Appraising apples and doing something to oranges

Andrew Booth's latest article in HILJ [subscription required] is, I assume, a refection on a forthcoming systematic review of Clinical Librarianship. In it, he looks at the problems of in evaluating a clinical librarian service in an objective, generalisable way. It's also a very entertaining article in Andrew's inimitable style. Definitely get hold of the full copy if you can.

The issues around evaluating clinical librarian services are many, but a particular one that stood out to me is the sample of clinicians and clinical teams.

"The team selected for participation in such a service is not selected at random and so does not represent clinicians in general."

This is so true, we are always advising people setting up new services to seek out "champions" to pilot a project and help to spread the word. These are often already library service users, and experts in evidence based medicine. This approach is partly to avoid wasted effort on the part of the Clinical Librarians, but perhaps those most in need of a service are the clinicians who don't know they want that service.

The different models of Clinical Librarians are discussed, and I identified with the introverted vs. extroverted librarians section. I think here at Leicester, we're all very much in the extrovert camp.

Andrew's final PICO is excellent.

"In a self-selecting or deliberately skewed population of clinicians is a range of activities loosely grouped together under the label of 'clinical librarian' better than doing nothing when measured across a selection of favourable and non-objective outcome measures, including those are difficult both to articulate and quantify?"

Of course! It does make me wonder how we ever managed to prove our worth at all. At UHL, we often feel we ought to be evaluating the service we provide, but never quite get around to it. I'm now wondering whether the excuse of being simpy far too busy providing the service is the only reason for our reluctance.

I'll certainly be interested to read the full systematic review when it's published, though I will admit I've had a couple of sneak previews, both at the HLG conference and the writing for publication course I attended earlier this month (more on that soon).

Updates to the UHL CL website

I've been very slack lately in keeping the Clinical Librarian Bibliography up to date, and I hadn't (until this morning) added links to the presentations from the Study Day in October either. However, I have done it now, and everything should be there to view.

I do worry about the bibliography, I wonder how useful it is, and if I am managing to capture everything. Thankfully, many people are happy to blow their own trumpet & let me know what they've published! I am grateful for that. I do have a lot of alerts set up through HDAS and PubMed, but I know I miss things.

At UHL we use articles about clinical librarianship as inspiration for what we could achieve, and as evidence to pass to our managers to prove our value. Do others do this?

We leads me to wonder if we should publish more, and if so, what? The day job is busy enough keeping on top of the searches and the current awareness, as well as the admin tasks we all have. Do we also have a responsibility to be writing and publishing and practising what we preach on evidence based practice?

eBooks Study Day

I was asked to speak at the National eBooks Study Day at Christie Hospital in Manchester last month. I was slightly surprised to be asked, since I don't think I'm any kind of expert in this area, and I did try to foist the "opportunity" onto my colleague Andrew! But I ended up doing it anyway, and found the whole day to be really interesting.

We recently purchased iPads using money generated by hosting external events, and we've been looking at ways to use them in our Clinical Librarian work, and in the wider library setting. With eBooks however, it's quite tricky, since Apple don't allow DRM software on the iPad or iPhone. In my talk, I looked at the issues with using iPads and eBook readers from the point of view of a Clinical Librarian. I had to be honest, my main issue is that I rarely use books at all, whether they're electronic or print. Ideally, what I want to access is clinical summary databases for quick & dirty answers in a clinical meeting or on a ward round, I don't want to be logging in to an eBook provider and searching within individual books. My research reminded me that we did some work on PDA devices some years ago that allowed for localisation of the resources and searching across the information loaded onto them, which were very helpful.

I must admit I'm yet to fully get to grips with everything on offer through the iPad, and to make real use of it on the wards, but there is a huge amount of potential out there and doing it is the only way I will learn. I'd be interested to know what, if any, apps other CLs are using, and if you are making use of eBooks in your work.

Charging for literature searches - from discussion lists

Another topic of interest covered in the discussion lists. This one was brilliantly summarised by Sarah Gardner of Kingsmill Hospital:


Thank you very much to all who replied to my query about charging for lit searching. A lot of people were interested to know what I found out, some had ideas or alternative systems; a few people had had experience of charging but no-one responded who currently does so. Opinions were expressed on the desirability or otherwise of charging. Here is an compilation rather than a true summary of the responses, so apologies for the length!:

Ideas
"If charges are made by time taken to do the search, then it could be possible to charge people for very few results and a short search but with plenty of hits would be cheaper"
"There is the national work that is underway on costing library services Linda Ferguson and David Copsey are leading on this so this might enable you to actually cost each literature search"

