Seventy-Five Trials and Eleven Systematic Reviews a Day: How many Trained Librarians?

1. Seventy-Five Trials and Eleven Systematic Reviews a Day: How many Trained Librarians? Andrew Booth, Reader in Evidence Based Information Practice, ScHARR, University of Sheffield

2. Outline • Growth of Evidence Based Practice and the Cochrane Collaboration • Opportunities for Librarians • Which Skills are Required? • How Do We Acquire these Skills?

3. The Rise and Rise of Systematic Reviews

4. Epidemiology of Systematic Reviews (SRs) • 8,633 reviews published (1996-2003) • Four reviews per day (2003) • One in five SRs published by Cochrane Collaboration, HTA reports (2/5) and academic literature (2/5) • HTAs grown twice as rapidly as Cochrane SRs • UK greatest producer of Cochrane SRs (60%), • USA greatest producer of meta-analyses (at least 30%). • Only Cochrane reviews are regularly updated. • Since 2001 rate of updated reviews has plateaued at 200 p.a. • 1,000 updated reviews required p.a. to achieve 2-year update time. Mallett & Clarke 2002, 2003

5. The number of published trials, 1950 to 2007.

6. The number of systematic reviews in health care, 1990 to 2007.

7. The rise in non-systematic reviews, case reports, trials, and systematic reviews, 1950 to 2007 (as identified in MEDLINE). Added Value of Librarian as “Filter”

8. The Cochrane Collaboration

9. Archie Cochrane, 1979 “It is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomized controlled trials”

10. Facts and Figures • “Every day someone, somewhere searches The Cochrane Library every second, reads an abstract every two seconds and downloads a full-text article every three seconds.“ -Cochrane Library usage data 2009 • Over 4,500 Cochrane Reviews currently available in The Cochrane Library plus 2,000 protocols. • 2009 Impact Factor for Cochrane Database of Systematic Reviews, a database of The Cochrane Library was 5.653. CDSR is therefore 11th out of 132 journals included in ISI Medicine, General & Internal journal list. • At least 10,000 Cochrane Reviews needed to cover all healthcare interventions already investigated in controlled trials. These reviews will need to be updated at rate of 5000/year. • More than 28,000 people are involved in activities of Cochrane Collaboration – authors, group co-ordinators, search co-ordinators, administrators, IT specialists.

11. A Modern Fable - 1 • Prior to the formation of Co– Co– multiple enterprises performed essentially the same task. • Bringing these together into “cocawine collaboration” allowed joined-up working and common product • Forming single international entity with easily recognisable logo stimulated uptake and growth.

12. A Modern Fable - 2 • To protect identity and quality of the product Co– Co– organisation emphasised exclusivity. • Standardised on single version of product • If it didn’t contain the essential ingredient (Merchandise 7X/the “Gold Standard”) then it was an inferior imitation

13. A Modern Fable - 3 • Over the years this position has relaxed. • Co– Co--organisation now contributes to many related products most well-known in their own right Sprite-ly HealthTechnologyAssessments Fanta-stic Guidelines

14. A Modern Fable - 4 • Co– Co– organisation has also experimented with different ingredients and different versions of same essential product. • So now there are Diet versions; Caffeine-free versions; Versions with Fruit and Vanilla versions! Now with Added Health Economics, Diagnosis or Fruitful Qualitative Research!

15. Originally Randomised Controlled Trials • Now Diagnostic Accuracy Studies • Now Qualitative Research Studies (alongside Trials) • Now Economic Evaluations (alongside Trials) • Now Interrupted Time Series and Controlled Before and After (CBA) (Effective Practice and Organisation of Care (EPOC) Group

16. Cochrane Processes • Finding the Studies • Maintaining Study Register • Identifying Need For Reviews • Prioritising Reviews • Planning Reviews • Conducting Reviewers • Updating Reviews • Providing Advice, Training and Support to Review Authors • Helping Readers to Find and Use Reviews

17. Cochrane Processes • Finding the Studies • Maintaining Study Register • Identifying Need For Reviews • Prioritising Reviews • Planning Reviews • Conducting Reviewers • Updating Reviews • Providing Advice, Training and Support to Review Authors • Helping Readers to Find and Use Reviews

18. Opportunities for Librarians

19. Evidence Producers Cochrane Collaboration Information Specialists Trial Register Coordinators Health Technology Assessments Clinical Guidelines Systematic Reviewers Developers of Filters Evidence Consumers Clinical Librarians Tutors in EBP/Critical Appraisal Digest Producers Research Summarisers Opportunities in EBP

