Raising the bar: the importance of hospital library standards in the continuing medical education accreditation process.

The Connecticut State Medical Society (CSMS) reviews and accredits the continuing medical education (CME) programs offered by Connecticut's hospitals. As part of the survey process, the CSMS assesses the quality of the hospitals' libraries. In 1987, the CSMS adopted the Medical Library Association's (MLA's) "Minimum Standards for Health Sciences Libraries in Hospitals." In 1990, professional librarians were added to the survey team and, later, to the CSMS CME Committee. Librarians participating in this effort are recruited from the membership of the Connecticut Association of Health Sciences Librarians (CAHSL). The positive results of having a qualified librarian on the survey team and the invaluable impact of adherence to the MLA standards are outlined. As a direct result of this process, hospitals throughout the state have added staffing, increased space, and added funding for resources during an era of cutbacks. Some hospital libraries have been able to maintain a healthy status quo, while others have had proposed cuts reconsidered by administrators for fear of losing valuable CME accreditation status. Creating a relationship with an accrediting agency is one method by which hospital librarians elsewhere may strengthen their efforts to ensure adequate library resources in an era of downsizing. In addition, this collaboration has provided a new and important role for librarians to play on an accreditation team.

Access to information about AIDS.

Medical information related to human immunodeficiency virus (HIV) infection is highly diverse, and the practicing physician or researcher may find specific information difficult to locate. To provide timely access to medical information on topics related to the acquired immunodeficiency syndrome (AIDS), several computer-based products have recently been developed. Some are available from vendors of online information systems, whereas others are available only on CD-ROM or floppy disk. We review several computer-based products. AIDSLINE is the most comprehensive bibliographic index, AIDSTRIALS contains specific information about ongoing unpublished investigational studies, and AIDS Knowledge Base from San Francisco General Hospital is an up-to-date electronic textbook covering all aspects of AIDS. COMPACT LIBRARY: AIDS operates on a microcomputer and combines several databases, including full-text AIDS-related articles from nine major medical journals. AIDS References from the Bureau of Hygiene and Tropical Diseases provides critical analysis of publications worldwide. Although smaller in size than AIDSLINE, about one third of the publications covered by this resource are not covered by AIDSLINE.

AIDS specialty journals.

Prior to 1983, there were no journals specific to the acquired immune deficiency syndrome (AIDS). Publications relevant to the disease are numerous, and are scattered among many sources. These factors, as well as the rate at which relevant information is published, limit the efficient methods by which researchers can obtain current information on AIDS. Use of an "electronic textbook" is one way; online searching of bibliographic databases is another. However, many of the specialty journals are not yet included in major biomedical indices. Thus, they are not brought to the attention of researchers or librarians. Whether any of these titles will gain the status of the primary journals in general medicine remains to be seen. The place of AIDS as the nation's number one health priority could mean that the most important findings may continue to be published in the primary general medical journals. In the meantime, however, librarians should be aware of the content of these journals, and the differences among them. Individual reviews are presented, covering AIDS, AIDS Alert, AIDS Clinical Digest, AIDS Medical Report, AIDS Patient Care, AIDS Research and Human Retroviruses, Acquired Immune Deficiency Syndrome Newsletter, CDC AIDS Weekly, Immunodeficiency Reviews, and Journal of Acquired Immune Deficiency Syndromes.

An unsuspected sign of cutaneous allergy.

An eczematous eruption in the superior retroauricular areas of the scalp and often on the posterior aspects of the pinnas may be seen in about 30% of allergic children. The eruption is not generally noticed because the overhanging hair covers the affected areas. The dermatitis is seen mainly in those children afflicted with bronchial asthma, perennial allergic rhinitis, or both. A previous history of atopic or seborrheic dermatitis is, as a rule, not elicited.

Pulsus paradoxus in childhood asthma--its prognostic value.

One hundred asthmatic children were examined for pulsus paradoxus, a palpable diminution or obliteration of the peripheral pulse during inspiration, while in bronchospasm. Pulsus was measured with a sphygmomanometer and the difference in systolic pressure between inspiration and expiration was noted. Seventy-five children with mild asthma had no palpable pulsus and responded with complete subsidence of symptoms with one or two injections of aqueous epinephrine, 1-1000. Twenty-five children had palpable pulsus ranging from 10 mm to 30 mm. Five patients with pulsus between 10 and 15 mm were admitted to the hospital with status asthmaticus and pneumonia; eight other patients responded to parenteral epinephrine. Twelve children had pulsus of 20 mm or greater and all were hospitalized for uncomplicated status asthmaticus. Pulsus paradoxus may be found in acute exacerbation of childhood asthma and its degree correlates with both the severity and response to bronchodilating agents.

The effects of pregnancy on asthma: a prospective study.

Forty-seven pregnant asthmatics were studied in a prospective study. Maternal asthma was exacerbated in 43%, most often in the last trimester. Normal physiologic alterations of pregnancy are reviewed as plausable explanations for the course of asthmatic patients during pregnancy.