Alternatives
"Our approach is to limit the number of databases searched or time spent searching, as well as to limit who does what search (see table below). This information is included on our request forms. However, we have found out that the majority of our searches are for patient care so they generally involve one of the 2 professional librarians ... which means they can easily spend a large proportion of their time searching. This is where we have come a little unstuck....!
Guidelines for searching
The extent of the literature search and the amount of time spent will be guided by the search purpose, and the number of references required by the user. It is not practical to lay down precise limits; however, the following guidelines should be used:
Searches to support college assignments will be limited to 1 database or 2 hours searching time, whichever is more appropriate;
Searches to support presentations/lectures or interviews will be limited to 3 hrs searching time.
If staff are looking for information to give to patients/relatives, searches will be limited to 1 or 2 good quality web sites, such as EQUIP (www.equip.nhs.uk) or Patients UK (www.patient.co.uk).
Searches to support professional development will be limited to a maximum of 2 relevant databases.
Requests for information to support patient care, research and the production of guidelines and protocols require more detailed searches and will not be restricted to a limited number of sources. However, searches should only be allocated a reasonable length of time. The library does not have the staffing to carry out systematic reviews.

Search purpose Staff grade
Information for patient / relative Library assistant
College assignments Library assistant
Presentations/lectures/interviews Depends on complexity and urgency.
Usually Library assistant.
Professional development Depends on complexity.
Professional librarian or library assistant.
Patient care. Professional librarian
Guidelines/protocols Professional librarian
Research Professional librarian

"Currently we don’t charge for literature searching, though users are advised that they should be doing their own searching and we provide training and e-learning for this (the e-learning is open access and available at www.pillarsvle.net – everyone can just log on as a guest and you’re welcome to use this or send the link to your users too!). We do however provide a literature searching service for specific work related projects (the majority of our enquiries come from people doing something academic). These are discussed on a case by case basis with the individual or service for suitability for the programme and we do a ‘mini systematic review’ style search for them. This can often be quite in-depth and time consuming – hence the ‘screening’! It’s a possibility that at some point we will charge departments for these in the future so I would be very interested in the replies to your enquiry"
Opinions / experiences
" Oh, I'd charge, if I thought I'd get away with it! Apart from anything else, it might make some of our users more appreciative of what's involved. Like so much in life, people sometimes only appreciate what they pay for....."

"We do not at present charge for any searches, no matter who asks or for what reason. Our view is that literature searching is a core service of the library, whether for patient care, research or for educational purposes, since we still see this as part of staff development. We do not at present envisage changing this policy. We are in the fortunate position of having a dedicated training/research library post but even without this, the library has always seen search requests as part of our remit, regardless of the reason for the search. We always give clinical requests priority"
"We charged for a few years and then decided not to in order to encourage requests. But it has made little difference. So I’m happy not to in the interests of encouraging library use, and to keep things simple. This relates to staff use rather than for students. We charged £2, which was just to make people think about what they were asking; we did not expect to make money on it. We did not advertise the change. But as we were having more contact by phone and email rather than in person, it became more difficult to manage the charging. We haven't done hundreds of them each year".
"We used to years ago but were told to stop it at an accreditation assessment.... but maybe the economic climate has changed again! It was a system I inherited when I started this job about 13 years ago, and I didn't feel in a position to question it. I think we charged £10 a search but it may have been £20 I can't remember. We charged for all searches, and I have to say looking back that even so we did more searches then than we do now - people manage themselves more now. However it was perceived by the accreditation panel as being a barrier to the knowledge base, and I have to say I tend to agree. I was happy to stop charging - it reduces the admin too. I think it would be difficult to charge only for some sorts of searches, as how would you identify which searches fell into the 'charging' category? We now only charge external (non-NHS) customers, and as far as I can recall we have never been asked to do a search for one of them".

"We don't charge for searches at the moment but if we find ourselves subject to budget cuts this is one of the services we will have to get our users to pay for".

"This is something we were thinking about as well. However, because of the way the healthcare libraries are funded and structured in Northern Ireland, it was felt to be inappropriate at the time. Not much help I know. However, times are changing and it may well be something that needs to be revisited here given the ever decreasing amount of resources available to us".

