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BCKOnline Metadata Schema 1.0 – Usage Guide December 2004

BCKOnline Metadata SchemaVersion 1.0

December 2004

Developed by Sue McKemmish, Rosetta Manaszewicz, and Chan Cheah on behalf of the BCKOnline Research Team

The BCKOnline Project was funded by an Australian Research Council Linkage Grant (2002-3), BreastCare Victoria - an initiative of the Victorian Department of Health and Human Services, the Breast Cancer Action Group Inc. (Vic).Chief Investigators of the BCKOnline project are: Professor Sue McKemmish, Head of the School of Information Management and Systems (SIMS), Monash University; Associate Professor Frada Burstein (SIMS);Associate Professor Julie Fisher (SIMS) Dr. Kirsty Williamson (SIMS); Ms. June Anderson (SIMS); Ms. Sue Lockwood (The Breast Cancer Action Group Vic. (BCAG). Other personnel include Research Fellows Rosetta Manaszewicz (SIMS & BCAG) and Fiona Ross (SIMS), research students Pooja Malhotra, Jane Moon and Chan Cheah, and programmer, Sergio Viademonte.

Acknowledgement

This Usage Guide is based on National Archives of Australia. (2002). AGLSMetadata element Set: Part 2 - Usage Guide, Version 1.3. Version 1.3 of theGuide has been used with the permission of the National Archives. Thecurrent version of the Usage Guide is available athttp://www.naa.gov.au/recordkeeping/gov_online/agls/metadata_element_set.html

INTRODUCTION

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http://www.naa.gov.au/recordkeeping/gov_online/agls/metadata_element_set.html


The Breast Cancer Knowledge Online project addressed the individual and changing information and decision-support needs of the breast cancer community by developing a prototype intelligent portal driven by a metadata repository of user-centric resource descriptions. The development of the related metadata schema provided the ‘template’ for the standardised descriptions of breast cancer information resources stored in this repository or online catalogue.

Usually online catalogues or metadata repositories contain descriptions of information resources that are “resource-centric” – they describe the resource in terms of its attributes: Author, Title, Subject. Search engines are given access to contextual information about the resource, but not the user. The BCKOnline portal contains a metadata repository, which is a catalogue that describes resources in this conventional way, but also includes ‘user-centric’ resource descriptors. For example, the metadata stored in this catalogue includes information about target audience, how to access the resource if it is available offline, restrictions associated with its use, and information about quality and reliability. By referring to the descriptions of information resources in its metadata repository, the portal will identify and retrieve resources with greater precision and hence relevance to the individual user. For example, treatments vary according to disease stage, hence the woman faced with advanced disease will require different information to that of an early breast cancer patient. Furthermore, depending on her age, educational level, and personal values, she may desire information, which is solely psychosocial as opposed to medical/scientific.

The conception and development of the portal was funded through an Australian Research Council Linkage Grant (2002-2003) with support from industry partners BreastCare Victoria and the Breast Cancer Action Group. The primary objectives of the project were to:

investigate and analyse diverse information needs amongst women with breast cancer and their families

identify and analyse existing knowledge resources design an appropriate scheme for the description of these

resources, in order to support differentiated online information access.

More information about the project is available on http://www.sims.monash.edu.au/research/eirg/bcko.html . The portal itself may be accessed via http://www.bckonline.monash.edu.au.

The project adapted and extended the AGLS Metadata Element Set to produce standardised descriptions or cataloguing records of breast cancer information resources. These records are stored in a metadata repository/database and are used by the portal technology to match search queries with descriptions of relevant resources. The nineteen element AGLS metadata scheme is an Australian National Standard which is based on and extends the Dublin Core set of metadata elements, an international code which was designed to facilitate resource discovery on the Internet. The schema used in the BCKOnline metadata repository in the portal adopted sixteen of the AGLS metadata elements, and added a new Quality element

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http://www.bckonline.monash.edu.au/

http://www.sims.monash.edu.au/research/eirg/bcko.html


and qualifiers. Additional qualifiers and encoding schemes were also defined for a number of other elements. The Quality element was added to deal with the breast cancer community’s requirements relating to reliability and quality, as revealed in the user needs study which comprised an important stage in the project.

This document explains the Metadata Schema developed for the Breast Cancer Knowledge Online (BCKOnline) metadata repository of resource descriptions relating to breast cancer information resources.

This document represents:(i) an end product deliverable from the prototype development(ii) a usage guide detailing the metadata schema definitions

pertinent to the prototype as well as the rationale underpinning development

The BCKOnline Metadata Scheme was customised from the AGLS Metadata Element Set Version 3.1, and this document is based on its Usage Guide, (December 2002). The BCKOnline Metadata Schema contains several modifications and additions in order to enable the description of resources in ways sensitive to the needs of the target audience. These are outlined in the following table.

AGLS Elements & Qualifiers

BCKOnlineElements & qualifiers

BCKOnlineEncoding Schemes

Creator CreatorDate:

Created Modified Valid Issued

Date: Created Modified Issued

ISO 8601

Description DescriptionTitle:

AlternativeTitle:

Alternative

Type: category aggregation document service

*Type: category BCKOnline Category

Scheme

Function -

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Subject: *Subject: MESHBreastCare Victoria GlossaryBCKOnline Disease TrajectoryBCKOnline ‘Key Words’

Availability AvailabilityIdentifier Identifier URI

ISBNISSN

Publisher PublisherAudience *Audience:

Age Disease Stage Information

Preference Locality User Type

BCKOnline Audience Qualifiers Scheme

Coverage Jurisdiction Spatial Temporal Postcode

-

Language Language RFC 3066

Contributor Contributor

Format: extent medium

Format Internet Media Types (IMT)

Mandate act regulation case

-

Relation isPartOf/hasPart: isVersionOf/

hasVersion isFormatOf/hasFormat references/

isReferencedBy isRequiredBy/requires isReplacedBy/replaces isBasedOn/isBasisFor

Relation isPartOf/hasPart references/

isReferencedBy isBasedOn/

isBasisFor

URI

Rights Rights URI

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Source Source

- QUALITY Credentials of

Creator, Publisher or Contributor

Review Process Attribution of

Sources Evidence Based

Category Purpose Balance Currency Quality Report

BCKOnline Quality Qualifiers Scheme

*NOTE: Shaded areas represent searchable elements within BCKOnline.

