Krafty Librarian

According to Modern Healthcare, “Hospital megamergers continue to drive near-historic M&A activity,” the actual number of hospital mergers and acquisitions have been similar to 2018 and the numbers seem to be pretty consistent from when the merger and acquisitions “trend” hit in 2010. What is different according to the article is the amount of revenue that is part of the process. The money involved was “nearly four times higher in the second quarter of 2019 compared with the prior-year period.” No longer content with serving a specific locale (city, county, etc.) hospital systems are expanding to larger regions and into different states to diversify and expand market share.

What this article doesn’t talk about is everything that happens once these hospitals are acquired and merge. Everything from HR, GME, billing, etc. gets assimilated to the buying entity’s system. As librarians we see this every time our hospitals merge, doctors, nurses, and some administrators assume that they automatically have access to the library resources “now that we are part of your hospital.” That is not the case. Like many other librarians, I am forever explaining that our license agreements only extend to the current facilities and do not automatically allow for newly acquired institutions to be added. If the newly acquired institution wants to be added to the licenses, they must agree to pay the costs of the library resources. This blows their minds. I don’t know why, because that is same deal with EMR systems. You just don’t get EPIC for free now that your hospital was bought by a hospital using EPIC.

Nursing, Pharmacy, IT have programs and resources that they license for the institution to be used by their people. Why is it that they seem to get those added to the new institutions faster than library resources when some of resources are drug databases and nursing information tools and are often sold by the same companies that sell to libraries? It was only a few weeks ago when I was once again reciting my license speech when it hit me. Every hospital (buyer and acquired) has a CNO, Chief Pharmacy Officer, CTO, etc. Yet, due to an increase in layoffs and “retires but no rehires” (see Hospital Library Association benchmarking survey) there are very few “Chief Librarians” or any librarians at many of the hospitals. So while the two CNO’s work together to discuss address issues, costs, etc. of their two hospitals merging, the librarian rarely has a peer at the other hospital to do the same thing. Not only that, but there is no hierarchy for the librarian of the buying hospital to consult at the acquired hospital to address the issues, costs etc. of merging. Because there is no librarian, there is nobody supervising the librarian, buying/budgeting library resources, licensing them, etc. It is basically a black hole.

Can you think of this happening within any other hospital department? I’m trying… help me out.

Without my counter part at the other hospital to discuss the merger and to discuss the costs, logistics, onboarding, etc. with their boss, I am left to talk to the wall. Nobody in the newly acquired hospital knows how to handle it and plays hot potato passing along the “library stuff” to the next administrator who also doesn’t know…. all before I drop the cost bomb. So, I am left giving my license speech to doctors and nurses explaining why I can’t give them access. I become the big bad librarian, alienating potential customers.

If a tree falls in the woods and nobody is there, did it make a sound? If a hospital librarian asks about resources and services and nobody is there, do we even exist? How can hospital librarians navigate this situation? Where do you find the support for resources in a hospital system that never supported it and doesn’t have the infrastructure to create it?

For years I have complained about predatory publishers found in PubMed. The publishers entry point is through PMC. Articles submitted to PMC are searchable and findable using the PubMed interface DESPITE being from a journal that is NOT indexed in MEDLINE.

Librarians and very savvy researchers might know the distinction, but the vast majority of the people using PubMed do not know or care. If it is found in PubMed then it they believe it has passed some sort of litmus test. Librarians, ask yourself, how many times have you done a long complicated search in PubMed and then looked at the journals to try and weed out predatory journals. Several different people have questioned, criticized or stated concerns about the PMC backdoor to PubMed. However, a recent post on Scholarly Kitchen reveals things have gotten worse. Predatory journals can now be found in other biomedical databases such as Science Direct and WoS via cited references. Where PMC was the backdoor for predatory publishers to be findable in PubMed, the cited reference has become the backdoor for these publishers to be findable in other biomedical databases.

Citation Contamination: References to Predatory Journals in the Legitimate Scientific Literature by Rick Anderson identified seven journal titles that fell victim to publishing junk articles or fake editor approval. He then looked for any published articles that cited and article published in these seven journals. What he found was articles published in predatory journals are indeed being cited by authors who are writing in non-predatory journals and thereby are findable in WoS and Science Direct and DOAJ.

