EBM and Clinical Support Librarians@UCHC

A blog for medical students, faculty and librarians about their use of evidence based medicine, clinical literature, Web 2.0, sources and search strategies

Category Archives: Academic Medicine

Teaching & Learning in Medicine, Research Methodology, Biostatistics: Show Me the Evidence (Part 3)

This post is the third in a series entitled Show Me the Evidence. It is about the evidence gained from bibliometric data and journal impact factor analysis.

Let’s start with an excerpt from an 2008 article:

The assumption that Impact Factor (IF) is a number absolutely proportional to science quality has led to misuses beyond the index’s original scope, even in the opinion of its devisor*. When the IF is inappropriately attributed to all articles within a single journal, it leads to false applications regarding the  evaluation of individual scientists or research groups. This is, unfortunately, a common practice, especially among governmental funding boards and academic institutions entitled to judge scientists for positioning and grant allocation. The IF has thus accumulated huge strength and importance, mainly implied by its, at least to a degree, undue application as an index of overall scientific quality“.

Excerpt on page 1 from “The Top-Ten in Journal Impact Factor Manipulation” by ME Falagas and VG Alexiou, published in Arch Immunol Ther Exp (Warsz). 2008 Jul-Aug;56(4):223-6 – All rights reserved – Copyright 2010

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This post was sparked by a recent reference question from a retired professor who needed some assistance on how to find and search the Journal Citation Reports® database*, which is described by its’ producer, Thomson Reuters,  in this way:

Journal Citation Reports® (JCR) offers a systematic, objective means to critically evaluate the world’s leading journals, with quantifiable, statistical information based on citation data. By compiling articles’ cited references, JCR® helps to measure research influence and impact at the journal and category levels, and shows the relationship between citing and cited journals. “

Text source: Thomson-Reuters –http://wokinfo.com/products_tools/analytical/jcr/ – All rights reserved – Copyright 2010

So let’s take a look ways to find current evidence about publication patterns in the biomedical literature.

There were two things about JCR® that needed explanation for the professor.  First, the latest annual edition of JCR® was released in June 2010 and indexes journal citation data for the 2008 calendar year only (not 2009).  Second, only those journal titles indexed in the Web of Science database* are searchable in JCR®.

As one example: Let’s say that you’re a scientist working on stem cell research and you subscribe to ten international journals that are critical to your continuing professional knowledge, lab work and research.  It’ll be a good idea to check the list of 6,600+ journals that are included in the Web of Science database in order to determine if your “best” journals are searchable in Journal Citation Reports®.  If those titles are not covered in JCR®, you’ll be missing essential facts for comparing bibliometric data.

Here is a screenshot of a search done on the 2009 JCR® database for journals indexed under Cell and Tissue Engineering:

Image source: Thomson-Reuters – All rights reserved – Copyright 2010

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Some folks assume that “every journal in the world” is included in Journal Citation Reports, but that’s not the case.  9,100 journal titles were indexed in the 2009 edition.

Another thing to know is that there are six subsets available for annual subscription from  JCR® and UConn Libraries subscribes only to these two: Science Citation Index Expanded (indexing of 7,100 major journals across 150 disciplines and Social Sciences Citation Index (2,474 journals across 50 social science disciplines).

Below is a screenshot from an online tutorial about ways to search Journal Citations Reports® (with my added comment in the upper left-hand corner):

Image source: Thomson-Reuters – http://thomsonreuters.com/products_services/science/science_products/a-z/journal_citation_reports – All rights reserved – Copyright 2010

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Next, the professor asked: “I have a manuscript to submit for publication.  Is this the only place I should use to look at statistics about specific journal titles? “.

While JCR® is an important reference resource, it’s neither free or the only one available worldwide for researchers to search.  Below are sites which provide evidence that there are other ways to do citation analysis in year 2010 (some are free, some are via subscription).

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SCImago Journal & Country Rank Indicator (SJR). I like this site – it is easy to learn to use.  There are many ways to search their datasets (ranked by country, by journal title, by countries grouped by continent, etc.).  I also found their Map generators intriguing, which show comparative relationships between discipline or subject-specific citations.

Below is a screenshot of the SCImago Journal & Country Rank page showing a search done on Year “2008”,  “Medicine” as a general category, “Emergency Medicine” as a specialty and USA for the “country, with a limit for displaying journals that had at minimum 12 citable documents over 8 years:

Image source: http://www.scimagojr.com/journalrank.php – All rights reserved – Copyright 2010

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Link here to a 2007 paper written by the creators of SCImago which describe the process by which journals are ranked on their site.

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Those who have access to the Scopus database* through their library may have already discovered the Scopus Journal Analyzer, where allows one to select a discipline (shown below as “Biochemistry, Genetics and Molecular Biology”) and a journal title (“Cell” was searched below) and then choose method of analysis to determine journal impact.  Elsevier is the producer of the Scopus database. 15,000 journal titles are indexed for inclusion in Scopus analytics.

A screenshot below shows results of a search performed in Scopus Journal Analyzer recently for the broad topic of Biochemistry, Genetics and Molecular Biology.  The journal Cell holds the most-cited place in the list (no surprise there):

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The journal analyzer can be sorted using the following criteria: SJR versus SNIP.  I  found out that four years of data are necessary for sorting results using these filters.  Below, see a different screenshot:  rankings by SJR and SNIP for the same subject area:

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Explanations for SJR and SNIP were easily found in the Scopus Help section (screenshots shown below):   

Credit for all Scopus Images shown above: Elsevier B.V. – All rights reserved – Copyright 2010

Want a different way to search Scopus analytics for evidence? Use the search feature in Journal Analyzer to select and compare up to ten Scopus sources on number of citations, documents, and percentage not cited.