Using the template provided by the BCKOnline Metadata Schema, resource descriptions or cataloguing records are developed which provide provenance and identifying information about the resource (Creator, Contributor, Publisher, Title and Date), an Identifier (usually the URL) which enables direct online access, or information about how to access the resource if it is offline (Availability), descriptors that enable retrieval of the resource by subject, resource type and target audience (Subject, Type, Audience), and descriptive information about rights management, related resources, and resource format (Rights, Source, Relation, Format). Finally the cataloguing records include information about the quality of the resource.

As the table indicates, the BCKOnline project developed additional qualifiers for the Audience element and sector specific encoding schemes developed for the Subject and Type elements.

The new Audience qualifiers were defined with reference to user profiling based on the needs of the target audience as identified in the user needs analysis. The user profiles were developed from an analysis of data emanating from the focus groups and the current literature. The profiles are intended to meet the characteristics of the majority of potential users. Results indicated that variables such as Age, Disease Stage, Audience Type, Locality and Information Preference were major factors in determining the content, type, and depth of information sought. The user profiles are also used in developing one of the three search strategies presented to the user of the portal. The portal interface enables the user to build a profile based on the attributes defined in the Audience element qualifiers, and then, by searching on the Audience element of the catalogue record in the metadata repository, matches the selected profile with resources that contain information highly relevant to the target audience represented by the profile. User profiles can be built from the following: Age (Under 40: 40-49: 50 –69:

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Over 70); Disease Stage (Early breast cancer: Recurrent breast cancer: Advanced breast cancer); Information Preference (Plain/Brief: Plain/Detailed: Scientific/Brief: Scientific/Detailed) and User (Self: Child: Friend: Partner/Spouse: Parent). For example, if a user selects ‘plain’ and ‘brief’ as a presentation format, then her search, for example, will not retrieve medical journal articles. If a young women is looking for personal stories and accounts the resources retrieved will be of stories from women in her age group.

The BCKOnline Metadata Schema adapted the Type element to enable classification of resources according to the categories Medical, Supportive and Personal. This classification was particularly important given the commitment to provide access to information that was not only of a medical or scientific nature. The information needs analysis clearly identified the need for psychosocial and facilitative information as well as personal anecdotes. The Type element qualifiers are used to enable users of the portal to narrow their search to include only resources of a medical, supportive or personal nature. This categorisation was also used in the identification and selection of resources for inclusion in the prototype.The AGLS Schema references a number of encoding schemes to assist users of the Schema in assigning metadata values to elements. The encoding schemes include specifications of how elements are structured (e.g. the ISO which regulates the presentation or structuring of dates), classification schemes, thesauri and sets of indexing terms. For medical subject matter, AGLS specifies use of MESH, an international standard for the classification of medical knowledge. As its applicability is limited for consumer use in relation to some specific diseases, the BCKOnline Metadata Schema includes two additional sets of indexing terms. Developed by one of the project industry partners, the BreastCare Victoria Glossary is a listing of terms, which are specifically geared to breast cancer diagnosis, treatment and management. Hence it allows a far more precise classification than is currently available through MESH. The BCKOnline Disease Trajectory Encoding Scheme provides the basis for one of the three search strategies available to users of the portal – the capacity to search on terms relating to detailed phases in the disease trajectory of breast cancer. It was also used to select resources to be included in the prototype. The additional BCKOnline subject encoding schemes both incorporate terminology that is more likely to be used by a lay audience, e.g. drug names such as Herceptin instead of monoclonal antibodies, and parochial expressions, idioms and acronyms such as HRT in place of hormone replacement therapy.The qualifiers for the Quality element were developed using a conceptual analysis framework derived from examination of existing quality standards and codes, e.g. Health on the Net HonCode, the AMA Guidelines for Medical and Health Information Sites, HiEthics, MEDCERTAIN, DISCERN and OMNI, coupled with an analysis of the findings of the user needs study relating to quality. These properties specify attributes of the resource such as the credentials of the author and publisher, the purpose and currency of the resource, whether the resource is well referenced, whether the resource has gone through some kind of review process, whether it is evidence-based, and whether it contains information that represents a consensus of opinion or is controversial. The Quality element also enables the portal to provide the user with a narrative report highlighting the essential characteristics of the

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‘quality’ of the individual item – its provenance, authoritativeness and reliability.

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BCKOnline Metadata Elements

1. Creator element

Name CreatorHTML element name DC.CreatorXML element name dc:creatorDefinition The entity primarily responsible for creating the

resource content (equates to author in most cataloguing schemes)

Obligation MandatoryBCKOnline Use Displayed in Long Record. Not a searchable

element.

1.1 Guidelines for content creation for CreatorUse this element to provide the name of the person or organisation responsible for creating the content of the resource.When expressing personal names, include the last name first followed by a comma, then the first name (eg Smith, Mary). The Creator element is repeatable. In the case of multiple authors, use the Creator element for the first four authors. If the resource involves more than four authors, list the 5th and ensuing authors under the Contributor element. NOTE: Where no individual author is indicated, the organisational name is entered. For example, the resource located at http://www.breastcancer.org/testing_images.html does not cite individual author names. In this instance the creator is entered as ‘Breastcancer.org’.

2. Date Element

Name DateHTML element name DC.DateXML element name dc:dateDefinition A date associated with an event in the life of the

resourceObligation Mandatory - if availableBCKOnline Use Displayed in Long Record. Not a searchable element.

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http://www.breastcancer.org/testing_images.html


2.1 Guidelines for content creation for DateUse this element to provide information about when the resource was created, modified or issued. Format the Date element according to ISO 8601, i.e. in the form YYYYMMDD. NOTE: BCKOnline does not include ‘time formats’. See Appendix F for more information on the ISO.

2.2 QualifiersUse the following qualifiers with the Date element:

Created: The creation date of the resource. In the case of medical journal articles this is usually the publication date used in the citation. For example: the editorial located at http://bmj.bmjjournals.com/cgi/content/full/329/7477/0-g is entered as 2004/11/27

Modified: The date the resource was last modified. Also use this qualifier for dates of ‘review’ or ‘editorial review’, e.g. when the content of a resource has undergone specific reappraisal and revision, such as reviews of alternative/complementary therapies from the National Cancer Institute.

Issued: The date on which the resource was made formally available in its current form. If a resource is available online, this date will be the date it was first published online in its current form. In the case of archived materials for which no official ‘issue’ date is given, use the ‘created’ qualifier – for example: medical journal articles which were originally published several years ago, but have since been made available as scanned online copies.

3. Description Element

Name DescriptionHTML element name DC.DescriptionXML element name dc:descriptionDefinition A brief textual description of the content and purpose

of the resource Obligation MandatoryBCKOnline Use Displayed in Short Record and Long Record. Not a

searchable element.

