Thursday, 14 December 2017

NOACs and DOACs - a search strategy

Newer anticoagulant drugs, alternatives to warfarin, are a frequent talking point at Cardiology meetings, and I am making links with our Anticoagulation Service, which also needs to know about them.

These drugs are referred to as "novel (or new) oral anticoagulants" or NOACs, or "direct (or direct acting) oral anticoagulants", or DOACs.  They are, as I have heard pointed out, not so "new", now.

But how to find literature about them?   Some literature will of course use these phrases, but some will refer to specific drugs.    I have come up with:


1.  doac* OR noac*).ti,ab 
3. ((direct OR novel) ADJ2 "oral anticoagulant*").ti,ab
4.  “Direct thrombin inhibitor*”
5.  “factor xa inhibitor*” or “fxa inhibitor*”
6.  (dabigatran OR rivaroxaban OR apixaban OR edoxaban OR ximelagatran OR “fondaparinux sodium” OR bivalirudin OR argatroban OR angiox OR pradaxa OR xarelto OR eliquis OR Arixtra OR exembol).ti,ab             
7.  1 OR 2 OR 3 OR 4 OR 5 OR 6)     

1.  (doac* OR noac*).ti,ab 
3.  ((direct OR novel) ADJ2 "oral anticoagulant*").ti,ab
4.  “Direct thrombin inhibitor*”
5.  “factor xa inhibitor*” or “fxa inhibitor*”
6.  (dabigatran OR rivaroxaban OR apixaban OR edoxaban OR ximelagatran OR “fondaparinux sodium” OR bivalirudin OR argatroban OR angiox OR pradaxa OR xarelto OR eliquis OR Arixtra OR exembol).ti,ab             
7.  (1 OR 2 OR 3 OR 4 OR 5 OR 6)      

A PowerPoint from Imperial College Healthcare NHS Trust, called To DOAC or not to DOAC (Googling the title finds it!), provided three names (dabigatran, rivaroxaban, apixaban).  I added more names from the BNF.    Embase's indexing is extremely thorough, with a lot more individual drug names which I have not included in the free text search.

This post from Life in the Fast Lane explains some things about the names (as well as looking at the agents from a critical care perspective).

And this article from the Journal of Thrombosis and Haemostasis (subscription required) discusses recommendations for nomenclature.

Wednesday, 6 December 2017

East Midlands Congenital Heart Centre - adding research to a campaign

Our Congenital Heart Centre, at Glenfield Hospital, was scheduled to close, following a proposal from NHS England to decommission services.  Other centres in England were affected by the proposals too.

Following a big local campaign, a synergy of Trust board, communications staff, doctors and nurses, patients, support groups, local MPs, the press and the local community, the Trust presented alternative proposals to NHS England, and last week at a board meeting, NHS England announced that EMCHC would remain open.   

Some agenda items got a lot of national publicity, so many watched the live feed for those.  But we, and colleagues elsewhere too were watching it for this particular item. 

What has this to do with Clinical Librarians?

Well, I set up a weekly Medline alert to look for research articles discussing complications of, and mortality following, congenital heart surgery, and looking for articles using audit or registry data.  I wanted to make sure colleagues knew of any new research that might be useful to our alternative proposals.   The alert went straight to senior clinicians and the project manager, but also to me so I could check the search was finding what I had in mind, and so I could check for things I thought would be worth reading in full.   

UHL's press release about the announcement.

More about the Centre, including press releases and information from the campaign.

Thursday, 24 August 2017

Lyme disease - some resources

Lyme disease, first identified in the town of that name in Connecticut in the 1970s, is a bacterial infection spread by ticks.   Lyme disease is mainly found (according to Fit For Travel) in Europe, North America and temperate areas of Asia.  The ticks pick up the infection from infected animals, then get attached to humans, who they bite.   Being bitten is a risk in wooded areas, moors and heaths.

It has been in the news in the UK lately following reports that Matt Dawson contracted it, was misdiagnosed, and had to undergo heart surgery.

Here are some resources about it, that you could bring to the attention of clinical colleagues who might encounter it (although those clinicians are perhaps more likely to be GPs).

Fit For Travel - travel health information from NHS Scotland. 

NHS Choices -  this also lists areas of England and Scotland reported to have a high population of ticks, and information on how to remove one.

Public Health England - includes information about diagnosis, signs and epidemiology, as well as a Factsheet about tick bite risks and prevention of disease.  Under diagnosis and treatment there is a suggested referral pathway for patients.

Outside the UK, there is:


CDC  - a very comprehensive site.   This site also includes information about "Lyme carditis" .   

PubMed search for lyme carditis will also search for lyme myocarditis, another name.   Any search of the literature also ought to take into account that Lyme disease (or its causative agent Borrelia burgdorferi) can cause heart block, pericarditis and heart failure!

Patient support groups include Lyme Disease UK, Lyme Disease Action and BADA UK (Borreliosis and Associated Diseases Awareness UK).

Thursday, 10 August 2017

Pre International Clinical Librarian Conference Meal Opportunity and optional Orientation Walk

Coming to the International Clinical Librarian Conference or thinking of coming?
Then join us for a pre-Conference meal and start that your networking super early. On Wednesday 20th of September, we will be going to Zizzi an Italian Restaurant on Belvoir Street in Leicester (for non Leicestershire people that’s pronounced Beaver! – weird but true). Just email if you are interested in joining us.