A 12-page PDF white paper (from 2006) is available to download from Scopus, entitled “Using Scopus for Bibliometric Analysis: A Users’ Guide“.  Following is an excerpt from that document:

Introduced in January 2006, the Scopus Citation Tracker enables users to easily evaluate research by using citation data. This tool offers at-a-glance
intelligence about the influence of a set of articles, an author or group of authors over time, so users can quickly spot trends using a visual table of citations broken down by article and chronology
. “

Text Source:  Courtesy of Elsevier B.V. – All rights reserved – Copyright 2010

Two other Scopus pages which I found useful were the Scopus Top Cited page and Scopus Journal Metrics Factsheet.

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No use trying to make this post pithy.  It would be an error not to mention the following means of assessing the scientific literature:  Eigenfactor, h-index and JANE.

University of Washington biology professor Carl Bergstrom and colleagues created the  Eigenfactor Project™.   The main webpage is  http://www.eigenfactor.org.

Give the interactive map a try: click here. Here is an example for Molecular & Cell Biology Map:

Image Credit:  http://www.eigenfactor.org/map/ –  All rights reserved – Copyright 2010

Following is an excerpt from a May 2007 article that Dr. Bergstrom wrote for the Association of College and Research Libraries publication, College & Research Library News:

We can view the Eigenfactor score of a journal as a rough estimate of how often a journal will be used by scholars. The Eigenfactor algorithm corresponds to a simple model of research in which readers follow citations as they move from journal to journal. The algorithm effectively calculates the trajectory of a hypothetical “random researcher” who behaves as follows: Our random researcher begins by going to the library and selecting a journal article at random. After reading the article, she selects at random one of the citations from the article. She then proceeds to the cited work and reads a random article there. She selects a new citation from this article, and follows that citation to her next journal volume. The researcher does this ad infinitum.

” Since we lack the time to carry out this experiment in practice, Eigenfactor uses mathematics to simulate this process.

” Because our random researcher moves among journals according to the citation network that connects them, the frequency with which she visits each journal gives us a measure of that journal’s importance within network of academic citations. Moreover, if real researchers find a sizable fraction of the articles that they read by following citation chains, the amount of time that our random researcher spends with each journal may give us a reasonable estimate of the amount of time that real researchers spend with each journal.

Text source: College & Research Library News – Vol 68:5 (May 2007) – All rights reserved – Copyright 2010

A slideshow presentation created by Dr. Bergstrom and presented at a conference hosted by Microsoft in 2009 can be viewed here.

Professor Alan Fersht wrote an article in 2009 published in PNAS Vol. 106(17):6883-4 (Apr 28 2009) entitled “The Most Influential Journals: Impact Factor and Eigenfactor” which is available free online on the PubMedCentral website.

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Physics professor Jorge E. Hirsch wrote a paper published in 2005 in PNAS entitled “An Index to Quantify an Individual’s Scientific Research Output“, in which he outlined the algorithm known as the Hirsch Index (or h-Index).

And – LOL – according to Scopus, that PNAS paper by Dr. Hirsch has been cited 575 times!

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JANE (or Journal Author/Name Estimator) is a software tool created in 2007 by members of the Biosemantics Group, a collaborative group at the Medical Informatics department of the Erasmus MC University Medical Center of Rotterdam and the Center for Human and Clinical Genetics of the Leiden University Medical Center.  Following is  how the creators of JANE describe the purpose of the tool:

Have you recently written a paper, but you’re not sure to which journal you should submit it? Or are you an editor, and do you need to find reviewers for a particular paper? JANE can help!  Just enter the title and/or abstract of the paper in the box, and click on ‘Find journals’ or ‘Find authors”.  JANE will then compare your document to millions of documents in Medline [over 10 years] to find the best matching journals or authors. ”  —

Source: http://www.biosemantics.org/index.php?page=jane – All rights reserved – Copyright 2010

M. J. Schuemie and J.A. Kors – two of the creators of JANE – published a paper about the software in the journal Bioinformatics – Vol 24:5 (Mar 1 2008).

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* Dr. Eugene Garfield was a co-founder of the Institute for Scientific Information, the producer of Science Citation Index.  A professor at the University of Pennsylvania and a prolific author, Dr. Garfield is now 85 years old.  Here is a link to his website.

In 1955, he wrote a paper titled “Citation Indexes to Science: A New Dimension in Documentation through Association of Ideas“, published in the journal Science (Vol. 122:108-111).  The online version is available to be read at this link.

From looking around on his Library website (url above), I think he has a sense of humor and the soul of an archivist. A great deal of his professional life has been taken up thinking about information management, and the ways in which scientists use their literature. I – and other librarians everywhere – should thank him for being an early adopter!

For example, in a commentary he wrote in 1963 published in the journal Science (Vol. 141:3579 – Aug 2 1963), titled “Citations in Popular and Interpretive Science Writing“, he admonishes mainstream periodical editors for not including basic volume and issue information.  Here is a direct quote: ” Librarians and scientists spend hundreds of hours tracking down precise literature citations which are missing in articles published in otherwise reputable publications like Scientific American, the New York Times, or The Sciences-a task that could be eliminated if brief but complete citations were given. This is certainly false economy and annoying “.  Garfield… You go!

The text of a presentation he gave at the International Congress on Peer Review And Biomedical Publication (2005) can be read online at  “The Agony and the Ecstasy: The History and Meaning of the Journal Impact Factor“.

I performed an author search on PubMed for his publications and created a small group of citations, those search results can be viewed here.

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In addition to thanking Dr. Garfield for creating this field of citation analysis, there are many fellow health science or academic librarians whose work has helped me understand this complex subject, or who have made public their own instruction for others to benefit from. These folks deserve recognition (and applause!).

Thanks to UCHC collection management librarian, Arta Dobbs, for her suggestions and explanations of sources and methods of bibliometric analysis.

Thanks to Janice Flahiff and Jolene Miller, librarians at Mulford Health Science, University of Toledo (Ohio) who have written a great fact sheet on the uses and misuses of interpreting journal impact factors.

