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A community-based participatory health information needs assessment to help eliminate diabetes information disparities.

This article describes the participatory research process, results, action plan, and implications of the community health information needs assessment conducted within the African American community in two South Carolina counties. The REACH 2010: Charleston and Georgetown Diabetes Coalition library program is a partnership among community organizations, public and health sciences libraries, and lay community health advisors. A planning committee studied digital divide issues related to health information, designed and implemented a survey, held focus groups, analyzed data, identified needs and assets, and formulated an action plan to increase the dissemination of diabetes information. Key survey findings show that older (older than 60) and less educated (fewer than 12 years of education) African Americans in Charleston and Georgetown counties lack skills to access Internet and library services and suffer disparities in health information. Based on assessment evidence, the community plans to increase Internet access points and provide a train-the-trainer program to teach people skills for using Internet and library resources to get high-quality information about diabetes and its complications. This process taps community resources, builds local capacities and technical skills, educates about health, and empowers participants as active partners in their own health and their community's health.

Adult↗

The medical libraries of Vietnam--a service in transition.

The medical libraries of Vietnam maintain high profiles within their institutions and are recognized by health care professionals and administrators as an important part of the health care system. Despite the multitude of problems in providing even a minimal level of medical library services, librarians, clinicians, and researchers nevertheless are determined that enhanced services be made available. Currently, services can be described as basic and unsophisticated, yet viable and surprisingly well organized. The lack of hard western currency required to buy materials and the lack of library technology will be major obstacles to improving information services. Vietnam, like many developing nations, is about to enter a period of technological upheaval, which ultimately will result in a transition from the traditional library limited by walls to a national resource that will rely increasingly on electronic access to international knowledge networks. Technology such as CD-ROM, Integrated Services Digital Network (ISDN), and satellite telecommunication networks such as Internet can provide the technical backbone to provide access to remote and widely distributed electronic databases to support the information needs of the health care community. Over the long term, access to such databases likely will be cost-effective, in contrast to the assuredly astronomical cost of building a comparable domestic print collection. The advent of new, low-cost electronic technologies probably will revolutionize health care information services in developing nations. However, for the immediate future, the medical libraries of Vietnam will require ongoing sustained support from the international community, so that minimal levels of resources will be available to support the information needs of the health care community. It is remarkable, and a credit to the determination of Vietnam's librarians that, in a country with a legacy of war, economic deprivation, and international isolation, they have somehow managed to provide a sound basic level of information services for health care professionals.

Communism↗

The role of a clinically based computer department of instruction in a school of medicine.

The evolution of activities and educational directions of a department of instruction in medical computer technology in a school of medicine are reviewed. During the 18 years covered, the society at large has undergone marked change in availability and use of computation in every aspect of medical care. It is argued that a department of instruction should be clinical and develop revenue sources based on patient care, perform technical services for the institution with a decentralized structure, and perform both health services and scientific research. Distinction should be drawn between utilization of computing in medical specialties, library function, and instruction in computer science. The last is the proper arena for the academic content of instruction and is best labelled as the philosophical basis of medical knowledge, in particular, its epistemology. Contemporary pressures for teaching introductory computer skills are probably temporary.

Computer User Training↗

InfoServerPlus: providing a medical library as application service.

Clinical decision making necessitates convenient access to high-quality content. The advanced requirements for a multipurpose application must be met technologically by an appropriate system design in the form of a client-server architecture which demonstrates a functional view in differentiating three tiers: presentation, application and data supply. The technical realisation has been accomplished by an application server which serves thin clients on several platforms. Despite considerable expenditures, this solution represents a promising way of disseminating information and knowledge via Intra- and Internet. The requirements and the accompanying system architecture could be satisfactorily implemented.

Access to Information↗

Library involvement in the implementation of a course management system.

Course management system software has much to offer the faculty and students in universities that adopt this technology. Libraries have used this technology to provide links to library resources, but they can also have a role in implementing the adoption of the course management software. The Penn State College of Medicine successfully implemented the ANGEL course management system under the guidance of a medical librarian. Tasks specific to the librarian included communication and promotion of ANGEL, in addition to providing training and technical support.

