Health care vs. wealth care

Haply you shall not see me more; or if,
A mangled shadow: perchance to-morrow
You'll serve another master.

Antony and Cleopatra 4.2

The Canadian Medical Association unveiled its "new vision" in a policy document released on July 30. As reported by the CBC, the CMA wants provincial governments to hire private-sector firms to deliver publicly funded health care services to prevent delays for medically necessary treatment. Association president Colin McMillan said Canadians need timely access to medical services, and the private sector could act as a "safety valve" to ensure wait-time guarantees are met. "The CMA believes that we must now take that principle forward to meet the needs of a new generation."

Just as Dr. Michael Rachlis, a well-known critic of privatization, predicted last year (1), the operators of private clinics and their supporters -- encouraged by the Supreme Court’s ruling against a Quebec ban on private insurance for Medicare-covered treatments -- are aggressively shilling their wares, with the CMA’s explicit support.

Despite the CMA’s stance on the matter, polls consistently show that a large majority of Canadians endorse the recommendations of Health Commissioner Roy Romanow, whose 2002 Final Report strongly opposed privatization and outlined a system for updating and re-inventing health care (2). These popular instincts are strongly supported by reams of research, including a recent systematic review comparing health outcomes in Canada and the United States. It concluded that Canada’s single-payer system, which relies on not-for-profit delivery, achieves health outcomes that are at least equal to those in the United States at two-thirds the cost (3) -- while, it should be added, ensuring that no one is consigned to the special circle of hell reserved for the uninsured.

Many Canadian health librarians care deeply about this country’s successful single-provider system and see their work as an integral part of publicly funded health care delivery. Access to knowledge-based information and promoting health literacy were important issues in the Romanow Report (pp. 76-82), and were clearly reflected in Recommendations 10 and 12. There is even a pull-quote from the Canadian Health Libraries Association on page 79. Publicly funded and operated services, such as Alberta’s Health Knowledge Network or the UK’s National Library for Health, emphasize access and delivery through policy coordination, shared technology, and improved cooperation. Such resources are a fundamental part of a public health care system, and librarians should be concerned that any serious tampering with that system could eventually lead to their dissolution.

For a compelling alternative to the CMA’s vision for Canada’s health care system, see Mending Medicare, a collection of articles published by the Canadian Centre for Policy Alternatives. As the title of one of its contributions declares, health care and wealth care can’t viably co-exist (4). Tepid tolerators of Medicare, like the Canadian Medical Association, have taken advantage of legitimate public concern about delays in the system to push ill-advised policies such as for-profit delivery and private finance. But allowing private insurers to compete with the public system will increase wait times for treatment, not lower them. There is currently a shortage of doctors and nurses. Letting the private system draw already limited human resources out of the public system, and letting doctors bill on both sides of the fence, will only make this situation worse. As many astute observers have asserted time and again, solutions can be found and implemented within the public system.

If the Canadian Medical Association is successful in its efforts to disassemble public health care, then we shall have failed to heed Malcolm Gladwell’s warning. His disturbing meditation on the plight of uninsured Americans appeared in The New Yorker two years ago:

The United States has opted for a makeshift system of increasing complexity and dysfunction. Americans spend $5,267 per capita on health care every year, almost two and half times the industrialized world’s median of $2,193. … And, of course, every other country in the industrialized world insures all its citizens; despite those extra hundreds of billions of dollars we spend each year, we leave forty-five million people without any insurance. A country that displays an almost ruthless commitment to efficiency and performance in every aspect of its economy -- a country that switched to Japanese cars the moment they were more reliable, and to Chinese T-shirts the moment they were five cents cheaper -- has loyally stuck with a health-care system that leaves its citizenry pulling out their teeth with pliers (5).

