Friday, 22 December 2017

Finding case reports

I searched PubMed for a rare topic and found 361 references.

Filtering to “case reports" left 197.

Of the 164 not tagged in this way, some do appear to be case reports, with titles involving phrases like “two cases”, “a rare case”.  (See below for a discussion about whether reports of more than one case are a “case report”!).

Why are these 164 not tagged?   A glance at the titles suggests some are case reports.  Some of these will be PubMed Central and some very new, so therefore not indexed.   What about the rest?  The publication type "Case Report" was first used in 2008, but then applied retrospectively back to 1966, although I wonder how consistently it was applied to older material.  

Of the 361, 73 have the word "case" in the title and 20 have “cases”.   Some of those are general articles (“associated malformations… in cases of…”) but some are definitely reporting actual cases.   76 have “cases” in the title or abstract, and some of those are definitely reporting actual cases, without mentioning that in the title.

43 have “case” or “cases” in the title, but are not indexed as Case Reports.  

Some of the items mentioning “case(s)” in the title or abstract could be case control or case series, rather than a case report.   A case series is “A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment.”  (NCI Dictionary of Cancer Terms).   There is a discussion of how this differs from a cohort study in this Annals of Internal Medicine article (subscription needed).   A case control study involves a control group.

I couldn’t find a search filter for case reports (if you know of one, please let me know!).   For HDAS,  
(case or cases).ti,ab may be enough, although that will also find case series and case control studies, as well as things which are nothing to do with specific cases.      

To be more specific, you could try my filter suggested below, although that will miss titles like “two cases”, “a new case”, “a case of”.

Does a case report have to be a single case?   BMJ Case Reports require prospective authors to contact the office if there are more than three cases. Oxford Medical Case Reports and European Heart Journal Case Reports don’t specify, but the latter uses the CARE reporting guideline, which seems to imply a “case report” is one single case.   And certainly cases presented to our Cardiology Education Meeting are single cases.

MeSH defines “Case Reports” as “Clinical presentations that may be followed by evaluative studies that eventually lead to a diagnosis”, which could mean one case or more.

If you don’t want to use just the word case(s), here is my possible filter, for HDAS Medline, with my search topic:

1          ("ectopia cordis").ti,ab            (340)
2          "ECTOPIA CORDIS"/    (108)
3          (1 OR 2)           (355)
4          ((case OR cases) ADJ2 (report OR review)).ti,ab       (533,996)
5          ("Case Reports").pt     (1,857,467)
6          (4 OR 5)           (2,020,257)
 7         (3 AND 6)        (229)
 8         (3 AND 5)        (197)

Changing set 4 to (case or cases).ti,ab makes set 4 3,015,101 but set 7 275.

Why that topic?   Read more about Vanellope Hope Wilkins in the Leicester Mercury (she and her parents have featured in many other media outlets too).    

The HDAS search was run on 22nd December 2017 and all the links worked on that date.

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, and Lyme Disease Action.

(Links were checked on 6th February 2018)

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.

Wednesday, 14 June 2017

Bicuspid aortic valve - Medline search strategy

The aortic valve should have three "leaflets", so is "tricuspid".    Sometimes it has only two, because two are fused together, and then it is "bicuspid".

Bicuspid aortic valve (BAV) is a congenital condition.  It is linked to aortic aneurysms.

How to find literature about BAV?

There is no MeSH term for bicuspid aortic valve, although there is a "supplementary concept" Bicuspid aortic valve.  This is searchable in PubMed as [Supplementary Concept], but as far as I can work out, is not searched or searchable in HDAS.

In PubMed, the freetext term "bicuspid aortic valve" maps to the supplementary concept.

So is it enough to rely just on the phrase "bicuspid aortic valve(s)"?   I think not, because: 

a) I have seen phrases like "bicuspid and tricuspid aortic valve" and "bicuspid aortopathy".  The latter, I think, relates to the aorta, not the valve, but the aorta as it is affected by the valve.  

b) Perhaps there is literature where BAV is indexed under Heart Defects, Congenital/ and a MeSH term relating to the aortic valve but where phrases describing BAV itself are not used.