 We will be having a special set menu, with plenty of choices for £19.95.That way that everyone can have their own bill and we don’t have to hire a statistician to work out who had the deep fried camembert (that’s not on the menu, so sorry to fried cheese lovers amongst you).

The table(s) are booked for 7pm to allow those of you with jetlag to get to bed early and play catchup on your sleep. If anyone would like a city walking tour before the meal, meet Sarah at the restaurant at 6 pm and she will take you for a quick look at the highlights of Leicester’s City Centre. This walk is not suitable for those with mobility issues because of the time limitations, but those with such issues are welcome to contact Sarah for a slower paced tour earlier in the day.

Monday, 31 July 2017

Apply for HEE bursary to attend International Clinical Librarianship Conference

Health Education England is funding 4 bursaries for attendees at the International Clinical Librarian Conference (ICLC) in Leicester between 21st & 22nd September -

HEE are centrally funding the cost of full registration + evening meal (£270); individuals should make alternative arrangements to cover travel/accommodation expenses.  One of four bursaries is explicitly for an attendee from the Midlands and East of England.

HEE are keen that these bursaries support attendees who are considering clinical librarian roles, but may not be in these roles currently.  To apply, please email your LKS Regional Lead, or by 3pm on Tuesday 15 August demonstrating in up to 200 words that you meet the following criteria:

- Applicants should be working in a library and knowledge service and newly appointed to, or considering, a Clinical Librarian role.
- Applicants should be qualified librarians or working towards a qualification.
- Applications should demonstrate how you expect to benefit from attendance.
- Applications should demonstrate how you would share learning, including producing a conference report and tweeting from the event.

Ruth would be very happy to chat informally to anyone considering making an application.

Wednesday, 12 July 2017

Sharing Best Practice at the Midlands and East Summer Conference

I was invited to run two sessions on "Sharing Best Practice" at this year's Summer Conference, held in Peterborough, on 12th July.

I spent some time thinking about what "best practice" actually is, is it different from good practice, from evidence based practice, and is it different from innovation?

In the first session there was a lively discussion on whether librarians actually do evidence based practice, and whether we practise what we preach on using evidence. Does all evidence come through desk based research, or simply learning from others' successes and failures?  There was a lot of talk around whether the evidence base for clinical librarians is now well established to the point that no further work is needed (I'd say not, others disagreed).

We discussed how we use professional judgement and experience alongside evidence gathered through observation and conversation with colleagues in other organisations.

When looking at the best forum in which to share activities we consider as best practice, we talked about conferences and meetings as "down time" and whether it's easier to share in these environments than make time in a busy working day to write a blog post, draft a journal article or enter an award. Many of us are keeping up with the day job and finding that takes all of our energy.

We discussed the value of local networks, talking with trusted colleagues we know well so feel more able to be open. The East of England libraries network run "Can Do Caf├ęs" as forums to share ideas and learn from each other, along with themed "Share Your Stories" sessions, which sound like an excellent way to throw an idea out to colleagues and get feedback and encouragement and/or commiseration.

In the second session we discussed whether it is possible to define what best practice is without giving examples of activities we feel are embodying best practice. Words such as "efficient" and "relevant" were used, but we found it difficult to come up with a single best fit for what best practice is. The group felt that it can be very location and context dependent when deciding what constitutes best practice as it may not work everywhere.

Sharing is not just down to being present at events such as the Summer Conference, the EoE librarians have a well established tradition of reporting and sharing best practice through their LQAF (Library Quality Assurance Framework) returns. This may not work for all, working in the East Midlands, I've never seen another library's LQAF return until I worked as a peer reviewer this year.

Local networks again came up where people feel they can talk openly with trusted colleagues. This did make me wonder how you can break out of your own network and find out about wider practice, and members of the group said that if you want to know, just ask! But this assumes that we're able to find out that something is going on, that we might want to know more about.

Mailing lists, more on the local scale rather than national were thought to be useful where colleagues are not able to meet face to face regularly. There seemed to be a sense of not wanting to put yourself out there for judgement.

We then got onto a rich discussion of whether we ought to be sharing our failures as well as our successes, and if we're reticent to share our success, failure is going to be even harder to come by!

Innovation versus best practice came up again, and the feeling of needing to be doing something unique AND interesting in order to qualify as an innovation before shouting about it appeared to be a widely held concern in the group. However it was agreed that we don't always need to feel we're in direct competition with other health libraries.

Wednesday, 21 June 2017

World Sickle Cell Day

Better late than not at all... 

Monday 19th June was World Sickle Cell Day and our local CLAHRC has been conducting a survey, which found that a greater awareness of sickle cell disease would improve patients' experience, and that staff in emergency settings had a relatively poor knowledge.

They have produced an infographic.

To improve your clinicians' and practitioners' knowledge, here are some resources:


Professor Simon Dyson, De Montfort University,  especially the Resources and Information page, which lists UK organisations and resources for schools.  Professor Dyson has also produced some open educational resources.

Rest of the UK

Clinical Knowledge Summaries for an evidence based summary.

HealthTalk for patient experiences of screening.

NHS Choices for an overview and links to other NHS resources.

NICE material is included in the set relating to blood conditions - a clinical guideline (CG143) and a quality standard (QS58)

Sickle Cell Society - UK based patient support organisation

Rest of the world

emDOCS - The sickle cell patient: ED management of acute complications.   Detailed discussion from this US based emergency medicine blog.  

Life in the Fast Lane (LITFL) - Sickle cell crisis.  Another blog for emergency medicine and critical care, based in Australia and New Zealand.

MedGen for everything genetic.