Health Insurance Literacy Webinar (free!)

This webinar, advertised through NN/LM, is a free look at Health Insurance Literacy. We haven’t talked about health insurance, but I imagine it is something that we should be comfortable with. I don’t know how often medical librarians are asked to help explain health insurance or to contribute to health insurance literacy, but why wouldn’t we be asked? It’s certainly one of the more confusing and frustrating aspects of the medical field.

The seminar is tomorrow at 4pm eastern. I won’t be able to make it, but would love to hear about it if anyone else is able to attend.

Sleep deprivation (or excess!) and cognitive dysfunction

This doesn’t have anything to do with medical librarianship, but this very short video discusses the apparent effect of sleep duration and quality on cognitive function. I personally feel like I have been sleep deprived for at least the last decade and a half, so this really hit home. I find myself searching for words more and more often (often knowing what the word starts with and how many syllables it has, but I’m still unable to grasp it). Lucky for me I keep constant access to an online thesaurus to help with my early “senior moments”. Interestingly, sleeping too much has the same effect…

I guess the point is to remember that finishing projects at 3 in the morning is not really beneficial, nor is storing up all of your sleep debt for marathon sleeping over the weekend. 

Examining how sleep quality and duration affect cognitive function as we age

Searching MEDLIB-L Archives

Anyone else having issues searching the archives? I can get to a page that lists the archived emails, but when I try to “Search Archives” it gives me the wheel of frustration and will never load (ultimately timing out). This has been happening from more than one computer, and for over 24 hours. Something else I need to try??

Article Summary 5: The effect of a clinical medical librarian on in-patient care outcomes (Esparza et al.)


In an attempt to demonstrate the effect of a clinical medical librarian (CML) on patient outcome, the authors studied a group of patients at the Louisiana Health Shreveport hospital over approximately 2 years.  All subjects were patients who spent over 24 hours in the hospital. The CML (already employed by the hospital) participated in daily clinical rounds and served as an immediate or timely source of information for the physicians, medical students, and other members of the staff or school that participated in rounds. The CML was expected to review each patient’s medical record prior to rounds. While the CML participated in only the rounds of certain patients, all physicians and students were able to make use of the Medical Library at the associated School of Medicine.

Comparisons between patient outcome associated with CML input (intervention group) and a control group were achieved in two ways. While all members of the group that had a CML in attendance were eligible for inclusion in the Intervention Group, only those who asked a question of the CML were included – the rest of the members who had access to a CML and did not ask a question were combined with those who did not have access as the Control Group. This initial comparison showed that those patients who had medical teams taking advantage of a CML had longer length of stay, higher costs, and higher readmission rates (but also were “more ill” than those in the control group, according to a matched analysis that aimed to compare patients in the Intervention Group to those in the Control Group with respect to initial diagnosis, age, secondary diagnoses, etc.).

The second comparison was performed using a matched pair analysis, in an attempt to remove those factors that would skew results (by virtue of the Intervention Group being more ill at the outset).  Members of the Intervention Group were paired with aggregates of Control Group members who shared similar initial illness levels. These groups showed no statistically significant differences with respect to hospital stay, hospital cost, total number of diagnostic codes, or mortality while hospitalized (While Intervention Group mortality rates were about half that of the Control Group, 1.5% compared to 3.8%, the difference was not statistically significant). Interestingly, the intervention group had a much higher rate of readmission within 30 days than those of the control group.

The authors note several problems in studying clinical librarianship, and with this article in particular. There is considerable difference between the two groups being studied (especially with respect to level of illness), and it is difficult to make meaningful comparisons. Additionally, this study only compared groups in one hospital, with one CML. The authors emphasize the need for future studies using large sample sizes and more sophisticated analysis.


If nothing else, this article reiterates how important it is for librarians to always be mindful of their perceived value. As the authors noted, this study had many more limitations than only those associated with study group differences. But how might this study impact the hospital’s view of their CML? It is difficult to assert your worth when statistical studies do not support it.