Computer-Assisted Instruction↗

Networking consumer health information: bringing the patient into the medical information loop.

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

CD-ROM↗

Educational materials reviewed for AVLINE.

The need for a central source of information regarding the availability, suitability, and quality of educational materials has led to the development of AVLINE. AVLINE is a computer information service available through the MEDLARS system of the National Library of Medicine. The Association of American Medical Colleges is gathering information from faculty members concerning useful materials and is bringing together content specialists, instructional designers, and technical specialists to review these materials. Information on materials that are recommended is provided to the National Library of Medicine to be cataloged, indexed, and abstracted for ultimate listing in AVLINE. Twenty-eight percent of the material has not been recommended; the many reasons for low ratings are categorized under content quality, instructional design, and technical quality.

Audiovisual Aids↗

A bibliography of scanning electron microscopy in dentistry.

This bibliography represents a compilation of pertinent technical literature on SEM in dentistry. The purpose of this collection of references is to help dental researchers and students by bringing together a comprehensive ready reference for their use. Our library utilizes the BRS (Bibliographical Retrieval Service) as their data base vendor. BRS offers a SDI (Selective Dissemination of Information) service method which automatically produces a printout of new information as it is added to the BRS medical and dental file database each month. The search strategy profile is determined by the user and can be updated at anytime. The BRS system has been utilized for the accumulation of data for this bibliography and has been updated through October, 1981. The search strategy includes SEM with a comprehensive list of dental and dental related terms, however, the 659 references contained in the bibliography is not totally inclusive of SEM in dentistry since "SEM" is not included in all citations, titles, abstracts, or key words and will, therefore, be lost to other primary and secondary titles. A subject index follows on page 225. Scanning electron microscope (y, ic) is abbreviated as SEM to conserve space and time.

Bibliographies as Topic↗

Prehospital 12-lead electrocardiography impact on acute myocardial infarction treatment times and mortality: a systematic review.

OBJECTIVES: Prehospital 12-lead electrocardiogram (PHECG) interpretation and advance emergency department (ED) notification may improve time-to-treatment intervals for a variety of treatment strategies to improve outcome in acute myocardial infarction. Despite consensus guidelines recommending this intervention, few emergency medical services (EMS) employ this. The authors systematically reviewed the literature to report whether mortality or treatment time intervals improved when compared with standard care. METHODS: The authors used the Cochrane strategy to search MEDLINE, EMBASE, Current Contents, Dissertation Abstracts, Cochrane Library, and Index of Scientific and Technical Proceedings. Bibliographies and grant-agency Websites were reviewed, and primary investigators and industry were contacted for published and unpublished studies. Inclusion criteria included PHECG and advance ED notification versus standard EMS care; controlled trials; English only; and evaluation of treatment time intervals, all-cause mortality, or both. Study selection was hierarchical, blinded, and independent. Agreement at each level of review was evaluated by using a kappa statistic. Study quality was measured with a validated scale and was interpreted by two independent reviewers. RESULTS: A total of 1,283 citations were identified, and five studies met the inclusion criteria. The weighted kappa for selection was 0.61 (standard error [SE], 0.045) for titles, 0.63 (SE, 0.051) for abstracts, and 0.79 (SE, 0.146) for full articles. Mean study quality measures by two independent reviewers were 6.0/15 and 5.5/15 (correlation coefficient, 0.85; p = 0.06). PHECG and advance ED notification increased the weighted mean on-scene time by 1.2 minutes (95% confidence interval [95% CI] = -0.84 to 3.2). The weighted mean door-to-needle interval was shortened by 36.1 minutes (95% CI = 9.3 to 63.0: range of means, 22-48 minutes vs. 50-97 minutes). One study reported all-cause mortality, with a statistically nonsignificant reduction from 15.6% to 8.4%. CONCLUSIONS: For patients with AMI, the literature would suggest that PHECG and advanced ED notification reduces in hospital time to fibrinolysis. One controlled trial found no difference in mortality with this out-of-hospital intervention.

Electrocardiography↗

Desktop document delivery using portable document format (PDF) files and the Web.

