2012 National Health Promotion Summit

Posted 05/09/2012 by margotmal
Categories: Professional Dev

Tags: , , ,

Wash DC

Back in the nation’s capital (and back on my blog after a long hiatus).  I attended the 2012 National Health Promotion Summit   Here is a summary of my experiences…

On Monday, April 9, Ed and I took Amtrak to Washington, DC.  After more than eight hours on the train, we embarked on an Alice-in-Wonderland search for the Capitol City Brewing Company.  Two years ago, we stumbled upon this brewery in the National Postal Museum building—just outside of the Amtrak station.  Alas, it is there no longer.  Our train-weariness impaired our ability to take this all in.  We finally settled for fish & chips and a Guinness at the Dubliner.

Thus fortified, we jumped on the Metro to head across town to check into the Omni Shoreham Hotel.  This is a lovely, older hotel located in a neighborhood-y section of the city.  I pinned up my poster “Hospital Collaboration with a Public Library” and we headed out to explore the Adams Morgan area.  Attracted by the beer list, we stopped in at The Black Squirrel.  We were pleased to see that the Red Sox game was on—turns out, the bartender was from Western Massachusetts!  Small world of baseball and good beer.

In the morning, I headed down to the Summit and Ed headed off to the Newseum (and to find the errant Capitol City Brewing Company).  At the Opening Presentation, Howard Koh, Assistant Secretary for Health, welcomed the attendees, exclaiming that it was tremendous to have us here from all over the country to show our passion.  He exhorted us to protect the gift of good health, pray for boredom and enjoy the miracle of a healthy day.

Secretary Kathleen Sebelius took the stage for the Keynote Address, claiming the ability to leap tall buildings in a single bound.  We all need that level of confidence!  She spoke to the national goal of improving health as fundamental to opportunity.  Prevention, she said, is not just the work of health agencies.  I felt heartened by this, as my goals are to work with public libraries and other community organizations to disseminate reliable health information.  Here are her priorities for a healthier, stronger, more prosperous America:   http://www.hhs.gov/secretary/about/priorities/strat_initiatives.pdf

Next up:  the Plenary PanelMayra Alvarez, Director of Public Health Policy, spoke about the importance of the Affordable Care Act.  She bemoaned the profusion of misinformation.  She stressed the tremendous value of not allowing insurance to impose lifetime limits and pre-existing conditions limits.  She celebrated the mandate to conduct insurance rate reviews as a way to slow the rise in premium costs.  She pointed to the fact that 2.5 million young people can pursue internships and volunteer opportunities while remaining on their parents’ insurance (not to mention, low-paying jobs with no health benefits… on a personal note, our family is benefiting from this.)

Dr. Georges Benjamin, Executive Director for the American Public Health Association, followed up by stating that public health begins with health care coverage.  My ears perked up when he moved on to encourage hospitals to develop community benefits programs that truly engage the community in a meaningful way.  I aim to be a part of this.

Delaware’s Karyl Rattay caught my attention when she talked about the lack of Quadrant 2 work (with a nod towards us Seven Habits fans).  I’m a believer in relationship-building.  She encouraged us to tie multiple programs together and latch onto national momentum.  Empowering individuals through diverse approaches, she said, will drive the needle toward improved health for all.

I must admit to scooting up to my room for my business cards during most of Howard Frumkin’s talk.  I did make it back into the room to hear him tell us to put time into long-term investments rather than choose methods that seem easy, popular, and cool.

After the Plenary, I headed toward the Policy & Data session.  I jotted down how the new HHS population survey standards allow for more flexibility— for example, not limiting to Hispanic or Latino, but measuring identification with country of origin or descent (Mexico, Puerto Rico…) For the first time, HHS will measure self-reported language proficiency.  This adds more depth to our understanding of our population.

I noted how the Speak to Your Health! Community Survey, conducted by the Prevention Research Center of Michigan (PRC/MI), are surveys of the community by the community— and the data is used to support community grant proposals.

Fenway Institute addressed data collection on sexual orientation in a clinical setting.  The Fenway Institute encourages the inclusion of sexual orientation in the electronic health record.

At my lunch table, Maaden Eshete encouraged me to check out the library on the Office of Minority Health webpage.  During lunch, Todd Park, Chief Technology Officer, announced the winners of the Leading Health Indicators App Challenge.  Community Commons is the big winner.  Todd Park is my winner for the most enthusiastic presenter.  If you have a bit of time, check out this presentation.