3.1 Guidelines for content creation for DescriptionUse the Description element to provide a brief textual description of the content and purpose of the resource. The primary function of the description

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http://bmj.bmjjournals.com/cgi/content/full/329/7477/0-g


is to provide the user with sufficient information to gauge the potential relevance of the resource. If the resource being described has the status of a clinical guideline or consensus statement, include reference to this in the description (see below for definitions). For example: The official guidelines issued by the Royal Australian College of General Practitioners on the diagnosis, treatment and management of osteoporosis in postmenopausal women. Included are: risk assessment variables; drug therapies; the controversy surrounding HRT; vitamin supplements and contact details of support organisations. Diagrams and graphics are included. (Australian) (http://www.racgp.org.au/afp/downloads/pdf/october2002/20021001guidelines.pdf)Include geographic references where appropriate. For example, where specific procedures/equipment/protocols are associated with only one particular hospital (e.g. material describing the radiotherapy operations at Peter MacCallum Cancer Institute in Melbourne), or where protocols are associated with one specific country (e.g. material outlining tumour grading in the United States). For example: Information on how to interpret and understand a pathology report. Included are explanations of tumour grading, lymph node involvement and clinical diagnosis. NOTE: the classification scheme referred to is American based and hence may not coincide with schemes used elsewhere. (American) (http://www.breastcancer.org/pathology_brochure.html)

Include a list of ‘Chapter contents’ when describing resources not available online.If the resource includes non-textual material, indicate the medium of the resource and its duration. For example, the user is alerted to whether the resource ‘may be viewed, listened to’ or whether it is an ‘interactive slide show’. This is especially important if the user is provided with a choice as to the medium through which the resource may be accessed. For example, some materials are available in multiple media types such as a transcript in a text document, an audio recording, or a streamed video. The user is alerted to this fact in the following manner - A webpage that provides links to a discussion on chemotherapy side effects. The information may be read or listened to. Included are such topics as: chemotherapy side effects; medications to manage, lessen or prevent side effects; and advocacy for improving the chemotherapy experience. (American) (http://www.healthtalk.com/breastcancer/programs/030403/index.cfm)

If a resource is of a particularly graphic nature, and has the potential to be disturbing/distressing, alert users to this potential in the description. For example: A brief outline of the physical process of death. Specifically written for the caregiver, this list of physical symptoms is organised according to time lines. For example - what to expect 1 to 3 months before death; several weeks before death and the days leading up to death. NOTE: Some users may find this disturbing. (American) (http://www.cancerlynx.com/dying_guide_line.html)

NOTE: Definitions of guidelines and consensus statements:Guidelines: Materials designated as ‘guidelines’ by official bodies such as the National Breast Cancer Centre, State and Federal Cancer Councils, the

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http://www.cancerlynx.com/dying_guide_line.html

http://www.healthtalk.com/breastcancer/programs/030403/index.cfm

http://www.breastcancer.org/pathology_brochure.html

http://www.racgp.org.au/afp/downloads/pdf/october2002/20021001guidelines.pdf

http://www.racgp.org.au/afp/downloads/pdf/october2002/20021001guidelines.pdf


National Health & Medical Research Council, the Australian Medical Association and its Colleges. For example – “Clinical Practice Guidelines: Management of Advanced Breast Cancer”Consensus Statements: Materials emanating from both government bodies as well as medical colleges and specialities which are intended to address specific clinical issues about which no official guidelines currently exist – for example, hormone replacement therapy and the risk of breast cancer.

4. Title element

Name TitleHTML element name DC.TitleXML element name dc:titleDefinition A name given to the resourceObligation Mandatory – BCKOnline Use Not a searchable element. Displayed in both Short

Record and Long Record and functions as the hyperlink enabling user direct access to resource.

4.1 Guidelines for content creation for TitleIt is often difficult to decide the correct title for a resource. Creation of ad hoc titles for resources is not recommended. General title rules are: use the content of the HTML <TITLE> tag (if provided) as long as it clearly

describes the resource; use the wording of the title on the resource where this conveys the correct

meaning for the resource; and do not use the file name of the resource.The format for entering title in BCKOnline is: Lower case except where the first word is either a definite or indefinite article, e.g. An Exploration of the psychosocial …

4.2 QualifiersThe element refinement Alternative is the only qualifier for Title. Use it where the resource is also known under a different title, or has recently changed its title and is still known by its previous title.

5. Type element

Name TypeHTML element name DC.TypeXML element name dc:type

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Definition This element and its Category Qualifier are used to categorise the resource as Medical, Supportive or Personal

Obligation Mandatory BCKOnline Use Key search term. Displayed in Short Record and

Long Record.

5.1 Guidelines for content creation for Type and Category QualifierThe Type element and its Category Qualifier enable the sorting and discovery of resources with reference to three major categories: Medical, Supportive, Personal. Some resources should be classified under a single Category Qualifier. Numerous medical websites provide a wide range of resources which may incorporate medical as well as facilitative or supportive information. This is especially true of home pages and resources issued by consumer groups. In these cases the Category Qualifier may be repeated.

5.2 Use of Encoding SchemeBCKOnline has one element refinement: Category. As indicated above, there are only three BCKOnline values for this qualifier: medical, supportive or personal. See Appendix B for the BCKOnline Category Scheme which defines the terms Medical, Supportive, and Personal.

6. Subject element

Name SubjectHTML element name DC.SubjectXML element name dc:subjectDefinition Provides subject descriptors for the topic or content of

the resourceObligation MandatoryBCKOnline Use Key search element. Displayed in Long Record

6.1 Guidelines for content creation for SubjectThe main objective is to choose the most specific, significant and unique subject terms, avoiding those too general to describe a particular resource, and recognising the importance of describing resources in ways that are most meaningful to BCKOnline’s target audience. Repeat the Subject element as often as is necessary to achieve this objective.Provide adequate terms to allow resource discovery, but do not repeat variations of terms, synonyms, case or tense variations, or alternate spellings except where:

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recognised international variations exist, e.g. ‘lymphoedema/lymphedema’; ‘Effexor/Efexor’

acronyms represent current common usage, e.g. HRT for hormone replacement therapy

lay usage of terminology differs markedly from medical terminology – i.e. ‘advanced breast cancer’ as opposed to ‘Neoplasm metastases’.

Separate terms or phrases by a semicolon. If the subject of an item is an individual or an organisation, write the name in the manner described for personal names under the Creator element.

