While we have referred to this as a recent remodeling project, it actually began in the fall of 2010 as the “Ceiling Project,” when the library had to close off sections for asbestos abatement, and updates to electrical systems and network wiring.

We want to thank all of our patrons for their patience and understanding during these crazy months.

• The communication gap between physician and patient
• Encouraging full participation by patients
• The complexity of the healthcare system itself.

Talking to my doctor

In an article in the New York Times’ “Health” section, Pauline Chen, M.D., describes talking to a friend informally about her friend’s health condition and the latest research in the area. But when Chen suggested her friend discuss options with her primary care provider, her friend went quiet.

When she finally spoke again, her once-confident voice sounded nearly childlike. “I don’t really feel comfortable bringing it up,” she said. While her doctor was generally warm and caring, “he seems too busy and uninterested in what I feel or want to say.”

“I don’t want him to think I’m questioning his judgment,” she added. “I don’t want to upset him or make him angry at me!”

For many, including this writer, doctors are so highly regarded that it borders on intimidation. Couple that with a reimbursement system that necessitates seeing as many patients as possible in order to be successful, and you have a recipe for the physician-patient relationship demonstrated above. Recent efforts to make the healthcare decision making process a joint effort has improved medical visits, but it has failed to take into account the patient’s perspective. A recent study using patient focus groups sheds light on why some patients are reluctant to speak up for themselves:

• Even well-educated and well-to-do patients feel pressure to conform to social expectations, trapped into responding in certain ways to doctors
• Some physicians can be authoritarian
• Patients fear being labeled as a “difficult” patient

While most of the participants in this study were over 50 and lived in relatively affluent areas, it stands to reason that others from different socio-economic backgrounds would feel the same way.

Chen effectively sums up what’s needed:

Care organizations and doctors’ practices must be restructured to allow more in-depth conversations; clinicians need to be reimbursed for the time required for more meaningful conversations; and health care systems must adopt rigorous quality standards that measure and value real patient engagement in decisions.

Supporting healthy lifestyles

As we work to transform our healthcare system to improve patient-doctor communication, it must also undergo radical change to support wellness, rather than profiting by the quantity of sick people treated. As noted recently in The Atlantic, more research is needed on how to successfully motivate people to live healthier lives.

This is not as easy as it seems, for it requires walking a fine line between encouraging behavioral change and individual freedom. “For example, a program could let diabetic patients earn points toward more affordable insurance coverage by completing a self-taught module on diabetes” (from article in The Atlantic). There are even mobile tools to help manage diabetes, as previously noted in this column. Such methods for improving health literacy show promise, yet need confirmation by research with large samples over long periods of time.

Yet some people will not change their behavior no matter what positive incentives are offered. For these patients, it would be all-too tempting to tie insurance rates to blood test results obtained while visiting one’s primary care physician. While no one is currently suggesting turning doctors into health police, if it could be made profitable, somewhere it would be tried.

In a sense, what is needed is a kind of health literacy for physicians and insurers. They need to know and understand what works and what does not in encouraging healthier lifestyles in patients: modes of education, treatment regimens and combinations, incentives and more. Redistribute profitability so a greater share of reward is earned for wellness, rather than sickness.

A better system

No matter your political persuasion, most seem to agree that the current system should be made better. Simplifying the process of obtaining, utilizing and keeping health insurance coverage. We pay far more for healthcare than other industrialized countries, and yet our system is ranked 37th in the world. Reforms to the health care system are a step in the right direction, and more are needed. T. R. Reed’s book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, shows five different systems in other countries that provide a better healthcare system than we currently offer. Many in this country pride themselves on their ability to “go it alone.” It’s time we started learning from others successes.

Move your mouse over a region (one or more provinces) and it turns a darker shade of grey. Click on the region, and it takes you to a map of that region. Using the map tools (zoom, move, etc.), you can zoom quite far in to a given area.

A tool like this could help show patterns in areas needing additional education and outreach. And if the U.S. had a map like this, one could add an optional overlay to note “red” and “blue” states, which might offer additional insights for which political leaders could be enlisted to assist with raising awareness and health literacy levels.

Does the U.S. have a map like this? How else could this information be used? Tell us (in the comments)!

• Picking the right search terms
• Understanding search results
• Narrowing a search to get the best results
• Searching for evidence for research tasks
• Evaluating credibility of sources

This video includes two librarians talking briefly about the transformation of their jobs, and the importance of overcoming the digital divide: those who can versus those who cannot search effectively.

While these lessons are aimed at primary and secondary school students, Google’s Search Education could also be incorporated in to college freshmen level courses, especially those that everyone is required to take.

Pros and cons

On the positive side, this package of lesson plans could be incorporated into any school’s curriculum, perhaps with testing to assure students are reaching certain levels of proficiency. If students moving from one level of education to another (primary to secondary to higher ed) bring sufficient levels of search proficiency, this provides opportunities for them to take these skills to the next level, creating and contributing new content. If librarians and other educators embrace this curriculum and can clearly demonstrate its value (grant-funded study, anyone?), it will eventually become required learning.

On the negative side, what if the librarian’s Masters of Library Science degree was replaced with a “Bachelors in Education with Search Certification” degree? If using Google and a few selected credible resources is all that’s needed for primary and secondary education, why would anyone spend the extra time and money to get an MLS? Colleges and universities may still need Information Specialists (i.e. librarians) to teach how to use specialized databases for a time. But what if Google decided to weigh in on the subscription database business, setting up a single standard for organizing data for searching? Google could become a single-point of access to any and all publishers’ content. This could make or break a publisher or other content provider. While major vendors such as EBSCO and LexisNexis could find the resources to adapt, smaller publishers could be pushed aside, and ultimately be absorbed by their larger competitors.

Could this happen? Why or why not? Tell us (in the comments)!