Rick Anderson isn’t the only person to have discovered this problem. Authors of the article, Citations of articles in predatory nursing journals, in Nursing Outlook found “814 citations to articles published in predatory nursing journals. These articles were cited in 141 nonpredatory nursing journals.” The authors correctly noted that CINAHL and MEDLINE do not index predatory journals and that the prevalence of predatory journals in other databases is still small. Yet these journals are findable in PubMed (through the PMC backdoor) and other databases through the cited references backdoor, I feel it inadvertently and falsely gives these journals some legitimacy to authors.

Unfortunately, NLM has yet to adequately address the PMC problem. NLM employees responded to the CMAJ article “How predatory journals leak into PubMed” stating, “journals that apply to be in PMC undergo a rigorous assessment of scientific and editorial quality.” Really? Then why are there articles from predatory publishers even in PMC? IMHO, rigorous assessment of scientific and editorial quality means that no article published in a predatory journal should be allowed, regardless of whether NIH grants were used for the research.

Rick Anderson’s post is very recent (published Oct. 28, 2019), as of today (Nov. 5, 2019) I have not found any responses from the databases he mentioned regarding infiltration of predatory journals via cited references. Several databases have stated they have taken steps to help prevent the indexing of predatory publishers’ journals, but I couldn’t find anything dealing with the issue of cited references.

Predatory publishers have become the dandelion weed in the garden of biomedical literature. While they have not completely infested the landscape, their seeds distributed on the winds of Google, PMC, and other databases have invaded legitimate biomedical databases that researchers, clinicians and others use to share knowledge and treat patients. It will take a concerted effort by librarians, legitimate publishers, editors, and researchers to eliminate the predatory journal seeds from spreading further into the biomedical databases and invading the literature. If not, our biomedical databases will be like this.

It isn’t your imagination, more and more people are writing and publishing systematic reviews. In a recent research letter from JAMA Internal Medicine, Assessment of Publication Trends of Systematic Reviews and Randomized Clinical Trials, 1995 to 2017, the authors noted the rate of growth in published systematic reviews was ginormous. I know ginormous is not a technical term and the authors would not use it in a publication like JAMA Internal Medicine, but when the rate of growth is 4676% I think the word ginormous is appropriate.

The systematic review is the new little black dress on the publishing runway, everybody must have one dahling.

But not all systematic reviews are created equal. The JAMA Internal Medicine study did not look at the quality of these systematic reviews. It just looked at the number of publications across 18 medical and surgical areas that made it into PubMed and were indexed as systematic reviews. Many systematic reviews do not meet basic standards. (Why are we calling them systematic reviews then?!) Melissa Rethlefsen reports in the Journal of Clinical Epidemiology. 2015 Jun;68(6):17-26, systematic reviews that included librarians or an information specialist as a part of the process were more likely to be reproducible and meet specific search standards.

So, it would behoove people who want to do a systematic review to contact a librarian to help. That is a good thing. Unfortunately, it seems too many people don’t understand what is really needed to do a proper systematic review. They just want that little black dress, and they want it now.

Librarians are not only drowning in the requests for systematic reviews, but the pool is continually filling with people who refuse to understand the requirements for a systematic review, or they are delusional about the commitment in time and effort needed to do one. Librarians are continually trying to lower the water level through education, but those educational methods are not hitting home with the right people.

I have seen librarians post information sheets online detailing the process. I know some librarians require forms and “contracts” to be fully filled out prior to discussions. Yet there still are those who are surprised by search results in the thousands (even though they were informed this is typical and they need to go through them) and ask for fewer results. There are systematic review searches that the librarians spend days creating that are languishing in systems like Covidence or DistillerSR never to be revisited by the requestor.

It isn’t that librarians don’t want to do systematic reviews, they don’t want to waste their time (often several days) on something that goes nowhere or is of such poor quality they need to ask that their name be removed from the paper. So they continue with their education efforts, guiding researchers to on how to do a proper systematic review or suggesting different types of searches as appropriate.

