On the Importance of Getting Away

Work-life balance is essential for a high-performing organization.

You can’t tell, but I am actually on vacation. I’ve taken off on a two-week road trip with a good friend. We’re traveling through the South and Southeast, enjoying friends in Asheville and Birmingham, checking out the music scenes in Memphis and Nashville, and visiting the monument to the Little Rock Nine honoring the high school students who, in 1957, braved physical and verbal abuse to desegregate Little Rock Central High School.

Two weeks of relaxing, reading, learning, visiting, and spa-ing are definitely good things.

I’ve been fortunate to have had many memorable vacations throughout my life, from camping trips in Maine with my parents and nine siblings to quick get-aways to the Jersey shore to some delightful work trips that let my son, Conor, and I add on time to explore parts of Asia, Europe, and South America. I have been lucky to have had the resources to fund vacations and the support of colleagues who made sure the work at home continued while I was away.

Through it all, I have come to realize it is just as important to have spaces between work as it is to have meaningful work.

As a nurse and an industrial engineer, I know that human performance is at its best when one takes breaks to relax and refresh. Inspiration gleaned during a hike through the woods can fuel the next research idea. Appreciating a centuries-old temple can open the mind and put into perspective a particularly knotty work challenge. And cleaning out closets or attending to family matters during a staycation can ease worry and bring a sense of peace that leaves you feeling rejuvenated.

At NLM I encourage staff to take time away. I believe that a high-quality work-life balance is essential for a high-performing organization. It’s important to me as a leader to accept, even support, time away from the office and away from work.

So I urge you—to the extent possible—take time and get away: a week, a weekend, even a day. You’ll return to your work with fresh perspectives and a well-rested countenance.

Remember, too, to help colleagues get away, both through your encouragement and by picking up a bit of extra work, if needed. You’ll learn something, your coworkers will benefit, and your operation will be well on its way to greatness.

What does a glioblastoma look like?

Guest post by James G. Smirniotopoulos, MD, chief editor for MedPix®.

Arizona Senator and former Vietnam POW John McCain was recently diagnosed with the most aggressive form of brain cancer: glioblastoma.  This is the same type of tumor that killed Vice President Joe Biden’s son Beau and Senator Ted Kennedy.

Glioblastoma originates in the brain. It arises from astrocytes,  one of the supporting cells of the brain, and grows by sending tendrils into the surrounding tissue.

Because of its diffuse nature, glioblastoma is not curable. However, surgery to remove as much of the tumor as possible, followed by both radiation and chemotherapy, has improved the prognosis. Median survival rates—which means half the patients live longer and half die sooner—now run 15-18 months, whereas 5-10% of patients live five years following diagnosis. Novel treatments, including immunotherapy, have been effective in some patients.

The symptoms of glioblastoma can vary, depending on the part of the brain in which it occurs. Different parts of the brain perform different functions, so some tumors cause seizures, while others may cause numbness or speech problems. Some of the most common symptoms are:

  • Headaches
  • Nausea and vomiting
  • Changes in your ability to talk, hear, or see
  • Problems with balance or walking
  • Problems with thinking or memory
  • Feeling weak or sleepy
  • Changes in your mood or behavior
  • Seizures

Doctors diagnose glioblastomas and other brain tumors by doing a neurologic exam and tests including an MRI, CT scan, and biopsy.

MedPix®, NLM’s open-access medical image database, includes about 500 images of glioblastomas, largely MR and CT scans, gross photographs, and pathology slides of tumor histology.

For example, the following images show two different glioblastomas. The image on the left is from an MRI (axial, T2-weighted) of Patient A and that on the right is an axial gross cut-section from Patient B. The tumors, outlined in red, show a general similarity in shape and size, and both tumors have distorted the brain and compressed normal structures, like the cerebral ventricles (blue outline) that contain cerebrospinal fluid.

two brain images with the glioblastoma tumors outlined
MedPix images of similar glioblastomas from two different patients show the tumors (outlined in red) pushing on the surrounding tissue and compressing the cerebral ventricles (highlighted in blue).

Launched in 1999, MedPix now holds over 54,000 images from more than 12,000 patients, including unique whole brain sections from the era preceding non-invasive diagnosis using MRI and CT imaging. Designed as a teaching file, the database includes clinical information about each patient, along with their diseases and diagnoses. The medical cases in MedPix have been peer-reviewed and pathologically proven, making them an excellent resource for teaching and learning about disease.

Guest blogger James G. Smirniotopoulos, MD, serves as chief editor for MedPix. Now retired and a special volunteer at NLM, Smirniotopoulos formerly served as a professor and chair of radiology at the Uniformed Services University of the Health Sciences.

Hospital Libraries Matter

Libraries impact clinical decision-making, support hospital functions.

Guest post by Basia Delawska-Elliott and Donna Belcinski, medical librarians serving hospitals in Oregon and Connecticut.

