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 occured 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.
Thursday, July 9, 2009
Thursday, May 21, 2009
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 1st 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:
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:
2 same result if you input myocardial infarction. No link is suggested between the two terms by W|A.
Search Principle Blog
Mr.W's lecture at Berkman Center, Harvard
The NYT
The Register's not-so-glowing review
(for more see 1st 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.
Thursday, May 14, 2009
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?
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?
Thursday, April 16, 2009
Dealing with emotions: challenge
Today I want to gather my thoughts on what happens sometimes when I am faced with trying to help a patient who is suffering emotionally and so the consult ends up being about more than just finding information. When this happens, not too often thankfully, I am sometimes left with the feeling that I could and even should have done something differently, but at a loss as to how.
Health care professionals are formally taught how to communicate and establish trusting, humanistic relationships with their patients (though of course not all will excel at this).1 2 3 4 For obvious reasons, librarians/info professionals do not get such training. We are taught how to conduct a reference interview, sure, but not exactly what to do if a patient is referred to you and then angrily questions what you can do for them. They look from you to the computer and flat out state (with maximum scorn) that they could do what you are about to do for themselves and with the same results. They are not a "problem patron." You know they are suffering from anxiety, or depression, or have just been diagnosed with colon cancer and that their emotions are understandably running high, but you have no script, no checklist to smooth the interaction. Do you sympathize? Do you try to lighten the situation? Do you engage or remain impassive and try to conduct business as usual?
In situations like these my instinct is to throw the idea of finding information out the window in favour of just listening. I know a little bit about active listening (from life as well as from library school) so I try to paraphrase what is being said to me, while repeating as many times as possible that I understand their frustration, that I *might* be able to find something they have missed in the course of their own searches on Google (or at least validate that their search was well done), and that I will be available when they are ready if today is not good.
But this just an instinct. And once in a while I get flustered. Then I forget the above and I try to forge ahead, to prove myself by finding something useful, sometimes unsuccessfully (because of aforementioned flustered-ness). This of course undermines the trust that I am hoping so much to establish, and leaves me feeling inadequate and inadequately prepared.
Either way I have no real formal training to deal with such situations, and no way to establish whether my instincts are correct except based on how the situation resolves itself (i.e. are they still angry when they leave? Did they come away with something useful?). My thinking is that some of the literature developed for health professionals might be of service (just the reading from today was helpful). I wonder if any other information professionals working in my area of speciality have faced this kind of problem and how they have sought to resolve it. Your thoughts are welcome.
1 Branch WT, Kern D, Haidet PWeissmann P et al. The Patient-Physician Relationship. JAMA 2001;286(9):1067-1074. Accessed April 16 from: http://jama.ama-assn.org/cgi/content/abstract/286/9/1067
2 Gask L, Usherwood T. ABC of psychological medicine: The consultation [clinical review]. BMJ 2002;324:1567-1569. Accessed April 16 from: www.bmj.com/cgi/content/full/324/7353/1567
3 Bedell SE, Graboys TB, Bedell E, Lown B.. Words That Harm, Words That Heal [commentary]. Arch Intern Med. 2004;164(13):1365-1368. . Accessed April 16 from: http://archinte.ama-assn.org/cgi/content/full/164/13/1365
4 Hastings A. The Good Consultation Guide for Nurses. s.l.*:Radcliffe Publishing;2006.
*As a total aside- how come both Google Books and Amazon do not include location in their records? Very frustrating. I do not have the patience to check more than 3 sources today (also checked McGill's catalogue to see if they had a copy but no luck). Hopefully my readers will forgive my laziness:-b
Health care professionals are formally taught how to communicate and establish trusting, humanistic relationships with their patients (though of course not all will excel at this).1 2 3 4 For obvious reasons, librarians/info professionals do not get such training. We are taught how to conduct a reference interview, sure, but not exactly what to do if a patient is referred to you and then angrily questions what you can do for them. They look from you to the computer and flat out state (with maximum scorn) that they could do what you are about to do for themselves and with the same results. They are not a "problem patron." You know they are suffering from anxiety, or depression, or have just been diagnosed with colon cancer and that their emotions are understandably running high, but you have no script, no checklist to smooth the interaction. Do you sympathize? Do you try to lighten the situation? Do you engage or remain impassive and try to conduct business as usual?
In situations like these my instinct is to throw the idea of finding information out the window in favour of just listening. I know a little bit about active listening (from life as well as from library school) so I try to paraphrase what is being said to me, while repeating as many times as possible that I understand their frustration, that I *might* be able to find something they have missed in the course of their own searches on Google (or at least validate that their search was well done), and that I will be available when they are ready if today is not good.
But this just an instinct. And once in a while I get flustered. Then I forget the above and I try to forge ahead, to prove myself by finding something useful, sometimes unsuccessfully (because of aforementioned flustered-ness). This of course undermines the trust that I am hoping so much to establish, and leaves me feeling inadequate and inadequately prepared.
