By the Book


April 2016

NLM Funded Project

This came through on the SLIS listserv. I wanted to make sure people didn’t miss it – it looks like a great opportunity.

This summer (2016), the Brown Center for Biomedical Informatics (BCBI) is seeking a library/information sciences graduate student to work on a project funded by the National Library of Medicine, National Institutes of Health. The student researcher will be directly involved with the analysis of existing metadata schema associated with biological and biomedical resources, with the goal of developing a metadata crosswalk that links information about medicinal plants among publicly accessible resources. The researcher will also be involved with the development of a systematic mapping process that includes data from large stores of biomedical and biodiversity data, aiming to support the discovery of potential phytotherapies across non-conventional sources that are being analyzed for the overall project.

The researcher’s total summer stipend will be $4,500. He/she will be expected to submit 5 bi-weekly installments of $900 (see below for proposed invoice schedule). Competitive candidates will be currently enrolled in an ALA-accredited Master’s degree program. Experience (including coursework) in interpreting metadata documentation and creating crosswalks is highly desirable.

The student will be expected to be onsite in Providence, Rhode Island for at least one of ten weeks in the summer.

1. June 15, 2016
2. June 29, 2016
3. July 13, 2016
4. July 27, 2016
5. August 10, 2016

Interested students may email Erika Sevetson,<>, with their resume/cv. Cover letter is not necessary.

Erika Sevetson, MS
Head of Health and Science Information Services/Health Sciences Librarian
Brown University Libraries
Box G-M155
Providence, RI 02912

Analysis of Inconsistencies in Terminology: An Article Summary

Arvin, Shelley D. “Analysis of inconsistencies in terminology of spinal and bulbar muscular atrophy and its effect on retrieval of research.” Journal of the Medical Library Association, 102.2 (2013): 147-150.

Arvin notes that the many names diseases are called (especially new and rare diseases) can lead to problems in searching. While trying to assemble a complete bibliography on spinal and bulbar muscular atrophy (SBMA), she formulated some strategies for searching which medical librarians can utilize for such difficult searches. Usually searching can be performed with reference to the thesaurus and subject headings available. Unfortunately, this is not always possible with rare and new diseases. In the case of SBMA, more accurate and newer subject headings were not backdated, so many of the older articles would not be retrieved by a search for the newer subject headings anyway. Arvin started with a basic overview of the disease, as well as two known name variants. Whenever new variants were discovered, they were added to the search process, and old searches were re-run to make sure that nothing was missed. Arvin used EndNote to keep track of the name variants and how often they occurred. Through this process, she turned up 788 records (some repeated with slight variations) under 206 name variants published from 1968-2010. An analysis of the data showed that most of the variations were used very infrequently – a search of just the top 8 name variants would retrieve 83% of the results found. Additionally, name variations ran in families, many barely different from each other. She concludes that being aware of such difficulties and trends may help researchers struggling with similar cases.

I’m not sure that it merited a full article, but the search process was carried out well and quite impressive in its results. It was nice to see an example of the whole search process worked out.

Comparing UpToDate and ClinicalKey

Naturally, after looking at both UpToDate and ClinicalKey, I was interested in seeing how they compare to each other. Several articles have compared the two, but I looked at this one. It details a survey of user preferences sent to medical students and professors associated with the A.T. Still University of Health Sciences. Overall, respondents found UpToDate slightly preferable. Practitioners working in a clinical setting strongly preferred UpToDate for its “ease of use and efficiency in answering specific questions.” Those based in classroom settings, however, tended to like ClinicalKey more, because it offered better research support.

Overall, it sounded to me like both are excellent resources for health care givers, even if UpToDate perhaps has the edge of point-of-care needs. It’s great that practitioners have tools like these to draw upon.


Tonight in class we talked about point-of-care tools. With that on my mind, I though I might find out a little more about ClinicalKey, Elsevier’s offering. It was launched in April of 2012, combining content from several of Elsevier’s previous products, notably MD Consult. According to its website, ClinicalKey boasts more than 2 million images, 1,000 reference books, and 60 full text journals. It provides topic pages (which reminded me strongly of libguides) for more than 1,400 diseases. An interesting feature I discovered was that there are built in features to make creating a presentation of the material as easy as possible.

Although sources were more difficult to find on this than on UpToDate, there are a number of YouTube videos which provide good walk-throughs and background on the resource. One of the ones I looked at is below.

The Effect of a Clinical Medical Librarian On In-Patient Care Outcomes: An Article Summary

Esparza, Julia M., et al. “The effect of a clinical medical librarian on in-patient care outcomes.” Journal of the Medical Library Association, 101.3 (2013): 185-191.

