practicing up-to-date-medicine
TRANSCRIPT
Practicing Up To Date MedicineAn overview of things that can make it easier
Andrew Milne, NHS Librarian
Today we’ll cover:
• What the Library can offer you
• What NHS OpenAthens offers you
• How to use those services as part of the Evidence Based Medicine cycle
• Sources of additional support
Working at Imperial College Healthcare NHS Trust means access to an Imperial College network of libraries.
That’s the book stock of six libraries instead of just one hospital library.
Opening hours vary by site
Hammersmith9am – 9pm Monday to FridayPlus out of hours access to PCs until midnight and on
weekends
Opening hours vary by site
Charing Cross9am – 9pm Monday to FridayPlus 10am – 5pm Saturdays
Opening hours vary by site
St. Mary’s9am – 9pm Monday to Friday
1:30pm – 5pm SaturdayPlus access to the upper
gallery every day from 7am til midnight
Joining is simple
1. Show Commonwealth Building security your
hospital ID to get an Imperial College ID card.
2. Fill in a registration form at the library.
Now that you’ve joined you get:
books e-booksjournals e-journals
PC accessprinting and copying
quiet study spacegroup study rooms
databases free interlibrary loans
help and training from library staff
We offer thousands of books covering general medicine, medical specialisms, nursing, allied health, and research skills.
Central Library also has books on other topics, including fiction.
We arrange our books based on NLM –
National Library of Medicine classification.
This means books are grouped by
subject at general and specific levels.
We arrange our books based on NLM –
National Library of Medicine classification.
This means books are grouped by
subject at general and specific levels.
WJ = general subject39 = specific subjectOXF = title or first author
The library website has a dedicated section for NHS users.This offers information and links to a variety of resources and services.
You can also search the catalogue for books and journals or specific journal articles directly from library web pages.
For the most up to date current awareness and primary sources of evidence, you should be looking at journal articles.
We keep some current issues of journals in the library, with older issues available on request.
Many are now provided electronically instead and can be viewed at one of our PCs.
As well as journal articles, our PCs give you access to:
Internet
Microsoft Office
Additional resources from Imperial College London – for example UpToDate
You can send work to the B&W or colour printer
from our PCs and release it from a printer with
your Imperial College card if it has credit.
Scanning is free.
OpenAthensand why it’s a vital tool for any health professional
OpenAthens gives you access to a wide range of resources – from any device, anywhere.
You can self-register for OpenAthens online – if necessary, we’ll check and approve your account.
NICE Evidence search is quick and handy ‘Google’ for health queries.
Use it to search for clinical knowledge summaries,
guidelines, care pathways, and more.
The A-Z list of journals gives you access to the archives of a variety of journals – at the library, the hospital, at home, and on the go.
Great when you have a specific
journal or article in mind.
The Cochrane Library
A library of meta-analyses and systematic reviews available through NICE Evidence website.
Systematic reviews = the gold standard
HDAS is the jewel in NICE Evidence’s crown.
Healthcare Databases Advanced Search gives you 8 databases to
search for articles specific to your clinical or research query.
The Evidence Based Medicine Cycle
Uncertainty translated into
answerable question
Systematic retrieval of high quality relevant
evidence
Critical appraisalApplicable results
applied to practice
Evaluation and audit
Step 1 – Asking the right question
• Be specific and provide as much detail as possible
• Anticipate how you’ll use the answer• Consider techniques like PICO
PICO
Population (or Patient)
Intervention
Control (or Comparison)
Outcome
• Is acupuncture effective?VS
• Is acupuncture an effective treatment in smoking cessation?
Step 2 – Gathering evidence
• Use a variety of databases• Use consistent searches• Break your question down into ‘search
chunks’• Identify a variety of keywords and
synonyms for each chunk
Rather than searching everything at once as in Google…
Use OR to combine keyword searches for similar and synonymous terms – i.e. to create chunks or groups of keywords.
Oxygentherapy
Oxygendelivery
Oxygen inhalation therapy
Use OR to combine keyword searches for similar and synonymous terms – i.e. to create chunks or groups of keywords.
