(post duplicated on http://medlibschat.blogspot.com/)
One day you are Katrina and the Waves and you are “Walkin’ on Sunshine” everything is good and falling into place. Your searches are matching up just perfectly with MeSH, patrons are writing thank you emails, the CEO just praised you, and a new project is going like gang busters. Life in the library is perfect.
BUUUT the next day (or week) you are Joan Jett growling, “I Hate Myself for Loving You” as nothing you do seems to be working. PubMed keeps crashing, patrons are upset because you can’t get the article from the Journal of Big Toe Science written in Hindi rushed the same day and translated into English, your budget was cut more than expected, and administration or IT (take your pick) throws cold water all over your pet project. Life in the library is like a bad relationship.
Like any career, medical librarianship has its ups and downs. Friday is Valentine’s Day and to get in the spirit the #medlibs Twitter chat group will be having fun discussing our love/hate relationships with medical librarianship.
So grab some wine and chocolate, after all it is the day before Valentine’s Day and curl up with your laptop and chat with us this Thursday 9pm eastern. Don’t forget to follow the word #medlibs to watch and participate in the discussion. Lurkers and late arrivals are welcome. Nikki Dettmar and I will be moderating and we look forward to seeing you online.
For more information or questions tweet @eagledawg or @krafty or drop us an email.
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I haven’t done a Friday Fun post in a really long time. These last two weeks have been rough. Discussions about library closings and the weather playing havoc with work and school days, we are overdue for some fun.
This has nothing to do with libraries, but it puts a smile on my face and that is all I am trying to do. So enjoy.
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Many have been wondering what MLA has done for them regarding government lobbying and trying to advocate for the profession.
IF you are a member of MLA, it isn’t hard to find out what MLA is doing in this area. Simply go to the Annual Reports and look for the Government Relations Committee (GRC) report. I have posted edited versions of their full report (edited due to space) here. Check out their entire report, which shows how much more they are doing.
In the 2009/2010 report they…
- Published public policy updates in MLA Focus (lots of Focus issues listed) including NIH funding, patient safety, health information technology, etc.
- Distributed three action alerts urging support for NIGH funding and FRPAA.
- Planned a legislative update day for the 2010 meeting. Where MLA’s Washington representatives and Health Medicine Counsel of Washington provide key issues and information to members participating in MLA’s Capitol Hill Day.
- Planned Capitol Hill Day for 2010 Annual Meeing. MLA members were given briefing packets, fact sheets and other information resources to use in their Hill visits.
- Connie Shardt wrote Senators John Cornyn and Joe Lieberman expressing support for S. 1373
- Requested opportunity to present testimony in Washington DC on behalf of MLA in support of NLM’s Fiscal Year 2011 appropriation
- Hope Barton co‐chaired, along with J. Michael Homan, a working group of the task force to develop the statement, “Health Sciences Libraries and Health Care Reform: Providing Quality
Information for Improved Health.” http://www.mlanet.org/government/gov_pdf/2009_july_hlthcarerefrm.pdf
- Educated Congress and relevant federal and international agencies about importance of maintaining fair use in digital environment in support of health care, education and research
In 2010/2011 they some of the things they did were…
- Published public policy updates in MLA Focus (lots of Focus issues listed) including NIH Public Access Policy, America COMPETES, meaningful use of electronic health records.
- MLA and AAHSL prepared testimony in support of NLM’s appropriation which was submitted to the House and Senate L-HHS Appropriations Subcommittees
- Requested opportunity to present testimony Washington, DC on behalf of MLA in support of NLM’s Fiscal Year 2012 appropriation
- Educated Congress about the role that funding for the National Library Medicine plays in support of our nation’s health care, education and research and the role health sciences librarians play
- MLA sent a joint letter to the chairs and ranking members of the Senate Committee on Commerce, Science and Transportation and the House Committee on Science and Technology expressing concern about the public access provision section 123 of the America COMPETES Reauthorization Act of 2010.
- In response to GAO September 2010 report (GAO-10-947) MLA, AALL and SLA wrote a to the Senate Committee on Environment and Public Protection Agency (EPA) library network.
