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barriers to using research information in clinical decision making. Journal of Advanced Nursing 2002, 39, 46 – 60. Royal College of Nursing. Report of key findings of RCN’s survey of the information needs of nurses, health-care assistants, midwives and health visitors. London: Royal College of Nursing, 2005. Urquhart, C. & Hepworth, J. The value of information supplied to clinicians by health libraries: devising an outcomes-based assessment of the contribution of libraries to clinical decision-making. Health Libraries Review 1995, 12, 201–13. Urquhart, C. & Davies, R. EVINCE: the value of information in developing nursing knowledge and competence. Health Libraries Review 1997, 14, 61–72. Pyne, T., Newman, K., Leigh, S., Cowling, A. & Rounce, K. Meeting the information needs of clinicians for the practice of evidence-based health care. Health Libraries Review 1999, 16, 3 –14. Reid, L., Ikkos, G. & Hopkins, W. Clinical librarians at Barnet Primary Care NHS Trust: addressing the information requirements of clinical governance. Health Information and Libraries Journal 2002, 19, 52–5. Ward, L. M., Honeybourne, C. J. & Harrison, J. A clinical librarian can support clinical governance. British Journal of Clinical Governance 2001, 6, 248–51. Urquhart, C., Light, A., Thomas, R., Barker, A., Yeoman, A. & Cooper, J. Critical incident technique and explicitation interviewing in studies of information behaviour. Library and Information Science Research 2003, 25, 63–88. Brophy, P. Narrative-based librarianship. In: Kocojowa, M. (ed.). The Area of Information and Social Communication: Festschrift for Professor Wanda Pindlova. Studies in Library and Information Science Vol. 10. Krakow: Jagiellonian University Press, 2004: 188–95.
Accepted September 2006 Brief communication Suppl.communications 23 communication 1
Signposting best evidence: a role for information professionals Mala Mann*, Lesley Sander* & Alison Weightman†, *Support Unit for Research Evidence, Sir Herbert Duthie Library, Cardiff University, Cardiff and †Arts and Social Studies Library, Cardiff University, Cardiff, UK Introduction To consider the future roles of health library and information professionals, it is important to look Correspondence: Mala Mann, Information Specialist, Support Unit for Research Evidence, Wales College of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK. E-mail:
[email protected]
at the way in which the role has changed from simply acting as an evidence locator to being a critical appraiser and to even being a change manager.1–3 The rapid advances in information technology and the growth of evidence-based health care have strongly influenced this change. Along with the changing role, job titles given to librarians vary hugely; learning resource advisor, information specialist, and knowledge manager and many more (see Table 1 for examples). Needless to say, the job titles of librarians and the work they do depend heavily on their work environment. Changing role for information professional Information and Communication Technology (ICT) has transformed society, and the information profession has become overwhelmingly driven by technology. Even although new technologies are often seen as an easy replacement for libraries and librarians, within the health-care sector it is recognized that the skills of the information professional are needed to harness the information available through new technology. One of the main changes within health care has been the introduction of clinical librarianship, and the role of the informationist.4,5 Several studies have shown that clinical librarianship programmes are both efficient and effective.6,7 Information professionals roles are becoming more diverse. In the Chartered Institute of Library and Information Professionals (CILIP), Library and Information Gazette job descriptions vary for those working in the health- and social-care sector. The following job descriptions were taken from recent postings in the supporting website (http:// www.cilip.org.uk/jobscareers/lisjobnet/default.htm). ‘Educated to degree level, with a professional qualification in librarianship, you will have welldeveloped ICT skills, an enthusiasm for both virtual and physical library services and be keen to develop your teaching and presentation skills’ ‘delivering training in searching the literature. The postholder will be expected to design, deliver and evaluate a training programme aimed at teaching literature and searching skills’
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Brief communications Table 1 Examples of job titles given to librarians Acquisitions librarian Cataloguers Corporate librarian Disseminator E-literate librarian Information architect Information manager Information resources manager Information specialist Knowledge manager Learning adviser Postgraduate centre librarian Research officer Systems librarian Technical librarian
Adviser Clinical librarian Critical appraiser Educator Information analyst Information facilitator Information officer Information scientist Information worker Knowledge officer Mediator Research librarian Resources provider Teacher Web librarian
