by Ann Hallyburton (Research and Instruction Librarian/Liaison to the Health and Human Sciences, Associate Professor, Hunter Library, Western Carolina University; Allied Health Subject Editor, Resources for College Libraries: Career Resources)
Column Editor: Anne Doherty (Resources for College Libraries Project Editor, CHOICE/ACRL)
Column Editor’s Note: The “Collecting to the Core” column highlights monographic works that are essential to the academic library within a particular discipline, inspired by the Resources for College Libraries bibliography (online at http://www.rclweb.net). In each essay, subject specialists introduce and explain the classic titles and topics that continue to remain relevant to the undergraduate curriculum and library collection. Disciplinary trends may shift, but some classics never go out of style. — AD
Allied health comprises a sizable chunk of the healthcare professions and covers areas including dental assisting; dietetics; medical technology; occupational, physical, and respiratory therapies; radiography; and speech pathology. Allied health professionals undergo highly specialized career training and typically must apply for licensure. As an academic health careers librarian, I care a great deal about the information students in allied health professional programs use in their assignments. However, I worry much more about the information they use (or do not use) when they become care providers. The practical skills that future practitioners acquire as students carry over to their careers in patient care. The information-seeking skills students learn, together with many of the resources used, should carry over as well. Departing from the standard focus on monographs for this column, this essay features allied health resources available online that are suitable for the classroom and clinical environments.
Websites maintained by the United States government provide some of the most credible, least biased, and most directly applicable information for allied health professionals. While I imagine my words will meet a predominantly American audience, these resources are available for use outside the U.S. as well. Government resources are freely available and, since the mid-2000s, primarily online, factors enabling wide access to a treasure trove of general information, multi-disciplinary research, and regulations that had previously been challenging to access.1-2 Free is the right price for many under-resourced clinicians who can be easily overwhelmed by the glut of information online or consume little new information outside of mandatory continuing education. USA.gov, a search engine administered by the U.S. government’s Federal Citizen Information Center, provides a one-stop search interface for federal, state, local, tribal, and territorial governments’ online resources.3 USA.gov offers an easy-to-search portal to information ranging from crime statistics to taxes. Healthcare practitioners and consumers may find this resource particularly useful. While finding individual articles is crucial in research settings, frontline care practitioners rarely have time on the job to sort through hundreds (or thousands) of articles on a particular topic, discern which publications are relevant to their clinical needs, and then evaluate whether those research findings have serious flaws. When several patients present similar symptoms hinting at a communicable disease, a quick search of USA.gov yields the Centers for Disease Control and Prevention’s Current Outbreak page and encyclopedic coverage of virtually all known illnesses. In addition to the CDC, there are other standouts among the resources simultaneously searched by USA.gov.
One resource of particular merit to both healthcare providers and consumers is the National Library of Medicine’s MedlinePlus.4 While MedlinePlus is directed at healthcare consumers, its accessible explanations and links to high-quality information sources provide value to care providers as well. This resource (quite different from the soon-to-be-discussed, researcher-focused PubMed) pulls together public and private resources dealing with thousands of health issues, conditions, and treatments. All resources are vetted by National Library of Medicine (NLM) staff for credibility and are generally accessible to readers at a sixth-grade level. Spanish language options are available for all topics, and most topics include information in multiple languages. MedlinePlus does what other consumer-focused resources like WebMD do, without advertisements and with the added value of organized definitions, statistics, and patient tutorials from reputable sources.
Another standout is the Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ), which provides evidence-based, authoritative resources for healthcare professionals and consumers.5 AHRQ’s National Guideline Clearinghouse (NGC) offers free access to thousands of domestic and international clinical guidelines.6 NGC provides syntheses for topics with multiple guidelines, which can be used to reach consensus. Aside from offering treatment recommendations and relevant updates from many of the most influential public and private organizations in the world, the NGC interface enables users to find relevant results whether they use a basic keyword search or advanced, discipline-specific search limits.
When searching for nutrition or food safety information, USA.gov yields bedrock resources from the U.S. Department of Agriculture. The USDA National Nutrient Database for Standard Reference, a free resource that may be downloaded or used online, is “the major source of food composition data in the United States” and “provides the foundation for most food composition databases in the public and private sectors.”7-8 In addition to searching government agency information, USA.gov offers several curated collections from its main search page. Of particular relevance is the “Health Insurance, Nutrition, and Food Safety” collection for professional and consumer health information and the “Reference Center and General Government” collection, which includes links to current statistical resources (such as those from the National Center for Health Statistics) and data repositories (like the public data clearinghouse DATA.gov).
Aside from current and credible general information on health issues, USA.gov is useful to those conducting more involved research. PubMed, NLM’s free interface to the large biomedical bibliographic database MEDLINE, originates from NLM’s own government Website, hence a USA.gov search also searches across PubMed and MEDLINE citations.9 While there are better and more efficient ways to search MEDLINE, using the simple USA.gov interface retrieves results with information on treatment protocols, outbreaks, and help resources, interspersed with article citations dealing with much more specific (and sometimes arcane) aspects of a topic. Future and current frontline care professionals may find these resources much more accessible and, importantly, deserving of greater consideration in making patient care decisions. USA.gov acts as a gateway into additional resources available under NLM’s PubMed umbrella and connects readers with free full-text articles of some research publications indexed in PubMed/MEDLINE. Interpreting research articles such as those found in a PubMed/MEDLINE search can challenge students and practitioners alike. A work like Trisha Greenhalgh’s How to Read a Paper: The Basics of Evidence-Based Medicine provides straightforward recommendations for deciphering articles, evaluating research quality, and interpreting statistics.10 Greenhalgh’s book offers simple descriptions of various research types (quantitative, qualitative, etc.) and explains differences between publication types from case studies to clinical guidelines.
