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The health information environment: a view of organizational and professional needs and priorities.

Inspired by Platform for Change: The Educational Policy Statement of the Medical Library Association, this paper discusses the institutional changes, new delivery modes and services, learning and development, leadership, and strategies needed for health sciences librarians to prosper in the changing medical information environment. To fulfill their potential, librarians must articulate and act upon a vision that involves them more fully in the work of faculty, researchers, and medical practitioners.

Curriculum

Charting a path for health sciences librarians in an integrated information environment.

Changes in the health information environment present a major challenge to health sciences librarians. To successfully meet this challenge, librarians must apply the concepts of informal, self-directed, lifelong learning to their own carers. The Joint Commission on Accreditation of Healthcare Organizations is creating an integrated information environment in health care organizations. The health sciences librarian brings unique knowledge and skills to this environment. The reference technique, a methodology that closely parallels other problem-solving approaches such as the physician's diagnostic technique, equips librarians with the conceptual skills to develop creative solutions to information management problems. Each health sciences librarian must assume responsibility for extending professional skills and abilities and demonstrating them in the workplace.

Curriculum

The Virginia Henderson International Nursing Library: resource for nurse administrators.

This article describes the major knowledge resource of the Virginia Henderson International Nursing Library, The Registry of Nursing. The first part of this article examines informatics issues and is accompanied by examples of retrieval from a typical bibliographic database and a retrieval from the Registry of Nursing Research using case mix, both as a subject heading and as a research variable. The second part of the article examines the interaction of informatics and technology used in the Registry and presents some other Library resources.

Humans

Health information multitype library reference referral networking: panacea for the '90s.

Librarians are exploring new approaches to information sharing to cope with a rapidly changing environment dominated by budget cuts, information explosion, and globalization of the economy, science, and culture. In 1990, the University of Illinois at Chicago Library of the Health Sciences (UIC LHS) initiated a pilot project aimed at establishing an effective balance between state-of-the-art information technology and traditional library methods and promoting cooperation among health information professionals by establishing the Health Information Referral Network (HIRN) in the state of Illinois. HIRN's background and development, Internet home page, and networking techniques reviewed in this paper are applicable to multitype libraries and information centers interested in improving information use and the referral process.

Computer Communication Networks

The development and application of automated gridding for efficient screening of yeast and bacterial ordered libraries.

An automated gridding procedure for the inoculation of yeast and bacterial clones in high-density arrays has been developed. A 96-pin inoculating tool compatible with the standard microtiter plate format and an eight-position tablet have been designed to fit the Biomek 1000 programmable robotic workstation (Beckman Instruments). The system is used to inoculate six copies of 80 x 120-mm filters representing a total of approximately 20,000 individual clones in approximately 3 h. High-density arrays of yeast artificial chromosome (YAC) and cosmid clones have been used for rapid large-scale hybridization screens of ordered libraries. In addition, an improved PCR library screening strategy has been developed using strips cut from the high-density arrays to prepare row and column DNA pools for PCR analysis. This strategy eliminates the final hybridization step and allows identification of a single clone by PCR in 2 days. The development of automated gridding technology will have a significant impact on the establishment of fully versatile screening of ordered library resources for genomic studies.

Animals

Automated high-throughput liquid-liquid extraction for initial purification of combinatorial libraries.

An automated high-throughput liquid-liquid extraction (LLE) methodology has been developed and utilized for the initial purification of the combinatorial library samples containing unreacted amines and other water-soluble byproducts or impurities. Various extraction solvents were evaluated along with different extraction devices. The LLE method was automated using 96-well-format plates and a robotic liquid-handling workstation. In the optimized LLE method, crude combinatorial library samples were dissolved in a water-immiscible organic solvent, butyl acetate, and added to each well in a 96-well-format plate packed with an inert support material coated with hydrochloric acid. Separation occurs based on the partitioning of the compounds between two liquid phases. Product recovery, purity, and amine removal efficiency were determined by HPLC with and without precolumn derivatization. The automated method was successfully applied to the cleanup of some representative combinatorial library samples with greater than 98% amine removal and an average product purity of 90%. The application of the automated high-throughput LLE method should greatly reduce the labor, time, and cost associated with the purification of combinatorial libraries.

Amines

Automation of film library functions.

The use of computer routines in the film library has resulted in tremendous improvements in the prompt interpretation of radiologic studies with comparison studies and in the furnishing of radiologic studies on demand to referring physicians. The four most important aspects of this automation are the simultaneous immediate availability of patient information upon inquiry at a terminal; maximum advance notification of the need for a new folder or a master folder on a returning patient; master folder, subfolder, and examination folder tracking; and the management of extradepartmental loans.

Computers

Automating Veterans Administration libraries: II. Implementation at the Kansas City Medical Center Library.

In 1985, the Kansas City Veterans Administration Medical Center began implementation of the Decentralized Hospital Computer Program (DHCP). An integrated library system, a subset of that program, was started by the medical library for acquisitions and an outline catalog. To test the system, staff of the Neurology Service were trained to use the outline catalog and electronic mail to request interlibrary loans and literature searches. In implementing the project with the Neurology Service, the library is paving the way for many types of electronic access and interaction with the library.

Catalogs, Library

Developing a health information infrastructure for Arizona.