After lunch, I headed up to my room again.  I needed a mindfulness meditation break to improve my afternoon outcomes (otherwise known as a little nap…)

Revived, I made my way to the afternoon session on How Community Health Workers are Making a Difference in Public Health.   First up, community health workers (CHWs) in Boston are delivering care by Family Van. CHWs are liaisons between the community and the health care system.  50% visitors to Family Van are men.  Fantastic!  Clearly, this model of health care appeals to them.  Family Van keeps people out of the ED by providing care in their neighborhoods.

Second, ECARE-DIABETES looks at re-designing primary care in East Carolina.  Adding motivational interviews to the primary care visit leads to significant differences in the management of diabetes.

Third, partnering to improve health outcomes for Cambodian and Latino families in Santa Ana, CA.  Health education for community members and health care providers leads to greater awareness of health disparities and improved patient-provider interactions.

Fourth, CHW Initiative of NHLBI includes capacity building of CHWs to implement programs… ah, my attention is fading.  Did I see sweet tea?  I am not in Western Massachusetts anymore!

During breaks, I made my way to the Poster Presentations to speak about my collaboration with the Springfield City Library.  Over the course of the day, I spoke with more than a dozen people.  My business cards and copies of my poster flew off the board!

The last session of the day addressed Effective Solutions for Chronic Disease Management.  Patient navigators in Lubbock,TX—referencing Paulo Freire; talking about promotoras.  Chronic disease self-management in rural Idaho—barriers to health care include not wanting to be told what to do.  Student-run clinic in Washington, DC—look to your universities for support in community work.

At the close of day, Ed and I compared notes poolside.  Yes, it was warm enough in April to take a swim outdoors at the Omni Shoreham pool.  Ed enjoyed his day, as I did mine.  We headed out to Bardia’s New Orleans Café  for dinner.  We sat in the window seat and were thoroughly charmed by the owner.  This sounds cliché, but it was like a visit to the French Quarter.

The following day, after refreshing my presentation with additional business cards and copies of my poster, Ed and I took the Metro to explore the Library of Congress.   The building itself is phenomenal.  Looking down upon the main reading room is breathtaking.  We walked through several exhibits—the Swann Gallery of political cartoons; Sakura, cherry blossoms as symbols of friendship; the legacy of George and Ira Gershwin; exploring the early Americas (including some incredible maps from the sixteenth century); and Thomas Jefferson’s library collection.

Back to the hotel to gather our belongings and roll up my poster.  We grabbed a delicious lunch at the Lebanese Taverna before getting on the Metro, catching our train at Union Station, and arriving in Springfield,MA around 10:00pm.  A quick, but delightful trip.

Instant Classic

Posted 07/06/2011 by margotmal
Categories: Archival Work

Tags: ,

Instructor with Students in Nursing Arts Lab

I published my first professional article in the Journal of Hospital Librarianship, 11:107-114, 2011 (woohoo!) detailing our pilot project to digitize hospital archives.  In May 2009, I suggested to my director that we might look into creating an online archive of our historical materials.  Our primary purpose was to enhance the usefulness of this memorabilia.  We saw this as a way to expand our function within our institution and the communities that we serve. 

By October 2009, our images were displayed as part of Digital Treasures, a shared digital repository focusing on the cultural history of Central and Western Massachusetts.  I created a poster for MLA 2010 Washington, DC entitled “Reflecting on Our History:  Digitizing Materials for Hospital Archives.”  During that poster session, I met several librarians who were working on digitization projects.  I learned that many of the issues we encountered were shared.  I am pleased that these ladies agreed to participate in my article-making.  A shout out to Molly Knapp (LSU-HSC), Elaine Skopelja (IU School of Medicine) and Ann Pederson (Altru Health System)!

Nurses in the Maternity Ward

The future of digital archives is undeniable.  People expect items to be available online.  As digital archives become more familiar, hospitals may expand their expectations of librarians as archivists of a digitized local medical history.  These items are useful for establishing the institution as an integral part of community history and of medical practice.  Some librarians reported being contacted by people interested in exploring their family history.  Nursing school graduation pictures and documents detailing hospital staff could have a broad appeal. 

