MDMLG News

Christina Wallace, Editor
Valerie Reid, Webmaster

Table of Contents

Upcoming MDMLG Meeting
EBM: Dragging Them Kicking and Screaming
EBM Series in CMAJ
MHSLA Conference Commentary Collage
MHLSA Update
Fridays @ Shiffman Learning Café Series
What’s New/Announcements
New at Children’s Hospital of Michigan Medical Library

Upcoming MDMLG Meeting

Where will you be - the mall, the airport, a library conference - when the person/friend/family member collapses with a heart attack? What will you do?  Do you even know what an automatic external defibrillator LOOKS LIKE?

Then attend the hands-on demonstration of this device and what it can do, led by Jennifer Pickett of the American Heart Association. Normally costing $100 to attend, this seminar will be free of charge before our general business meeting.

When? Thursday, December 2, 2004

Where? Henry Ford Hospital in Detroit, Room 2038-C, Education and Research Building

Itinerary:

Parking is available in the patient visitor garage. Parking access is directly off the John Lodge service drive. The southbound Lodge is now open all the way to downtown and the surface streets are all clear.

Further information is available on the MDMLG website.

Diana Balint
Program Committee Chair

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EBM: Dragging them kicking and screaming

As many of us well know the transition to a more evidence-based medical practice has affected every aspect of medical care. Librarians have been at the forefront because we are the folks, in many cases, who hold the keys to the information castle.

We have had different sorts of experiences with clinical staff in transitioning to this new practice paradigm. The newest people in the field have had a more in-depth exposure, as it is a part of the educational program for most recent nursing and medical school graduates¹. The more well established and computer fearful administrators, physicians and nurses are having more difficulty because it involves a change for them and relearning new patterns. Not everyone is eager to "shake hands" with the new way of conducting patient care.

Some of the particular issues we have encountered in teaching evidence-based medicine include the following (from Center for Health Evidence).

• Many attending staff start with rudimentary critical appraisal skills and the topic may be threatening for them.
• People like quick and easy answers. Cookbook medicine has its appeal. Critical appraisal involves additional time and effort, and may be perceived as inefficient and distracting from the real goal (to provide optimal care for patients).
• For many clinical questions, high quality evidence is lacking. If such questions predominate in attempts to introduce critical appraisal, a sense of futility can result.
• The concepts of evidence-based medicine are met with skepticism by many attendings who are unenthusiastic about modifying their teaching and practice in accordance with its dictates.

In addition, there are the usual cohorts of lack of time and energy to absorb this new practice and, to a greater extent, distrust of its true validity. It is also true that for many questions there isn’t enough valid research in order to make a well-qualified conclusion.

Given all of these factors what can we do to aid in this transition?

The answer is as simple and as complicated as the people involved. We must first establish the basis of fear and apathy towards the issue. There is usually an "aha" moment in which the clinician can see that over time they spend less time evaluating each case. That once established and reviewed periodically they can more quickly decide the best course of treatment for more common diseases and conditions. They will also endear themselves to their administrators because they will likely be ordering fewer tests and will cost less money; shorter hospitals stay, and have lower morbidity. They will use the most effective methods and treatments for the majority of their patients – knowing what they are from their research.

Eliminating the fear of the computer can be a lengthy process. We are aided in most of these processes because there is help from the IT departments (sometimes) and from Physician Support Services in most, if not all, cases. The clinical staff must be able to use the EMR functions as well as the remote access systems in order to participate in most hospital clinical functions. This enforces the need to get over computer fear. Eventually it turns in into computer resentment (where most of my docs are by my professional experience), but in most cases that is an easier state with which to cope.

Once you are able to show the staff how to access and use tools like Cochrane and PubMed search hedges, they can begin to see that it’s not so difficult. We can make it easier for them if we have all of these items easily marked on the main desktop*, and they don’t have to rely on memory to access the proper URL. Cheat sheets or Pathways for Searching will also assist those whose memory for detail has been burdened by information overload. None of this will happen quickly, but over time it will become more second nature. Learning to formulate the right question to achieve a good answer takes time and practice as does learning to use the tools that provide them.

The clinicians may have some rather valid reasons for a general distrust of EBM. We all deal with change with different degrees of aplomb. Having to adapt to a new professional standard is stressful and time-consuming. Remember having to learn about the Internet and WWW? It created a whole new standard (without having a standardized consistent product) in much the same vein. There is also a basic distrust of information that may come from a source outside of those deemed "expert" in the field, or that, which may run contrary to personal experience.

