I have ventured into the world of the YouTube influencer. I am unlikely to make my fortune, as the number of people interested in the finer points of biomedical database searching is finite, but I was asked by Health Education England to make one outlining a method for translating database alerts from NICE’s Healthcare Database Advanced Search (HDAS) syntax to the Ovid native interface, in preparation for the retirement of HDAS next year.

I followed this up with one on translating alerts into the other native interfaces, EBSCO and ProQuest, using the Systematic Review Accelerator projects Polyglot Search Translator tool, and most recently one on spelling errors, and when they should be deliberately included in search strategies.

I have another one in preparation on the use of proximity operators. I had a brilliant idea for another recently, which I didn’t write down and have since forgotten. If there is any aspect of literature searching readers would like me to cover, do comment below. 

My father and grandfather were both general practitioners in Cambridge, and starch supporters of the NHS. My grandfather, George Roper, practicing first from Regent Street, then from Lensfield Road, died in October 1948. He saw only a few months of the National Health Service, therefore, and had retired from practice, but he was delighted it had come into being. In practice from the early years of the century, and as a Medical Officer for Health, he saw extreme poverty among his patients in the slum parts of Cambridge such as Newtown and Mill Road. He tried to make health more accessible by the simple expedient of ‘losing’ bills when he knew his patient or their family would struggle to pay them. It is reputed that on his death many of these bills were found among his papers, to the amusement of my father, but the fury of other members of the family. He also caused some scandal among his fellow members of the medical profession by joining the Labour Party in the early 1930s, appalled at the conditions in which his patients had to live during the slump.

My father began practice after the war, taking over from my grandfather. He qualified from St Georges, did his house job and then served with the Royal Army Medical Corps in the Sudan. He was a staunch defender of the NHS throughout his life, retiring in the 1980s. His career took in advances such the discovery of the link between smoking and lung cancer (a heavy smoker, he stopped as soon as the evidence was known), organ transplantation, child vaccination programmes, fertility treatments and IVF. He died in 1997; I can guess at what he would have made of the NHS in 2018, and suspect I would share his view, that its founding principles, that it should meet the needs of everyone, that it should be free at the point of use, and that it should be based on clinical need, apply as much today as they did seventy years ago. Politicians have come and gone: the principles endure. 

"That he who runs may read," read the epigraph to a legal reference work, whose monthly updates it was my duty, as a humble Senior Library Assistant in Hendon Reference Library, to interfile. It's a misquotation of Habbakuk Chapter II v 2, which reads in the Authorised Version in full as  ^"And the Lord answered me, and said, Write the vision, and make it plain upon tables, that he may run that readeth it". Be that as it may, the legal publishers intention was clear: they wanted to save the busy lawyer time, as we do with Ranganathan's Fourth Law: save the time of the reader.

I'm also aware that the way this blog is laid out, unchanged since 2004, does not make it easy to read large passages of text. So here are the six things I thought worthy of reporting back to my colleagues after ICML and EAHIL 2017

• What opportunities exist for us to get involved in teaching critical appraisal to patients?
• Evaluating search services: we presented on this, so did Sandra McKeown of Queen's University, Kingston, Ontario: what actions should we now take?
• Text mining tools for searchers: I, at least, really need to understand these, and srart using them systematically
  
• Clinical librarian services: so far we've developed ours in an ad-hoc way.  I was interested in Victoria Treadway's approach, where they conducted a knowledge needs survey, and built the service on that
  
• CADTH have provided some excellent resources for searchers
  
• There's lots of hard thinking to be done about librarian's competencies

What I have to say about this session is limited, I fear, as I was presenting myself, and I find it hard to take in other papers when my mind’s on not splitting my trousers on stage. I mean no disrespect to my fellow presenters, and hope they understand. I’ve reconstructed a lot of this from the Twitter archive on Symplur. 

