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… 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 20 th Century (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? Now 75 RCTs and 11 systematic reviews per day

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

17. 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

20. 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

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