Yesterday I read an interesting piece by Oliver Obst, “Trust no guideline that you did not fake yourself.” (Journal of EAHIL. 2013. v9 (4) p25) Obst references the German newspaper Frankfurter Allgemeine Zeitung, which reported several cases of fake practice guidelines. I don’t read German and it appears you must pay to access FAZ’s article archive, but if you read German and have access to the archive, the link to the article is here. According Obst’s summation of the article and Google Translate’s translated version of the abstract, the newspaper attributes thousands of deaths in Europe due to guidelines from the European Society of Cardiology and scientific misconduct.
Unfortunately this is not a single incident, Obst reports “many more examples can be found in a disturbing report by Jeanne Lenzer in the British Medical Journal, ‘Why we cannot trust clinical guidelines.” Lenzer’s article reports that doctors with ties to pharma companies are writing the guidelines. Since most guidelines are written by a large group of doctors you would think it would be difficult to have financial bias make any sort of impact on the guidelines. However, Lenzer discovered a survey showing that it is entirely possible.
“A recent survey found that 71% of chairs of clinical policy committees and 90.5% of co-chairs had financial conflicts.12 Such conflicts can have a strong impact: FDA advisers reviewing the safety record of the progestogen drospirenone voted that the drug’s benefits outweighed any risks. However, a substantial number of the advisers had ties to the manufacturer and if their votes had been excluded the decision would have been reversed.13“
The Cochrane Collection is not immune either according to Lenza.
Early 1990′s-Reinforced by a Cochrane review, high dose steroids became the standard of care for acute spinal cord injury. The Cochrane Collaboration, permitted Michael Bracken, “who declared he was an occasional consultant to steroid manufacturers Pharmacia and Upjohn, to serve as the sole reviewer.”
The standard was just reversed in March 2013 with the Congress of Neurological Surgeons new guidelines. They found, “There is no Class I or Class II medicine evidence supporting the benefit of [steroids] in the treatment of acute [spinal cord injury]. However, Class I, II, and III evidence exists that high-dose steroids are associated with harmful side effects including death.”11
Lenza believes another example of biased guidelines is beginning to emerge regarding stroke and the use of alteplase.
“American College of Emergency Physicians with the American Academy of Neurology (jointly)18 and the American Heart Association,19 separately, issued grade A level of evidence guidelines for alteplase in acute stroke. The simultaneous recommendation by three respected professional societies would seem to indicate overwhelming support for the treatment and consistent evidence. However, an online poll of 548 emergency physicians showed that only 16% support the new guidelines.20“
Lenza points out that “claims of benefit rest on science that is contested. Sceptics say that baseline imbalances, the use of subset analyses, and chance alone could account for the claimed benefit.24 26 31 32 33 They also note that only two of 12 randomised controlled trials of thrombolytics have shown benefit and five had to be terminated early because of lack of benefit, higher mortality, and significant increases in brain haemorrhage.”33 Lenza also notes that “13 of the 15 authors had ties to the manufacturers of products to diagnose and treat acute stroke; 11 had ties to companies that market alteplase.”19
So what does this mean for librarians as we try and find the best research out there for our doctors, nurses and patients? This is a problem. Even if you take out the pharma bias, bio-medical scientific literature rarely publishes work on failures. Add the pressure from pharma wanting and promoting positive outcome research to published, we have even fewer examples of “what didn’t work” research articles and quite possibly what we thought was good evidence isn’t as good as we thought.
As Obst notes, librarians must be aware of this issue and to keep our patrons informed. Unfortunately this may be the only thing we can do and even then it might not be enough. Lenza ends her article by saying;
“Yet these and other guidelines continue to be followed despite concerns about bias, because as one lecturer told a meeting on geriatric care in the Virgin Islands earlier this year, ‘We like to stick within the standard of care, because when the shit hits the fan we all want to be able to say we were just doing what everyone else is doing—even if what everyone else is doing isn’t very good.”Share on Facebook
This week I was at the SCC/MLA annual meeting in Fort Worth teaching a class. I got in a little early and I was glad I did.
