28 August 2007

Blog burnings

Being on holiday, I've had a chance to do a little thinking about the blogging experience. I read blogs compulsively, blogs by librarians being the most numerous of my subscriptions. I am fascinated by big tech blogs like Downloadsquad, Lifehacker and Engadget; and I value more offbeat productions like 3 Quarks Daily and Separated By A Common Language.

Like real life, the world of the blog can get crazy sometimes — and really nasty. We are familiar with blogs whose primary role is to attack or ridicule without pity, shame or self-respect. I think of the pathetic celebs of perezhilton.com, Anne Coulter's ghastly effusions, or Canada's own rabid small dead animals. It's an uncontrolled, scabrous and ribald world out there in Blogland, where the still-steaming offal is flung at and by the moneyed, the moronic and the run-amoks.

The classic blog attack
There's nothing that gets my pulse going like a no-holds-barred blog attack. A good example is the recent hilarious tirade by David Rees that appeared in the Huffington Post, Cormac Ignatieff's "The Road". Rees takes perverse pleasure in publicly eviscerating former Harvard intellectual, now deputy leader of Canada's Liberal Party, Michael Ignatieff — and scattering his entrails across cyberspace. Rees writes in a uniquely American patois which combines elements of Vaudeville, tent preaching, scat singing, diss tracks, talk show one-liners, and Madison Avenue jingle into a roiling, roisterous monologue of vilification and contumely, all set in a colourful text boasting 33 words entirely in upper case and 40 exclamation marks!

One of America's peculiar gifts to the world is this kind of unhinged, loopy, over-the-top rant. What a performance! But for all the Schwärmerei of his perfervid prose and his sheer delight in not merely flying to extremes but abiding there, Rees commits the error that many bloggers fall into. Not that he cares, but he cannot break out of his own clowning, frantically clawing, self-referential, all-consuming act. Here in spades is a notable feature of postmodernity: the encanaillement and Tarantinization of social discourse among the educated elite. Yes, he nails Ignatieff — an easy target whom many Canadians lampoon as the "Prince of Darkness" — but only in the way one would embarrass an opponent by, say, ripping off his pants in the middle of Times Square, slapping him about, and then pushing him into traffic. Committed political argument is replaced by cruel badinage in Bourdieu's society of the spectacle.

Caught in its own kitsch, Rees's surreal criticism amounts to little more than unrestrained and quasi-violent raillery. Through some awful metastasis of his psyche he swells up with frightful Schadenfreude — he knows a mountebank when he sees one — but beyond the seething invective his critique is limited to variations on "You lying sack of s**t." He does not seem to have a very active sense of history, either as hope or as memory. His smirking, gloating, parodying, bombast approaches the hysterical sublime. He's as mad as a one-legged man in an ass-kicking contest; but he can't hold himself back and come up with a substantive analysis. Rather than encouraging his audience into some form of resistance to the threat of poseurs and lackeys like Ignatieff, Rees is content to finish up his dirty work, mop his hands, pop a final raspberry from behind that thicket of exclamation marks, and exit stage left. The comedic spectacle concludes, and we poor onlookers are left with nothing but fading laughter amid the wreckage.

From the hysterical sublime to the ridiculous
I have a particular interest in blogs dedicated to hating or parodying a certain person, notion or institution. The I Hate Wikipedia blog's purpose is pretty obvious, and I Hate The New Yorker is still hurling the magazine across the room. In the tech world there is the The Secret Diary of Steve Jobs (whose author was recently revealed to be Daniel Lyons, a senior editor at Forbes magazine) and Microsoft Sucks!!!

I distinguish these from the we-mean-business hate blogs, of which there are far too many for our own good. Beyond the febrile and furunculous ravings of klansmen, knuckle-draggers and just plain kooks, there are complete nutters like Topeka's Fred Phelps. In Canada the good reverend has been the source of many a cocktail party snicker for having called this country "the sperm bank of Satan." (Although it is not a blog, I notice that someone has set up an anti-Phelps website called SatanLovesFredPhelps.com. Vengeance is mine, saith the Lord.) On the opposite side of the fence are the need-a-life atheists like those represented in the strident A Blog From Hell. I wasted an entire afternoon browsing through a tawdry collection of hate blogs with an assortment of targets: Hillary Clinton (why is this woman so hated?), Liberals, Republicans, Muslims, Catholics, Jews, Capitalism, the Right, the Wrong, the epicene, the porcine, the merely breathing, even blogs themselves. Amidst these lurid, bloviating efforts there are the truly creepy (Atlas Shrugs, Spiritual Pathways Ministries Library) or the just plain sinister (Hier ist Deutschland, StopTheACLU).

Library hate blogs
But let us not venture further into these trackless wastes. My mouse-clicking tendon is getting sore. Returning to the world I know best, I must ask, what about library hate blogs? I enjoy The Annoyed Librarian, especially the recent Library 2.0 fulminations, but I haven't found a blog whose sole purpose is to diss libraries, or one library in particular.

Until recently. Enter Stabiblues, an earnestly contrarian blog devoted entirely to dishing out the dirt on the State Library of Berlin (Staatsbibliothek zu Berlin), also known as the Stabi. As might be expected, it's entirely in German. A few selected translations will give you an idea of what's going on in this blog, whose subtitle is "The daily insanity of the Berlin State Library."

Here are some recent entries:

Posted August 2, 2007
Yesterday, on leaving the library, I'm asked once again for my ID card by the exit guard on duty. My new technique: simply ignore her. Why should I have to show my ID card when exiting, just because a few other visitors have the habit of leaving their cards where they have been studying in the library?

Got the Stabiblues? (A comment from a reader)
13:22 - December 19, 2006
Reading Hall full, 5-day wait for a book on hold, war damage, etc. — The Stabi has really driven every user to despair. The Stabiblues blog offers every Stabi-plagued soul a platform for venting their frustration. The curious and extraordinary from the limitless expanse of the Stabi-day-to-day.

Who are these people?!
Posted November 3, 2006
How I hate having to read library books in which some stupid idiot has scribbled annotations. In the jargon of the Berlin State Library this is called "illicit marking up." ... I hope the perpetrators are found and punished appropriately. If I had my way they'd be put out of business by being banned from the library.

Cast thy net upon the waters!
Posted October 26, 2006
No Wi-Fi in the Berlin State Library. That would be too user-friendly, wouldn't it. Just think about it. No 15-minute queues at the Internet workstations just to write a quick email or read the news. Searching the catalog from your carrel, requesting a book with your own laptop. All too user-friendly! Not happening ...

Posted October 24, 2006
It's hard to believe but it's true: in the toilets of the Berlin State Library there is the most infernal stink! Are there corpses lying about in there? Is the air conditioning not working? Does any cleaning get done?

The situation is truly disgusting. At the moment I'm seriously considering using the toilets at Starbucks for hygienic reasons.
Just a bit of a chip on his/her shoulder, wouldn't you say, as the anonymous author retreats to the comforts of American hygiene? You wouldn't believe the number of items posted on Stabiblues, some extremely long, detailed and angry. There are lots of comments too. Obviously all is not well with the Staatsbibliothek, especially when it comes to the plumbing. With those final critical remarks still in our nostrils, we shall leave our blogger with the Stabi blues. I'd love to find something similar in the English-speaking world. Meanwhile, I try not to drive my patrons to despair, and I make sure the toilets are clean.