Lower respiratory tract infection
Whooping cough
Pertussis
Use OR to combine keyword searches for similar and synonymous terms – i.e. to create chunks or groups of keywords.
Child Infant Young
Use AND to combine the groups of keywords – bringing back only results relevant to every group.
Oxygen therapy etc.
Lower respiratory tract infections etc.
Child etc.
How this looks in practice…
Map to thesaurus
Map to thesaurus
• Use your own keywords• Use keywords you identify in relevant
literature• Use ‘map to thesaurus’ to search the
database’s indexing system
• Constantly re-evaluate and develop your search strategies.
• Don’t fall into the Google trap!
You’re not doing a quick Google search (or searching for pizza)
Step 3 – Critical Appraisal
“the process of carefully and systematically examining research to judge its trustworthiness, and its value and relevance in a particular context”
(Critical Appraisal Support Programme)
www.casp-uk.net
Critical Appraisal…
…stops you being a passive reader;
…helps you to filter out low quality evidence;
…should lead to stronger research output as you become aware of what makes evidence robust.
Step 3 – Critical Appraisal
• Use checklists by organisations like CASP
• Maintain a critical eye• Does the study ask a clear question?• Is the study well-designed for what it
tries to investigate?• Is it statistically significant?• Is it clinically and locally significant?
Research design and methodology
• Is the study type appropriate?• Is it ethical?• Was blinding used?• Were participants randomised?• Was intention to treat analysis used?• How many participants were lost to
follow-up?• Was collection of results consistent?
Results
• How large was the treatment effect?• Is the primary outcome clearly
specified?• What results were found for each
outcome?• How precise is the estimate of the
treatment effect? (confidence intervals; power calculations)
Favours Treatment
Value of no effect
0 1 2 3 4-4 -3 -2 -1
Favours Control
95% confidence interval
Stats cheat sheet
• Look for p-values of 0.05 or less• Power calculations in the range 80-95%• Shorter confidence intervals mean closer
pinpointing of the true result• Confidence intervals that cross 0 mean an
inconclusive result• Number needed to treat (NNT) – lower is
better, but avoid 0 or negative!• Relative Risk: 1 means no difference in risk
between groups; either side favours one or the other
Implications of research
• Can it be applied locally?• Costs and harm versus benefits?• Statistical significance does not
mean clinical significance• Is further research needed?• Any conflicts of interest?• Any weasel words? (“approaching
statistical significance”)
Three Rs
• RIGOUR
• RESULTS
• RELEVANCE
• Join or set up a journal club• Follow journal clubs online (e.g.
#TwitJC)• Attend a critical appraisal workshop• Read new literature • Save searches in HDAS and create
alerts for when new literature is published
Steps 4 & 5
• Applying the relevant results to your practice is up to you and your colleagues
• Evaluation and audit makes continued use of your information skills and critical skills
• Remain reflective and don’t rely on received wisdom or assume you’ve perfected something
• Return to step 1
The Evidence Based Medicine Cycle
Uncertainty translated into
answerable question
Systematic retrieval of high quality relevant
evidence
Critical appraisalApplicable results
applied to practice
Evaluation and audit
In summary
• The library is here for you to use – use it• OpenAthens is there for you to use – use
it• Apply systematic search techniques to
answer focused questions• Set up alerts for those searches• Critically appraise your results before
applying to practice• Seek help when you need it
Library Induction
Searching Databases
Current Awareness
Critical Appraisal
The four modules of the Library’s information skills training programme
Library Induction
Searching Databases
Current Awareness
Critical Appraisal
The four modules of the Library’s information skills training programme
You might be able to skip steps if you feel comfortable. The goal is to help you complete
the programme with the foundations necessary to make effective use of resources with
stronger information literacy.
Critical Appraisal
Text here
SocialMedia?
Searching Databases
Library Induction
ReferenceManagement?
Current Awareness
NewTech?
???
But eventually…
• Additional modules
• New content• A growing set of
key skills for you to pick and mix
• Consistent delivery
• Fresh training responding to your needs and wants