Recently there have been a number of messages going out to medical library discussion lists announcing the unfortunate closing of yet another hospital library. It seems that, in this era of for-profit medicine, libraries are looked upon as luxuries. Yet those of us who work in them know our services are not only needed but valued by the physicians, nurses, and other health professionals who regularly call on us to answer their questions.

Anyone who doubts the need for information professionals in a hospital probably doesn’t understand what we do.

Many people think everything is on Google, and it might be, but it’s not easy to find. Medical literature is found in databases that often require time, patience, and skill to search, and a subscription to access.

Furthermore, someone has to assess the information needs of the hospital community, negotiate pricing for and purchase the resources that best fit those needs, work with vendors and the institution’s IT department to set up access to the resources, and then navigate the resources to retrieve what is in them.

Searching databases takes time, patience, and skill. While it is certainly possible for medical professionals to have the patience and skill, do they really have the time? How many nurses and physicians, in the course of a busy 12-hour shift, can find the time to search the medical literature?

A point-of-care tool can give a quick answer, but if something in-depth or out of the ordinary is required, those tools aren’t usually helpful. More specialized skills and knowledge of how information is organized are needed to answer complex clinical questions. Hospital librarians have not only the educational background, but also the experience to navigate databases and retrieve hard-to-find information.

symbols representing different types of medical information hover over a laptop on which a doctor typesMany people don’t seem to understand what a librarian does, why it’s different from a Google search, and that the “information bubble” is as real in medicine as it is in other disciplines. They may also be unaware that googling can lead to selective retrieval of information and confirmation of bias. The groundbreaking 1992 Rochester study (Marshall) and the 2013 follow up (Marshall) showed the vast majority of physicians changed the course of patient treatment based on library-provided information—80% in 1992, 75% in 2013. This telling statistic confirms that librarian-mediated searches and resources curated by hospital librarians do make a difference.

Every time a hospital library closes, we send out a call to arms and vow to stem the tide of attrition in our ranks. Yet the task of saving hospital libraries has become increasingly difficult. Once mandated by law, requirements for hospital libraries have been dropped by regulatory agencies—first by the Health Care Financing Administration in 1986, then The Joint Commission in 1993. In the climate of expense cuts, this shift has made hospital libraries an easy target. Point-of-care products, which synthesize current evidence in support of decision-making regarding tests, interventions, or diagnosis, have also made it more difficult to convince administrators that other information resources are still needed—and oftentimes more reliable. And with health systems increasingly consolidating, health system administrators—now  removed from everyday hospital concerns—may see the library only as an expense and not as an asset their hospital staff value and rely upon.

Although hospital librarians have primarily concentrated on providing patient-care information, we also support a number of different important hospital functions and initiatives including research, information literacy training, graduate medical education, undergraduate and graduate nursing and allied health education, continuing education, Magnet preparation, evidence-based nursing practice, and hospital administrative and competitive intelligence research. Cuddy (2005) described a similar assessment of the breadth of library contributions in the Fuld Campus study.

The value of a hospital librarian has been proven. And with doctors and nurses asked to practice evidence-based medicine, is it really wise to close hospital libraries and dismiss the professionals best equipped to find that evidence?

What steps can we take to ensure the latest announcement of a hospital library closing is the last?

Sources cited
Cuddy, T.M. (2005). Value of hospital libraries: The Fuld Campus study. Journal of the Medical Library Association, 93, 446-449.

Marshall, J.G. (1992). The impact of the hospital library on clinical decision making: The Rochester study. Bulletin of the Medical Library Association, 80, 169-17.

Marshall, J.G., Sollenberger, J., Easterby-Gannett, S., Morgan, L. K., Klem, M. L., Cavanaugh, S. K., . . . Hunter, S. (2013). The value of library and information services in patient care: Results of a multisite study. Journal of the Medical Library Association, 101(1), 38-46.

Photo credit (top): Flickr | New Jersey Library Association (CC BY-NC-ND 2.0) | cropped

From One National Library to Another—Similar, Yet Different

Strategic planning underway at two national libraries

Guest post by Dianne Babski, Deputy Associate Director for Library Operations at NLM.

The United States doesn’t have a single national library like other countries. Instead, we have five—the Library of Congress (LC), the National Library of Medicine (NLM), the National Agricultural Library, the National Library of Education, and the National Transportation Library—with LC and NLM the two largest. All five libraries are in the Washington, DC area.

Last month NLM Director Dr. Patricia Flatley Brennan, Dr. Mike Huerta, Associate Director for Program Development, and I took advantage of the proximity and headed to the Library of Congress for a strategic planning conversation. We were joined by LC staff from the Strategic Planning and Performance Management office, including Dianne Houghton, Director, and Emily Roberts, Management and Program Analyst.

Together we celebrated our new directors: Carla Hayden, the 14th Librarian of Congress, and Dr. Brennan, NLM’s 19th leader. Each the first woman appointed to her position, they were sworn in within days of each other last September—and took the helm of two national treasures on the verge of major planning initiatives.