24 August 2007

The Matrix Method

Garrard J. Health sciences literature review made easy: the matrix method. 2nd ed. Sudbury (MA): Jones and Bartlett; 2007.

No, we're not talking about ways to solve the Schrödinger Equation. I ordered this book recently for my library on the strength of a 5-star recommendation from Doody's, and I wasn't disappointed. I read it through this morning, delighted by its competent discussion on organizing one's research. As the reviews say, it is easy-to-read and practical, primarily designed for the student, but of interest to anyone who does systematic research. Judith Garrard teaches at the School of Public Health, University of Minnesota. She makes use of her long experience guiding student research to describe what she calls the Matrix Method for reviewing and tracking scientific literature.

Avoiding the longueurs of most treatises I have seen of this type, Garrard introduces her method in simple and elastic prose: "a plan for gathering materials to be included in a review of the literature, systematically analyzing the information and writing a synthesis, and organizing and filing documents, notes, and other materials in one of four sections ... in a Lit Review Book during and after completion of the review" (p. 164).

The four sections are:

  1. Paper Trail: the record of the search process used to identify relevant materials;
  2. Documents Section: all the actual documents gathered for the literature review;
  3. Review Matrix: data arranged in columns and rows in order to abstract selected information about each document;
  4. Synthesis: a written synthesis of one's critical review of the literature based on the information abstracted in the Review Matrix.
The results of this labour are collected and put into what Garrard calls a "Lit Review Book," essentially a large binder with the four sections outlined above. She does not fuss about format, however, and leaves it to the researcher how he or she will create the "book," whether on paper or with a computer.

The Review Matrix is the heart of the Matrix Method. Its purpose is to provide a standard structure for creating order out of the welter of information from the literature. It is essentially a large spreadsheet. Each row is a journal article, book chapter, etc. The columns represent categories for breaking down the contents of documents into analyzable pieces, e.g., year of publication, purpose, methodological design, variables, number of subjects, instrument, special notes.

There are distinct advantages to this kind of abstracting process, provided that the researcher has done a thorough job of collecting the most relevant research papers on a subject (and Garrard frequently recommends consulting a librarian in the research process). As she puts it,
In the first place, you learn something about the sociology of the subject you are reviewing [i.e., who the important authors are, which studies are cited repeatedly, etc.]. Second, by taking apart and abstracting each study using the same set of topics, you are better able to state questions of your own. Finally, you begin to have a better sense of what is missing and areas in which new research is needed (p. 120).
In other words, the matrix provides a convenient format that allows for rapid comparison of vital aspects of each document, depending on the researcher's particular needs. The result is a comprehensive overview and synthesis of what has been written on one's chosen topic. You "own" the literature.

Complementing Garrard's method, the Matrix Indexing System offers a common-sense way of using reference management software to organize references found in various databases. The author is a firm believer in chronologically arranging physical documents in three-ring binders or folders and pointing to them using location labels in individual citations. Storing everything in the Lit Review Book, in combination with the bibliographic control afforded by the reference database, is the best way of keeping track of a research project over time. Visual examples and a single case study are woven throughout the text to help us see how this method can be applied in real-life research.

I have benefited from this book and will soon be creating my first Lit Review Book. The Matrix Method will also help me when I am assisting patrons who inquire about literature reviews. Highly recommended for any health library.

22 August 2007

Related article searching

A study on PubMed related article searching, which I learned about from a post by David Rothman last month, got me excited again about a feature of the database that I use frequently but unreflectively. Like many of my colleagues, I welcomed the introduction of related articles linking in PubMed and rejoiced at the inclusion of the top five related links in the AbstractPlus display. As I work away at my literature searches, I have often wondered how this feature is being used, what is driving the sophisticated software gears turning in the background, and how successful it is at retrieving truly relevant material.

A recent Technical Report from the University of Maryland, Exploring the effectiveness of related article search in PubMed (1), explains how "related article links create dense clusters of relevance that make for a potentially fruitful browsing experience" (p. 9). Query logs created for the study show that PubMed searchers often click on related articles suggested by the system. This enhanced feature of PubMed, the authors conclude, forms an integral part of the information-seeking experience of many users.

During a period of one week the authors observed 35,136,632 page views across 7,964,643 sessions. Many of these had to be discounted because they represented bots and direct access to MEDLINE via embedded links or another search engine. Their final data set was whittled down to a mere 1,941,329 sessions (24.4% of the total). These sessions included at least one PubMed search query and view of an abstract - in other words, "actual attempts at addressing information needs in PubMed," as the authors put it (p. 7-8).

From this subset it was observed that roughly a fifth of all "non-trivial" PubMed sessions (18.5%) involved examination of related articles. Subsequent actions of users were also analyzed after they clicked on a related article link. Once they started browsing related articles they were likely to continue doing so more than 40% of the time. The study demonstrates quite clearly that related article search receives "high sustained usage" (p. 9).

Points to remember about related article searching

More than two years ago Jan's Search Tips was recommending adding related article searching to our arsenal of strategies, and she listed briefly the advantages and disadvantages. To review the topic again and refresh my own memory, I would like to restate here the relevant points about the Related Articles feature (you can also review PubMed's help file under "Finding articles related to a citation"):
  • The AbstractPlus display automatically includes the first five Related Links citations.
  • Each citation in PubMed includes a link that retrieves a pre-calculated set of citations that are closely related to the selected article. PubMed creates this set by comparing words from the title, abstract, and MeSH terms using a word-weighted algorithm.
  • If you select Related Articles from the Display menu without selecting specific citations, PubMed will retrieve the related articles for the citations displayed on the page.
  • Related article searching is not comprehensive.
  • Any limits you applied to your original search are NOT in effect when you use a Related Articles link, even if Limits are selected.
  • By using History you can reapply limits (e.g., English, dates) but this removes the ranked order and may remove citations that are most relevant.
  • Relevancy can drop off quickly. The list you get with a Related Articles link is displayed in ranked order from most to least relevant.
  • And, of course, you need to start with a relevant citation for the feature to work at all.


Related Articles searching is undoubtedly a valuable addition to even the most carefully planned PubMed run. For all my sedulous crafting of comprehensive professional search strategies, I still find myself stumbling over citations that have eluded my detection methods. So I almost never complete a search without taking the extra step of checking related articles on the most pertinent citations I have found. The serendipitous benefits of these links have been highlighted once again for me in a recent paper on searching for systematic reviews in palliative medicine, which appeared in the American Journal of Hospital & Palliative Medicine (2).

The authors of this study report that PubMed related articles links yielded 15% of all the citations finally included in their systematic literature review on cancer symptom assessment instruments. Although the related articles link is not included in methodologic recommendations for systematic literature reviews, the experience of the authors suggests that it is a useful tool in PubMed for reviewing complex evidence. Related links searches are recommended for any systematic PubMed literature review on a complex topic.