Karen Keller, Dena Hanson, Lynne Harmon, and Barbara Steffensen at Cook Children’s Medical Center presented a paper on the creation of a tool for non-academic health sciences librarians to measure the value of research performed by librarians. The tool attempts to measure the value and establish an ROI of librarian expertise. The abstract of the paper can be found in their online program(pg 25 of 36 in PDF viewer)
I found this to be really interesting. Medical librarians have been looking for ways quantify what we do and put a value on it to our administration. I did not get a chance to listen to the actual paper presentation. I found out about it because I attended the Hospital Librarianship Forum where we discussed ideas and issues facing hospital librarians. In the forum Karen mention her tool. Unfortunately the tool is not available. The are still testing it.
Even though it it isn’t ready for prime time I wanted to blog about it to make sure it is on the radar for librarians who might also be interested. So keep your eyes and ears open.
November 1st seems to be the deadline for a lot of things. So if you are thinking about applying for something, nominating somebody, or presenting something at MLA 2014, you better start checking your deadlines.
(reposted with persmission)
Please consider nominating a colleague for the Louise Darling Medal for Distinguished Achievement in Collection Development in the Health Sciences!
The Louise Darling Medal is presented annually to recognize distinguished achievement in collection development in the health sciences. The award was established in 1987 and first awarded in 1988, with a contribution by Ballen Booksellers International, Inc. The recipient receives an engraved medal, a certificate, and a $1,000 cash award.
If you want to nominate a deserving colleague, please go to www.mlanet.org/awards/honors/ for more information and online nomination forms. The deadline for applications is November 1. Please contact jury chair Jeff Williams at jeffrey.williams [atsign] nyumc [dot org] with any questions.Share on Facebook
(reposted from Midwest MLA listserve)
The Association of Academic Health Sciences Libraries (AAHSL) is pleased to announce the 2013-2014 year of the leadership program jointly sponsored by the National Library of Medicine (NLM) and AAHSL. The NLM/AAHSL Leadership Fellows Program is focused on preparing emerging leaders for the position of library director in academic health sciences libraries.
Fellows will have the opportunity to develop their knowledge and skills in a variety of learning settings, including exposure to leadership in another environment. They will be paired with mentors who are academic health sciences library directors. In addition to the individual relationship with their mentors, fellows benefit from working collaboratively with other fellows and mentors. Experienced program faculty and mentors will provide content and facilitation for the cohort. The program takes advantage of flexible scheduling and an online learning community to minimize disruption to professional and personal schedules. The sponsors will provide financial support for a small cohort of fellows and will underwrite travel and meeting expenses.
Fifty-five fellows have participated in the program in the first eleven classes. To date, twenty-two fellows have been appointed to director positions.
The one-year program design is multi-faceted: three in-person leadership institutes; attendance at an Association of American Medical Colleges (AAMC) annual meeting; a yearlong fellow/mentor relationship; webinars and discussions on issues related to library leadership; and two weeks of site visit to the mentor’s home library.
The program is designed to:
- Introduce fellows to leadership theory and practical tools for implementing change at organizational and professional levels;
- Introduce fellows to critical issues facing academic health sciences libraries;
- Develop meaningful professional relationships between fellows and mentors that give fellows access to career guidance and support;
- Expose fellows to another academic health sciences library and its institutional leadership under the guidance of their mentors;
- Examine career development and provide models of directors to fellows;
- Create a cohort of leaders who will draw upon each other for support throughout their careers;
- Promote diversity in the leadership of the profession; and
- Offer recognition to emerging leaders and enhance the competitive standing of fellows as they pursue director positions.
The NLM/AAHSL Leadership Fellows Program is currently accepting applications and nominations for the August 1, 2013, deadline for potential fellows for the 2013-2014 experience. Candidates for fellow should have a strong interest in pursuing a directorship in academic health sciences libraries, as well as significant management experience. Applications are welcomed from professionals working in academic health sciences libraries, hospital libraries, or other library-related settings. Applications from qualified minority candidates are encouraged.