If you would like to read my article, it is available for subscribers.  Or, at Taylor and Francis Online non-subscribers can pay $34 (haha…I don’t expect you to!)  I’m allowed to share copies with some colleagues, but not on a systematic basis.  Copyright.

House Staff 1956

Partnering with Public Libraries: Report

Posted 06/06/2011 by margotmal
Categories: Consumer Health

Tags: ,

Woman at ComputerI received funding from the National Network of Libraries of Medicine (NN/LM) for the work that I am doing with Springfield City Library.  The funding helped offset our expenses from January-April 2011.  I am in the process of writing my final report for that funding.  As a result, I am taking a good look at how the classes worked and what we lacked.

Baystate Health Sciences Library and Springfield City Library offered monthly instruction in the use of MedlinePlus.gov as a reliable source of health information on the internet.  Each class featured a distinct health topic, such as Diabetes, Healthy Weight, Heart Health and Autism. 

We anticipated that most of the class participants would be patrons of Springfield City Library and that they would have low- to moderate computer skills.  Our goals were to boost confidence levels in the use of MedlinePlus and to satisfy those interested in learning how to find reliable health information on the internet. 

According to our evaluations, the project achieved the two goals of increasing confidence levels and satisfying participants.  The project successfully attracted low- to moderately skilled computer users in the City of Springfield.  Our biggest problem?  Enrollment numbers.

We had an average of 6 participants for our classes, including those that were held in 2010.   This is lower than the expected numbers for Springfield City Library classes on Computer Basics, Web Basics, and Microsoft Office.  We realize that community members may not be accustomed to computer classes on specific topics like health information. 

According to the 2009 National Survey of Public Library Computer and Internet Access, 90.1% of Massachusetts public libraries offer classes on general internet use (email, browsing, etc).  Only 10.8% offer classes on accessing government information (Medicare, taxes), 13.6% on accessing job-seeking information, and 14.5% on accessing medical information.  I suspect that more libraries are offering  job-seeking classes in 2010-2011 due to the current economy.  Likewise, I hope to attach public libraries to national efforts for improving health literacy skills by 2020.

Our class evaluations indicate that this is plausible.  Our pre-instruction assessments found that only 21.4% of class participants felt that they knew how to search for information in MedlinePlus.gov and only 42.8% felt that they knew how to print information from the website.  After instruction, 100% agreed or strongly agreed that they knew more about MedlinePlus.gov and felt more comfortable with using computers.

Our most successful marketing strategy was to recruit participants of the Web Basics classes.  Matthew Jaquith, Springfield City Library’s Programs & Training Librarian, encouraged those class participants to come practice their new skills.  The classes on MedlinePlus.gov reinforced information literacy concepts taught in the Web Basics class.  Here was a chance to get help with computer skills (scrolling, clicking, printing and looking for new windows) while looking for information about health topics. 

In May, we offered a class on probiotics.  I spent time going over evidence grading, and then we did some live searching in MedlinePlus on the proven use of probiotics.  Our participants enjoyed the class.  This summer, we are offering classes on Omega-3′s and Vitamins/Supplements (I’ll focus on Vitamin D). 

I do want to figure out the marketing piece, but I also want to look at how I measure impact.  There may be more to this story.  Sure, I had participants check off boxes that they learned something.  But, how does that learning impact their lives?

Goaltending or Legal Block?

Posted 05/06/2011 by margotmal
Categories: Instruction

Tags: ,

A couple of weeks ago, Lawrence Lessig delivered a talk on Copyright in Geneva, Switzerland.  If you haven’t listened to or read anything by Lessig, please do!  He speaks well to the current culture  of creativity and the swampy mess of copyright.  This video is nearly an hour long.  Let me give you some points made:

  • What used to be a liberal idea may no longer be a liberal idea (JSTOR).
  • Even Harvard professors believe that ”everything is available on the internet.”
  • There is a place for sensible copyright to protect some creative work.
  • Fifteen year olds shouldn’t need to consult a copyright attorney to create a video.
  • Copyright should work toward getting artists paid; that’s not currently happening.

 Although Lessig’s focus is on access to scientific knowledge, he does touch on access to information for patients & families in one of his illustrative stories.  He also explores reuse of the arts and makes a not-so-subtle plug for his book Remix

Find yourself an hour, or, like me, a few 12-15 min. blocks of time and watch this:  The Architecture of Access to Scientific Knowledge

In the Birthplace

Posted 03/06/2011 by margotmal
Categories: Consumer Health

Tags: , , ,
James Naismith

James Naismith (public domain image file from Wikipedia Commons).