The conclusions of this study make good sense, but take a look at the authors' search strategy in Table 2 (p. 182):
First search
Neoplasms AND signs and symptoms AND scale, OR instrument, OR checklist, OR inventory, AND evaluation OR assessment, OR rating, OR distress, OR severity, OR frequency

Second search
Incorporating (prevalence) and (incidence)

No wonder they had trouble finding good stuff without relying on related articles searching. The strategy looks sketchy and incomplete to me. There isn't any indication of how or whether they balanced MeSH and text string searches. Some obvious approaches seem to have been omitted. The MeSH heading Questionnaires was not used - even though it is to be found in the PubMed record for the actual systematic review of which this is a companion article (3). And what about other appropriate headings like Pain Measurement or Nursing Assessment? I'll wager that contributions from readers of this post, based on just a few minutes of analysis, could have greatly improved the results of the original project, or at least reduced the work of this team of scientists and physicians in producing their results. But perhaps I am being presumptuous.

The use of sophisticated computer algorithms to extract knowledge from the MEDLINE database is a feature of the third-party PubMed alternatives that have come along lately. For an overview see the recent article by David Rothman (4) and numerous references on his blog. There is a comprehensive list on the Arrowsmith website, and I surveyed a few myself earlier this year in my library's Info-RX newsletter. (I like PubFocus for its cool way of incorporating journal ranking into searches.)

There is a considerable literature on MEDLINE data mining. I looked at a few articles with various proposed methods of citation relevance scoring (5,6,7), but found no further details on PubMed's own related articles algorithm. This research is interesting if you can get by the mathematical formulas, but I would like to see more work assessing the value of what we have now and suggesting practical methods for search enhancement.
I to the world am like a drop of water
That in the ocean seeks another drop.

Comedy of Errors 1.2


1. Lin J, DiCuccio M, Grigoryan V, Wilbur WJ. Exploring the effectiveness of related article search in PubMed. Technical report LAMP-TR-145/CS-TR-4877/UMIACS-TR-2007-36 /HCIL-2007-10, University of Maryland, College Park, July 2007. 2007 July:1-10 [cited 2007 Aug 20]. Available from: http://hcil.cs.umd.edu/trs/2007-10/2007-10.pdf

2. O'Leary N, Tiernan E, Walsh D, Lucey N, Kirkova J, Davis MP. The pitfalls of a systematic MEDLINE review in palliative medicine: symptom assessment instruments. Am J Hosp Palliat Care. 2007 Jun-Jul;24(3):181-4.

3. Kirkova J, Davis MP, Walsh D, Tiernan E, O'Leary N, LeGrand SB, et al. Cancer symptom assessment instruments: a systematic review. J Clin Oncol. 2006 Mar 20;24(9):1459-73.

4. Rothman D. A selection of useful third-party PubMed tools. MLA News 2007 Jun-Jul; 397:12,24.

5. Demner-Fushman D, Lin, J. Answering clinical questions with knowledge-based and statistical techniques. Computational linguistics. 2007 March;33(1): 63-103.

6. Tbahriti I, Chichester C, Lisacek F, Ruch P. Using argumentation to retrieve articles with similar citations: an inquiry into improving related articles search in the MEDLINE digital library. Int J Med Inform. 2006 75(6):488–495.

7. Ruch P, Boyer C, Chichester C, Tbahriti I, Geissbühler A, Fabry P, et al. Using argumentation to extract key sentences from biomedical abstracts. Int J Med Inform. 2007 Feb-Mar;76(2-3):195-200.

19 August 2007

"It takes the facts a long way."

There are many lives of much pain, hardship, and suffering, which, having no stirring interest for any but those who lead them, are disregarded by persons who do not want thought or feeling, but who pamper their compassion and need high stimulants to rouse it.

Charles Dickens, Nicholas Nickleby, Ch. 18

Stanley (not his real name) is an occasional visitor to my library. By any standard, Stanley is poor. He is shabbily dressed, he doesn't smell very good, and he looks like he needs a decent meal. I've known Stanley for a couple of years now. I suppose many would call him a loser, but I just see him as rather lost. You could say he's a couplet short of a sonnet.

Stanley likes "to go on the Internet" to research what he will only describe as his "condition." So now and then he shuffles into the library and goes to work. He sits for hours intent on the monitor in front of him, like Mr. Dick labouring on the famous Memorial. Mr. Dick shows young David Copperfield a large kite he has made completely out of his closely and laboriously written manuscript: "There's plenty of string ... and when it flies high, it takes the facts a long way." (David Copperfield, Ch. 14) Stanley uses the currents of cyberspace for a similar purpose. Yet despite all his efforts, he never seems to accomplish much and his condition persists.

Stanley had a hard time of it when the rules changed at my library. The large University system I belong to now requires that external users authenticate for any kind of Internet use beyond our own or the government's websites. In order to get his temporary log-in, Stanley has to show some ID and sign a form each time he visits the library. People like Stanley don't possess much in the way of identification, so after much concern and hand-wringing on his part, we settled on a faded birth certificate and his proof-of-age card from the Manitoba Liquor Commission. Once he got the hang of logging in, Stanley happily continued his research.

A couple of weeks ago one of my staff poked her head into my office, sighed, and informed me that Stanley was looking at an "inappropriate" website. When I walked over to his workstation to see what was going on, there was Stanley heedlessly violating the rules, right in the middle of the library and in full view of my staff and other patrons. I asked if I could speak with him in my office, and he meekly accompanied me, apologizing the whole time for causing any problems. Although I am well aware that some patrons like to wander too freely on the web, I have never caught anyone in flagrante delictu. How to deal with Stanley? I explained to him that, as a public service supported by the taxpayer, the library could not countenance the use of its computers for such things, and so on in my most officious manner. Stanley looked back at me with that curious blank stare he reserves for representatives of authority, nodding his head and interrupting frequently with apologetic ramblings. Then he said something that surprised me: "I wasn't trying to make any trouble, but, like, you've got my ID and all, and I thought that since I had to go through all that signing-up stuff, I was free to do whatever I wanted with the computer." I didn't know how to respond to this, so I simply repeated my explanation, gave Stanley a warning, and obtained his promise not to stray from the straight and narrow.

After Stanley had left I realized this was not a cynical evasion on his part. In his own half-baked reasoning he was quite serious. How ironic that the University's move to restrict Stanley's access to the web had had the opposite effect. Having listened to all our official claptrap and complied with all our fussy regulations, he had somehow become convinced he had been given licence to use the library's computers for something more than his usual wool gathering. In fact it was only since the imposition of authentication that Stanley had tried pushing the limits.

Stanley's strange excuse led me to reflect on the various ways society seeks to regulate and "enclose" the lives of the disadvantaged. However justifiable the imposition of authentication, however expedient for security-obsessed managers and the technicians who guard the unapproachable complexity of their systems, it represents yet another form of enclosure, another hedge on Stanley's freedom, another symbol of his dispossessed state. Should I have banned Stanley from using my public access workstations? I couldn't bring myself to do it. Yes, he occasionally deviates in unacceptable ways from his normal pursuits, as we all do. But by and large Stanley is making legitimate use of my library to improve his health as he sees fit, researching his "condition," and even seeking reference help to find websites.