Literature search disclaimers

I know we all find disclaimers a bit tricky, so nice to know what the Canadian Health Librarian's discussion list came up with on this topic, from Sarah Vanstone in the Canadian Medical Association:

"I am sharing the information I gathered about literature search disclaimers. Here are some examples of disclaimers that were sent to me or that were found on the internet. I also include at the end, emails from librarians who do not currently use disclaimers.
regards, Sarah

Sarah Vanstone Manager, Information Services (Acting) Canadian Medical Association - L’Association Medicale Canadienne 1867 Alta Vista Dr., Ottawa, ON. K1G 5W8
613.731.8610 (2144) 800.663.7336 (2144) Fax: 613.731.2076
Examples of disclaimers and comments about disclaimers
Information is provided as a service by the Neil John Maclean Health Sciences Library. The information is gathered from standard medical sources and is not intended to provide comprehensive coverage of the subject. The information may not be applicable in any given clinical situation, nor is the selection of material intended to suggest a diagnosis or treatment modality. Results of any literature search are subject to the limitations of the database searched, consequently, some citations which are retrieved may not be directly relevant to the desired topic. The information is only valid as of the date and time conducted. From time to time inaccuracies may exist in a citation. The information is not intended to be a substitute for medical advice or care from a physician or other health care professional. The Neil John Maclean Health Sciences Library is not responsible for consequential or incidental damages arising out of reliance on the information it gathers, and its liability is limited to the cost of services provided.
------------------------ Please note that this literature search is limited to the contents of the databases and there is no guarantee as to completeness.
------------------------
Results of any literature search are subject to the limitations of the database searched. Consequently, some citations which are retrieved may not be directly relevant to the desired topic. Inaccuracies from time to time may exist with a citation and are beyond our control. While database searching does offer speed, online searches are not meant to represent a comprehensive treatment of a topic. The Prior Health Sciences Library is not responsible for consequential or incidental damages arising out of reliance on the information it gathers, and its liability is limited to the cost of services provided. ------------------------
The Briscoe Library staff makes every effort to provide accurate and complete database search results. However, we assume no liability for information retrieved, its interpretation, applications, or omissions. ----------------------
Disclaimer: The search is conducted using the resources available to the University of Queensland Library and within time limits. It is not intended to provide healthcare staff with either advice or recommendations on the management of individual patients. Nor does it provide medical advice to health consumers. The search results consist of bibliographic references only, not the full-text of original papers. These requests are stored in a database housed on protected UQ Library server. All requests will be kept confidential.
-----------------
Exclusion of Liability: The results retrieved by this literature search are for the information of the requestor. Queen’s University or its employees are not liable for any errors or omissions, negligent or otherwise, in the search process or in the content of the database(s). The search results may not represent all the information available on the search topic, and the requestor agrees not to rely exclusively on the information retrieved by this search.
----------------
Please carefully examine the results and search terms used for the search. HHN Library Services makes every effort to provide accurate and complete database search results; however, it assumes no liability for the information retrieved, its interpretation its application or for omissions. Your input and subject expertise are invaluable in devising the search strategy and selecting appropriate resources. If after viewing the search result you would like to expand or refine the search, please contact Library Service to further discuss your request. Thank you.
---------------
…..while I do not put a disclaimer in the lit searches I perform here, I have, in a previous job as Information Specialist, put the following disclaimer after listing the databases searched.
Date: ___ Researcher: ________________________ Due to the limitation in scope of the databases, it is not certain that all relevant information was detected. While every effort has been made to ensure the accuracy and completeness of the information provided, the researcher cannot be held liable for any loss of business revenue as a result of the provision of the data provided.
---------------
I don’t use a disclaimer, because I usually do the search with the person sitting with me. So, we talk about the vagueries
of databases and choose the level of precision versus recall together. They get to see if the search is working or not and
have the opportunity to shape it to their needs. In the academic medical environment, we’re not usually dealing with people who are going to sue us because an article didn’t show up in the search – which is usually the purpose of the
disclaimer. I used to do a lot of patent searching, and for that I did have a disclaimer that I used occasionally – usually when I was dealing
with a member of the general public (read “backyard inventor”) who clearly did not understand that there are limits to searching, and even
though we’d had the discussion and s/he had sat with me through the search, was still asking questions like “Is this 100% certain that there is nothing like my idea out there?” My colleague at UBC, who also did patent searching for the public, had a disclaimer that he always threw on top of the search, just to
be on the safe side. But I think he did a lot more searching without the client present. Sandy Campbell John. W. Scott Health Sciences Library University of Alberta
--------------------- I don’t have a specific disclaimer per se, but am very clear about what I was able to search within the parameters I was given.
This is usually related to the amount of time I have to do the search vs. what they requested (I get a fair number of grey literature search requests, and when my hours were reduced to part-time, it’s not generally possible to be thorough within the lead times I’m given.
Paula Clark, MISt Health Services Research Librarian Institute for Clinical Evaluative Sciences "

Clinical Librarian Study Day debrief

I wish I could tell you all about the business planning session run by Jacqui Cox and Louise Hull, but I was helping out in another session with Sarah Sutton, so I couldn't sit in on that one.