References:

1. Rachlis M. Better public than private solutions to Medicare wait problem. The CCPA monitor. 2006 May:34.
2. Commission on the Future of Health Care in Canada. Building on values : the future of health care in Canada. Saskatoon : Commission on the Future of Health Care in Canada, 2002. Available from: http://www.hc-sc.gc.ca/english/care/romanow/index1.html.
3. Guyatt GH, Devereaux PJ, Lexchin J, Stone SB, Yalnizyan A, Himmelstein D, et al. A systematic review of studies comparing health outcomes in Canada and the United States. Open medicine 2007 1(1).
4. Flood CM, Sullivan T, Roos N, Lewis L, Noseworthy T. Health care and wealth care can’t viably co-exist under Medicare. The CCPA Monitor. 2006 May:16.
5. Malcolm Gladwell. The moral-hazard myth: the bad idea behind our failed health-care system. The New Yorker. 29 Aug 2005. Available from: http://www.newyorker.com/archive/2005/08/29/050829fa_fact (Gladwell is the author of The tipping point, and Blink: the power of thinking without thinking.)

My NCBI text file toothache

"PubMed, you’ve got a wonderful head on your shoulders. Tell me: whose is it?"
It’s not that I want to harp on about My NeverCanBeInspiring. I have already posted on its virtues, which are amiable though not yet abundant. I am exceedingly fond of the Collections feature, which I use as a kind of super clipboard for merging the results of complex searches. Once a collection is created, I can append citations to it at any time without duplication -- a great convenience when a search takes more than a single sitting to complete.

But all is not well with My NCBI Collections. It's a tooth that’s driving me to extraction. I need relief.

I sense hecklers gathering at their keyboards, grumbling at my nitpicking. But hear me out as I start at the beginning with a run-of-the-mill PubMed search. I’ve done my search, my selections are in the Clipboard, and my Clipboard citations are on the screen. By default they are displayed in reverse chronological order. Something I do frequently is to change the display to Abstract and the sort to journal title order. I then send the results to a text file, which loads into my favourite text editor, PSPad. The display and the sort are preserved. Alles in Ordnung. Kein Problem.

"And now I live out of all order, out of all compass." (Henry IV, Part 1, 3.3)
Here's the kicker. When I'm working with a search saved in My NCBI Collections, I can't do this. No sorting is preserved when 'sending' to a text file. Through much tweaking and fiddling I have experimented with the different sort options. Yet whatever I do, the downloaded text file is always sorted the same peculiar way: in ascending order by the PMID number. Donner Wetter. This looks like a difficult answer whose question is obvious. I can’t find anything in PubMed's documentation and I can't dig up any discussion of it on the web. Or is this issue so five minutes ago that everyone has thrown up their hands and moved on?

For follow-up: I've had a report from a colleague that sort shortfall (sortfall?) can happen in the regular Clipboard as well. But when I have tried to duplicate the problem on a number of occasions, my Clipboard sorts have been preserved in the downloaded text file. As far as I can tell, it is only in My NeverCanBeImitated Collections that the failure is glaring and persistent.

"Please follow the example of your head and come to the point."
There is a workaround. If you want to get a Collection into a sorted text file, send the citations to Text. For some reason this works:

1. When working with a search saved in My NCBI Collections, use 'Show' to put all citations into an unbroken sequence (up to 500).
2. Display and sort the citations as desired.
3. Select 'Text' from the 'Send to' menu.
4. Copy the resulting file and paste it into a text editor or word processor.

"So what exactly is on your mind? If you’ll excuse the exaggeration."
My complaint may seem as insignificant as a fly on a puck, but it's more than just a lot of willie wagging. Text file sorting by journal title makes a big difference to my staff. When a search is returned to them with selected articles marked by the patron, they benefit from seeing all the citations from a single journal together. It makes it easier to find those items on the shelves or online, saving time and effort. What’s more, in cases where there are many brief notices on a topic in a single journal issue, the journal title sort keeps them together. If we subscribe to the paper version, we can just lend the whole issue to the patron rather than printing out each item.

"The Tongue is ever turning to the aching tooth." (Poor Richard's Almanack, 1746)
I realize the topic of today's disgruntlement amounts to little more than a software side note. The sorting problem in My NCBI Collections looks like an oversight on the part of the PubMed developers. Perhaps they will work a fix into a subsequent update, if anyone cares enough. Meanwhile, my tongue has no rest.

Missing the obvious

I have the greatest respect for the Archives of internal medicine. It is a venerable institution, which, according to Journal Citation Reports, ranks eighth amongst general medicine journals with an impact factor of 7.920. To get published in the Archives is a mark of distinction, to be sure. Now, I'm certainly not privy to the editors' rationale for selecting articles, but I do have a bone to pick with one I read recently.