The state of Stanley's health is intimately entwined with the state of his pocketbook. This is something Mr. Micawber could expostulate about at length:

Annual income twenty pounds, annual expenditure nineteen nineteen and six, result happiness. Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery. The blossom is blighted, the leaf is withered, the god of day goes down upon the dreary scene, and - and in short you are for ever floored. As I am! (David Copperfield, Ch. 12)
There is much talk these days about the determinants of health and how poverty is at the top of the list. From the Second Report on the Health of Canadians and Strategies for Population Health we learn that:
  • Only 47% of Canadians in the lowest income bracket rate their health as very good or excellent, compared with 73% of Canadians in the highest income group.
  • Low-income Canadians are more likely to die earlier and to suffer more illnesses than Canadians with higher incomes, regardless of age, sex, race and place of residence.
  • Social status is linked to health. At each rung up the income ladder, Canadians have less sickness, longer life expectancies and improved health.
  • Large gaps in income distribution lead to increases in social problems and poorer health among the population as a whole.
Health libraries are part of the civil commons, which protects and enables the access of all members of a community to basic life goods. Is it conducive to Stanley's health to be deprived of access to information by the very institution that is supposed to be dedicated to providing it? Creating a healthy society must also mean finding ways to include the Stanleys who inhabit the margins. Or do we pamper our compassion and need high stimulants to rouse it?


'What do you think of that for a kite?' he said.
I answered that it was a beautiful one. I should think it must have been as much as seven feet high.
'I made it. We'll go and fly it, you and I,' said Mr. Dick. 'Do you see this?'
He showed me that it was covered with manuscript, very closely and laboriously written; but so plainly, that as I looked along the lines, I thought I saw some allusion to King Charles the First's head again, in one or two places.
'There's plenty of string,' said Mr. Dick, 'and when it flies high, it takes the facts a long way. That's my manner of diffusing 'em. I don't know where they may come down. It's according to circumstances, and the wind, and so forth; but I take my chance of that.'

Charles Dickens, David Copperfield, Ch. 14

13 August 2007

Necessary as shoes

I do a lot of PubMed searches for patrons, at least one or two a day on average. It is my bread and butter, after all, and I have a demanding clientele. I assume that many fellow librarians out there are doing the same. So I must say I am surprised at how little discussion there is about search strategies in the health library blogosphere. Did I miss the killer PubMed webinar that settled all questions once and for all? Am I the only librarian who harbours lingering doubts about the quality of my searches on complex subjects? Why this peculiar silence? Are we concerned about the critical eye of our peers and therefore prefer to shower in our underwear, so to speak? Do we fret that we don't fully understand the probabilistic content similarity algorithm underlying PubMed's related article search; that we haven't read every last word of the help pages and memorized all the search tags; that we can't easily explain the difference between sensitivity and specificity (quick, in 25 words or less); that we're not always sending a RefShare link with our results; or that our search string is not as big as our rival's?

Or more likely perhaps, are we simply unspeakably bored with PubMed? The pervasiveness, the profuseness of it. It has all the glamour and prolixity of a C++ manual. How can you be mindful of its programming marvels when you are yawning your way through your 69th search on catheter insertion points? Are you really that excited about filter preferences in My NCBI? If you are at lunch with a colleague and raise the issue of fuzzy sets on Boolean lattices, does she suddenly drop her pita and say, "Excuse me, my leg has gone to sleep. Do you mind if I join it?"

Granted: PubMed is as necessary as shoes, and usually worn as hard, redolent with the odour of Heideggerian Zuhandenheit. Like the philosopher's Birkenstock, it is ready-to-hand, a taken-for-granted household item. What was a near miracle just a few years ago now suffers a coolness deficit, especially when most of us would rather go on and on and on about Facebook or Web 3.1415926, or any other of today's objects of hypostatized belief. And yet we're expected to include PubMed in our professional reading. Who among us has dutifully waded through Brian Katcher's edifying if not electrifying MEDLINE : a guide to effective searching in PubMed and other interfaces? Whose heart has thrilled to read the latest NLM Technical Bulletin on terms used in toxicology? Worse still are most scholarly studies on PubMed searching veritable Exocets of ennui. Not poppy, nor mandragora, nor all the drowsy syrups of the world can compete with a long and meticulously footnoted paper on improving the efficacy of PubMed clinical queries. If her bedtime reading had been restricted to papers on the optimal retrieval of randomized controlled trials, the hypersensitive princess of Andersen's tale would never have lost a moment's sleep to that notorious little pea.

The Task

At the risk of causing excess NCBI (narcoleptic coma benevolently induced) in my readers, I wanted to devote this post to a discussion of one PubMed search strategy. I was recently given the task of setting up a PubMed automated update on a number of topics related to health care quality and the patient experience of health care (English articles only). Hospital managers in my neck of the woods are finally discovering the power of periodic email updates on topics that interest them. Would that I could convince them to subscribe to RSS feeds. But, frankly, it would be easier to explain the theory of relativity or go back to photocopying tables of contents. All I have to say about RSS is that, as far as my patrons are concerned, I started out with nothing and I still have most of it left. They thrive in an email ecosystem, and one must adapt or risk utter exclusion. Yet I live in hope.

The patron who consulted me had a broad interest in a number of topics:
  • patient satisfaction
  • patient, family, consumer involvement
  • patient safety
  • health care quality
Having worked with PubMed all these years, I realize that no search so broadly cast would be perfect. For one thing, the database itself is imperfect, being a product of human beings and subject to human error. The MeSH headings for quality are a bit slippery; there is no easy way to specify only those articles that would be of interest to this particular kind of manager; some text string searching would be necessary; in short, it would be a bit of a cat's breakfast. Upon consultation, my patron expressed a philosophical acceptance of the likelihood of inexactitude and database noise, and she is a cat lover. So I went to work.

In addition to a PubMed search on the broad topics, it seemed expedient to add a TOC aspect by including a search for the contents of the best journals in the field of health care quality. I thus ended up with three PubMed searches, which would be combined for one weekly update:
  1. Tables of contents of nine major health quality journals.
  2. Results of a comprehensive search on the broad topics of interest: patient satisfaction, consumer and patient involvement in care, patient safety, quality in general.
  3. To make up for some deficiencies in PubMed's indexing of articles in the areas of interest, I included a roundup of quality-related citations from the ten most important medical and health management journals citations that might not be caught by search strategy no. 2.

1. Major journals on quality

Journals of note were suggested to me by a colleague, by lists I found on the web, and a search of the NLM catalogue for currently published titles. After more consultation these were the nine titles preferred by my patron:

  • Am J Med Qual
  • Healthcare Benchmarks Qual Improv
  • Int J Health Care Qual Assur Inc Leadersh Health Serv
  • Int J Qual Health Care
  • Jt Comm J Qual Patient Saf
  • J Healthc Qual
  • J Nurs Care Qual
  • Qual Manag Health Care
  • Qual Saf Health Care

2. MeSH and text string search

Medical Errors[MAJR] OR Consumer Participation[MAJR] OR Patient Satisfaction[MAJR] OR "patient safety"[TW] OR "public involvement"[TW] OR "consumer involvement"[TW] OR "consumer directed"[TW]

3. Other journal title searches + MeSH search

A search of the following ten journals was performed and ANDed with the following MeSH term: Quality of Health Care[MAJR]. Some articles of importance in these journals might not be caught by strategies 1 and 2. The heading Quality of Health Care by itself is too broad to be of use for this patron. But combined with the following journals, it will gather a few useful articles that would otherwise be missed.