‘you will be responsible for planning and organizing a high standard responsive, multidisciplinary Library and Information Service, in order to support clinical governance, evidencebased practice and high-quality patient care’ Apart from the increasing technology, in the health-care sector evidence-based medicine (EBM) has been gaining support amongst health professionals as they have become more aware that this benefits patients.8,9 However, the main hindrance to practising EBM is the lack of time to read and evaluate the available literature.10–12 The growth of EBM creates challenges to both health-care and health-information professionals. As information professionals are becoming more involved in the EBM process, they are increasingly expected to be expert searchers, organisers and analysers of information,13,14 as well as to design and deliver training programmes, and to teach information literacy skills within their institutions.15 Clinicians need evidence from high-quality research, but lack the time to search for and analyse study trial results. Research evidence therefore needs to be presented in a way that is appropriate and accessible. For the busy clinician coping with the everyday challenges, information summaries signposting to best evidence are aids to helping them improve patient care. Thus, the layout used in Health Evidence Bulletins Wales (HEBW),16 represents an example of how scientific research
evidence may be presented in a succinct and easyto-use format. Background to Health Evidence Bulletins— Wales project The HEBW project based in the Support Unit for Research Evidence (SURE) (http://www.cardiff. ac.uk/insrv/sure) at Cardiff University is a joint initiative involving library and information units and providers of primary and secondary healthcare within and beyond Wales. The project evolved from the Protocols for Investment in Health Gain17 which were written in the early 1990s to suggest areas where the introduction, or more widespread use, of certain practices could lead to worthwhile improvements in health for the people of Wales. The documents also highlighted current practices that were of questionable value. The updated protocols (or Health Evidence Bulletins Wales) were designed to provide clear, concise summaries with a precise indication of the strength of the evidence and the sources for each statement. Each Bulletin provides a concise and current review of a subject area via a two-column format. In the first column, the statements summarize the best evidence. In the second, full details are provided of the supporting publications (and the evidence type or research design). Quality has been assured by the use of a strict methodology (http://hebw.cf.ac.uk/ projectmethod/title.htm) covering information searching, critical appraisal and review. Coronary Heart Disease Bulletin The bulletins on Cardiovascular Diseases18 and Healthy Living19 both informed the plan for the National Service Framework for Wales (NSFW) on Coronary Heart Disease, (Tackling Coronary Heart Diseases in Wales: Implementing Through Evidence20). An updated bulletin specifically to support the implementation of the NSFW was published in January 2004. The statements in the Bulletin and the evidence-based standards, on which the implementation plan is based, have been derived from a systematic summary of the evidence found through a formal literature search across a wide range of sources, and critically appraised using internationally accepted methods.
© 2006 The authors Journal compilation © 2006 Health Libraries Group. Health Information and Libraries Journal, 23 (Suppl. 1), pp.47–64
Brief communications Table 2 Selected topic areas for an updated search suggested by the Welsh Cardiac Networks Co-ordinating Group Blood pressure Familial hypercholesterolaemia Hyperlipidaemia Hypertension Multi-slice CT scanning Resource centres
patient care is about informing practice through accessing and evaluating evidence and signposting the best current evidence across a wide range of evidence types. This was a new initiative in the field of health information in the late 1990s, which is still valued by health-care professionals. For information professionals working in the healthcare sector, there are many opportunities to use their skills in providing solutions and meeting information needs.
Coronary Heart Disease Bulletin update As a result of the usefulness of the Coronary Heart Disease Bulletin21 the HEBW team has recently been asked to carry out an update search on selected topic areas (see Table 2) suggested by the Welsh Cardiac Networks Co-ordinating Group.22 Use of the bulletins Since the publication of the first bulletin, several evaluation studies have taken place.23–25 Based on evaluation and feedback from contributors to the project and users of the bulletins, a number of changes have taken place in the way each bulletin is now prepared. The main difference is that members of the information team have been trained in critical appraisal skills and now carry out all the literature searching, preliminary appraisal and summary work. Results from a survey of links followed from the Turning Research into Practice () database (http://www.tripdatabase.com) between January and December 2005, found that the HEBW site was in the top 10 most popular links, with Chapter 2 from the CHD Bulletin being the 7th most popular document viewed (n = 129 hits). Overall, HEBW documents were viewed 1160 times in 2005. A recent analysis of statistics for the HEBW Internet site showed that, in the latter quarter of 2005, the site was visited 101 342 times, and that the Coronary Heart Disease Bulletin was viewed 12 320 times. This shows an excellent response to the bulletins. Conclusion This collaboration between information professionals and a multi-disciplinary team directly involved in
Key Messages Implications for Policy • Research shows that a major barrier to practising evidence-based practice is lack of time and skills needed by the health-care professional. • Therefore, an involvement of a librarian is a benefit to health-care professionals. Implications for Practice • The traditional skills of searching, organizing, processing and locating information are still the foundation for the new information age. • Evidence-based culture provides the opportunities for information professionals in health care to play a high-profile, pro-active role.