6.2 Use of Encoding SchemesBCKOnline resource descriptions use the Medical Subject Headings thesaurus MESH (2004) and the BreastCare Victoria (BCV) Glossary in the first instance. MESH is an international standard for the classification of medical knowledge, but it is not breast cancer specific and the terminology may not in all instances be appropriate for the predominantly lay target audience of BCKOnline. The BreastCare Victoria Glossary is disease specific and incorporates medical terminology as well as common usage terms which are particularly appropriate for the Australian context and current evidence-based guidelines, e.g. ‘hormone replacement therapy’ as opposed to the MESH subject term of ‘estrogen replacement therapy’ and ‘locally recurrent’, as opposed to the MESH ‘neoplasm recurrence, local’.If appropriate terms are not available in either of these thesauri, then check BCKOnline’s ‘Key Words’ which incorporate common usage terms as well as terms which capture the psychosocial aspect of the breast cancer experience – for instance ‘women’s stories’ – or the facilitative nature of many of the resources, such as ‘addresses and contacts’.The BCKOnline Disease Trajectory will also be used. This encoding scheme provides a broad classification of the various medical stages associated with breast cancer treatment as well as two categories which may be applicable across the entire trajectory – ‘psycho-social support/information’ and ‘alternative/complementary therapies’. The BCKOnline Disease Trajectory is primarily intended as a browsing option, when no specific search terms are entered by the user. The categories within the Disease Trajectory are: diagnosis; types of breast cancer; early breast cancer; prevention/risk factors; surgery; chemotherapy; radiotherapy; hormonal therapy; recurrent breast cancer; advanced breast cancer; palliative care; alternative/complementary therapy; psychosocial support/information. Again, certain materials may necessitate the assignment of more than one disease trajectory description.NOTE: See Appendix C for MESH, the BreastCare Victoria Glossary, BCKOnline’s ‘Key Words’, and the BCKOnline Disease Trajectory.

7. Availability element

Name AvailabilityHTML element name AGLS.Availability

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XML element name agls:availabilityDefinition How the resource can be obtained or accessed, or

contact informationObligation Mandatory for descriptions of offline resources, but not

used when the resource is online and readily availableBCKOnline Use Displayed in Short record and Long Record

7.1 Guidelines for content creation for AvailabilityThe Availability element is primarily used for non-electronic resources to provide information on how consumers may obtain physical access to a resource. In this element, provide a free text description of how to obtain the resource including name of organisation housing item; address; telephone numbers and email contact details. Also include information about potential costs that may be incurred in accessing the item.

8. Identifier element

Name IdentifierHTML element name DC.IdentifierXML element name dc:identifierDefinition An unambiguous and unique reference to the resource

within a given contextObligation MandatoryDisplay Displayed in Short and Long Record

8.1 Guidelines for content creation for IdentifierRecommended best practice is to identify the resource by means of a string or number conforming to a formal identification system. Examples of formal identification systems include the Universal Resource Identifier (URI), the Uniform Resource Locator (URL), the Digital Object Identifier (DOI), International Standard Book Number (ISBN) and International Standard Serial Number (ISSN). For online resources, use the URL of the resource.It is important to note that the Identifier element will only work if the online resource being described has a stable URL or URI. Web systems that dynamically generate resources with a different URL or URI each time they are served cannot support the deployment of AGLS metadata. In the BCKOnline resource selection process resources which were likely to be of an ephemeral nature are not included. For instance, news bulletins highlighting latest research results are generally excluded since the URL would only be constant for 30 days. In many cases, websites indicate their archiving protocols enabling judicious resource selection.

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For online resources like formal publications that bear an International Standard Book Number (ISBN) or International Standard Serial Number (ISSN), repeat the element to provide this information as well as the URL.

9. Publisher element

Name PublisherHTML element name DC.PublisherXML element name dc:publisherDefinition The entity responsible for making the resource

available onlineObligation Mandatory BCKOnline Use Displayed in Long Record

9.1 Guidelines for content creation for PublisherThis element is used for providing information about the publisher of the resource. In certain cases the publisher will be the same as the creator and may also be the copyright holder. If a higher level organisation is involved, then treat this entity as the publisher. For example, an article appearing in the British Medical Journal would have the Publisher element as BMJ Publishing Group Ltd. Similarly, an item located in The Lancet is listed under the Publishing element of Reed- Elsevier B.V.

10. Audience element

Name AudienceHTML element name AGLS.AudienceXML element name agls:audienceDefinition The target audience of the resourceObligation Mandatory BCKOnline Use Displayed in Long Record. Key search element

enabling matching of user profiles to resources relevant to particular target audiences.

10.1 Guidelines for content creation for AudienceAGLS uses the Audience element to support direct targeting of specific community sectors. BCKOnline links this element and its qualifiers to self-selected ‘profiles’ on the user interface. Qualifiers may be repeated, depending on the content, apart from ‘information preference’. For example: sources describing various treatments such as chemotherapy may apply to

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different age groups as well as different audiences and disease stages. In this instance, values are repeatable. Other sources specifying specific drugs however may only be applicable to advanced disease or postmenopausal women and hence the values are not repeatable. The values contained in ‘information preference’ are not repeatable and each resource should be assigned only one value.

10.2 Qualifiers and Use of Encoding SchemeThe Audience Qualifiers developed to characterise the breast cancer community of users include age group, disease stage, information preference, user type and locality of user descriptions. The BCKOnline Audience Qualifier Schemes defines the following metadata values:

Age groups: under 40, 40-49, 50-69, Over 70

Disease Stages: early breast cancer, recurrent breast cancer, advanced breast cancer

Information Preference: plain-brief, plain-detailed, scientific-brief, scientific-detailed

User Type: self, partner/spouse, friend, parent, child

Locality of user residence: as rural, urban and rural.

NOTE: See Appendix D for the BCKOnline Audience Qualifiers Scheme which provides definitions of the metadata values for the Audience Qualifiers.

11. Language element

Name LanguageHTML element name DC.LanguageXML element name dc:languageDefinition The language of the intellectual content of the

resourceObligation Mandatory BCKOnline Use Displayed in Long Record

11.1 Guidelines for content creation for LanguageUse to describe the language of the content of the resource. The default value is English (‘en’) or Australian English (‘en-AU’). No other languages are being considered at this stage.