What I can tell you about is the marketing session. Sarah gave one of her trademark presentations bursting with ideas, and then threw the floor open in little groups to come up with a few more that have worked. I heard some things I hadn't thought of before, and I have the sheet with all the post-its on in my folder next to me right now, to be typed up and put onto our website proper. Sarah referenced a particularly good article in her presentation:

Bridges, Jane. Marketing the hospital library. Medical Reference Services Quarterly, 2005, 24(3), 81-92.

I've definitely come up with a few things I'd like to do in the future, such as hook up with our internal conference organiser & see if we can offer things like summaries of available evidence on topics, or recommended reading lists.

After a lovely curry lunch (Leicester Hospitals do curry really rather well), there was plenty of time to do some catching up with old faces and meet quite a few new ones. Since I was on home turf, I did also get to pop back to the library and man the desk while the library assistants got some lunch too.

We had a brief talk from Jacqui Cox about moving clinical librarianship forwards after the break, and then it was time for more workshop sessions. I ran a session on a digests that was really just an informal chat between groups of what should and shouldn't go into a digest. We all mused about whether a search strategy should be there at all, and whether it should have star billing. As librarians, I think we tend to feel that the strategy is king, and it is, but I have an inkling that the customers may be more interested in the results than the process.

Having looked at the evaluation forms at the end of the day, I think we packed a lot in, and most people seemed happy with what they'd taken from the day. We try our best to plan days that allow for plenty of networking, since a lot of CLs work in a kind of isolation, and it's always nice to get out, meet colleagues and find reassurance that you're not the only person doing things a certain way. We're always interested in new suggestions for things we can do though.

Which leads me to the launch of the 5th International Clinical Librarian Conference. I put out a call for papers at the Study Day and via clin-lib@jiscmail.ac.uk this week, and the website is now live and accepting bookings (credit card payment to follow). Maybe something we talked about at the Study Day will be enough to spark one of you into submitting an abstract for a presentation in Birmingham next year!

I'm going to get the Study Day details on the website ASAP, but I'm moving house next week, so it might take just a little while longer.

Writing for publication

In July 2010, I realised a five year long ambition - to actually attend a training session on Writing for Publication. It's been a standing objective on my annual appraisal since I began working as a Clinical Librarian. Once, I signed up for a course only for it to be cancelled. Another time, I totally missed one by virtue of not reading a conference programme properly. In fact, I was so convinced I would never manage to achieve this at my last but one appraisal, I set about looking at things from a different angle - more on that another time.

But this Summer, I finally managed to find a session and go to it - at the Health Libraries Group Conference 2010, run by Maria Grant, Editor of HILJ, and Andrew Booth, from ScHaRR.

This came back to mind today for two reasons. One, I just received the post, and found this:
On the back was the writing objective I set for myself in the session. I've written "Project: MSc dissertation (and article?) - systematic review of PDAs. Audience: Examiners! And hopefully clinicians/librarians. Timescale: End of Sept for dissertation; end of year for article". And I've already achieved the dissertation part, which makes it all the sweeter. I have an Outlook reminder to start thinking about the article part next week. I love it when this happens, it makes me feel efficient.

I was in the group that did the "nutshelling" practical, which basically meant sitting down with a blank sheet of paper and just writing down what I wanted to say. There's meant to be no going back & crossing out, you just write and get over the fear of having that blank sheet in front of you! Editing can be done later. I've used it to draft this post today too; I've found it very helpful indeed.

I have had some other recent experience of writing for publication. Back in May I was asked to write a chapter for a new Facet Publishing book on Web 2.0. It was incredibly daunting, but with a bit of nutshelling, and a lot of research, I've just about managed it. It was another learning curve, using the style guide and instructions for authors and trying to make my point clearly. Between the chapter and the dissertation it's also meant I've got to grips with Refworks which has been really useful.

Another thing I have learned from the process of writing the dissertation, the chapter and this blog is that writing regularly is the key. Even if you do screw up that piece of paper & toss it in the bin.

Bye bye Bloglines

I have to admit, I switched to Google Reader a couple of years ago, but I do think the demise of Bloglines should be lamented. I found it incredibly useful when I did use it, and I can't actually quite remember why I switched anyway. I do remember it being fairly easy to export all of my RSS feeds, so hopefully anyone having to make the switch now won't find it too onerous.