Props to Kathi Sarli, health science librarian at Bernard Becker Medical Library of Washington University of St. Louis,  wrote a very useful library guide called “Tools for Authors“… check the section-tab for “Preparing for Publication“.

I enjoyed watching an excellent tutorial on Journal Impact Factors produced by librarians at the Ebling Library for the Health Sciences, University of Wisconsin-Madison.

Finally, remember this is all about Publish or Perish.


* Subscription via UCHC Library.  If off-campus, use your library proxy number to connect.

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Oncology, Statistics, Summary Reports: Treating Cancer, Living with Cancer

Ask almost anyone you know about cancer, and they will have stories to relate about parents or family, close friends or co-workers (or themselves) who have received a diagnosis of cancer, or are going through treatments, or who have been declared cancer-free.  Living as a cancer survivor has become more common, thankfully, than in previous decades, and represents one of the health success stories of our era.

This post presents a short, eclectic sample of recent cancer-related news, statistics, research or summary reports.  The final portion of the post links to video presentations given by two UCHC research faculty as they discuss clinical and translational cancer research (filmed in November 2009).

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First: The National Conference of State Legislatures (NCSL) website provides an assortment of statistics or background pieces on state-based social or economic indicators, health initiatives, legislation or other current issues.  This site is a valuable resource for reference librarians, epidemiologists, policy-makers or anyone seeking current statistics about state-sponsored programs.

NCSL provides a collection of documents about Cancer Data, Trends and Policy 2009 reports, free and open to anyone to access (although registration is required to view some of the tables).  That page is where the table describing U.S. Cancer Incidence, 2009 shown below. According to statistics from the American Cancer Association, lung, prostate or breast cancers represent the most common diagnoses in the United States in 2009:

Image Source: http://www.ncsl.org/Portals/1/Documents/magazine/articles/2009/SL0110_Statestats.pdf – All rights reserved – Copyright 2009

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Next:  Several paragraphs from a December 2009 article written by Harmon J. Eyre, formerly chief medical officer of the American Cancer Society, entitled “Winning the Cancer Fight: Looking at the Future“:

” The medical management of cancer for the past 100 years has grouped cancers by the organ in which they originate and used standard interventions such as surgery, radiation, and chemotherapy.  With the development of the cancer genome anatomy of various cancer sites, individualized cancer therapy will quickly follow.

Specific genetic profiles are being introduced to project the risk of breast cancer recurrence and to shape the choice of treatment agents. We have decades of data on outcomes using estrogen receptor, progesterone receptor, and human growth factor receptor 2 testing which dictates treatment in breast cancer. Tests such as these are needed for lung, colon, prostate, lymphoma, leukemia, and other cancers. They are beginning to be developed and disseminated, with encouraging early results.

Despite keeping records in cancer registries for many decades, widespread evaluation of the level of quality care in cancer is lacking. We know that large variations in the delivery of care occur by hospital, city, state, and region. There are a number of groups working to develop indicators of quality cancer care, but there is a lack of agreement on these indicators and they are not being widely collected. For optimal outcomes, quality care has to be delivered nationwide to all cancer patients. ”

Text Source: Page 863 – Primary Care, Vol. 36:859-865 (December 2009) – All rights reserved – Copyright 2010

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An 18-page annual report from American Society of Clinical Oncology entitled “Clinical Cancer Advances 2009: Major Research Advances in Cancer Treatment, Prevention, and Screening—A Report
From the American Society of Clinical Oncology
” was published in December, 2009.  Following is an excerpt from this report:

This report [from ASCO] now it its fifth year, was developed under the guidance of a 18-person editorial board made up of leading oncologists and other cancer specialists… The editors reviewed research published in peer-reviewed scientific journals and the results of research presented at major scientific meetings over a 1-year period (October 2008 to September 2009).

Only studies that significantly altered the way a cancer is understood or had an important impact on patient care were included. Research in each section is divided into “major advances” and “notable advances,” depending on the impact of the advance on patient care and survival. “

Excerpt from ” Clinical Cancer Advances 2009: Major Research Advances in Cancer Treatment, Prevention, and Screening—A Report“, published Dec 10 2009 in Journal of Clinical Oncology – Vol. 27, No. 35:6052-606

ASCO provides links to reference information about current cancer treatments for physicians or other clinical staff, called Cancer Portal, which can be accessed at this link.

The society also provides free cancer information targeted for people living with cancer on their website, Cancer.net.

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Next: Two segments from a lecture series given in 2009 by UCHC faculty.  Oncologist Susan Tannenbaum is Medical Director of the Clinical & Translational ResearchProgram at UCHC, is shown in a 54-minute presentation on trends and improvements in the treatment of metastatic breast cancer.

The second video is a presentation on translational research given by Kevin P. Claffey, PhD, who is co-director of the UConn Health Center Breast Cancer Translational Research Group and an associate professor in Cell Biology, Center for Vascular Biology.

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Video Credits: http://mediasite.uchc.edu/Mediasite41/Viewer/?peid=22f078e3c075411380af60acdab8da83 – All rights reserved – Copyright UCHC 2010

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Next: Regarding a May 6 2010 New York Times editorial written by Nicholas D. Kristof:

In “New Alarm Bells About Chemicals and Cancer” (column, May 5 2010) writer Nicholas D. Kristof drew attention to a document being released by the President’s Cancer Panel that warns that – in Mr. Kristof’s words – “our lackadaisical approach to regulation may have far-reaching consequences for our health. ”

Text Source: The New York Times – All rights reserved – Copyright 2010

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I found readers’ comments as (or more) interesting to read as the original editorial.  There are 200+  comments which can be read at this link:  http://www.nytimes.com/2010/05/08/opinion/l08kristof.html

News, Medicine, Librarians, Blogosphere: Participate in Medlib’s Blog Carnival – June 2010

Image/Photo Credit: http://blogcarnival.com/ – All rights reserved – Copyright 2010

Big News!

