By JM2010 Quad-chairs: Ellen Aaronson, Rebecca Birr, Judy Bube, and Kathy Zeblisky

The Joint Meeting of the Medical Library Group of Southern California and Arizona (MLGSCA) and the Northern California and Nevada Medical Library Group (NCNMLG) was held at the Renaissance Glendale Hotel and Spa in Glendale, Arizona, January 27-30, 2010.

125 attendees enjoyed the beauty and serenity of the Arizona desert while participating in a stimulating program that featured a diverse field of speakers and continuing education opportunities.

• David Rothman, a Hospital Librarian, blogger, and self-proclaimed technology geek in New York opened the meeting with a lively and fast-paced discussion of current technology trends.
• Dr. Keith A. Frey and Nadine Ellero updated us on the Electronic Medical Record (EMR) in medical practice, and how medical librarians can become involved with this transition.
• David Levy, Professor at the University of Washington, explained how technology has changed, how this change affects the quality of life, and why we have “No Time to Think”.
• Connie Schardt, MLA President  and Associate Director for Public Services at Duke University Medical Center presented a very engaging and factual account of  why EBM (evidence-based medicine) is far from “dead”!

Continuing education courses included Emerging Technologies for Librarians, Understanding Healthcare Literature, PubMed Rediscovered, Creating Online Tutorials, and Locating Cancer Information.

Meeting activities were shared via the “Connect/Follow/Share” link on the JM2010 website.  The program featured 16 posters and 21 contributed papers.  Blog posts were submitted by 16 official bloggers along with photos on Flickr and posts to the JM2010 Facebook page.

Attendees responded very positively when surveyed about the program schedule, content, and quality of the sessions, the exhibit hall (32 vendors!!), the networking and social activities, and the conference facility.

The comprehensive final report is available on the MLGSCA website.

Posted 5/13/10

The MLGSCA/NCNMLG Joint Meeting 2010 survey results are available online for all to see. Thank you to all who completed the survey.  We are thrilled with both the quantity and quality of the responses!  Your feedback and comments will do much to help us improve and enhance future conferences.  The results of the survey are available via SurveyMonkey.  Thank you to everyone who made the Joint Meeting in Glendale so successful.

Posted 4/30/10

Locating Cancer Information for Your Clinicians and Patients. Stephanie Fulton, MSIS, Assistant Library Director, Research Medical Library, and Elizabeth Brackeen, MSIS, Senior Librarian, The Learning Center at MD Anderson Cancer Center, Houston, Texas.

Information on searching for cancer related information was interwoven by a research medical librarian and a consumer health librarian to offer participants many academic as well as consumer resources specific to cancer related issues.

For PubMed cancer related issues, consider using the “cancer” limit, and set up filters, subsets, and pre publication options.  Using DynaMed can also find information using ICD 9 coding for specific cancers.

LabTests Online has specific information on cancer related lab tests, canceradvocacy.com for questions consumers can ask their health care providers, and FDA.gov for the drug development and approval process.  For National Cancer Institute statistics, check SEER databases (seer.cancer.gov) for incidence, prevalence, and survival rates of specific cancer types.

For a complete listing of cancer related sites, check out the MLA09 cancer wiki.

Engaging Users with Powerful Visuals – on the Cheap!

Kelli Ham, Consumer Health Coordinator, NN/LM Pacific Southwest Region, UCLA Louise M. Darling Biomedical Library, Los Angeles, CA.

Ms. Ham noted that most medical librarians are involved in some way with teaching differing groups of users, and that graphic images implanted in a presentation can heighten interest, promote communication and enhance understanding.

Several software programs were displayed including free resources like Picasa® (free photo editing) to change size, orientation, brightness of photos, Snag It® (improved screen print capture with the ability to right size the screen print and the ability to capture the scrolling of a website), and video tutorials software (Jing®) which assists with the creation of  video tutorials. Jing can be used to see a screen action, while simultaneously hearing voice instruction and can be shared by email, or embedded in a blog or website.

For further information, check out these books:

• Beyond Bullet Points: Using Microsoft® Office PowerPoint® 2007 to Create Presentations That Inform, Motivate, and Inspire by Cliff Atkinson
• Better Than Bullet Points: Creating Engaging e-Learning with PowerPoint by Jane Bozarth

Also, the NIH has an image library that is free and can be utilized to add anatomic illustrations to presentations.