Directors with at least five years’ experience as director of an academic health sciences library should indicate preliminary interest in being matched as a mentor by contacting the AAHSL Future Leadership Committee by August 1.
The program brochure, including information on program design, schedule, and application process, is available at http://www.aahsl.org/assets/documents/2013/2013-2014_nlm_aahsl_lfp.pdf.
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The last month we have had some really good #medlibs discussions on Twitter. Many have been moderated by guest #medlibs who host the discussion on a specific topic.
- March 11, 2013 Chat with Ambulance Riding Librarian
- March 6, 2013 Apps and Tablets
- February 28, 2013 The Horizon Report
- February 20, 2013 Opinion vs Libel
I hosted the Apps and Tablets discussion (as well as several previous ones) it is not only fun but pretty darn easy to do. You welcome everybody to the group discussion and then you get the ball rolling with a question, thought or talking point that you post. From there the discussion almost takes on a life of its own. If there are specific points or topics you want to make sure you hit, then you monitor the discussion and throw them in either when the discussion moves that way or after a certain amount of time.
One important thing you need to know is you don’t have to be an expert in the topic to moderate. You just have to have an inquisitive mind and the ability to ask questions. The rest of the group will take the discussion and move with it. Often there are several people with many different perspectives that can help educate you and the rest of the group.
So if there is a topic you are dying to discuss, please become a #medlibs moderator. (Remember I said it is very easy.) Go to the #medlibs Calendar and click on a date that works for you. Then enter your topic and information in the details link. Once you have done that, you are on the schedule and we will look forward to tweeting with you.Share on Facebook
I live in a suburb of Cleveland, OH and we used to joke all the time that besides snow storms there really wasn’t much from an natural disaster standpoint that would hit us. Nobody really thought a hurricane would effect us. Yeah we would get a lot of rain, but it would be like any other bad storm…right? Wrong. Sandy uprooted or split trees causing them to fall on power lines, houses, across streets, etc. Leaving large areas of the Cleveland area without power for 6-7 days. Areas without power that relied on pumps to either pump water out of locations (as in sump pumps in basements) or pump up to locations (water pumped to upper levels of apartments) had lots of problems.
I am not trying to minimize the East Coast’s damages from Sandy. Many people there have huge problems, you probably don’t think much about losing power for 6 days when your house has been swept away. I wouldn’t even know where to begin if that happened. But I thought I would take a bit of my blogging time to share some things I learned while out of power for 6 days, hopefully this can help you.
Note: This is primarily about personal prep for disasters, if you want information for your library check out NLM’s Disaster Information Management Research Center and the latest #medlibs chat transcripts on disaster management.
Things I Learned:
IF you have a sump pump it is totally worth it to get at least one of these two things: generator or water powered sump pump. If you think your battery backup will be fine, it will, but for only 6-12 hours. So if the power is out for longer and you don’t have generator or a water powered backup sump pump you are either bailing, or your basement is wet. We had a battery backup. It stopped after 6 hours. Everybody mentions generators or the water power sump pumps as being too costly for those once in a while events. ”Consumer Reports’ generator tests show that you can start powering a houseful of lights and appliances for less than $700.” Our plumber gave us a quote for a water powered back up sump pump for $600-$800, installed. So if we get both (which we will) $1500 in prevention is worth it compared to the several thousand dollars a flooded basement costs. Go to Floodsmart.gov to get an idea of how much even 2 inches of water can cost.
Look at your insurance now. I think most know that regular home owners insurance doesn’t cover flooding from a river, ocean, lake, etc. coming into your house. That type of coverage if you want it must be purchased in additional to regular home owners insurance. However there are many who don’t realize regular home owners insurance does NOT cover flooding due to sump pump back ups or sewer back up. You need to get a special rider for those to be covered. The costs per month are based on your selected monetary coverage and are usually a minimal increased monthly fee.