EBM and Clinical Support Librarians@UCHC has been invited to host Medlib’s Round Blog Carnival for the month of  June 2010. How does this work?  Here is an excerpt from the Blog Carnival FAQ page:

Welcome to the Blog Carnival page! We love the idea of blog carnivals where someone takes the time to find really good blog posts on a given topic, and then puts all those posts together in a blog post called a “carnival”… Carnivals are an edited (and usually annotated) collection of links that lets them serve as “magazines” within the blogosphere…

Since blog carnivals include lots of posts on specific topics, they also serve as a place to connect with those who are expert (or at least highly opinionated!) and those who are interested in that field. Blog Carnival simplifies carnivals for two kinds of people:  People who read and contribute to blog carnivals, and  people who organize and publish blog carnivals.

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What is the subject for Medlib’s Round Blog Carnival?

As a reference and public services librarian, over the years I have assembled a group of classic questions or library patrons in my mind that could be summarized as:  Questions (or People) I’ll Always Remember at the Health Science Library“.

This intent of this collaboration is learn more about the unique experiences of others librarians worldwide, or from those who work with health science librarians to teach, train and find medical information.  

Who should submit to the Medlib’s Round?

Bloggers from around the world

Medical/reference  librarians, folks who blog about clinical reasoning, evidence-based medicine, teaching and learning medicine (or practicing medicine).  I would appreciate hearing from physician- or scientist-bloggers who collaborate with health science librarians, medical students and others as they use digital library collections.

What should I write about?

Funny, sad, poignant, teachable moments (or people) encountered in your health science library.

  • Librarians: Please share some positive “memorable” encounters that took place in a public service/reference desk setting, over your career.
  • Clinicians, researchers,  pharmacists, graduate students, nurses: If your clinical or educational work as a scientist or care-provider has been positively enhanced by working with a librarian or librarian-instructors in health science library settings, please share your stories with us.

Is there a deadline to submit an entry?

Yes – please write your article, post it to your blog and send it to BlogCarnival.com no later than Tuesday, June 8th.

OK – I have an article to share.  Now what do I do?

First, go this link at BlogCarnival.com and paste the URL of your blog post using their online form.  You’ll need to also type in your name and email address.  (See screenshot below).  BlogCarnival will manage it from there.

Image/Photo Credit: http://blogcarnival.com/ – All rights reserved – Copyright 2010

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Questions – I have Questions. Who do I ask? Send an email message to ebmblog@gmail.com.  Thanks in advance!

Teaching & Learning in Medicine, Research Methodology, Biostatistics: Show Me the Evidence (Part 2)

May is the time of year when I get to sit in the back of a classroom with my mouth shut, listening (as opposed to standing in the front of a classroom, yakking about searching).

This post, Part 2 of “Show Me the Evidence“, is not about how to search a database better or when to find a systematic literature review… or anything about a library or its collections.

The “evidence” in this case isn’t a tangible product, nor can it be measured in ounces or liters.  This evidence is formed during years spent in a classroom and framed by clinical experience, listening to a patient describe their symptoms or the way a tumor feels under one’s hand or scalpel.  This evidence dwells in a scientists’ mind, whether they practice medicine or perform experiments, collecting images and allowing a peripheral brain to develop.  This knowledge has been informed by a hundred nights on call, scrutinizing CT scans, dissecting mice, examining EKG strips, observing the gait and balance of a child, listening to the characteristic sounds of COPD through a stethoscope. It could be the red flag raised by how a patient’s liver appears in a CT scan, or a questionable lab value.

This evidence-base has been formed by workdays lasting 18 hours, hunkered down in a pathology lab or an operating room.  It allows a collection of “clinical suspicions” to coalesce.  It improves diagnostic accuracy and surgical intuition.  It dwells in the life of the mind, it could be called intellectual rigor.

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A newer graduate program offered at UConn Health Center is the Masters in Clinical and Translational Research (MCTR) program.  There are over 50 faculty who teach individual components for this course, and it is a varied group: senior researchers, epidemiologists, a couple of psychiatrists, a pharmacologist, two biostatisticians, a health law attorney, an IT specialist, hospital administrators.

As the only librarian in the group, my main contribution is to spend three hours teaching the students about the range of information available to them through the UConn libraries and how to best choose, search and evaluate the sources that complement their clinical areas.  Following are key areas of course content:

  • Clinical Research Fundamentals.  Trial Design, Execution, Management. The role of the Principal Investigator.
  • Selecting the Type of Study: Observational Prospective Studies.  Experimental Intervention Studies.  Non-Randomized Intervention Studies.  Case-control and Non-Randomization Study Design.
  • Measurement of Exposure; Principles for Inferring Causation.  Group Interventions, Intention to Treat Analysis.
  • Application of Pharmacokinetic Principles in Design or Execution of Phase I or Phase II Studies.
  • Patient Recruitment, Retention and Management.
  • Elements of Informed Consent; Drafting the Form.  HIPAA Rules.
  • Ethical Treatment of Human Subjects.  The Common Rule. Federal Regulations. Scientific Misconduct.
  • Survey Design: Questionnaires, Sampling, Response Rates, Recruitment.  Cross-sectional versus longitudinal surveys.
  • Working with the Institutional Review Board (IRB).
  • Studies in Genetics.
  • Computerized Data Management: Storage and Retrieval Needs, Data Elements, Data Entry; System Security, Backup and Storage. Data Archiving.

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Each student in the program presents a capstone research project at year-end; the assignment is to design a clinical study of their choice from beginning to end with special care taken to select the “correct” potential patient subjects and to choose the “best” study design. The individual who writes the proposal serves as the PI (principal investigator).  There were six students in the class this year. Four are physicians, the others are in physical therapy or dentistry.