In the winter of 1891-1892, Canadian graduate student James Naismith invented basketball in Springfield, MA as an adaptation of many sports (rugby, lacrosse, soccer) for  indoor play.  Nearly 120 years later, a group of community activists meet weekly to address the skyrocketing rates of diabetes and cardiovascular disease in this same neighborhood.

I am honored to be working with the newly formed Healthy Community Collaborative in Mason Square.  This task force is a collaboration of ten established organizations in Springfield.  The idea is to train people from each of these organizations to be advocates for healthy behavior in their community.  I see my role as teaching reliable online health resources.  At this point in time, we are getting to know each other.  This task force is a 4-year project funded by Baystate Health.   Below is a list of the organizations, a link to their websites, and a synopsis of what they do. 

I hope my work with them will be a two-way street:  help them learn about reliable online resources and help me understand the issues faced by the residents of Mason Square.  This is an exciting opportunity for our library to expand our purpose for existing—helping address the health issues of Springfield through educating AND learning from residents.  So, when I head out to Mason Square, this is who I am meeting with! 

Concerned Citizens of Mason Square/Farmers’ Market  For years, due to economic decline and government neglect, the area surrounding Mason Square was a food desert.  While there are plenty of fast food and take-out options, until the market, there were very little chances to purchase nutritious, whole foods at an affordable price.  The Concerned Citizens of Mason Square organized and started the Mason Square Farmer’s Market to fill that void. 

Gardening the Community  Gardening the Community is a youth-centered, community based urban agriculture program in Springfield that is committed to teaching the benefits of organic farming and healthy eating. The vision is to introduce and foster principles of sustainable living through active engagement with the community. 

EACH, Inc. Somali Access Project (no website)  The Somali Access Project is a project guided by Healthy Community Collaborative to support Somalis and all East African Communities residing Mason Square and greater Springfield to create healthy community of New Americans from East Africa.  The goal is to give these communities the experience of how to increase lifespan, decrease deaths from heart disease and stroke, control of infectious diseases and to have healthier parents and babies.

Faith Unlimited Institute  The mission of the Faith Unlimited Institute is to reduce recidivism, enhance self-sufficiency, and enhance family life for ex-offenders returning to their families and their communities by mentoring, reunifying and strengthening families, and facilitating education, employment and career development through communities and people of faith.

Mason Square Veterans Outreach Center  Outreach Centers are non-profit organizations that receive state money through DVS to assist veterans and their families with a range of services. These vary by location and can include: assistance and referrals to obtain federal and state veterans’ benefits; food pantry and clothing closets; transportation services; community activities and a wide variety of counseling services.

Men of Color Health Awareness Project  MOCHA is an innovative health movement in Springfield, Massachusetts which seeks to reduce health disparities in the city by creating health-conscious norms and diffusing them through men of color’s personal and social networks.

Puerto Rican Cultural Center  The mission of the Puerto Rican Cultural Center, Inc. is to advocate and provide a forum for educational, leadership and economic development programs, promote cultural awareness and enable access to benefits from available resources to the Puerto Rican and other Spanish speaking communities.

SCAN 360   SCAN 360 is a One Stop Family Center and Network in the city of Springfield which offers assistance to families in the community who have a family member with a developmental disability. Staff are committed to helping families access information and support through a network of human service agencies and community service providers.

Springfield Partners for Community Action  Springfield Partners for Community Action serves more than 11,000 low-income people annually. Their mission is to empower people in need to attain self-sufficiency and economic stability. They do this through education and outreach, and by offering programs to help people build assets, obtain affordable childcare, get free home weatherization and tax filing services, and much, much more.

Stone Soul Festival  Stone Soul began in 1989 as a community reunion picnic aimed at gathering together the Mason Square Community. It has since evolved into a three day festival, encompassing the Springfield and greater Springfield area.  The main goals of Stone Soul Festival are to establish an annual festival to provide family oriented activities, entertainment and cultural enrichment. It is a vehicle for minority businesses to display their wares and crafts. Local, state and national entertainment are provided free of charge. Stone Soul hosts Job Fairs, Social Service Agencies, Health Care Providers and many other community services.