In the issue of 11 June 2007 a "research letter" was published with the imposing title: World Databases of Summaries of Articles in the Biomedical Fields. A Greek MD and a group of collaborators report on their hunt for databases from around the world which "archive information regarding scientific publications in biomedical and life sciences." The fruit of their research is a page-long list, a diverse collection of resources such as the ArabPsyNet (Arabic, French, English, described only as covering 23 psychology and psychiatry journals), and Media Sphere (Russian, 14 searchable medical journals from a single publisher). The list ranges from the vast and expanding EBSCOHost to the 11 journals covered by the Greek-language Iatrotek.org.

Much labour must have been spent in doing the research for this brief article. But as I looked it over it struck me that the way the authors had gone about their work was entirely wrongheaded. Not only had they missed the obvious, I should think it hardly possible to come a cropper with more precision.

I read the entire article carefully, analyzing the methodology, looking for that familiar word starting with the letter 'l' which would indicate that they had perhaps not totally wasted their time. Nowhere was it to be found. Not once in the entire text of this article do the authors mention that they consulted a librarian or even used a library's online resources.

We are told that at the onset of their investigations the authors "made an initial list of relevant databases based on our previous knowledge." Naturally one has to begin somewhere. But this kind of exercise is to research methodology what Chopsticks is to Chopin.

With their initial list drawn up, the authors proceed to part two of their methodology. They "looked in popular World Wide Web search engines (specifically, Google, AltaVista, and Yahoo)." They used "several keywords including medical, biomedical, medicine, biomedicine, databases, library, archive, and online." Acknowledging that they were not trying to produce an exhaustive compilation, they assert that their aim was "to generate an initial list of such databases that may gradually be expanded by the input of the scientific community."

There is a peculiar blindness and ingenuousness in their approach, and one can't help squirming slightly, as one would at a sophomore’s half-page explanation of the Hegelian dialectic.There is a well-known definition of an expert as a person who avoids the small errors while sweeping on to the grand fallacy. (Arthur Bloch, Murphy's law and other reasons why things go wrong, 1977). Well, in our research letter even the small errors seem to be compounded, sweeping on to something approaching Grand Guignol.

I will refrain from going into any further detail. Read the article for yourselves, and weep. Had the authors ignored Google for a moment and gone to any self-respecting health library’s website, anywhere in the world, they would have found that most of their work had already been done for them. Instead they have the distinction of having published an article in the Archives of internal medicine that is at best a curiosity. Although some little-known resources are brought out of obscurity, this effort does nothing to enhance medical research, but succeeds wonderfully at raising librarians' hackles.

The Q's: Mouseless Browsing and Pagerization (for Firefox)

My inner geek must come out, and today I'm blogging on something that's normally shelved in the Q's.

Lately PubMed has been driving me snaky. I nearly lost a big search when, for whatever reason, it decided to go and commune with the ancestors for a few minutes. No amount of clicking would revive the My NCBI Collections create box. Having lost my Clipboard in mid-search a number of times this summer, I braced myself for the annihilation of more than a hundred carefully gleaned citations on CPOE. Miraculously, PubMed recovered and I lost only my temper, not my search results.

Seeking to forget how sore my arm had become after hours spent in my PubMed click-a-thon, I decided to investigate Mouseless Browsing more thoroughly. This is a Firefox add-on I mentioned in a recent post. It works by adding small numbered boxes (called IDs) beside every important link, frame and form element in the browser. Instead of further inflaming the tendons of my right forearm, I can now type a number with my left hand, never having to leave the keyboard. And it works in PubMed.

By combining the new add-on with a couple of other tricks, I have been able to reduce my daily mouse use by more than half. Here’s how to do it:

1. Install Mouseless Browsing (for Firefox only) and enable IDs. There are various options. I prefer to use my keyboard’s Pause key to turn the program on only when I need it.

2. Go to the Google home page and select Preferences. Change the “Number of Results” to 100 (the maximum). This supposedly slows Google down, but I have noticed no appreciable difference.