In the first presentation, Danielle Rabb from CADTH, spoke on Single drug vs multiple intervention reviews: trends in systematic searching.  When searching for multiple interventions searches can become quite complicated. They tend to use very broads PICOs. Useful resources from her paper included their grey literature checklist, Grey Matters, the Cochrane Handbook, Cochrane's Methodological Expectations for Cochrane Intervention Reviewsand the European Νetwork for Health Technology Assessment's Guidelines for Information Retrieval. CADTH themselves, as well as Grey Matters, offer other tools for searchers, the Peer Review of Electronic Search Strategies (PRESS) instrument and their filters, all available on their Literature Searching Tools in Support of Systematic Reviews page. 

My paper, co-authored with Igor Brbre and Rachel Playforth, was What do users perceive to be the strengths and weaknesses of librarian- mediated and unmediated evidence/knowledge searches?  We hope to publish, so, very briefly, we surveyed those who had evidence searches from Brighton and Sussex NHS Library and Knowledge Service in 2016, to see what they thought were the strengths of mediated searches. We found that librarians’ searches were perceived to be significantly better for all the attributes we asked about, expect for one, the understanding of the search question. What can we do about this? More attention to the reference interview, perhaps. I set the scene, while Rachel bore the brunt of the presentation. We kept Igor in reserve to answer the awkward questions.  

Wichor Bramer presented Comparing the effectiveness of conceptual search methods: is a fast approach sufficient for the production of (sound) systematic reviews: a prospective, double- blinded, controlled study. Wichor's methods, which allow him to construct a systematic review search strategy in 70 minutes, are controversial, but full marks to him for putting them to the test with his co-authors Melissa Rethlefsen and Margaret Sampson. So far he’s tested his method with three searchers, all of whom missed some relevant papers, but he’s looking for more volunteers to join the study; I’d suggest contacting him on Twitter if you’re interested.  

Finally, Mark Clowes, now working at ScHARR , spoke on What’s the prognosis for health librarianship? The role of the information specialist in a prognostic review. Mark has moved from being a traditional liaison librarian role to an embedded librarian,  a co-producer of research. He told us of his involvement in a Health Technology Assessment in rheumatoid arthritis, which tried to assess which patients were more likely to develop severe symptoms. He used the text mining tool VOS Viewer to look for additional candidate markers of rheumatoid arthritis, which gave some reassurance that major search concepts had been covered, . 

At the end we took part in a panel for questions and answers; I’m afraid panel discussions reduce me to a gibbering state. It’s like a job interview, but in front of a panel of several hundred people. I think I coped with the questions reasonably well, but don’t ask me what they were. There’s no evidence of any gaffes on Tiwtter, at least. We were fortunate in our session chair, Marshall Dozier,  past president of EAHIL, who put us at our ease and encouraged us.  

On Thursday morning, after the official conference run, I went to a technology parallel session. One speaker failed to show up, so we heard Michelle Kirkwood on Value of accessing Evidence Based Clinical Reference Content from within the Clinical Workflow. Michelle works for Greater Glasgow and Clyde, the largest health board in Scotland, possibly in the whole of Britain, in the eHealth directorate. Drawing our attention to the Clinical Decision Support (CDS) Roadmap for NHS Scotland and an excellent page of resources prepared by the US Agency for Healthcare Research and Quality  In April 2016 they launched Trakcare, a patient information system with embedded evidence: an evidence icon links out to an external page maintained by NHS Education Scotland, taking them on to evidence resources, with no further login required. It links to local resources, for examples pathways, and a clinical portal brings together records from multiple systems. There are three sets of resources: national subscription services, national (i.e. Scotland) in-house services, and local services. National subscriptions include Dynamed (declaration of interest, they paid for Michelle's attendance at the conference). national (Scotland) resources such as SIGN guidelines, and local resources, for example the Adult Therapeutic Handbook. The library and knowledge service offers search services. It too them twenty-four months to develop a guidelines app, a lesson to those of us who think an app can be put together quickly. To overcome the problem of a large staff turnover, they had to do a lot of awareness-raising, putting it in clinical governance bulletins, on the web and Twitter and running pop-up events as well, of course, as new doctor inductions. Among the lessons learnt were the need to have a consistent approach to use of own devices on network and to provide more content for non-medical staff. Next steps include making it –look the same across all health boards, and implementing in other systems (there are 754 in use!). They want to embed their clinical search and synthesis service bit will need to ration it: it offers a four-hour turn round for searches and is labour intensive. Michelle’s presentation may be seen here: https://librarynetwork.zendesk.com/hc/en-gb/articles/115003714549-What-is-Clinical-Decision-Support

