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Sandyford Training Session
Seona Hamilton
Specialist Librarian
Programme
• The Knowledge Network
• Databases
• Critical Appraisal
• Library Services
The Knowledge Network
• The eLibrary has “evolved”
• Everything the eLibrary had but– Easier to navigate– Better search– Better customisation
• “NHS Google”
Logging In
• www.knowledge.scot.nhs.uk
• NHS Scotland Athens Password
• Link through to subscription resources without additional log in
• Access Customisation features
• Use bookmarking facilities
Where has my eLibrary gone?
• How to do the stuff you used to do on the eLibrary– Find ejournals– Find databases
Homepage
Tabs:• My Home• My Community Space• My Resource Space
Three customisable pages – your personal settings are retrieved when you log in.
Homepage
Widgets:• Welcome, Announcements• eLibrary• What is here for me?• My Quick Links• My Journals• My eLearning• My News & Updates
Personalisation
• Add/remove widgets
• Editable widgets (My Quick Links etc)
• Editable Profile
• Add/remove resources from your My Resource Space bookmarks
Alerting
• Feeds Library:– Contents page alerts for your favourite
journals– A wide range of other health and social
care updates– Add to “My Resource Space” with one click– Add feeds to the Feeds Library for others
to use
Other ways of keeping up to date
• Create your own database Autoalerts
• Sign up for Autoalerts/SDIs via the NHSGGC Library Network
• Sign up for NHSGGC Current Awareness Bulletins
Communities
• The Knowledge Network provides tools to help groups of NHS Scotland Staff & Partners to work together and share information
• Shared Spaces
• Community Websites
Communities
Shared Spaces• Closed virtual workspace• Athens password required to request
membership• Share documents, discussions
Communities
Community Websites• Open web space • Range of tools for editing content• Share documents, discussions, blogs• MKNs
Other tools for sharing information
• Refshare – share your literature search
results/personal bibliographic databases
• OVID personal accounts– Share your literature search
strategies/alerts
• Sharepoint– NHSGGC tool– Intranet-based
Help with the Knowledge Network
• Knowledge Network Help pages & online guides/tours/training
• NHSGGC Library Network Knowledge Network events – May/June 2010
• Request training from librarians
• Request help with setting up personalisation features
Databases
Needle in a haystack
• Huge growth in the number of medical/nursing/allied health journals
• Large number of databases indexing different collections of journals
• 15 million records in Medline with 400,000 added per year
• Massive variance in quality between publications/articles
• Where to start?
Databases
• Two types of database: filtered & unfiltered
• Filtered resources: databases of secondary literature – systematic reviews, guidelines, critically appraised individual articles
• Unfiltered resources: contain the above plus research articles, case reports, letters, editorial material
Filtered resources
• Cochrane Database of Systematic Reviews• Cochrane Central Register of Controlled
Trials• Database of Abstracts of Reviews of Effect
(DARE)• National Guidelines Clearinghouse (
www.guidelines.gov)• ACP Journal Club
Unfiltered resources
• Medline
• Embase
• Cinahl
• PsycInfo
• British Nursing Index
• AMED
Searching the databases: 10 top tips
1. Plan your search before you start
• What do you need to know?• What do you not want – limits• What sort of material do you want to
find?• Do you want everything or just a few
general articles?
Searching the databases: 10 top tips
2. Write things down
• Break your search down into topics• Brainstorm the different
words/phrases/acronyms/abbreviations that might be used to describe these topics
• Think about what databases you might search – write that down too
Searching the databases: 10 top tips
3. Use Subject Headings
• “Labels” applied to all articles about a particular topic
• Makes your search more specific…• …if you find the right ones• Sets of Subject Headings differ
between databases
Searching the databases: 10 top tips
4. Use Key Words
• “free text” searching• If there are no relevant Subject
Headings• If you need to make sure you don’t
miss anything• Less specific search – more sensitive
Searching the databases: 10 top tips
5. Use shortcuts when keyword searching
• Truncation (*) – for words with the same root but different endings
• Wildcard (?) – for words with different spellings
• Adjacency (ADJ, ADJ3) – to specify that words should be next to/near each other
E.g. searching for articles about children
Some possible words:child, children, childhood, infant, infants,
infantile, paediatric, paediatrics, paediatrician, pediatric, pediatrics,
pediatrician
Search for:child* or infant* or p?ediatr*
Searching the databases: 10 top tips
6. Combine searches using OR
• For searches about the same topic
• To broaden your search
• To get a bigger set of results
• Usually near the beginning of a search
Searching the databases: 10 top tips
7. Combine searches using AND
• For searches about different topics
• To narrow your search
• To get a smaller set of results
• Usually near the end of a search
Using AND and OR
ANDYou want both terms to be
present in the results: cheese AND pickle
ORYou want either terms to be
present in the results: apples OR pears
AND OR
Searching the databases: 10 top tips
8. Use Limits to narrow your search to…
• A particular publication date(s)
• A specific age group
• A particular publication type
• A particular language (eg English)
Searching the databases: 10 top tips
9. Use Filters to…
• Narrow your search to a particular level of evidence (RCTs, Systematic Reviews)
• Clinical Queries filters – from Limits
• Other filters saved as Expert Searches
Searching the databases: 10 top tips
10. If at first you don’t succeed…
• Read back through your search strategy• Check for spelling errors, AND instead of OR• Think about ways of describing your topic you
may have missed• Did you narrow your search too much? Not
enough?• Ask a librarian – we’re happy to help!