"Big Five" Medical Journals
  • BMJ
  • JAMA
  • Lancet
  • NEJM
  • CMAJ (for Canadian articles)


Health Care Management Journals
Five source journals related to health care management were selected for analysis, based on the findings of a recent article in JMLA:

Health services policy research journals:

  • Health Affairs (Millwood)
  • Health Services Research
  • Medical Care Research and Review

Practitioner-related research journals:

  • Health Care Management Review
  • Journal of Healthcare Management

Source: Taylor MK, Gebremichael MD, Wagner CE. Mapping the literature of health care management. J Med Libr Assoc. 2007 April; 95(2): e58-e65.

Final Search Methodology

#1 "Qual Manag Health Care"[Journal:__jrid2514] OR "Qual Saf Health Care"[Journal:__jrid27051] OR "Am J Med Qual"[Journal:__jrid2239] OR "Healthcare Benchmarks Qual Improv"[Journal:__jrid29857] OR "Int J Health Care Qual Assur Inc Leadersh Health Serv"[Journal:__jrid21292] OR "Jt Comm J Qual Patient Saf"[Journal:__jrid32349] OR "Int J Qual Health Care"[Journal:__jrid20209] OR "J Healthc Qual"[Journal:__jrid1993] OR "J Nurs Care Qual"[Journal:__jrid1231]

#2 Medical Errors[MAJR] OR Consumer Participation[MAJR] OR Patient Satisfaction[MAJR] OR "patient safety"[TW] OR "public involvement"[TW] OR "consumer involvement"[TW] OR "consumer directed"[TW]

#3 ("Health Aff (Millwood)"[Journal:__jrid4064] OR "Health Serv Res"[Journal:__jrid3988] OR "Med Care Res Rev"[Journal:__jrid20809] OR "Health Care Manage Rev"[Journal:__jrid3962] OR "J Healthc Manag"[Journal:__jrid21284] OR "BMJ"[Journal:__jrid2274] OR "CMAJ"[Journal:__jrid20656] OR "JAMA"[Journal:__jrid5346] OR "Lancet"[Journal:__jrid5470] OR "N Engl J Med"[Journal:__jrid5985]) AND Quality of Health Care[MAJR])

#4 #1 OR #2 OR #3

#5 #1 OR #2 OR #3 Limits: English

I set up a weekly updated My NCBI email alert for the patron and hovered a bit until I knew she had verified her email address. A week later the results started rolling in and the document delivery requests started too. Another happy customer.

Web Links

The Ontario Health Quality Council has a handy list of web links. I looked around a bit more, tweaked the list a bit, and sent it to my patron. I also informed her about del.icio.us and how it might be useful in her work. There will be more on that score later, but this is a decent beginning.


Canada Health Infoway
Canadian Council on Health Services Accreditation (CCHSA)
Canadian Institute for Health Information
Canadian Patient Safety Institute
Evaluation Society of Canada
Health Council of Canada
Institute for Safe Medication Practices
Quality Healthcare Network
Safer Healthcare Now!
Statistics Canada


Cancer Quality Council of Ontario
Change Foundation
Guideline Advisory Committee
Hospital Report Research Collaborative
Institute for Clinical Evaluative Studies
Ontario Hospital Association Patient Safety Support Service

Other Canadian provinces

Health Quality Council of Alberta
Health Quality Council (Saskatchewan)
Western Health Improvement Network

Manitoba Institute for Patient Safety


The International Society for Quality in Health Care
Agency for Healthcare Policy and Research
Agency for Healthcare Research and Quality
Balanced Scorecard Collaborative
Joint Commission on Accreditation of Healthcare Organizations
Institute for Healthcare Improvement
NHS National Patient Safety Agency
National Quality Forum (US)
National Patient Safety Foundation

10 August 2007

Big Science

Another Web 2.0 twist in the trail has left me slapping my forehead again. Why didn't I think of that? Sometimes it's like I live on the wrong side of a one-track mind. What grabbed my attention today was a script for Greasemonkey, the Firefox add-on that continues to delight me with its inventive web mash-inations. This elegant and irresistibly useful bit of code brings new interest to the routine activity of browsing e-journal tables of contents. If you don't want to read any further, get the Quotes from Chemical Blogspace and Postgenomic Greasemonkey script at userscripts.org. Chemical Blogspace and Postgenomic are wonderful websites that tumble together hundreds of blogs in a kind of omnium gatherum of scientific communication. What if you could connect all that procreative blogosphere superabundance to the dry tables of contents provided by scientific publishers on their e-journal sites? Is somebody blogging about an article in Nature? The script knows.

Why should I care about this? How often am I going to plough through the TOCs of PNAS or BioMed Central just because this cool script exists? Let me explain. I'm happy with RSS syndicating, del.icio.us bookmarking, Flickr tagging, RefWorksing, PubMed alerting, blog browsing, podcasting, YouTubing, Facebook fiddling, listserv lurking — all the 'ings' my passions and my profession involve me in, those convenient Librarian 2.0 competencies I posted about a while ago. I think I'm pretty well informed, but sometimes I feel I'm in a bit of a rut. Information science is one thing, but what about Science with a capital S? From the staid confines of my library, peering out from behind these ranks of medical texts shelved in the W's, I am confronted by the frenetic world of scientific endeavour.

I am fascinated by Science, but only in its less formal garb, unencumbered by the starch and stays of mathematical rigour. As a student of science I have always been a flop. I was flummoxed by Newton's laws, easily fazed by trigonometry, and I fizzled entirely trying to calculate moles and masses. One could say that I have a limited grasp of science's myriad complexities. I prefer the simple approach: if it squirms it's biology; if it stinks it's chemistry; if it explodes it's physics; if it's incomprehensible it's mathematics; if it doesn't work it's engineering.

I gravitate to the more popular sources of science information: Scientific American, PBS's Nova, radio programs like CBC's Quirks and Quarks (also available as a podcast), and some wonderful websites and blogs. One thing I have always enjoyed is browsing through journals like Nature, awed by the stunning fecundity of scientific research. Now, with my new script installed, I have easy access to bloggers' opinions about articles in Nature directly from the journal's TOC. It's everything Web 2.0 is supposed to be about, injecting a bit of jaunty twoness into a method of presenting information that hasn't changed much since books were copied by hand. The script does not interfere with the publisher's site in any way. It overlays a 'Pg' or 'Cb' logo onto a table of contents item, indicating that someone has blogged on that article. On mouseover an excerpt of the blog post pops up. The reader merely clicks on the link to get to the blogger's post.

A footnote in an article on scholarly communication (1) led me to a discussion of the script on the Blue Obelisk wiki and a link to download the latest version. Noel O'Blog (Noel O'Boyle, University of Cambridge) extended the script, originally created by Pedro Beltrão to work automatically on a number of popular sites, including Nature, PLoS, PNAS and BioMed Central. His version, posted on userscripts.org, is the one to get.

