Medical Resident Resource Use Trends: Looking at the Past to Inform Future Decisions

Objective: Since 2006, the University of Tennessee’s Preston Medical Library (PML) has collected survey feedback from exiting residents. One question asks residents which types of articles or sources they use to find information. In this study, we examine responses to this question, assessing the change in resident utilization of resources to better inform future library decisions on instruction and marketing. Methods: Surveys were distributed to exiting residents through targeted emails or at the required exit process in the library. The question asked them to select which types of articles or sources they used to find information from among the 16 options currently listed, including an “other” box with free text functionality. The resident can select any number of options. Some options have changed over time as resources have ceased to exist, merged, or been cancelled. Survey results were examined from each year, noting how many times each resource had been selected and the total number of residents taking the survey. Results were compiled by resource usage per year and particular resource usage over the study’s timespan. Results: Results indicated changing resident use of PML’s resources. Of note, we found UpToDate usage to be remarkably consistent, with 80% of residents, on average, selecting it every year. Usage of reviews, RCTs, case reports, and practice guidelines generally increased over the survey period while use of Google, colleagues, and librarians modestly decreased. Conclusions: Resident resource usage varied over time, demonstrating an encouraging increase in attention to other evidence-based tools. UpToDate’s consistent popularity shows the durability of the product. The increase in resource type (reviews, RCTs, case reports, practice guidelines) selection reflects greater employment of more in-depth resources than merely expert opinion. Survey results will inform future outreach focus

Thinking Outside the Box to Square the Circle: Realigning Library Services with Stakeholder Needs

Objectives: In an age of electronic databases and Google, librarians must find ways to expand library services to meet the needs of patrons who no longer seek some traditional services. How do we identify needs in our organizations that are not being met, and market our abilities to fill those needs while maintaining our identity as librarians? Methods: With the full support of the library director, whose priority was to update academic and clinical services, newly hired librarians took time to observe the initiatives and goals already established across their respective residency and nursing departments. Despite increased liaison activity, decreasing demand for literature searches led us to investigate other ways we could serve the departments. We discovered needs that librarians could help with such as: assisting with surveys and pretests, measuring research impact, growing institutional knowledge through tutorials and archives, finding grant opportunities, and dealing with technology questions. A search of the literature and recent job postings provided additional ideas for value-added services, as well as best practices for identifying needs and building patron relationships. Results: Librarians focused on outreach, listened to their stakeholders’ pain points, and offered to take on different kinds of projects. This required additional training in some cases, flexibility and willingness to fail, and undertaking responsibilities that might be seen as outside a librarian’s normal duties. However, these new assignments resulted in increased collaboration and visibility for librarians. Conclusions: While there is still a need for librarians in healthcare organizations, they must work harder than ever to market themselves and offer more value-added services. By defining those services through outreach and research, librarians can better align their goals with those of their respective stakeholders

Analyzing point of care tools through faculty, resident, and stakeholder buy-in: a cautionary tale

Purpose: Costs for Preston Medical Library’s primary point-of-care (POC) clinical tool have increased to half of the acquisitions budget, while user affiliation data have not been provided to facilitate cost sharing. In response, user preferences for POC tools were analyzed to determine a viable, less expensive alternative to the current subscription. Setting/Participants/Resources: Faculty and residents at the University of Tennessee Graduate School of Medicine (GSM), and other clinical staff at the University of Tennessee Medical Center (UTMC), a 685-bed teaching hospital. Methodology: At the direction of school leadership, a working group of library staff, resident physicians, and medical faculty members was appointed, and data were gathered through individual user surveys of clinical support tools. Three POC tool options were considered. Select clinicians evaluated the tools using a series of questions individually chosen as typical to their disciplines. Additionally, feedback was sought from other AAHSL institutions regarding subscriptions to the tool in question and funding schemes. At the same time, the Dean communicated to the medical campus community that cost increases for the product had become prohibitive, requiring consideration of alternatives. Results/Outcomes: Survey responses revealed a strong preference for the incumbent tool, rating PubMed as the second preferred source, but not substitutable. Working group members preferred the current product at POC, judging one of the candidate tools as “adequate” but less user friendly and more time consuming to access. Hospital leadership also received responses from clinical staff. As a result, a cost sharing agreement with the school was forged. Discussion/Conclusion: A deliberative approach to assessing POC clinical tools was used, resulting in continued access to the preferred product. Enhanced data gathering on a go-forward basis will help to ascertain use patterns by academic and hospital users. The library and the other stakeholders will monitor development of alternative POC tools and costs for future decision making