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12. Contributor element

Name ContributorHTML element name DC.ContributorXML element name dc:contributorDefinition An entity responsible for making important but

secondary contributions to the content of the resource

Obligation Optional BCKOnline Use Displayed in Long Record

12.1 Guidelines for content creation for ContributorUse for providing the name of a person or organisation with an important contributory role in the creation of the resource content. NOTE: Where a resource has more than 4 primary authors, list the 5th and ensuing authors under Contributor. Where the resource is a transcript of a discussion, or a web cast/audio representation, list the facilitator of the discussion as a Contributor together with the participants in the discussion.

13. Format element

Name FormatHTML element name DC.FormatXML element name dc:formatDefinition The physical or digital manifestation of the resourceObligation Mandatory BCKOnline Use Not a searchable element. Displayed in Long Record

13.1 Guidelines for content creation for FormatThe Format element allows the description of the physical or virtual characteristics of the medium in which the resource is manifested. NOTE: The AGLS Metadata set Version 3.1 does not incorporate values for audiotapes. BCKOnline enters such resources under ‘multipart/mixed’.

13.2 Use of Encoding SchemeMetadata values for electronic resources should be selected from the Internet Media Types (IMT) list of terms in Appendix G.

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14. Relation element

Name RelationHTML element name DC.RelationXML element name dc:relationDefinition A reference to a related resourceObligation Optional BCKOnline Use Not a searchable element. Displayed in Long Record

14.1 Guidelines for content creation for RelationThe Relation element identifies a relationship that exists between the resource being described and another resource, and also specifies the type of relationship between the two resources. This relationship is expressed as an element refinement (eg DC.Relation.hasVersion). Typically, the value for this element is a formal identifier (eg a URI).In BCKOnline metadata records, use the Relation element to indicate the relationships between the following resources:

medical journal articles comprising one part of a specific journal issue a commentary on, or review of, a clinical trial or study and the study

being reviewed a bulletin board posting which is part of an extended list of postings on

the same issue any presentation, transcript, web cast, etc. which is part of a formal

conference individual book chapters and the book they are part of.

14.2 QualifiersBCKOnline uses three of the AGLS element refinement pairs. Use whichever is the relevant side of the pair:

isPartOf/hasPart: one resource is a physical or logical part of another (journal article is part of an issue of the journal; book chapter is part of a book; paper is part of a conference; a bulletin board has a bulletin board posting as one of its parts)

references/isReferencedBy: one resource cites, acknowledges, disputes or otherwise refers to another resource (a review of a study references that study; an article is referenced by a review)

isBasedOn/isBasisFor: one resource is a performance, production, derivation, translation, adaptation or interpretation of another resource (a commentary on a study is based on that study; the study is the basis for the commentary)

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NOTE: In BCKOnline the Relation element provides a direct link to the homepage of the resource, or to the contents page for the specific issue if the resource is a medical journal article. For example: an article appearing in the British Medical Journal has the value – http://bmj.bmjjournals.com/current.shtml

15. Rights element

Name RightsHTML element name DC.RightsXML element name dc:rightsDefinition Information about rights held in and over the resourceObligation MandatoryBCKOnline Use Not a searchable element. Displayed in Long Record

15.1 Guidelines for content creation for RightsUse for copyright statements about information resources. It can be text, or a URL pointing to a copyright statement, but the preferred option in BCKOnline is a verbatim statement derived from the resource or its publisher. May also be used to describe access terms and conditions applying to the resource being described.

16. Source element

Name SourceHTML name DC.SourceXML element name dc:sourceDefinition Information about a current resource and from where

it is derived Obligation OptionalBCKOnline Use Not a searchable element. Displayed on Long Record

16.1 Guidelines for content creation for SourceUse for providing a pointer to the original from which the resource being described was derived. In BCKOnline both the Relation and the Source element are used for materials appearing in journals or newsletters and chapters of books. The Relation element is used to direct the user to the home page, or contents page of the specific issue, whilst the Source element description is the full citation of the resource. For example – if an article published in the British Medical Journal is being described, the Source description is - BMJ 2003: 327: 999-1000.

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http://bmj.bmjjournals.com/current.shtml


17.Quality Element

Name QualityHTML name BCKO.QualityXML element name bcko:qualityDefinition Information related to the quality of a resourceObligation Mandatory BCKOnline Use Not a searchable element. Displayed in Short Record

and Long Record

17.2 Guidelines for content creation for QualityDuring resource discovery, users will see a narrative report relating to the quality of the information resource as part of the Short Record so that they can make their own quality assessment. This is derived from the Quality Narrative Report Qualifier. They will see all of the Quality Element Qualifiers in the Long Record. The information presented to them includes the credentials of creators, contributors, and publishers, the nature of any related review process, an indication if references are provided/sources cited, the evidence based category of the resource, an indication of the purpose of the resource, whether the resource contents relate to a contested area, or one in which there is a consensus view, and the currency of the resource.The narrative quality report qualifier is structured according to the following order: creator, publisher, review process, attribution of evidence; evidence based category, currency, purpose and balance. Two examples follow:This material was created by a lay author and published by a consumer group. The content has undergone editorial review. References are not included and the subject matter represents current personal opinion. The purpose is educational/informative and the controversial nature of some of the issues has been noted.

This material was created by clinicians and published by a medical organisation. The content has undergone editorial review. References are included and the subject matter represents current case/cohort evidence. The purpose is educational/informative and is of a non-controversial nature.

17.3 Qualifiers and Use of Encoding SchemeThe Quality element is defined in terms of its refinement or qualifier elements. The metadata values are derived from the BCKOnline Quality Qualifiers Scheme and are outlined in the Table below. For detailed definitions of these metadata values, see the BCKOnline Quality Qualifiers Scheme in Appendix E.

Attribute Properties BCKOnline Encoding Scheme

Quality Credentials of Creator, For individual: lay author; clinician; researcher

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Publisher or Contributor

Review Process

Attribution of Sources

Evidence Based Rating Type

Purpose

Balance

Currency

Quality Report

For organisation: consumer group; commercial body/group; educational institution; government organisation; medical organisation; cancer organisation

Editorial Board; peer review process; no review/editorial process

Yes/No

Meta-analysis; randomised clinical trial; case/cohort study; review; consensus opinion; personal opinion

Educational/informative; commercial; reportage of results; discussion forum

Controversial issue – noted; controversial issue – not noted; non controversial issue

Current; non-current

Enabling capture of properties in a narrative form

APPENDIX A: BCKOnline metadata summary

Table A: BCKOnline metadata summaryAGLS elements

Element refinements

Encoding Schemes

Notes

Creator (*)

PublisherContributorAvailability (* if no Identifier)

Used for offline resources

Title (*) alternativeSubject (*) MeSH

BCKOnline ‘Key Terms’

BCV Glossary

BCKOnline Disease

Medical Subject Headings

Additional suitable terms not contained in other encoding schemes

BreastCare Victoria Glossary

diagnosis, types of breast cancer, early breast cancer,

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Trajectory prevention/risk factors, surgery,, chemotherapy, hormonal therapy, radiotherapy, recurrent breast cancer, advanced breast cancer, palliative care, alternative/complementary medicine, psychosocial support/information

Date (*) createdmodifiedissued

ISO 8601 International Standard for date encoding

Identifier (*) URIISBN

ISSN

Uniform Resource IdentifierInternational Standard Book NumberInternational Standard Serial Number

Rights URIDescription (*) URISource URI

ISBNISSN

Language RFC3066 Internet Engineering Task Force Request for Comment for language and country encoding. Only “en” or “AU-en” is used for BCKO.