I was working on a search about fusion patterns in BAV, that is, which leaflet is joined to which, and that gave me some more terms.

So, taking all that into account, here is my draft of a search strategy for Medline via HDAS:

1. ("bicuspid aort*").ti,ab
2. (BAV).ti,ab
5. exp "AORTIC VALVE STENOSIS"/         
8. (fusion OR fused OR fusing OR morphol* OR morphotyp* OR phenotyp* OR habitus OR raphe).ti,ab
9. ("right noncoronary" OR "left noncoronary" OR "right left" OR "left right").ti,ab
10. ((left OR right) ADJ2 "non coronary").ti,ab
11. (classif* OR pattern* OR commissur*).ti,ab
12. 1 OR 2
13. (3 OR 4 OR 5) AND 6
14. 3 AND 7
15. (8 OR 9 OR 10 OR 11)
16. ("aortic valve*").ti,ab
17. (3 AND 15)
18. (15 AND 16)

19. (12 OR 13 OR 14 OR 17 OR 18)

Lines 3 - 7 are an attempt to capture the way BAV is indexed in the absence of a single MeSH heading.

Lines 8 - 11 describe the fusion patterns and other features of a BAV, although some words are possibly too general ("pattern" for example could be referring to something else, not the valve).

On 14th June 2017, line 1 found 2454, line 19 found 12693.    How many of these extra ones are relevant, but not found in set 1 or 2, is not clear.


12 or 13 or 14 

would be enough (this finds 9939).

All of this, of course needs, testing.  

Perhaps which strategy you use (assuming you think it worth using!) would depend why you are searching, and if there were other aspects to the search, it may matter less.

Tuesday, 23 May 2017

International Clinical Librarian Conference - Programme released

9th International Clinical Librarian Conference, in Leicester UK.
21st to 22nd September 2017

We are pleased to announce the programme for the next ICLC conference, organised by University Hospitals of Leicester NHS Trust.

The conference will be held at Leicester Racecourse, in the vibrant multicultural city of Leicester. Leicester is only 66 minutes away from London via train, and Stratford Upon Avon is only an hour away by car. Leicester is also the home of world famous sports teams, so you could stay on after the conference for some exciting sports viewing!

Accommodation suggestions can be found here and there is free parking at the conference venue.

Monday, 22 May 2017

NEJM Group announces a new website for librarians

Announcement from the New England Journal of Medicine:

You’ll find articles that share the expertise of leading medical librarians, take you behind the scenes of products and events at NEJM Group, and provide resources to help your community take full advantage of our offerings.

Please explore our new site and be sure to register on the home page for an email alert to let you know when new articles are posted.

Friday, 19 May 2017

International Clinical Trials Day

James Lind (1716-1794), by Sir George Chalmers

Friday May 19th is International Clinical Trials Day.

The NIHR is holding events under the heading "I am Research", to increase public awareness of research.

We compiled a set of webpages for the Hope Clinical Trials Facility, based at the Leicester Royal Infirmary, and the pages include links to information about trials registries, participating in trials, and procedures and reporting guidelines.

Have a browse, on this International Clinical Trials Day.

Why this day?   According to the Association of Clinical Research Professionals site, May 20th 1747 is when James Lind began what was probably the first RCT, investigating scurvy.

The James Lind Library contains material illustrating the development of "fair tests of treatments", and can be browsed by topic.   It has information about Lind's trial here.

Portrait of Lind from

Wednesday, 10 May 2017

Systematic review filter for ProQuest PsycInfo

Looking for systematic reviews, I needed a systematic review filter for ProQuest PsycInfo.  

I had searched other databases for the same project and used SIGN's filters, but SIGN did not have one for PsycInfo and the other PsycInfo ones I had found were for other interfaces.

The idea behind using a filter, and not relying on database publication type limits, is that not every SR is indexed as one, so the filters look for terminology that is common in SRs to identify items that are SRs.