Here is Google’s video describing this new service:

While Google does not share its trade secrets, the ReadWriteWeb blog reports that, in part, this system relies on Freebase, “a structured database of semantic information. It maps synonyms to help Google understand the meaning of words.” It also incorporates content from Wikipedia, Google Books and the World CIA Factbook [1], which means it is seeking to be more authoritative. This has implications for online content providers. As the EverSparkInteractive blog notes:

Because Google is providing this information to users, you can bet your bottom dollar the search engine will expect the sites it top ranks to provide information like this. So, when you are writing content for your website, remember to include verifiable facts. [2]

While libraries specialize in providing authoritative content via free and subscription databases and other resources, will Google’s new approach recognize this and increase their visibility? Librarians wear many hats, and it can be quite easy to slap up web content without proper metadata, let alone add important links “above the fold.” The structure and organization of information on a library’s website — its information architecture — may or may not be carefully planned and executed. How will this affect its ranking by Google now?

Have you used the new KG? Have you found it helpful? Tell us!

Reference:

1.         Mitchell, J., Google Goes Back to What It Does Well: Finding Things. ReadWriteWeb, 2012. 2012(May 29): p. Online article or blog post about changs to Google’s search interface, and the addition of the Knowledge Graph, with Wikpedia-like content.

2.         Baumwell, A., Google Knowledge Graph: Will It Change the Face of Search? EverSparkInteractive, 2012. 2012(May 29): p. Online article or blog post about changs to Google’s search interface, and the addition of the Knowledge Graph, with Wikpedia-like content.

According to Dr. Jing Fang, an epidemiologist in CDC’s Division of Heart Disease and Stroke Prevention, the increased prevalence is largely due to lifestyle factors including obesity, high blood pressure and smoking. This report also notes that caring for stroke survivors cost our economy an estimated $18.8 billion during 2008, plus an extra $15.5 billion due to lost productivity and premature mortality.

Since higher education levels show a decreased prevalence of stroke in this report, it seems only natural to assume that health education and outreach would help combat this. As reported in a previous post, the  El Paso County Public Health department has partnered with Harrison High School to integrate health literacy education into classes beyond the traditional physical education and health offerings. If programs such as this were implemented nationwide, it could help reduce the incidence of stroke and other preventable causes of long-term disability. Such outreach efforts would probably more than pay for themselves in the long run.

What outreach efforts to improve health outcomes for U.S. citizens do you think should be better funded? Tell us!

In addition to surveying everyday Americans, this poll “examined sick Americans’ experiences with and perceptions of the costs and quality of medical care over the last year. ‘Sick Americans’ (27% of adults surveyed) are defined as those who said they had a serious illness, medical condition, injury, or disability requiring a lot of medical care or who had been hospitalized overnight in the past 12 months.”  Of the 1,508 adults randomly surveyed, nearly three-quarters consider healthcare costs to be a “very serious problem,” and about half consider the quality of healthcare a serious problem as well.

Of those polled who fell into the “sick Americans” category, one in six could not get the medical care they needed for the following reasons:

• Could not afford medical care: 52%
• Insurance would not cover: 24%

We have the most expensive healthcare, per capita, in the world, yet not everyone can get the care they need when they need it. Just what is it we are paying for, then?

Have you been hospitalized or had a serious illness, medical condition, injury, or disability requiring a lot of medical care in the last 12 months? If so, could you afford the care you needed? If not, why not? Tell us!

Obesity is common, serious, and costly. More than one-third of adults (35.7%) and approximately 17% of children and adolescents are obese.

To confront this epidemic, the Centers for Disease Control and Prevention (CDC) is collaborating “with public health researchers and practitioners, partners, state and community leaders to raise awareness, share evidence-based strategies.”  Since visual messages are among the most powerful in today’s society, the CDC has developed a series of four videos that document the consequences, costs, and challenges for confronting obesity as part of their “Weight of the Nation” campaign:

• Part 1: Consequences
• Part 2: Choices
• Part 3: Children in Crisis
• Part 4: Challenges

The videos are just over one hour in length, and premiered May 14-15 on HBO. Below is the first video to get our readers started.

How has obesity adversely affected your life, or the lives of those you care about? If you have overcome obesity, how did you do it? Tell us!

Popular social media sites have millions of registered users (Facebook, over 800 million; Twitter, over 500 million; WordPress, over 15 million), many of whom log in daily to share intimate details of their lives, including symptoms, illnesses and struggles with chronic diseases. This is a treasure trove of informal data available for research and monitoring of public health issues. While tapping this resource raises many ethical issues, particularly individual identification, initial research has demonstrated that it may help with disease surveillance.

St Louis and Zorlu offer the following examples:

• Recent analysis of three million tweets from May – December 2009 showed that “the 2009 H1N1 flu outbreak could have been identified on Twitter one week before it emerged in official records from general practitioner reports”
• Physicians, unable to reach patients with chronic conditions after the tsunami in Japan in March 2011, turned to Twitter and the mobile Internet to direct patients to sources for their medications.
• Digital surveillance platforms such as BioCaster and HealthMap regularly search and extract information from news, social media and other sites looking for hints and clues of new public health threats.

While these examples are compelling, and collaborations between HealthMap and public health agencies are underway to track influenza and other public health challenges, Twitter cannot replace traditional methods of tracking and verifying diseases. How many times have you or someone you know attributed symptoms to one illness, only to find it was a different illness? Monitoring must be coupled with verification, else we risk spreading rumor and panic.

Do you use Twitter or other social media to talk about your health concerns and conditions? How do you feel about having this information monitored for the good of many? Tell us!

References:

St Louis, C., & Zorlu, G. (2012). Can Twitter predict disease outbreaks? BMJ, 344, e2353. doi: 10.1136/bmj.e2353

Szomszor, M., Kostkova, P., & De Quincey, E. (2012). Swineflu: Twitter predicts swine flu oubreak in 2009.