And for inspiration, check out this eleven-minute video:

Books on the Bench

Posted 02/06/2011 by margotmal
Categories: Strategic Planning

Tags: , ,

Last week, I began pulling books in our Consumer Health Library.  I made the ruthless decision to pull anything that was published over 5 years ago.  This weeding left me with about 25 books.  I considered some keeping some older anatomy books but many were looking their age.   I did keep the nice-looking anatomy books.  I was surrounded by books.  I had to hold back any sentimentality (mine and others–but the books are in such good shape!  they are good books!).  They are old books.

To prepare for this moment, I looked at the usage statistics for last fiscal year and the first quarter of this fiscal year.  We do not circulate our books.  We do keep hash marks for usage of these materials:  computers (we have 2 PCs), books, anatomy models, brochures (from Channing Bete and JourneyWorks), newsletters (Harvard, UC Berkeley, John Hopkins, Mayo) and magazines (Diabetes, Arthritis). 

Computers are the clear winner at 72% of the usage pie.  Truth be told, the computers are most frequently used by employees for work-related reasons.  Not a direct service to patients & their families.  Next in popularity (at 14%) are the anatomy models.  The black lung and pound-of-fat are always eye-catching.  The brochures are perused 8% of the time.  And, often taken.  The newsletters and books are tied at 3% each.

I reflected on the usual interaction between myself and a patient or family member.  Someone walks through the door.  Pushes the brochure rack around and eyes the titles.  Looks at the anatomy models.  And then asks a question.  OR… someone comes rushing through the door and asks a more desperate question.

And, what is my initial reaction?  To turn to MedlinePlus.  I don’t pull out the mammoth PDR, or the Merck, or Lange’s Current Medical Diagnosis & Treatment.  Why don’t I pull out these books?  I guess I feel that MedlinePlus is faster, more consumer-friendly, and offers a variety of options.  Generally, I print out 2-3 items and slip these sheets of paper into an envelope along with a handout on how to get in touch with me for additional materials.  If the person seems interested in books, I spin around in my chair and– with a few taps on my keyboard– search the public library catalog.  I’ll even look up the hours of the local library and suggest approaching the reference librarian for a specific title.

What’s it like to get benched?  A good ball player will stay attentive to the game and be ready to go in at any time.  Books do belong in consumer health education.  Books are wonderful sources of support.  I will keep a handful of books that may come in handy.  I am open to the idea that my strategy could change.  But, for now, books are going to sit this one out.

Passing Angles

Posted 01/06/2011 by margotmal
Categories: Instruction

Tags: , ,

Angles on Basketball Court

On December 20, 2010, the Association of Research Libraries (ARL) published a new report on Fair Use Challenges in Academic and Research Libraries.  This report results from a collaborative partnership between the ARL, the Center for Social Media and the Washington College of Law Program on Information Justice and Intellectual Property.  Investigators spoke with sixty-five librarians on the application of fair use doctrine and copyright law.

To be honest, I am relieved that other librarians are as confused as I am about copyright law.  Fair use  is intentionally fuzzy.  Court decisions are truly on a case-by-case basis.  And here we are, rooted in our missions to faciliate teaching, research and learning, and someone approaches us about using copyrighted material.  (Or not.  Sometimes we hear that faculty have used copyrighted material in a manner that seems dangerously carefree).  The person in front of us wants a hardline answer. 

Librarians… found it frustrating not to be able to draw on a consensus about fair use at copyright workshops for faculty (and similar settings), and regretted having instead to use phrases such as “probably ok, but different people say different things” and “you should be in the clear, but some librarians don’t share my view” or “you should probably get permission, though there are some who would say you’re OK.”

The biggest concern is e-reserves– what kind of materials, how much of a work, how long to allow access, etc.  Most of us feel unprepared to give guidance on these issue.  I was amused by the finding that librarians make up their own rules, imposing arbitrary limits in order to give a definitive answer.

License agreements, of course, are more restrictive than copyright.  One of the “Next Steps” in this report is to encourage librarians to assert fair use rights when negotiating licenses with vendors.  Doesn’t that sound like fun?  Especially when you are uncertain about the legality of your request? 

