by Cynthia Kahn, MILS, MPH, AHIP, Reference and Instruction staff of the George Washington University’s Himmelfarb Library

Georges C. Benjamin, MD, FACP, FACEP (Emeritus) addressed the Mid-Atlantic Chapter (MAC) of the Medical Library Association (MLA) at the MAC/MLA 2007 Annual Meeting on October 10, 2007. Dr. Benjamin has been the Executive Director of the American Public Health Association (APHA) since December 2002. Prior to his position at the APHA, he was secretary of the Maryland Department of Health and Mental Hygiene, where he played a key role developing Maryland’s bioterrorism plan. His talk “Building Community Resilience: Ensuring Emergency Preparedness” built upon his years of experience in bioterrorism planning and public health.

Did you know?

• Most people are unprepared for a public health crisis & they know it
• Many people believe they are more prepared than they actually are (i.e. having a 3-day supply of food, water & medication)
• The term ‘public health crisis’ does not resonate with people. Yet they are concerned about events that could lead to one.
• Vulnerable populations are especially at risk for emergencies

Dr. Benjamin’s noted that you have to know what to be prepared for. While it seems like common sense, it is easier to say than to do. Public health leaders imagine what can go wrong, they try to anticipate events. How you train people, even highly trained, skilled workers, such as those in public health, for events that are unanticipated is the real question. Another way to think of it is that a disaster does not have to be disastrous.

“In a disaster, a resilient community should be able to mitigate the risks to individuals, families, and the community as a whole from preventable, serious health threats.”

There are five capacities of a resilient community, or needed to build a resilient community. They are planning, education, family/individual preparedness, public health response, and recovery. Planning, Benjamin related, is a process, not a point in time. He illustrated this point by showing that planning, i.e. writing a planning document, is fine, but typically no one knows what it says, or worse, what their role is. Therefore, community participation, drills and media engagement are essential.

Individuals and families have a responsibility. At present, only half have a three day supply of food, water & medication. Some aspects of individual and family involvement include having health insurance, learning how to get care and keeping medical records and immunizations up to date. Another facet is creating a family plan or a family emergency communication plan.

In addition to individual and family preparation, it is essential to build a resilient community. The community takes many forms from the individuals and family to businesses, schools and healthcare. Community response would include first responders, a core public health response, managing social disruption and continuing human services. For example, trash and sanitation are important. If the disaster was the flu, yet trash pick-up was disrupted, the community might develop plague in addition to the flu.

To address this issue, APHA is creating a national health movement to prepare individuals from preventable, serious health threats, called “Get Ready”. The first campaign is to ‘get ready’ for the flu. To learn more, take a look at the website http://www.getreadyforflu.org/newsite.htm and the blog http://www.getreadyforflu.blogspot.com/

Visit www.pandemicflu.gov for one-stop access to U.S. Government avian and pandemic flu information, including health care planning resources at http://www.pandemicflu.gov/plan/healthcare/index.html and guidelines at http://www.pandemicflu.gov/plan/healthcare/index.html#guidelines.

Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers (PDF - 405 KB) (Occupational Safety and Health Administration) http://www.osha.gov/Publications/OSHA_pandemic_health.pdf

This guidance provides a wide range of information and tools helpful to pandemic planners, including: Internet resources, communication tools, sample infection control programs, and self-triage and home care resources. It also offers how-to advice on diagnosis and treatment of staff during a pandemic, developing planning and supply checklists, and risk communication.

On page 42 the OSHA Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers promotes understanding of the needs for psychological support for staff. This boxed item gives highlights of doable interventions to lessen stress.

The National Guideline Clearinghouse™ (NGC) Web site is updated weekly. The “What’s New Archive” contains each weekly update file, organized by year since the release of the NGC Web site. To view a guideline summary, click on a title. If the guideline you select has been updated or withdrawn, you will be redirected to the Guideline Archive. http://www.guideline.gov/whatsnew/whatsnew_GuidelineArchive.aspx

The following new information was posted to the NGC Web site the week of October 22, 2007.

American Association for the Study of Liver Diseases
Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis: http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=11370

To sign up for the weekly NGC Update Service or to manage subscriptions, visit the Subscription Management page. http://www.guideline.gov/whatsnew/subscription.aspx

Compiled by AcademyHealth
Funded by the National Library of Medicine http://www.nlm.nih.gov/nichsr/corelib/hsrmethods.html

The National Library of Medicine (NLM) contracted with Academy Health to develop a core and a desired list of books, journals, bibliographic databases, web sites, and other media in the field of health services research methods. Both core and desired lists serve as guides for health librarians who want to develop a health services research methods collection.