Tamura, Y., & Fukuda, K. (2011). Earthquake in Japan. Lancet, 377(9778), 1652. doi: 10.1016/s0140-6736(11)60672-7

Google, Yahoo!, Bing, and Ask.com are by and large effective search engines for helping lay users get health and medical information. Nevertheless, the current ranking methods have some pitfalls and there is room for improvement to help users get more accurate and useful information. We suggest that search engine users explore multiple search engines to search different types of health information and medical knowledge for their own needs and get a professional consultation if necessary.

Researchers searched for “breast cancer” using the four top search engines, combined the top 200 non-redundant results from each source into a list, and then gave that list to eight volunteers to evaluate, scoring there relevance to research on a scale of 0-10 (low to high). Volunteers were all highly educated, most of them with backgrounds in science. They were provided with six “gold standard” sites for information on this topic to compare against before making their determination:

1. U.S. National Cancer Institute
2. American Cancer Society
3. Mayo Clinic
4. MedicineNet
5. Wikipedia
6. Susan G. Komen for the Cure

The volunteers tended to score the popular science and personal websites the highest overall, while scoring corporation and advertising websites the lowest. Researchers conclude that search engines do provide good information overall, though their sample is small, both in number of participants and topics searched.

This study has a number of serious flaws in it, and begs the question: is a little bit of mediocre research better than no research at all? First, the high education levels of the volunteer evaluators, plus their choices to score popular science websites above commercial websites indicate high levels of information literacy. Yet other research shows that over 90 million adults in the U.S. (36% of the population) have poor health literacy. How would people like this evaluate and select the right sources using a search engine? As any librarian watching patrons search will tell you, most people never look beyond the first three search results, let alone the first page of results. And search engines like Google employ algorithms to customize search results based on your previous searches, which may or may not give you the best resources.

Next, the researchers note the shortcomings of search engines in “ranking the websites according to their usefulness,” and recommend that “users apply multiple search engines when looking for medical and health information online, instead of using only a single search engine.” As a librarian and past computer consultant, I’ve learned that many people cannot distinguish between “the Internet” and a web browser, let alone utilize and critically evaluate search engines and the search results they generate. Librarians and researchers are the professionals best suited to handle that task.

Finally, while the “gold standard” sites probably contain all the basic information on breast cancer from the view of their medical expert, how readable and understandable is their content across different groups and ability levels? Had the researchers chosen to include a librarian on their team, she or he could have provided important insight and evaluation of these sites in this area. And why was a site like MedicineNet included while MedlinePlus was excluded from the short list? MedlinePlus is advertisement-free, offers information in Spanish and other languages, and is written at a level that can be understood by a wider audience.

While search engines will, generally speaking, help end users find helpful health and medical information, the will inevitably lead some people to inaccurate or misleading information. And with so many people having low information and health literacy skills, it is imperative that they be directed to quality, evidence-based resources for answers to their questions. This study does nothing to assist in that endeavor.

References:

Kutner, M. (2007). Literacy in everyday life: Results from the 2003 National Assessment of Adult Literacy.

Wang, L., Wang, J., Wang, M., Li, Y., Liang, Y., & Xu, D. (2012). Using Internet Search Engines to Obtain Medical Information: A Comparative Study. Journal of medical Internet research, 14(3).

The biggest drawback is price: $99 at the online Apple Store (or local Apple Store), and $75 online or at your local Walgreens for the peripheral, and it includes 50 initial test strips. Additional strips are $65 per 50 online through Walgreens. The app is free, and the manufacturer does offer a program to reduce the cost for the strips, down to about $20.

But the real test is whether or not it helps people achieve better glycemic control. Husain points out that while some evidence exists to support the claim that mobile devices help with glycemic control, a full clinical trial is needed to test the effectiveness of this device, perhaps in comparison with other devices as well.

Are you a person with diabetes who uses this or another mobile device to track your BG levels? Does it help improve your success at glycemic control? What strengths and weaknesses does your system have? Tell us about it!

• Cardiologists interpreting ECGs from paper
• Emergency room doctor interpreting from paper, and
• Cardiologist interpreting from mobile device

The first group made fewer major mistakes than the other two groups, as was expected. However, there was no statistically significant difference between the second and third groups. This suggests that “sending the ECG images via a multimedia message service may be a practical and inexpensive telecardiology procedure,” and could be a helpful aid in cardiology consultation. In practical terms, an ER physician working in a rural or remote area could consult with a cardiologist in a larger metropolitan area, and get a faster second opinion before proceeding with treatment. And while the iMedicalApps author points out that it would, indeed, be interesting to see this repeated with higher-resolution phone cameras, this technology could be implemented now, and begin helping to save lives sooner. While telemedicine cannot be a permanent substitute for in-person care, it could save lives in an emergency.

Reference:

Bilgi, M., Gulalp, B., Erol, T., Gullu, H., Karagun, O., Altay, H., & Muderrisoglu, H. (2012). Interpretation of electrocardiogram images sent through the mobile phone multimedia messaging service. Telemed J E Health, 18(2), 126-131. doi: 10.1089/tmj.2011.0108

Among participants with low HL, 28.8% self-reported as being uninsured, compared to 16% of people with adequate HL. For those respondents who reported being employed full time, ” those with low HL were less likely to have been offered employer-based health insurance than those with adequate HL (19.9 percent versus 11.4 percent).” And while participants with low HL were just as likely to be employed full-time as those with adequate HL, they were less likely to have been offered health insurance by their employer.

