Presentation at the #NVB09: “Help, the doctor is drowning”

16 11 2009

15-11-2009 23-24-33 nvb congressenLast week I was invited to speak at the NVB-congress, the Dutch society for librarians and information specialists. I replaced Josje Calff in the session “the professional”, chaired by Bram Donkers of the magazine InformatieProfessional. Other sessions were: “the client”, “the technique” and “the connection”. (see program)

It was a very successful meeting, with Andrew Keen and Bas Haring in the plenary session. I understand from tweets and blogposts that @eppovannispen en @lykle who were in parallel sessions were especially interesting.
Some of the (Dutch) blogposts (Not about my presentation….pfew) are:

I promised to upload my presentation to Slideshare. And here it is.

Some slides are different from the original. First, Slideshare doesn’t allow animation, (so slides have to be added to get a similar effect), second I realized later that the article and search I showed in Ede were not yet published, so I put “top secret” in front of it.

The title refers to a Dutch book and film: “Help de dokter verzuipt” (“Help the doctor is drowning”).

Slides 2-4: NVB-tracks; why I couldn’t discuss “the professional” without explaining the changes with which the medical profession is confronted.

Slides 5-8: Clients of a medical librarian (dependent on where he/she works).

Slides 9-38: Changes to the medical profession (less time, opinion-based medicine gradually replaced by evidence based medicine, information overload, many sources, information literacy)

Slides 39-66: How medical librarians can help (‘electronic’ collection accessible from home, study landscape for medical students, less emphasis on books, up to date with alerts (email, RSS, netvibes), portals (i.e. for evidence based searching), education (i.e. courses, computer workshops, e-learning), active participation in curriculum, helping with searches or performing them).

Slides 67-68: Summary (Potential)

Slide 69: Barriers/Risks: Money, support (management, contact persons at the departments/in the curriculum), doctors like to do it theirselves (it looks easy), you have to find a way to reach them, training medical information specialists.

Slides 70-73 Summary & Credits

Here are some tweets related to this presentation.

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Grey Literature: Time to make it systematic

6 09 2009

Guest author: Shamsha Damani (@shamsha)

Grey literature is a term I first encountered in library school; I remember dubbing it “the-wild-goose-chase search” because it is time consuming, totally un-systematic, and a huge pain altogether. Things haven’t changed much in the grey literature arena, as I found out last week, when my boss asked me to help with the grey literature part of a systematic review.

Let me back up a bit and offer the official definition for grey literature by the experts of the Grey Literature International Steering Committee: “Information produced on all levels of government, academics, business and industry in electronic and print formats not controlled by commercial publishing i.e. where publishing is not the primary activity of the producing body.” Grey literature can include things such as policy documents, government reports, academic papers, theses, dissertations, bibliographies, conference abstracts/proceedings/papers, newsletters, PowerPoint presentations, standards/best practice documents, technical specifications, working papers and more! (Benzies et al 2006). So what is so time consuming about all this? There is no one magic database that will search all these at once. Translation: you have to search a gazillion places separately, which means you have to learn how to search each of these gazillion websites/databases separately. Now if doing searches for systematic reviews is your bread-and-butter, then you are probably scoffing already. But for a newbie like me, I was drowning big time.

After spending what seemed like an eternity to finish my search, I went back to the literature to see why inclusion of grey literature was so important. I know that grey literature adds to the evidence base and results in a comprehensive search, but it is often not peer-reviewed, and the quality of some of the documents is often questionable. So what I dug up was a bit surprising. The first was a Cochrane Review from 2007 titled “Grey literature in meta-analyses of randomized trials of health care interventions (review).” The authors concluded that not including grey literature in meta-analyses produced inflated results when looking at treatment effects. So the reason for inclusion of grey literature made sense: to reduce publication bias. Another paper published in the Bulletin of the World Health Organization concluded that grey literature tends to be more current, provides global coverage, and may have an impact on cost-effectiveness of various treatment strategies. This definitely got my attention because of the new buzzword in Washington: Comparative Effectiveness Research (CER). A lot of the grey literature is comprised of policy documents so it definitely has a big role to play in systematic reviews as well. However, the authors also pointed out that there is no systematic way to search the grey literature and undertaking such a search can be very expensive and time consuming. This validated my frustrations, but gave no solutions.

When I was struggling to get through my search, I was delighted to find a wonderful resource from the Canadian Agency for Drugs and Technologies in Health. They have created a document called “Grey Matters: A Practical Search Tool for Evidence-Based Medicine”, which is a 34-page checklist of many of the popular websites for searching grey literature, including a built-in documentation system. It was still tedious work because I had to search a ton of places, many resulting in no hits. But at least I had a start and a transparent way of documenting my work.

However, I’m still at a loss for why there are no official guidelines for librarians to search for grey literature. There are clear guidelines for authors of grey literature. Benzies and colleagues give compelling reasons for inclusion of grey literature in a systematic review, complete with a checklist for authors! Why not have guidelines for searching too? I know that every search would require different tools; but I think that a master list can be created, sort of like a must-search-these-first type of a list. It surely would help a newbie like me. I know that many libraries have such lists but they tend to be 10 pages long, with bibliographies for bibliographies! Based on my experience, I would start with the following resources the next time I encounter a grey literature search:

  1. National Guideline Clearinghouse
  2. Centre for Reviews and Dissemination
  3. Agency for Healthcare Research and Quality (AHRQ)
  4. Health Technology Assessment International (HTAI)
  5. Turning Research Into Practice (TRIP)

Some databases like Mednar, Deep Dyve, RePORTer, OAIster, and Google Scholar also deserve a mention but I have not had much luck with them. This is obviously not meant to be an exhaustive list. For that, I present my delicious page: http://delicious.com/shamsha/greylit, which is also ever-growing.