Founded in the early 1800s, both libraries have long histories and serve unique roles. LC is a research service for the US Congress, home of the Copyright Office, a national library for the blind and physically handicapped, and sponsor of the Poet Laureate. It develops its collection based on the Jeffersonian ideal that all subjects will be of interest and value to Congress, scholars, and researchers, as well as the public. In contrast, NLM, the world’s largest biomedical library, builds upon its vast collections in biomedicine, health care, and the history of medicine to further health care practice, support life sciences research, and enhance personal and public health.

The trio poses in front of an ornate fireplace
Dianne Babski, Dr. Mike Huerta, and Dr. Patricia Flatley Brennan visit the Library of Congress to discuss strategic planning.

While our collections, roles, and customers differ, the two libraries face similar challenges, including shifting budgets, dwindling space for growing collections, an evolving publishing landscape, ever-expanding digital and IT footprints, and the need to recruit, train, and retain an educated workforce. These core similarities gave us much to talk about as we discussed our respective strategic planning efforts.

LC is in the early stages of “Envisioning 2025,” its planning initiative designed to chart the course for the Library’s next decade. In-house “tiger teams” comprised of LC staff are formulating questions and raising issues that will help set priorities for future strategic planning activities. LC expects to have a full set of priorities established by the end of the fiscal year and, if all goes well, will start to implement them in 2018.

Meanwhile, NLM is quite far along in its planning process. We have solicited input from our broad stakeholder community, brought together experts to discuss challenges and opportunities around four key themes, gathered ideas and suggestions from NLM staff, and collected and synthesized public comments. This input has been sorted, analyzed, debated, and refined, and together it will inform the recommendations report set for release in late 2017. Those recommendations will, in turn, shape the priorities for NLM’s next decade.

It’s an exciting time at both libraries.

We expect to build on that excitement through ongoing collaboration, sharing experiences in risk management, digitization and preservation, and workforce development.

With more in common than different, we have much to learn from each other, and our two dynamic, new leaders are ready to guide us into a promising future.

There Is an Internet in Space

Guest post by Vint Cerf, vice president and chief Internet evangelist at Google.

In a recent blog, Dr. Brennan correctly identified a future issue: access to medical information from a Mars colony, should one be established. In her summary, she said there was no internet in space.

Actually, there is.

It uses a protocol suite other than the terrestrial TCP/IP originally designed by Bob Kahn and me beginning in 1973 and which has evolved over time thanks to the work of the Internet Engineering Task Force and many researchers and internet practitioners around the world.

The Interplanetary Internet (sometimes called the Solar System Internet by the UN’s Consultative Committee on Space Data Systems) adopted a suite of protocols known generally as the Bundle Protocols. The prototypes of these protocols are on board the Mars rovers, Spirit and Opportunity, the Mars Science Laboratory, and the International Space Station.

The rovers and Science Laboratory use the Bundle Protocols to deliver their data to Earth by way of re-programmed orbiters initially sent to Mars to map the surface of the planet. In essence, the rovers and Science Laboratory capture sensor data, which they beam to the orbiter(s) as the orbiter(s) become visible. The orbiters then hold that data until they can be transmitted to Earth by way of the Deep Space Network (DSN), which was put into operation in the early 1960s to support manned and robotic space exploration. This transmit-and-hold approach of the Bundle Protocols is representative of Delay and Disruption Tolerant Networking (DTN).

The Deep Space Network has three 70-meter dishes located at Canberra, Australia; Madrid, Spain; and Goldstone, California. There are also several 34-meter dishes at these same locations. The DSN is operated by the Jet Propulsion Laboratory  in Pasadena, California, under the oversight of the California Institute of Technology. These large dishes allow the Jet Propulsion Laboratory to receive very weak signals from spacecraft very distant from Earth. The Voyager spacecraft, Voyager 1 and Voyager 2, are now respectively 20.7 billion kilometers and 17 billion kilometers away from Earth and into interstellar space. The DSN can still read the very, very weak signals from both spacecraft.

If a plan does indeed emerge to assure that relevant information from the National Library of Medicine is available to Mars astronauts and perhaps colonists, the natural preparatory step would be to outfit the NLM online systems with Bundle Protocol capability. But don’t expect any kind of real-time, interactive World Wide Web-like service for Mars residents. The light speed round-trip times between Earth and Mars vary from 7 minutes to 40 minutes, and the data rates between Earth and Mars currently run less than 1 Mb/s using conventional radio communications. Experiments have been conducted using laser communications between Earth and the Moon at 600 Mb/s, so one might hope for significant data rate improvements in the future.

If humanity is to become a space-faring species, it will need continuing access to the scientific and medical advances cataloged in the NLM’s systems. We can certainly imagine putting up local data servers on Mars for rapid local interaction while updating these local archives from Earth NLM periodically.

More Information
InterPlanetary Networking Special Interest Group

Image source (top): NASA: Mars Explorers Wanted Posters | modified