New article on an old article

Professor J Eldredge has reviewed the only RCT in to evaluate Clinical Librairanship for the latest issue of Evidence Based Library and Information Practice. This RCT was conducted between Sept 1978 and August 1979 - is it time we were due another?
Free full text

Giant microbes!

Are you looking for a gift for that special clinician?

Check out Giant Microbes! For the librarians among us there are even bookworms on offer.

NLH Document of the week

Taken from the National Library for Health "Document of the week"

Librarian support decreased the length of hospital stay.

Case control study looking at the effect of librarian support on patient care.
This case-control study found that during residents' morning report, where case discussion was taking place, supported by a librarian-guided, computerized literature search, the length of hospital stay for patients was reduced. The researchers concluded that "Morning report, in association with a computerized literature search guided by the librarians, was an effective means for introducing evidence-based medicine into patient care practices."
View full text
View print version
View supplementary material
Citation:Decreased hospital length of stay associated with presentation of cases at morning report with librarian supportDE Banks, R Shi, DF Timm, KA Christopher, DC Duggar, M Comegys, J McLartyJournal of the Medical Library Association, 2007, 95(4), pp371-373

I've just printed off & read this article through, using the CASP Critical Appraisal Checklist for Case-Control studies.

The study asked the question of whether a combination of Morning Report + librarian-provided literature search results altered length of stay, hospital charges (it's a US-based study) or readmission rates. Over 8 months, 105 patients were presented at Morning Report, and these were apparently random, as the doctors involved were given no directions over which patients to select. The comparisons were drawn from the hospital register of almost 20,000 patients admitted over the past 5yrs and 7months, and were matched by ICD9 diagnoses, age & secondary diagnoses. The results of the study show that the median length of stay was 2days in those patients presented at Morning Report (p=0.0238). The authors appear to have taken into account issues of selection bias, and the problems with matching all patients.

I've been thinking a bit more about this, and it is hard to tell which aspect of the intervention made the real difference - was it the extra interest from Morning Report, the literature search, or both? And were the cases presented naturally more interesting/complicated cases? If they were more complex conditions that stimulated interest, you'd expect more time to spent on the patient, possibly more diagnostic tests, and interventions. I suppose it all balances out, but it made me think about which clinical questions make it to the Clinical Librarian.

It's a eally interesting study, as we're always looking for ways that CLs make an impact on patient care, and it can be hard to define what it is we do. Often we're using anecdotal evidence to make a case for our necessity, and this article provides the kind of evidence that people should be listening to. What do you think?

Deep web

I have only just got around to sorting out my bag of delights from the EAHIL workshop in Krakow, in September.

One presentation that particularly gripped me was all about Deep Web - the places Google doesn't reach! From this, I found a number of useful sites, some of which I'd heard of before, but none of which I'd made anywhere near enough use of.

Here's a quick rundown:

Images

www.picsearch.com - a database for finding images, seems more useful than Google Image Search

http://friskr.com - ditto the above

Meta search engines

www.dogpile.com - searches across Google, Yahoo, MSN and Ask all at once

http://clusty.com - A clustered search engine - it clusters the results it brings back by categories

www.mamma.com - similar to the above

Health meta search engines

www.medic8.com - can also browse index as well as search this one

www.webmd.com - health search engine

www.mammahealth.com - same stable as Mamma, but health related - seems very good indeed -try out the aspirin search!

Database search engines

www.completeplanet.com - searches for databases on a topic, and has a browse-able index

www.geniusfind.com - another index of databases categorised by topic.

I'll be adding all of these to my favourites & giving them a go in a real life search very soon.

The blogosphere

I've been doing a little bit of handholding with a friend setting up her RSS feeds, and in return, she's been sending me links to some really good resources she's found.

I'll be perusing this list of medical library blogs this afternoon, and will be logging myself in to add this blog!

I'll also be having a look at the wealth of medicine-related RSS feeds on Medworm to see if there's anything I should add to my own feeds. This is a search engine of RSS feeds, so it may be something I add into my protocol for searches on new and emerging clinical techniques. There's also Libworm too!

As I also do a lot of current awareness (is the right term anymore? I have heard it's outmoded) work, I am going to try saving some of my PubMed searches as RSS feeds. I'm told it automatically updates the search everytime you log into your aggregator, which sounds interesting. I can't believe I hadn't investigated it before now - I've really taken my eye off the ball!

How to use web 2.0 in your library by Phil Bradley is a book that's been sitting on my desk unread for months. I need to schedule myself a catch-up on all this new stuff!

