Clinical Evidence Based Information Specialist — Part I
Last week I alluded very briefly (one paragraph!) about what I actually do in my day-to-day job. And then I made a promise to expand on it further — so here I am ‘expanding’. The crux of my role is that myself and the team provide evidence for specific questions that come in from varying individuals around the hospital. So — on any given day we could get a request from a doctor, a nurse, a nurse director, a physiotherapist, a plastic surgeon. Our work is fairly constant, with large influxes in September and January from people gearing up for conference submissions. However, it’s not just conference submissions but also applying for research grants.
As someone who *hasn’t* worked in this field before — both research and health, I have had a STEEP learning curve. What has probably helped, is having done three degrees (a rare occasion when writing three dissertations is a plus factor) and having fairly logical thought process as to ‘how things should be done’. The health side of things is harder, as there is a lot of terminology that I have to learn as I go and it does make reading and assessing articles take a lot longer. But this is ok, because it puts me in the great position of being able to ask questions (you can always judge a team/workplace by how they respond to you asking obvious questions) and further my understanding. I would also add that watching my boss at MS do a very similar role (albeit with business and primarily using Gartner), has meant that I had some latent knowledge of the relationship building that goes into the process of teasing out the information I (we) need when trying to find the best possible evidence.
The first thing to learn as an evidence specialist is WHERE DOES EVIDENCE GO? So if there are any historians out there — it’s very similar (primary, secondary and grey) but then because it’s health and medical, we take it a step further. This is a big part of the work we do for our users, essentially taking a lot of the legwork out their ongoing research. A basic literature search, what we call a scoping search would be someone taking a question and taking all the articles they find and dumping them into a document and forwarding them on the person who made the request. We go a step a further and using the pyramid, we assess the evidence we find. The pyramid below is a basic summary of where things *could go*.
There have been many debates in our office as to whether something should belong in certain categories — if you look at the pyramid — we have regular arguments about if something is a ‘case series’ OR a cohort study. The top of the pyramid is inhabited by ‘systematic reviews’, but as we always like to say:
Your systematic review is only as good as what’s been reviewed and the rigorousness of the person (it should be people!) who did it.
Equally, things like narrative reviews, editorials are at the very bottom, but this is actually really misleading in our work. Sometimes, the qualitative information in an expert opinion can be incredibly more useful to a user than a systematic review that delves into studies that may be too much for someone looking for a summary on a topic. By the same definition when you’re looking at Random Trials, the title may sound great, but when you start looking at the details and it’s only 10 people or, it’s only been done over a few weeks…well it’s not something that you would want to include. Because sometimes, it really is hard to figure out and it’s a combination or practice, but also just reading the article a couple of times. It is comforting to know that many academics have problems with exactly the same question. Janet Martin (Associate Professor, Department of Anesthesia & Perioperative Medicine and Department of Epidemiology & Biostatistics) plays ‘Name that Study! Do We need a new Category?’ with her students yearly.
But where are we looking? Unlike one person who commented ‘Oh you just use Google’ (I mean aside from wanting to hurt this person) we use a range of different medical databases and yes, in a pinch when there is *nothing* we will use Google Scholar . Also when you start your search there is nothing wrong with using Google and/or Wikipedia to get a better understanding of the topic at hand. I had to do exactly that recently on ‘hand therapy’ (exactly what you think it is and so so much more). Never be ashamed to say you don’t understand or you need a bit help — because if you set off half-cocked, you could actually be using the wrong search parameters leading to the wrong results — you get the idea.
First port of call is usually PubMed (we are slightly different from other NHS libraries in that we don’t use HDAS [Healthcare Databases Advanced Search]) is usually the best place to start — especially if it’s a clinical question. PubMed allows you to set up your search to become increasingly more narrow and detailed but something like Trip can only use keywords and even then you will pick up a lot of studies/guidelines/policies that are usually irrelevant to what you’re looking for. NICE Evidence provides access to high quality authoritative evidence and best practice — especially useful when we’re searching for Guidelines. Following these, we look at CINAHL and EMBASE which are respectively nursing and pharmacy based. EMBASE is always a surprise for whatever reason it always brings up conference abstracts or other things that don’t crop up elsewhere. If I sound like I know this stuff exceptionally well, I think I’ve been using them everyday for the past 6 months so I reckon it would be weird if I didn’t, no?
That’s not say that a level of lateral thinking isn’t required. A most recent example is a question I’ve had on ‘The use of pabrinex and hydrocortisone in sepsis’ — pabrinex is a not a commonly indexed term in any of the databases we look at so I had to find out what the components of it are. Turns out that pabrinex is primarily made up of thiamine and vitamin c (also known as ascorbic acid). Adding these phrases to my search string meant that I was able to find results but also relevant results for the user. One of the best parts of the job is learning about all the different conditions, and it means that no one day is the same, as we always have requests coming in.
It’s not always the clinical requests (where we have to look up the words) either. Questions around education, simulations, reflective practice are also part and parcel of what we do. One of the skills I bring to the table is my background of working in a large organisation — so it has meant that I’ve started taking on some of the more woolly, ‘corporate’ questions — things around strategy, governance. These types of questions don’t fit into a traditional search methodology for the databases we use; making them more challenging, to parse into a search string to enable us to find the right and relevant information. I love it though — the woollier the question the more fun I have and usually when I go back to the person and start teasing out what they need/want from the information.
My background is as a qualified librarian but I’ve never worked in a traditional library and my colleagues are from an equally varied background! This means that we bring different skill-sets to the role namely — systematic thinking, an eye for detail and the ability to think critically and laterally about the questions that we’re given. Weirdly we’ve all lived overseas for prolonged periods of time, love travelling and we all have partners of different nationalities to us — I reckon there’s something in flexible thinking and attitudes that also makes us suited to the roles. It’s not something I ever saw myself doing but the more I’ve worked in libraries the more I’ve come to enjoy the process of searching, understanding and sharing information and knowledge with an interested audience.
Next week, I’ll delve a bit more into the different types of search strings that can be utilised for clinical and non-clinical questions.