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Evidence, Bias, and Use…Oh, My! (MLA12 Seattle: Complementary and Alternative Medicine Section)

So at the meeting, librarians present their papers that were accepted to the conference.  These are organized into groups of four sponsored by one of the MLA’s sections.  I’m pleased to say that on Monday I made it to an entire session.  Complementary and Alternative Medicine includes everything from yoga to special diets (veg*nism, gluten-free) to acupuncture to traditional Chinese medicine to etc….  I appreciate CAM because it tends to look at the patient as a whole instead of just the diseased body part.  Plus I was curious as to what the presentations would have to say.  One thing that it is important to know.  Cochrane is a database of systematic reviews.  A systematic review is a study of the studies done.  It then summarizes what we know so far.  Think of it as centralized scientific study information.  The other thing to know is that in Western medicine, a treatment is come up with and then tested before it is used with people.  In CAM, the treatments are already in practice, so traditional randomized control trials (RCTs) used in Western medicine aren’t super-applicable.

“Cochrane Complementary and Alternative Medicine Systematic Reviews: An Analysis of Authors’ Comments on the Quality and Quantity of Evidence and Efficacy Conclusions” by Robin A. Paynter

  • CAM limited by RCT-driven evidence-based practice
  • 10% of database are CAM topics
  • Cochrane has a project to develop a classification scheme of CAM topics.
  • 47 out of 53 Cochrane groups have at least one review on a CAM topics
  • Treatment ares cover everything from vitamins to yoga
  • dietary intervention has 37 studies
  • Cochrane expresses concern over poor study designs.
  • Difficult to determine active content in plant-based meds
  • Significant groupage of comments around insufficient evidence and no effect.
  • cross-cultural issues

“Alternative Research Education in a Post-R25 World: Assessing Acupuncture and Oriental medicine (AOM) Student Attitudes Toward Research and the Scientific Method” by Candise Branum

  • Acupuncture and Oriental Medicine–AOM
  • R25 grants intend to develop research literacy and view research as a bridge between Western medicine and CAM
  • Acupuncture Practitioner Research Education Enhancement (APREE)
  • AOM student interest in research declined with years in school, a 2006 study found
  • Do students recognize the benefits of AOM research? Overwhelming yes.
  • Students at schools without dedicated research departments were very unsure about the impact of research.
  • Feelings about research slope toward the negative over time.
  • Students see the benefits of research but that doesn’t necessarily mean they like it
  • A lot of students want to stay alternative and not become complementary
  • If they don’t want to be attached, they’re not gonna want to use the bridge of research.

“Complementary and Alternative Medicine’s (CAM’s) Research Agenda and Its Unique Challenges” by Jane D. Saxton

  • In 2007: 38.4% of adults used CAM over the previous 12 months.  Also, adults spent $33.9 billion out of pocket on CAM.
  • NIH funding to CAM is only 0.5% of the overall budget.
  • CAM is individualized not standardized.  (It’s adjusted to fit the patient not one standard applied to all patients).
  • Whole Systems Research (WSR) is a term coined in 2002.  It is an approach to studying non-linear, whole systems of care.
  • Use of pragmatic RCTs: measure effectiveness, don’t use placebos, patient-centered outcomes (transformational change)
  • CAM is the opposite of Western meds.  The treatment is already in use, whereas Western medicine is proposed, tried, then used.
  • You don’t need to know the biological mechanism in order to know its effectiveness.
  • MeSH terms currently available: complementary therapies, nonlinear dynamics, systems integration
  • We need more funding, different approaches, Whole Systems Research!
  • Please take a moment to check out the libguide of this presentation.

“Hitchhiker’s Guide to One Corner of the Complementary and Alternative Medicine (CAM) Universe” by  Ron LeFebvre

  • Vitalists are more interested in information (they “know” it works).
  • Empiricists value EBM but may not be great at finding what they’re looking for.
  • Chiropractors don’t like to be associated with medicine.  Use terms like “health care” and “practice” with them.
  • A good chiropractic search string: spinal manipulation OR chiropractic OR manual therapy
  • New graduates are more likely to be EBP savvy.
  • “There’s nothing that makes you more skeptical about research than studying it.”
  • There is no widely-used, well-regarded point-of-service tool to serve chiropractic interests specifically.  They do use Dynamed though.
  • PEDRO–database for physical therapy/exercise therapy that is also useful to chiropractors

Q and A

  • Diet is odd.  Sometimes it is viewed as an alternative medicine, sometimes not.  If it’s a non-western diet, though, it’s considered alternative.
  • NIH funded PROMIS is focused on patient-reported outcomes, particularly in treating anxiety/depression.
  • N-CAM databse has outcome scales and measures
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What Librarians Talk About (MLA12 Seattle: Plenary 3: Janet Doe Lecture by Mark E. Funk, AHIP, FMLA)

The first plenary is given by the MLA president, the second by someone who is not necessarily a librarian but has something interesting to say that will aid us in our profession.  The third plenary, however, is given by a librarian.  Mark E. Funk’s presentation was entitled, “Our Words, Our Story: A Textual Analysis of Articles Published in the Bulletin of the Medical Library Association/Journal of the Medical Library Association from 1961 to 2010.”  Here are my notes.