New version of TRIP

I'm really quite excited about the new version of TRIP being launched. I use the database for almost every search I do, often as a scoping search, sometimes after having already searched the primary biomedical databases & Cochrane Library.

Here's what John Brassey has been saying on the TRIP blog:

• Much improved search algorithm, more relevant results at the top and less 'noise'.
• 26 specialist search engines. 26 today and more in the near future. These specialist search engines allow users to simultaneously search the core TRIP content plus the top 10-15 journals specific to that area. I see it as a bridge between users having to go from TRIP to the full, difficult to use Medline.
• New content, we've added a load of web 2.0 content, wikis, podcasts and webcasts.
• A trial of linking to UK-approved education. Today the UK but if the trial works we'll introduce education from around the world.
• A new category 'More' to house the new content.
• Ability to arrange results by relevance or by year.
• We've removed the big google ads banner.

There's more, but those are the main improvements.

I think I'll be using TRIP even more in future!

EAHIL, Krakow

Now that I'm fairly sure I am getting the funding to go to the EAHIL workshop in Krakow in 2 weeks time (rather than turning up & hoping they'll let me in!) I feel able to say - if you're also going, come along & say hello to me & Sarah Sutton.

Blogging the conference #2

Day Two of the conference kicked off with a talk from Claire Honeybourne, NHS National Core Content Manager. Claire talked about the new developments coming from the Core Content, and the role that Clinical Librarians may be able to play. I must admit she got me thinking about networks, and ways that we can interact with one another. There was some discussion post-conference about the use of the Clinical Librarian Jiscmail mailing list, and whether we make enough use of it to discuss the future of the profession. There was lots to think about from this, so watch this space.

Jacqueline Verschuere presented again, this time on how the Clinical Librarian can still make a difference when the evidence base is low. We often expect there to be perfect answers to the questions we're asked by clinicians, and finding a lack of high-level evidence can be disappointing, especially when you're starting out as a new CL. Jacqui wanted to spark a debate about whether guidelines are high evidence - is a NICE guideline that is based on case series as good as a systematic review?

Klara Brunnhuber and Jane McHugh from BMJ publishing group presented the results of some work they had been doing with clinicians on barriers in the EBM process. I'll admit that at this stage, nerves had got the better of me, as I was up shortly after the tea break, and I was frantically scribbling notes on my presentation script.

A CL conference isn't a CL conference with Andrew Booth. Andrew talked about the work that ScHaRR had been asked to do regarding the training of CLs. I have mixed feelings about this, because while I agree that a CL training programme would be an interesting addition to already existing training options, I do think that a lot of clinical librarianship is personality-based and cannot be taught from a curriculum.

Next up was me, so I'll gloss over that. It was a bit of a blur anyway. I talked about the Pharm-assist project we're running using PDAs at Leicester. It's ongoing, but we hope to present preliminary results at the EAHIL workshop in September.

Caroline Storer & Linda Dobrzanska followed, talking about how they have implemented SIGs - Special Interest Groups at Bradford & Airedale tPCT.

A brief presentation from Ovid turned into a lot of praise from our Australian delegates for its QUOSA product - it's on my ever-expanding list of web sites to check out!

After lunch, Sarah Lewis & Nia Wyn Roberts talked about how they've set up & evaluated peer support sessions in Thames Valley & Hampshire. It's something we've tried in Leicester, based on the Vanderbilt "SearchTalk" sessions that Becky Jerome & colleagues told us about at "Lost in Space"in 2006. I found this talk really interesting, and hope we can get back to doing our sessions again soon.

Following on in the peer support/networking theme, Debra Thornton & James Allen talked to us about how they've set up a journal club for librarians in the North West, based on the principles of clinical journal clubs that they've attended. The idea of practising what you preach in terms of evidence-based practice came across loud and clear! This was another inspiring talk - there'll hardly be any time left for the searching once we've done all this.

Brenda Goddard & Helen Williams talked to us about the way they've restructed library services at Winchester & Eastleigh to reflect more outreach work. This was an interesting presentation in that it was recognised that the library assistants pretty much run the library as a physical resource while librarians go out & gatecrash clinical meetings. Some of it did feel to me like preaching to the converted, as I'm quite well practised in the art of gatecrashing! Hopefully it inpsired the more reticent among us to get out there.

Finally, we broke off into three workshop sessions. I attended Sara Clarke's workshop on the way in which NLH Specialist Libraries and CLs can work together. I'd previously been quite wary of Specialist Libraries, thinking that they were attempting to virtually replace CLs, but after some discussion, we realised that there are ways in which we can complement each other. With the potential for personalisation of the Specialist Libraries, there may be ways of promoting CL services to users from the Trusts that have them.

