Searching for the best evidence and supplying some perfect papers to a busy clinician is perhaps one of the most satisfying aspects of clinical librarianship. But what if you don’t find anything? Often it’s a case of apologising to the clinician and hoping for the best that it isn’t your searching skills that are to blame. But if you don’t find anything in a well-conducted literature search, then the likelihood is that no-one has carried out any research in that area as yet. And now there is a mechanism to flag this up. The UK Database of Uncertainties about the Effects of Treatments (UK DUETS) (www.library.nhs.uk/duets) was set up by the James Lind Initiative and is now part of the suite of NHS Evidence Specialist Collections (formerly NLH Specialist Libraries). It aims to collect uncertainties – identified by clinicians, by research and crucially, by patients themselves.
Why, you might ask, do we need to collect uncertainties? Iain Chalmers, one of the founders of the DUETS project, outlines some compelling cases where not knowing about the effectiveness (or otherwise) of treatments can cost lives. The CRASH trial is a major example of this. Patients admitted to hospital with head injuries were routinely treated with corticosteroids, despite limited evidence of benefit. The CRASH trial aimed to address this uncertainty by carrying out the largest randomised controlled trial on head injury ever conducted[i]. The results were surprising – patients randomised to receive corticosteroids were more likely to die than those on placebo[ii]. As Chalmers points out, how many people may have died due to being given corticosteroids before this uncertainty was addressed? And how many other uncertainties are causing unnecessary deaths?
By identifying uncertainties and adding them into a centralised database, there is a record of what research is genuinely required. This record can, in turn, begin to feed in to those organisations that are setting research priorities. Perhaps in time we will begin to see research carried out that really answers the questions that need to be answered, including those posed by patients wondering about their quality of life.
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 (http://www.library.nhs.uk/DUETs/DuetsSubmissionForm.aspx). Information Specialists from the NHS Evidence Specialist Collections will then assess it for addition to the UK DUETS database, where it can then be used to help highlight potential research projects for funders in the future.
[i] MRC Media release accessed 3rd April 2009 on http://www.crash.lshtm.ac.uk/
[ii] Edwards, P. et al ‘Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes at 6 months’ Lancet 2005 Jun 4-10;365(9475):1957-9 PubMed abstract: http://www.ncbi.nlm.nih.gov/pubmed/15936423
[...] 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 [...]