This study has implications for federal, state and local public policy, such as the implementation of the Affordable Care Act (ACA). Using the results as an estimate of HL levels in the U.S. population as a whole, about ten million of the thirty-two million people who will now have access to medical care under ACA will have low or poor HL, and probably many more than that. How will we implement the ACA in ways that will accommodate persons with:

• Low HL
• Inadequate computer and information literacy skills (navigating insurance exchange websites, understanding online forms, weighing pros and cons and trade-offs, etc.)
• English as their second language
• Cognitive and physical disabilities

This also has enormous implications for libraries, especially public libraries. At a time when budgets are being frozen or slashed, and branches are being closed, libraries will be hard-pressed to meet the resulting increase in demand for computer and Internet access. Library staff will be asked to help patrons navigate the myriad choices being offered by these insurance exchanges with little or no additional training. And if a librarian helps a patron successfully navigate this selection process, could the library be sued if something goes awry with insurance, medical care, etc?

While the concept of insurance exchanges seems like a good idea, without adequate preparation and support,  it may not succeed, and in a short time opponents of health insurance reform will renew their calls to “repeal Obamacare” as it is currently mis-labeled. To help people successfully access this yet-to-be created system, why not:

1. Involve librarians in the planning and organization of the insurance exchanges themselves
2. Provide additional funding to state libraries and the National Network of Libraries of Medicine to train staff at public libraries on how to assist patrons through this process.
3. Provide additional funding for computers and high-speed Internet access.

Librarians already have too much on their plate, so some things may need to be set aside as a result. But we will cope while doing our best to serve our patrons.

How else should libraries prepare for this next challenge? What have you, our fellow librarians, learned from other endeavors that would assist us in preparing? Tell us!

Reference:

1.    Weinstein D. Pre-op videos may ease recovery for cancer patients: study – Medical Marketing and Media. May 3, 2012 2012;2012(May 7):News article about recent study in the Journal of the American College of Surgeons.

2.    Crabtree TD, Puri V, Bell JM, et al. Outcomes and Perception of Lung Surgery with Implementation of a Patient Video Education Module: A Prospective Cohort Study. Journal of the American College of Surgeons. 2012;214(5):816-821.e812.

Join us for the exhibit’s opening reception on Friday, May 11, 2012, from 4:00 – 5:30 pm. Light refreshments will be served, and no RSVP is required.

Questions? Contact Joan M Gregory, 801-581-5269,

(Directions to the Library)

• a short booklet aimed at researchers explaining the relevance of information literacy to their work, and
• a two-page pamphlet version of key information from the booklet.

Included in these materials is a diagram of “Information literacy lens on the Vitae Researcher Development Framework using the SCONUL Seven Pillars of Information Literacy.” IL for the researcher involves the ability to:

• Identify an information need for answering a research question,
• know the Scope of gaps in their current knowledge that need filling,
• Plan strategies for finding needed data and information,
• Gather data, information and other needed resources,
• review and Evaluate the research process and resulting data
• Manage information so it is organized both professionally and ethically,
• apply and Present research results by synthesizing new and old information to create new knowledge, and disseminate it in multiple ways

As discussions in our regular “Librarians Meeting” indicate, academic libraries supporting research need to move from a ready-to-help-librarian model, to a partnership with researchers where we bring our expertise at organizing and finding information to the research planning process. Our challenge is to build collaborative relationships with researchers at our institutions so that as they begin planning research, we can facilitate the process so research information and results are well-organized, and packaged for reuse. Eccles Library is dedicated to supporting the medical research community, and has on staff a dedicated Research Librarian, Abby Adamczyk.

Are you a researcher planning a new endeavor? Have you ever considered partnering with a librarian during the planning process? Tell us about it!

Health care professionals must become “medically bilingual,” that is, learn to speak both medical jargon and plain language. I like to ask myself, “How would I explain this to my mother?”

When a physician is explaining her/his findings and recommendations, if the patient does not understand, he/she may not even ask for clarification out of fear of appearing ignorant. While medical schools are working to train doctors to speak using everyday language, patients can take some simple steps to avoid making this mistake: ask three simple questions:

1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?

And if your physician answers in a way that is confusing or loaded with unintelligible jargon, stop her/him and ask for them to explain in simpler language.

The National Patient Safety Foundation (NPSF) created the Ask Me 3^TM patient education program “to promote communication between health care providers and patients in order to improve health outcomes.” When patients clearly understand health information and instructions, they make fewer mistakes and can better manage their own healthcare. The NPSF offers patient brochures and other reference materials, and created this video to assist in improving patient-doctor communication.

While it is important that patients ask questions, and doctors answer using understandable language, it is also important to acknowledge that the current health system does not reward physicians for taking time to speak with patients. Regulation needs to be enacted or changed so that physicians can be reimbursed by health insurance, Medicare, Medicaid and other plans for the time spent. It will likely save the system money in the long run as well.

What other steps can be taken to improve doctor-patient communication? Tell us about it!

From 2006 – 2008, families in a six-site nationwide study participated in a program to enhance parenting skills. Participating parents were monitored for “depression, health- and healthcare-related practices, and surrounding family conditions at baseline and 6-month intervals for up to 36 months.” Data from this study, available in a publicly-funded AHRQ/NIH database, was recently analyzed, and while participants began with reduced health literacy skills, “after 1 year of enhanced home visitation, vulnerable parents were better able to manage personal and family health and healthcare, especially if depressed.” While the sample size (2,572 parent/child dyads) was modest, the findings demonstrate one way we can improve parental health literacy levels even among depressed parents.

In addition to demonstrating the benefits of home visitation in improving health literacy, this study provides support for those that argue for making publicly-funded research data available to all. While no less important back then, health literacy was not the burning topic in 2006-2008 as it is today. Principal investigators had no idea that their work could or would be used in this way. If this data was locked behind a publisher’s pay-wall, this study might never have happened. Because it was publicly available, it could be re-used to test new ideas and ways to help people today.

Researchers must have open access to as many data sources as possible in order to find new ways to help those in need. Access must take precedence over ownership and control when the health outcomes of vulnerable populations (in this case, children) is at stake.