  • An analysis of the words revealed four key areas that librarians talk about: environment, management, technology, and research.
  • Although we talk more about building than people, that gap is narrowing.
  • We are basically almost not talking about books, but we are increasingly talking about journals.
  • Reference is steady.  Searching is increasing.
  • Information is the #2 word.
  • As our information world becomes more complicated, we are talking more and more about teaching.  “I predict teaching will become ever more important.”
  • We are now concerned about what we can do to improve health.
  • New groups we’ve reached out to include: clinicians, consumers, and patients.
  • We use management words to tell our story.
  • We are no longer running our libraries like academic environments; we are running them like businesses.
  • We are early adopters and write about it.
  • Sometimes new technology becomes so embedded in our lives that we don’t mention it anymore.  For example, you say you talked to someone but don’t mention the telephone.
  • Our attention has shifted from automating to digitizing.
  • We don’t talk about the internet.  We talk about the web and navigation.
  • The word with the sharpest rise and fall is: Gopher
  • IMRaDification of our profession.  (IMRaD–Intro, Methodology, Results, Discussion)
  • MLA strategic plan encouraged us to do more research, and we responded.
  • Hockey Stick terms–little to no use, sharp recent uptake.  May indicate future usage but it could be a drastic rise and fall. Only time will tell.
  • EHRs are white hot now. (EHR–Electronic Hospital Record)
  • Why do we study history?  It’s very good at explaining change.  Answers the question, how did we get here?
  • De-emphasis on physical.  Emphasis on information.  Prefer evidence-based.
  • Emphasis on health.  Expanded audience.  Outside the library.   Teaching people.
  • Libraries more business-like. Technophiles. More research articles using IMRaD.
  • History can hint at the future, but it can’t predict it.
  • Our story is being written every day.  We can’t skip chapters to see what happens next.

Statistical Literacy and Techniques in Library Research and Practice (MLA12 Seattle: Research Section)

So at the meeting, librarians present their papers that were accepted to the conference.  These are organized into groups of four sponsored by one of the MLA’s sections.  I was a bit late to the Research Section, since I got caught up at the poster exhibit, but here are my notes for the two presentations I did see that day.

“The Analysis and Translation of Unpublished Health Sciences Data: Extra Innings for the Library Profession” by Wallace McLendon, David Potenziani, and Susan Corbett, AHIP

  • The ability to use data to answer questions brings more work to library.
  • When people say they want to access data, they really want the information that can be derived from it.
  • analytics: reactive vs. proactive
  • Libraries hold and curate data. Expand that to analysis.
  • Do more to reach administrators in terms of competitive intelligence.
  • Don’t define your job too narrowly.

“Hitting a Home Run: Statistician Consults at the AG-VET MED Library Improve Research Design Quality” by Ann Viera

  • Medical libraries are partnering with statisticians.
  • Librarian-statistician partnership to improve research design.
  • The alternatives search was occurring too late in the process to improve animal welfare.  This frustrates the librarian and angers the researcher.
  • Access to statistical reports needs to be happening earlier in the research program.
  • Consulting on stats improves animal welfare.
  • Having the statistician in the library improves the concept of library as space.
  • Providing access to the statistician protects faculty from becoming overburderned.
  • Do it right or do it over (in research and construction).
  • Doing the research before designing the study helps you design the study correctly the first time.

Friday Fun! (Seattle and MLA12)

Hello my lovely readers!

You may have noticed a recent surge in librarianship posts this week.  I was so energized and excited about my career after MLA12 that I decided to post up my notes from the various sessions I attended here.  It helps me organize my thoughts about them, but also gets the knowledge out there for others to see.

But enough about the conference, I know you guys are wondering about Seattle!

Pike Place Market painted piggy.

My first day I made it to Pike Place Market.  It’s a famous market in the Puget Sound.  Unfortunately, it’s kinda well-known for how the fish sellers throw the fish around.  Obviously, being a vegetarian lady I wasn’t too keen on watching dead bodies of innocent creatures being thrown around, so I avoided that particular sector of the market.  I did find some things in the market that entertained me in their own way, though.  The very first Starbucks, complete with its topless lady logo.  I stopped to listen to a band of old men jamming (they were very talented).  I met the giant carving of Sasquatch that Seattle is evidently very proud of (although I was never in the woods, so, alas, did not meet the real Sasquatch).  I also managed to find an adorable independent bookstore called Left Bank Books with quite possibly the best bookstore logo ever: Read a Fucking Book.  Also they had an entire animal liberation section that warmed the cockles of my heart.