Network connectivity is critical in Arizona, where travel distances are great, academic programs dispersed, and health care practitioners often geographically isolated. Accordingly, the University of Arizona (UA) applied for $50,000.00 in National Library of Medicine/National Science Foundation (NLM/NSF) Connections Program funding to promote statewide collaboration in supporting UA's health sciences education and research programs by expanding network connectivity to hospitals and other health-related institutions. The proposal outlined three strategies: Each major nonuniversity teaching hospital would secure and maintain a leased communications line dedicated to network connectivity, and NSF funds would be used to buy some necessary hardward. NSF funds would be used to establish a modern bank for dial-up Internet access by rural practitioners and teaching sites. Co-principal investigators of the project would promote and support the use of this new statewide connectivity and foster its continued expansion. The proposal was based on a conservative philosophy: familiar technologies and, where possible, existing networks and equipment would be used. The proposal was approved, and NSF funds hastened creation of an expanded health information network in Arizona. Once that network was in place, participants moved quickly from managing the mechanics of connectivity to planning for a computing and communications platform with services. Private funds were obtained to help organize the Arizona Health Information Network to direct these expanded services.

Arizona

The controversy over change.

The full impact of twentieth century technology upon medical libraries was first felt in the late 1950s and early 1960s with the introduction of electronic automation into library methodology. During those years, often the aura of technology for the sake of technology prevailed, and medical librarians did little to inform themselves of capabilities, potentialities, and limitations in relation to cost-effective library usage of automation. Likewise, currently microforms and audiovisuals are frequently acquired for their own sake instead of for their capacity to transmit messages in the most effective and comprehensive way possible. Controversy has raged and still rages over the pros and cons of applying modern technology to library procedures and over the coexistence of the printed page with electronic media. New systems and methodologies, machine or manual, must realistically be evaluated in terms of increased service output by the library to its clientele. Regardless of technological sophistication, any machine that does not significantly contribute to that specific aim has no place in a library. The tradition of the medical librarian has always been to collect, organize, store, and disseminate information in the most efficient manner that the media of the times have had to offer.

Audiovisual Aids

New developments in automated PrepLCMS extends the robustness and utility of the method for compound library analysis and purification.

New developments in the high throughput purification of combinatorial libraries by automated preparative LC-MS is presented. To facilitate high speed purifications at the multimilligram level, short columns operated at ultra high flow rates were incorporated. In order to match the linear velocity of the short analytical columns for high speed separations (operated at 4.0 mL/min), it was required to operate the preparative columns at flow rates in excess of 70 mL/min. For chromatographically well-behaved compounds, analytical LC-MS analyses and preparative LC-MS analyses could be achieved in as little as 5 min. For compounds exhibiting poor chromatographic peak shapes and/or for compound mixtures requiring higher resolution separations, slightly longer preparative LC-MS analysis times were required (8-10 min/sample).

Chemistry, Pharmaceutical

Inventory management and reagent supply for automated chemistry.

Developments in automated chemistry have kept pace with developments in HTS such that hundreds of thousands of new compounds can be rapidly synthesized in the belief that the greater the number and diversity of compounds that can be screened, the more successful HTS will be. The increasing use of automation for Multiple Parallel Synthesis (MPS) and the move to automated combinatorial library production is placing an overwhelming burden on the management of reagents. Although automation has improved the efficiency of the processes involved in compound synthesis, the bottleneck has shifted to ordering, collating and preparing reagents for automated chemistry resulting in loss of time, materials and momentum. Major efficiencies have already been made in the area of compound management for high throughput screening. Most of these efficiencies have been achieved with sophisticated library management systems using advanced engineering and data handling for the storage, tracking and retrieval of millions of compounds. The Automation Partnership has already provided many of the top pharmaceutical companies with modular automated storage, preparation and retrieval systems to manage compound libraries for high throughput screening. This article describes how these systems may be implemented to solve the specific problems of inventory management and reagent supply for automated chemistry.

Automation

The library and its home computer: automation as if people mattered.

To provide its users with quick and easy access to the library resources, the Muriel and Philip Berman National Medical Library, Jerusalem, between 1978 and 1982 developed an integrated library system (MAIMON) on a minicomputer. Because humans are the most important element of the library system, MAIMON's performance was evaluated in terms of benefits provided to patrons, library management, and library staff. After successfully adopting the system, users' needs and expectations have grown. How the existing system will be used and expanded to meet the new information demands at the library is discussed.

Computers

Screening yeast artificial chromosome libraries with robot-aided automation.

Screening of collections of yeast artificial chromosomes utilizing the polymerase chain reaction (PCR) requires large numbers of reactions in parallel. Four steps were implemented to reduce the labor involved: (a) The number of initial samples for DNA extractions was decreased by compressing libraries up to 12-fold. (b) DNA extraction from yeast clones was robot assisted. (c) A BIOMEK 1000 station was adapted to pipette samples for PCR assays. (d) Sample preparation was integrated with a temperature cycler constructed to carry out up to 576 reactions in six 8 x 12-well trays. The implementation of these steps increases the number of reactions per person per day by an order of magnitude. In tests with X-chromosome-specific probes, the robot-aided screening recovered all of the clones detected by slower manual methods.

Chromosomes, Artificial, Yeast