Relation isPartOf/hasPart

is references/isReferenced ByisBasedOn/isBasisFor

URI

ISBNISSN

Type (*) Category (*) BCKOnline Category Scheme

Medical, Supportive, Personal

Format IMT Internet Media Types

Audience (*) Age Group (*)

Disease Stage (*)

Information Preference (*)

User Type (*)

Locality of user (*)

BCKOnline Audience Qualifiers Scheme

Under 40, 40-49, 50-69, over

Early Breast Cancer, Recurrent Breast Cancer, Advanced Breast Cancer

Plain/brief, plain/detailed, scientific/brief, scientific/detailed.

Self, partner/spouse, friend, parent, child

Rural, Urban & Rural

Quality (*) Credentials of Creator, BCKOnline Quality For individual, lay author,

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Publisher or Contributor (*)

Review Process (*)

Attribution of Sources (*)

Evidence based rating type

Purpose (*)

Balance (*)

Currency(*)

Quality Report

Qualifiers Scheme clinician, researcher; for organisation, consumer group, commercial body/group, education institution, government organisation, medical organisation, cancer organisation

Editorial board, Peer review process, No review/editorial process,

Yes/No

Meta-analysis, Randomised clinical trial, Case/cohort study, Review, Consensus opinion, Personal opinion,

Educational/informative, Commercial, Reportage of results, Discussion forum

Controversial issue – noted, Controversial issue – not noted, Non controversial issue

Current, non-current

NOTE: elements marked * are mandatory

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APPENDIX B: BCKOnline CATEGORY QUALIFIER Scheme

BCKOnline uses the Category Qualifier of the Type Element to categorise resources into the following classes: Medical, Supportive, Personal.

BCKOnline Category SchemeCategory Type ScopeMedical Resources related to the treatment

and management of disease, such as: treatment options; clinical trial reports; drug news. This category may include any of the following:Scientific papersClinical Practice GuidelinesClinical trial information and/or resultsDrug reportsTreatment reviewsResearch media releases

Supportive Supportive may be regarded as psychosocial outcomes which include: the effect of the disease on the woman and her family; aspects of social and psychological functioning either on a temporary bases or as the long term consequences of the disease; facilitative information which may include addresses of support groups, government assistance information; local council contacts for home-help. This may include:Information regarding financial, emotional support, practical assistanceInformation on various therapies designed to ameliorate the physical and psychological impact of disease and treatmentCase studies

Personal This may overlap with the psychosocial, but may be different

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and generally embody the value systems in the life of the individual. These outcomes are often based on reflection of the experience of disease, including its treatment rigours, and incorporate the stories and personal reflections of other individuals. The ‘voice’ of the health professional would also be included in this category. This may include:Women’s/families’ and professional reflection or appraisals of the individual’s experience of breast cancer.

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APPENDIX C: SUBJECT ENCODING SCHEMES

APPENDIX C1: MESH: MEDICAL SUBJECT HEADINGS APPENDIX C2: BREASTCANCER VICTORIA GLOSSARYCreated by BreastCare Victoria this glossary deals exclusively with the diagnosis, treatment and management of breast cancer. See attachment for a full listing of terms and their definitions.APPENDIX C3: BCKONLINE “KEY WORDS’Captures the terminology used by the lay consumer and have particular relevance for the Australian audience in terms of variant spelling and in its employment of drug brand names. The key words also include various acronyms which are in common usage by patients and their families, e.g. CMF as a chemotherapy regimen, in place of cyclosphosphamide, methotrexate and fluorouracil. See attachment for a full listing of terms and their definitions.APPENDIX C4: BCKONLINE DISEASE TRAJECTORYRepresents the potential stages of disease progression and associated treatment/management regimens. Whilst there may be some overlap between categories, and certain categories such as ‘psychosocial’ may apply throughout the disease experience, documents should be classified according to the major emphasis of the content.

BCKOnline Disease Trajectory ScopeDiagnosis Documents which relate to the initial

testing, discovery, and determination of the onset of disease. This may include:MammographyBiopsyClinical Breast ExaminationBreast Self ExaminationPathology/Cytology testingLymph NodesER positiveER negative

Types of breast cancer Documents which detail the variety of possible breast cancers, or which deal with one or more specific types of the disease. This may include:DuctalLobular

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InflammatoryPaget’s diseaseFamilial (BRCA1/BRCA2)TubularDuctal carcinoma in situHyperplasiaLobular carcinoma in situ

Early breast cancer Documents which relate to treatment, management, and discussions of early breast cancer. That is, breast cancer which is locally contained and has not spread to other organs or tissues in the body.

Prevention/Risk factors Documents which relate to the recognised ‘risk factors’ and/or prevention strategies for the onset of breast cancer. These may include:DietWeightEnvironmental factorsAge of menstruationFamily history (BRCA1/BRCA2)ExerciseSmoking

Surgery Documents which relate to all aspects of breast cancer surgery once the disease has been confirmed, including reconstruction. For example:Sentinel lymph node biopsyMastectomyLumpectomyPain managementBreast reconstruction – autologous reconstructionAxillary dissection

Radiotherapy Documents which relate to the treatment of breast cancer by radiation therapy. This may include:Brachytherapy

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Hormonal Therapy Documents which relate to the treatment of breast cancer via the use of drugs classified as ‘hormonal agents’ and administered to both pre-menopausal and post-menopausal women. This may include:TamoxifenAromatase inhibitors

Chemotherapy Documents which relate to the treatment, management and side effects from the use of cytotoxic and other drugs. This may include various drugs and treatment regimens such as:AdriamycinCyclophosphamideMethotrexateEpirubicinVinorelbine