However, I feel this approach is a little bit like the librarian sticking their finger in the leaking damn. It isn’t until somebody repairs the damn will the leak actually stop and prevent the flooding of poor systematic reviews.

Publishers, faculty, researchers, and authors need to step up and help repair the leak.

1. Publishers need to make it very clear to authors the criteria needed for a systematic review and anything that doesn’t meet the criteria will be immediately rejected. Some publishers are good at this, many are not. We have over a 4000% increase in published systematic reviews, clearly some publishers are not that strict.
2. Faculty need to stop assigning systematic reviews as a summer project to their students. Assigning how to learn the methods or requirements to conduct a systematic review is entirely achievable for the summer. Telling students, residents, and other junior researchers to do a systematic review over the summer is not.
3. Researchers and authors need to have a reality self check. We are not lying when we say a proper systematic review typically takes 12-24 months. You will not be the one who is “different” and can get it done in 4-6 months. You will also need at least 3 colleagues who have same time, opportunity, and dedication as you do because you need at least 3 reviewers (including yourself) to minimalize reviewer bias.

A quality little black dress is something that you will come back to and use as often as the need arises. A good systematic review is something that people can utilize to form policies, treat patients, and base recommendations. Unfortunately, a poorly done systematic review is worse than ill fitted, poorly stitched, little black dress made out of cheap material. Poorly done systematic reviews not only waste time but it flood the databases and do little to improve policy or treat patients. But hey, you got that little black dress published and it is now on your CV, so who cares if we pull a thread and it all falls apart. You don’t need to be the Ralph Lauren of systematic reviews, but you also shouldn’t be Amazon version either.

**Quick edit/update**
After posting this, I started thinking we librarians need to start being more assertive when somebody wants a “systematic review” without knowing or wanting to put in all of the work of actually conducting a systematic review. In addition to educating them, we have to remember to say No. It is hard to say no, librarians don’t like to say no. Perhaps we should also say no.

*Disclaimer* The authors in the JAMA Internal Medicine cited above are from my institution and one of them is my librarian co-worker.

I first became a medical librarian 20 years ago. I was bright eyed and bushy tailed ready to learn everything I could about medical librarianship. Naturally over the 20 years I changed as a librarian, I became more confident, specialized in certain aspects of medical librarianship…essentially evolved.

However, I think the biggest change that I have experienced is the change in my librarian-ness when I became director of my library. I remember when I was hired I was told I will need to learn to let go of some things because the things I needed to do as director would fill those spots. Intellectually I understood this, but I don’t think I realized how much I would have to let go until I attended MLA and the whole slew of other librarian meetings that happened in Cleveland this year

As I walked the exhibit floor talking to vendors, I spoke to some great people at companies telling me how their product does this or how they’ve improved things. As I talked with these people I started to really realize that I was not the right person for them to be talking to. Yes, I make the final decisions with purchasing, but I have found that I am just not using these products as I once did.

I still do searches. We get a lot of search requests so every librarian on staff steps up and does a lot of searches. But I don’t do systematic reviews. Five years ago I would have jumped at the chance to do them and learn everything I could about doing them. Now, I just don’t have time to do them and I give them to one of the librarians who do them. I don’t edit web pages or test products as much as I would like to. Honestly, I had to go to one of my LibGuide librarians to remind me how to a certain thing in our guides.

As I look back, the transition has been a little weird to me. I don’t have the time I once had to investigate things. It is no longer my job to be the expert on library things. My job is to make it so my co-workers can be the expert in library things. That means I do everything I can to make it so they can do their jobs. My job is to be the expert at running the library. That is a big switch.

You can take all of the leadership and management classes from MLA and AAHSL (and I encourage everyone to do so) but until it happens, you really don’t understand how things change. I am forever grateful to my library friends and peers for sharing their knowledge and letting me pick their brains. Without that camaraderie, the switch to library director would have been more difficult. Librarians a great group of people who share. I hope as I continue to grow and change and be a different librarian that I am able to share with others and give back as much as others have given to me.

Don’t be afraid of change, of moving to a different job, role, or path. It will be different, but that isn’t necessarily bad, it can be quite good.