What data sources should be made accessible that are not available right now? Or, what publicly available data/studies/etc. would you like to see analyzed in new and creative ways? Tell us about it!

Reference:

1.    Smith SA, Moore EJ. Health Literacy and Depression in the Context of Home Visitation. Maternal and child health journal. Nov 26 2011.

This is not a call to break up or bring down big-name publishers. They provide services that libraries have come to depend on. But if research is funded by public funding — gathered through taxes or charitable contributions — then the public should have complete and prompt access to its results, good or bad.

Publishers counter with (among many claims):

• Their work provides added value to the research, and
• The current one-year embargo is not enough time to recoup the investment made in adding value.

In testimony before Congress, one publisher argued

“The cutting-edge research in psychology published by APA is rarely obsolete within a year and may have a shelf life of five to 10 years or more. Furthermore, only 16 percent of the eventual ‘lifetime’ usage of APA journal articles—in the form of downloads—occurs within the first year after publication.”

The best rebuttal to this argument actually came in the form of a comment on the article in the Chronicle of Higher Education: publishers “neither pay for the intellectual content they publish (authors get no payments including no royalties), nor do they pay for the intellectual effort of the peer-reviewers – all of that professional/academic expertise is given to them for free.”

In addition, is the “added value” anywhere close to the prices publishers charge for access to this information? Now there is an area ripe for research!

One argument for open access is seldom, if at all, being made, and for this author, it is the most compelling: lives may hang in the balance. Some people cannot wait one, five or ten years for the publication of research that will lead to life-saving medical advances. Loosely described, building up collected knowledge of research is like arranging a box of dominoes so they are all standing on end, and next to one another. Arrange them all in the right way, and a single tap will send them all cascading into one another, until all are knocked down.  Researching and determining steps to treatments to take down conditions such as diabetes, various cancers, treatment-resistant diseases, and a myriad of other maladies should occur promptly, and benefit the many, not be delayed for the profit of a few.

Looking for resources to improve health literacy and communication at your medical practice? The Health Literacy section of the AMA’s website toolkits, patient safety tip cards, and other resources to assist providers. Also, the Agency for Healthcare and Research Quality (AHRQ) of the U.S. Department of Health and Human Services has resources for addressing health literacy and cultural competency.

What tools have you found helpful in improving patient health literacy? Tell us about it!

Reference:

Pawlak, R. (2005). Economic considerations of health literacy. Nurs Econ, 23(4), 173-180, 147.

Villanueva-Whitman, E. (2012). Communication is key to better health care  Retrieved April 26, 2012, from http://www.DesMoinesRegister.com/article/20120410/LIFE/304100053

Do you use an app or other software to assist in making clinical decisions? What do you like and dislike about it? Tell us!

When talking about cancer or any other life-threatening medical condition, numbers about risk, results, etc. can begin to blur for any patient. Having a tool like this to provide a clear visualization can help any woman and her doctor think through medical decisions more carefully. The website does note that the calculations this tool is based on ” calculations result from a computer simulation model, not a clinical trial.” Long-term validation studies of this tool are needed to confirm its accuracy.

But a woman facing important decisions about breast cancer risk and prevention needs the best information available now, and this tool appears to be a good way to help visualize the risks and benefits of treatment options and timing, in consultation with a physician. And being online, rather than in print, it is free and immediately available. Kudos to Standford for developing this important resource!

First, the Center for Health Literacy Promotion Blog has a great story about “Esther,” a woman in the 1830′s whom the author calls “ahead of her time.” Too sick a 21 to help on the family farm or marry, she became a servant in a convent. When she became too sick to work there, she was sent home, where she founded a school, taught others to be teachers (who then started other schools), and broke social norms of the time to teach boys and girls together. At age 40, she and her teachers were recognized by the Catholic Church, becoming the Order of the Sisters of Saint Anne. While it may seem far afield to mention religious education in this context, closing words from the post make it a bit more relevant:

Aunt Esther was born two hundred years ahead of her time. Today her vision of literacy as the foundation for health, an escape route from poverty and the key to the advancement of women and society is an idea whose time has come. She inspires my work at the intersection of health and literacy.

The second item worth noting is a wiki created by researchers at the University of Michigan that is a catalog of more than 100 medical devices and technologies that can be used in poorer areas of the world. Example include:

• Pedal-powered nebulizer for asthma treatments
• Using a hand-cranked salad spinner as a centrifuge for blood samples
• Small, wax-filled sleeping bags that could be used to keep premature babies warm

Finally, an article in the Wall Street Journal asks some challenging questions about mobile devices and the future of medicine. In short, with all of the add-ons that are being created for smartphones, how will this transform the practice of medicine? The author offers these examples:

You can get an add-on to a smartphone which does eye refraction and then texts [the prescription] to get your glasses made. If you’re an optometrist, you might be worried about that. Or you can get your skin lesion scanned and get a text back quickly that there’s nothing to worry about. If you’re a dermatologist, that’s a big part of your practice. You will be able to take a DNA sequence on a USB port and pop it into your smartphone and get data out of it. It just goes on and on.

For patients that live a distance from a specialist in one area of medicine or another, online appointments could be used to maintain communication and improve patient outcomes. And many yet-to-be-invented uses of technology will radically alter how medicine is practiced. Yet medicine, as a profession, is slow to change. Will technology change that, or will it leave traditional medicine behind?

What do you think of these different stories and what they have to offer? Tell us!

“there has also been criticism that this concept has been poorly defined, that it stretches the idea of “literacy” to an indefensible extent and more specifically, that it adds little to the existing concerns and intervention approaches of the better established discipline of health promotion.”

She goes on to select one definition of health literacy (Nutbeam, 2000) and using the concept of “critical health literacy” to determine its usefulness in improving the health of communities and individuals. This article concludes that the concept of critical health literacy connects ideas across multiple domains, yet retains “a key focus on the interaction between individuals and information about health” and how information can be used to improve health outcomes.