It’s the Evidence, Stupid.

We all learned in the process of conducting a Reference Interview that we need to figure out the question the patron really wants answered. It’s much the same in beginning an EBM search. The querent needs to pose a clinical question that can be answered by the literature.

The components of the appropriate question are²: who (population or group affected), which (procedure, drug, treatment), and outcome (reduced mortality, ease of symptoms, fewer side effects). The querent may not find evidence to support a clear course of action, particularly if the condition is rare.

In that case the next phase of researching may come into play. The clinician needs to look at several components of a particular study: type of study (meta-analysis, double-blind), population (size and diversity), design (outcome and measurement), control (for bias and focus on question), and credibility (reputation of researchers, professional experience, validity of results).

It is likely that a small reputable study is located or a large one that may have flawed conclusions. It is up to the clinical expertise of the querent to determine the best course of action.

There are some well-regarded sources of EBM³ information. This is only a partial list; there are new titles and databases every day, as well as local and society sources.

Cochrane Database of Systematic Reviews

DARE – Database of Abstracts of Reviews of Effectiveness 

Clinical Queries (PubMed)

Clinical Evidence database (BMJ and Ovid)

ACP Journal Club (print and online)

POEM’s (Journal of Family Practice)

Evidence-based Medicine Journal

* Unless you work for an institution that disallows links on desktops due to standardization as I do. Then you have to rely on Intranet links, printouts and signs.

Juliet Mullenmeister 
St. Joseph Mercy of Macomb

1. Sackett, DL., et al. Evidence-based Medicine; how to practice and teach EBM. 2^nd ed. Edinburgh, Scotland, UK: Churchill-Livingstone, 2000
2. Greenhalgh, Trisha. How to Read a Paper: the basics of evidence based medicine. 2^nd ed. London: BMJ Books, 2001
3. Grandage, KK , Slawson DC. When less is more; a practical approach to searching for evidence-based answers. J Med Libr Assoc 2002 July; 90(3):298-304  [PDF Article]

Further Information (from Center for Health Evidence Users Guides)

Lindberg DA. Information systems to support medical practice and scientific discovery. Methods Inf Med. 1989 Nov; 28(4): 202-6.

Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical Epidemiology, a Basic Science for Clinical Medicine. 2nd ed. Boston: Little Brown & Co Inc; 1991: 218.

Kuhn TS. The Structure of Scientific Revolutions. Chicago: University of Chicago Press; 1970.

L'Abbe KA, Detsky AS, O'Rourke K. Meta-analysis in clinical research. Ann Intern Med. 1987 Aug;107(2):224-33. Review.

Ransohoff DF, Feinstein AR. Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. N Engl J Med. 1978 Oct 26;299(17):926-30.

Nierenberg AA, Feinstein AR. How to evaluate a diagnostic marker test. Lessons from the rise and fall of dexamethasone suppression test. JAMA. 1988 Mar 18;259(11):1699-702. Review.

Haynes RB, McKibbon KA, Fitzgerald D, Guyatt GH, Walker CJ, Sackett DL. How to keep up with the medical literature: V. Access by personal computer to the medical literature. Ann Intern Med. 1986 Nov;105(5):810-6.

Bulpitt CJ. Confidence intervals. Lancet. 1987 Feb 28;1(8531):494-7.

Godfrey K. Simple linear regression in medical research. N Engl J Med. 1985 Dec 26;313(26):1629-36.

Haynes RB, Mulrow CD, Huth EJ, Altman DG, Gardner MJ. More informative abstracts revisited. Ann Intern Med. 1990 Jul 1;113(1):69-76. Review.

Haynes RB. The Origins and Aspirations of ACP Journal Club. [Editorial]. ACP J Club. 1991 Jan-Feb:A18. Ann Intern Med 1991:114S1.

Audet AM, Greenfield S, Field M. Medical practice guidelines: current activities and future directions. Ann Intern Med. 1990 Nov 1;113(9):709-14.

Guyatt GH. Evidence-based medicine. ACP J Club. 1991;114(suppl 2):A-16

Light D Jr. Uncertainty and control in professional training. J Health Soc Behav. 1979 Dec;20(4):310-22.

Chalmers I. Scientific inquiry and authoritarianism in perinatal care and education. Birth. 1983 Fall;10(3):151-66.