The problem with IPs; How to Manage the IP Ranges Publishers Hold to Authenticate Your Library, presented by Ian Hames of PSI , a fascinating presentation, though ta little outside my area of professional practice — they don’t trust me to have anything to do with authentication these days.

The origins of PSI’s solution lie in subscription fraud problems, for example the abuse of personal subscriptions by institutions to defraud publishers, where a personal subscriber might share their access with others in the insitutition. PSI  helped publishers take down rogue agents and recovered significant sums for publishers. Publishers suspected that fraud was going online, and so PSI started c hecking IP ranges, finding that, while there was little fraud per se, publishers’ housekeeping of IP ranges was poor. Publishers’ records contained many unverified, or outdated, IP ranges.

So they built a database of institutions and their IP ranges. It works on a self-service basis so, libraries can edit the IP ranges associated with their institutions. The service is free to libraries, but publisher pay a subscription. To give us an idea of the scale, Ian mentioned Oxford University,who needed to change IP ranges. This required 400 e-mails, lots of problems, and no one  removed the old IP ranges. There are risks to not updating IP data, chiefly that duplicated or overlapping ranges can make nonsense of usage data. The systems tends to amplify dirty data. There’s also a problem of multiple institutions with the same ranges. While we have DOI for content, ORCID for researchers, there’s  nothing to unambiguously identify institutions. Their Global IP Access Database will launch soon at Global IP Access Database soon at http://theipregistry.org/

In some interesting questions, someone suggested that this could be used to detect fake publishers, while someone else asked if they had found any evidence of association with SciHub, to which the answer was yes, a lot, e.g. identify theft and massive downloads.

Then we were back for a plenary with Dr Mark Murphy,  a GP and lecturer at the Royal College of Surgeons in Ireland (he has a page on the Health Research Board Centre for Primary Care Research too) whose youth and enthusiasm meant that I struggled to keep up with his argument at times.

To cheers and applause, he declared himself a fan of librarians, and took us thro0ugh his library history, using libraries at UCD, Sligo University Hospital, ICGP and the RCSI. What separates doctors from homeopaths, he asked, the answer being evidence. But doctors still don’t implement evidence-based medicine. Quoting Richard Lehman,  whose splendid weekly review of the main medical journals is required reading for all, he said we still train doctors to be ignorant.  We [i.e. doctors-TR]over-estimate treatment effects and risks, for example NSAIDs and cardiac arrest. It’s hard to explain risk on the radio. We suffer from cognitive bias and variation is widespread.  He discussed the  competencies and challenges of modern medicine,  citing @Aoife Lawton’s  review of competencies needed for health librarians Lawton, A. and Burns, J. (2015), A review of competencies needed for health librarians – a comparison of Irish and international practice. Health Info Libr J, 32: 84–94. doi:10.1111/hir.12093

GPs need to practice shared decision making with patients with multi-morbidities.  He was not taught the EBM triad at med school, and papers too often ignore the outcomes that are meaningful to patients. We don’t share evidence well, the linguistic deceit of treatment threatens EBM and we rush into binary thinking. We practice too much medicine — care is often ineffective.