Looking up through Seattle’s sidewalk.

The next day I somehow managed to squeeze in the Seattle Underground tour around the conference.  Basically, Seattle burned down back in the day. They decided this was a good chance to solve the whole sewage constantly in the street because of lack of proper drainage problem. But the merchants didn’t want to wait the 7 years it would take to elevate the ground, so they built their building at regular level, but made the pretty entrance on the second floor. That way as the city built up the retaining walls and filled in the street and such, the first floor became the basement, and the second floor the first floor. So we were wandering around underground on what used to be the above-ground sidewalks. Confused yet?

Outside the EMP Museum

My final day in Seattle, I went to the EMP Museum (Experimental Music Project).  I wasn’t so into the main museum itself, but they were having a special exhibit called “Can’t Look Away.”  Besides learning more about the sociology and history of horror, I also saw: an Alien from Alien, the monster’s boots from Abbott and Costello Meet Frankenstein, the saw from Saw, the axe from The Shining, models used in special effects from The Fly, Freddy Kruger’s glove, the interrogation chair from Hostel, and much more!! It was totally bad-ass. I was in heaven.  Also they gave me a list of the 100 horror films to see before you die.  I’ve seen 29, which is pretty good for being 25 myself.

Freddy Kruger's glove!

So beyond the touristy stuff, what did I think of Seattle?

The Cool:

  • Buildings hand out free “umbrella bags” so you can bag your umbrella and not drip everywhere.
  • Buildings also have overhangs so most of the sidewalk is not actually out where you get rained on.
  • Super hilly, which is good for the legs.
  • Skid Row term originated there.
  • The history is skeezy and fascinating.  All the stuff I love about the old west.
  • The accent is pretty adorable.  Kind of a softened version of Midwest with less niceties.
  • Legal happy hour.

The Annoying and/or Odd:

  • Getting called ma’am all the time.
  • Having doors held open for me even when it’s not necessary or particularly helpful.
  • Way too many homeless people.
  • Omg the smoking.
  • Seriously, where the hell are the pizza places and why did the two I found not sell by the slice?
  • The Space Needle is seriously underwhelming.
  • The fashion is. Well. It’s like Berklee threw up on people.

Really, though, I had a wonderful time at the conference and being a tourist.  It’s not like it surprised me that I wouldn’t want to call Seattle home.  I’ve known a very long time now that Boston is my city soulmate.  But I had fun visiting and definitely would go back as a tourist again.  I just would skip Pike Place Market and spend a lot more time in Pioneer Square.

The Slow Hunch (MLA12 Seattle: Plenary 2: McGovern Award Lecture by Steven Berlin Johnson)

After the president’s lecture (and a break) came the John P. McGovern Award lecture.  This was, I have to say, my favorite presentation at MLA12.  Steven Berlin Johnson is the author of popular science books aka science for the layman aka one of my favorite genres!  I was super-excited to get to hear him speak and honestly, his intelligence and wit are even more evident in person.  His books that were referenced in the lecture include: Where Good Ideas Come From: The Natural History of Innovation and The Ghost Map: The Story of London’s Most Terrifying Epidemic–and How It Changed Science, Cities, and the Modern World.  I now present to you my notes from his amazing lecture that I like to call “The Slow Hunch.”

The Eureka Moment Myth

  • Truly disruptive ideas do not have a eureka moment.  The eureka moment is a myth.  The best ideas almost always start as a hunch.
  • Oftentimes, the external conditions need time to catch up to the idea.
  • Darwin had the theory of evolution before he realized it.
  • Commonplace Book–collection of quotes that mean something to the owner.  They’d then reread them and out of this their own intellectual sensibility would take shape.

How Coffee Changed the World

  • What environments support collaboration and fluidity of ideas?  Liquid networks, such as libraries and coffee houses.
  • Almost every key breakthrough in the Enlightenment featured a coffee house.
  • It is no accident that as the population went from imbibing a depressant (alcohol) to a stimulant (coffee), the Enlightenment happened.
  • There is a lot of diversity of people in a coffee house.