3. Install the Greasemonkey add-on for Firefox. (More on Greasemonkey in another post.)

4. Install the Pagerization script.

By the way, all this is freely available on the web. You don’t need any programming skills to use Greasemonkey, and the installations are accomplished with a click or two.

Pagerization does one thing and it does it well. It automatically appends the results of the "next page" button to the bottom of the web page you are currently on. Pagerization works on most sites (including Google, Google Image Search, Flickr, Yahoo!, del.icio.us, and YouTube) by automatically rendering the next results at the bottom of the current page. This saves a healthy amount of browsing time and tendon abuse.

Here is how Mouseless Browsing and Pagerization work together in a Google search:

Sadly, I can't pagerize PubMed, but with the database's ability to display up to 500 citations, I'll live. I will voice a small complaint, however. Why can't PubMed be modified permanently to display more than 20 citations at a time? This option should be added to the My NCBI user preferences.

Final hint: I select "Citation" for the "PubMed single citation display" in order to find relevant MeSH headings more quickly.

Food insecurity in Canada: almost one in ten

Health librarians need to be aware of this sobering report from the Canadian Community Health Survey:

Canadian Community Health Survey, Cycle 2.2, Nutrition (2004)–Income-Related Household Food Security in Canada

It is recognized that “food security exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life.” (Food and Agriculture Organization 1996). This report reflects the characteristics of food security captured in the CCHS 2.2–specifically, the financial ability of households to access adequate food, which is strongly related to household income.

Key Findings

• Although most Canadian households had consistent access to food in 2004, more than 1.1 million households (9.2%) were food insecure at some point in the previous year as a result of financial challenges they faced in accessing adequate food. In these households, at least one adult or child member experienced multiple conditions characteristic of food insecurity.
• Overall, 2.7 million Canadians, or 8.8% of the population, lived in food insecure households in 2004.
• Across the country, rates of household food insecurity ranged from 8.1% in Saskatchewan to 14.6% in Nova Scotia.
• Among households with children, 5.2% experienced food insecurity at the child level-that is, at least one child in each of these households experienced food insecurity in the previous year. More than 700,000 children lived in households in which either adults or children experienced food insecurity at some time in 2004, including 366,200 who lived in households in which one or more of the children were food insecure.
• Food insecurity was generally more prevalent among adults (9.0%) than among children (5.2%) in the household-especially when the experience of food insecurity is severe (adults 2.9%, children 0.4%)
• The prevalence of food insecurity was higher among households with certain characteristics, including:
  • those with incomes in the lowest (48.3%) and lower middle (29.1%) categories of household income adequacy, compared with those in the middle (13.6%), upper middle (5.2%) and highest (1.3%) categories of household income adequacy,
  • those relying on social assistance (59.7%) or workers’ compensation / employment insurance (29.0%) as their main source of household income, compared with those with salary / wages (7.3%) and those with pensions / seniors’ benefits (4.9%) as their main source of income,
  • off-reserve Aboriginal households (33.3%), compared with non-Aboriginal households (8.8%),
  • those who do not own their dwelling (20.5%), compared with those who do own their dwelling (3.9%), and
  • those with children (10.4%), compared with those without children (8.6%).
• Among households with children, the prevalence of food insecurity was higher among:
  • those led by a lone parent (22.5%), especially a female lone parent (24.9%), compared with households led by a couple (7.6%),
  • those with three or more children (15.0%), compared with those with one or two children (9.6%), and
  • those with at least one child under the age of 6 years (13.0%), compared with those without a child under 6 years of age (8.8%).
  • Among households without children, the prevalence of food insecurity was higheramong unattached individuals (13.7%), compared with couple households (3.5%).
    
    

Implications

For the first time in Canada, data are available from a sophisticated multiple-indicator survey tool that enables a more confident estimate of the prevalence of household food insecurity. Although most Canadian households had consistent access to food in 2004, the findings of this analysis confirm what other studies have reported-that food insecurity is a reality for many socio-demographically vulnerable Canadian households.

A PDF version of the full report is available.

UpToDate's new search engine

I had a look at UpToDate's new search engine, which now allows users to enter multiple terms simultaneously. This sounded too good not to check out right away. The more specific the search, they claim, the more accurate the resulting topic matches.