This report is an easy read and well worth your time.  I followed my reading with a video from the TED talks.  Margaret Gould Stewart gives this six-minute talk on how YouTube deals with copyright.  Enjoy!

Standards & Measures

Posted 12/06/2010 by margotmal
Categories: Strategic Planning

Tags: , , ,

Measure

The most recent update of Medical Library Association’s (MLA)  Standards for Hospital Libraries was published in 2007.  These guidelines were developed by the Hospital Libraries Standards Committee to assist hospital administrators, librarians and accrediting bodies in the design and maintenance of an effective hospital library.  Recently, I decided to apply these standards to my own developing career as the Outreach Librarian at Baystate Health. 

The MLA is fond of using the term “knowledge-based information (KBI)”.  KBI is expert information found external to the organization and is utilized in support of patient care, strategic decision-making, patient safety, research initiatives, patient education, and other organizational efforts.  KBI is found in journals, texts, best practices, research studies, etc.  Basically, KBI is a fancy term for library resources.  

The focus of these standards is to encourage librarians to gather evidence of the need for library resources and services.  For me, the whole point is this:  it isn’t enough to do a good job.  We need to document what we are doing, why we are doing it, and find some way to connect our work with improvements in the health and well-being of our communities. 

Of the 11 standards,  I chose three—basically because I am not the director of the library and most of the standards are geared toward that role.  So, I chose the standards that more easily address how I might approach my own work. 

Standard 5 speaks to gathering evidence to demonstrate how library collections and services connect with effective patient education (among other hospital responsibilities).   The meaningful use mandate is the perfect opportunity for us to introduce ourselves to any and all patient education teams.  Standard 5 wants to see my name on the minutes of any meeting I attend.  I guess that is documentation.

Standard 5 also wants me to offer my skills in helping select, create and/or filter sources of patient education materials.  And, to document the direct provision of library-purchased patient education materials to clinicians and consumers.  Teaching consumer health information, marketing library services to patients and their families, and gathering evidence of these activities fulfill the demands of Standard 5.

Standard 6 calls for gathering evidence of ongoing needs assessments.  The expectation is that I am using formal and informal techniques to assess the information needs (in this case, of consumers) for KBI.  The needs assessments should include turnaround time as well as appropriate materials. 

Expected resources are: 

  • Convenient access to a librarian
  • Current and authoritative collections
  • 24/7 access to KBI
  • Technology required for access
  • Methods of locating materials (catalog or database)
  • Resource-sharing agreements to expand access

So, how am I doing?  Possible ways to discover are consumer focus groups, user surveys, analysis of usage patterns, inventory of collections, etc.  The Consumer and Patient Health Information Section (CAPHIS) of MLA  provides lists of recommended resources and other vital guidelines for managing a consumer health library.

Standard 7 presses the librarian to provide documentation of action taken to promote library resources and services.  Several methods of promotion are suggested:

  • Announcements of new services and resources
  • Orientations to the library
  • Observances of National Library Week and National Medical Librarians Month
  • Participation in information fairs
  • Promotions of established services and resources
  • Presentations to user and non-user groups

One particularly nifty way of documenting your efforts is news coverage.  I was interviewed for not one but two local newspaper articles on consumer health information programs that I am presenting at public libraries.  I got a lot of mileage out of these stories, sending links to everyone I could think of. 

To be honest, garnering news coverage looks easier than collecting data on the above measures.  I have some work to do!

Partnering with Public Libraries: Talking

Posted 11/06/2010 by margotmal
Categories: Consumer Health

Tags: , ,

Medical choicesDuring the month of October 2010, I facilitated a series of discussions on health topics at The Jones Library, Inc. in Amherst, MA. My goal was to broach subjects involving some controversy or confusion and to encourage discourse.

Cancer Screenings. I opened with last year’s announcement from the United States Preventive Task Force that after years of reviewing studies, the USPSTF found  “moderate or high certainty” that teaching self-exams “has no net benefit or that the harms outweigh the benefits” and that women can wait until 50 years of age to get biennial mammograms.  This announcement was met with much concern.

The American Cancer Society and the American College of Obstetricians and Gynecologists still recommend breast self-exams for women over 20 and mammograms for women over 40.

The Comprehensive Breast Center at Baystate Health does not accept the revised recommendations and continues to follow guidelines as put forth by the American Cancer Society and others. BH CBC’s Medical Director Grace Makari-Judson, MD states, “All women should be taught the signs and symptoms of breast cancer and report concerns to their health care provider.”