Generators shouldn’t be exposed to the elements. There is lots of information out there about not having your generator in your garage (its carbon monoxide will kill you), but there is little information about not leaving your generator out in the rain or snow. Since a bad storm is usually what kills the power, that storm might continue a few days when you need to operate your generator. The USFA and FEMA recommend operating it on a dry surface under an open canopy like structure. They also warn NEVER to plug the generator into your home (aka backfeeding) that kills people. Plug your appliances into the generator with extension cords. Only a transfer switch (installed by an electrician) is the appropriate and safe way to have your generator power your house without using extension cords.
Best flipping flashlight I have ever used is the Coleman Quad LED Lantern. It is very bright and each quad of can be detached and used as a personal flashlight, leaving the rest of the lantern lit for others. Very handy. It takes D cell batteries, we used it a lot over 6 days and the batteries did not die on us. (Don’t know how much life they have left so I did pick up another pack of Ds at Costco). You can buy it for cheaper than Coleman’s site.
If you decide you have to leave or your just tired of not having power and want to stay in a nearby hotel, make that decision quickly. The nearby hotels were full after the second day. We did not stay at a hotel (had to keep the camping generator power the sump pump) but others who did told me that some offer storm rates and other help for people affected by the storm.
If your cell towers are down and voice and data are slower than a snail, then you might want to try texting to get your information. Check out How to use the Internet when the Internet is gone for tips on how to get email, Google, and news tweets by using text.
Food in the fridge. Ugh. When in doubt pitch it out. But here is a general guideline for you to use.
Heat…I can live without air conditioning but no heat is such a problem. If you have a generator that can handle your furnace and you have it hooked up properly to prevent backfeeding you are golden. For the rest of us, remember to get your chimney cleaned (don’t want a chimney fire to add on top of your power outage) so you can have a little warmth from the fireplace. Getting the chimney cleaned was on our ”todo” list which hadn’t been done before Sandy. Previously we were warned it was very dirty and would be dangerous if we had a fire, so we learned our lesson. Regularly clean your chimney. If it is below freezing and you are worried about pipes freezing let a small trickle of water flow through the taps. Thankfully it wasn’t that cold in Ohio following Sandy, but those out East got socked with a snow storm following Sandy.
Gas up your cars and portable gas tanks before the storm. The long lines in New Jersey and New York are a reminder of that. Consider getting a generator that runs on propane instead of gasoline.
Kids…. School will most likely be cancelled for some time. If the weather is nasty or if there are still downed power lines in the area, they will stuck indoors with you without power. Get creative. I am not creative and the boys were nearly trying to kill each other every 5 minutes while the 2 yr old girl hit them both with her sippy cup. You can only do so many board games. We ended up going to friends houses with power for long play dates. We went to the rec center to play baskeball and swim. We went to a movie. It wasn’t just the fact that we had no power, it was the fact that we had no power and we couldn’t always go somewhere to do something due to weather or trees or power lines being down.
I realize this is long, I hope some of it was helpful. If you have any ideas you want to share please comment. I know I didn’t cover everything you should consider in times of a disaster, these are just some of the things I learned from this event.Share on Facebook
Now with the Presidential election over with, it is time for MLA members to set our sights on voting within our membership. This is the membership’s opportunity to help guide the direction of MLA. By electing the MLA President, Board of Directors and the Nominating Committee the membership chooses who will represent MLA and the members and its future.
The position of President is an easy concept for members, but Board of Directors and Nominating Committee aren’t always as clearly understood. The MLA Board of Directors are people who “act on behalf of the membership according to the (MLA) mission statement, goals, and objectives, and strategic plan within parameters of the bylaws. Direct business of the Medical Library Association (MLA), establish policies and procedures, foster the growth and development of MLA.” In a nutshell the Board of Directors act on bahalf of the MLA members, represent MLA, and work really hard to continue the growth and development of the association. The Nominating Committee are nine people who select MLA members to run for President and Board of Directors.
Before you vote, make sure you look at the people who are running. You can do this at http://www.mlanet.org/members/mla_news/2012/nov_dec_12/index.html
Make sure you vote! You have until December 7th.Share on Facebook
Hopefully I will resume posting in the next week.