I adapted the University of Texas School of Public Health filter (found via the ISSG Search Filters Resource) for ProQuest.

This was what I came up with:

1. TI,AB,IF((comprehensive* OR integrative OR systematic*) NEAR/3 (bibliographic* OR review* OR literature))

2. TI,AB,IF((meta-analy* or metaanaly* or "research synthesis" or ((information or data) NEAR/3 synthesis) or (data NEAR/2 extract*)))

3. TI,AB,IF(review NEAR/5 (rationale or evidence)) and ME("Literature Review")

4. AB(cinahl or cinhal or (cochrane NEAR/3 trial*) or embase or medline or psyclit or psychlit or pubmed or scopus or "sociological abstracts" or "web of science")

5. ME("systematic review" or "meta analysis")

6. 1 OR 2 OR 3 OR 4 OR 5

The UTSPH filter is one line, but I got muddled with brackets and found it easier to have several lines...   Line 3 does not include the word PsycInfo because (as I discovered!) every reference in the database has that word in the abstract...  

Monday, 30 January 2017

Registration is now open for ICLC 2017

The International Clinical Librarian Conference (ICLC) runs conferences, targeted at Clinical Librarians and any other health librarian who finds the topics covered of interest.

21st to 22nd September 2017
Leicester Racecourse
Leicester LE2 4AL

The International Clinical Librarian Conference is organised by the Clinical Librarian team at University Hospitals of Leicester NHS Trust (UHL) in the United Kingdom.

To find out more information on the UHL team and what they do, please visit their website at

Abstract submissions are also currently being accepted:

Tuesday, 10 January 2017

Call for Papers for ICLC 2017 - reminder

Hopefully you will have had time to consider over the Christmas and New Year break what sort of paper you would like to submit for the International Clinical Librarian Conference 2017. If you have, then here is the submission form.

Friday, 6 January 2017

Transfusion Evidence Library

This database of systematic reviews, RCTs and economic studies relevant to transfusion medicine is available to the NHS.  It is compiled by the Systematic Review Initiative, an Oxford based clinical research group.

I must admit this is the first time I have used it.    Search terms used in my exploration are in bold.

Areas covered are listed.   The main audience will be people involved in transfusion medicine, but there is material in it of interest to surgeons, critical care specialists and haematologists. 

The search guide gives search tips, and details of how records are found for inclusion.
  • Total knee replacement finds 164 records
  • Phrase searching is allowed, so “Total knee replacement” 90
  • Boolean is allowed, so total knee (replacement OR arthroplasty) finds 283
  • Like PubMed, strings of words are AND’ed, so total AND knee AND (replacement OR arthroplasty) also finds 283.

Results can be filtered by:
  • Clinical specialty – these include, of course, blood donors, but also haematology and oncology, obstetrics and gynaecology, and surgery.   
  • Subject area - these include Fractionated blood products (under “Alternatives to blood”) and Management of anaemia (under “Clinical Practice”).
  • Study design - SR, RCT or economic.
  • Text availability - TEL links to some publishers and providers like Ovid, but also to things like PubMed Central.

You can apply only one filter from each group at a time.  You can apply filters from different groups together, for example, clinical specialty and study design.  Filters stay applied to searches until you clear them.

Some items (not many in any of the searches I did) have clinical commentaries evaluating quality.

For some searches, you see (at the end of the first page) the expanded query”. This looks like the search that is actually done, but I am not sure.  Sickle cell anaemia does not show an expanded query, where sickle cell anemia does, although both searches give the same number of results. Searching hiv gets the same number as searching hiv OR “human immunodeficiency virus”, and neither shows an expanded query.  For ITP (not the best search in the world!), the expanded query suggests it has searched inosine triphosphate, but the results suggest it has searched immune thrombocytopenia (which is what I was thinking of).   (Using the full name of ITP finds more)

Transfusion Evidence Library looks useful, and I plan to try it out on search requests, where appropriate.  We will be promoting it to our Transfusion team. 

Have you used it?    Please put your thoughts, or anything I have missed or got confused about, in a comment.