I had the unique pleasure to be the moderator for the McGovern Lecture at this year’s Medical Library Association Meeting. You must login w/ your paid meeting registration to watch. If you didn’t go to the meeting you can get a virtual registration to watch (scroll down to econference rates)

The McGovern Lecture traditionally is one person who give a lecture on a topic of importance to health sciences librarianship. This year the lecture featured 4 speakers (an Academic Hospitalist, a Professor of Physical Therapy, a Family Medicine doctor, and a Director of Nursing Research) all speaking about how they find information to stay up to date in their areas of specialty.

Each one of them used the library. Each one of them loved their librarians. Each one of them professed that they get the most up to date information in their specialty from Twitter. This was mind blowing to almost every librarian in the audience. These professionals use Twitter to connect across the globe with others (mentors, friends, experts in the field). They have a very curated list of people they follow on Twitter, so that they receive tweets specifically targeted on topics of interest in their field. If somebody they follow tweets about a good article, they get it. Its a bit like the old commercial when EF Hutton talks they listen.

We have all known that caregivers consult each other when faced with questions or staying up to date. In the past these people were usually in the same place of employment or geographical area. Now, with Twitter there are no boundaries for professional networking and consulting.

What also shouldn’t come as a surprise is these people mentioned that they get the articles in the easiest way possible. Sometimes that is the library, sometimes that is not. One person said if they can’t find it easily at the library, “there are other methods to get the article” implying less kosher methods. As I mentioned this should come as a no surprise, we (librarians and publishers) suck at getting people hooked up to their entitled articles and professionals don’t have the time nor patience to deal with our sucky methods. RA21 is not the answer either. RA21’s proposed method is still more complicated and more clicks than getting something from SciHub or ICanHazPDF.

If you are a librarian or somebody who works for a publisher or information provider, I highly recommend watching this lecture. It really illuminates what our patrons do in real life to get information, and it isn’t what we think they do. I also think people at NIH and NLM need to really watch this to see that front line caregivers never mentioned MedlinePlus as a resource to give their patients information until librarians in the audience asked. The speakers listed every CHI resource BUT MedlinePlus. Perhaps NLM may need to re-focus on hospitals and providers as the people who provide CHI information in addition to NLM’s efforts to connect to public libraries.

When RA21 was brought to my attention I was concerned because it was coming from a lot of publishers and vendors familiar with their world and the world of large academia but completely unfamiliar with the medical and hospital world.

In my post Medlibs Needs RA21 on Their RADAR, I briefly described RA21 and some of the concerns I had with moving towards this method of authentication and I was extremely concerned that the people talking about it hadn’t the faintest clue about library resources, usage, and IT in the hospital and academic medical world.

While I still have a lot of concerns about RA21 I am pleased to announce the creation of the RA21 Hospital/Clinical Access Working Group.  Their objectives are to “survey, identify and define the use cases/problems for accessing licensed resources from within a hospital/healthcare system that are involved with RA21 adoption and are related to RA21’s authentication use cases.”

In an effort to understand hospital and medical library authentication issues and needs they have created a survey  https://www.surveymonkey.com/r/RA21_Survey of 20 questions that they would like any librarian serving in a hospital or health care institution or academic health care institution to take. (If you participate you can also enter into a raffle for an Amazon gift card.) *The survey closes March 1, 2019!!

I encourage every qualifying librarian to take this survey so that the working group has a clearer picture of the issues and needs regarding access to information.

The working group was started in July 2018 and the website says it will complete its work by the end of February 2019. Hmm…. I hope they plan to continue their work.  If they continue, I hope they will include some non-vendor people on the working group from medical libraries familiar with IT issues. The co-chairs are from the vendor community and while I am sure they are lovely people, they are not in the library dealing with IT and hospital policies and restrictions.  The RA21 team does have some people from large academic institutions, but is still very vendor heavy and has no representation from the medical or hospital community.

Wow it has been a while since I have published. Hopefully, I won’t have that kind of blogging break again.

As librarians we all know there are many ways to get scientific articles, some are legit while other methods are illegal. SciHub is one of the illegal methods.  For those of you who haven’t heard of SciHub, think of it as Napster for scientific articles. Alexandra Elbakyan, participated in research forums where scientists asked each other for research papers.  Elbakyan created SciHub as an automated method to share those papers. The process made it easier for people without access to paywalled papers or difficult to find papers to download them.  Sound familiar? Napster was founded by Shawn Fanning and Sean Parker as a peer to peer sharing service “for music enthusiasts to download copies of songs that were otherwise difficult to obtain.”