In the official press release, some examples are given. For information on treating hypertension in pregnancy, specifying "treatment of hypertension in pregnancy" will yield the best results. For pediatric titles or patient information, adding "in children" or "patient information", respectively, will also yield the best matches. So far so good.

Then I tried my own examples. My conclusion? I still find the UpToDate method of searching peculiar. Still rather hit-and-miss.

Here is one of my examples. Try typing in "morton's neuroma." You get five search results. Now type in "morton's neuroma treatment." You would expect fewer search results because of the greater specificity. Instead, you get 29 results, among them "treatment of hirsutism." Go figure.

Your luck is no better if you search "treatment of morton's neuroma." The answer is the same 29 hits. However, enter "traumatic prepatellar neuralgia" and you zero in on only one entry.

We are also told that the new search engine allows users to scan the results before selecting a topic. This works well, and it is a welcome improvement. By positioning the mouse pointer over a topic title in the list of results, an outline of that topic appears to the right. Users can scan the content from the outline, or click on an outline heading to directly access a specific section of that topic, such as "Treatment".

I'm still waiting for UpToDate to get really serious about its search engine.

For more information on the search engine and other developments at UpToDate, visit the website for a copy of their newsletter.

My NCBI Collections: bricks and bouquets

The NLM Technical Bulletin has announced a four-minute Quick Tour, Editing Collections in My NCBI. I am a compulsive consumer of this kind of thing, because every now and then you actually learn something new. Not this time. The little presentation was reliably humdrum. I don't know if it will inspire new users.

But I am a total convert. Since its introduction I have adored the Collections feature. When I am working on a complex literature search it may end up requiring several sessions over a period of a few days. In the old days I used to grumble about not being able to set up more than one Clipboard. Then came My NCBI Collections and my cramped and crabby little search world was transformed. I now use Collections to create multiple clipboards, which I merge for the final product.

I enjoy the ease of the PubMed interface, although I hope to see some interface improvements in the future. I still have a major outstanding complaint. How about keyboard commands for PubMed? Google Mail and Google Reader have them in spades. Bloglines has them too. I suffer from tenosynovitis in my right forearm. PubMed is a total clickarama, and I spend a great deal of time with it. It may be one of America's greatest gifts to humankind, but it is killing me.

For relief I have turned to various solutions but settled on a Firefox add-on called Mouseless Browsing. This little program adds small boxes with unique number IDs beside every link and/or form element on a web page. Simply type in the number and press enter (there is also an automatic mode available) to trigger the appropriate action such as following a link, pressing a button, etc. I have it configured to work only when I call it up with the Pause/Break key. I don't always want to see dozens of little boxes with numbers on a web page, but for PubMed and Google searching the program is invaluable.

Am I a Librarian 2.0?

I don't hear my colleagues talk much about librarian competencies, even though we're surrounded by clinicians for whom competency is a serious career issue. Let alone the so-called Library 2.0 competencies, which some people I know view as a derisory notion. In the health library biz we are acutely aware of the preponderance of technology in our work, and we hustle as diligently as David Beckham with his personal trainer to keep up with the unceasing digital whirr.

Most of us, that is. We all know fellow workers who fit the adage "To err is human, but to really foul things up requires a computer." We anxiously observe them jabbing about with the mouse as they struggle with elementary software routines, stretching a bikini's worth of skill over their variously sized talents. Experiencing an in-service with a few of these types (or worse, asking for their help at the Reference Desk) is like a long wait for a delayed flight in Purgatory's airport lounge.


"Experience is something you don't get until just after you need it."
Once upon a time we breathed in the smell of beeswax and parchment in drafty scriptoria, and measured our competencies in terms of the cut of our quill pens and the quality of our uncials. Today we inhale digital oxygen and cut code. Library 2.0, as the borrowing from software marketing implies, represents a natural development from what went before. It is not just a smattering of adventitious embellishments. I know this in my html'd heart, but I don't yet see it given the significance it has for me in the elegantly worded charters, protocols, standards and guidelines of my profession.

Interested in measuring my own knowledge and performance against some standard (if I were younger this might be called ambition), I want to record in this post my web wanderings and stretch out a more generous swatch of spandex from the fabric of information I discovered.

