A quantitative survey was conducted in two Canberra hospitals that aimed at ascertaining the impact of information provided by medical libraries on clinical decision making. Specifically, this research study investigated clinical, cognitive and quality value of information provided by the medical librarians to the management of patients and doctors' ability to handle clinical cases differently as a result of such information. Furthermore, the relative value of information received from the library was assessed by comparing it to the value of information received from other sources in dealing with clinical problems. The research involved medical specialists and registrars affiliated with these hospitals. Doctors were asked to select any clinical situation which they frequently or currently encounter and for which further information would be useful to them. Once their information requests were identified, they were then asked to present such requests to the hospital library. In order to avoid any special treatment, participants were urged not to identify themselves to the library staff as partaking in the study. It was important that participants did not search for the information themselves. The doctors were asked to evaluate the material provided by the library in relation to clinical care and, thereafter, complete a short questionnaire. This research took place between October 1994 and March 1995. The questionnaires were sent to 288 doctors. This represented the total population of specialists and registrars affiliated with both hospitals at the time of the study. Analysis of the results is based on a 34% useable response rate. Medical specialists were by far the higher number of respondents (70%) as compared with registrars (30%). Eighty-one per cent of the doctors said that the information provided by the library refreshed their memory and 82% said that it would contribute to better quality of medical care. Eighty-six per cent indicated that some of this information was new to them and 99% said that the information provided was up to date. Ninety-four per cent said that the information provided by the library was of clinical value to them. As the result of the information provided by the library 75% of respondents would either definitely or probably handle some aspects of the clinical situation differently than they would have done it otherwise. The level of importance of the change for the optimal care of patients was assessed with 54% regarding it as important, 42% as moderately important. Specifically, as the result of the information provided, the doctors were able to change the following: diagnosis 10%, choice of lab tests 20%, choice of other diagnostic investigations 24%, choice of drugs 27%, choice of other management 58%, reduce length of hospitalisation 10%, post-operative care of patients 25%, advice given to patients 47%. On the basis of the received information the doctors were able to avoid the following: hospitalisation of patients 11%, risk of hospital acquired infection 8%, surgical intervention 19%, tests or other investigation 23%, additional out-patient visits 12%. Discussions with colleagues were reported to be most valued sources of information for the purpose of clinical decisions (59%), followed by diagnostic imaging (49%), librarian (45%), lab tests (42%) and patients' medical records (30%). The librarian's role as contributing to the process of clinical decisions was rated highly with 88% ranking it as either important or moderately important. The results of significance p test statistic performed at 0.05 significance level suggested that, for this study, there was a significant relationship between the frequency of library use and doctors' ability to change the choice of laboratory tests, diagnostic investigations, and the choice of prescribed drugs. The results of this research study demonstrate that medical librarians can positively contribute to clinical management of patients by providing timely and accurate information. Further research is recommended in order to determine the impact of the whole range of library services on health care outcomes.

A Feminist Action Research methodology was used as a collaborative process with five ACT Health social workers based at the Community Health Centres and four at the Woden Valley Hospital. The primary purpose of the study was to investigate, both through critical reflection and action in their work setting, the participants' relevance or otherwise to Aboriginal people in the ACT and region. Behind this is the question of how encapsulated social work is by racism. The impetus for the study arose from my unresolved concerns regarding these issues, having been a social worker in ACT Health for 6 years, to 1990. Decisions on how to proceed involved a process of ongoing consultation between the participant social workers and myself. Exploratory meetings were held in March and April, with an ongoing program being held 2-3 weekly from June to September, followed by a review in December. Most gatherings were specific to the Woden Valley Hospital or Community Health settings. However two half-day workshops were held for all the participants. All the sessions from June were taped. Aboriginal leaders were consulted, as were several managers in ACT Health. The phenomena of institutional, cultural and personal racism were addressed by the social workers through discussion, exercises, and anti-racist initiatives in their work setting. They found that significant time restraints presented an example of institutional racism working against their good intentions. Another dimension arose from implicitly racist education in social work courses when most of the participants undertook their undergraduate courses in the 1960s and 1970s. Aspects related to professionalism such as its language and separation of a personal and professional self were indicative of cultural racism. Stories of personal racism were shared, in the context of raised awareness leading to changing those attitudes and behaviours. The fact that the study took place in 1993 - a watershed year for Aboriginal/white relations in Australia - seemed to lead to greater momentum for the project. The social workers found that participation in this study increased their knowledge of, and their confidence - both actual and potential - in interaction with Aboriginal people. However, they also understood these to be just small steps towards greater justice for the indigenous people. An outcome of the project has been involving some colleagues in similar anti-racist actions to those the social workers participated in during the time of the study. The action research project has continued on in different ways, beyond 1993, despite my withdrawal as 'the researcher' who took the initiative.