Desktop access to electronic full-text literature was rated one of the most desirable services in a client survey conducted by the University of Washington Libraries. The University of Washington Health Sciences Libraries (UW HSL) conducted a ten-month pilot test from August 1996 to May 1997 to determine the feasibility of delivering electronic journal articles via the Internet to remote faculty. Articles were scanned into Adobe Acrobat Portable Document Format (PDF) files and delivered to individuals using Multipurpose Internet Mail Extensions (MIME) standard e-mail attachments and the Web. Participants retrieved scanned articles and used the Adobe Acrobat Reader software to view and print files. The pilot test required a special programming effort to automate the client notification and file deletion processes. Test participants were satisfied with the pilot test despite some technical difficulties. Desktop delivery is now offered as a routine delivery method from the UW HSL.

Computer Systems↗

Public librarians as a resource for promoting health: results from the Health for Everyone in Libraries Project (HELP) librarian survey.

Public libraries are located in all communities, and two thirds of adults visit one each year. Libraries give the public access to computers and the Internet, and librarians offer technical assistance for accessing information. The interests and training needs of public librarians for assisting the public in accessing health information have not been addressed. One public library/librarian in each North Carolina county was randomly selected to complete a written questionnaire to assess health-related information services and librarians' skills for providing these services. 84% of librarians (83/99) completed the questionnaire. Results indicate that librarians answer more than 10 health-related questions per week, feel moderately comfortable answering these questions, and are very interested in receiving additional training for addressing health-related questions. Creating public library/public health partnerships holds much promise for enhancing the ability of community members to access desired health information.

Data Collection↗

Quality assurance for abdominal CT: a rapid, computer-assisted technique.

OBJECTIVE: Maintaining high standards in a large CT imaging department with multiple scanners, a large technical and clerical staff, and a rotating staff of radiologists is an ongoing challenge. We undertook a project to design and implement a simple, rapidly performed computer-assisted system of quality assurance (QA) for use in abdominal CT. In our project, we also analyzed the results of that QA system. MATERIALS AND METHODS: We graded 1810 abdominal CT studies done in a 50-week period, using a three-point scale to indicate the quality of the following five parameters of technical quality: IV contrast enhancement, oral contrast opacification, window settings and artifacts, conformity to radiologists' protocol, and completeness and accuracy of header and scout data. In addition, a parameter reflecting performance of the film library and clerical staff was similarly graded. To provide a measure of peer review for radiologists, any disagreements with prior CT study reports were recorded when comparison studies were reviewed in the process of CT interpretation. A commercially available spreadsheet and database software program was tailored to allow rapid, easily performed data entry and analysis. Tables and graphs showing performance of technologists and film library and clerical staff were generated. This customized program was made available on the radiology department computer network. Results generated by the program were further analyzed with linear regression models. RESULTS: Our QA system was successfully integrated into the routine operation of the abdominal CT division. During the first 11.5 months of operation, the system reflected improvement in each of the technical parameters with a statistically significant improvement in the combined average technical score (from 1.15 to 1.68 on a scale of 0-2; p < .0001). The "Throughout Speed/Old Exams" parameter for performance of the film library and clerical staff, which was analyzed separately from the technical parameters, also improved significantly (from 1.3 to 1.8; p < .02). Improvements were statistically significant, even when we controlled for potential variations in quality among different CT scanners and variations among the radiologists who rated the quality of the examination. Thirty-eight disagreements with previous scan interpretations (5% of all scan comparisons) were recorded for evaluation at peer review conferences. CONCLUSION: The ability to monitor performance continuously using a rapid, computer-assisted system has effected measurable improvement in our CT service. Technologist and film library and clerical staff performance improved for all parameters studied. Deficiencies were revealed and trends demonstrated. The QA system allowed us to identify disagreements in interpretation of CT examinations for subsequent peer review by radiologists. Our QA software program has been made available on the Internet as freeware to licensed Excel users via anonymous file transfer protocol at Internet Protocol 134.192.6.110.

Administration, Oral↗

[Scholarly communication in the digital era: has a new era really begun?].