References 1 Berley, C. A., Booth, A. & Bath, P. A. The role of the information specialist in the systematic review process: a health information case study. Health Information and Libraries Journal 2003, 20, 65–74. 2 Harris, M. R. The librarian’s roles in the systematic review process: a case study. Journal of the Medical Library Association 2005, 93, 81–7. 3 Atlas, M. C., Smigielski, E. M., Wulff, J. L. & Coleman, M. T. Case studies from morning report: librarians’ role in helping residents find evidence-based clinical information. Medical Reference Services Quarterly 2003, 22, 1–14. 4 Davidoff, F. & Florance, V. The informationist: a new health profession? Annals of International Medicine 2000, 132, 996–8. 5 Giuse, N. B., Koonge, T. Y., Jerome, R. N., Cahall, M., Sathe, N. A. & Williams, A. Evolution of a mature clinical informationist. model. Journal of the American Medical Informatics Association 2005, 12(3), 249–55. 6 Veenstra, R. J. & Gluck, E. H. A clinical librarian program in the intensive care unit. Critical Care Medicine 1992, 20, 1038–42.
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Brief communications 7 Wagner, K. C. & Byrd, G. D. Evaluating the effectiveness of clinical medical librarian programs: a systematic review of the literature. Journal of the Medical Library Association 2004, 92, 14 –33. 8 McColl, A., Smith, H., White, P. & Field, J. General Practitioners’ perceptions of the route to evidence-based medicine: a questionnaire survey. British Medical Journal 1998, 316, 361–5. 9 Pyne, T., Newman, K., Leigh, S., Cowling, A. & Rounce, K. Meeting the information needs of clinicians for the practice of evidence-based health care. Health Libraries Review 1999, 16, 3–14. 10 Chambliss, M. L. & Conley, J. Answering clinical questions. The Journal of Family Practice 1996, 43, 140–4. 11 Ely, J. W., Osheroff, J. A., Ebell, M. H., Chambliss, M. L., Vinson, D. C., Stevermer, J. J. & Pifer, E. A. Obstacles to answering doctors’ questions about patient care with evidence: qualitative study. British Medical Journal 2002, 324(7339), 710. 12 Forrest, M. & Robb, M. The information needs of doctors-in-training. case study from the Cairns Library University of Oxford. Health Libraries Review 2000, 17, 129–35. 13 Alpi, K. M. Expert searching in public health. Journal of the Medical Library Association 2005, 93, 97–103. 14 McGowan, J. & Sampson, M. Systematic reviews need systematic searchers. Journal of the Medical Library Association 2005, 93, 74–80. 15 Booth, A. & Walton, G. Managing Knowledge in Health Services. London: Facet Publishing, 2000. Available from: http://www.shef.ac.uk/scharr/mkhs/ (accessed 2 February 2006). 16 Support Unit for Research Evidence (SURE), Cardiff University. Health Evidence Bulletin Wales (HEBW).
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Available from: http://hebw.cf.ac.uk (accessed 27 October 2006). Welsh Health Planning Forum. Protocols for Investment in Health Gain. Cardiff: Welsh Office, 1990–1993. Welsh Office. Health Evidence Bulletins — Wales: Cardiovascular Diseases. Cardiff: Welsh Office, 1998: ISBN 0 7504 2283 1. National Assembly for Wales. Health Evidence Bulletins—Wales: Healthy Living. Cardiff: National Assembly for Wales, 2000: ISBN 0 7504 2285 8. http:// hebw.cf.ac.uk/healthyliving/pdfhealthyliving.pdf (accessed 27 October 2006). National Assembly for Wales. Improving Health In Wales— Tackling Coronary Heart Diseases in Wales: Implementing through Evidence. Cardiff: National Assembly for Wales, 2001: ISBN 0 7504 2700 0. Health Evidence Bulletins—Wales. Coronary Heart Disease Bulletin. Available from: http://hebw.cf.ac.uk/coronary/ index.htm (accessed 27 October 2006). Cardiac Networks Co-ordinating Group. Available from: http://howis.wales.nhs.uk/cardiacnetworks (accessed 27 October 2006). Weightman, A. L., Coyle, E., Phin, N., Lancaster, J. & Mann, M. K. The Health Evidence Bulletins Wales. Talk presented at: Converge on London 2000, 8th International Congress on Medical Librarianship, July 2000. 2000. Weightman, A. L. & Mann, M. K. Evidence in seconds? Health Libraries Review 2000, 17, 63–70. Urquhart, C., Broady-Preston, J., Durbin, J. HOWIS Knowledgebase Evaluation Report for CCISG. Aberystwyth: University of Wales Aberystwyth Knowledge Management Research Group, May 2002.
Accepted August 2006
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