Doctors often have to research in order to provide superior patient care. The importance of this part of the healthcare process (together with the rise of the Internet) led to the creation of clinical medical librarians (CMLs) in the 1970s. CMLs are generally considered to be quite helpful in research, but their actual impact has proved difficult to measure. Although one study performed found that the CML involvement led to a shorter patient stay times and quicker treatment, the field of patients which matched the criteria was very limited. To begin filling this void, the authors decided to study whether having an embedded CML at LSU Health Shreveport would make a difference in patients’ length of stay/cost of care/readmission rate for patients. An experienced CML was hired, and began going on the morning rounds with the care providers. Additionally, the CML was given access to the electronic patient records. Two groups (one control, one test) were selected, 253 patients in each. Patients were added to the test group when a care provider asked the CML a question about care specifically for that patient. Three analyses were performed in total: a comparison between test and control groups for outcome variables, between the time in care, etc. between each of the test group and up to 4 patients with similar situations in the last 5 years, and between the in-hospital mortality rates of test subjects with the closest matched control. During the study, the CML was most often asked questions concerning treatment and diagnosis, but also called upon for general overviews of the subject. The sites most often consulted were PubMed, AccessMed, and MD Consult. Overall, results for the intervention group were much worse than the control group. This turned out to be because patients in the test group were overall in worse condition (though also younger) than those in the control group. When the findings were adjusted for this, they found no particular difference between the presence and absence of a CML, except that (bizarrely) the intervention group were readmitted within 30 days something around 5 times more frequently. Although the discussion did reveal certain limitations of the study (only one CML was studied, study wasn’t randomized, and the groups studied could have been larger) it also noted a remarkable number of variables beyond the control of the researchers, some of which probably influenced the outcome of the study.

This paper was an interesting look at a study that was conducted scientifically but still yielded disappointing results.

Health Literacy: What Is It? An Article Summary

Berkman, Nancy D., Terry C. Davis and Lauren McCormack. “Health Literacy: What Is It?” Journal of Health Communication, 15.S2 (2010): 9-19.

The authors start with an examination of the history of measuring literacy in the United States. Interestingly, this shows that the level of ability involved in the definition of literacy used in measurements has increased over time. (For example, up through the 1930s, literacy was simply considered the ability to read and write in any language. But by the 1905s, functional literacy was considered as having at least a 6th grade education, and today people are often expected to have postsecondary training in order to get jobs.) Although studies have shown that illiteracy is declining, many adults still function with very low literacy levels. Widely cited surveys of adult Americans in the 1990s which looked at literacy as a set of skills with three domains (prose, document, quantitative skills) found that 21-23% of the population was in the lowest of the 5 literacy levels, with 25-28% in the second lowest.  However, it was not until 2003 that a large scale assessment included questions on health literacy (National Assessment of Adult Literacy Survey (NAAL) asked questions involving clinical, preventive, and navigation of the health care system).

The article notes that there is not really a consensus on what health literacy means, but rather many separate definitions. For their own use, the authors modify a widely used definition of health literacy: “the degree to which individuals can obtain, process, understand, and communicate about health-related information needed to make informed health decisions” They then provides a discussion of all the different components which make up the warring definitions. Firstly, is health literacy an individual-based or broader construct? They conclude that it is generally targeted at the individual – aimed at a single person’s ability or capacity. How does the health care system influence the definition of health literacy? They find that while health literacy definitions should take into account technology and the society overall, they shouldn’t overdo it. Finally is health literacy static or dynamic? They think that it is dynamic, growing as individuals encounter new situations. Overall, however, the authors conclude that there is no one right definition of health literacy. Since this variety reflects the complexity of the field, researchers should choose the definitions which fits their needs.

This was a very useful article for the student or professional just coming to the subject of health literacy. I found it to be thoroughly researched and quite well done.


Although the topic of point-of-care tools was moved from presentations to class, I thought I might do a little research on my own. The first tool I looked at was UpToDate, which is currently owned by Wolters Kluwer.

UpToDate was originally created by Dr. Burton Rose, a teacher at the Harvard Medical School. He had written and published a textbook on nephrology, and was eager to make it readily available to doctors through the emerging medium of computers. His publisher would not take on the project, so Dr. Rose and his wife, together Dr. Joseph Rush, began the company in Rose’s basement.

According to their website, UpToDate now services over 1.1 million clinicians in 180 countries with 23 different specialties. Surveys show that users find what they need more than 92% of the time.

For more information, check out these pages:

And for an extended tour of UpToDate’s features, watch this video:

Vital Pathways

I think Vital Pathways was mentioned just in passing during class, but I decided to look a little further into it. Vital Pathways: The Hospital Libraries Project was created by the MLA in 2005 to study trends in hospital libraries and see how the organization could best support hospital librarians. After an extensive amount of study, the task force recommended several strategies to help hospital librarians continue in the face of cutbacks. These included self promotion, doing research and sharing results, getting rid of irrelevant or outdated services, and networking with colleagues to share ideas. You can read a more extensive report at

Cohort Studies

Earlier this semester, I was in a group which gave a presentation on cohort studies. In this study type, the researcher identifies a group (cohort) with similar characteristics, and observes whether or not similar developments occur across the group over time. If so, it is possible that the characteristics have an influence on the developments.

This type of study has been employed by scientists since the 1700s, when James Lind used it to discover treatments for scurvy. Although cohort studies are used in many disciplines (including library science) the bulk are still performed in the areas of medicine and health science. This makes it a useful term for a medical librarian to be acquainted with (especially when searching for particular types of studies).

For more about cohort studies, try looking at these articles:

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