All in all, I found it to be an exhausting & inspiring two days. I find that being a CL can be quite isolating, even in a Trust where there is more than one of us, so it is always reassuring to know that there are more of us out there, all facing very similar problems.

I hope that the presentations will soon be available on the web site. http://www.uhl-library.nhs.uk > Clinical Librarians > Study Days

Blogging the conference - day one

We kicked off with a keynote speech from Ffion Davies, Consultant in Emergency Medicine & Head of Department at University Hospitals NHS Trust. Ffion was inspiring in telling us just how much clinicians need Clinical Librarians, and how we can work together with each other in education and evidence-based medicine. Look out for the article by Tim Coats & Sarah Sutton on the role of the Clinical Librarian in the Emergency Department -it's currently awaiting publication.

Steve Sharp gave us an insight on the Current Awareness methods used by the NLH Specialist Libraries, which was fascinating, as I hadn't realised just how much work goes into keeping the information current & relevant.

After tea, we broke off into parallel sessions, and I attended Veronica Delafosse's presentation on "The Visible Librarian", which was an interesting description of how Veronica had implemented and evaluated a series of training sessions for Occupational Therapists at the Caulfield General Medical Centre in Australia.

Just before lunch, we had a session by Mick Arber from BMJ Clinical Evidence. Mick told us about the process Clinical Evidence use to identify topics for their database, and how articles are appraised before synopses are written. Unfortunately the NHS in England no longer centrally subscribe to Clinical Evidence, which is a shame, as I've often found it to be a really useful resource in my searching.

It was during the morning session that we realised the acoustics in the Maclagen Hall at St. Williams College were not quite the same when full of a bunch of excited information professionals, so we quickly managed to hire in a PA system.

After lunch, at which some of our foreign contingent were mildly confused by the meringues we had for dessert, Andrew Booth chaired, and oversaw Jacqui Verschuere & the team from University Hospitals of Coventry & Warwickshire collect the Evidence in Practice Award prize. The team's submission was a unanimous winner amongst the judges. It followed the process through from the question being asked, to the Clinical Librarian's search to implementation of a wristband to alert patients, care providers and airlines to the risks for patients who have had intraocular gas tamponades.

This was followed by the team from the Netherlands who described to us how Clinical Librarianship has evolved there since the 1990s, which was a very entertaining tour of their work. I was impressed that the library at the Amsterdam Medical Centre commissions artwork!

Sara Sutton followed up on the international theme by telling us all how to blag our way around the world in the name of furthering the profession and our own professional development.

Following on from the much-needed afternoon teabreak, I attended the workshop on RSS feeds run by Heather Gardner of Derby Hospitals Foundation Trust. We discussed the usefulness of different methods of promoting current awareness, and the hindrances we face in trying to do it.

Finally it was back to the main hall for a whistlestop tour of the new features of the Cochrane Library from Nigel Thompson. In this, we learned that South America has moved to Africa (you had to be there!), and that there are a number of elearning resources now available on the site.

It was a packed day, and we still managed to gather a few of us together at 7.30 by the West doors of the Minster to join the Ghost Trail. Having seen last week's Doctor Who, I was unable to turn my back on the statues!

New TRIP design

As I was demonstrating TRIP to Elisabeth, our lovely work experience girl from Norway yesterday afternoon, I soon realised it's had a redesign!

Now there are snippets of each result displayed below the title, and it seems to be running a lot faster too. More details are on the TRIP blog.

TRIP is a resource I use for just about every search I do, as it searches the main features of Cochrane, North American & European Guidelines, PubMed and eMedicine, to name a few.

New WHO Clinical Trials Web Site

A new website launched by the World Health Organisation (WHO) aims to improve online access to data on clinical trials, so that researchers, doctors and patients can obtain reliable information. Initially, data from 50,000 clinical trials provided by three registers (Britain, Australia/New Zealand and the US) have been put on the site, which can be accessed via the link below. The Clinical Trial Search Portal is “a collaborative international initiative led by WHO that facilitates the identification of all clinical trials, regardless of whether or not they have been published."

Registers submitting data must ensure they meet a minimum quality standard and that all trials are registered before any participants are recruited. Data will not be accepted directly from drug companies. The network of registers, which are required to disclose their ownership, governance structure and for-profit status, will be expanded to make it more comprehensive.

http://www.who.int/trialsearch/

Clinical Evidence, Searching Tidbits, and Other Minutiae

Clinical Evidence, Searching Tidbits, and Other Minutiae is a blog by Becky Jerome, of the Eskind Biomedical Library, Vanderbilt Medical Center, Tennessee.

