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Collection development using interlibrary loan borrowing and acquisitions statistics.

Libraries, especially those supporting the sciences, continually face the problem of selecting appropriate new books for their users. Traditional collection development techniques include the use of librarian or user subject specialists, user recommendations, and approval plans. These methods of selection, however, are most effective in large libraries and do not systemically correlate new book purchases with the actual demands of users served. This paper describes a statistical method for determining subject strengths and weaknesses in a library book collection in relation to user demand. Using interlibrary loan borrowing and book acquisition statistics gathered for one fiscal year from three health sciences libraries, the authors developed a way to graph the broad and narrow subject fields of strength and potential weakness in a book collection. This method has the advantages of simplicity, speed of implementation, and clarity. It can also be used over a period of time to verify the success or failure of a collection development program. Finally, the method has potential as a tool for use by two or more libraries seeking to improve cooperative collection development in a network or consortium.

Interlibrary Loans↗

[Animal experimentation in Israel].

In 1994 the Israeli parliament (Knesset) amended the Cruelty to Animals Act to regulate the use of experimental animals. Accordingly, animal experiments can only be carried out for the purposes of promoting health and medical science, reducing suffering, advancing scientific research, testing or production of materials and products (excluding cosmetics and cleaning products) and education. Animal experiments are only permitted if alternative methods are not possible. The National Board for Animal Experimentation was established to implement the law. Its members are drawn from government ministries, representatives of doctors, veterinarians, and industry organizations, animal rights groups, and academia. In order to carry out an animal experiment, the institution, researchers involved, and the specific experiment, all require approval by the Board. To date the Board has approved some 35 institutions, about half are public institutions (universities, hospitals and colleges) and the rest industrial firms in biotechnology and pharmaceutics. In 2000, 250,000 animals were used in research, 85% were rodents, 11% fowls, 1,000 other farm animals, 350 dogs and cats, and 39 monkeys. Academic institutions used 74% of the animals and industry the remainder. We also present summarized data on the use of animals in research in other countries.

Animal Welfare↗

ICT in health care: sociotechnical approaches.

The importance of the social sciences for medical informatics is increasingly recognized. As ICT requires inter-action with people and thereby inevitably affects them, understanding ICT requires a focus on the interrelation between technology and its social environment. Sociotechnical approaches increase our understanding of how ICT applications are developed, introduced and become a part of social practices. Socio-technical approaches share several starting points: 1) they see health care work as a social, 'real life' phenomenon, which may seem 'messy' at first, but which is guided by a practical rationality that can only be overlooked at a high price (i.e. failed systems). 2) They see technological innovation as a social process, in which organizations are deeply affected. 3) Through in-depth, formative evaluation, they can help improve system design and implementation.

Computer Communication Networks↗

Variability science in intensive care - how relevant is it?

The article by Seely et al. in this issue of Critical Care highlights that variability portend prognosis. Numerous parameters interact to modify variability in intensive care. The commentary discusses why variability can nevertheless accurately estimate prognosis and how easily this can be implemented in the critically ill.

Artifacts↗

Injury and violence in Los Angeles. Impact on access to health care and surgical education.

The Los Angeles County (California) Trauma Hospital System was designed to ensure that all patients requiring specialized trauma care would be transported directly to a trauma center using established trauma triage criteria. The designation and implementation of all level 1, 2, and 3 (rural) trauma centers were completed between October 1983 and July 1985. However, by February 1, 1985, one level 2 trauma center withdrew, and nine other level 2 and 3 trauma centers followed suit over the next few months and years. The reasons for closure of these 10 trauma centers were almost exclusively related to economic factors. The major impact of trauma center closure on surgical educational programs at the Drew University of Medicine and Science and the Martin Luther King, Jr/Charles R. Drew Medical Center have been additive and cumulative. The high volume of patients with trauma has been cited, sometimes correctly and sometimes incorrectly, as the primary reason for a lack of access to health care for patients without trauma. We have developed a blueprint for survival that, when fully implemented, will improve access to health care for all residents in our catchment area and optimize surgical education. While the Los Angeles County Trauma Hospital System has had many difficulties during the last 9 years, the population it serves is greater than that in 42 states in the United States. The experiences gained in Los Angeles County may be beneficial to statewide systems in the United States and in countries of comparable size.

General Surgery↗

The organization of statistical activities at medical research institutions.

