Unreliable-reliable information: case

The other day I was in the teaching room and I was putting out some of the new brochures I ordered on the topic of contraception. We have a little display in there so the residents can grab something quickly when I'm not at the clinic.

Information about choosing a contraceptive method is one of the most commonly requested handouts and we keep running out. I found what I thought was a really good one produced by the Society of Obstetricians and Gynecologists of Canada (SOGC). You can't get more reliable and authoritative than that, I figured. I still think that... but....

One of the supervisors opened one up- they look like little brochures but actually they are little posters folded up nicely. When you unfold them you get a comparison chart at the top that shows the number of unintended pregnancies for all the different methods, from Intrauterine system (IUS), through Oral contraception, Condoms, Diaphragm etc., all the way to No contraception (no surprise, pretty high failure rate here: 850 out of 1000, or 85%).

It struck the doctor as odd that Intrauterine device (IUD) had such a high failure rate compared to the others (9 out of 1000 with perfect use vs 3 out of 1000 for the pill for example). It did seem a bit odd. Also for typical use there was a little "-" instead of a number, implying what I'm not sure. No data? Zero failure rate? An asterisk next to the 9 brings you to a little footnote: "This perfect use failure rate corresponds to the Nova-T 200. The typical use failure rate for the Nova-T 200 is likely slightly superior." So then shouldn't there be a number there instead of "-", maybe a higher number than 9?

I decided to check out the references listed right below the chart: Trussell 2007, Trussell 2004, Black 2004* and Andersson 1994.

The paper that seems to have provided the data for the chart is Trussell 2007, or complete reference:

Reducing unintended pregnancy in the United States
Contraception, Volume 77, Issue 1, Page 1
J. Trussell, L. Wynn doi:10.1016/j.contraception.2007.09.001

I am still a bit confused. The paper has a table that shows numbers that correspond exactly to all the other data in the chart except for under IUD we have:

Contraceptive method Typical use Perfect use

IUD
ParaGard (copper T)	0.8	0.6
Mirena (LNG-IUS)	0.2	0.2

So where is the Nova-T 200? And how come the above numbers aren't used? I did not find Nova-T 200 data in the other papers either. Provided I found the right ones.**

I still think the handout is great. It provides much more than just data. Aside from the chart there is information about all the contraceptive methods, what they are, how they work, advantages, disadvantages, stuff that will certainly help people make informed choices. And if they have any questions they can discuss with their GP.

However it is interesting to see that even information provided by the most authoritative sources can be flawed. Considering all the shocking debacles we have seen recently, Elsevier's fake journals, authors ghostwriting for pharmas, this is just one more reason to start assessing the contents of individual resources, and not rely so much on authorship.




* These are the Canadian contraception guidelines: http://www.ncbi.nlm.nih.gov/pubmed/15115624

** Once again, is it too much to ask that people provide the full reference? Some authors are prolific. It took me a while to figure out which Trussell 2007, and which Trussell 2004 etc. Still not sure about all of them. It shouldn't be so hard.

Picky eaters: case

It's time to revisit picky eaters.

Scenario

A mother comes to see me in my office carrying her 12 month old son who, she tells me, refuses to eat meat. Luckily he will eat just about anything else. She does not want to force him to eat meat, but no one else in the family is vegetarian so she is not sure how to make sure he's getting enough of the vitamins and minerals he needs.

Resolution

I am able to find quite a few good resources that provide information about vegetarian diets for children:

KidsHealth: Vegetarianism
KidsHealth: Snacks for Toddlers
KidsHealth: Toddlers at the table- avoiding power struggles

Vegetarian Society: Infant diet

Caring for Kids: Feeding your vegetarian child

NOAH: Vegetarian diets (for babies)

Challenge: Knowledge translation

Since the CHLA conference I've been thinking a lot about knowledge translation (KT) and what it means to me and for me i.e. how I understand the concept and how I can put it into practise.