In 2011/2012 the GRC reported they…
- More than 30 public policy updates have been distributed through the GRC and Legislative Task Force listservs
- Published public policy updates in MLA Focus (lots of Focus issues listed) including NIH and NLM funding, EPA’s Strategic Plan for its library network, Rederal Research PUblic Access Acts
- An Action Alert was distributed on the Research Works Act
- Submitted House testimony in March and Senate testimony in April on NLM Fiscal Year appropriation
- Developed of the association’s annual testimony to the House Labor -HHS-Education Appropriation Subcommittee and distributed current fact sheets, statistics, and anecdotal information with Congressional staff during Legislative Task Force Capitol Hill meetings each year.
In 2012/2013 the GRC reported they…
- Published public policy updates in MLA Focus (lots of Focus issues listed) including NLM funding, impact of sequestration, Orphan Works, Meaningful use of Electronic Health Records.
- Provided updates on FRPAA legislation, the Research Works Act, and OSTP initiatives related to public access policies
- MLA and AAHSL submitted a joint statement to the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies in March and to testimony to the Senate in April supporting NLM funding
- Signed two group letters to Congress expressing concern about the impact of continued cuts on the NIH, urging Congress to support a balanced approach to deficit reduction that avoids further cuts.
- MLA and AAHSL wrote to the chairs and ranking members of the House and Senate Committees on Appropriations; Labor -HHS-Education and Related Agencies Submicommittees, etc. over concerns about the sequestration.
- MLA signed onto an Ad Hoc Group for Medical Research letter expressing the research community’s concerns with several provisions related to the NIH appropriations bill
- MLA signed onto a Coalition for Health Funding letter to Congress
As I mentioned this is just a snap shot of their submitted reports. My fingers could not type everything and this blog is too small for the reports in their entirety. To read the GRC’s complete annual reports, detailing their activities go to MLA’s Annual Reports page, click on a year then click on Committees and look for the Government Relations Committee. Also click on Add Hoc Committees and Task Forces to see what the Joint MLA/AAHSL Legislative Task Force is also doing in this area as well. To get a better idea of what MLA had done in ways of advocacy and policy check out their Information Issues and Policy page.
All of the MLA staff work to help advocate for medical libraries and librarianship, but they do have one staff person who is responsible for government relations and she works with the Government Relations Committee and MLA/AAHSL Legislative Task Force. If you are concerned about medical libraries and librarians and would like advocate for them to the government and other political agencies then I am sure the Government Relations Committee would love to have your help. Although the deadline to officially join a committee has past (October 31st), perhaps you can contact somebody on the committee for more information on how you can be of help advocating for the profession.
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Recently there has been a lot of discussion on the medical library email listserv about the closure of another hospital library. Also in the news the CBC reported on the reprehensible state of their Health Canada library.
“Health Canada scientists are so concerned about losing access to their research library that they’re finding workarounds, with one squirrelling away journals and books in his basement for colleagues to consult.”
Not only are the collections missed by researchers but the librarians as well. Multiple researchers commented to the CBC on how important the librarians are to their research.
“My staff can do so much in sort of Googling around and trying to find this and that or stuff that may come into us. But being able to use the experts and to get their assistance makes a world of difference.”
Like the cuts made to hospital libraries, Health Canada states the cuts were made to save money. However there is a question as to whether those cuts indeed saved Health Canada any money. The CBC reports, “One of the stated goals of Health Canada’s contracting out of library services was to save money. According to the report, though, the new arrangement is more expensive.”
I have seen this happen in American hospitals that cut libraries AND American hospitals that don’t understand how to work with their librarians. A hospital cuts the library believing it is a way to save money. They often end up licensing duplicate online databases, journals, or delivery services. Fail to understand the nuances of negotiating library resources and end up with a poor deal. They fail to to get a decent ROI because they haven’t properly supported and integrated the resource into the system. Why pay thousands of dollars for an online journal that nobody knows exists because you didn’t set up the IP addresses and just handed out the username and password to a few physicians that asked? Another favorite of mine is a department buying a database for several thousand dollars, hoarding it among their employees in their department and then wondering why it was only used once a month.