I'll start by defining terms. In a CLA-approved contribution, Competencies for Change, Jennifer Slouter (Leddy Library, University of Windsor) defines competency as a "framework composed of the skills, knowledge and abilities required within a profession/industry to operate effectively and perform the necessary functions of the job. These can include personal attributes and learned skills." While acknowledging the importance of tech skills, she stresses (too much at the expense of technical mastery, IMHO) the importance of personal attributes such as flexibility and critical thinking. Yet it's hard not to agree with her conclusion: "While knowledge and skills must be learned as responsibilities or environments change, our ability to inhabit personal competencies and spin all iteratively is key to success in any library environment." Beautifully put and quite true. I am all for perky and prodigiously cultivated librarians. But if truth is beauty, why can't you get your hair done in the library and find an attractive personality to explain how to display your shared Google Reader feeds in your blog?


Between 1.0 and 2.0
The current Standards for Hospital Libraries (2002) and its 2004 revisions mention "evaluating new information technologies and assessing their application to library management and services" and "performing mediated searches of Internet and KBI resources." But for competencies they refer us to SLA's Competencies for Special Librarians of the 21st Century. Browsing through this document one comes across a few examples of information technology skils, such as creating a home page and linking it "to other sites of interest on the Internet." It all means well, I'm sure; but doesn't it sound just a bit dated?

Over at the UBC Health Library Wiki there is a fine list of core reference competencies for health librarians. It sticks pretty much to standard electronic resources, although there is a nice link to resources on blogs, podcasting and RSS feeds. But no mention of our Librarian^2.0.

Of course, for our Librarian^2.0 these competencies have developed from a foundation of fundamental computer skills such as those enumerated in Library Revolution. But I find such lists slightly embarrassing. The ability to type is not listed as a competency, because it is taken for granted. In the same way librarians shouldn't have to debate any longer about knowing how to copy and paste a word-processed sentence. Yeesh.

I'll also give a brief mention to a still relevant two-year-old list from The Shifted Librarian, 20 Technology Skills Every Librarian Should Have. No doubt there are other documents I have missed, but this gives me the lay of the land.

So what about today?

Librarian^2.0

Earlier this month the Cool Librarian asked how to overcome the growing divide between the techie camp and their fellow librarians. At the end of an entertaining and informative discussion of competencies her answer is a blunt: "Hell, I don't know." What we do know is that today something essential to librarianship is missing without an active knowledge of technology and the infinite variety of its practical implementation. That hole in your head had better be for jacking into cyberspace, or you should see a doctor.

In a recent post David Lee King prefers to refrain from calling them tech competencies at all, and I agree with him. It is impossible now to separate out the tech components of our work, which combine with our intellectual labour into an imbricated whole.

David provides a comprehensive list of skills:

Specific 2.0 skills:

• write and post to a blog
• add photos and videos to a blog post
• embed a widget into blogs and social networking accounts (like MySpace)
• social network knowledge - basic understanding of Facebook, MySpace, Twitter, etc. and the ability to explain them to others
• create, upload and edit photos, short videos, podcasts, and screencasts
• use IM in different forms
• use and explain rss and rss readers to others
• send and read sms text messages
• edit an avatar’s appearance
• basic console gaming skills (multiple formats preferred)
• ability to do basic HTML editing - an understanding of (X)HTML and CSS
• know how to pick up a new device (mp3 player, mobile phone, etc) and figure out how to use it
• the ability to assess and learn the basics of a new digital service or tool within 15 minutes of fiddling around with it

“Big Picture” 2.0 skills:

• understand how everything above works in a library setting
• understand how everything above complements a physical, traditional library
• and most importantly - the ability to tell the library’s story, through various media - writing, photography, audio, and video

Suggestions from commenters:

• ability to understand the difference between a dynamic URL and an permanent URL
• knowledge of OpenURL
• basic understanding of social bookmarking (e.g., del.icio.us) and citation management tools (RefWorks, Zotero)
• awareness of grey literature and the invisible web

Of course, a Librarian^2.0 is also comfortable with at least one operating system and a wide range of software. A key to "twoness" in my opinion is the ability to "conduct" a suite of applications, both web and non-web, to achieve professional goals and objectives.