Clinical Query filters
• Filters by a specific clinical study category, eg therapy, diagnosis
• Filters for high level of evidence
• Options of sensitive or specific filter
• Based on filters developed by Haynes et al (BMJ 2005)
Expert Search Filters
• Accessed via OVID personal account (see filters handout)
• Pre-saved searches which can be added to your own search strategy
• Available for a range of databases, sensitive/specific, systematic reviews, clinical queries
Still confused?
• Training available from the NHSGGC Library Network (one to one or small group)
• Use the Ask a Librarian button on OVID to send your search strategy to the library team
• NHSGGC Literature Search service
Finding the full text
Finding the full text
• Knowledge Network article search via the eLibrary widget
• From within the databases– Direct full text links– SFX button to search the Knowledge
Network
• No full text? No problemwww.gglss.scot.nhs.uk
Critical Appraisal
A brief overview
Overview
• Definitions
• Some types of study design
• Tools and checklists
What is critical appraisal?
The process of systematically examining research evidence to assess its:
• validity
• importance
• relevance
before using it to inform a decision
Critical appraisal:
• helps us to make sense of research by using a systematic approach
• helps us to interpret the methodology and results of research
• allows us decide on the quality and usefulness of a published paper
• allows us to make decisions about our own practice, based on evidence
Why do we need to appraise articles?
• not every study is of good quality• results can be misleading• publication bias• published research is not always relevant to
local population and circumstances• “information overload”
“Information overload”
• Clinicians would have to read 17 articles per day, 365 days per year to keep up with research being published *
• research is of variable quality
* Source: A Booth, School of Health and Related Research, University of Sheffield, 2000
Hierarchy of evidence
Systematic reviews
Randomised controlled trials
Cohort studies
Case-controlled studies/Case series/Reports
Primary evidence
Primary research studies
New information, original research
Case control study
- epidemiological study design
- used to identify causes of a condition by comparing subjects who have the condition with a “control” group, who don’t have the condition but are otherwise similar
- retrospective, non-randomised
Cohort study
• longtitudinal or observational study• tracks population over a period of time.
Provides information on eg. causation and risk of disease
• cohort = a group of people who share a characteristic, eg. born on the same day or exposure to a drug
• comparison group = a group of people similar to the cohort group apart from the characteristic (eg. the general population)
Randomized controlled trials
• a type of clinical experiment, designed to measure efficacy or effectiveness.
• involves the random allocation of different interventions (treatments or conditions) to subjects.
• patients are divided into two or more groups
• patients are allocated randomly to different arms of the trial. If enough patients are included, groups should be comparable
• the most important advantage of proper randomization is that it should eliminate selection bias
Secondary evidence
Secondary research studies
Research which uses already existing studies
Secondary evidence
• Systematic reviews (reviews in which primary evidence on a topic has been systematically identified, appraised and summarised according to explicit evaluation criteria)
• Meta-analysis (a statistical technique which summarises the results of several studies into a single estimate)
The SIGN hierarchy of evidence
1++ High quality meta analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias
1+ Well conducted meta analyses, systematic reviews of RCTs, or RCTs with a low risk of bias
1- Meta analyses, systematic reviews of RCTs, or RCTs with a high risk of bias
2++ High quality systematic reviews of case-control or cohort studies. High quality case control or cohort studies with a very low risk of confounding bias or chance and a high probability that the relationship is causal
The SIGN hierarchy of evidence (continued)
2 - Case control or cohort studies with a high risk of confounding bias, or chance and a significant risk that the relationship is not causal
3 Non-analytic studies, eg. case reports, case series
4 Expert opinion
How can I know if a paper is “good” or not?
A good study should..
• Be trying to answer a clear question• Have a research methodology designed to
answer that question• Primary outcomes should have been
specified in advance• Maximise attribution - Have a “Power”
calculation• Minimise error – remove all possible
influences except that of intervention/exposure
Tools & Checklists
• Tell you what questions to ask
• Guide you through the process
• Different checklists for different study types
Sources
Public Health Resource Unit (PHRU) - CASPhttp://www.phru.nhs.uk/pages/phd/resources.htm
SIGNhttp://www.sign.ac.uk/methodology/checklists.html
University of Glasgow, General Practice and Primary Care
http://www.gla.ac.uk/departments/generalpracticeprimarycare/ebp/checklists/#d.en.19536
Using a tool - CASP
• The CASP tool for assessing randomised control trials asks you to consider:
• Is the trial valid?• What are the results?• Will the results help locally?
• The checklist is designed to help you find the answers to these questions
Screening questions
• Did the study ask a clearly focussed question?
• Was this an RCT and was it appropriately so?
Use the answers to these questions to decide whether to continue.
Detailed questions
• These look at issues such as:– Adequate randomisation– Blinding– Follow up– Power– Whether the results are statistically
significant– Whether it is relevant to local practice
Want to know more?
• Have a look at: – How to read a paper T. Greenhalgh (available NHSGGC
Library Network)– User’s guide to the medical literature JAMA (available
NHSGGC Library Network)
• Critical Appraisal training from the Library Network
• Start a Journal Club (help available from the Library Network)
Library Services
What’s there for you?
Libraries
• NHSGGC Library Network – 13 sites working closely in partnership with..
• Sandyford Library
• www.nhsggc.org.uk/libraryservices
• www.sandyford.org/practitioners/sandyford-library-and-information-.apx
www.gglss.scot.nhs.uk
• Create an account to access NHSGGC Library Services online
– Literature Search Service– Document Delivery Services– Current Awareness/Updating Services– Reading Lists– Enquiries
Training
• Bespoke information skills training for individuals/groups
• FIRST blended learning courses• Links to online resources via the Library
Network Website• Tailored training for study days etc• Resource lists for specific topics/to
support study days