In this paper the author examines the issue concerning the future direction of scholarly publications. The scholarly community has sufficient expertise and incentive to collaborate on the design of a new model for scholarly communication that takes advantage of networking technology and extends the traditional benefits of print publications. The "multicanality" presents a unique approach that integrates the elements of scholarly communication beginning at the author's keyboard and ending in the library's archives. The "multicanality" simplifies the work of authors, editors and librarians, and reduces related publishing expense. The needed technical expertise is already available to begin it.

Biomedical Research↗

Tying up lions: multilateral initiative on malaria communications: the first chapter of a malaria research network in Africa.

"When spider webs unite, they can tie up a lion" (Ethiopian folk adage). The Multilateral Initiative on Malaria Communications Network (MIMCom) facilitates a new way of doing research in Africa and African scientists' participation in the international scientific community. The MIMCom supports full access to the Internet and the resources of the WorldWide Web at 19 research sites in 11 African countries. Furthermore, the MIMCom project comprises two websites: one includes links to resources, databases, and publications as well as a document delivery service for full text journal articles, and the other is a research agenda specific website with a server for a research network desiring to share raw data. Other important components of MIMCom are training and evaluation components. The MIMCom was conceived in 1997 by African researchers and has been designed, implemented, and overseen by the U.S. National Library of Medicine in collaboration with partners in Africa, the United States, and the United Kingdom. This project demonstrates clearly that it can make a positive difference in the functioning of remote research sites in Africa, in terms of site growth and productivity and in the professional lives of individual researchers. This report reviews the project's background, methods of operation with an emphasis on local needs and priorities, cost effectiveness, and local responsibility; results focusing on a technical network; documentation of the system and two-way exchange of information; the MIMCom website; a network approach to research; and financial sustainability. The report concludes with summaries of evaluations by an independent panel, the Multilateral Initiative on Malaria Secretariat, and the U.S. National Library of Medicine.

Africa↗

'Genetics home reference': helping patients understand the role of genetics in health and disease.

The surge of information generated by the Human Genome Project has left many health professionals and their patients struggling to understand the role of genetics in health and disease. To aid the lay public and health professionals, the US National Library of Medicine developed an online resource called 'Genetics Home Reference' (GHR), located at http://ghr.nlm.nih.gov/. Launched in April 2003, GHR's goal is to help the public interpret the health implications of the Human Genome Project. It bridges the clinical questions of consumers and the rich technical data emerging from the sequenced human genome. The GHR web site is designed for easy navigation among summaries for genetic conditions and the related gene(s) and chromosome(s). This design strategy enhances the user's appreciation of how genes, chromosomes, and conditions are interrelated.

Genetic Diseases, Inborn↗

TOXLINE--an information resource.

TOXLINE is the National Library of Medicine's online bibliographic database covering the toxicologic, pharmacologic, biochemical, physiologic, and environmental effects of chemicals. It is a merged database composed of subsets from 13 different sources. Most of the citations in TOXLINE refer to journal articles; other publication types include meeting reports, monographs, patents, research project reports, technical reports and theses. TOXLINE is searched using a number of synonyms to fully express a concept, as compared to MEDLINE which can be searched by standard terms, thus obviating the need for synonym search terms. Toxicologists, other scientists, and clinicians are encouraged to become familiar with online searching techniques and to conduct their own searches.

Drug Information Services↗

Internet resources available to otolaryngologists.

During recent years, the Internet has evolved into the largest computer network in the world, allowing access to vast amounts of information and services. Medical information is increasingly available to both patients and professionals, and ever more biomedical resources are becoming available on-line to assist in research, clinical medicine, and education. The Internet has always provided useful resources to otolaryngologists, implemented at various academic departments and national organizations or by specialists or specific medical web sites offering technical, scientific, and biomedical information. The purpose of this article is to provide as complete a list as possible of the World Wide Web sites accessible through the Internet that are of interest to otolaryngologists. It summarizes different types of resources available, including educational material, audiology sites, outcomes research, discussion lists, research laboratories, publications, medical libraries, news and medical conferences, organizations, academic departments, otolaryngological and medical resources, medical and surgical equipment and suppliers, and miscellaneous other sites of interest to otolaryngologists. This review is intended to present the wealth of the accessible information on the Internet and to promote the use of the network to otolaryngologists who do not have extensive experience in computers or telecommunications.

Computer User Training↗