The 13 Things

Now compare all this to "The 13 Things" from the University of Michigan. Actually consisting of about ten distinct competencies, this list is looking for a catchier title. The competencies are tied in to workshops being offered this summer to participating librarians:

Blogs & RSS
1) Create a blog using MBlog or another blogging platform.
2) Set up an account on Google Reader (or another feed reader of your choice) and subscribe to two library-related and one non-library-related blog via their feeds.

Social Tagging
3) Create a del.icio.us account (link to it from your blog post). Post (and tag!) three URLs related to Web/Library 2.0.
4) Create a flickr account (link to it from your blog post). Join the MLibrary2.0 group. Explore flickr and add a few pictures to your favorites.

Social Networking
5) Create a Facebook account and join the MLibrary2.0 Facebook group.
6) Consider how the library could use Facebook for outreach or for reference; make a wall or discussion post about your thoughts in the MLibrary2.0 group.

Next Generation OPACs
7) Play with one of the Next Generation OPACs. Do a variety of searches and explore features not available in a traditional catalog. Make comments in your blog about your experience.
8) Perform a set of searches in at least three of the Next Generation OPACs. Make a blog entry about your experience. Compare the features, capabilities and usability of the interfaces and make a prioritized list of the features you would most like to see in Mirlyn.

Podcasting & YouTube
9) Find & subscribe to three podcasts you are interested in using iTunes, Google Reader, or another program.
10) Create a YouTube account. Find a library-related video and add it to your favorites. Embed this video in an entry in your blog.

Firefox Extensions
11) Install LibX and Zotero for Firefox on your home or work computer.
12) Use LibX to locate a book/article that is of interest to you, and use Zotero to save it to your personal library. Extra credit for adding tags.

Wrap-up by blogging the experience and maintaining the blog
13) In your blog, reflect on your experiences with Web/Library 2.0 and what you have learned. Consider keeping your blog alive past the 13 things by continuing to post your thoughts on libraries.

I liked Michigan's inclusion of next-generation collaborative catalogues, like LibraryThing. It's a good thing they didn't add a Thing on setting up a SecondLife account, because, the thing is, I don't see the point of SecondLife ... yet. I lose marks because I have yet to embed a video in a blog post; and perhaps because I'm Canadian I'm leery of writing on someone's Facebook wall. It seems somehow intrusive, even illicit. But then, Canadians tend to have an exaggerated idea of our own unimportance. And finally, will someone please tell me what the point of Twitter is?

I'm really pleased to see a library take a systematic approach to fostering Librarian^2.0 competencies. That means a lot of workshops, a lot of earnest exchanges in the Tim Horton's line-up, a lot of lunch chat. It means collaboration and cooperation, a team environment, and what academics like to call collegiality. In Health Library 2.0 what would we add to the above lists? Perhaps third-party PubMed tools and knowledge of medical wikis. I'm looking forward to 3.0 and 4.0, which I'm sure are just around the virtual corner.


"I'm not young enough to know everything." (J.M Barrie)
From all these Librarian^2.0 competencies I now have a framework I can build on. It has taken a while for me to develop the skills that most fourteen-year-olds seem to acquire automatically along with puberty and pimples. It's not easy to keep up with the young ones, who never seem to mistake their CSS for RSS, always know how to find something cool at bittorrent sites, and drink their code straight. Me, I can't even think straight. But it's a great time to be a librarian.

Off The Shelf: Still waiting for a breakthrough with physicians

Davies K. The information-seeking behaviour of doctors: a review of the evidence. Health Info Libr J 2007 Jun;24(2):78-94

The Author's Abstract: This paper provides a narrative review of the available literature from the past 10 years (1996-2006) that focus [sic] on the information seeking behaviour of doctors. The review considers the literature in three sub-themes:

• Theme 1: the Information Needs of Doctors includes information need, frequency of doctors' questions and types of information needs;
• Theme 2: Information Seeking by Doctors embraces pattern of information resource use, time spent searching, barriers to information searching and information searching skills;
• Theme 3: Information Sources Utilized by Doctors comprises the number of sources utilized, comparison of information sources consulted, computer usage, ranking of information resources, printed resource use, personal digital assistant (PDA) use, electronic database use and the Internet.