As with Napster there seems to be an anti SciHub group (which obviously includes the publishers) and a pro SciHub group who want easier access to materials that are hard to obtain or they don’t want to pay for.  As an individual it can be very easy not to care about the publishers who are profit driven making money on the backs of poor researchers and academic institutions struggling to deal with publisher price gouging rate increases.  While it is easy to think that way, there are many layers to the problem that has led us to this SciHub situation. Publishers, libraries, users, changes in society, technology, politics, and money are all to blame for the evolution of SciHub.

Until recently Elbakyan has been basically untouchable by the U.S. and European courts. While there have been several lawsuits that have gone against her and SciHub, she lives in Russia and has said she plans to ignore the lawsuits. Blocking SciHub doesn’t work either, it switches domains and mirror sites.  It is kind of like playing online Whack-a-Mole, you hit one site and another pops up elsewhere.

Well it seems as if things in Russia might be changing.  According to an article in Chemistry World, SciHub is now blocked in Russia following a Russian court ruled against the site.  Moscow City Court ruled the site should be blocked in Russia following complaints from Elsevier and Springer Nature over intellectual property infringement.  As a result of the ruling, several Sci Hub and Library Genesis domains are now inaccessible by Russian internet service providers.

An article from TorrentFreak.com says “Sci Hub is no to blocking efforts” and probably has other domains “up its sleeve.” TorrentFreak says those other domains can be targeted by rights holders and Elbakyan is encouraging users to “use tools to circumvent Internet censorship – which you can search for in Google or by using the bot in Telegram.”

So it looks like Elbakyan and Sci Hub may be touchable in Russia after all. I don’t think Elbakyan is a hero nor a villain. My hope is that through all of this Sci Hub  evolves like Napster did. Napster is now into the on-demand streaming business. Even if we aren’t using Napster directly as our streaming service, many  are using the pieces of Napster and don’t realize it.  The iHeartRadio All Access app is powered by none other than Napster. It took a Napster to bring about changes in online music. Hopefully Sci Hub can be the catalyst to bringing change to the scientific online paper world so that more papers are easily available and legally.

 

 

A recent article in The Guardian “Predatory publishers: the journals that churn out fake science” reported on an investigation (in collaboration with German broadcaster Norddeutsher Rundfunk) into predatory publishers and fake science.

According to the article more than 175,000 scientific articles have been produced by the five largest “predatory open access publishers”  and 5,000 scientists at British universities have published in predatory publications in the last 5 years.  The article mentions that many of the researchers were “exploited by the publishers, who aggressively seek new business from academics who don’t know their reputation.”

Predatory publishing has been on the minds of librarians for quite some time, I often feel like it is old news.  Unfortunately, I think is still new news to many researchers and STEM authors.  I can point to examples of clinicians looking to publish a paper who didn’t even understand the difference between open access and traditional access.  In their mind a journal like NEJM appears open access to them because they are able to access it freely using the library subscription.

So when you have this access perception problem it isn’t hard to see how some can be fooled by predatory publishers.  Their game is more difficult to spot than the Nigerian Prince who just needs you to send him $1,000 for you to receive $10,000.  The problem isn’t just with publications. There at predatory conference promoters.  Back in May I posted about receiving an invitation to speak at a conference in China.  Considering I have been asked to speak in Ireland and other places it isn’t all that far fetched to think somebody from China would be interested.  After getting my hopes up momentarily, careful review led me to realize this was predatory conference spam mail.

I think as librarians we need to remember that there are still many authors who are unfamiliar with the concept of open access and as a result unfamiliar with appropriate open access article submission guidelines and expectations.  Lists of predatory publishers will come and go, we need to work with people to be able to better identify the red flags.  We need established publishers to step up their game and help with the education process. We need database providers to establish criteria for inclusion, rather than including any research article that was publicly funded.

Only by working as group can we have a hope at turning the tide.