KT came up a lot in the presentations at the conference and on the Tue before I left an entire panel was devoted to discussing it. Three panelists, Orvie Dingwall, MLIS Librarian and Project Manager CPSI-ICSP ( Presentation, Handout), Sara Kreindler, DPhil Winnipeg Regional Health Authority - Research & Evaluation Unit, and Elizabeth Hydesmith, MSc Senior Project Manager NCCID, discussed KT in their organizations (can I take a moment to say kudos to CHLA for making almost all papers and posters immediately available on their website? It would be great if MLA did the same*). While the panel was very interesting it left me wondering what KT means in a hospital library or consumer health resource setting. Dr. Thomas Kerr also mentioned KT in his presentation, Bridging the Gap between Evidence, Policy and Public Opinion: Lessons from the Scientific Evaluation of Vancouver's Supervised Injection Site, and it was he who gave me an idea. More in this later...

It hasn't been easy to find a "plain language" explanation of what KT actually is (CIHR, IDRC) (WHO's isn't bad) which is kind of ironic. I'm not ashamed to admit that KT is term that I was not familiar with before the conference. In my last semester at library school, which I completed at McGill, I was briefly introduced to another "K" term, Knowledge Management or KM, but not to KT. Neither came up in my studies at Dalhousie. I won't try to speculate as to why and don't feel that I was cheated out of anything since I was given the tools to understand the concepts. I think catchphrases and buzzwords are useful, up to a point. Even scholars of KT aknowledge there is some confusion about KT and related terms such as knowledge transfer, knowledge exchange etc. (Lost in translation: Time for a map?, IDRC). I honestly couldn't have stood the discussion that would have ensued, considering how much time we spent on the data vs information vs knowledge debate (only slightly less annoying than the art vs craft debate I suffered through at NSCAD).

The important thing is to own a concept, to understand it on a deep enough level that it becomes part of how you behave and your decision-making process, regardless of what word(s) you use to describe it. This is the very process KT is concerned with and jargon can interfere, as acknowledged by the existance of KT opportunity 3, identified by CIHR, which urges the use of "plain language."

Now we are getting to the "in" that I was looking for. Consumer health information is all about "plain language" and bridging what WHO calls the "know-do" gap. So providing patients and families with easy-to-read health information falls within the KT realm. But there has to be more to it than that since I work with health professionals as well as consumers. KT opportunities 4 and 5 allow me to take things a bit further.

This is in fact a solution to a problem I've been mulling over for some time. Since I have been working in the teaching rooms at the Herzl, and I don't have precedent for my service (except one, now defunct), I wanted to have some way, other than just saying so, to show the residents and their supervisors that what I do is evidence-based and not just an idea I came up with and was able to convince a few doctors was a good idea.

It was clear to me that I could not expect anyone to read the needs assessment proposal I wrote several years ago which included an extensive lit review of such concepts as health literacy, shared-decision-making, the doctor patient diad, patient empowerment etc, and how the participation of a librarian and the provision of consumer health information can positively impact all of the above. Nor could I expect them to study the detailed report on the results of that needs assessment.

I needed a much simpler and quicker way. Dr. Kerr mentioned having used "plain language summaries of SIF research" called Insight into Insite. It occurred to me that I could do something similar, one page evidence-summaries on a few relevant topics. Obviously I am not communicating the findings of my own research, but there is research to support what I do, research that can serve to encourage use of my service. Behold the first one of what I hope to be a series: Health information in multiple languages at Herzl. Where do "multidirectional communications and ongoing collaborations among relevant parties, interdisciplinary process etc" come in you might ask? Well, I am using research generated by both librarians and health professionals, and before sending my little summary out I showed it to one of the physicians I work with the most, who suggested an article I might add to it.

At some point I would like to expand to the rest of the hospital, and put out evidence summaries under the library umbrella as well.

*A few hours after writing this post I received my MLA Focus which announced that "full video/audio with synchronized slides of MLA plenary sessions"are now available to members only via the website.

Wolfram Alpha: "computational knowledge engine"

Wolfram|Alpha has been in the news/blogosphere lately.