It's an excellent resource for the die-hard searchers among us.

3rd UK Clinical Librarian Conference - social activity!

If you're attending the 3rd UK Clinical Librarian Conference, don't forget that we've arranged a Ghost Walk in historic & haunted York! The cost is £4, payable on the night, and will be run by: http://www.ghosttrail.co.uk/

Health professionals said that clinical decision support was beneficial to their practice.

Clinical decision support helps clinicians take better care of their patients.

The findings of this survey to identify factors that affect the acceptance of clinical decision support (CDS) among primary care physicians, are published in BMC Medical Informatics and Decision Making. 110 out of 225 physicians responded to the survey, and the majority said that CDS "helps them take better care of their patients." The study asked specific questions relating to acceptance of alerts for different situations, eg elderly patients, multiple medications and multiple chronic clinical conditions. Most of the clinicians said that they were often running behind schedule, and if they were running late, they were less likely to accept the alerts. The conclusions were that they do find CDS beneficial to patient care but they would like more time to use CDS.

View full text

View print version

Citation:
A survey of factors affecting clinician acceptance of clinical decision support
DF Sittig, MA Krall, RH Dykstra, A Russell, HL Chin
BMC Medical Informatics and Decision Making, 2006, 6:6

Clinicians were more likely to look for information when working with a librarian.

Clinical librarians encourage clinical staff to look for information.

This paper highlights the results of an 18-month evaluation of a clinical librarian project, carried out in North Wales. The purpose of the study was to find out the benefits of using clinical librarians to support clinical teams. The results showed that with a clinical librarian on their team, clinicians were "more willing to spend time searching for information related to patient care."

View full text

View print version

Citation:
Changes in information behavior in clinical teams after introduction of a clinical librarian service
C Urquhart, J Turner, J Durbin, J Ryan
Journal of the Medical Library Association, 2007, 95(1), pp14-22

Clinical librarians: a valuable addition to the critical care decision making team.

A new column in the Journal of the Medical Library Association looking at the value of good health information services.

This is a new column looking at the challenges of information service provision in health care. There will be case studies from medical librarianship, health informatics, medicine, and research, focusing on a variety of scenarios to help encourage discussion and development in this area. This first scenario focuses on the involvement and importance of a clinical librarian in the treatment of a patient with respiratory failure and hepatic encephalopathy associated with advanced liver failure. Comments can be made on this case online at http://jmlacasestudies.blogspot.com

View full text

View print version

View supplementary material

Citation:
Expert synthesis of the literature to support critical care decision making
RN Jerome, RA Miller
Journal of the Medical Library Association, 2006, October, 94(4), pp376-381

Evidence in Practice Award extended AGAIN!

Due to some unforeseen technical issues with the Insiteful Survery submission form, we've taken the decision to extend the closing date for entries to the Evidence in Practice Award to 20th April.

We've now changed the submission form to a Word proforma. All other details remain the same.

Please note that the award is open to UK Librarians & Clinicians only.

Please download an entry form here.

Evidence in Practice Award

We are pleased to announce an opportunity to share great
practice and see the world for the winners of the 2nd Evidence
in Practice Award - now open for entries

In approximately 750 words, can you describe a case study
where your work has influenced clinical practice? We are
looking for examples of good evidence-based librarianship
practice in a healthcare setting, examples of where librarians
and information professionals have influenced clinical practice
and patient outcomes. The competition is open to partnerships
of clinical and health professionals in the UK.

The winning partnership will each receive a Personal Digital Assistant,
£500 each towards attendence at a professional conference or course
of their choice, plus a free delegate place at the 3rd Clinical Librarian
Conference (see link below).
Prizes are jointly sponsored by NLH and BMJ Group.


Click here for our online entry for the competition

http://www.insitefulsurveys.com/Survey.asp?SI=110406111828

Entries can be submitted up to 31ST MARCH 2007 after which
anonymised case studies will be judged by an independent panel
combining clinical and information expertise.
The judges' decision will be final.

The award will be presented at the 3rd UK Clinical Librarian
Conference, 11th & 12th June 2007, St William's College, York
Minster, where the award winners will an opportunity
to share their example of successful practice.



Please feel free to share this message with your networks

Conference Early Bird Rate to end

The early bird rate for the Clinical Librarian Conference ends on 31st Jan. If you still would like to take advantage of the lower rate for early registration, we'll need your registration form by tomorrow!