The discussion on the medlibs listserv seemed to center around the question about what can be done about the situation and who should be doing it. What can individual librarians do and what should MLA be doing to get hospitals, administrations, governing and standards organizations to keep libraries in hospitals. Several people wrote that MLA should be doing more for hospital librarians and work to get the library back in the JCAHO standards or other accreditation organizations.
First I want to say that any medical librarian that believes the our salvation lies with getting JCAHO to reinstate the library as a requirement in hospitals is waiting for something that will never happen. JCAHO has moved on. It is a dead issue. It isn’t even going to be re-animated as zombie issue. It is dead, dead.
So now that we have cleared the air of the JCAHO thing….
I will bring up the issue that some librarians think MLA should be doing more to ensure our survival. Let me just say MLA staff (all 16 of them) are doing as much as the cany for the MLA members including advocating for them. The MLA President and Board are doing as much as they can too. However it is unfair to compare the advocating clout of ALA (which has a staff of over 300 and over 56,000 members) to that of MLA.
The only way I see medical librarians continuing on is to work together to get our message out. As many said on the listserv, medical librarians are too often preaching to the choir about our value and benefit. We need to take our message out to our patrons. Not only do we need to do this locally but nationally. As much as I am in favor of our medical library journals, we need to stop publishing about the value of library services in them and start publishing those kind of studies in our patrons’ journals which is what they read. Our patrons don’t read our professional journals. We need to attend and present at their meetings.
One librarian noted that publishing articles and attending their meetings is a little lofty of a goal for the part time librarians who are just struggling. I get it, you don’t have a lot time and some of that can be difficult. But we aren’t asking everybody to do everything. Work to your strengths. I am not good at research but I am good at social media and I am think of ways to get our word out via social media. (BTW at the suggestion of a person on the list, I have already tweeted Dr. Besser MLA’s 2013 speaker about the plight of medical libraries. It isn’t perfect but it is a start somewhere.) (*update* Dr. Besser responded and retweeted my message to his 33,000 followers. It is a baby step, but you have to take steps before you walk.)
Just because you are part time doesn’t mean you can’t do something when you aren’t in the library and you are at home. I am a working mother of 3 young children. My work on my blog, tweeting on #medlibs, writing journal articles, teaching MLA CE classes, and some of my work on the MLA Board often is done during my PERSONAL time. Almost everything I write is done when the kids are in bed and I’m watching TV. I have often had to take my own vacation time to teach CE classes or attend some meetings. Believe it or not I still find time to have a normal life with my family for vacations, kids activities, movies, and life.
If you doubt what regular ol’ working librarians can do please do a little looking into Ohio Public Libraries, 2009, budget cuts, and Governor Strickland. In 2009, out of the blue the Ohio governor proposed a 50% cut funding to public libraries. This type of cut would close many public libraries and leave many irreparably devastated. Within 1 hour of the announcement the story hit Twitter and the hashtag #saveohiolibraries was created to categorize the Twitter messages. A Facebook site was created and had over 50,000 followers in less than 3 weeks. Another librarian created a website, www.saveohiolibraries.com. Not only did they get national attention but the Ohio legislature received between 37,000-45,000 emails in one week regarding the budget cuts.
(I live in Ohio so I remember much of this but I was able to find the specifics in the Introduction of Laura Solomon’s book the Librarian’s Nitty Gritty Guide to Social Media)
The thing to note was that ALA didn’t get involved within an an hour of the announcement. Much of the ground work was done by regular librarians like you and me who saw the immediate need to advocate for their jobs. Given the differences between the funding of medical libraries and public libraries, I think we medical librarians can’t afford to wait for the budget cut announcement. We need to advocate for ourselves now! MLA is helpful and they will do what they humanly can to support us. But we need to stop looking to them to make everything all better, we need to get the message out in whatever way possible.