Recurrent Breast Cancer Documents which relate to the local recurrence of breast cancer . Note: this category may include locally advanced, or contralateral occurrences, but is not to be used for a recurrence diagnosed as metastatic. This may include:SymptomsAvailable tests/pathologyTreatment optionsPsychological impact

Advanced breast cancer Documents which relate to the onset, diagnosis, treatment of advanced disease – that is, disease which has spread to other organs/tissues. This may include:Herceptin (monoclonal antibodies)Bone metastasisLung metastasisLiver metastasisBisphosphonatesPain management

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Death and dyingPsychological impact

Palliative care Documents which relate to the palliative care aspects of breast cancer. This may include:Death and dyingFinancial issues‘Living wills’Pain managementFacilitative information

Alternative/Complementary therapies

Documents which focus primarily on alternative/complementary therapies and their use in breast cancer treatment and management. The documents may be relevant across the entire disease trajectory from early to advanced disease and may incorporate a range of modalities from herbal, to the psychological such as meditation techniques for pain relief. Categories may include:Chinese herbal medicinePhytoestrogensDietary supplementsHypnosisYoga/MeditationArt therapy

Psychosocial support/Information Documents which relate primarily to the psychological and emotional import of breast cancer, both for the individual involved, as well as family members and friends. Facilitative information may also be included.

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APPENDIX D: BCKOnline AUDIENCE QUALIFIERS SCHEME

BCKOnline Audience QualifiersAge Group Under 40

40 – 4950-69Over 70

Disease Stage Early Breast Cancer - Where the disease has not metastasised (spread) to other organs or tissues in the bodyRecurrent Breast Cancer – Where the disease has recurred/reappeared, either in the same breast, or in the contralateral breast, but has not metastasised to other organs or tissues in the body.Advanced Breast Cancer – Where the disease has spread to other organs and tissues in the body and where this is determined to be of a ‘secondary’ nature.

Information Preference NOTE: BCKOnline defines the information seeking preferences of users in describing how they prefer to visualise the resource contents. The user’s information preference element addresses the ‘depth’ or brevity of the resource as well as the ‘scientific’ nature of the content. For classification purposes the following criteria were developed.Plain/brief – includes resources of less than 500 words and written in a language immediately accessible to the lay consumer. That is, no prior ‘medical’ knowledge or familiarity with the terminology is required in order to comprehend the material. Examples include: homepages of organisations, support groups, lay versions of scientific media releases and abstracts.

Plain/detailed – includes resources

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of more than 500 words and written in a language accessible to the lay consumer. Unlike the plain/brief category, this may entail an indepth discussion/review of latest research, or treatment, but the defining characteristic remains its predominant use of non-scientific language. Examples include: experiential and/or professional summaries of treatment; extended lay reviews of current practise (for example ‘consumer guidelines’).Scientific/brief – resources of less than 500 words and written in a language which assumes some familiarity with medical/scientific terminology and concepts. Examples include: abstracts to scientific/medical journal articles; homepages to scientific organisations (Human Genome Project; CSIRO, etc.)Scientific/detailed – resources of more than 500 words and written in a language which assumes some familiarity with medical/scientific terminology and concepts. Examples include: full length medical journal articles; researchers’ presentations at conferences; reviews/meta-analyses of clinical trials, etc.

Locality Rural – resources which have specific relevance to users residing in rural or remote areas. For example documents which provide information on travel assistance schemes to country users; support groups located in rural areas, etc.Urban and rural: resources which may be relevant to both rural and urban users. That is, the content of these resources is not geographically defined. Example: a generic resource explaining chemotherapy applies equally to residents in rural areas as it does to users residing in metropolitan centres.

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APPENDIX E: BCKOnline QUALITY ELEMENT ENCODING

BCKONLINE QUALITY ELEMENT ENCODING SCHEME

Credentials Generally assumed to imply the ‘authoritativeness and credibility’ of the individual or organization responsible for the document, BCKOnline subcategories are defined as:Lay Author: an individual who has no officially recognized ‘expertise’ or qualifications in the medical arenaClinician: a suitably qualified health practitioner engaged in the clinical practice of medicine Researcher: a suitably qualified health practitioner, but one whose primary area of expertise resides not in clinical practice, but in applied research and discovery.Consumer Group: any organization whose members are primarily lay consumers. The organization may be formally affiliated with other umbrella groups, or may be legally constituted as either a charity, support group, or advocacy group.Commercial Body: any organization which is constituted under the Trade Practices Act as a ‘commercial’ organization. This may include both private and public bodies.Medical Organisation: this may include both individual bodies as well as affiliated groups such as the Royal Australian Colleges and their respective regional divisions. Hospitals and University Teaching Hospitals are also included in this category.

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Cancer Organisations: bodies and/or groups which focus on the treatment, management and research of cancer. For example, COSA (Clinical Oncology Society of Australia), Cancer Council, etc.Government Organisations: organisations and departments which are funded or auspiced by federal or state governments. For example: the American National Institutes of Health, the Australian Dept. of Health and Ageing.Educational Institution: organizations whose primary purpose is teaching. For example, universities or teaching hospitals affiliated with academic departments or faculties.

Review Process Editorial BoardPeer Review ProcessNo Editorial/Peer Review Process

Attribution of Sources References Cited – Yes/No

Yes: Where the content is associated with either footnotes, endnotes, a bibliography or references which clarify for the reader the source of the information and enable her to ascertain author, publication, and date.

No: Where the content is not associated with any of the above.

Evidence Based Category Personal Opinion: Where the content largely represents views expressed by an individual or several individuals. This may ‘endorse’ current best practice, but does not emanate from an official body or organisation.

Meta-analysis: Where the content represents evidence or results

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aggregated from a series of randomized clinical trials and where the ‘end-points’ of such clinical trials are the specific focus.

Randomised Clinical Trial: Where the content largely represents ‘evidence’, or results emanating from a nominated randomised clinical trial, or several such trials. A randomised clinical trial involves a ‘control’ group and a ‘treatment’ group which is randomly assigned and ‘blinded. That is, neither the patient nor the doctor knows who is receiving the new experimental treatment or receiving the standard therapy. NOTE: this category differs from a ‘review’ in the sense that the information is not an expansive overview and restricts itself exclusively to clinical trials.

Case/cohort study: Where the content largely represents a single study and is not a double-blinded, randomised clinical trial. Generally case/cohort studies focus on single individuals or specific populations. They are not necessarily representative of the population as a whole.

Review: Where the content largely represents an extensive overview of research conducted on the issue. The research may incorporate any or all of the following kinds of studies: randomised clinical trials, case/cohort studies, qualitative interviews, meta-analyses and epidemiological population based investigations.