Whether you did or did not attend the Joint Meeting in Glendale last month, we would LOVE to hear from you!  If you DID attend, we want to hear your thoughts on the conference.  If you DID NOT attend, we are very interested in knowing what prevented you from attending.  Your feedback will help to improve future conferences.

The conference evaluation survey can be found on Survey Monkey or on the Evaluation tab on the Joint Meeting website.

For questions about the evaluation, please contact Molly Harrington (molly.harrington@chw.edu) or Billie White (billie.white002@chw.edu).

Membership will be notified of the tallied results.  If you have already completed the survey, THANK YOU for your input.

Posted 2/16/10

Invited Speaker: David Rothman, Information Services Specialist, Community General Hospital Medical Library, Syracuse, NY, “A Refreshing Take on Technology Trends”

Everything old is new again. Well, that adage really doesn’t apply when we listen to what David Rothman had to say during the Joint Meeting about emerging and evolving technologies, past and present.

The first plenary session “A Refreshing Take on Technology Trends” was
nostalgic, especially for those who have been in the library profession for decades. We’ll never take our memory sticks for granted after viewing the computer memory storage “units” of the 60’s and 70’s that were perhaps eight to ten times larger (or more) than the Smart Car. David’s trip down memory lane was compelling considering he is only in his early thirties.

We’re amazed at the change in technology, especially in relation to older computers. Their size, capacity and limited memory/storage capability intrigued many of us at the time, but you just have to wonder what was  going through David’s mind as he presented these images of  state-of-the-art developments from the past. Many of us vividly remember vinyl records, 8 tracks, microfiche and even the Dictaphone;  however David’s presentation, delivered with energy, and enthusiasm made us all feel comfortable with the wonders yet to come.

Posted 2/5/10

A PDF version of the Financial Realities of Planning the 2010 Joint Meeting report is also available.   

Concerns about Joint Meeting finances arose during the MLGSCA Business Meeting and AC Meetings held on January 28, 2010.  The quad-chairs are therefore providing the following background information about the meeting planning process and financial outcomes:

1.  No Final Report was available from the Las Vegas Joint Meeting to guide us in any aspect of the conference, including the most important estimates of room block and food commitments.

2.  The “Goldilocks” effect:  Our group is just a bit too big to hold the conference in boutique hotels, and way too small to interest the larger hotels.  We only received two bids for the conference that suited our date needs and room rate.  These were from the Renaissance Glendale Resort and Spa, and the Chapparal Suites Hotel in Scottsdale, Arizona.  We would have been embarrassed to hold the conference at the Chapparal Suites.  The conference dates for Arizona are also limited due to the popularity of baseball Spring Training which increases hotel rates starting in February.

3.  Our “Application for Credit” with the hotel was denied because MLGSCA does not have a strong enough credit history.  We had to send the hotel a deposit in December. Additionally we had to make an estimated final payment to the hotel 10 days before the conference (with a 15% overage estimate), instead of being able to pay the final bill 30 days post-conference.  This means we wait for the hotel to reimburse us post-conference for any overpayment.  It also results in loss of interest in the Vanguard account.  We were also surprised to find that the hotel does not review credit applications until 45 days before an event.

4.  Our budget was based on 175 people attending the conference, scaled back from the original 200. Only 125 attended.

5.  Folks love being able to register for the conference by credit card using Acteva.  However Acteva charges us a 10% fee on these transactions. There were also quite a few people who changed their registration options resulting in additional fees we had to pay Acteva.

6.  Hotels charge hefty service fees.  The fee at the Renaissance was 22%.  There is a 9.5% city sales tax on top of the service fee. The service fees are standard hotel charges and cannot be negotiated.

7.  Sponsorships, which were plentiful in the past, are hard to come by now.  Our largest amount for sponsorship was for $1,500 from NEJM.  Most amounts were for $250.

8.  The Advisory Council agreed to subsidize this meeting to encourage attendance during bad economic times. This meant keeping the conference rate below $200, and the cost of continuing education classes low. The conference rate was all-inclusive to further entice attendees.  Quote from the AC Budget Meeting of 7/24/09:

“Ellen needs to know if we want to go forward?  Yes.