Due to the breadth of the methodological areas covered by health services research, the library is organized both by core and desired materials, as well as by topic area, offering a framework for developing a collection of HSR methods resources. The benefit of dividing the resources based upon “core” and “desired” resources, as well as by discipline, is that librarians will have a choice of which specific subtopics they deem to be most beneficial for their collection.

Across all topic areas identified, the core list contains 56 books, 50 journals, 6 bibliographic databases, and 23 web sites (and ‘other’ resources such as instructional videos).

The NIH Health Services Research Study Section sought to define HSR as a distinct field of scientific inquiry at the intersection of public health and medical care, informed by disciplinary perspectives. The field has evolved to encompass multiple disciplinary perspectives, including methods from cognate disciplines such as economics, statistics, political science, sociology, and many other schools of thought. The field has also developed new models and techniques to address research questions in specialized areas of inquiry such as patient safety and access to care.

The Academy Health definition of health services research, developed in 2000 by Kathleen Lohr and Don Steinwachs, is as follows:

Health services research is the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, and ultimately our health and well-being. Its research domains are individuals, families, organizations, institutions, communities, and populations

HSR methods are not confined to disciplinary methods, but rather, are unique in their approach to medical and health care delivery questions because the field was developed to facilitate study of applied questions. These include:

• Who has access to health care?
• Do patients in large urban areas receive the same level of services as those in rural areas?
• At different levels of care, which patients have the best outcomes?

Librarians may wish to utilize the modules by choosing specific content areas that will benefit their library’s needs. Likewise, faculty developing new courses may look to this list for suggested current textbooks in the field. The organization of the list is intended to facilitate understanding of the array of options in different disciplines.

These lists of resources are not intended to define the full range of HSR methods texts. They provide a set of resources considered valuable by librarians and academics in the field of health services research.

The field of health services research is continually expanding and developing new methods to apply to health care and health care delivery questions. Due to the fact that the field is growing rapidly, users of these lists should search for updated versions of the resources cited here in order to ensure the most recent information on methodological topics.

http://dietarysupplements.nlm.nih.gov

The National Library of Medicine has released a new resource focused on dietary supplements. The includes information from the labels of over 2,000 brands of dietary supplements in the marketplace, including vitamins, minerals, herbs or other botanicals, amino acids, and other specialty supplements.

The database is designed to help both the general public and health care providers find information about ingredients in brand-name products, including name, form, active and inactive ingredients, amount of active ingredient/unit, manufacturer/distributor information, suggested dose, label claims, warnings, percentage of daily value, and further label information.

Links to other NLM resources, such as MedlinePlus and PubMed, are provided for additional health information. In addition, links to related Fact Sheets from the U.S. Food and Drug Administration ( FDA), Office of Dietary Supplements (ODS), National Center for Complementary and Alternative Medicine (NCCAM ), and the National Cancer Institute (NCI) are also available.

AHRQ has just released a new statistical report entitled HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2005. Using the Nationwide Inpatient Sample (NIS) databases, this report presents information about hospital care in 2005, as well as trends in care from 1993 to 2005. The HCUP Facts and Figures report showcases the wealth of statistics available from the HCUP NIS database.

Featured are:

an overview of numerous hospital-related topics,
information about the most common diagnoses, conditions, and procedures associated with inpatient stays;

data focusing on the costs and charges associated with hospitalizations; discussion of uninsured hospitalizations.

Highlights of hospital care in 2005 include the fact that 6 of the 20 most costly conditions associated with hospitalizations were related to the heart and that 6 percent of all hospital discharges involved a blood transfusion. Examples of trend information presented in the report include findings that the total number of inpatient bariatric surgeries increased 15-fold from 1995 to 2004, but stabilized in 2005; the number of hospital stays for septicemia (sepsis) rose 30 percent from 1997 to 2005; and the number of C-sections grew 67 percent between 1996 and 2005. HCUP Facts and Figures can be found in the Reports section of the HCUP-US Website. A description of the NIS is available on the HCUP-US Website.

HCUP is the Agency for Health Research and Quality’s Healthcare Cost and Utilization Project

The History of Medicine Division (HMD) of the National Library of Medicine is pleased to announce the launch of a new website featuring historical literature on cholera: http://www.nlm.nih.gov/exhibition/cholera/index.html.

Cholera is an acute, painful, and often fatal disease which ravaged populations all over the world in several pandemics during the 19th century. News of its spread and impending approach often sent panic into entire nations, and health professionals were largely at a loss as to how to treat or prevent it until modern epidemiological and laboratory techniques were developed later in the century.

