Medlib’s Round, April 2009April 8, 2009
I’m really delighted to be presenting this month’s issue of Medlib’s Round, the blog carnival started by Jacqueline of Laika’s Medliblog in January this year. It was great to receive and read through such a wide range of posts, and in the process to discover new blogs and bloggers.
This month’s theme : “evidence”
This month’s theme was “evidence” – not just in the terms of “Evidence Based Medicine” but in the widest possible sense. Evidence is a hot topic in the UK at the moment – indeed, the National Library for Health (NLH) is to be relaunched at the end of this month as NHS Evidence, “a web-based service that will help people find, access and use high-quality clinical and non-clinical evidence and best practice.” (NICE>About NICE>NHS Evidence, accessed 6 April 2009). My own interest comes from time spent last year working for NHS Scotland’s elibrary and, until last week, for the NLH Eyes and Vision Specialist Library (EVSL), which is about to become NHS Evidence – Eyes & Vision.
Like all Specialist Libraries, EVSL compiles annual evidence updates on major topics and contributes to the Database of Uncertainties about the Effects of Treatments (DUETs). In particular, the EVSL Management Team has been working on a project to identify all potential systematic reviews published since 1997 and assess them using the QUORUM standards. It’s interesting to see how much of current practice has been established through systematic reviews and meta-analyses and how much we still need to rely on lower-level evidence like clinical trials and observational studies. Clinical consensus is still an important factor in decisions for diagnosis and treatment.
Evidence Based Medicine (EBM)
But enough about my interests and on to the carnival bloggers. Possibly the most exciting thing this month is the news that Medlib’s Round has inspired a group of librarians at the Royal Free Medical Library to start blogging. (Note for those not familiar with London geography: the Royal Free is a short walk from Hampstead Heath, hence the derivation of the blog’s name, Hampstead Health). In their first blog post, Sara Clarke poses the question ‘What if there isn’t any evidence?‘ and describes the DUETs project. Sara concludes by suggesting we all get involved in mapping the gaps in the evidence: “Next time your literature search doesn’t throw up any results, consider submitting your findings to DUETs as a potential uncertainty using the online form.”
Nicole Dettmar, aka Eagle Dawg, the host of next month’s Round, suggests another way to get involved as an ‘EBM Librarian‘, by participating in Connie Schardt’s EBM Librarian Wiki, which was created after a class Nicole attended “an opportunity to continue learning and sharing resources for medical librarians everywhere who are teaching about evidence based practice in their organizations.”
General Practitioner and Clinical Lecturer Anne Marie Cunningham provides an easy-to-digest overview of sources of EBM in her post ‘Accessing Evidence Based Medicine‘. This includes a you-tube video of Sir Muir Gray, arguably the main driving force behind the EBM movement in the UK, and is a great starting point for anyone interested in the subject. Meanwhile, round founder, Jacqueline, plunges in more depth into one EBM tool and asks, ‘How evidence based is UpToDate really?‘ - a reminder that however neat and convenient the product may be, we always need to keep our critical faculties about us.
In her guest blog on Laika’s Medliblog, Shamsha Damani, a clinical librarian based in Texas, outlines the difficulties she’s seen some healthcare providers have in implementing EBM – “lack of time, lack of resources, or not really knowing where to start.” She advises keeping it simple – “Ask a focused question, find the evidence, critique the studies found, and then make a decision,” and, crucially, points out that “EBM is about evidence, but it is also about using that evidence in conjunction with your clinical judgment. Don’t let the evidence hijack your clinical expertise.”
Evidence in practice
Several bloggers highlighted individual issues in which EBM has been implemented … for good or for ill, in their assessment. Hanna Lewin, of the health informaticist, highlights the social value of the Quality Adjusted Life Year (and reveals a little bit about NHS Evidence); Dr Shock considers the (lack of) use of scales to measure outcome in depressed patients; and Chris Nickson posts a strongly-worded opinion piece on the evidence for homeopathy (for reference, the NLH Complementary and Alternative Medicine Specialist Library;s coverage of homeopathy is here).
In preparing for this Round of the Carnival, I went out looking for posts slightly outside the range of evidence in mainstream medical librarianship, and first on my list had to be the always wonderful Literature, Arts and Medicine Blog, with its post on body representation. In it, Joyce Cutler-Shaw, Artist in Residence at the School of Medicine at University of California at San Diego describes humarn anatomy and illustration and its significance as evidence. A real eye-opener.
Frank Norman exhorts us to think carefully about Evidence Based Library & Information Practice (EBLIP), illustrating the need to find research that corresponds to one’s own library situation, and admirably defending, in part, what he terms ‘Gut Feeling Based Librarianship’ (I’ll steal this phrase for a lecture one day, Frank), and neatly pointing out the divide between research and practice even in our own world of libraries. That said, he does highlight the work of three estimable research & policy bodies in the UK – JISC, RIN and UKOLN.
Tennessee-based librarian Lin Wu provides an example of practitioner research in her brief report on a recent user survey, ‘What faculty members need of a librarian‘, and, just as Frank’s GFBL might suggest, finds that librarians are expected:
- To provide expert literature searches to support research and educational programs
- To offer instructional sessions or workshops to their students on literature searching
- To be the information messenger between the college and the library
- To be flexible in offering library workshops considering the needs of distance learning community
Alisha Miles asked how to introduce web 2.0 to medical staff ; Margaret Garcie suggests 100 best tools and tips to organize your inbox ; and Erica Collin presents 100 tips, tools and resources for librarians on twitter.
The patient is paramount
Several librarians stress the importance of the patient. Alisha Miles highlights the importance of keeping the patient informed at each stage of their treatment ; C.F. Goulart posts briefly on the symptoms of diabetes (for which see also the NHS guide to diabetes) ; and Eli Bastin writes of the significance of meeting patients in her post on ‘Evidence and World Kidney Day’. As Eli puts it, “it was only when I met people who dialyse at home or at hospital, who have had transplants but are on dialysis yet again, that I have been able to get a better perspective on why the National Library for Health Kidney Diseases Specialist Library can be a source of important evidence and reference documents for clinicians and nurses” – at the end of the day, whatever research the medical profession conducts, however it is assessed and rated, it’s how it affects us – all of us – as patients that really counts.