Esparza JM, Shi R, McLarty J, Comegys M, Banks DE. The effect of a clinical medical librarian on in-patient care outcomes. J Med Libr Assoc. 2013; 101(3): 185-191.


Article Summary 4: Variations in Medical Subject Headings (MeSH) mapping: from the natural language of patron terms to the controlled vocabulary of mapped lists (Gault, Shultz, and Davies)

Gault et al. compared the methods and associated effectiveness of mapping from patron terms (natural language) to Medical Subject Headings (MeSH) across 6 MEDLINE interfaces. The results indicate that different interfaces (or more appropriately, different methods of MeSH mapping) often return different results following searches using patron terms.

The authors collected patron search terms from the Library of the Health Sciences, University of Illinois, then applied MeSH headings to each search term. The patron terms were then used in searches in 6 separate interfaces, allowing a comparison of mapping success across the interfaces. “Mapping success” is investigated by determining whether the patron term was successfully mapped to the MeSH term, where the appropriate term appeared within the list of possible MeSH terms, and the total number of MeSH term possibilities returned.

The authors give a brief summary of MeSH utility, explaining that while the use of these terms increases the specificity and accessibility of returns, patrons often are dependent on interface mapping to arrive at appropriate MeSH terms (e.g., the mapping of “heart attack” to “myocardial infarction”). If the patron term is not directly mapped to a MeSH term, many interfaces provide lists of possible terms for use.

The six MEDLINE interfaces studied were Internet Grateful Med (IGM), two PubMed options (MeSH Browser and Index/Preview function), OVID, and two OCLC FirstSearch interfaces (Index option using MeSH Heading Phrase and Index Option using MeSH Heading). IGM searched and mapped individual words in the patron term (using the Unified Medical Language System metathesaurus as well as MeSH terms ), so returns often mapped appropriately to one word but did not adequately translate to the term as a whole. The PubMed MeSH Browser provides a list of possible terms if an exact match to the patron term is not found. The PubMed Index/Preview feature returns terms that match alphabetically to the first (sometimes only) word of the patron term. OVID maps patron search terms to a list of possible MeSH terms using a “tree or thesaurus” to match meaning. The OCLC FirstSearch Index returns a list of terms that surround the patron term alphabetically. The OCLC FirstSearch Index option using MeSH heading phrase returned words and phrases that surround the patron term alphabetically, while the Index Option using MeSH Heading only returned single-word terms (located around the first letter of the patron term).

The results from patron term searches indicate a wide variety of search returns among the interfaces, with IGM (no longer in service) showing the highest rate of return. Looking at those searches that were mapped successfully, the authors examined the placement of the correct term within the listed results (with the understanding that a term returned higher on the list would more likely be found and subsequently used). Concept-based interfaces (IGM, PubMed MeSH Browser, and OVID) showed higher mapping success, but of the terms successfully mapped the alphabet-based interfaces were as successful in placing appropriate terms high on the return list. Variation in list length (or possible number of matches to patron term) led the authors to question if an optimum list length exists (ensuring appropriate return but not overwhelming the user).

Of the concept-based interfaces, differences in success rates are attributable to several possibilities. In some cases the MeSH term-linkage structure was not utilized by the interface (even if it existed in printed MeSH vocbularies), and in others the patron term did not have an adequate MeSH counterpart.

 This article highlights several things that librarians should keep in mind: identical searches of the same database will not yield identical returns if they are performed using different interfaces; knowing how the interfaces map to controlled vocabularies is an important aspect of success rate, and in many cases may alter how searches are performed; there is not necessarily a “best method” (although it can be said that concept-driven interfaces are more successful than alphabet-based approaches), and issues of precision and accuracy must be matched to patron needs when selecting an interface.

Gault LV, Shultz M, Davies KJ. Variations in Medical Subject Headings (MeSH) mapping: from the natural language of patron terms to the controlled vocabulary of mapped lists. J Med Libr Assoc. 2002; 90(2): 173-180.