While much of the research around the topic of health literacy has be quantitative in measure, qualitative research is also needed to address the “socially situated nature of health literacy, involving interpersonal relationships, emotional involvement, and issues of power and resistance” (Chinn, 2011). Knowing how people utilize their personal networks to assemble an understanding of their health situation has the potential to increase the effectiveness of health literacy outreach efforts.

But we cannot stop there. It is also important to know what individuals and organizations benefit from poor health literacy, and what roadblocks and hurdles – legal, political, and more – are being put or kept in place to maintain the status quo.

What questions do you think researchers should be asking about critical health literacy? Where should academic institutions, libraries, non-profit organizations and others be focusing their resources to address this timely issue? Tell us about it!

References:

Chinn, D. (2011). Critical health literacy: a review and critical analysis. Soc Sci Med, 73(1), 60-67. doi: 10.1016/j.socscimed.2011.04.004

Nutbeam, D. (2000). Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. [Article]. Health Promotion International, 15(3), 259.

The number of incidents, when compared to the total number of disciplinary actions taken by medical boards, is small, but can be expected to grow as more physicians embrace and use social media.

In contrast, at Ohio State University (OSU), instructors recognize that today’s learners rely more heavily on technology to gain knowledge for a future career. A pilot study showed how social media (in this case, Twitter and Facebook) can be used to “push” helpful information to students on a daily basis. More than half of the participants had not used Twitter previously, and upwards of 80% found it a useful and helpful addition to their course.

Any tool can and will be used and misused, social media included. What is important is to learn from our mistakes, and remain open to new and novel ways to benefit all.

What uses are these devices being put to?

Amanda Chiplock MLS, the Acquisitions Emerging Technologies Librarian at the Nova Southeastern University Health Professions Division Library reported that most of the physicians who borrow their iPads are using them for teaching and presentations (45%) or videos and research (40%) [from iMedicalApps post].

Doctors and other patrons who check out these devices can install their own software selections, and retain access to those apps for use via their account at the iTunes Store, should they decide to purchase an iPad for themselves. Challenges arise when using these devices to access institutional electronic medical records (EMR), but they are not insurmoutable. Upon return to the library, these devices are easily wiped and reset back to their basic configuration for the next patron.

As noted in an earlier post, the Eccles Health Sciences Library also has a mobile device check-out program, providing patrons the option of test-driving any of the following eReaders and tablets before purchasing one for themselves:

• Apple’s iPad (3 available)
• Motorola Xoom (3 available)
• Amazon Kindle (6 available)
• Barnes and Noble Nook (3 “1st Edition” and 3 color)

The check-out period is two weeks (as of this writing), and upon check-in, patrons are asked to complete a brief survey on how the device was used, etc.

Have you checked out an iPad, eReader or other mobile computing device from Eccles Library or another library? What device did you check out, and how did you use it? What did you like and dislike about it? Tell us!

Here in the Beehive State, our participation in this celebration is called “Utah Libraries SNAPSHOT DAY 2012: one day in the life of Utah Libraries.” All kinds of libraries — academic, public, bookmobiles, school, tribal and special libraries — will be recording with stories, photographs, and statistics the indisputable proof that libraries consistently provide invaluable services to our constituents.

Eccles Library’s designated “Snapshot Day” is today, April 11, 2012, and we will be documenting our service to the community in a variety of ways:

• Tracking basic statistics such as hours open, total visitors, items borrowed, etc.
• Inviting patrons to share brief testimonials of how libraries (and, specifically, Eccles Library) make a difference in their lives.
• Photographing (with written permission) patrons using library services and attending library programs.

A brief questionnaire is available at the front desk. Please take just a couple of minutes to share how Eccles Library has helped or supported your resource needs. All information gathered will be shared with the Utah State Library to document the positive impact libraries services make every day in communities statewide.

Libraries provide informative programming, and Eccles Library is no exception. Be sure to attend today’s LIFT Forum, where Jake O’Connor will speak on “How to Effectively Use YouTube in the Workplace.” More information is available in an earlier post and on LIFT Forum page.

What positive impact have libraries had in your life? How has the Eccles Health Sciences Library helped you? Tell us about it!

Health literacy is the ability to get information, understand it, and use information to lower risk and better health.

In addition, this site posted a YouTube video from Harvard School of Public Health’s Dr. Rima Rudd, Senior Lecturer on Society, Human Development, and Health. In it, she talks about the “Perspective” article she wrote for the New England Journal of Medicine on improving Americans’ health literacy.

Unfortunately, NEJM’s link to one of the sources cited in her paper is not working properly, namely, the report “Literacy & Health Outcomes” from AHRQ (the link to the left works). If only librarians had been consulted in the building of the Internet and World Wide Web…

The post goes on to offer “8 creative ways to use embeddable tweets.” Here are the first four:

1. Add customer comments and testimonials
2. Share event invitations
3. Add opinions and ideas from others to your blog posts.
4. Continue a Twitter conversation in a blog post.

Here is an example of #1:

@EHSLibrary You are very welcome. You do such a great job with your health literacy advocacy!

— Susan Camille (@sumarcam) March 29, 2012

Kroski’s page includes widgets to watch for times when her library is mentioned in/on:

• Twitter
• LinkedIn
• message boards
• Google alerts, and more.

To watch Facebook, the page’s user needs to be logged-in to Facebook first, which means this page cannot be shared as easily as this librarian would desire. Still, it’s a great idea, and kudos to her for sharing!

How do you watch for mentions of your library across various media and platforms? What does/not work for you? Tell us about it!