Finally, a request for the experts out there: if you have any tips on how to make this process less painful, please share it here. The newbies of the world will appreciate it.

Shamsha Damani

Clinical Librarian

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Time to weed the (EBM-)pyramids?!

26 09 2008

Information overload is a major barrier in finding that particular medical information you’re really looking for. Search- and EBM-pyramids are designed as a (search) guidance both for physicians, med students and information specialists. Pyramids can be very handy to get a quick overview of which sources to use and which evidence to look for in which order.

But look at the small collection of pyramids I retrieved from Internet plus the ones I made myself (8,9)………

ALL DIFFERENT!!!!

What may be particularly confusing is that these pyramids serve different goals. As pyramids look alike (they are all pyramids) this may not be directly obvious.

There are 3 main kinds of pyramids (or hierarchies):

  1. Search Pyramid (no true example, 4, 5 and 6 come closest)
    Guiding searches to answer a clinical question as promptly as possible. Begin with the easiest/richest source, for instance UpToDate, Harrison’s (books), local hospital protocols or useful websites. Search aggregate evidence respectively the best original studies if answer isn’t found or doubtful.
  2. Pyramid of EBM-sources (3 ,4, 8 )
    Begin with the richest source of aggregate (pre-filtered) evidence and decline in order to to decrease the number needed to read: there are less EBM guidelines than there are Systematic Reviews and (certainly) individual papers.
  3. Pyramid of EBM-levels (1, 2, 5, 7, 9)
    Begin to look for the original papers with the highest level of evidence.
    Often only individual papers/original research, including Systematic Reviews, are considered (1, 9), but sometimes the pyramid is a mixture of original and aggregated literature (2,5)
  4. A mixture of 2, 3 and/or 4 (2,5)

Further discrepancies:

  • Hierarchies.
    • Some place Cochrane Systematic Reviews higher than ‘other systematic reviews’, others place meta-analysis above Systematic reviews (2,6). This is respectively unnecessary or wrong. (Come back to that in another post).
    • Sometimes Systematic reviews are on top, sometimes Systems (never found out what that is), sometimes meta-analysis or Evidence based Guidelines
    • Synopses (critically appraised individual articles) may be placed above or below Syntheses (critically appraised topics).
    • Textbooks and Reviews may at the base of the pyramid or a little more up.
    • etcetera
  • Nomenclature
    • Evidence Summaries ?= Summaries of the evidence? = Evidence Syntheses? = critically appraised topics?
    • Etcetera
  • Categorization
    • UpToDate is sometimes placed at the top of the pyramid in Summaries (4) OR at the base in Textbooks (5), where I think it should belong in terms of evidence levels, but not in terms of usefulness.
    • DARE is considered a review, but it is really a synopsis (critical appraised summary) of a Systematic Review.

Isn’t it about time to weed the pyramids rigorously?

Are pyramids really serving the aim of making it easier for the meds to find their information?

Like to hear your thoughts about this.

What my thoughts are? I will give a hint: I would rather guide the informationseeker through different routes, dependent on his background, question, available time and goal. The pyramid of evidence sources and the levels of evidence would just be part of that scheme, ideally.

Will be continued….





Related Articles = Lateral Navigation

18 05 2008

What I did pick up form the WordPress announcement by Matt on possibly related posts (see previous post) is the term “lateral navigation” for navigating from one post to another. Why is this such a nice term?

Well, in my classes on systematic searching I teach people to perform (1) backward searching (checking citations in the reference list of selected papers), (2) forward searching (looking for papers that cite relevant papers) and (3) to browse Related Articles in PubMed or use “Find Similar” in OVID (MEDLINE, EMBASE). This approach is called snowballing or pearl method. It serves to find papers that you might have missed, but even more so to find new terms to add to your search, so you catch these ‘missing studies’ with your final search strategy.

The term lateral searching is so perfect because you can easily vissualize what this word stands for and it fits in with backward and forward searching.

So lateral searching will now be added to my slides! (see figure)

lateral searching

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NL flag NL vlag

De post van Matt (WordPress) over “possibly related posts” (zie mijn vorige post) bracht me op een voor mij nieuw begrip. “lateral navigation”, of in mijn geval nog beter “lateral searching” (lateraal of zijwaarts zoeken). Dit vind ik nl. een heel toepasselijke term voor het zoeken naar verwante artikelen.

In mijn cursussen “systematisch zoeken” raad ik mensen aan om aan de hand van geincludeerde (geselecteerde) artikelen systematisch ontbrekende studies te vinden door (1) “backward searching” (referentielijst checken), (2) “forward searching” (citerende artikelen zoeken) en (3) Related Articles in PubMed or “Find Similar” in OVID (MEDLINE, EMBASE) door te nemen. Deze zoekmethode wordt ook wel de sneeuwbal- of parelmethode genoemd. Het dient niet alleen om de ontbrekende artikelen te vinden maar vooral om nieuwe termen te vinden waarmee je je zoekactie kunt vervolmaken, zodat je deze èn andere artikelen met je uiteindelijke zoekactie vangt.

The term “lateral searching” past zo mooi bij de termen backward and forward searching, omdat ze alle 3 een beweging uitdrukken, waarbij de zijwaartse beweging nog het minst doelgericht lijkt en dat is het ook. Als je niet uitkijkt zwalk je zo van de ene naar de andere studie, en daarmee verlies je de systematiek. Leuk als je op nieuwe ideeen wilt komen, niet goed als je systematisch wilt zoeken.

Dus vanaf nu komt “lateral searching” op mijn powerpoint-presentatie te staan! (zie figuur))

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Previous posts on related articles/posts at this blog:
https://laikaspoetnik.wordpress.com/2008/05/16/possibly-an-announcement-about-possibly-related-posts/