Their presentations were awe-inspiring. They have such a sure technical grasp of  methodologies (that remain dense to me) and confidence in planning the micro- and macro-aspects of their clinical research project. Certainly I hope they will succeed in securing funding for these proposals.

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So I sit in the back of the room, and am reminded annually of just how much I’ll never understand about gene expression profiles, how vectors are designed or how chromosome 10 got lost.  It is a humbling experience.

Didn’t Ben Franklin say: “It is better to keep one’s mouth closed and to be thought a fool, than to open it and remove all doubt“?  That’s excellent advice.

But the students also showed that they have become better searchers and THAT evidence is awesome, too! 🙂

News, Medical Education, Med Schools in the Making and Doctors Day

Today, March 30th, is National Doctors’ Day 2010*!

Photo Source/Credit:  http://www.doctorsday.org/ – All rights reserved – Copyright 2010

( Link here for a short explanation of the Tradition of the White Coat )

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Found on American Medical News this Monday, a feature article describing plans in process for establishing 13 new allopathic schools of medicine in the U.S. (with nine in the preliminary planning stages).

(Link to a graphic from the AMedNews site showing their geographic locations.)

Locally, Quinnipiac University (Hamden, CT) announced their intention in January 2010 to seek accreditation to open a new medical college.  The school plans to begin admitting students in academic year 2014.

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A developing medical school in the United States or Canada must complete five steps to become fully accredited by the Liaison Committee on Medical Education (LCME)…. Each step has its own requirements, and a school may not recruit applicants or accept student applications before reaching Step Three. ”

Excerpt from New School Process Overview, found on the website for Liaison Committee on Medical Education, a division of AAMC

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LCME and U.S. Department of Education are the organizational agencies governing curriculum and educational standards that 117 U.S. and 17 Canadian allopathic medical schools must conform to.

Alternatively, osteopathic medical education is governed by U.S. Department of Education and the Commission on Osteopathic College Accreditation (COCA), an agency of the American Osteopathic Association.  Twenty-six colleges in the U.S. are accredited to grant Doctor of Osteopathic Medicine (DO) degrees; five new schools opened in the U.S. in the past several years.  

Click here to see a map of colleges of Osteopathic Medicine in the U.S.

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Finally: Published on Feb 15 2010, a reporter from the New York Times interviewed medical students who have chosen to attend some of the “newest” schools of medicine.  Read the article at this link..

* See also #doctors day on Twitter.

Academic Medicine, Teaching & Learning in Medicine: Announcing a New Series called Learning Medicine

It’s looking more like spring each morning in the Northeast, after a nasty late winter. There are daffodils poking out of the ground. The days are growing longer. This morning I saw a green bagel in the cafeteria because tomorrow is St. Patrick’s Day*.

This makes it a good time to try something new on the blog. Today marks the first post in a series which I have titled Learning Medicine: Ten Questions.

The series is intended as an open dialog between current and former medical students, educators, clinical researchers, PBL facilitators, librarians (and anyone else I can rope into answering 10+ questions!). The content or questions in the interview may vary, depending on the background and professional experience of the interviewee.

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Today, please welcome esteemed veteran blogger and physician Graham Walker!

A Background Question – Who Are You?

Graham Walker describes himself in this way:

I’m a second-year Emergency Medicine resident at St. Luke’s-Roosevelt Hospital System in New York City. I was originally a medical school blogger (at the now-defunct Over  My Med Body! ) blog. Recently I’ve returned to blogging as a contributor to The Central Line, the official blog of the American College of Emergency Physicians.

My interests include: surviving residency, technology and web design, simulation medicine, informatics, health policy and caffeine highs.  I’m originally from Kansas, went to undergrad at Northwestern in Chicago, studying social policy/health policy, then went to Stanford for med school with a concentration in Community Health.

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Making the transition from undergraduate/or pre-med to graduate medical student

Can you name 4 or 5 key things that (in retrospect) you wished you had known before you began your first day of medical school?

Oh boy. Hopefully I can still remember anything about being a premed!  Here goes:

1) Know how you study, and develop good study skills in undergrad. Medical school is tough — they say it is like trying to drink water out of a firehose — so make sure that you’ve got a system in place to organize information in your head and commit it to memory.

For some people that’s flashcards, for others it’s study groups; for me, I *still* find I have to write things down in a notebook to get them to stick.

2) Know how you relax, and don’t give up doing that. For some people, that’s going to the gym. For others, that’s playing the guitar. Or doing a hobby. Or keeping in touch with your family. Medical school (and residency even more-so) requires copious coping mechanisms so have yours ready.

3) Get by with a little help from your friends. Don’t be a gunner in medical school. You’re in — You get to be a doctor — Yay!  Med school will be much easier if you work together with your classmates rather than view them as competition — *especially* once clinics start.

4) It is normal to feel overwhelmed. Accept it and embrace it, and it won’t be so stressful. There are parts of it that you’re going to hate, that are not going to be intuitive. But it will get better!

5) Try to get yourself all figured out. Know yourself by the time medical school starts, because while you’re in the thick of things, it’s easier to have as many of your own internal issues worked out before trying to ascend Mt. Medical School. “

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Being a Person AND a Medical Student

Please tell us about some moments in medical school or clerkship that:

Made You Angry: I remember two instances that made me upset: one was the way some OB-Gyn residents were talking disrespectfully about a terminal cancer patient. (I actually kind of understand their perspective as a resident now, but still don’t agree with it.)

The other was a grossly abnormal physical finding in a patient that I found that a group of residents chose to ignore, because I was a medical student. As the medical student, you are — more than anyone — your patient’s advocate. Know when to speak up.”

Made you wish you had Studied More: “ The Boards. But you always wish you could memorize more. Do your best, and move on “.