I understand, we all are worried about the future of medical and hospital libraries. Just because I have a full time job and and I’m active in the organization doesn’t mean I am not worried. In fact it makes me more worried because I have seen how easily it can turn. But I refuse to sit back and subscribe to what some of the “realist” librarians have said, “It doesn’t matter how proactive we are; it doesn’t matter who gets involved; it doesn’t matter how many people come to our defense; it doesn’t matter how much evidence we have to justify our positions; it doesn’t matter how much time we save for others; it doesn’t matter that after we are gone there will be problems for people who need our services. All of that weighed against the decision of the ‘powers that be’ that they can cut the librarian will not help. They will not change their minds.” To those realists I say, “There’s no fate but what we make for ourselves.” I see you what you have made for your fate. Your fate is not mine.
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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.”
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Don’t think of it as a New Year’s resolution, think of it as just taking inventory of your career path. Whether you are looking to find a new job in a new organization or just trying to add a new direction to your current job, it is a good idea to think about, evaluate, and discuss (pick people’s brains) your ideas and options.
So tune in to #medlibs on Twitter tonight at 9pm Eastern.
See you there.
Reposted form (Medlibschapt.blogspot.com)
Join Heather Holmes (@LaMedBoheme73) and Michelle Kraft (@Krafty) for this week’s #medlibs talk as we discuss all good things related to jobs, such as: looking for a new job, preparations to move (yourself, your family, etc), learning or brushing up on skills, transitioning to a new position in the same institution, or transitioning to a related but totally different position. What are some of the positive reasons you are looking for or have accepted a new position or are seeking new skills and abilities? This won’t be a rant session, we want it to be a positive and constructive discussion so please join us and spread the word – we’d love to welcome library students and others interested in learning more about the field!
Some resources to consider:
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I stumbled across this blog post a week ago and thought it was a wonderful example of the way social media can be used to better biomedical science.
The New England Journal of Medicine published an article in June on the prevention of MRSA in the ICU. The study was very large, 74,256 patients, and the results looked impressive, BUT nobody could get the stats didn’t add up. The numbers given in the published paper didn’t correlate with the Number-Needed to Treat (NNT)
A blog post on Intensive Care Network posted the following about the stats in the NEJM article:
ARE THE STATS CORRECT?
We were hashing this out in our journal club, but could not get the stats to add up.
If you can PLEASE COMMENT HERE!
The NNT’s of 54 and 181 seem impossibly small, with huge clinical implications.
Please try it yourself; look at Table 3. Frequency and Rates of Outcomes during the Baseline and Intervention Periods, According to Study Group
With bloodstream infection from any pathogen, the Group 1 (standard care) number of events per 1000 patient days is 4.1. With Group 3, the number of events is 3.6 per 1000 patients days. Even taking change from baseline into account and assuming these NNTs have been calcuated AFTER randomization, between Group 1 and Group 3, we get nowhere close to their NNT’s.
PLEASE have a go and see if you can match their NNT’s.
IF you can’t there is a serious problem, with practice changing implications.
It’s too late to write letters to the NEJM, so a robust discussion in a peer reviewed forum seems a good way to go.
The authors of blog post intention was to discuss the problem in “a peer reviewed forum” and according to them “there was lots of insightful commentary from around the globe.”
The fact that they were able to discuss problem with others around world is big but not unheard of, more and more scientists are discussing issues online. To me the biggest thing is that the paper’s lead author, Susan Huang engaged in a discussion with the social media reviewers with a “prompt and gracious reply” agreed the published calculation was an error and showed “true scientific and academic integrity by contacting the NEJM as soon as there was a suggestion that the stats were incorrect.” NEJM responded by publishing an correction to the paper.
It is very cool how scientists discussed online a paper’s validity and work together to essentially provide world wide peer review. However, what I find even cooler is that the author was engaged with the social media process AND a respected journal addressed and responded to the findings. This is an example of everything that is right with social media and professional communication. It will be interesting to see if we will see more of this type of world peer review in the future especially now that PubMed Commons can also foster this kind of scientific inquiry and discussion.
NEJM is a big journal with lots of very smart authors contributing papers that are subjected to very peer reviewers, but still there can be mistakes. World peer review via social media could help improve the process. One question I keep wondering is, if we have this type of world peer review, could this cut down on the academic fraud that sometimes eludes the careful eyes of publishers’ peer reviewers? What would have happened had Wakefield’s fraudulent study linking vaccines and autism (published in 1998) been published today? Would that paper have had a chance to make it the general public’s consciousness and be as unfortunately influential as it still is today?