We can decide later where the funds will come from.  Stipulation is that we will seriously evaluate joint meetings in the future. Any suggestions can be e-mailed to Ellen or other chairs.”

JM2010 registration activity was presented and included as a handout at the November 20, 2009 Business Meeting.

9.  At the MLGSCA Business Meeting on January 28, 2010, Ms Aaronson cited a figure of $75,000 which had already been paid to the hotel.  Unfortunately this number shocked listeners who did not understand points 1 through 8 above, and the rest of the message was lost.  The rest of the message was that we were still receiving funds from registration, continuing education courses, exhibitors, sponsors and advertisements. We do have additional expenses to be paid such as speaker and instructor fees and expenses, and program printing costs. We are awaiting reimbursement from the hotel for the previously mentioned overpayment.

10.  Numerous steps were taken to reduce conference costs.  These included:

a.  Using a conference planner at no cost to us.  Mr John Vanella negotiated with the hotel on many issues including reducing our food commitment, and cutting our AV quote from $26,000 to approximately $16,000.

b.  Selecting the lowest priced food and beverage items for our events.  This included omitting the boxes from the traditional “boxed lunches” for the Round Tables which reduced the cost by $1 per person.
c.  Selecting speakers whose fees were low or who did not charge us to speak.
d.  Omitting conference bags
e.  Convincing 32 exhibitors to attend in a down economy, then further convincing them to donate raffle items

11.  Recommendations for future meetings:

a.  The Advisory Council must discuss how often to hold these meetings and explore barriers to attendance.  Work with other Chapters, and MLA, to address these issues
b.  Explore other times to hold the meeting; hotel rates are extremely low in Phoenix during the off season of June, July and August.
c.  Raise meeting registration and continuing education fees to a level which recoups expenses
d.  Do not offer an all-inclusive meeting rate; charge for food and drink at a level which recoups expenses
e.  Raise exhibitor fees to a level which recoups expenses
f.  Maintain a good credit history for the group; this meeting should help. The hotel required a five year history.
g.  Obtain an institutional credit card which would help develop a credit history and provide greater payment flexibility
h.  Possibly merging financially with NCNMLG to share cost of future meetings

12.  Conclusion:    The Advisory Council agreed to subsidize the 2010 Joint Meeting as a gesture of good will towards members and a nod to the tough economic times we all face.  The quad-chairs were instructed to go forward with the meeting and keep the all-inclusive conference rate below $200.  The quad-chairs and planning committee members delivered an incredible meeting at the lowest cost possible.  We fulfilled our charge.

13.  Final numbers will be available at the next MLGSCA Business Meeting.

Posted 2/5/10

Seidl’s vision plus an excellent dinner made for a wonderful evening. This librarian was immensely entertained, intrigued, educated, and adored the presentation of “The Hollywood Librarian”. The interviews with various librarians (including our own Chris Ewing) were extremely interesting and the passion shared by the librarians towards their profession was heartwarming and justified my career choice. And then of course my favorite movie, “It’s A Wonderful Life” was brought to our attention.

All movie snippets that mentioned libraries or librarians or eluded to them were edited to be included in Seidl’s production; very cute! Thank you to the Joint Meeting Planning Committee, 2010. The evening was a relaxing one and the movie truly served us well.

Posted 2/4/10

Ann McKibbon, MLS, PhD, from McMaster University, Faculty of Health Sciences started the CE class “Understanding Healthcare Literature” with different definitions for evidence-based medicine (EBM). A simple definition is: “evidence-based healthcare (EBHC) is the integration of best research evidence with clinical expertise and patient values.” Ann focused the presentation on three steps of the 5-step process for EBHC:

1. Framing the question appropriate to the needs of the patient/situation…
2. Evaluating the evidence (critical appraisal or reading the article)
3. Making and doing the decision.

One of the goals for the class was to learn how clinicians look at articles. A big component of this is critical appraisal. Critical appraisal is the reading and understanding of an article. It is a three step process:

1. find good evidence
2. find good results
3. figure out how the patient matches the study

Ann also talked about different categories of clinical literature: original studies (e.g. case report) versus synthesis (e.g. systematic reviews, practice guidelines). She then went into details of the similarities for these different kinds of literature and showed us where to look for this information in an article. All clinical literature has certain components. They are all question based, preplanned, and comparative, etc. For example one can find information about the patient/participant group of a study in the method section, in the first part of the result section, or in Table 1. The setting of a study can be found in the abstract or method section, etc.