Here is a list of the sites covered in Noel's script. (The list is taken directly from the script, hence the asterisk storm. It should be possible to edit the script to add other sites, and the author encourages this.)

http://*.oxfordjournals.org/* (Added 01/May/07)

This non-scientist must express his appreciation for a truly innovative way to enhance communication in the scientific community. It's a very cool Web 2.0 tool, which I'm sure will evolve into something even more interesting over time. And it doesn't explode.


1. Martinsen DP. Scholarly communication 2.0: evolution or design? ACS Chem.Biol. 2007 Jun 15;2(6):368-371.

08 August 2007

The Purring Keyboard

Here I am working in a hospital library every day, so close to people in pain, and yet often neglecting my own body's elaborately evolved electrochemical semaphore of tissue distress. I am one of the vast multitude who toil with computers, clacking away for hours at keyboards designed in the 19th century. And like my suffering comrades I frequently end my day with a stridently complaining forearm or a racking headache. For many it is a gimpy wrist, a spavined neck, or a trounced back. For all those Windows users whose well-being the computer has cruelly compromised, there is balm in Gilead. (We know that you Mac users are here on earth to do good to others by showing them the right path. What the others are here for you haven't been able figure out yet, but Steve will be announcing that at the next Mac Expo.)

AutoHotKey is a little program that allows you to create scripts or macros to automate common activities. The key to its extraordinary power is its ability to hook onto events of the Windows operating system, most notably keystrokes and mouse operations. This versatile “hotkey” ability allows you to:

  • Automate almost anything by sending keystrokes and mouse clicks. You can write a mouse or keyboard macro by hand or use the macro recorder. (Have more than one email signature? Use macros to switch between them.)
  • Create hotkeys for keyboard and mouse. (Start a program, enter today's date with a key combination.)
  • Expand abbreviations as you type them. (Tired of typing MeSH, UpToDate, autochthonous?)
  • Remap keys and buttons on your keyboard and mouse. (Got a better use for that feckless F12 key?)
There are macro programs aplenty out there, many of them costing a fair amount. I have tried all of them and have had nightmares about imaginary ones. Nothing has worked as well as AutoHotKey, and it's free of charge.

The only problem is that AutoHotKey's documentation, while remorselessly thorough, is not designed for the beginner. If I were running the company, a simple beginner's interface would be added to the package. However, for anyone with Windows experience, basic AutoHotKey scripting can be absorbed quickly. There is no need to learn how to create the really elaborate macros. Leave that to the programming aficionados of the AutoHotKey Forum.

If you're game to try, start with the Quick Start Tutorial and read over the Hotkeys and Hotstrings sections. After downloading AutoHotKey you create your scripts in one or more text files with a .AHK extension.

How am I using AutoHotKey?
Here are a few of my favourite shortcuts, hotstrings, abbreviations, and key remappings. On any day my sore arm is spared a great deal of typing and hundreds of mouse clicks. If you are bored already, have a look at the section on AutoHotKey and PubMed. You may perk up.

It is very easy to automate the opening of a file with a simple key combination. The two examples below start my acquisitions spreadsheet and whatever Microsoft Word file I have been working on last.

The first two symbols of the macro text stand for Ctrl-Alt, followed by a letter. Pressing these three keys 'runs' the macro, in the first example Ctrl-Alt-A opens a Microsoft Excel spreadsheet on my network's S: drive. The hotkey is separated from the command by two colons.

^!a::Run S:\njmhsl\sbgh\acquisitions sbgh.xls

To start Word I type Ctrl-Alt-W. The script adds /mFile1 to the program path. This cool DOS-style Microsoft switch opens the last Word file you have worked on. Very handy.

^!w::Run C:\Program Files\Microsoft Office\OFFICE11\WINWORD.EXE /mFile1

Of course, you can also do this sort of thing by going into the Properties of a Windows icon and adding a key combination to the Shortcut Key box. But what I have shown above is just the most basic AutoHotKey function. An experienced user can program in a host of other actions to be performed with a key combination.

These are simple macros that expand a short form into full text. The standard code is colon-colon-abbreviation-colon-colon-result. Special codes, such as an asterisk, may be inserted between the first two colons. This means that the abbreviation will be expanded to the corresponding full text as soon as it is typed.

:*:asa::as soon as possible
:*:btw::By the way, `

These hotstrings replace the abbreviation with the text that comes after the colons. When there is no asterisk between the first two colons, you must hit the space bar, a period, or Enter to execute the replacement macro. It's up to the user whether to script for instant replacement or not.

The following is just a small sample of my list of little shortcuts. These one-, two- or three-letter macros can really ease common typing headaches, such as repetitive boilerplate, or other long or difficult-to-type text (e.g., internal upper case as in UpToDate).

For macros of this type, I use the semicolon as the first element of the abbreviation. This allows me to employ any combination of letters, numbers or symbols for my macro, without concern for conflict. For example, if you create an auto-replace hotstring to change 'and' to 'AND' you would rarely be able to type the word 'and' in lower case. Upon hitting the spacebar you would be converting it to upper case automatically. Adding a preceding semicolon, as in the PubMed example in the next section, avoids this problem. The semicolon is easy to find on the keyboard, but other initial macro symbols like the slash or vertical bar would work as well.

:*:;al::academic librarian
:*:;hs::Health Sciences Libraries
:*:;my::My NCBI
:*:;th::Thank you for your cooperation.
:*:;us::United States

Employing the same method, signatures and other boilerplate can be entered easily. Use the opening and closing parenthesis to surround text. In the following example, typing semicolon-j-s instantly produces this signature.

Joan Smith
General Hospital

AutoHotKey and PubMed
I spend a great deal of my time in PubMed. I prefer command line searching, avoiding the mouse as much as I can. Searching PubMed professionally is unbearable without macros. The script below includes a few of my favourites. AutoHotKey makes PubMed purr like a kitten.

For example, instead of typing AND in a search box, I only need to type a semicolon and the word 'and' in lower case. The macro erases what I have just typed and replaces it with AND in upper case plus a space so that I can just continue with the next word. The same goes for OR, NOT, [MAJR], [TI], etc. Admit it, have you ever cursed quietly while trying to find those ridiculous square brackets on the keyboard? How often do you hit the wrong one? I have been touch typing for 40 years and I still can't get them right.

I'm very fond of my ';5' macro. It's a lot easier to type than selecting Limits in PubMed and then clicking all over the place just to limit to English language, last 5 years.

The junk macro 'jk' gets rid of some publication types I don't want for certain searches.

(The question mark before the asterisk means the hotstring will be triggered even when it is inside or adjacent to another word. It therefore doesn't matter whether [TI] is attached to or separated by a space from the preceding word. The asterisk means that an ending character (e.g. space, period, or enter) is not required to trigger the hotstring.)

:*:;5::AND english[la] AND "last 5 year"[dp]
:?*:;ab::[TIAB] `
:*:;and::AND `
:*:;jk::NOT (letter[PT] OR comment[PT] OR editorial[PT] OR news[PT] OR interview[PT])
:?*:;mh::[MH] `
:?*:;mj::[MAJR] `
::*:;not::NOT `
:*:;or::OR `
:?*:;ti::[TI] `
:?*:;tw::[TW] `

I would love to hear from any readers who have found ways to automate standard PubMed functions. My most hated feature of PubMed? Having to check those dreadful little boxes to select articles. Many years ago, in the old DOS version on CD-ROM, a citation could be selected merely by pressing the space bar. If only I could get AutoHotKey to do that ...