It appears RSS feeds are on the way out, but why? Twitter is fine, but:
1. I had to get special dispensation to be allowed to use it at work.
2. It's a bit of a jumble with professional/personal crossover, and I don't want to deal with more than one account.
3. Sometimes it just moves too damn quickly! I'm not permanently plugged into it, I have other things to do.

I like the option to dip into my RSS feeds two or three times a week and find everything there, just waiting for me (I also really liked being able to publish useful stuff on my own Bloglines blog, but I didn't think anyone else was looking, so wondered what the point was). I've built up my RSS feeds over time, and don't know where else I would be able to find that wealth of information just waiting for me to read it when I'm ready. The Krafty Librarian agrees.

Google Reader does a decent enough job for me to keep up with all of my feeds in one place, although as the Health Informaticist points out, it has an annoying habit of asking me to upgrade my locked-down, NHS-issue IE6 browser on a regular basis. I'd love to dear, but I can't!

Protocol Harem

I recently put out a request to the Clinical Librarian mailing list for literature search protocols and I promised to share what I found. Life then took over with a pile of literature searches and the small matter of finishing my dissertation for an MSc in Health Services Research.

So, a bit of background. I had noticed that the whole library team were using very different approaches to how we went about doing literature searches, and presenting the results back to the requesters. Don't get me wrong, I think a variety of approaches is absolutely fine, we've spent time all doing the same search before and then discussing how we went about it, and my general anecdotal finding is that everyone finds the major relevant studies no matter how they combine the terms. Scoping something out first may be your thing, or you might, like me, jump straight in at Medline and throw words at it and launch into a full search. I realise my route probably isn't perfect, as with a therapy question you really ought to check for the highest level evidence on the Cochrane Database of Systematic Reviews first (and it was nearly my downfall when I interviewed for this job - luckily I remembered in the nick of time, yet I've still not learned).

I thought we needed a bit of a plan at least, to make sure that people requesting searches get an equitable service. And the response I got to my request for literature search protocols was really quite good, since clin-lib doesn't get a lot of traffic and you can never be sure who's out there in the ether.

Some of the protocols are web-based, which I think is a really good idea. You're advertising exactly what your requester can hope as service when they ask their question. One such protocol is from the Royal College of Obstetricians & Gynaecologists (RCOG). It's simple, succinct and explains clearly what you can expect. Elaine Garrett, from the RCOG told me that it's based on the ATTRACT protocol

A more detailed protocol is actually on the NHS Evidence "For Librarians" section, from the Thames Valley Health Libraries Network (updated link). This is really comprehensive and would definitely be of use to the novice searcher as well as the expert. I also received protocols from the Library & Knowledge Service at Derby Hospitals NHS Foundation Trust, which is very similar in the depth of detail to the Thames Valley version, and also another similar one from the Medical Library at the Royal Free Hospital, so thanks to Lisa Lawrence and Ruth Muscat respectively.

The main points to note from all of these is preparing for the search, making sure the question is understood, documenting the process (standards about the format are an issue we've been trying to iron out), searching the right resources for the question (in the right order? I'm undecided about the order being important), and presenting the results clearly back to the requester. We haven't yet decided whether to adopt a formal protocol at UHL, but we're looking at the way we all do searching, which I hope to share in the future.

There are so many factors at play in every single request for information that I'm not sure a definitive search protocol that could be applied to every single question exists. I view the protocols more as guidelines for searching, or as an aide memoire, but I would be interested to know what colleagues and readers of this blog think.

Bibliography updated

At long last I've found the time to wade through all of my Pubmed search alerts, and my frankly quite flaky NHS HDAS search alerts & update the Clinical Librarian bibliography on our web site.

We also have a link to do a quick Pubmed search from the site, so even if I've been slack, you can see what's been published recently in the field. It's not the most sophisticated search, so if you have comments or suggestions, feel free to let us know!

http://www.uhl-library.nhs.uk/cl_research.html

Study Day 11th October 2010

It's a way off yet, but during the season of mists and mellow fruitfulness, we're planning our next Clinical Librarian Study Day. For more details, visit our web site: http://bit.ly/95rVGH

We're planning on making it much more about what people say they want to talk about from previous evaluations, and to have a real chance to share ideas between all attendees. Hope you can make it!

Clinical Evidence Based Information Service Specialists

A rose by any other name?

University Hospitals Coventry and Warwickshire NHS Trust are looking for three Information Specialists for their new service. http://www.jobs.nhs.uk/cgi-bin/vacdetails.cgi?selection=912447555

The posts sound like a very interesting take on the Clinical Librarian model, so certainly one to watch!