Search Principle Blog
Mr.W's lecture at Berkman Center, Harvard
The NYT
The Register's not-so-glowing review
(for more see 1^st item in this list)

I've spent a bit of time fiddling with it to see what it can do and whether it might be useful for either myself, health consumers or the health professionals I work with.

So far I have found one potential use which is to look up disease mortality rates. If you type in lung cancer for example, you will get Canadian & world mortality figures (number of deaths & rate of death, per year). If you type lung cancer Italy, you get the results for that country & the world.

More interesting is the list¹ of background sources and references that pops up when you click on source information for the original query. In this case:

• World Health Organization. "Data and Statistics" 2009.
• Centers for Disease Control and Prevention. "National health Center for disease Statistics." 2009.
• Centers for Disease Control and Prevention. "NCHS--Mortality Data from the National Vital Statistics System." 2008.
• The Disaster Center. The Disaster Center. 2009.
• [Poodwaddle.com.] World Clock. 2009 This one is mesmerizing and creepy. I'm not sure that Poodwaddle is an entirely credible source (possibly why Wolfram|Alpha leaves that bit of info out), but whoever they are the data apparently comes from "World Health Oragnization, CIA Factbook, US Census Bureau and other sources."
• Centers for Disease Control and Prevention. "NCHS--Data Warehouse." 2008.

I guess potentially this is a very quick way to find sources that offer statistics for a particular disease, though you still have to search the resources to find the specific data. Unfortunately Canadian resources are not included. Also not sure which diseases are in there. Only one way to find out...

...even more interesting:

Type in heart attack and you get a risk calculator (based on Framingham) that lets you input age, gender, cholesterol levels, blood pressure, and risk factors, and which then computes the likelihood that the person whose data is inputted will die from a heart attack in the next ten years.² You are also shown the impact of cholesterol and blood pressure on risk.

I look forward to testing it out further over time. My biggest concern is how reliable and authoritative the information we are getting is. So far my confidence has not been inspired,¹ and I'm not ready to recommend it except as something with potential that's fun to play with. Try asking it how old it is.

Cheers,
FF


¹ Here's what W|A has to say about the list:

This list is intended as a guide to sources of further information. The inclusion of an item in this list does not necessarily mean that its content was used as the basis for any specific Wolfram|Alpha result.

Hmm. Interesting way to cite your sources. Not sure this would wash in a term paper. I have a feeling the issue will come up again (it was also mentioned in the question period of Mr.W's lecture at Berkman Center, Harvard.)

² same result if you input myocardial infarction. No link is suggested between the two terms by W|A.

Meta post: challenge

"What is the brand of this blog?" This is a topic that a former classmate of mine wrote about not too long ago. Now that I reread his post, and more specifically my response to it, I realize that this has been an issue for a while and here I am still thinking about it. Maybe I should take my own advice.¹

One of the blogs I read on a regular basis² is Caveat lector. I think one of the reasons I read it is precisely because Dorothea Salo will write about anything she feels like, most unapologetically. Sometimes that's music, and sometimes it's weekend hikes or loons, though mostly it's to do with librarian/web geekery. Much of it goes over my head to be honest (see footnote no. 2), but that's okay. I don't have to read every post. I also really like Learn to live which is sporadically peppered with posts about non-consumer health related things such as sushi and birds.

So I guess what I'm doing is giving you fair warning that I will henceforth be addressing topics other than consumer health and/or my service. That I will, gasp!, at times be writing about something entirely unrelated to librarianship.

For instance, have I mentioned how proud I am of my non-Luddite grandmother? Over the past 40 years she has slowly transformed a garbage dump into a public garden.³ My sister made a documentary film about it called Pupa's garden which some of you may have the chance to watch someday. It's also a film about my aunt who had MS and how my grandmother found solace in helping green things grow while her daughter's health slowly and drastically failed. There has never been a more poignant illustration of the dicotomy between life and death. And such beauty!

1 Is there a librarian equivalent for physician heal thyself?
2 I don't publish my blogroll here partly because I haven't gotten around to figuring out how- I am still and happily, despite everything, a bit of a vestigial Luddite.
3 How many grandmother's have websites?