Teaching Evidence Based Medicine – CEBM Oxford

classroom-381900_1280Next week I am going to be doing a short course in Oxford at CEBM called ‘Teaching Evidence Based Medicine’. I’ve just got the timetable today and it is going to be intense! Class starts at 8.30am and finishes at 6.30pm. My husband and I are staying in the centre of Oxford so it will be an early breakfast for me and a 20min walk to St Hughs. I plan to write some posts about what I learn but it looks like I might be pushed for time in the evenings. On Wednesday there is the group dinner at the college which starts at 7.30pm after a faculty Q&A. Perhaps there will be enough time to nip up to the B&B and collect my husband, who knows? We made a reservation at Jamie Oliver’s in Oxford for 7pm (I think) on Tuesday. I’m wondering how I can fit everything in … You can tell I am feeling rushed already! I’ve done the reading bar one editorial and all I have to do now is write out a lesson plan for critical appraisal (I already have one, just have to fix it up a bit). I guess we will be working ons during group study times. However, I’m hoping it will be a worthwhile course. According to the timetable, we will be learning different teaching methods for different aspects of EBM – diagnostics, statistics, SRs, and even searching (which will be interesting as it is a how to teach search methods). I was talking to someone from Cochrane about the course earlier this year and he knew someone who had done it and was impressed. He said it was geared more for clinicians though but that could be a plus as us medical librarians are supposed to be teaching this audience.

It has been all change at work. Not only are we merging with another library, but the Clinicians Health Channel changed resource providers from EBSCOHost to OVID (which I’ve not used much before) last week. We are losing CINAHL. So instead of a quiet time before leaving, I have to grapple with searches using the new interface. Fun times!

My first ward round

N0011853 Hospital ward round teaching session Credit: Wellcome Photo Library.

N0011853 Hospital ward round teaching session
Credit: Wellcome Photo Library.

The header title is not strictly speaking correct. If you read my previous post about Donate Life week, you would have discovered that I’ve had a kidney transplant. My first ward round experiences were as a patient. Like clockwork, the Drs, students and others would come around to read my chart and discuss any issues and plans. Sometimes they would come around twice a day – once in the morning and once later in the day. Life as an inpatient can be very boring so the ward rounds were a diversion and also a way to mark time. When I started as a clinical librarian, I was wondering how joining a ward round could be useful. I knew from experience that they are very fast and sometimes there are so many people involved, they don’t all fit in the patients room. I was chatting to a  consultant at the front desk at the library one day about something not connected to ward rounds, and she asked out of interest, what other things clinical librarians do. I mentioned ward rounds (among other things) and expressed my doubts about utility but she said – why not come along and we can find out. So last fortnight I turned up at the acute care unit at 8am (the round started about 30mins after that) and went on 2 rounds. One with just the registrar and the consultant and after break, again around to see more patients with the registrar, consultant, pharmacist, physiotherapist, nurse and interns. The consultant introduced me at the earlier round and asked if the patient and family were happy to have me there – yes they were, no problems! The patients and families were delighted when the crowd of people turned up – the faces of some of the patients just lit up. I got my first go at bedside conversation and I got questions to answer (I took along the ipad just in case there was an opportunity to search but there wasn’t – it was too fast). And did everyone fit in the patient’s room during the second rounding? No, but I managed to sometimes.


HTAi15 IRG Advanced Searching Workshop: Understanding and Using Text Analysis Tools

IRG Text Analysis 15The final session of the IRG Advanced Searching Workshop was divided up into 4 parts and was rather intensive. Well, the entire workshop was intense! A lot was covered. Julie Glanville from York Health Economics Consortium spoke briefly about text analysis tools (which was covered in more detail at the HLA event earlier this year) and Carol Lefebrve talked about the 2002- project to test the Cochrane Highly Sensitive Search Strategy for RCTs (developed in 1993-4) to determine whether it still performed well with as little terms as possible. Since the development of the Medline filter, a few changes had occurred – the addition of the Controlled Clinical Trial publication type in MeSH (quasi-randomised trials), better trial reporting due to CONSORT guidelines, and the development of text analysis tools. It was through testing with a gold standard set of RCTs and a set of non-trial records using WordStat that the best identifier term was Controlled Clinical Trial PT. But due to indexing changes (RCTs and CCT PT double-indexing cessation) reassessment led to the best identifiers (those terms locating most RCTs) was  RCT MeSH OR CCT PT. This was one of the issues with the filter that Carol mentioned (always be aware of indexing policies and changes!) and the other was the non-text terms to catch non-indexed records. Siw Waffenschmidt and Elke Hausner from the Institute for Quality and Efficiency in Healthcare (IQWIG) discussed generating search strategy development test sets for data analysis and guidance for identifying subject terms and text-words. The guidance is from the recently published EUnetHTA Process of information retrieval for systematic reviews and health technology assessments on clinical effectiveness (still in 2nd draft stage). Hausner spoke about the work she and other IS researchers did in comparing the conceptual and objective approach to search strategy development, one which is elaborated in this journal article: Development of search strategies for systematic reviews: validation showed the noninferiority of the objective approach.  Basically, the research showed that a conceptual  strategy developed by Cochrane with more synonyms was not superior to a objective search strategy on the same topic developed by IQWIG. However, the objective approach is not faster than the conceptual. Time saved is not the issue here though, it is the quality of the search. IQWIG demonstrated with their projects that the conceptual approach can produce high quality strategies that are stable over time and more suited to complex questions.  Take home points: text analysis tools are here to stay! It will take time to learn this approach but the plus side is that it produces strategies of equal quality to those developed using the conceptual approach as well as data to demonstrate strategy development and decision-making.