Resources Administration, to develop an inventory of the AHEC type of projects in the United States. Specific study tasks included a review of these programs as they relate to library and information activities, on-site surveys on the programs to define their needs for library services and information, and a categorization of library activities. A major finding was that health science libraries and information services are generally not included in AHEC program planning and development, although information and information exchange is a fundamental part of the AHEC type of programs. This study suggests that library inadequacies are basically the result of this planning failure and of a lack of financial resources; however, many other factors may be contributory. The design and value of library activities for these programs needs explication.

Area Health Education Centers↗

[General principles for scientific reading and writing].

OBJECTIVE: To present an introduction to scientific writing and reading. METHODS/RESULTS: To analyse the most frequently used different formats of scientific-technical documents as reported by UNESCO (1983) including Scientific journals, books, monographs, presentations to congresses, technical reports, yearbooks and bulletins. We describe the main characteristics of each one. CONCLUSIONS: To emphasize the importance of written communication, in its different formats, in health sciences, for health care professionals formation and information.

Publishing↗

A systems approach to planning biomedical information services.

A systems approach to planning was applied within the Biomedical Information Communication Center at Oregon Health Sciences University when its User Services division launched a strategic planning effort. By looking at the choice subsystem, the organizational structure, and the behavioral subsystem, those engaged in planning attempted to assure that desired change would permeate the entire system. The challenge of applying a theoretically ideal planning model within an environment averse to planning is delineated.

Information Centers↗

Current practices in spatial analysis of cancer data: mapping health statistics to inform policymakers and the public.

BACKGROUND: To communicate population-based cancer statistics, cancer researchers have a long tradition of presenting data in a spatial representation, or map. Historically, health data were presented in printed atlases in which the map producer selected the content and format. The availability of geographic information systems (GIS) with comprehensive mapping and spatial analysis capability for desktop and Internet mapping has greatly expanded the number of producers and consumers of health maps, including policymakers and the public.Because health maps, particularly ones that show elevated cancer rates, historically have raised public concerns, it is essential that these maps be designed to be accurate, clear, and interpretable for the broad range of users who may view them. This article focuses on designing maps to communicate effectively. It is based on years of research into the use of health maps for communicating among public health researchers. RESULTS: The basics for designing maps that communicate effectively are similar to the basics for any mode of communication. Tasks include deciding on the purpose, knowing the audience and its characteristics, choosing a media suitable for both the purpose and the audience, and finally testing the map design to ensure that it suits the purpose with the intended audience, and communicates accurately and effectively. Special considerations for health maps include ensuring confidentiality and reflecting the uncertainty of small area statistics. Statistical maps need to be based on sound practices and principles developed by the statistical and cartographic communities. CONCLUSION: The biggest challenge is to ensure that maps of health statistics inform without misinforming. Advances in the sciences of cartography, statistics, and visualization of spatial data are constantly expanding the toolkit available to mapmakers to meet this challenge. Asking potential users to answer questions or to talk about what they see is still the best way to evaluate the effectiveness of a specific map design.

Data Interpretation, Statistical↗

The status of hypnosis as an empirically validated clinical intervention: a preamble to the special issue.

In his introductory remarks to this Journal's special issue on the status of hypnosis as an empirically supported clinical intervention, the editor briefly describes the dawn of clinical hypnosis research, the logic of the natural science model, the importance of an inspired but tough-minded clinical science, and the auspicious confluence of practice and research purpose in this enterprise. The progenitor of this effort was indeed the Report of the Royal Commission coauthored by Benjamin Franklin and Antoine Lavoisier, among others, more than 215 years ago--a report noted as one of the most important documents in the history of human reason. The ethos and logic of this special issue is grounded on the legacy of that document. Eschewing the conflicting mental health agendas of managed-care, government, patient rights, and professional guild interests, this special issue seeks to present a frank, evenhanded, informed, and dispassionate assessment of what science knows and does not know about clinical hypnosis.

Humans↗