Librarians and GPs have in common that we are both on the outside but with important contributions to make. There’s over-diagnosis and over-detection (e.g. prostate-specific antigen tests, incidentalomas), we treat hypertension as a disease, not as a risk-factor. Dr Murphy quoted some of the authors who had formed his thinking: Petr Skrabanek  and his Follies and Fallacies in Medicine, James McCormack, Margaret McCartney and Iona Heath.

Corporate demands are prioritised over evidence. In ethics primum non nocere is not the most important thing, but patient autonomy. It’s normal to die, and to want to die at home. Ireland, he told us, is the next most litigious part of the world after Florida. Half his patients see him for free, half pay. It’s the main determinant of people’s health and care is fragmented by the cash nexus.

Research methodology is poorly understood, especially qualitative research which is under-valued. Critical appraisal isn’t happening and education is the poor relation. Our education doesn’t give sufficient emphasis to the real-world situation, e.g. multi-morbidity. Politics creates everything

He quoted  Richard Dawkins on the tyranny of the discontinuous mind. Evidence is much abused in politics. Dr Murphy uses Twitter to lobby politicians and journalists. He quoted the example of  Trump’s daughter Ivanka  and her #nationallibraryweek tweet.

He suggested a slogan, how to take advantage of your medical librarian. We improve patient care and there are huge opportunities for librarians in general practice. He (rightly) criticising that Gaiman quotation (Google can bring you back 100,000 answers. A librarian can bring you back the right one ) for underestimating our contribution

His talk provide a lot of questions, for example from Sue Thomas on how to achieve patient autonomy in the 'mess we’re currently in', - he says through high-quality decision aids in the consultation,. He sees 35 patients a day, and needs something that will work with that workload. Richard Lehman and others are putting NNTs (Numbers Needed to Treat) into formats patients can understand. Another question asked about multi professional education. Dr Murphy thought librarians could co-deliver teaching on methodology, critical appraisal. And Andrew Booth, who  asked a question in, I think, every session he attended, asked that if there are heart-sink patients,  are there also heart-sink evidence users?  Dr Murphy answered that yes, there were, and we needed to steer the debate towards the evidence.

Then there was another parallel session, and I attended one on research and evidence-based library and information practice (EBLIP). The first presentation was from Sarah Lewis and Tracey Pratchett on STEP, a set of freely available generic e-leaning modules, developed as part of Knowledge for Healthcare. It began with a phone call in January 2016. Sarah and Tracey secured funding from Health Education England. They had a distributed project team and a twelve-member steering group, and consulted to determine priorities, encourage use and buy-in. They had 139 responses from staff (13% response) and 173 from healthcare staff. Their top concern was how to develop a search when it retrieves too many results. Healthcare staff are not interested in advanced search techniques, e.g. thesaurus use. Both groups thought broadening a search should be a priority.  E-learning needs to be accessible anywhere and interactive. They derived recommendations for structure, design and content from the survey. They had no baseline measurement.  A Virtual Reference Group (I’m one of the 42 members) was set up,  using Yammer, to advise on learning objectives and content.

STEP has seven modules; each is short, taking around 20 minutes and interactive. Some of the lessons they learnt is that it’s hard to do things on a large scale and at a distance. Some found Yammer clunky, difficult to engage with. It’s hard to write e-learning materials. But the modules will launch this summer and they have shared their learning on the Knowledge for Healthcare blog http://kfh.libraryservices.nhs.uk/category/service-transformation/service-transformation-e-learning-project-step/

Next was Sandra McKeown of Queen’s University, Ontario, Canada, on evaluating the quality of a literature searching service, of great interest to me and my fellow delegates from Brighton and Sussex NHD Library and Knowledge Service, Rachel Playforth and Igor Brbe, as that afternoon we were to present a paper entitled What do users perceive to be the strengths and weaknesses of librarian-mediated and unmediated evidence/knowledge searches?