The U.S. National Institutes of Health is the world’s largest funder for medical research and, since mid-2008, NIH-funded research must be made freely available through NLM’s PubMed Central.11-12 The PubMed Central digital archive offers freely accessible biomedical research findings along with numerous full-text open access journals.13 While this resource does not eliminate the need for institutional subscriptions to healthcare-related journals and databases, it does ensure wide availability to research funded in part by U.S. taxpayers.
For future and current care professionals, evidence-based practice — the art of combining one’s patient care expertise with the findings from the best, most applicable clinical research to improve patient care — is an imperative across disciplines. New research streams constantly, and accepted practices may be found ineffective or even harmful. This impermanence necessitates that healthcare providers remain current in their practice. Busy practitioners, already challenged by daily emergencies, can find it nearly impossible to stay current on best practices. PubMed offers the Clinical Queries tool specifically for identifying evidence-based practice publications, though much of that information may stem from studies that analyzed overly homogenous populations; received backing from funders with investments tied to outcomes; or suffer from numerous other research failings. Even when credible, applicable research is found, the scientific language employed by authors may seem impenetrable or information may only be available for a price. For these reasons, another freely available online resource requires consideration. The UK-based Cochrane Collaboration, known for its Cochrane Systematic Reviews, makes detailed abstracts and, best of all, plain language summaries of those same reviews available to all.14 While only subscribers may access the full text of Cochrane Systematic Reviews, the plain language summaries and detailed abstracts are written in such a way as to provide enough information for individuals to make initial decisions on overall effectiveness or applicability of an intervention. Systematic reviews hold a place of preeminence in evidence-based practice literature because these “studies of studies” go across multiple research reports and publications to present findings on what the preponderance of the evidence suggests for a certain issue. Stringent vetting of review group members, rigorous review protocols, and a commitment never to oversell a treatment make Cochrane Systematic Reviews the gold standard among systematic reviews and all types of evidence-based practice literature. Abstracts and authors’ conclusions of Cochrane Systematic Reviews are, incidentally, indexed in the aforementioned PubMed/MEDLINE, and reviews done by the Cochrane Neonatal Review Group are available in near-complete format through the National Institute of Child Health and Human Development’s Website, both searchable through that Swiss Army knife of resources, USA.gov. It is worth noting that one drawback of the USA.gov tool is its lack of a “did you mean” suggestion feature like those offered by Google and other search tools, although the accuracy of such utilities varies widely. Misspellings can yield no or wildly erroneous results in a USA.gov search and leave users frustrated. A print medical dictionary becomes quite useful in such situations. Taber’s Cyclopedic Medical Dictionary is a long-respected resource that not only provides concise, accessible definitions but also makes scanning for correct spellings fast.15
The usefulness of the resources described here is not limited solely to allied health practitioners, care providers at underfunded institutions, and healthcare consumers. These Websites do well in meeting the needs of practitioners, researchers, and interested students across disciplines. As with any resource, information from these online sources is not always perfect and should be evaluated with care, especially when used in clinical settings. However, these resources offer applicability, credibility, and reliability that surpass the majority of materials available both freely and at substantial subscription prices.
Endnotes
U.S. General Accounting Office. “Government Printing Office: Technological Changes Create Transformation Opportunities: GAO-04-729T.” Washington D.C.: April 28, 2004.
Nickum, Lisa S. “Elusive No Longer? Increasing Accessibility to the Federally Funded Technical Report Literature.” Reference Librarian 45.94 (2006): 33-51.
Federal Citizen Information Center. “USA.gov.” http://USA.gov*
National Library of Medicine. MedlinePlus. http://www.nlm.nih.gov/medlineplus/*
U.S. Department of Health and Human Services. “Agency for Healthcare Research and Quality.” http://www.ahrq.gov*
Agency for Healthcare Research and Quality. National Guideline Clearinghouse. http://www.guideline.gov*
U.S. Department of Agriculture. The USDA National Nutrient Database for Standard Reference. http://ndb.nal.usda.gov/*
Ibid. Documentation and User Guide, Release 27. August 2014.
National Library of Medicine. PubMed. http://pubmed.gov*
Greenhalgh, Trisha. How to Read a Paper: The Basics of Evidence-Based Medicine. 5th ed. Hoboken: John Wiley & Sons, 2014.*
National Institutes of Health. “Funding for Research.” http://www.nih.gov
Ibid. “NIH Public Access Policy.” http://publicaccess.nih.gov/policy.htm
National Library of Medicine. PubMed Central. http://www.ncbi.nlm.nih.gov/pmc/
Cochrane Collaboration. “Cochrane Summaries.” http://summaries.cochrane.org*
Venes, Donald, ed. Taber’s Cyclopedic Medical Dictionary. Philadelphia: F.A Davis, 2013.*
*Editor’s note: An asterisk (*) denotes a title selected for Resources for College Libraries.