Brought Tears to your Eyes:  “ I remember it like it was yesterday. It was on my medicine rotation, one of the first patients that I really felt was “mine.” My residents let me “be in charge” as much as I could, and I fought for him to get a much-needed foot amputation. I was off or post-call one day, and I remember coming back the next morning and finding out he had died.

I wrote up the experience: Wonderful, Just Wonderful, Dr. Walker at: http://www.grahamazon.com/over/2006/02/wonderful-just-wonderful-dr-walker/ “.

Made you Roll on the Floor Laughing:  “ Slap-happy post-call. I’m known for being a little hyper and a bit of a morning person, which usually drives people crazy. Also any shift in the Emergency Department “.

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Learning Medicine, Becoming a Doctor. Empathy, gravitas, demeanor, honesty

Part A:  How does one learn to “act like a physician”?   (It’s not really in a textbook.)

I certainly steal bits and pieces from different mentors and heroes of mine. A phrase from this attending, a style from that one. Tips and tricks along the way.

There’s no one way to “act like a physician,” and often it changes for the situation and the patient. I’m a different type of doctor when I’m seeing an infant compared to when I’m evaluating a trauma patient or interviewing a 95 year-old. Being able to adapt and change: maybe that’s the ticket. ”

One area the third-year medical students are concerned with is effective communications with patients and their families when managing someone with a terminal illness, in palliative care or especially when attending unexpected deaths due to accidents, homicide, military, etc.

Part B:  How does a physician learn to “deliver bad news” to a patient or their family members?

Get at or below the patient or loved one’s level. Empathize. Speak in private. Speak their language, if you can. (Learn as many languages as you can.) Make eye contact. Be direct, calm, and compassionate. Tell them however they’re feeling or reacting is normal and okay: everyone reacts differently.

Be present in the moment.  This is one of the hardest things for me to do now, and I have to remind myself of it, especially in a busy emergency department. Don’t worry about what’s happening to the rest of the team, or the other patients, or the rest of the department. Just be there, if only for a few minutes.   Apply the Golden Rule “.

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Congratulations – You are now a resident!  Choosing a specialty.

Match Day is Thursday, March 18, 2010. Can you describe the process that allowed you to select a medical specialty (Emergency Medicine) and why?

Man, it’s hard to remember, because my view of the specialty has changed so much as a resident. I remember really connecting with the type of attendings and residents who went into Emergency Medicine.  My type of people, I guess.

They say it’s much easier to rule out specialties than rule any in, and that’s very true. I was the type of medical student who enjoyed most of my clerkships, but in the end, I chose the one that I thought I’d enjoy, be challenged by, and excel at. ”

What advice would you give fourth-year students as they learn their Match and prepare for residency?

Get excited, relax, and get scared. Residency is not anything like a harder version of medical school, like I imagined it to be.  Enjoy your last few free months. Travel. Get married. Spend time with the people who are important to you.

Do. NOT. Study. And most of all: learn Spanish “.

Do you ever get enough sleep?

Yes, I do. My program is pretty resident-friendly in that regard, and I think it makes us all better, happier, more efficient, and more compassionate doctors. It’s hard to go the extra mile (which is what you realize you have to do as a resident) when you’re exhausted and cranky. ”

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Since this blog is written to inform readers about health science literature, trends in medical or scholarly communications, effective search strategies and sources, the next question focuses on your experience in learning to effectively use health science literature, sources for evidence-based practice or anything digital.

Have your information needs and/or searching behavior(s) changed between medical school and residency?  Are mobile computing resources and technologies important to you?

Definitely.  In medical school it’s all about learning about the basics, and the basics of how you treat X.

In residency, it’s much more about management, when to use what, finesse, and pattern recognition. I think it’s different for every specialty, too.

Regarding searching for clinical evidence, which sources, journals or databases have you found most-useful in answering clinical or patient care questions over time?

Great question. If I’m going to anything, it’s usually either UpToDate or E-Medicine or straight to actual papers, via Pubmed.

I really like JAMA’s Rational Clinical Examination series, as well as BestBets, The TRIP Database, Cochrane Reviews, and often just… Google.  I also keep a private little blog of things I’ve learned and journal articles I want to hold onto for future reference.”

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What aspect of medicine/science digital communication and/or particular use of the Web for medicine or patient care interests you the most? (This is a completely open-ended question.)

I love Podcasts, Videos, Image Banks and clinically-useful blogs. It’s a whole other style of learning that helps you learn more when you’re tired of reading journal articles, review articles, or textbooks. ”

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Bonus Question: What question would you like to ask the readers? – or – What do you want medical students who read the EBM and Clinical Support Librarians@UCHC blog to learn from our interview?

I’d love to know how the students think medicine is going to change in their lifetime.

What do they think of the blurring of private/public life through [social media sites such as] Facebook?  Should we as doctors hide our private lives — that is, is it inappropriate for a patient to see a doctor, say, smoking or drinking on a site like Facebook?

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And that’s the first interview for Learning Medicine: Ten Questions series.  Special thanks again to Graham Walker for sharing his time, expertise, advice and experiences.

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Happy St. Patrick’s Day!

News, Academic Medicine, Teaching & Learning in Medicine, UCHC: NEGEA Conference 2010

I have been unable to post very much on the blog lately, and apologize for this.  It has been largely due to a combination of workload and snow-days!

The Northeastern U.S. has been smacked by weekly snowstorms lately – but as the days grow longer and the sun gets a little warmer daily, there is hope that snow-season is drawing to an end.

One of the items on my work horizon is participating in next week’s 2010 NEGEA Retreat, hosted by the University of Connecticut School of Medicine.  The theme for this year’s meeting is “Innovations in Medical Education: Responding to Health Care Reform“. *

Here is a screenshot of the conference program page:

Image Credit: https://negea.uchc.edu/index.asp – All rights reserved – Copyright 2010

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This retreat will be held in Farmington on Friday, March 12 and Saturday March 13, 2010.  Click this link to view the complete list of programs and speakers (68-page PDF).