Monday night Hurricane Sandy hit the East Coast. Because it was such a big storm, its outer circle came over Cleveland. What made matters worse for Clevelanders was we were already dealing with another storm at the time. So Sandy and our storm overlapped in sort of a venn diagram to create a bigger storm that hit Cleveland. I am not trying to minimize the destruction that hit New Jersey, New York or the rest of the East Coast. I am just explainning that the combination of the other storm and Sandy made for a stronger storm that you normally don’t see as far inland as Ohio.
As a result Monday night was interesting. We had sustained 40 mph winds with frequent gusts at 70 mph (hurricane strength) which snapped trees in half, uprooted trees from saturated ground, ripped off siding, bent flag poles flat, etc. We lost power at 10pm Monday night. After seeing a neighbor’s tree split in half and fall across the road we worried about the two large trees in front of our house and moved everyone to the first floor family room to sleep. Thankfully our trees stayed up.
It is Wednesday and we still don’t have power. Cross your fingers we get it soon because I don’t know how many more nights I can go waking up every 3 hours to run the little camping generator to power our sump pump to keep our basement dry.
I have learned a lot about what works and what doesn’t for personal disaster planning. After some time, power, and rest I might post about the things I learned so that others can benefit.Share on Facebook
This idea has been bouncing around in my head for a while and I have tweeted about it on #medlibs tweet chat. Every hospital is very proud (and rightfully so) to be listed as US News Top American Hospital and a lot of work goes into making those hospitals as good as they are. It is my belief that there are certain qualities unique to top hospitals that helps make them a top hospital. They have a certain infrastructure so to speak, that encourages education, innovation, and excellence. I believe part of that infrastructure of those hospitals is library (specifically the librarian) that help make the hospital be the best they can be and a top hospital.
I am not saying that every hospital that has a library is a top hospital. There are hospitals that aren’t top hospitals that have libraries. What I am thinking is that in order to be a top hospital you must have the necessary infrastructure, which includes libraries. My guess is that at least every hospital listed in the top ten have a library but the Top Hospitals list is over 900 institutions long in many specialties, so who knows how many in that large group have a librarian.
US News and World Report states “death rates, patient safety, and hospital reputation were a few of the factors considered,” for the top hospitals. I want to know more. What goes into making a top hospital a top hospital and are there libraries in each one? There is a phrase, “Behind every great man is a great woman.” (I would also say the phrase can be flipped to say behind every great woman is a great man too.) I want to know if the same applies to hospitals. Behind every great hospital is a librarian.
Originally my idea was to look at the Top Hospitals and determine whether they have a librarian. I also wanted to do more than just make it an attendance sheet. After all librarians do more than just show up, they support their hospital’s endeavors and mission. How do I quantify that? (Oh the question we always ask.) Well I assume that a top hospital in a certain specialty probably employs the thought leaders in that specialty and as thought leaders they would have published a about their specialty. So my thought was to take a specialty like cardiology, look at all the hospitals and determine if they have a librarian and how much they are publishing on that broad topic. I realize that isn’t perfect but it was an idea.
As much as I want to look at the Top Hospital list and try and see if they have librarians helping the hospitals be the best, it is a huge project and I am certain there are better ways to do it or better measures. Finding research is my specialty, conducting research is not. However I know there are a lot of librarians and non-librarians out there who are good at doing research. So, I am practicing what I preach, I am reaching out through social media about my research idea. I don’t care if you want to help and have a better way of doing it or if you want to do the whole thing on your own and “scoop me.” I think proving that good librarians are a necessary part of a Top Hospital is very important, I don’t care who/how it is proved.Share on Facebook
I just finished writing my post on the Official MLA’12 Blog about the online program planner. Good news the online planner is live and ready for you to use. Unfortunately you can’t add your own personal items in the planner, BUT you will be able to do so soon. That feature is something that will be added.
In the post I also included links to instructions for saving your itinerary and uploading it into Google Calendar, Outlook, and Lotus Notes. So if you are going to MLA, check out the blog post and start getting your schedule together in the program planner.Share on Facebook