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This article provides a brief history of the development of the MEDLINE database and its huge impact within the UK, from its inception to the present time. The origins of MEDLINE can be traced back to a collection of books in the US Surgeon General's Office during the American Civil War and John Shaw Billings' decision, during 1867, to make this Library as complete as possible. From these beginnings, Index Medicus was developed in the early years of the 20th century, and electronic versions of the database began with the computerized on-demand search service MEDLARS in 1964 and then via CD-ROM and Internet Grateful Med to the web-based and free-to-all service, PubMed, in 1997. The response to PubMed was immediate and startling with usage increasing from 7 million searches per annum in 1996 to 400 million searches per annum in 2001 and the service continues to improve. MEDLINE providers are now offering mapping of natural language queries to the sophisticated indexing vocabulary (Medical Subject Headings, MeSH) and the provision of specific filters for different types of publication to improve searching efficiency, as well as links to full-text versions of the papers where available. The next steps are likely to involve an increased blurring of database and full-text boundaries, incorporating seamless access to the best available evidence within MEDLINE and a wide range of other information resources within a single search and to an increasing amount of full-text via various open-archive initiatives. As ever, the US National Library of Medicine is in the vanguard of research and further applications of its MEDLINE database for users within the UK will be awaited with great interest.

Objective: An updated systematic review was carried out of research studies looking at the value and impact of library services on health outcomes for patients and time saved by health professionals. Methods: A comprehensive systematic search was undertaken of the published literature to September 2003 in ERIC, LISA, Medline, PreMedline, Embase, the Cochrane Controlled Trials Register and Google. Some handsearching was carried out, reference lists were scanned and experts in the field were contacted. 28 research studies of professionally led libraries for healthcare staff, including clinical librarian projects, met the inclusion criterion of at least one health or 'time saved' outcome. Papers were critically appraised using internationally accepted criteria. Data were extracted and results were summarised using a narrative format since the studies were heterogeneous and precluded a statistical analysis. Results: There is evidence of impact from both traditional and clinical librarian services. The higher quality studies of traditional services measured impacts of 37-97% on general patient care, 10-31% on diagnosis, 20-51% on choice of tests, 27-45% on choice of therapy and 10-19% on reduced length of stay. Four studies of clinical librarian projects suggested that professionals saved time as a result of clinical librarian input, and two of these studies showed evidence of cost-effectiveness. However, the clinical librarian studies were generally smaller, with poorer quality standards. Conclusions: Research studies suggest that professionally-led library services have an impact on health outcomes for patients and may lead to time savings for health care professionals. The available studies vary greatly in quality but the better quality studies also suggest positive impacts. Good practice can be gathered from these studies to guide the development of a pragmatic survey for library services that includes the direct effects for patients among the outcome measures.

Evidence-based practice is gaining support amongst health professionals. However, the major barrier remains the lack of time to read the literature. There are also problems with the take-up and use of evidence-based information sources such as Cochrane reviews and Effective Health Care bulletins. If such evidence is to be incorporated into local guidelines and used in day-to-day practice, practitioners request that these and other reliable publications be further summarized in short packages and available within seconds. The Health Evidence Bulletins Wales offer a model for this approach. The Bulletins have gone through several developmental stages leading to a novel two-column format. In the first column, brief statements summarize the best available evidence within a topic area. In the second, full details are provided of the supporting publications (and the evidence type, or research design) with links to the full text of documents, where possible from the electronic versions of each Bulletin. Results from a questionnaire study using a random sample and unsolicited feedback suggest that this ‘two-tier’ approach to information provision is valued by users and has implications for information services currently under development to support clinical governance.