Cassell EJ. The nature of suffering and the goals of medicine. N Engl J Med. 1982 Mar 18;306(11):639-45.

Ende J, Kazis L, Ash A, Moskowitz MA. Measuring patients' desire for autonomy: decision making and information-seeking preferences among medical patients. J Gen Intern Med. 1989 Jan-Feb;4(1):23-30.

Carter WB, Inui TS, Kukull WA, Haigh VH. Outcome-based doctor-patient interaction analysis: II. Identifying effective provider and patient behavior. Med Care. 1982 Jun;20(6):550-66.

Greenfield S, Kaplan S, Ware JE Jr. Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med. 1985 Apr;102(4):520-8.

Haynes RB, McKibbon KA, Walker CJ, Ryan N, Fitzgerald D, Ramsden MF. Online access to MEDLINE in clinical settings. A study of use and usefulness. Ann Intern Med. 1990 Jan 1;112(1):78-84.

McKibbon KA, Haynes RB, Johnston ME, Walker CJ. A study to enhance clinical end-user MEDLINE search skills: design and baseline findings. Proc Annu Symp Comput Appl Med Care. 1991;:73-7.

Laupacis A, Sackett DL, Roberts RS. An assessment of clinically useful measures of the consequences of treatment. N Engl J Med. 1988 Jun 30;318(26):1728-33.

Department of Clinical Epidemiology and Biostatistics. How to read clinical journals: II. To learn about a diagnostic test. Can Med Assoc J. 1981 Mar 15;124(6):703-10.

Department of Clinical Epidemiology and Biostatistics. How to read clinical journals: V: To distinguish useful from useless or even harmful therapy. Can Med Assoc J. 1981 May 1;124(9):1156-62.

Oxman AD, Guyatt GH. Guidelines for reading literature reviews. CMAJ. 1988 Apr 15;138(8):697-703.

Campbell EJ. The diagnosing mind. Lancet. 1987 Apr 11;1(8537):849-51.

Feinstein AR. What kind of basic science for clinical medicine? N Engl J Med. 1970 Oct 15;283(16):847-52.

Mulrow CD. The medical review article: state of the science. Ann Intern Med. 1987 Mar;106(3):485-8.

Eddy DM. Clinical decision making: from theory to practice. Guidelines for policy statements: the explicit approach. JAMA. 1990 Apr 25;263(16):2239-40, 2243.

Bennett KJ, Sackett DL, Haynes RB, Neufeld VR, Tugwell P, Roberts R. A controlled trial of teaching critical appraisal of the clinical literature to medical students. JAMA. 1987 May 8;257(18):2451-4.

Kitchens JM, Pfeifer MP. Teaching residents to read the medical literature: a controlled trial of a curriculum in critical appraisal/clinical epidemiology. J Gen Intern Med. 1989 Sep-Oct;4(5):384-7.

Shin J, Haynes RB. Does a problem-based, self-directed undergraduate medical curriculum promote continuing clinical competence? Clin Res. 1991;39:143A.

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EBM Series in CMAJ

The Canadian Medical Association Journal (CMAJ) is publishing a series of articles on evidence-based medicine. What makes this series unique, is that the articles are specifically geared toward two groups: learners of EBM and teachers of EBM. Each topic will have two complementary articles – "Tips for Learners" and "Tips for Teachers". Articles also come with access to corresponding EBM Tools, such as an interactive version of the article, demonstrations and other teaching/learning tools. The nice thing is that you don’t need a subscription to CMAJ to access the full articles or the EBM Tools.

Click here to see the current list of EBM articles from CMAJ.

To access the EBM Tools and Teaching articles, be sure to click on the "EBM Resources" link below the link for the PDF version of the article.

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MHSLA Conference Commentary Collage

I want to thank MDMLG for funding my registration to the MHSLA annual conference in Kalamazoo. It was a great conference, I learned a lot, and I had an opportunity to network with other medical librarians in the state and represent MDMLG at the conference. I think it is important that the President of our group attend and it will be a great benefit to all our succeeding presidents.

Twenty-two additional members of MDMLG were also there and we were all impressed with the quality of the programming, the hospitality of the Radisson, the enjoyable entertainment and the innovativeness of both Bronson and Borgess medical centers. WMHSLA put a lot of thought and heart into the conference and it showed.