I use auto-expansion to add diacritics to any text. The scripts below all work the same way. If I type 'xxaf' anywhere, it magically replaces itself with 'â'. And so on. The abbreviations are mnemonic: 'f' stands for circumflex, 'g' for grave, 'u' for umlaut, etc. The double x makes sure that the diacritics show up only when you want them.


This feature is amazingly easy. Find out the AutoHotKey term for the key, type two colons, and then the code for the action you want to perform instead of the key's normal function. Use sparingly. As long as you have the AutoHotKey script loaded, your new choice will replace the key's normal functioning.

I like to use the far right keys on the number pad to close things. The minus key now acts the same as Alt-F4. The plus key is remapped to Ctrl-F4, and the numpad Enter key is Ctrl-W, allowing me to close Firefox tabs with ease. This saves an incredible number of hand movements.

For Internet browsing, the right Alt key, normally unused, is remapped to Page Up. That makes it easy in Firefox to alternate between Space Bar to move down one screen and Right Alt to move one screen up. You don't have to move your hand at all. Finally, the unnecessary F1 and F12 keys are remapped to change the font size in Firefox without requiring the usual Ctrl-Minus and Ctrl-Equal Sign.







As you can see, AutoHotKey is an inexhaustible treasure of techy tweaking for geeks of the strict observance as well as for the geek novitiate. Don the habit, fall on your knees, and make your solemn vows now. Here are some pilgrimages to make for more inspiration:

AutoHotKey Script Listing

10 Ways to Use AutoHotKey to Rock Your Keyboard

Skrommel's AutoHotKey Scripts

07 August 2007

Barriers to Best Practice

Just when I least expected it, I received a real stumper of a literature search request. A client from Public Health was looking for any recent research – actually anything at all on the effectiveness of plastic wrap (a.k.a. shrink wrap, Saran Wrap) as a safe barrier for oral sex. That should be easy, I thought, an interesting little side trip through the web, visiting some well-known safer sex sites and gleaning any references on offer. Not one to shrink from a challenge, I plunged right in.

Little did I know what I was getting into: there is more to wrap than sandwiches. The web contains multitudes of safer sex sites, most of them offering opinions on the use of plastic wrap. Where advice is given it covers the range from squeamish acceptance to lukewarm approval. But not one of these sites offers evidence in support of its opinion. Not even the CDC.

Unrolling the Secret of Polyethylene

Disappointed, I initiated a formal literature search. I began, as usual, with PubMed. It offered very little, although I did discover the unfamiliar MeSH headings Rubber Dams, Cellophane, Permeability, Polyethylenes, and Polyvinyl Chloride. Most of what literature I could find on safe sex barriers is about latex. Some articles on non-latex barriers, which looked promising initially, were actually about the shelf life or resistance to tearing of the material, or its permeability to semen, not about its ability to withstand microbial penetration.

Google Scholar, as usual, was a mess, with everything from a goofy patent for a safe-sex mask to a study of oral gratification in Melville’s Typee. As I anticipated, just-plain-Google was able to produce, amidst the unavoidable prodigality of its porn links, reams of consumer health literature. Much of this had not been updated in years. Here is a representative sample:

  • HIVInsite calls it "probably the most versatile barrier." No mention of the least versatile.
  • Gay Men’s Health Crisis says that it stops HIV and advises: "Be careful not to turn the dam or plastic wrap inside-out while you use it."
  • Some sites, such as the lgbthealthchannel, warn that ordinary plastic wrap can be used as a dental dam "as long as it is not the microwavable kind, which is porous." The question of which is which is left to the reader.
  • Even more cautious is the 2006 Oral Sex pamphlet from the Canadian Public Health Association, which does not even mention plastic wrap, only dams. Did they check the literature and decide that the evidence simply wasn’t there?
  • The men’s safe sex tips from Toronto’s Hassle Free Clinic also omit any mention of plastic wrap.

In none of the resources I found is there any evidence cited for the efficacy of plastic wrap in preventing the transmission of STIs. This is not purely an academic exercise. In a poster prepared by the Project START Study Group, Sexual behavior and substance use during incarceration (2004), we learn that 12% of incarcerated men in the United States are using Saran wrap and other plastic substances as a means of protection during consensual sex. Among lesbians and bisexual women, 2% report using plastic wrap for oral sex, according to a 2000 article in the Journal of the Gay and Lesbian Medical Association. What are heterosexuals doing? What about HIV-discordant couples?

I’m still looking for the evidence, and I have extended my search to other resources like Scopus and Web of Science. I have come across considerable research (and controversy) about the effectiveness of latex condoms, dams, and gloves, and polyurethane barriers such as female condoms. But the case for wrap is not transparent.

Safer Saran Wrap

The always surprising Wikipedia has articles on plastic wrap in general, and Saran in particular. It turns out this stuff is not the homogeneous thing I thought it was. Plastic wrap, known as cling film in Britain and cling wrap in Australia, was discovered by accident in 1953. In Canada, Saran Wrap is the genericized trademark. The original Saran Wrap was made of polyvinylidene chloride (PVdC). In 2004 the formulation was changed to low density polyethylene (LDPE). The manufacturer claimed that this change was a result of an initiative to look for more sustainable and environmentally acceptable plastic. The film in Saran Premium Wrap does not contain chlorine, which is a good thing. However, we are told that LDPE does not possess the same barrier qualities to oxygen, aroma, and flavour molecules as vinylidene chloride copolymers, making the new formulation a lower quality plastic wrap, less useful in protecting from spoilage or flavour loss. How would it deal with HIV or treponema pallidum pallidum?

I went to the official Saran website, http://saranbrands.com/. The manufacturer, SC Johnson & Son, calls itself a "family company." They have an online survey: "How do you use Saran products?" Wouldn’t they like to know. In the FAQ I discovered that Saran Wrap is microwaveable. I guess that would disqualify it from use in oral sex according to some so-called authorities. Beyond this, the website provides no assistance for the would-be barrier user. But believe me, the next time I’m putting away leftovers I won’t look at my roll of plastic wrap the same way ever again.

Plastic Wrap as Sex Accessory

To wrap up this discussion, there appears to be little scientific evidence for the safety of products like Saran or other plastic wraps when employed as barriers for oral sex. This is somewhat disturbing, given the near universal recommendation of plastic wrap by officials of the state as well as community activists for safer sex in the absence of preferred latex barriers like condoms or dental dams. In short, their reasoning is full of holes. Is this negligence or an excessively tolerant clinging to street-smart tradition? Could we also be dealing here with a coy, possibly sex-phobic reluctance to investigate the issue? Are we tempted to resort to lame humour in order to hide our embarrassment? Klingon safe sex: no bladed weapons!

There are other reasons for the lack of reliable information on plastic wrap. For one thing, this kind of research is unlikely to further any scientist’s career. Don’t expect generous government grants or a chirrupy announcement from the Bill and Melinda Gates Foundation. Another possibility, I suppose, is that either through innocence or denial this research topic has simply not yet occurred to anyone. Or is that stretching credibility till it snaps?

All I can say is that the next curious patron who comes to the library with this question will not find a barrier in me.

