Global information infrastructure

The High Performance Computing and Communications Program (HPCC) is a multiagency federal initiative under the leadership of the White House Office of Science and Technology Policy, established by the High Performance Computing Act of 1991. It has been assigned a critical role in supporting the international collaboration essential to science and to health care. Goals of the HPCC are to extend USA leadership in high performance computing and networking technologies; to improve technology transfer for economic competitiveness, education, and national security; and to provide a key part of the foundation for the National Information Infrastructure. The first component of the National Institutes of Health to participate in the HPCC, the National Library of Medicine (NLM), recently issued a solicitation for proposals to address a range of issues, from privacy to 'testbed' networks, 'virtual reality,' and more. These efforts will build upon the NLM's extensive outreach program and other initiatives, including the Unified Medical Language System (UMLS), MEDLARS, and Grateful Med. New Internet search tools are emerging, such as Gopher and 'Knowbots'. Medicine will succeed in developing future intelligent agents to assist in utilizing computer networks. Our ability to serve patients is so often restricted by lack of information and knowledge at the time and place of medical decision-making. The new technologies, properly employed, will also greatly enhance our ability to serve the patient.

Educational Technology Network: a computer conferencing system dedicated to applications of computers in radiology practice, research, and education

Educational Technology Network (ET Net) is a free, easy to use, on-line computer conferencing system organized and funded by the National Library of Medicine that is accessible via the SprintNet (SprintNet, Reston, VA) and Internet (Merit, Ann Arbor, MI) computer networks. It is dedicated to helping bring together, in a single continuously running electronic forum, developers and users of computer applications in the health sciences, including radiology. ET Net uses the Caucus computer conferencing software (Camber-Roth, Troy, NY) running on a microcomputer. This microcomputer is located in the National Library of Medicine's Lister Hill National Center for Biomedical Communications and is directly connected to the SprintNet and the Internet networks. The advanced computer conferencing software of ET Net allows individuals who are separated in space and time to unite electronically to participate, at any time, in interactive discussions on applications of computers in radiology. A computer conferencing system such as ET Net allows radiologists to maintain contact with colleagues on a regular basis when they are not physically together. Topics of discussion on ET Net encompass all applications of computers in radiological practice, research, and education. ET Net has been in successful operation for 3 years and has a promising future aiding radiologists in the exchange of information pertaining to applications of computers in radiology.

Accuracy of indexing coverage information as reported by serials sources

This article reports on the accuracy of indexing service coverage information listed in three serials sources: Ulrich's International Periodicals Directory, SERLINE, and The Serials Directory. The titles studied were randomly selected journals that began publication in either 1981 or 1986. Aggregate results reveal that these serials sources perform at 92%, 97%, and 95% levels of accuracy respectively. When the results are analyzed by specific indexing services by year, the performance scores ranged from 80% to 100%. All three serials sources tend to underreport index coverage. The author advances five recommendations for improving index coverage accuracy and four specific proposals for future research. The results suggest that, for the immediate future, librarians should treat index coverage information reported in these three serials sources with some skepticism.

National Network of Libraries of Medicine and health science libraries in Oklahoma

Rural physicians have access to a considerable variety of medical library resources, despite their outlying practice locations. This article outlines some of the sources available and how they may be reached.

Role of the journal editor in sustaining integrity in research

Editors have important but indirect roles in sustaining integrity in research, and they have major and highly visible roles in maintaining the integrity of science literature. They must publish the policies and the standards to which they will hold authors and reviewers, and then must enforce those policies. Editors cannot be responsible for the accuracy of what they publish, but they must respond thoroughly and consistently to allegations of misconduct concerning papers under consideration or already published. They must conduct appropriate inquiries and notify authors' or reviewers' institutions about possible misconduct found by those inquiries. Further, to maintain the integrity of the literature, editors must publish corrections, retractions, and notices of duplicate publication according to the standards set down by the National Library of Medicine.

The Unified Medical Language System

In 1986, the National Library of Medicine began a long-term research and development project to build the Unified Medical Language System (UMLS). The purpose of the UMLS is to improve the ability of computer programs to "understand" the biomedical meaning in user inquiries and to use this understanding to retrieve and integrate relevant machine-readable information for users. Underlying the UMLS effort is the assumption that timely access to accurate and up-to-date information will improve decision making and ultimately the quality of patient care and research. The development of the UMLS is a distributed national experiment with a strong element of international collaboration. The general strategy is to develop UMLS components through a series of successive approximations of the capabilities ultimately desired. Three experimental Knowledge Sources, the Metathesaurus, the Semantic Network, and the Information Sources Map have been developed and are distributed annually to interested researchers, many of whom have tested and evaluated them in a range of applications. The UMLS project and current developments in high-speed, high-capacity international networks are converging in ways that have great potential for enhancing access to biomedical information.