Pat Vinson, our Public Relations Officer, designed a wonderful MDMLG display for the Poster Session and we will bring it to our next meeting in December. Do remember to take a look at it and if you have other ideas or pictures to add, let Pat know.

So, thanks again and to paraphrase, "Wish all of you were there!"

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I am a LISP student (WSU, graduating 12/2004) and work as an Information Specialist at the Shiffman Medical Library. I attended the MHSLA conference for the first time in 2004. I presented a poster on Urban Health Partners, a project I worked on with project director Deborah Charbonneau at Shiffman. It was exciting to be able to share with librarians our experiences providing outreach information services to public health providers. The conference provided many learning opportunities such as sessions on options for electronic document delivery, the scholarly communication crisis, and what's new with MeL. The conference also provided many opportunities to meet health science librarians from across Michigan and to reconnect with former classmates.

A very well attended MHSLA state conference, entitled A Knowledge Kaleidoscope! was held on Oct. 13-15 in Kalamazoo, hosted by the Western Michigan Health Science Library Association.

Wednesday’s CE programs included classes on dealing with the information needs of hospital administrators, effectively communicating with physicians and coping with the large amounts of data librarians received daily (Information Overload). Feedback, among the crowd, seemed very positive.

Marge Kars and Bronson Methodist Hospital hosted an impressive tour of their completely new hospital and patient information center, which appeared more as a 5 star hotel than a hospital. Following the tour, an elegant reception was held, with welcoming comments from Bronson’s Vice-President for Community Affairs.

Thursday events began with a keynote address entitled: 50 Ways to be Indispensable to Your Organization, by Robert Berkman. He identified active, smart, effective steps to take to prove the value of library services and make yourself indispensable to your facility.

The Business Meeting consisted of outgoing President, Joannie Emahiser’s address, Treasurer’s Report, (Total Assets: $48,138.69 with many conference expenses still outstanding), committee reports and approval of by-law changes in regards to incorporation status and policy changes concerning nominating committee duties. The first MHSLA Librarian of the Year Award was given to Sandy Swanson for her thousands of hours of work in re-organizing and coordinating the Stat!Ref group purchase affairs. Jennifer Barlow, incoming MHSLA President, presented an eloquent address on her goals and desires for the coming year. Finally, Barb Platts and Susie Wichman presented a very inviting program on the Crystal Mountain area, the site for the September 21-23, 2005 MHSLA Conference.

Highlights of the afternoon session was the trip to the unique Borgess Navigation Center, a facility adapted to promote tools and opportunities to support employee education through the use of effective group processes that support strategies for bringing out the best in individuals and groups as they solve problems, design new strategies, address organizational challenges and determine ways of working more productively together. Participants experienced a mini session in this fun, imaginative arena.

The evening’ s special event, Bagpipes, Belly dancing and Boogie included something for everyone. Bagpipers from the Kalamazoo Pipe Band kicked off the evening with an assortment of tunes and maneuvers. A belly dance instructor performed for the audience and then "invited" some (many by default) to learn this exotic artful dance. (Pictures will be available on the website soon). Last, but not least, a DJ provided music and games relating library and book-themed tunes. Many later danced the night away to a variety of hits from today and yesterday.

The wonderful meal and entertainment were enjoyed by all.

On the Friday agenda was the ever-popular vendor exhibits, and 8 unique and informative poster presentations. The morning program was a very enlightening panel discussion on electronic document delivery. Participants provided insight on Ariel, Relais, as well as Borgess’s homegrown system. Many questions were answered which ultimately raised our awareness on this library task.

Finally, the afternoon provided opportunities to receive information on Archiving, How to obtain scholarly information within the restrains of publishers/cost factors and finally the presentation on the Evaluation of Evidence-based Medical Resources at the point of care.

This conference was filled with a variety of opportunities to enhance any librarian’s knowledge, in fun and creative ways.

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MHSLA Update

The latest MHSLA board meeting was held Tuesday, September 21, 2004 at Sparrow Hospital, Lansing, presided by Joan Emahiser.