Elevating Library Practice through Process Improvement Teams: The Electronic Resources Task Force

Objective Organizations in fields from manufacturing to health care use process improvement teams, an important aspect of LEAN practice, to improve their work. The library faced challenges with interfaces for electronic resources, including a dated electronic journals interface, out-of-control LibGuides, and lack of control over our web presence. The library formed the Electronic Resources Task Force to foster a collaborative approach to solving these problems. This poster will show techniques used and what we accomplished. Methods The library experienced many changes in the last year including changes in leadership and staff. With our new director’s emphasis on improving electronic access, new staff members, and a staff member’s recent training in Lean, we had a great opportunity to incorporate new techniques in team development. Our goal was to provide attractive, modern, and seamless access to evidence-based, high quality information resources. To share information and improve accountability, the team developed a shared flowchart document that allows any team member to update progress on any task at any time. The team meets regularly, further improving accountability and providing opportunities to address electronic resources and collections issues as a group. Results To date, the Electronic Resources Task Force has reduced the number of active LibGuides from 71 to 33 updated guides. Our transition to EBSCO’s Full Text Finder is complete. Additionally, we developed a new search box for LibGuides, introduced a LibGuides-based Databases A-Z page, updated LibAnswers, and rolled out a new literature search form and database. The team continues to follow up on a list of future improvements. Conclusions Incorporating Lean into our work is ongoing, as is our staff member’s training in these techniques. However, we can conclude that the techniques originally developed in manufacturing and being used in healthcare can also be used to improve library work

Collaborating across Organizations for a Remote Area Medical Event: Providing Consumer Health Information and Assessing Health Literacy

Objective: The University of Tennessee’s Preston Medical Library’s (PML) consumer health information service partnered with local librarians and Remote Area Medical (RAM) to increase consumer health information access as well as assess health literacy levels of RAM attendees. Methods: Librarians contacted RAM and obtained permission to both participate in the Knoxville, TN event and conduct anonymous health literacy assessments using the Newest Vital Sign (NVS) tool. Approval was obtained from PML’s institutional IRB. An email gauging participation interest was sent to local librarians at various institutions. A Zoom meeting was then set up to discuss RAM and participant expectations. A librarian with previous experience of partnering with RAM spoke at the meeting about his experiences and answered questions. Librarians volunteered for specific times so that two people were always at the library’s information table. Results: Ten librarians from across four different academic institutions attended the February RAM event and staffed a table with consumer health information handouts, health information request forms, and other informational materials. 137 people visited the table and 13 filled out health information request forms. Mental health was the subject area most frequently requested. Sixteen participants completed the NVS health literacy assessment tool. Results indicate that the majority of participants likely had adequate health literacy. Conclusions: Participating in the RAM event allowed for collaboration with multiple institutions in the local area, further building relationships for future collaborative efforts. Through participating in the Knoxville RAM event and analyzing collected data, researchers sampled health literacy of RAM attendees and planned more focused consumer health information outreach. Two other RAM events in east Tennessee were cancelled due to the COVID-19 pandemic; the library will participate in the annual Knoxville RAM event on a continual basis

Enhancing Learning and Collaboration in Organisations through In-house Crowdsourcing

Learning and innovation are central to organisations’ development. Insights and innovative ideas occur to individuals. However, learning in organisations takes place at several levels which include individuals, groups, and the organisation itself. Thus, there is a need to enhance the transfer of insights, ideas, and concerns from individuals to groups and to the organisation. This paper explores the role of in-house crowdsourcing and the design of interactive technologies for organisational learning. We build upon our earlier work on the use of interactive technologies for organisational learning. The main research contribution of this work is the conceptualisation of in-house crowdsourcing scenarios to support the design and development of interactive technologies for organisational learning

Mapping services at two Nairobi County primary health facilities: identifying challenges and opportunities in integrated mental health care as a Universal Health Coverage (UHC) priority

