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Evidence Based Practice: Two Waves for Health Librarians

Evidence Based Practice: Two Waves for Health Librarians. Dr Ruth M Sladek MPH, PhD Senior Lecturer in Medical Education Head of Medical Admissions School of Medicine. Today’s Presentation. A narrative about what EBP has meant for health librarians Two waves

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Evidence Based Practice: Two Waves for Health Librarians

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  1. Evidence Based Practice:Two Waves for Health Librarians Dr Ruth M Sladek MPH, PhD Senior Lecturer in Medical Education Head of Medical Admissions School of Medicine

  2. Today’s Presentation A narrative about what EBP has meant for health librarians Two waves • Contributing to others’ EBP, eg Informationist • Developing own EBP (EBL), eg Search filters Reflections about what it means now

  3. Historical Context… Now 75 RCTs and 11 systematic reviews per day • Long recognised problem of information overload • …“before the subject [of scurvy] could be set in a clear and proper light, it was necessary to remove a great deal of rubbish” (Lind, 1773) • Increasing emphasis on need for published evidence mid-end 20thCentury (Bastian, Glasziou & Chalmers, 2010) • Medline references: 1600 in 1865, 10 million in 2006 • Cochrane lamented need for summaries of RCTs (14 per day) • Is it any better now?

  4. First Wave: EBP Emergence of EBP • not only more primary evidence, but new sorts of evidence (SRs; EB Clinical Guidelines) EBP underscored ongoing need/relevance of health librarians • New broad role: improving others’ EBP (multiple professions) • Jumping with ‘ignorant’ glee!

  5. First Wave: EBP Why jumping with “glee”? • “Finding the Evidence” core concept (necessary but not sufficient) • Traditional experts in organising, identifying, accessing, providing published knowledge • Established roles in education, research & patient care settings • Confirmed importance/relevance to ‘healthcare’ • Could see an opportunity to contribute • Validation … balancing the ledger, market value

  6. First Wave: EBP But, why “ignorant” glee? • Assumption that they were ready: “At last!” • Little/no understanding of new knowledge/skills/demands • Mirrors other professions (?) • Evolutionary & revolutionary for health librarians

  7. First Wave: EBP Over time • A continuum of growing engagement with EBP • Recognition of new knowledge required (eg, epidemiology, critical appraisal skills) • Collaborated to provide point-of-care resources (eg, the Consortium a la SALUS) • Contributed to/purchased/taught new specific ‘EBP’ resources (eg, Clinical Evidence) • Integrated “finding the evidence” into University teaching programmes (eg, Flinders University)

  8. First Wave: EBP Over time (cont.) • Worked with own organisations to integrate best evidence, eg, committee membership • Collaborated, eg, ACEBCP Workshops • Ran seminars/training/workshops, eg, How to… • Contributed to synthesizing evidence • Cochrane Review Groups/Registers • Individual authors • Guidelines

  9. First Wave: EBP Over time (cont.) • Increased integration with healthcare team (eg, informationists (Davidoff & Florrance, 2000) • Attending death audits, grand rounds, clinical meetings, ward rounds • Identifying “patient-specific, relevant published evidence” • Thin, but sharp end of EBP wedge • Explicit roles to search, filter & provide the best evidence for clinical decisions • USA (1970s), UK (1990s), Australia (2000s) • Exploration of ways to make a meaningful difference

  10. Informationist at the Repat Making a Difference During a Ward Round • Dr A queried the evidence to support nebulised antibiotics for bronchiectasis for Patient X. • Written summary of best evidence provided to broader team, ie, Dr A, and Dr B (not involved with Patient X). • Later that day, Dr B discussed evidence with pharmacist for Patient Y, and dosage influenced by evidence. • Dr B also considered evidence for Patient Z. • One clinical question impacted 2 doctors, 3 patients in 24 hours (Sladek, Pinnock& Phillips, 2004)

  11. Second Wave: EBL Evidence Based Librarianship (EBL) • As with other professions, growing acknowledgment of need for own evidence • New discussions, new literature, new journals • Example of Search Filters

  12. Second Wave: EBL Search Filters Health librarians are expert searchers • Understand databases • Understanding syntax, subject headings, Boolean logic, rules • Can liken to clinical expert opinion But, is expert opinion enough? When the stakes are high (eg, searching for trials for systematic reviews), is there a more evidence-based approach?

  13. Second Wave: EBL Search Filters • An ‘evidence-based search strategy’ for a particular topic / database • Explicit, replicable methodology • Gold Standard Test Comparison study design (used to evaluate new diagnostic tests) • Known performance parameters • Still need to be mixed with expert opinion

  14. Second Wave: EBL For example, searching for RCTs on PubMed You could construct an expert search … OR you could run an RCT search filter (99% sensitivity; 70% specificity): ((clinical[Title/Abstract] AND trial[Title/Abstract]) OR clinical trials[MeSH Terms] OR clinical trial[Publication Type] OR random*[Title/Abstract] OR random allocation[MeSH Terms] OR therapeutic use[MeSH Subheading]) Haynes et al, various dates

  15. Second Wave: EBL For example, searching for palliative care: You could construct an expert search strategy …OR you could run a PubMed palliative care filter: (advance care planning[mh] OR attitude to death[mh] OR bereavement[mh] OR terminal care[mh] OR hospices[mh] OR life support care[mh] OR palliative care[mh] OR terminally ill[mh] OR death[mh:noexp] OR palliat*[tw] OR hospice*[tw] OR terminal care[tw] OR 1049-9091[is] OR 1472-684X[is] OR 1357-6321[is] OR 1536-0539[is] OR 0825-8597[is] OR 1557-7740[is] OR 1552-4264[is] OR 1478-9523[is] OR 1477-030X[is] OR 0749-1565[is] OR 0742-969X[is] OR 1544-6794[is] OR 0941-4355[is] OR 1873-6513[is] OR 0145-7624[is] OR 1091-7683[is] OR 0030-2228[is]) OR ((advance care plan*[tw] OR attitude to death[tw] OR bereavement[tw] OR terminal care[tw] OR life supportive care[tw] OR terminally ill[tw] OR palliat*[tw] OR hospice*[tw] OR 1049-9091[is] OR 1472-684X[is] OR 1357-6321[is] OR 1536-0539[is] OR 0825-8597[is] OR 1557-7740[is] OR 1552-4264[is] OR 1478-9523[is] OR 1477-030X[is] OR 0749-1565[is] OR 0742-969X[is] OR 1544-6794[is] OR 0941-4355[is] OR 1873-6513[is] OR 0145-7624[is] OR 1091-7683[is] OR 0030-2228[is]) NOT Medline[sb]) AND English[la] AND free full text[sb]Show Palliative Care eg 3 slides from website

  16. Some Reflections EBP and EBL, now what? • Health librarians want to make a meaningful difference • Stepping outside of the traditional boundaries (and stereotypes) • Multiple capacities/potential, but what is most meaningful for nursing/your organisation? • Involve each other at the start (KT principles) • The nature of “developmental” relationships – the need to evolve/nurture – the notion of a continuum

  17. Final Reflections Service provider? Professional? Healthcare professional?

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