It’s always enjoyable to attend a clinical librarian study day – there’s a chance to talk to people informally about what they’re doing and how they’re doing it, and this year’s programme intensified that possibility by embedding the sense of ‘peer sharing’ into the day’s talks.  The day began with an extremely interesting speech from Andrew Miniuk of NHS Evidence.  He described the development of NHS Evidence from its early origins even before the publication of the Darzi review, and in the process certainly filled in a lot of gaps in my knowledge, and I’m sure the same happened for the rest of the audience.  A key point of Andrew’s talk was the fact that commissioners of health services are often faced with a confusing overabundance of guidelines and other evidence.  Which is best and why?  NHS Evidence’s accreditation programme aims to help commissioners identify ‘what good care looks like’.  The first raft of accreditations are due to be rolled out later this year, with a target of 10 by the end of December – something Andrew himself wasn’t afraid to point out as incredibly ambitious.  Other information about the development of Evidence included the fact that Release 2 is scheduled for October 2009, aiming to include personalisation, alerts, search syndication (allowing other sites to use the Evidence search bar), the transition of the NLH material, and the accreditations.  Again, not an unambitious target!  The clinical librarians in the audience took the opportunity to quiz Andrew quite closely on the future plans for core collection journals and the Health Databases Advanced Search (Search 2.0) – we were reassured that Evidence is aiming to continue with the central journal purchasing, but there was less immediate information about the searching aspect.  All in all, this proved an excellent start to the day.

Next, we heard from five different clinical librarians, each showcasing their work.  It was immediately striking that there are such a wide variety of roles out there, ranging from providing a patient information centre, to attending ward rounds and searching for detailed clinical questions, to meeting with the Chief Executive and other high-ranking individuals to discuss Exceptional Case Reviews, where decisions are made about the treatment of an individual patient.  However, each clinical librarian essentially did the same thing – facilitate the provision of information to a clinician or patient who needs it to inform their decision making or work.  For me this acknowledgement of the diversity of clinical librarians served to reassure that despite the external differences in our roles, we are still all essentially providing the same service.

After a good natter and catch up with people over lunch, we separated into groups for practical sessions in the afternoon.  My first session was ‘What are we missing: exploring and sharing hidden sources’.  The aim behind this session seemed to be to try and begin a discussion where librarians could share their experiences of using different sources.  In the end it became a general discussion of our methods for searching.  This was an excellent opportunity to find out how others are tackling the same problems in the field, and it was very reassuring to hear that most of us are approaching things in the same way.  There was some discussion of whether it’s of benefit for health librarians to have a scientific or health background.  As a drama and theatre studies graduate, I felt very strongly that this has never been an issue, but it was interesting to hear how others felt.  One participant recommended a book called the Language of Medicine  as an excellent entry into medical terminology.  This is one book I will be looking into purchasing!

The final session of the day was looking at an intriguing area of literature searching – that of using subject search filters.  This is something I haven’t really come across before, normally just sticking to systematic review filters etc, and I did find it difficult to see the value in using them, unless of course you are regularly asked to look for information in a particular subject area.  The facilitators of the session provided an extremely useful handbook, together with examples of other subject search filters, and we were given free reign to experiment on Search 2 to try and develop our own.  It was very interesting to have some time to spend on an area that I haven’t really considered before.

The study day was extremely useful and enjoyable, and it was nice to feel a sense of camaraderie developing throughout the day.  I picked up a number of useful ideas that I will be taking back to my workplace as we develop our own clinical librarian service.

For presentations and programme see:

 http://www.uhl-library.nhs.uk/pdfs/cl_study_day_2009.pdf

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.