The Evolution of Ideas

  • An idea is a network of other ideas brought together in a new configuration.
  • exaptation–some feature/trait/aptitude that evolves for a specific purpose but serendipitously turns out to be good for something else when the environment changes (wings for warmth work for flying)
  • Exaptation often happens when one industry takes something from another industry, adapts it, and uses it in their own. (Use of wine presses for printing)

The Key to Innovation

  • We will be smarter and better as a society if we surround ourselves with those who are different because it provides the opportunity for exaptation.
  • The more innovative group has connections to different careers than their own. (Don’t just be friends with librarians)
  • Make twitter your diverse coffeehouse.  If you just follow people just like you, you get an echo chamber.  Value diversity because of the openings it allows us.

Information Should Be Open

  • Value connecting information over protecting information.
  • 311 is a city concierge.  People can call and report problems and also ask for information from it.  Meanwhile, the city is gathering data from the citizens who call.  The city is sharing information but also is taking in information.  This democratizes and diversifies problem-solving.
  • Open information architecture rives innovation.
  • Chances favors the connector.

Q and A

  • Remind people that surprise and serendipity is happening with the new information tools.  It doesn’t just happen when browsing physical stacks.
  • Core ideas are ideas that were simultaneously and independently discovered within the course of two to three years.  This happens because of the adjacent possible.  The adjacent possible is possible moves you can make at that moment in time.  The possibilities are limited.  You couldn’t invent computer programming before computers.  Thus when something in the world changes, the adjacent possible changes, leading to core ideas.
  • Create a culture of amateur inventors and innovators (lay experts).
  • Release early, release often.
  • There is a non-linear relationship between population size and innovation (10x population size = 17x innovation).  The thing to remember in modern times, though, is that the internet is big-city-like.

Anger Can Be Power (MLA12 Seattle: Plenary 1: President’s Address by Jerry Perry, AHIP)

Right after the new member’s breakfast was the first plenary session.  The president’s address.  I realized as soon as I saw him onstage that I had actually chatted with him at the new member’s breakfast.  He was so friendly and personable!  But he’s also intelligent and a game-changer.  I’m glad I got the chance to both meet him and listen to his speeches.  (Yes, speeches. The other was at the awards luncheon).  Perhaps what impressed me the most, though, was that Perry’s speech addressed a topic that was already on my radar.  Enough of my intro, though, here are my notes from the address.

  • Embrace a love of reinvention.
  • Create a legend around yourself.
  • Don’t look back. Something might be gaining on you.
  • Love what you do.
  • We need to get angry at the hand-wringing that is going on within the profession.  We are in fact doing that great American thing of reinventing and staying current.  We know we are changing and staying current, so it is more than ok to have righteous indignation at “the end is nigh” talk.
  • Anger can be power, and you know you can use it.

How could I not love an MLA president who tells us it’s ok to have righteous anger? 🙂

Librarianship Is About People (MLA12 Seattle: New Members Breakfast)

May 23, 2012 1 comment

My first real event at my first ever MLA conference was, appropriately enough, the New Members Breakfast, at the ungodly early hour of 7am. Thankfully I was still on East Coast time, so for me that was the much more sane 10am.

I want to share what I gleaned from that semi-formal meeting.  Maybe you’re a student who has yet to go to MLA or will be attending for the first time next year or maybe you’re just curious what they’re telling us new-folks nowadays.  In any case. Here are my notes from the breakfast.

The most important thing as a new member is to think about what you would like to get from MLA.  It’s here to help you in your profession, so think clearly about what it is that you want your career to look like.  Once you’ve figured this out, volunteer, accept committee appointments, get involved.

What’s the difference between a section and a SIG?

They’re both arranged around an interest, but sections are much more formal, they follow all the rules, and they ask for dues of $10 to $25.  SIGs (special interest groups) sit around and talk about the area of interest.  Their meetings are open to everyone.  This is the easiest way to get involved, plus they are free.

Colleague Connection is mentoring.  We’re probably too new to mentor ourselves, but you may want to sign up for a mentor.

Professional Recruitment and Retention Committee (PRRC) exists to get people to join the profession.  It also hosts and organizes the resume clinic.

Lucretia McClure closed out the breakfast.  She is evidently a legend in medical librarianship, although I didn’t know this at the time.  I certainly suspected it, since she is elderly and also has a real presence in the room.  Her speech was powerful and energizing.  I’ll do my best to summarize it next without bullet points, although of course Ms. McClure was far more eloquent than this.

Librarians must be better than ever.  We most know more and do things we never studied.  However, librarians’ edge is that we are people, not machines.  We are the most curious people in the world.  Remember as you attend this conference that the people around you are going to be your colleagues for the next two to three decades, and they want the same things you want.  Personal face to face communication is increasingly rare and special.  That’s what we get at MLA annual.  As you move forward in your career, get yourself prepared for changes and be willing to adapt or you will be unhappy.  A thinking librarian is the best resource in the library.

Remember one thing: People count.

Stay tuned for my notes from Plenary 1 (President’s Address).