Sandra’s work has been published: McKeown S, Konrad SL, McTavish J, Boyce E. Evaluation of hospital staff's perceived quality of librarian-mediated literature searching services. J Med Libr Assoc. 2017 Apr;105(2):120-131. doi: 10.5195/jmla.2017.201

She and her fellow authors used a Critical Incident Technique to ask users to identify and talk about one experience. They discussed their survey with their library team and with experts, and the responses  improved its design. They tested it to ensure internal consistency, and calculated the sample size needed to provide 95% confidence.

68% had tried their own search. Satisfaction seems to be related to method of request. They found a significant relationship between satisfaction and librarian clarification of question (compare or finding that the one area where search requesters did not consider mediated searches superior was in the understanding of the search question).

They had few patient care requests. People prefer electronic submission, and are generally satisfied with service, but those using a paper form are less satisfied. They wondered if the paper form is not too PICO based, especially if they receive few patient care questions. For future research they want to look more closely at the method of communication. Their results could be subject to recall and response bias. Compare responders with non-responders?

The last paper was about Australian health libraries and how they could help their parent organisations achieve accreditation, the HeLiNS (Health Libraries for the National Standards) Project  Australian hospitals have to meet ten national standards, so they surveyed libraries to see what services they offered to support the standards, for example in governance by  managing guidelines documentation, and creating and maintaining repositories of institutional research. Serious safety and quality incidents have provoked an interest in improving resources

In questions, someone asked if Sandra’s research included searches for course work. No, she answered, they exclude them, as indeed we do at Brighton and Sussex NHS Library and Knowledge Service. Andrew Booth (him again)commented on the high methodological quality of the papers and asked how did presenters gain these skills? Two of the  speakers had  MScs in research or epidemiology, others team had access to an expert. (STEP is not a research project in this sense)All expressed the wish that there was better access to biostatisticians. Another question concerned the Chinese whispers problem of search requests, where the search request reaches the searcher from someone other than the original requester, for example the question  goes from consultant to registrar to junior loss in translation?

After lunch in the Dublin sunshine (words I thought I was unlikely to write), and an Elsevier master-class on e-resources and value, the afternoon began with the second plenary speaker, Richard Corbridge, Chief Information Office of the Health Service Executive and Chief Executive of eHealth Ireland. 

Richard, advised by a careers questionnaire administered at school to become a health librarian, asked if our profession were what he called the sense-makers. Ireland has a complex health system; why is digital health worth doing? He introduced us to St Isidore, patron saint of computer scientists, and nominated Bob Dylan as the patron saint of e-health. With paper systems, it is hard to protect and share information.  At Heathrow’s new Terminal  5, when it opened, airport staff were puzzled to find huge numbers of people in the gentlemen’s lavatories; they thought that the solution was to provide more, until they asked people why they were in the gents, and discovered that it was the only place it was possible to hear the tannoy announcements.He quoted the example of Cork maternity hospital, which went paperless overnight. Ireland now has a universally used Individual Patient Identifier, and pilot projects in epilepsy, haemophilia and bipolar disorder. Instead of basing their strategy on what vendors offer, they have used a series of personas, who represent particular patients with particular needs and conditions, and ask vendors to say what their system can do for the personas. It's a ten-year project, and they’ve made progress. If we leave IT to IT, he said, it won’t be right, citing a UK project which digitised paper, but in black and white, not colour, although colour mattered to the end-user. There’s no simple clear answer, but there is an answer.  

Then I chose a stream of papers on the theme of Integration. First was Iain Sinclair of Health Improvement Scotland, who described the methodology he used to evaluate the EEvIT: evidence and evaluation for improvement team who support improvement work in NHS Scotland.