I expanded the topic to review changing guidelines for PAP, PSA and DRE tests and reticence to perform routine lung CT scans. These changes have an unsettling effect, to say the least.

That story about breast cancer—call it the ‘relentless progression’ mind model—is easy to grasp, makes intuitive sense and offers a degree of comfort: Every cancer is curable as long as you catch it in time.~ Convincing the Public to Accept New Medical Guidelines

The discussion turned to evidence-based medicine: don’t we want our clinicians to be consulting medical literature and basing decisions on the evidence?

Evidence takes time to develop and evaluate. The new American Psychiatric Association guidelines for depression treatments are based upon reviews of 13,000 research articles from 1999-2006.  In other words, these guidelines are given a great deal of thought.

So, what was up with the breast cancer screening announcement?  Why was that so hard?  Is it due to last year’s efforts toward health care reform”

“I can say honestly, absolutely, the word ‘cost’ was not in the room, it was not mentioned, it was not uttered.”  As for any political motivation, [USPSTF vice chair Diana] Petitti [MD, MPH] pleaded “woeful” ignorance of the specifics of healthcare reform legislation. She said she didn’t even know that the USPSTF was referenced in the healthcare reform bills, and when she heard that the recommendations would be published the week of a major vote in the Senate, she was shocked. ~Medpage Today

In this discussion, participants voiced different concerns. They were sincerely interested in the topic and were respectful of others’ opinions. Turnout was smaller than I expected, but the result was an intimate, thoughtful conversation.

Electronic Health Record.  The second discussion yielded an even smaller turnout, but that didn’t surprise me. The topic was the Electronic Health Record–a hot topic for medical librarians, but the public may not be as attentive to this shift in records management. I opened with the Bush Administration’s Executive Order (Apr 2004) to achieve widespread adoption of interoperable EHRs by 2014. In President Obama’s first address to the nation (Jan 2009), he reiterated the commitment to “computerized the nation’s health records in five years”.

I demonstrated that we have a long way to go, passing around a copy of Table 2 from the article “Use of Electronic Health Records in US Hospitals” ( Jha AK et al. N Engl J Med. (2009)).

I did my best to explain the nebulous “meaningful use” by stating that health care providers will need to demonstrate how the use of the electronic health record:

  • Improves the quality of care
  • Improves care coordination
  • Improves the health of population
  • Reduces health disparities
  • Engages patients and families
  • Ensures privacy and security

Here’s another case wherein it isn’t enough to be using tools (electronic health records); we need to demonstrate that these tools are helping us meet our end goals.  We touched on the emergence of the personal health record (PHR).  In general, participants had a “wait and see” attitude toward the EHR and the PHR.

Probiotics.  For my third talk, I began with a search on  probiotics on MedlinePlus.gov.  I selected 6-7 links to explore.  We looked at the Art and Science of Natural Products from the National Center for Complementary and Alternative Medicine and at specific information on Bifidobacteria and Lactobacillus from the Natural Medicines Comprehensive Database.  I chose several links detailing current research related to specific conditions.

I explained evidence grading systems and shared information from subscription database Natural Standard .

As of that talk, probiotics earned some A’s for

Reducing adverse effects of antibiotic use, particularly in reducing growth of Clostridium difficile bacteria (common complication in elderly) and Helicobacter pylori (cause of stomach ulcers).

Preventing eczema in children when mothers take probiotics during pregnancy and breastfeeding, and supplementing infants.  Children do differ in responsiveness to specific probiotics products.

lots of B’s and C’s…too many to list here…

and a couple of D’s for

Preventing bacterial infection translocation—passage of bacteria from the gut to other areas of the body during surgery.

Treating diarrhea for all HIV patients on antiretroviral therapy—well tolerated but may not be reducing gastrointestinal symptoms.

Improving fertility through effects on vaginal conditions during in vitro fertilization.

There is a lack of evidence for interactions with drugs, herbs and supplements.  And those that partake of probiotics should be cautious of allergies to dairy products and potential problems with gas due to corrective activity in the colon.

I was interested to hear from some of the participants that doctors are starting to explore the clinical usage of probiotics.

I finished up with the press release regarding  Nestle’s settlement with the FTC.   Oh, Nestle!


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