Either way I have no real formal training to deal with such situations, and no way to establish whether my instincts are correct except based on how the situation resolves itself (i.e. are they still angry when they leave? Did they come away with something useful?). My thinking is that some of the literature developed for health professionals might be of service (just the reading from today was helpful). I wonder if any other information professionals working in my area of speciality have faced this kind of problem and how they have sought to resolve it. Your thoughts are welcome.
1 Branch WT, Kern D, Haidet PWeissmann P et al. The Patient-Physician Relationship. JAMA 2001;286(9):1067-1074. Accessed April 16 from: http://jama.ama-assn.org/cgi/content/abstract/286/9/1067
2 Gask L, Usherwood T. ABC of psychological medicine: The consultation [clinical review]. BMJ 2002;324:1567-1569. Accessed April 16 from: www.bmj.com/cgi/content/full/324/7353/1567
3 Bedell SE, Graboys TB, Bedell E, Lown B.. Words That Harm, Words That Heal [commentary]. Arch Intern Med. 2004;164(13):1365-1368. . Accessed April 16 from: http://archinte.ama-assn.org/cgi/content/full/164/13/1365
4 Hastings A. The Good Consultation Guide for Nurses. s.l.*:Radcliffe Publishing;2006.
*As a total aside- how come both Google Books and Amazon do not include location in their records? Very frustrating. I do not have the patience to check more than 3 sources today (also checked McGill's catalogue to see if they had a copy but no luck). Hopefully my readers will forgive my laziness:-b
Thursday, April 2, 2009
Update
Jeez! Has it really been more than a month since I've posted? (I must apologize to Lori who commented on my last post way back in Feb. but the comment got held up for moderation and I never got an email notifying me- I have now changed back to unmoderated commenting). I guess the reason for my lacklustre attendance on my own blog is that I have been very busy running the service, which is a good thing right? Right!
Since my last confession I have had my contract here renewed (mostly officially) for another three years. I am very excited to be able to stop trying to prove the service is worthwhile and begin providing it full time. Well, full seven hours anyway.
I have my time divided on a weekly basis now, between the teaching room and my "office", so that means I've got three point five hours to do everything administrative, and still provide support for anyone who walks in the door which happens more and more these days, and maintain the pamphlet collection which gets used quite a lot judging by the "missing teeth" I find every Thursday afternoon, and maintain the website which got over 1500 visitors since January. I am not in any way complaining! I love feeling needed.
Tuesday afternoons in the teaching room are great. I get to meet whichever resident is working that day (usually somewhere between three and six) and continue to form new working relationships with them. It's very useful for me to be behind the scenes.
Being there means being able to find teachable moments (rather than just provide information) although this is a skill which I will need to improve. On-the-fly teaching is different than presenting prepared subject matter. I also need to get over feeling weird about teaching doctors. It's one thing to show a surgeon how to use EndNote properly, quite another to step in and say to a GP, here's how you could be doing your job better in this particular area.
It also , and I'm sure I've said this before, allows me to get a much better sense of how the team actually works and what patients really need. It is as important for me to identify information needs of patients and make sure they are being met as it is for me to acknowledge those cases where information is not called for. I now have a real appreciation for how difficult it sometimes is for a GP to figure out what the patient is even there for (similar to conducting a reference interview when your patron doesn't know what their own question is). And we all do it don't we? We all find ourselves in bookstores and libraries and doctor's offices not really knowing what to ask or why we're there. By listening in I can sometimes identify certain needs that are not being recognised by either the GP or the patient.
So that's my little update. I will try to post a case soon...
Since my last confession I have had my contract here renewed (mostly officially) for another three years. I am very excited to be able to stop trying to prove the service is worthwhile and begin providing it full time. Well, full seven hours anyway.
I have my time divided on a weekly basis now, between the teaching room and my "office", so that means I've got three point five hours to do everything administrative, and still provide support for anyone who walks in the door which happens more and more these days, and maintain the pamphlet collection which gets used quite a lot judging by the "missing teeth" I find every Thursday afternoon, and maintain the website which got over 1500 visitors since January. I am not in any way complaining! I love feeling needed.
Tuesday afternoons in the teaching room are great. I get to meet whichever resident is working that day (usually somewhere between three and six) and continue to form new working relationships with them. It's very useful for me to be behind the scenes.
Being there means being able to find teachable moments (rather than just provide information) although this is a skill which I will need to improve. On-the-fly teaching is different than presenting prepared subject matter. I also need to get over feeling weird about teaching doctors. It's one thing to show a surgeon how to use EndNote properly, quite another to step in and say to a GP, here's how you could be doing your job better in this particular area.
It also , and I'm sure I've said this before, allows me to get a much better sense of how the team actually works and what patients really need. It is as important for me to identify information needs of patients and make sure they are being met as it is for me to acknowledge those cases where information is not called for. I now have a real appreciation for how difficult it sometimes is for a GP to figure out what the patient is even there for (similar to conducting a reference interview when your patron doesn't know what their own question is). And we all do it don't we? We all find ourselves in bookstores and libraries and doctor's offices not really knowing what to ask or why we're there. By listening in I can sometimes identify certain needs that are not being recognised by either the GP or the patient.
So that's my little update. I will try to post a case soon...
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