One method to visualize a study is to map it out. The Equator Network compiles standards for writing articles and reporting guidelines. One of their standards is the Consort Flow Diagram that is a standardized presentation for randomized controlled trials. The STARD Statement is a diagram for diagnosis studies.

Ann showed us how to map out the playground article using the Consort Flow Diagram and by reading the abstract and the flow chart. She then explained statistics, e.g. the significance of P-values and confidence intervals by analyzing Table 1 of the article. She also mentioned the importance of the conflict of interest disclosures in articles.

Ann also talked about other techniques to represent articles, e.g. GATE by Rod Jackson at the University of Auckland, School of Population Health in New Zealand. We practiced putting in the information from several articles into the GATE frame. The GATE frame uses a method similar to PICO, called PECOT (Participants, Exposure Group (Intervention), Comparison Group, Outcome, Time). Randall developed GATE further and added some additional questions in regards to resources needed, responsibilities, and success.

Critical appraisal can be done in 3 different ways:

1. Group led with assumption that no one has read the article
2. Group led with division of labor among groups
3. Do it yourself

I learned many things in this class about what to look for in an article, where to find certain information, and how to find out if there are significant differences in the results of the study. This helped me to see how clinicians look at articles.

I would like to thank the NCNMLG for the professional development grant that made it possible for me to attend this class and the conference.

1. Equator Network
2. Howard AW, Macarthur C, Rothman L, Willan A, Macpherson AK. School playground surfacing and arm fractures in children: a cluster randomized trial comparing sand to wood chip surfaces. PLoS Med. 2009 Dec;6(12):e1000195. Epub 2009 Dec 15.
3. GATE

Posted 2/4/10

Contributed Paper: Readability of Patient Education Materials in Electronic Health Records. Jean Roehrs, Director, Medical Library, Phoenix Indian Medical Center, Phoenix, AZ.

This paper presentation focused on the search to provide patient education materials that are readable and understandable by patients. Many patient handouts are available, but the reading level of these handouts is too high. Logistically, it is not practical for individual medical care providers/institutions to create their own handouts.

It would be time-consuming to create individual handouts for each topic, they
have to be reviewed to ensure they are accurate, as well as updating/maintaining the handouts to keep the information current.

There are many patient education tools; this study focused on 5. Readability was tested on 30 topics; the average reading level for these tools was 12th grade (from 9.7th grade – 15.5th grade). Health literacy advocates recommend 8th grade level, and many providers would prefer an even lower level, somewhere between 5th – 8th grade.

The study came down to two patient education tools: Krames and PERC. Krames was chosen as the best solution for this environment because the available handouts provided 100% coverage of the chosen topics, and the average reading level was 7.7th grade, which was the lowest of any reviewed. Many of the patient education tools are marketed as “one-stop solutions” that are directed at administration and librarians are never involved. This is an ongoing issue with health care providers and librarians.

This was a very insightful presentation which provided awareness on an important topic that frequently gets overlooked.

Posted 2/4/10

Round Table: Return On Investment: Library Staff and Services. Facilitator: Suzette Kopec, Carondelet Health Network, St. Joseph’s Hospital Medical Library, Tucson, AZ.

Questions posed by the group:

• Libraries are downsizing & cutting budgets. What are the implications? What are libraries paying for, and how does it help the enterprise, impact patient care, and assist in training healthcare providers?
• How can we quantify what we do in a meaningful way?
• How do we turn those numbers we track into something useful? What do we do with our numbers?
• What are hospital administrators focusing on regarding ROI? What are hospitals tracking? Patient satisfaction, risk assessment/outcomes, length of stay, anything else?
• Can you translate literature searches and article retrieval into patient care?
• Does marketing trump ROI? Does relationship with administrators carry more weight than ROI?
• Do we record & report what we THINK should be important to administrators, or do we record & report what they actually ask to see?
• What can we (librarians) learn from the business model of information brokers? Is there anything they are doing that we can replicate/integrate into our business model?