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The Midwest Chapter’s latest membership survey indicated a need for better access to continuing education. What could help with better access than a stipend for CE?! The Board of the Midwest Chapter has announced that two $125 stipends are availalbe for 2014 to help fund library skills and CE attendance.
How do you get this stipend!?
- Be a Midwest MLA member.
- Send email to nreedx[atsign]midwestern[dot]edu to be entered in the drawing for it.
- The email must have your name, postal address, and whether you are a solo librarian or not. (Indication of solo librarian is not used for determining the winner, just for statistics and to help determine the need for future funding.)
All names will be put in a hat and one lucky winner will be drawn and announced Feb 3, 2014. A call for a new drawing will happen in June and that winner will be selected July 1, 2014.
An individual will only be eligible to win once/year.
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American Libraries Live will be hosting a panel discussion on the challenges and changes within the libraries for the near and distant future. It is Thursday January 9, 2014 at 2:00-3:00 Eastern. It is FREE to register and “attend” the discussion.
David Lee King, digital branch and services manager at the Topeka & Shawnee County Public Library will lead the panel which also includes:
- Marshall Breeding, Library Technology Consultant, Speaker and Author
- Buffy Hamilton, Librarian at Norcross High School in metropolitan Atlanta, Library Technology Writer and Speaker
- Bohyun Kim, Digital Access Librarian at Florida International University Medical Library
- Joseph Murphy, Director of Library Futures, Innovative Interfaces
Register for this episode so you get email reminders at http://goo.gl/1p5dpV .
Preregistration is not required to attend. You can also attend by simply going to the site at the time of the event. If you’re unable to attend live, it will be recorded and available at http://www.americanlibrarieslive.org shortly afterwards.
Innovative Interfaces is sponsoring this episode. AL Live is the popular free streaming video broadcast from American Libraries, covering library issues and trends in real time as you interact with hosts via a live chat and get immediate answers to your questions. With the help of real-time technology, it’s like having your own experts on hand. Find out more, including how to catch upcoming episodes, at http://www.americanlibrarieslive.org .
Future 2014 broadcasts will be:
- February 13: The Library Website
- March 13: E-Books: The Present and Future
- April 10: Copyright Conundrum
Sounds interesting. While they don’t have an medical librarians, I’m sure there will be something that will also apply to us. Since our ILS is an Innovative Interfaces system, I am curious as to what Joseph Murphy of Innovative has to say. I often think integrated library systems including Innovative’s are overly complicated and fail to address typical user needs. I am also interested in the March 13th E-Books discussion but I fear this will be more public library related and less related to the unique mess the medical publishers have created.
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Perhaps I have been listening to my son’s music a bit too much or perhaps I am just overly tired from celebrating the New Year with friends and family. Whatever the cause, when I heard Imagine Dragon’s “Radioactive” this morning it really hit a my librarian brain.
Granted, the lyrics have a post apocalyptic vibe to them that is more akin to Walking Dead or Terminator than the state of libraries. But it just hit a chord with me this morning. I feel like we are in a new age of information and completely revolutionizing the way people find things. Things have completely changed, and are still changing. The old way of doing things (the old world) is gone. We are waking up to the new age of information.
Just to prove I am not completely cracked (only half cracked), the singer, Dan Reynolds said the “song is about having an awakening; kind of waking up one day and deciding to do something new, and see life in a fresh way.” We have to see librarianship in a fresh way if we are going to continue.
According to Reynolds, “A lot of people hear it [Radioactive] in a dark way.” The song is meant to be an empowering song, and I definitely hear it that way. The changes in libraries can be empowering as well. Like music, it is all up to interpretation. Some may “hear” the library changes in a dark way. Some may “hear” the changes as an anthem to wake up and do something new in the wake of all the changes. They will end up shaping their world the way they hear the changes.
To quote a favorite line, “there’s no fate but what we make.”
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