Abstract: Introduction There is a need to scale-up mental health service provision in primary health care. The current extent of integration of mental health in primary care is pertinent to promoting and augmenting mental health at this level. We describe a facility mapping exercise conducted in two low-income/primary health facilities in Kenya to identify existing barriers and facilitators in the delivery of mental health services in general and specifically for peripartum adolescents in primary health care as well as available service resources, cadres, and developmental partners on the ground. Method and measures This study utilized a qualitative evidence synthesis through mapping facility-level services and key-stakeholder interviews. Services-related data were collected from two facility in-charges using the Nairobi City County Human Resource Health Strategy record forms. Additionally, we conducted 10 key informant interviews (KIIs) with clinical officers (Clinicians at diploma level), Nurses, Community Health Assistants (CHAs), Prevention of Mother-to-child Transmission of HIV Mentor Mothers (PMTCTMs), around both general and adolescent mental health as well as psychosocial services they offered. Using the World Health Organization Assessments Instrument for Mental Health Systems (WHO-AIMS) as a guideline for the interview, all KII questions were structured to identify the extent of mental health integration in primary health care services. Interview transcripts were then systematically analyzed for common themes and discussed by the first three authors to eliminate discrepancies. Results Our findings show that health care services centered around physical health were offered daily while the mental health services were still vertical, offered weekly through specialist services by the Ministry of Health directly or non-governmental partners. Despite health care workers being aware of the urgent need to integrate mental health services into routine care, they expressed limited knowledge about mental disorders and reported paucity of trained mental health personnel in these sites. Significantly, more funding and resources are needed to provide mental health services, as well as the need for training of general health care providers in the identification and treatment of mental disorders. Our stakeholders underscored the urgency of integrating mental health treatment, prevention, and well-being promotive activities targeting adolescents especially peripartum adolescent girls. Conclusion There is a need for further refining of the integrated care model in mental health services and targeted capacity-building for health care providers to deliver quality services

Witness: The Modern Writer as Witness

Editor\u27s Note [Excerpt] The United States, as a society, is on the brink of profound and positive change. Demographically and culturally, things are improving, and the reason is obvious to people who study history: Conflict pushes us to be better, to strive for principled goals. Consider the inspired eco-advocacy of Greta Thunberg. Or the swearing in of most diverse class of lawmakers in history into the 116th Congress. Or billionaire Robert F. Smith’s pledge to pay off every Morehouse College (in Atlanta, Georgia) student’s debt. Indeed, there are many good people helping and great moments happening in spite of a bleak 24-hour news cycle designed to ruin happiness and to limit our understanding of our human potential. We at Witness see this yearning for transformation in the works we selected. The doorway must be crossed, and the voices and characters we featured in our Winter 2019 issue stand at the vestibule, ready for the light to warm them, primed to fight for that necessary illumination.https://digitalscholarship.unlv.edu/witness/1000/thumbnail.jp

Titanium nitride coating of pectus bar increases metal contamination after minimally-invasive repair of pectus excavatum

Introduction Previous studies demonstrated a release of toxic metals, e.g. nickel and chromium, from stainless steel bars used for minimally invasive repair of pectus excavatum (MIRPE). In the present study, we investigated the impact of titanium nitride coating on the metal release and exposure of MIRPE patients. Material and methods We analyzed the courses of nickel and chromium levels in blood, urine and local tissue in patients undergoing MIRPE with a titanium nitride coated pectus bar between 03/2017 and 10/2018. Sample collection was scheduled prior to MIRPE, at defined postoperative time points and at bar removal. Additionally, we evaluated irritative symptoms. Results were compared to a control group who received uncoated stainless steel bars in a previous time period (03/2015–02/2017). Results 12 patients received coated pectus bars (mean age 15.7 years). The control group included 28 patients. After implantation of a titanium nitride coated bar, significant increase in systemic nickel and chromium levels after one, two and three years was noted. In an interim analysis one year after MIRPE, we observed patients with coated bars to have significantly elevated trace metal values compared to the control group. This elevation persisted throughout the observation period. Tissue metal values were also significantly increased. Irritative symptoms occurred significantly more often in study patients compared to controls (50.0% vs. 14.3%). Conclusions Coating of pectus bars with titanium nitride failed to reduce metal contamination after MIRPE. Instead, it resulted in a significant increase of trace metal levels after MIRPE, compared to patients with stainless steel bars, which may be explained by wear of the coating and inter-component mobilization processes. </jats:sec