The review is wide ranging. It would seem that the traditional methods of face-to-face communication and use of hard-copy evidence still prevail amongst qualified medical staff in the clinical setting. The use of new technologies embracing the new digital age in information provision may influence this in the future. However, for now, it would seem that there is still research to be undertaken to uncover the most effective methods of encouraging clinicians to use the best evidence in everyday practice.

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No real surprises in this welcome review of recent literature. I have seen this problem in my own practice: doctors have information needs and they have a wealth of resources to find the answers to their questions. But they do not have the time or the skills to get the best results from the tools at hand. Librarians have the time and training but have trouble communicating to clinicians the benefits of information literacy.

As I remarked in my post of July 14, even increasing computer use by physicians and their improved knowledge of health resources does not necessarily lead to a good search when it comes to the crunch. I would argue that we are still a long way from the AI killer app that will answer more complex clinical questions quickly and accurately. And we all know how hard it is to come up with innovative, truly effective instructional techniques, while every study of this kind enjoins us to do so, and to do more research to find out how to do it better.

Although roughly 60% of physicians' questions are simple, according to Davies' evaluation of the literature, that leaves a considerable number of complex queries being brought to Google or PubMed with a few key words typed into the search box. Not an encouraging prospect. Specialized EBM resources, such as the Cochrane Library and UpToDate, helpful as they are, have not done all that well in filling the gap. In a study in which librarians searched these resources for answers to complex questions, no answers were found 40% of the time. How would less skilled searchers have fared?

Among physicians, who are the only objects of this study, time has long been recognized as the key barrier to information searching, and Davies finds it worrying that clinicians are only able to complete "quick and dirty" searches because of time constraints, some spending as little as two minutes on average pursuing an answer. This obviously affects the efficiency of their searching. One study found that 82% of doctors' searches were merely fair (52%) or poor (30%).

Davies' bleak conclusion is that "doctors are not yet embracing the use of computerized resources." They still rely on text sources and the advice of colleagues. When they do search online, they encounter difficulties. Ineffective search strategies do not produce results. If information is not located, it is often assumed not to exist. This can lead to mistaken opinions concerning the contents and coverage of a database. Combine that with the traditional barriers we medical librarians face in making our skills known, and you end up with health professionals who harbour a false perception of their information literacy skill levels.

Time to renew my efforts to get the message out there.

PubMed searching. How do we improve it?

An article in Medical Education (May 2007) reports another study demonstrating yet again that medical students (like many of us) have problems using PubMed effectively.

After being given "pre-assigned readings introducing the logic and technique of searching the MEDLINE database," teams of year 1 and 2 medical students at the University of Louisville completed searches and emailed their search strategies for analysis by librarians. At the conclusion of these sessions, the teams completed a short-answer quiz. It wasn't clear whether PubMed or another incarnation of MEDLINE was used.

Interestingly, the students did well in the quiz, but that abstract knowledge didn't translate into a good search strategy. For example, 22 of the 24 teams received full credit on a question asking them to describe a MeSH term and how it helps to refine a search. However, at the same time the librarians found that "students used poor search techniques, did not understand Boolean logic, and overwhelmingly chose online article availability over article content, even if it resulted in not finding an article and failing the assignment."

To the authors of the study this indicates that although students may grasp the concept of MeSH terms, they do not understand searching logic and technique, that online convenience outweighs article quality, and that more thorough, formalized information literacy training is required.

Since the authors do not describe the "pre-assigned readings" given to the students, it is difficult properly to assess the study results. Perhaps the readings on Boolean logic were dry and did not keep the students' attention. The principal author of the study is not a librarian. I'm speculating here, but the selection of materials may have been made without the kind of assiduousness and professional discretion a librarian would have brought to the task.

It is obvious that good literacy training is required to help PubMed users develop effective search techniques. This study at least adds to the evidence that people need effective instruction which goes beyond passing them a handout.

Wood JA, Smigielski EM, Haynes G. Case-based approach for improving student MEDLINE searches. Med.Educ. 2007 May;41(5):510-511