Rebecca,
     Record #21269606 is an authenticated (field 042   nsdp |a lc) record and the last institution in the 040 was NLM (National Library of Medicine) following CONSER standards.  Since the word change is beyond the "first five words" and does not meaningfully change the scope of the publication, it is considered a "minor" change, i.e a variation as stated in the 246.  The second record you cite (#57519500) has a 936 Do not use note  and refers you to #21269606.
                                                                   Ann

Ann L. Gardner
Library Technical Assistant
Serials Cataloging/CONSER Unit
New York State Library
CEC, 6th Floor
Albany, N.Y.  12230

phone: (518) 474-7274
E-Mail: agardner@mail.nysed.gov

>>> "Kemp, Rebecca" <kempr@UNCW.EDU> 4/6/2009 2:49 PM >>>
Hi, all- would those experienced catalogers out there consider this a major title change, from _American journal of hospice & palliative care_ to _American journal of hospice & palliative medicine_?  OCLC #21269606 considers it a minor change, while several OCLC #s, including 57519500, consider it a major change.

--Rebecca

Rebecca Kemp
Serials Coordinator Librarian
W.M. Randall Library
UNC Wilmington
601 S. College Rd.
Wilmington, NC 28403
phone (910) 962-7220
fax (910) 962-3078
kempr<at>uncw<dot>edu