In this paper, we discuss the organizational structure for the conduct of statistical activities at medical Colleges and Universities. Here, we have particularly focused on two significant statistical activities, i.e., statistical consultation and research. The consulting service for medical researchers consists of practical statistical analysis, instruction on computer manipulation and software, response to reviewer's comments and statistical design of prospective studies. From our various experiences, we describe the actual implementation of statistical consultations for medical researchers. It has played an important role in supporting medical research. In addition, we also outline some research, with respect to new ways of applying statistics in medical science. This paper concludes that it may be practical for the existing computer center or department of medical informatics, in charge of the computing service, to conduct statistical activities until formal organizations are established at the academic institution. To realize the conduct of statistical activities by Department of Medical Informatics, it needs a team of biostatisticians, data analysts and computer personnel.

Computer Systems↗

International nursing education: challenges and strategies for success.

The Nursing Education Partnership Program between Nell Hodgson Woodruff School of Nursing at Emory University and Foo Yin Junior College of Nursing and Medical Technology in Taiwan is in its third year. This program provides an opportunity for associate-degree nurses from Taiwan to earn a bachelor of science degree in nursing. The educational challenges, inherent in such a program, became evident early in the first semester. This article outlines those challenges and the educational strategies that were successful with this group. Implementation of the curriculum reflects four culturally significant aspects of the educational process: identifying community resources to meet basic needs for adaptation to a foreign country; redesigning teaching and learning strategies for international students; preparing faculty, clinical agency staff, patients, and other students to accept and become actively involved in this international program; and developing faculty-student relationships that promote mentoring and foster professional role development. Although the strategies presented were used with a group of students from Taiwan, they also can meet the needs of other international students.

Community Participation↗

[The concept of social marketing--potential and limitations for health promotion and prevention in Germany].

"Social marketing" is the use of marketing principles to design and implement programmes to promote socially beneficial behaviour changes. In the field of health promotion and prevention, the systematic planning process of social marketing can offer new ideas and perspectives to the traditions of social science. Major characteristics of social marketing encompass continuous market research focussing on attitudes, motives and behavioural patterns of the target group, an integrated mix of strategic key elements, and the perpetual evaluation of all procedures. So far, however, it is unclear in how far social marketing is actually more effective than other concepts of programme planning. Furthermore, it has to be discussed whether the underlying philosophy of social marketing and its implicit understanding of relationships to the public are reconcilable with health promotion principles. In Anglo-Saxon countries, the social marketing concept has achieved widespread application and is subject to controversial scientific discussions, whereas this approach is hardly considered in German health promotion research and practice. Given the increasing call for quality management and evaluation of health promotion interventions, the social marketing concept may contribute useful insights at an operational level and thus add to a discussion on effective approaches for programme planning.

Germany↗

Implementing a comprehensive relative-value-based incentive plan in an academic family medicine department.

The authors describe the implementation and first three years (1997-1999) of a department-wide incentive plan of the Department of Family Medicine at the State University of New York at Buffalo School of Medicine and Biomedical Sciences. By using a consensus approach, a representative elected committee designed a clinical relative value unit (explained in detail) that could be translated to equally value and reward faculty efforts in patient care, education, and research and which allowed the department to avoid the imposition of a model that could have undervalued scholarship and teaching. By 1999, the plan's goal of eight patient-care-equivalent points per four-hour session had been exceeded for pure clinical care. Clearly, only a small financial incentive was necessary (in 1999, an incentive pool of 4% of providers' gross salary) to motivate the faculty to be more productive and to self-report their efforts. Long-term productivity for pure clinical care rose from 9.8 points per session in 1997 to 10.4 in 1999. Of the mean total of 3,980 points for the year 1999, the contribution from teaching was 1,146, or 29%, compared with 25% in 1997. For scholarship, the number of points was 775, or 20%, in 1999, compared with 11% in 1997. The authors describe modifications to the original plan (e.g., integration of quality measures) that the department's experience has fostered. Problems encountered included the lack of accurate and timely billing information from the associated teaching hospitals, the inherent problems of self-reported information, difficulties of gaining buy-in from the faculty, and inherent risks of a pay-for-performance approach. But the authors conclude that the plan is fulfilling its goal of effectively and fairly quantifying all areas of faculty effort, and is also helping the department to more effectively demonstrate clinical productivity in negotiations with teaching hospitals.

Faculty, Medical↗

An affiliated professional group approach to education.

It is challenging to create comprehensive yet flexible continuing education programs for the affiliated professional (AP) about heart failure and sudden cardiac death. This challenge exists due to the varying levels of experience among APs. Yet a group of APs met this challenge by designing such a program in a short time frame. The program included clinical science, drug and device therapies, case studies, content outlines, videos, and handouts. Content could be adapted to the knowledge level of any audience. This unique approach to developing an educational program, and its successful implementation, demonstrates its applicability to other topics in APs' continuing education.

Education, Nursing, Continuing↗

Mission-based reporting in academic psychiatry.