Selected, unsatisfactory references:

1. What's in store for non-latex barrier methods. Contracept Technol Update. 1998 Mar;19(3):40-1.

2. Carey RF, Lytle CD, Cyr WH. Implications of laboratory tests of condom integrity. Sex Transm Dis. 1999 Apr;26(4):216-20.

3. Cornish K, Lytle CD. Viral impermeability of hypoallergenic, low protein, guayule latex films. J Biomed Mater Res. 1999 Dec 5;47(3):434-7.

4. Drew WL, Blair M, Miner RC, Conant M. Evaluation of the virus permeability of a new condom form women. Sex Transm. Dis. 1990 17(2):110-2.

5. Free MJ, Srisamang V, Vail J, Mercer D, Kotz R, Marlowe DE. Latex rubber condoms: Predicting and extending shelf life. Contraception. 1996 Apr;53(4):221-9.

6. Frezieres RG, Walsh TL, Nelson AL, Clark VA, Coulson AH. Evaluation of the efficacy of a polyurethane condom: Results from a randomized, controlled clinical trial. Fam Plann Perspect. 1999;31(2):81-7.

7. Gallieni M. Transparent film dressings for intravascular catheter exit-site. J Vasc Access. 2004;5(2):69-75.

8. Imran D, Sassoon E, Lewis D. Protection of dressings and wounds by cling film [22]. Plast Reconstr Surg. 2004;113(3):1093-4.

9. Klein RC, Party E, Gershey EL. Virus penetration of examination gloves. BioTechniques. 1990 Aug;9(2):196-9.

10. Korniewicz DM. Effectiveness of glove barriers used in clinical settings. Medsurg Nurs. 1992 Sep;1(1):29-32.

11. Korniewicz DM, El-Masri M, Broyles JM, Martin CD, O'connell KP. Performance of latex and nonlatex medical examination gloves during simulated use. Am J Infect Control. 2002 Apr;30(2):133-8.

12. Korniewicz DM, Kirwin M, Cresci K, Sing T, Choo TE, Wool M, et al. Barrier protection with examination gloves: Double versus single. Am J Infect Control. 1994 Feb;22(1):12-5.

13. Lytle CD, Routson LB, Cyr WH. A simple method to test condoms for penetration by viruses. Appl Environ Microbiol. 1992 Sep;58(9):3180-2.

14. Lytle CD, Routson LB, Seaborn GB, Dixon LG, Bushar HF, Cyr WH. An in vitro evaluation of condoms as barriers to a small virus. Sex Transm Dis. 1997 Mar;24(3):161-4.

15. Macaluso M, Blackwell R, Jamieson DJ, Kulczycki A, Chen MP, Akers R, et al. Efficacy of the male latex condom and of the female polyurethane condom as barriers to semen during intercourse: A randomized clinical trial. Am J Epidemiol. 2007 Jul 1;166(1):88-96.

16. O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, et al. Guidelines for the prevention of intravascular catheter-related infections. centers for disease control and prevention. MMWR Recomm Rep. 2002;51(RR-10):1-29.

17. Rego A, Roley L. In-use barrier integrity of gloves: Latex and nitrile superior to vinyl. Am J Infect Control. 1999 Oct;27(5):405-10.

18. Wiwanitkit V. Bloodborne viral pathogens and the feasibility of passing thorough the gloves: An appraisal and implication on infection control. Am J Infect Control. 2006 Aug;34(6):400.

19. Yip E. Consideration of barrier protection and latex protein allergy in the evaluation of medical gloves. J Infus Nurs. 2004 Jul-Aug;27(4):227-31.

04 August 2007

Know one teach one

Better access to the literature, better health care in developing countries

Having commented on the Canadian health care system recently, I turned my thoughts to less fortunate societies where health care and the information to support it are in short supply. A recent article in the Mayo Clinic Proceedings (1) discusses a number of initiatives to improve access to online medical literature in developing countries. The authors identify three problems: inadequate and cost-prohibitive electronic access to medical journals, slow Internet access speeds, and the high cost of Internet access. They go on to discuss some effective projects that are seeking to overcome the odds.

A number of initiatives, notably the Health InterNetwork Access to Research Initiative (HINARI) program of the World Health Organization (WHO) and its partner publishers, provide free Internet access to the online versions of many medical journals to individuals with IP addresses from developing countries. Over 3,750 journal titles are now available to health institutions in 113 countries. But slow access speeds and high costs impede progress. And as a Thai physician laments in a guest article on the Open Medicine Blog, countries like his don’t qualify for HINARI access. In remote areas of Thailand, and many countries like it, accessing journals is very difficult in remote areas.

To counter the problems of Internet connections there is a project to install web-based digital libraries stored on local servers at African universities and other institutions. The eGranary, part of The WiderNet Project based at the University of Iowa, is working with WHO and the US National Institutes of Health to extend and improve the digital library model. This represents an opportunity to make an exponential advance in providing low-cost, high-bandwidth access to much-needed health care information. Educational organizations, such as Africa Partners Medical, are teaching African health professionals the principles and practice of evidence-based medicine using the eGranary digital library. As Dr.Larry Ebert, one of the founders of Africa Partners Medical, has said, "No one of us can solve the immense health care needs of the African continent, but together we can make a difference."

Some Non-Digital Solutions
Equitable and efficient online access for developing countries is highly desirable. The move to open access online journals will have a hugely positive impact. But there are other important initiatives for getting information to those who need it, of which I will mention a couple.

ICN Mobile Library
On another front, the International Council of Nurses launched the ICN Mobile Library in 2001. This project delivers state-of-the-art health information to thousands of nurses in remote clinics and health centres in developing countries (2). Mobile libraries contain more than 80 titles covering topics from disease prevention, surgery and anesthesia to how to look after a refrigerator and manage a health centre store. These materials are housed in a transportable trunk resilient to moisture, insects and hard knocks. The first units were shipped to Kenya, Zimbabwe and Botswana.

Books With Wings
Another initiative, which has its roots at my own University of Manitoba, is the Books With Wings project, which collects and ships medical textbooks and lab equipment to those in need (3). Books With Wings began as the Kabul Medical Library Project, initiated in 2005 by Dr. Richard Gordon and medical students at the University of Manitoba. Their efforts resulted in the collection and shipment of over 1,700 textbooks to Afghanistan. The project has since grown to involve medical students and staff at 13 universities across Canada. This year 3,800 current textbooks (17,000 lbs. worth) were collected, enough to supply five medical libraries and one dental library in Afghanistan.

How to help
The worthy projects mentioned here welcome donations or sponsorships at these links:

Africa Partners Medical

Books With Wings

eGranary and The WiderNet Project

ICN Mobile Library

1. Roberts LR, Missen C, Grimes GC. Casting a wider net: improving access to medical literature in developing countries. Mayo Clin.Proc. 2007 July;82(7):846-848.

2. Rural Africa benefits from ICN mobile libraries. International Council of Nurses. Int.Nurs.Rev. 2003 Mar;50(1):8-9.

3. Books with Wings. Info-Rx: newsletter of the Health Sciences Libraries [serial online] 2007 May/June. Available from: http://myuminfo.umanitoba.ca/index.asp?sec=857&too=30&eve=