As just one of many powerful examples of how the Health Sciences Library supports our users, we would like to share the story of Dr. Benny Joyner (MD/MPH ’02, Assistant Professor of Anesthesiology and Pediatrics, Division of Pediatric Critical Care Medicine, UNC School of Medicine).
Dr. Joyner was deeply troubled by the conclusions of the New England Journal of Medicine (NEJM) article “Mortality after Fluid Bolus in African Children with Severe Infection,” which stated:
Fluid boluses significantly increased 48-hour mortality in critically ill children with impaired perfusion in these resource-limited
settings in Africa.
His concern pushed him to collaborate with others on a response to challenge the article’s findings, which was also published by NEJM.
“If what they were saying was right, it flies in the face of everything I’ve been doing for nearly ten years in Emergency Pediatrics,” says Dr. Joyner.
As part of the ensuing debate, Dr. Joyner was invited to help Médecins Sans Frontières (Doctors Without Borders - MSF) shape any worldwide recommendations the organization would make on the subject. He welcomed the opportunity, but only had two weeks to prepare his case for the meeting in Belgium, while still working night shifts at UNC Hospitals. His initial literature search only compounded the challenge by producing 120,000 articles!
Dr. Joyner needed help, so he turned to Mellanye Lackey, an HSL Liaison Librarian who had assisted and callaborated with him before on other important projects. Mellanye worked with Dr. Joyner to put together a precise, yet comprehensive search strategy. As a result, he was able to fully leverage the myriad of resources the HSL purchases, manages and makes accessible for the Carolina health affairs community. Then she spent seven hours organizing the resulting information, a task Dr. Joyner says would have taken him days, maybe weeks, and would likely not include some important articles. Furthermore, Dr. Joyner admits he would never have been able to format all the information in such a user-friendly way. Mellanye also placed PDF’s of all the articles in his Dropbox where he could read them at any time, including on his iPad as he flew across the Atlantic without Internet access.
“It wasn’t just the information she provided - which was incredible - it was the way Mellanye organized the information for me and how quickly she could do it,” says Dr. Joyner. “It was awesome! It gave me the ability to efficiently assimilate the latest, current literature in fluid resuscitation in pediatrics in the short and pressured timeframe I had. I already had the ability to speak as a result of what I had learned experientially, but that wasn’t enough for the meeting.”
The value of Mellanye’s neatly-packaged information was further brought to light as the meeting unfolded when Dr. Joyner was able to refer the other world health experts to specific articles as they were discussed and/or questioned.
“Having reviewed all the articles and having them at my fingertips at all times was invaluable,” said Dr. Joyner. “Just my experience wasn’t enough to compel a change. However, in my opinion, having the body of evidence to support what I practice clinically allowed me to make a recommendation based not only in experience, but also a solid evidence base. And I would not have been standing on such a solid base during the meeting without Mellanye and the HSL.”
Dr. Joyner’s participation in the Brussels meeting played a significant role in shaping MSF’s latest worldwide recommendations on emergency pediatric fluid resuscitation. And with the help of the HSL, he was able to positively impact the lives of hundreds, if not thousands, of children treated by MSF health care providers throughout the world.
When reminiscing about the series of events a couple of weeks after the meeting, Dr. Joyner finishes the conversation by looking at Mellanye and sheepishly admitting something our librarians often hear:
“I should have called you a lot earlier.”
Information saves lives. But it must be vetted, organized, and accessible before talented people can put that information to use. Managing information is one area where the HSL makes its impact. And as Dr. Joyner can attest to, in some cases that impact can touch thousands of lives across the globe.