Then Victoria Treadway, Clinicial Librarian, spoke, accompanied by a Clinical Fellow whose name I failed to catch, I fear, and a Critical Care consultant, Dr Girendra Sadera. Victoria explained the role of an embedded librarian as knowledge mobiliser in critical care. This was one of the most interesting presentations, from the purely selfish point of view that I too work with, inter alia, Intensive Care. Victoria has been working with them for six years. In critical care, most clinical decisions are only supported by low level evidence. Phase one of their project, a collaboration between the library, the Trust and Liverpool University, was to survey the knowledge needs of critical care clinicians,  phase two to provide customised library and knowledge services and phase three to asses impact, reflect, and assess transferability. They ran a 22 statement questionnaire, with a 38% (? I may have this figure wrong) response rate. They also held ten semi-structured interviews and focus groups. Staff felt that the service benefitted patients and clinical decision-making, and they liked personal delivery. Some didn’t know about library services, some knew and didn’t use, some knew and used. A thematic analysis of the interviews highlighted communication and access to information. Victoria offers scheduled teaching, a pop-up library, support for journal clubs and a question of the month. Echoing our experience in Brighton she said that a clinical librarian presence on ward rounds is a way to put a foot in the door, but is not that highly valued. There was a point about uniforms that I didn’t catch —was it that she wears a uniform on the CCU?  Free pens always work, as do posters, and piggybacking on unit study days. Critical Care have a Facebook group, including a Facebook journal club and Victoria will be sent questions on Facebook Messenger.  They’re keen to involve patients, and get patient and family views, so plan a follow-up study on patient and family needs in critical care. ‘Embedded librarians have to overcome complex cultural factors beyond their control’ she said, in words that struck chords with all the clinical librarians in the audience.  

Then Susan Smith and Doug Knock presented Health Education England’s Library and Knowledge Services Value and Impact toolkit. An existing value and impact toolkit was felt to be too acute-sector focused. They conducted a  literature review, conducted a baseline survey, and analysed the Library Quality Assurance Framework (LQAF). The tools they developed are all available on the Knowledge for Healthcare blog. Doug startled us with a slide of the Gummy (or is it Gummi) Bear of Impact. Embedded services, teaching and current awareness services were all areas where impact assessment was necessary, but were served poorly by existing tools. They’ve developed some impact interview templates, freely available, and a submission form so anyone can submit case studies of impact. They were great assisted by Alison Brettle’s work on impact. 

After this, we heard After the Disaster: Lessons Learned by Public Librarians in Providing Health Information Services Following a Catastrophic Flood, A paper by Feili Tu-Keefner of South Carolina on disaster response from public libraries after the 2015 hurricanes in North and South Carolina. She was trying to answer the question, can public libraries help public health in the aftermath of a disaster. Public libraries offered centres where people could fill in disaster claims, could help people fill in the complicated forms, provide reliable information and help verify information from other sources — there were, sad to say, various scams promoted after the flooding. Internet access was maintained, and they found that Facebook had considerable reach. Sad to say though, Feili found no connections between public librarians and health librarians.  

I leave the last word to Bennery Rickard of Dr Steeven’s Library in our host city, She spoke on D.E.A.R. Drop Everything And Read “Eochair feasa foghlaim” Learning is the key to knowledge. D.E.A.R will be familiar to anyone in Ireland or Britain with school age children, though it’s new since the heirs to the Roper estates were at school. it’s a fifteen minute reading break in which the whole school, pupils, teachers, administrators stop what they’re doing and read. Bennery and her team decided to introduce this where they worked,  the head-quarters of Ireland’s Health Service Executive.  They linked their initiative with Library Ireland week  and based their campaign on topics, to lead to reading. Used broadcast e-mail. and LibGuides, Twitter and a blog, took a stand in hospital canteen, and prepared packs for senior managers. Bennery reported that they had lots of feedback, and their evaluation showed that it had an impact on CPD and keeping up to date, reaching non-users for little cost. On the other hand, it did involved a lot of photocopying, she found she had to manage expectations, there were some technical barriers, and unhelpful communications protocols. She left us with some words from her son, when she was worried about making a case to senior management. This young man, wise beyond his years, told her, ‘Mummy, tell them if the doctors don’t read, people will die’.