How serious is the earthquake threat in this area? According to Utah’s Seismic Safety Commission:

90% of Utah’s population lives in active earthquake zones. If a 7.5 Richter Magnitude quake were to occur in the Salt Lake City area, it is projected that 7600 people would die and approximately $18 billion would be lost to physical damage and loss of jobs and economic activity.

Utah has experienced damaging earthquakes in the past and geologic evidence indicates that earthquakes larger than any experienced locally in historical time are likely in the future.

In an emergency, we have only seconds to respond to assure our safety. Drills and practice assure we will do the right thing under pressure. More information is available from Emergency Management at the U, and the Great Utah ShakeOut website, including an online game, “Beat the Quake.”

So join us in this historic practice event. And if you read this blog from outside the area, tell us about how the news of this drill came across in your area!

…is being outpaced by most other developed countries when it comes to improvements in health outcomes, according to a new analysis by a researcher at the University Of Washington School Of Public Health. The researcher, Dr. Stephen Bezruchka, a senior lecturer in global health, says the decline comes despite increased U.S. spending on health care services.

In a published study titled “The Hurrider I Go the Behinder I Get: The Deteriorating International Ranking of U.S. Health Status,” Bezruchka looked at statistics on Infant and child mortality, maternal mortality, life expectancy at birth and at age 50, and adult mortality as mortality measures that reflect health over the course of one’s life, comparing them across developed countries. This study offers a succinct summary of its findings as follows:

1. Around 1950, the United States had among the best health outcomes measured by mortality indicators, but 60 years later, it ranked behind the other rich countries and a number of poorer ones.
2. The differences in mortality outcomes between the United States and the healthiest nations today represent substantial inequalities in health.
3. Reasons for this relative decline are likely due to structural changes related to societal determinants of population health stemming from high economic inequality and lack of attention to early life issues.
4. Public awareness of deteriorating health rankings in the United States is limited, so the next steps to improving health require major communication strategies.

Why do you think we have fallen so far behind in health outcomes compared to the rest of the developed world? What can or should we do to change it? Tell us!

This campaign encourages women to call 9-1-1 immediately if they experience one or more of the most common symptoms of heart attack:

• Chest pain or discomfort
• Unusual upper-body discomfort
• Shortness of breath
• Breaking out in a cold sweat
• Unusual or unexplained fatigue (tiredness)
• Light-headedness or sudden dizziness
• Nausea (feeling sick to the stomach)

More information can be found at the Make the Call website, including a quiz, how to survive a heart attack, and information about the myth of the “Hollywood Heart Attack.”

Review of applications will begin immediately and continue until the position is filled. View the full job description and apply online at the University of Utah Human Resources department site, posting #PRN01682B.

Recently, physicians at the University of Chicago published a research letter in the Archives of Internal Medicine detailing their experience with the routine use of iPads by internal medicine residents during their regular duties.

What they documented was that use of the mobile device was objectively associated with faster order entry after patient admission and the subjective assessment that it saves up to one hour per day for each resident.

Prior to initiating the program, investigators wisely met with hospital IT to determine their concerns and set up rules for usage of the devices. After initially having residents individually install apps via their own iTunes accounts, it was decided to work through a third-party vendor to standardize the devices — in this case, working with a company called Mobile Iron. Additional security protections included an eight-digit alphanumeric screen lock code (instead of the standard four-digit numeric code), and setting the iPads to automatically erase themselves after five unsuccessful attempts to log-in.

A great deal of interest has been generated since the research letter was published, and the authors plan to share what they’ve learned at conferences and workshops. In addition, the local ABC Television station did a segment on this event, which you can see below.

Have you used an iPad or other tablet computer in a medical setting? How did it work for you? Tell us about it!

The challenges faced by young people with various forms of cancer are difficult, to say the least: taking a variety of medications such as antibiotics, antiemetics, stool softeners, plus eating healthy when peers and the culture surrounding them are enjoying copious amounts of junk food. Roxxi the nanobot powers-up by following a real-life cancer regimen, and then she sets off to battle cancer.

Does this virtual-ly active role in battling cancer translate into increased motivation and empowerment for the young person playing it? According to a 2008 randomized control trial published in the journal Pediatrics, this video game intervention “significantly improved treatment adherence and indicators of cancer-related self-efficacy and knowledge in adolescents and young adults who were undergoing cancer therapy.”

For those who enjoy them, video games provide hours of satisfying play and escape from day-to-day challenges. A recent study examining the brain activity of patients who played this game provides a glimmer of how it translates into better adherence to the regimen necessary to battle cancer. Using functional magnetic resonance imaging technology to observe the reward circuits in their brains, 57 patients were assigned to either play or watch the Re-Mission video game. The result, as reported in a press release:

“Active involvement in video game play sparks positive motivation in a way that watching and hearing information does not,” said Steve Cole, Ph.D., Vice President of Research and Development at HopeLab, professor of medicine at the University of California, Los Angeles, and co-author of the article. “All participants in the study received the same information. It was the active participation in gameplay that made the big difference in motivation. This study helps refine our ‘recipe for success’ in harnessing the power of play in the service of health.”

Many libraries have embraced gaming as a way to connect to patrons. Imagine a library with a collection of video games with the artistry of the biggest sellers that promoted healthy living, and help young people cope with life’s challenges. Such an image gives this librarian hope that we might begin reversing the epidemics of obesity and other preventable diseases in this country.

Have you or someone you know played Re-Mission? What other health-inspiring video games would you like to see? Tell us about it!

It will be implemented by providing funding for nine “Acton Coalitions” across the country, each one working ”on at least one strategy related to academic progression and at least one related to employment for baccalaureate or higher-prepared nurses, to ensure demand for their services. Thus, academic-service partnerships are key to the success of this effort.”