Consensus opinion: Where the content largely represents current practice without the ‘official’ endorsement of ‘clinical practice guidelines’, or extensive Level 4 evidence (i.e. randomised clinical trials), but which has basically been agreed upon by a meeting of ‘experts’.

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Purpose Educational/Informative: Material whose primary function is to inform/’educate’ the reader by providing her with any or all of the following: background information; current status of knowledge on the issue; research results; potential application of such research; statistical analyses.

Reportage of Results: Where the content represents the results of a single or several studies.

Commercial: Where the content represents an overt attempt to ‘sell’ a product or service to the user. Advertising material, which informs the user as to the existence of a product or service, may not be construed as ‘commercial’ if the primary purpose of the webpage is deemed informative.

Discussion Forum: Where the content has been produced with the intention of publishing this on a discussion bulletin board/chat room, etc. The material may represent a response to a previous query, or be eliciting information from others, or simply presenting a personal point of view.

Review: Where the content represents an overview of the current state of knowledge which may be drawn from a variety of evidence levels. For example data may be derived from both randomised clinical trials and case/cohort studies

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BalanceControversial Issue – Noted: Where the content represents views, evidence, which are not endorsed by current best practice, or clinical practice guidelines, and where this fact has been acknowledged explicitly in the content.

Controversial Issue – Not Noted: Where the content represent views, evidence, which are not endorsed by current best practice, or clinical practice guidelines, and where this fact has not been acknowledged anywhere in the content.

Non-controversial Issue: Where the content represents views, or evidence which are consistent with current best practice and have been endorsed via official consensus statements or clinical practice guidelines.

CurrencyCurrent: Where the content represents views, evidence, personal opinions that still have a bearing on the clinical, emotional, or psychological treatment, management and research of the disease.

Non-current: Where the content presents views, evidence personal opinions that no longer have a bearing on the clinical, emotional, or psychological treatment, management, and perception of the disease. This may be the result of ‘new evidence’, which discredits the material under question, or because the material itself is no longer relevant to the changing social, political, clinical and/or economic conditions of the present day.

APPENDIX F: DATE ELEMENT ENCODING SCHEME

This appendix has been extracted from the proposed revision to the standard by ISOTC 154 (copy available at: http://www.mcs.vuw.ac.nz/technical/software/SGML/doc/iso8601/iso8601.html

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http://www.mcs.vuw.ac.nz/technical/software/SGML/doc/iso8601/iso8601.html


) and from ‘Date and Time Formats’ by Misha Wolf and Charles Wicksteed, Reuters, 15 September 1997, which is a W3C Note and is available at: http://www.w3.org/TR/NOTE-datetime-970911.html

ISO 8601 is the International Standard for the representation of dates and times. ISO 8601 describes a large number of date/time formats. To reduce the scope for error and the complexity of software, it is useful to restrict the supported formats to a small number. This profile defines some date/time formats which are likely to satisfy most requirements.The formats are as follows. Exactly the components shown here must be present, with exactly this punctuation. Note that the ‘T’ appears literally in the string, to indicate the beginning of the Time element, as specified in ISO 8601.Year:

YYYY (eg 1997)Year and month:

YYYY-MM (eg 1997-07)Complete date:

YYYY-MM-DD (eg 1997-07-16)

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http://www.w3.org/TR/NOTE-datetime-970915.html

http://www.mcs.vuw.ac.nz/technical/software/SGML/doc/iso8601/iso8601.html


APPENDIX G: FORMAT ELEMENT ENCODING SCHEMEThe more commonly used values from the Internet Media Types (IMT) are listed here. These values can be used with the Format element. The full listing is available from:http://www.isi.edu/in-notes/iana/assignments/media-types/media-types

Table J1 IMT valuesIMT Description

text/plain Unformatted texttext/html Web pages (HTML)text/sgml SGML documenttext/xml XML documentmultipart/mixed Mixed format resources, which are

encoded according to Internet MIME standard

message/rfc822 Electronic mail (Internet format)application/postscript Postscript documentapplication/rtf Rich Text Format documentapplication/wordperfect1.1 WordPerfect V1.1 documentapplication/pdf Portable Data Format documentapplication/msword Microsoft Word documentapplication/EDIFACT Electronic Data Interchange For

Administration, Commerce and Transport resource

image/jpeg JPEG encoded imageimage/gif GIF encoded imageimage/png PNG encoded imagevideo/mpeg MPEG encoded videovideo/quicktime Quicktime encoded videomodel/vrml VRML encoded resource

REFERENCES

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http://www.isi.edu/in-notes/iana/assignments/media-types/media-types


National Archives of Australia. (2002). AGLS Metadata element Set: Part 2 – Usage Guide, Version 1.3. http://www.naa.gov.au/recordkeeping/gov_online/agls/AGLS_usage_guide.pdf. (Accessed July 2nd, 2002)

Health on the Net Foundation. (2004). HON Code of Conduct (HONCode) for Medical and Health Web Sites. http://www.hon.ch/HONcode/Conduct.html

American Medical Association. (2004). Guidelines for Medical and Health Information Sites on the Internet: Principles Governing AMA Websites. http://www.ama-assn.org/ama/pub/category/1905.html

Health Internet Ethics. (???). Health Internet Ethics: Ethical Principles for Offering Internet Health Services to Consumers. http://www.hiethics.com/Principles/index.asp

MedCircle. (2002). The Collaboration for Internet Rating, Certification, Labeling and Evaluation of Health Information. http://www.medcircle.org/metadata/hiddel.php?lang=en&cmd=view&ovl=ovlacc&x=24&y=10

NHS Executive Research & Development Programme (2001). The DISCERN Instrument. http://www.discern.org.uk/discern__instrument.htm

University of Nottingham. (?) BIOME Guidelines http://biome.ac.uk/guidelines/

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http://biome.ac.uk/guidelines/

http://www.discern.org.uk/discern__instrument.htm

http://www.medcircle.org/metadata/hiddel.php?lang=en&cmd=view&ovl=ovlacc&x=24&y=10

http://www.medcircle.org/metadata/hiddel.php?lang=en&cmd=view&ovl=ovlacc&x=24&y=10

http://www.hiethics.com/Principles/index.asp

http://www.ama-assn.org/ama/pub/category/1905.html

http://www.hon.ch/HONcode/Conduct.html

http://www.naa.gov.au/recordkeeping/gov_online/agls/AGLS_usage_guide.pdf

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