Points of interest:

• Get involved in policy & procedures committees, patient care services committee. Look at it as investment in knowledge.
• Patient satisfaction surveys can help capture the direct impact of library services on patient care. Also survey your healthcare providers.
• Begin to assign your statistics directly to library programs and services (for example, TOC service, nursing services and/or nurse liaison librarian programs), and then query your relevant clientele (nurse administrators/educators, TOCs participants) to provide feedback via online surveys, emphasizing the importance of this feedback to the growth of that library service. Really lean on and rely on those professional relationships you have with your clients.
• Educate & promote to administration those non-clinical resources you offer (business resources & subscriptions, etc.)
• We work for data-driven people.
• We have to have both hard numbers and relationships.
• Capitalize on testimonials on your website. Consider a “I love the Library” video (Hopkins has one).
• Create a one-stop stats database to capture data AND testimonials so you can query & collate your data at a moment’s notice.
• Push out that doctor testimonial and attach an important stat with it – Dr Smith says how much the library has helped him improve patient care, then follow up the testimonial with a stat about the number of searches you’ve done this week/month/year for other doctors.
• Get a quote from your CEO that you can use in marketing pieces.
• Use customer satisfaction surveys & report comparisons to past surveys. Use the data, write it up & publish it. We are gatherers – let’s populate this information & publish it. People don’t know what you’re doing unless you tell them.
• Consult published studies on ROI and costs for replacing your library services on the retail market.
• Use software like Digital Measures (geared for faculty/academic) to track your professional activities & help you quantify what you’ve been doing in your role as librarian.
• Talk to administrators & ask THEM to quantify library services for you. Ask them what kinds of library statistics might be meaningful to them.
• Establish a Library Advisory Committee (LAC) to help develop meaningful measures for administrators and serve as library advocates.
• Use graphs/images to help show relationships & tell the story behind the numbers.
• Tracking consortial journal usage is difficult – in-house vs. external usage, type of clientele using them, etc. We need to find a better way to track this usage.
• It’s a matter of marketing & communication – letting users know that you can get articles quicker than they might think so please don’t buy off of publisher websites.
• We always promote ourselves as “we’re so inexpensive, we’re a great deal”. ROI calculators help put our value into context. Compare costs of maintaining a library to using an external information broker. Keep in mind that information brokers won’t have overhead and can set aside time for personalized service (they arent’ answering phones & covering service desks).
• Be aware that information brokers sometimes come into libraries to “set up shop”, help users for a fee, and you don’t even know they are there.
• The underlying message with information brokers coming into our libraries – people want articles! Librarians could do a comparison study of how quickly it takes library staff to get article vs. an information broker.
• Get to know your Quality Assurance people! Risk management is huge, especially at hospitals. Serve on Quality committees.

Taking it to the next level:

• Let’s find out what we need to know and do about ROI, and who can help train us/educate us.
• Let these round tables spin out into future workshops/CEs. We all have the same concerns.
• We need an ROI continuing education class at the next Joint Meeting! AAHSL had a speaker recently on ROI (need to find out who).
• We should have our own group /listserv/blog to keep ROI discussions going beyond the Joint Meeting, and invite the other ROI Round Tables to join us with their observations and concerns.

Posted 2/2/10

Contributed Paper: Evidence-Based Bioethics – Available Resources and Tools for Librarians.  Linda Suk-Ling Murphy, Health Sciences Librarian; Brian R. Williams, Librarian, University of California-Irvine Libraries, Irvine, CA.

The definition of evidence-based bioethics remains subject to debate among bioethicists themselves. Hence, how would you respond to a request to lead a discussion on that topic to senior faculty, local physicians, ethicists, lawyers and other experts in the medical ethics field? Enthusiastically (and with extensive preparation) according to medical librarian, Linda Suk-Ling Murphy and law librarian, Brian Williams, who recently received this invitation from the Bioethics-Biolaw Discussion Group (BEBLDG).

Today’s presentation summarized the key definitions Linda and Brian used in the discussion with the BEBLDG regarding EBP and bioethics. Integral to their success was the use of a case scenario to effectively guide the BEBLDG through a lively but focused debate.

Brian and Linda also generously provided a number of resources for those of us who may face research questions about evidence-based bioethics:

• Justcrim (Brian’s extensive compilation of cases and materials – see Bioethics column on right)
• Linda’s bookmarks on evidence-based bioethics
• Legal Information Institute
• Cornell University Law School Social Science Research Network (where pre-publication copies of many social science articles are available without cost).

Posted 2/2/10