• Reports and updates were given concerning the status of the conference preparation.
• By-laws changes to be presented to the membership were reviewed.
• MHSLA’s role in the registration process for the MLA teleconferences was discussed. It was determined that, once MLA confirmed their sites, if an interested site had not been selected/sponsored by GMR, MHSLA would sponsor one site, representing either a non-serviced or centrally located area.
• MHSLA membership, at fiscal year end, was 77 institutional members and 92 personal members.
• Discussion on Membership dues, which have not been raised in 10 years, was conducted. It was unanimously agreed that dues would remain at $45.00 for institutions and $15.00 for personal, for at least another year.
• The new MHSLA newsletter was mailed to the membership.
• Lea Ann McGaugh submitted final report on the NLM Ariel Grant.
• The new Stat!Ref contract was reviewed and is now in effect.
• MHSLA has received a GMR Exhibit Award to cover expenses associated with exhibiting at the Michigan Library Association Annual Meeting at Grand Traverse Resort. This will provide a vehicle to promote MHLSA mission to public library venues.

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Fridays Shiffman Learning Cafe Series

The Shiffman Medical Library offers a variety of educational programs for Wayne State University health sciences faculty, students and staff. The library also offers workshops and customized training programs for members of the community. The Shiffman Library is pleased to assist individuals in learning about health sciences information resources that can be useful in research, papers, presentations, instruction, and clinical care. These classes and training sessions are open to MDMLG members, so take advantage of what Shiffman has to offer!

Registration procedures are located on the Shiffman Education and Training website: http://www.lib.wayne.edu/shiffman/geninformation/ed.php  

More classes will be scheduled, so please continue to check back with our Education and Training website http://www.lib.wayne.edu/shiffman/geninformation/ed.php 

We welcome all MDMLG members to our Shiffman training/instruction sessions!

Look forward to seeing you,

The Collection Development Section of the Medical Library Association has created a Subject-Based Resource list to assist medical librarians with collection development. With all the confusion and controversy surrounding the discontinuation of the Brandon-Hill List, and the charge for Doody’s Core List (due out in December), this is a welcome tool for librarians with little time and less money!

Keep your eyes open for future articles on collection development in the MDMLG News.

In late October Christie Pearson Brandau sent a letter to all Michigan libraries inviting participation in the Michigan eLibrary Catalog (MeLCat) - the statewide union catalog and resource sharing system being built for Michigan's libraries and residents. All types of Michigan libraries are welcome to apply: public, academic, school, and special libraries. Applications are starting to arrive now.

MeLCat and the new MeL gateway will be launched in January of 2005 with the InMiCH libraries contributing to the first round. It is planned to continue adding library collections every four months. Participation is welcome. The value of MeLCat will increase with each added library collection.

If you have questions about being part of MeLCat, or would like to apply, you can find information posted at http://www.michiganelibrary.org.  You may also contact MeLCat staff at the Michigan Library Consortium by calling: 1-800-530-9019.

A new link has been posted on the MDMLG website for the Compensation and Benefits Committee. Visit the new section, "Compensation and Benefits Resources":
http://www.mdmlg.org/compensation-resources.htm  
This section provides valuable links to articles and other resources relating to compensation and benefits for librarians.

Webmaster Valerie Reid has added a few more photos to the MDMLG Photo Album: http://www.mdmlg.org/members/photo-album.htm.  You can view the poster MDMLG displayed at the MHSLA Meeting in 2003, and also see your fellow MDMLG members who participated in the Race For The Cure walk in 2001.

Remember that the Photo Album is on the members-only portion of the web site.  Please email Valerie privately if you need a reminder about the password.  Also, if you have any MDMLG-related photos, please submit them to Valerie to be posted. You can send the photos in electronic format via email, or you can send the actual photos (Valerie will scan them for the web site and return the photos to you).

Send to:

Valerie L. Reid
Webmaster / Senior Information Resource Specialist
Henry Ford Hospital / Sladen Library
2799 West Grand Blvd.
Detroit, MI 48202
vreid1@sladen.hfhs.org  

Children’s Medical Library received a Technology Improvement Award from the National Network of Libraries of Medicine, Greater Midwest Region for the proposal "Improving Support of PDA Technology and Training Needs at Children’s Hospital of Michigan". The award purchased 4 Palm PDA’s and 2 Pocket PC’s and provided a wireless hotspot for the Medical Library. Each PDA is loaded with at least 5 full text titles such as 5-Minute Pediatric Consult, Davis Drug Guide, and Nursing Diagnosis Handbook and is circulated for a five day period. Having the PDAs allows the library staff to support the Pediatric Education Program at Children’s, which supplies PDA’s to all pediatric residents, and to encourage the use of PDAs by other hospital staff. The PDA’ s were rolled out in July and have proven to be very popular.

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Communications Committee 2004-2005

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