OBJECTIVE: This article describes a data entry and analysis system called Mission-Based Reporting (MBR) that is used to measure faculty and department activities related to specific academic missions and objectives. The purpose of MBR is to provide a reporting tool useful in evaluating faculty effort and in helping chairs 1) to better assess their department's performance in relation to other departments and their school as a whole, 2) to plan for the future, and 3) to reward individual faculty members. METHODS: Mission-Based Reporting summaries, generated for each faculty member and each department, illustrate contributions to each of four missions: research, teaching, clinical service, and administrative/public service. Data from MBR can be used to evaluate whether faculty scholarly contributions are appropriate to their rank and series. That report provides data from the Department of Psychiatry and Behavioral Sciences at the University of California and the University of California Davis School of Medicine (UC Davis). CONCLUSIONS: Mission-Based Reporting is a useful management tool for department and school administrators. Improvements in implementation are proposed.

Data Collection↗

Minimally invasive management of colon cancer.

One of the most controversial issues in minimally invasive surgery has been the implementation of laparoscopic techniques for the curative resection of colorectal malignancies. Initial concerns included the potential violation of oncologic principles, the effects of carbon dioxide, and the phenomenon of port site tumor recurrence. Basic science research and large randomized controlled trials are now demonstrating that these fears were unjustified. Long-term outcomes of laparoscopic colon resection compared with open colon resection for malignancy are comparable, and there may even be a survival benefit for a subset of patients who undergo laparoscopic resection.

Colectomy↗

Towards the computerized animal house: the Newcastle University Animal House Management System.

A suite of computer programs (available from the Laboratory Animal Science Association) has been written to carry out much of the routine administration of a central animal house facility. Principal functions include stock control and accounting. The programs are fully portable and can be implemented on almost any microcomputer. They are protected against data-entry errors and can be used by staff who have little or no computer experience. In 10 months' use at the Comparative Biology Centre, the Newcastle University Animal House Management System has become an indispensable management tool. The system has also been successfully implemented at Bath University.

Accounting↗

A pivotal role for physician executives.

Physician leaders are needed to fill a pivotal role in the health care industry of the '90s. Medical education based solely on traditional scientific methods will continue to produce physicians with excellent clinical and research skills. However, study of science alone will not produce physician leaders. Effective leaders will also need to understand the tools and concepts of organization and management. These leaders will need to participate in the process of formulating and implementing policies to promote the development of economical financing and delivery arrangements while simultaneously improve the quality of care provided.

Health Policy↗

Why a research study needs a design?

Medical research requires as much attention to management as it does to science. Effective research depends first upon the thoughtful statements of purpose and objectives, and related research questions. These important initial steps in turn drive key decisions regarding study type, plans for analyses and competent implementation within bounded timeframes and budgets. The research endeavour materializes by selecting appropriate study types based on coherent research questions, appropriate data collection, and ultimately concludes by drawing inferences on the basis of properly planned analyses. This article reviews these principles and inter-relationships.

Clinical Trials as Topic↗

[Successes and failures of anti-HBV vaccination in France: historical background and questions for research].

The promotion in France, in the mid 90s of hepatitis B vaccination for pre-teenagers and high-risk individuals has been very successful. Between 1994 and 1998, vaccination coverage in pre-teenagers was over 75% and more than one third of the French population has been immunized, indicating that vaccination went well beyond its target. Vaccination of infants has been much less successful. Epidemiological studies, undertaken following notifications of neurological events following vaccination, could neither confirm nor totally disprove an association between the two events, even if the hypothesis of a coincidental temporal relationship remains by far the most likely explanation. This situation led to the stagnation or the decrease of the vaccination coverage for its various target-populations. However other factors may have contributed to this situation. Research in social sciences would be useful to study the contribution of a negative perception of the epidemiological relevancy of hepatitis B vaccination, especially in infants, as well as of the shortcomings in the management of the implementation of the vaccination strategies. The results would help to tailor communication strategies that are needed to support an active promotion of hepatitis B vaccination in France.

Adolescent↗

Student upward mobility: utilization of an educational support model.

Hampton University School of Nursing was funded by the Teagle Foundation in 1990 for four years and later expanded for an additional year to develop, implement and evaluate an innovative Individualized Educational Support Model for licensed practical nurses (LPNs) residing in Southeastern Virginia. Project staff assigned the Teagle Initiative developed a model program for LPNs seeking the Bachelor of Science degree in nursing. The Teagle model offers opportunities for advanced placement through National League for Nursing Mobility Examinations, CLEP, ACT-PEP, and challenge examinations; tutoring by faculty and peers; counseling by project staff for academic and financial aid, and other concerns as needed; socialization with other project students and generic students; monthly stipends to assist with additional expenses incurred when the adult student returns to school and an alternative admissions criteria for the LPN who may not meet all aspects of the Hampton University admissions criteria.

Career Mobility↗