From this author’s perspective, one question arises: are representatives for the libraries that will serve these students being included in these efforts? Some nursing professionals seeking their B.A. will likely enroll in online courses that allow flexibility in order to mesh with their own hectic schedules. Are library professionals going to be available for these new/returning students at all hours? How will they be taught the basics of information literacy applicable to earning such a degree? This initiative seems likely to bring many more into our libraries, and while we welcome the opportunity to serve, advance planning and coordination would greatly increase the likelihood of success for this initiative.

Are you or someone you know involved with an Action Coalition? How are libraries being included? Tell us!

• Easy to open packaging
• Easy entry & removal of the iPad
• A pictorial guide on how to use the sleeve.

The article summarizes its findings thusly:

While no medical device or sterile barrier can guarantee sterility if improperly used, this device appears to satisfy regulatory requirements for sterile barriers and, when used with an iPad that has been appropriately cleansed, should satisfy most hospitals’ requirements for operating room use.

Have you tried this covering on your iPad? How did it work for you? Tell us!

73 percent of users said they would not be OK with an online search engine keeping track of their queries even if the data provides personalized results in the future. And 68 percent said they were not OK with targeted advertising because they don’t want their online activities tracked and analyzed.

Google is the preferred search engine for most online searching, though people surveyed don’t want information about their searches tracked. Yet unless you take steps to make sure this information is not collected, Google tracks it. And its search algorithms that include this information are what provides users with  the results they like. In a sense, we want it both ways: quality search results and privacy protections.

This is an area ripe for research: if we could define and control what information search engines and other online service providers can collect, would end users’ satisfaction with search engines change?

What do you think? Tell us!

This practice can be applied to the clinical setting as well. When prescribing medication or other treatments, physicians can ask their patients to tell them what they’ve just learned. The Amednews blog gives one example of how to make this happen, as offered by one physician:

“The way I do it is to ask, ‘When you get home tonight, your husband or wife will probably want to know what happened. What are you going to tell him or her about what you and I agreed to in the office today?’ ” Dr. Zeitz says.

“If they can’t tell me what it is they need to do in the format of talking to their spouse, that means they’re not in command of the material, and I haven’t gotten them to successfully understand it. If I see they’re not in command, then I take another crack at it.”

This post goes on to cite data that should give physicians pause before assuming that all patients understand instructions received:

• Nearly 90% of U.S. adults are less than proficient in reading medical information.
• 3 of 4 of people with limited literacy do not tell their doctors about it.

Are you a physician or clinician who faces these challenges? If so, how do you help patients understand complex information? Tell us about it!

Reference:

O’Reilly, K. B. (2012). amednews: The ABCs of health literacy. March 19, 2012  Retrieved March 20, 2012.

• Download the new issue each Thursday, and store all downloaded issues in a personal library
• Bookmark articles, images & figures
• Watch clinical medicine videos
• Listen to an audio summary for each issue
• Capture and save article notes, and even share them via email, Facebook & Twitter

Non-subscribers view a fully functional free issue, preview the table of contents for each issue and read Online First articles. App-only subscriptions of the NEJM are $14.99 per month, and purchase of a single issue is $5.99 each. At first glance, it does not yet appear that institutional subscribers can use this app to access NEJM, which is a significant oversight. Many faculty, researchers and physicians here at the University of Utah rely on the NEJM, and if a clinical reference tool such as LexiComp can provide an institutional version of their software, so can a top-notch journal publisher.

In downloading the iPad app, I discovered the NEJM Career Center, an iPhone/iPad app that, like its website counterpart, will help physicians search listings of physician and locum tenens job listings by location, specialty or position type. It notifies users of new jobs that match their search criteria, and allows them to email or tweet jobs to themselves or their personal networks.

If you want to keep up on the latest researched published in NEJM, subscribe to their weekly audio summaries podcast, NEJM This Week. Each podcast is 20-25 minutes long, and includes new medical research findings, review articles, and editorial opinion pieces on topics related to biomedical science and clinical practice.

Do you use any of the NEJM apps? What do you like or dislike about them? Tell us about it!

The results suggest that most caregivers seek health information from a variety of resources, including print, non-print media (such as television and radio), family & friends. Because health care professionals are the primary, most-trusted source of information, the authors encourage health care professionals to be mindful of these caregivers’ potential lack of HL skills, as it can be a source for poor communication between these groups.

While the data obtained in this study is helpful, and is based on previous research, the authors’ hard work is presented primarily in text and tables. Comparisons of their findings to previous research are done entirely in text, where perhaps a graph or other visual form would make it clearer and more understandable.

• When: Thursday, March 22, 2012
• Meet ‘n’ Greet Reception: 3:30 p.m.
• Lecture: 4:15 p.m.
• Where: Eccles Institute of Human Genetics Auditorium (15 N 2030 E, Salt Lake City, UT)
• To view online, read a brief bio of Dr. Lindberg, or for more information, visit the event page on the BMI website.

Dr. Lindberg is a scientist who has pioneered applying computer technology to health care beginning in 1960 at the University of Missouri. In 1984 Lindberg was appointed Director of the National Library of Medicine, the world’s largest biomedical library. From 1992-1995 he served in a concurrent position as founding Director of the National Coordination Office for High Performance Computing and Communications (HPCC) in the Office of Science and Technology Policy, Executive Office of the President.

The spots you are seeing on the photographs are not the result of a dirty lens. It’s the dust from all the sanding going on!

The story goes on to cite the story of a 32-year old automobile accident victim, who could not move his left hand, arm or leg immediately after the injury. Use of the high-definition fiber tracking showed that the nerves serving the hand had greater damage than those for the arm and leg. The patient is now walking and using his arm, but cannot open his hand.

Knowledge is power, and for a person with TBI, it would be immensely helpful to know that a lack of progress in recovering is not due to a lack of effort on their part. In the future, scans like these might also be used to track and learn about how our brains grow new nerve connections.

The case report on this was published today in the Journal of Neurosurgery.

What scientific technological breakthroughs do you predict we will see in this decade? Tell us!