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UCHC reference librarians were honored to be invited to present a poster session at this meeting (wOOt).

In August 2009, a collaboration project between UCHC reference librarians (Jessica Kilham, Robert Joven, Hongjie Wang and myself) and a UConn School of Medicine 4th year medical student, Cheyenne Beach, resulted in a redesigned Library Orientation instructional session for the incoming medical and dental students (Class of 2013).

Ms. Beach and I wrote a 3-page mock problem-based learning (PBL) case which served as a live document for the hands-on interactive instructional session held on Aug 26 2009.  We met in one of the large wired auditoriums with 136 students and a group of faculty.

Cheyenne narrated the case for the group. The hypothetical patient was written up to present through the Emergency Room in acute pain and was later diagnosed with cholangitis.

As she explained findings about the physical exam, lab results, diagnosis and treatment, librarians took turns standing at the podium demonstrating links to Up to Date, DynaMed, Access Medicine, MD-Consult, histology images, drug information from Lexi-Comp and other sources.

The students were given an electronic copy of the case, which had hyperlinks to clinical subscription resources from UCHC Library embedded in the text.  This allowed them to choose whether to follow along with the case digitally or to simply watch and listen as librarians demonstrated how these resources “look” and search.

The intent of the session was to provide an overview of the “Where, How and Why” of finding health science resources at UCHC, and to reinforce learning set in the context of answering specific questions that apply towards formulating a hypothesis about diagnosing and taking care of this pretend “patient”.

One thing that I really enjoyed about this exercise was admiring how attractive  library resources look when they are projected onto a mega-sized projection screen.  (Answer: Wow!  Big!)

Here is a screenshot of our NEGEA poster:

Image Credit: http://www.uchc.edu/NEGEA – All rights reserved – Copyright 2010

If you are interested, the LibGuide created for the August 2009 session is available by linking here.

And who knew that a 42″ by 46″ poster would take so many hours to produce?   😯

Please stop by and visit us at the official Poster Session on Friday, March 12 from 11:30am-12 Noon if you’re around!

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* Factually speaking, Northeastern Group on Educational Affairs (NEGEA) is one of four regional groups that comprise the Group on Educational Affairs (GEA) for the American Association of Medical Colleges (AAMC).  UCHC is a GEA institutional member.

AAMC “represents all 131 accredited U.S. and 17 accredited Canadian medical schools; approximately 400 major teaching hospitals and health systems, including 68 Department of Veterans Affairs medical centers; and nearly 90 academic and scientific societies. Through these institutions and organizations, the AAMC represents 125,000 faculty members, 75,000 medical students, and 106,000 resident physicians.”

Finally:  Here is a link to the 2008-2010 Agenda for Action collectively created by institutional members of the Group on Educational Affairs.


News, Awards: VP and Dean Cato Laurencin honored at the White House

Besides serving as an educational administrator, Dr. Cato Laurencin, Dean of UConn School of Medicine and Vice President for Health Affairs, is also an orthopaedic surgeon, inventor and biomedical engineer, holds a PhD (from MIT) and an MD degree (from Harvard), and has 20 patents registered under his name.  He has been at UCHC since August 2008.  He even finds time to write a blog!

Dr. Laurencin was selected in 2009 as one of twenty-two recipients of the National Science Foundation‘s Presidential Award for Excellence in Science, Mathematics and Engineering Mentoring, an award given to those who mentor students in science and mathematics (at any grade level).

Award winners were announced in July 2009 by the White House (press release – link here).

Dr. Laurencin and other honorees attended an awards ceremonies at the White House on Jan 6 2010, which was hosted by President Barack Obama.


A Research Community, in Context: More on the We and the It (Part 2)

In this first post of 2010, I wish all readers a Happy and Productive New Year!

This post continues an earlier thread (Dec 28 2009) about the end of a decade, academic libraries, librarians, scholarly research, open access and thinking about effective ways of handling expected – if uncharted – changes to the manner and style in which people consume and apply  information.

Change can be chosen, or forced, but it should be anticipated and prepared for as part of the essential nature of business in a dynamic library.  The “it” can’t stay the same, it can only keep moving forward.

The previous post refers to the ten points raised in a “library manifesto” recently published by OCLC and the RLG Partnership Research Information Management Roadmap Working Group.  Principal authors of this paper were Chris Bourg, Ross Coleman and Ricky Erway, and these (and other) RLG members also write a collective blog, entitled Hanging Together.

This week, a colleague gently suggested that in a second part of this post, I highlight some members of the greater community in this discussion of the “we” and the it“.   She is correct; I would be remiss not to mention some of the many talented individuals in this community who provide very important intellectual, educational or structural “it-s” or “we-s” (please excuse my execrable grammar and punctuation here).

In this large building, multiple missions are taking place: patient care, medical and dental education, clinical research, research which may become translational. These endeavors represent the sum contributions of many; our students are in effect “consuming” the information or experiential they provide.