The National Library of Medicine has so far scanned over 100 English language pamphlets dating from 1817 to 1890 dealing with the cholera pandemics of that period. The selection of cholera was in part inspired by the 315-page “Bibliography of Cholera” compiled by John Shaw Billings in 1875 for the report by John M. Woodworth’s Cholera Epidemic of 1873 in the United States. This extensive bibliography by Billings meant to include all published monographs and journal articles “which relate mainly or entirely to cholera.” The bibliography was a precursor, perhaps a “pilot project,” to the great Index Catalogue of the Library of the Surgeon General’s Office, which began coming out in 1880.

For more information, please contact Michael North, Head, Rare Books and Early Manuscripts, northm@mail.nih.gov or 301-496-9204.

The fellows and mentors selected for the 2007-2008 class of the leadership program jointly sponsored by the National Library of Medicine (NLM) and the Association of Academic Health Sciences Libraries (AAHSL) have been announced. Of the class of 5 mentors, four serve Resource Libraries in our region. Well Done!

The NLM/AAHSL Leadership Fellows Program is focused on preparing emerging leaders for director positions in academic health center libraries. Selection as fellow is recognition of a substantial record of accomplishment and demonstrable potential. Fellows are paired with mentors who are academic health center library directors and will visit the libraries of their mentors.

• Mentor: Judith Robinson Assistant Dean for Library and Learning Resources
  Edward E. Brickell Medical Sciences Library
  Eastern Virginia Medical School

• Mentor: Nancy K. Roderer
  Director, Welch Medical Library
  Associate Professor and Director, Division of Health Sciences Informatics
  Johns Hopkins University

• Mentor: Patricia L. Thibodeau
  Associate Dean for Library Services and Archives
  Duke University Medical Center Library

• Mentor: Carol G. Jenkins
  Director, Health Sciences Library
  University of North Carolina at Chapel Hill

http://www.nlm.nih.gov/pubs/techbull/so07/so07_catalog_limits.html
by Sharon Willis, NLM Tech Bull. 2007 Sep-Oct; 358):e3.

An updated NLM Catalog Limits page debuted on October 3, 2007. The NLM Catalog Limits page was redesigned with an improved interface to limit searches by languages, publication types, dates and other parameters. Click the Limits tab to display the Limits page.

Enhancements include new limits such as “Links to full text” and the ability to choose one or more selections under categories such as Languages or Publication Types.

The new Limits page (partially shown).

For a fuller explanation with examples, see: http://www.nlm.nih.gov/pubs/techbull/so07/so07_catalog_limits.html

by Kathy Cravedi, NLM Office of Communications and Public Liaison
publicinfo@nlm.nih.gov

Landmark Framingham Heart Study Forms Foundation of New Understanding of Diseases and Disorders

The National Institutes of Health (NIH) - the nation’s medical research agency - is launching one of the most extensive collections of genetic and clinical data ever made freely available to researchers worldwide. Called SHARe (SNP Health Association Resource), the Web-based dataset enables qualified researchers to access a wealth of data from large population-based studies, starting with the landmark Framingham Heart Study. Funded by the NIH’s National Heart, Lung, and Blood Institute (NHLBI), SHARe will accelerate discoveries linking genes and health, thereby advancing scientists’ understanding of the causes and prevention of cardiovascular disease and other disorders.

Framingham SHARe includes data on more than 9,300 participants spanning three generations, including over 900 families, who had their DNA tested for 550,000 genetic variations (single nucleotide polymorphisms, or SNPs). In addition, the participants’ clinical data gathered during the study, such as test results or weight, are included. SHARe will enable researchers to relate study participants’ genetic variations with their clinical and laboratory test results. The Framingham Heart Study is funded by NHLBI in collaboration with Boston University School of Medicine (BUSM) and Boston University School of Public Health.

“The widespread availability of Framingham Heart Study data provides unprecedented opportunities to investigate the connections between genes and disease,” said Health and Human Services (HHS) Secretary Mike Leavitt. “SHARe represents a major milestone in moving toward an era of personalized health care - a future in which the ways we prevent, diagnose, and treat health problems are tailored to an individual’s genetic makeup.”

Resources now available include:

• Framingham SNP Health Association Resource (SHARe), http://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/study.cgi?id=phs000007
• NIH Policy on Genome-Wide Association Studies, http://grants.nih.gov/grants/gwas/index.htm
• dbGaP (database of Genotypes and Phenotypes), http://view.ncbi.nlm.nih.gov/dbgap
• Framingham Heart Study, http://www.nhlbi.nih.gov/about/framingham/index.html
• Personalized Health Care: Opportunities, Pathways, Resources, http://www.hhs.gov/myhealthcare