Comments on Navarro's review of Health services research: an anthology

In preparing Health Services Research: An Anthology, the editors attempted to broaden the definition of health services research promulgated by the National Library of Medicine. Many articles in the Anthology focused on stemming the avalanche of medicine's unevaluated procedures and prescribing practices, and on broadening the horizons of the medical establishment. Another anthology is clearly needed to address Virchow's dictum that medicine is politics writ large.

GenBank

The GenBank sequence database has undergone an expansion in data coverage, annotation content and the development of new services for the scientific community. In addition to nucleotide sequences, data from the major protein sequence and structural databases, and from U.S. and European patents is now included in an integrated system. MEDLINE abstracts from published articles describing the sequences provide an important new source of biological annotation for sequence entries. In addition to the continued support of existing services, new CD-ROM and network-based systems have been implemented for literature retrieval and sequence similarity searching. Major releases of GenBank are now more frequent and the data are distributed in several new forms for both end users and software developers.

Use of MEDLINE by physicians for clinical problem solving

OBJECTIVE

To understand the ways in which computer-mediated searching of the biomedical literature affects patient care and other professional activities. Undertaken to determine the ways in which on-line access to the biomedical literature via the National Library of Medicine's MEDLINE database "makes a difference" in what physicians do when confronted with a medical problem requiring new or additional information.

DESIGN

An adaptation of the Critical Incident Technique used to gather detailed reports of MEDLINE search results that were especially helpful (or not helpful) in carrying out the individual's professional activities. The individual physician was the source of the patient care incident reports. One thousand one hundred fifty-eight reports were systematically analyzed from three different perspectives: (1) why the information was sought; (2) the effect of having (or not having) the needed information on professional decisions and actions; and (3) the outcome of the search.

PARTICIPANTS AND SETTING

Telephone interviews were carried out with a purposive sample of 552 physicians, scientists, and other professionals working in a variety of clinical care and other settings. Of these, 65% were direct users of MEDLINE throughout the United States, and 35% had MEDLINE searches conducted for them either at a major health sciences center or in community hospitals.

RESULTS

Three comprehensive and detailed inventories that describe the motivation for the searches, how search results affected the actions and decisions of the individual who initiated the search, and how they affected the outcome of the situation that motivated the search.

CONCLUSIONS

MEDLINE searches are being carried out by and for physicians to meet a wide diversity of clinical information needs. Physicians report that in situations involving individual patients, rapid access to the biomedical literature via MEDLINE is at times critical to sound patient care and favorably influences patient outcomes.

The UMLS project: making the conceptual connection between users and the information they need

Conceptual connections between users and information sources depend on an accurate representation of the content of available information sources, an accurate representation of specific user information needs, and the ability to match the two. Establishing such connections is a principal function of medical librarians. The goal of the National Library of Medicine's Unified Medical Language System (UMLS) project is to facilitate the development of conceptual connections between users and relevant machine-readable information. The UMLS model involves a combination of three centrally developed Knowledge Sources (a Metathesaurus, a Semantic Network, and an Information Sources Map) and a variety of smart interface programs that make use of these Knowledge Sources to help users in different environments find machine-readable information relevant to their particular practice or research problems. The third experimental edition of the UMLS Knowledge Sources was issued in the fall of 1992. Current priorities for the UMLS project include developing applications that make use of the Knowledge Sources and using feedback from these applications to guide ongoing enhancement and expansion of the Knowledge Sources. Medical librarians are involved heavily in the direction of the UMLS project, in the development of the Knowledge Sources, and in their experimental application. The involvement of librarians in reviewing, testing, and providing feedback on UMLS products will increase the likelihood that the UMLS project will achieve its goal of improving access to machine-readable biomedical information.

Coach: applying UMLS knowledge sources in an expert searcher environment

With the development of the Unified Medical Language System (UMLS) Knowledge Sources, the National Library of Medicine (NLM) has produced a resource of great potential for improving the searching of MEDLINE. The Coach expert searcher system, an inhouse research project at NLM, is designed to help users of the GRATEFUL MED front-end software improve MEDLINE search and retrieval capabilities. This paper describes the Coach program, the knowledge sources it uses, and some of the ways it applies elements of the UMLS Metathesaurus to facilitate access to the biomedical literature.

Students online: learning medical genetics

It is possible to focus medical genetics education by using a model that integrates the skills of end-user searching of the medical literature into the traditional course content. Since 1988, 313 first-year medical students were studied as they accessed MEDLINE to retrieve information about biochemical genetic disorders. Their search behavior was studied by analyzing data from the National Library of Medicine's traffic files. The skills that they initially learned were reinforced as they searched clinical genetics problem cases in the second-year pathology course, and these skills were consolidated in the third year when the students addressed specific patient-care questions in pediatrics. The students' perception of the value of this model was studied by analyzing questionnaires completed during the exercise. It was demonstrated that when students were taught the skills of accessing MEDLINE by computer, they could formulate a question, retrieve current information, critically review relevant articles, communicate effectively, and use these skills to contribute to patient care.