Following are only a few of the many talented people that could appear on this list of the “We“:

  • Clinicians who are also educators and researchers.  Theirs is a lifetime of research on:
  • A collection of tutorials by UCHC faculty on the art and science of practical Physical Examination.
  • Professor Carol A. Pfeiffer is administrator of the Clinical Skills Assessment Program (CSAP) at UConn School of Medicine and has trained generations of students and residents on the art and science of patient assessment.  She trains those who serve as standardized patients.  She co-authored this curriculum training project (with other UCHC faculty and staff).
  • Family medicine physician Mary Guerrera, MD, FAAFP, DABHM, DABMA, directs the Complementary & Integrative Medicine program at UCHC.  Link here to read more about the Integrative Medicine in Residency, a grant-sponsored program which she administers (presentation from March 2009).
  • Kevin Clarke took a year off from medical school in Farmington to treat HIV-positive children in Zambia.  Now a b0ard-certified pediatrician, Dr. Clarke has returned to Africa and administers a pediatrics health clinic in Malawi.
  • Regarding those who are involved in selecting individuals to fill a new class of medical or dental students:  in a recent publication produced by University of Connecticut (Storrs) staff, I learned that in 2008 there were 2,919 applications received for the 85 available seats in the  UCHC Class of 2012…  or, 6% of those who applied were accepted.
  • Thanks to the 200+ community physicians throughout the state of Connecticut who each year volunteer their time to sponsor medical students, welcoming them into their exam rooms as they show and instruct them on ways to diagnose, treat and counsel patients.
  • A novel way to give back: Ten years ago, photographer Patty Swanson gave birth at UCHC John Dempsey Hospital where her twin daughters were born early and spent weeks in the NICU.  Over the past three years, Ms. Swanson has volunteered her time by taking portraits of NICU babies and their parents. These family portraits were featured in a news article published in the Hartford Courant on Dec 13 2009.

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Finally, in memory of an educator who filled many roles in this building and was held in high esteem by all who knew him:  Associate Dean and Professor Charles Huntington III.  He passed away unexpectedly at his home on Dec 27 2009 at the age of 60.

Charles was a kind and gracious gentleman, an excellent preceptor and administrator, a lifelong student, and friend and mentor to scores of students, staff and faculty here.  (Link here to his obituary from the Hartford Courant).

He came from a family of physicians; in 1872, his great-great grandfather, George Huntington, described and named the disease which came to be known as Huntington’s Chorea.

We will miss you, Charles.

Instruction, Information Seeking Behaviors, Clinical Evidence: Teaching with EBM Databases

This has been a busy month. The final first-year PBL class will be wrapping up, as the semester ends on Friday, Dec 18 2009.

On Monday, I taught an evidence-based medicine class for 28 third-year medical students (which I’ve done since 2001).  It is part of a week-long curriculum that all third-years attend as regular breaks from their clerkship rotation schedules.  They come back to the Health Center (for “Home Week”).

This 90-minute course represents a real opportunity for a librarian to connect with advanced students who are already savvy users of the medical literature.  They have completed two years of basic science and human systems curriculum, and have participated in four semesters of problem-based learning.  Each has passed the USMLE Step 1.  By this point in their graduate education, they are dedicated users of PubMed and Up to Date.

The location is one of the large classrooms equipped with computers, or students use their own laptops so that everyone gets to use a resource together.  Sometimes it gets pretty loud in that room!  The instructional challenge is to keep the content fast-paced and interesting enough for these experienced searchers while introducing (and convincing them to test out) some new clinical resources and search techniques.

Utilizing a PICO strategy (Patient or Problem-Intervention-Comparison of Treatments-Outcome) is briefly discussed.  The first half of the class is devoted to locating and applying MeSH headings and subheadings for effective search strategies and showing them ways to use the Clinical Queries search engine.  The student are asked to register for their own MyNCBI account in order to begin to organize their searches or create collections of documents in the future.

Always I ask this group if any are currently searching the SCOPUS database in addition to PubMed.  Their response?  Most are not, and that surprises me a bit.  However, once they view the links to online reference lists and “cited reference searching” capability in SCOPUS*, I’d venture a guess that 100% of this group will be using it from that day forward!  It is a database that generates instant loyalty for most users.  

Other EBM resources covered briefly are the five segments and uses of Cochrane Library, ACP Journal Club, JAMA Evidence-Guide to the Medical Literature (a digital subscription resource), and the classic BMJ series on How to Read a Paper (open access).  Ideally I end up with sufficient time to demonstrate using the TRIP (Turning Research Into Practice) clinical search engine.

The LibGuide used for the class is linked here.

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During their clerkship year, third-year students favor putting as many of the subscription resources as are available onto their PDAs.  Having drug-interactions databases, clinical DDx or algorithm calculators and a disease photo-atlas in their coat pocket comes in very handy (no pun intended) as they travel to different hospitals for their clinical rotations.

PDA resources popular with this group include Lexi-DrugsDynaMed and Diagnosaurus (which is free).

Two of the databases that I featured in the EBM class this week were ACP-PIER (American College of Physicians-Physicians Information & Education Resource) which UCHC library subscribes to via Stat!Ref, and Essential Evidence Plus (EEP) from Wiley-Blackwell.

Here’s a screenshot from EEP:

Image credit: http://www.essentialevidenceplus.com/content/eee – All rights reserved – Copyright 2009

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A press release from the company, issued Dec 14 2009, describes their new ‘point of care’ product:

Wiley-Blackwell today announced the launch of Essential Evidence (EE), a new product for PDAs which has been added to its online evidence-based, peer-reviewed subscription Essential Evidence Plus, a source which provides access to: Practice Guidelines, Decision Support Tools, History and Physical Exam Calculators, Diagnostic Test Calculators, the Derm Expert, ICD-9 Lookup Tool, Patient Education Handouts, links to Cochrane Systematic Reviews, and 950+ high quality photographs. Essential Evidence Plus links to Daily POEMs (Patient Oriented Evidence that Matters).

EE for PDAs is a topic-oriented clinical resource tool designed to help clinicians to effectively make diagnoses, chart treatment plans, and determine prognoses.  EE can be searched via the web or loaded onto a handheld computer (Pocket PC or Palm OS). EE currently features 700 structured medical topics and approximately 100 more are in development and will be added to the site soon…”

Text Source: http://www.essentialevidenceplus.com/articles/EE_Launch_12.09.pdf – All rights reserved – Copyright 2009

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And that’s my final formal class for 2009!

( Happy! )

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* How did we (i.e., those of us in academic-health science libraries) function without SCOPUS?  It’s like thinking about the days before cell phones – a time dimly remembered, difficult to recall… sort of like pre-historic times.