20. Evidence Producers Cochrane Collaboration Information Specialists/Trial Register Coordinators Cooper K, Squires H, Carroll C, Papaioannou D,Booth A, et al (2010). Chemoprevention of colorectal cancer: systematic review and economic evaluation. Health Technol Assess14(32):1-206. Mason, J., O'Keeffe, C., McIntosh, A., Hutchinson, A., Booth, A. et al (1999). A systematic review of foot ulcer in patients with Type 2 diabetes mellitus. I: prevention. Diabetic Medicine 16: 801-812. Papaioannou, D. Carroll C, Sutton A, Booth, A & Wong R (2010). Literature searching for social science systematic reviews: consideration of a range of search techniques. Health Information and Libraries Journal, 27 (2): 114-122. Glanville J, Bayliss S, Booth A, et al. (2008) So many filters, so little time: the development of a search filter appraisal checklist. JMLA96(4):356-61. Carroll, C, Booth, A.; Papaioannou, D., Sutton, A., Wong R (2009). UK Health-Care Professionals’ Experience of On-Line Learning Techniques: A Systematic Review of Qualitative Data. Journal of Continuing Education in the Health Professions, 29(4):235–241 Opportunities in EBP

21. Opportunities in EBP Evidence Consumers • Booth A, & Beecroft C (2010). The SPECTRAL project: a training needs analysis for providers of clinical question answering services. Health Information and Libraries Journal, 27(3):198-207. • Hicks, A, Booth, A, & Sawers C. (1998). Becoming ADEPT: delivering distance learning on evidence-based medicine for librarians. Health Libraries Review 15 (3): 175-184. • Bexon N. & Falzon L. (2003) Personal reflections on the role of librarians in the teaching of evidence-based healthcare. HILJ, 20: 112–115.  • Carroll, C, Cooke, J, Booth, A. & Beverley, C (2006) Bridging the gap: the development of knowledge briefings at the health and social care interface. Health and Social Care in the Community 14 (6): 491-498. • Wilkinson A, Papaioannou D, Keen C, Booth A. (2009) The role of the information specialist in supporting knowledge transfer: a public health information case study. HILJ26(2):118-25. • Booth A, Sutton A & Tattersall, A (2011) Using Web 2.0 to facilitate staff development. In: Younger P & Morgan P (eds) Using Web 2.0 for Health Information. London: Facet: 131-137.

22. Which Skills are Required?

23. Skills Required: Contextual knowledge [Specialist] Managerial skills [Generic] Professional skills [Generic] Learning and teaching [Generic] Interpersonal [Generic] &National HealthContext [Specialist] Technical [Generic/Specialist] = COMPLI&NT(Lacey & Booth, 2003)

24. Health Librarian roles Literature searching (reference work) Outreach work Teaching and training Numeracy-related skills, Influencing and persuading skills to work across organizational and departmental boundaries Experience of financial management Clinical Librarian roles Knowledge of anatomy and physiology, Origin and meanings of medical terms, Project management Literature searching Knowledge of evidence-based practice, Research methods (quantitative and qualitative) and epidemiology. Petrinic & Urquhart, 2007

25. How Do We Acquire these Skills?

26. The Wider Picture? • Declarative (What to do) • Procedural (How to do it) • Contextual (What the context requires) • Each requires different training formats/techniques (e.g. contextual – mentoring/shadowing/secondment)

27. Evidence Producers Cochrane Collaboration Information Specialists (Secondment) Trial Register Coordinators (Secondment) Health Technology Assessments (Secondment) Clinical Guidelines (Secondment) Systematic Reviewers (Training/ Mentoring/ Secondment) Developers of Filters (Mentoring) Evidence Consumers Clinical Librarians (Training/Shadowing) Tutors in EBP/Critical Appraisal (Training/Shadowing) Digest Producers (Mentoring/Secondment) Research Summarisers (Mentoring/Secondment) Opportunities in EBP

28. Two Examples: CLINICOS & FOLIAGE

29. CLINICOS • Understanding the business of clinical care - 10th of 12 courses commissioned by National Library for Health (NLH) under FOLIO Programme (2003-2005) • Online interactive course on clinical information delivered by email/Web pages as part of NLH Librarian Development Programme. • Week One – Introduction • Week Two – Information for diagnosis and prognosis • Week Three – Information for treatment and management • Week Four – Screening and prevention • Week Five – Decision making • Week Six – Conclusion http://clinicos.pbworks.com/w/page/16029910/FrontPage

31. FOLIAGE • Combined (blended) e-learning and face-to-face course for health library and information professionals, skilled in literature searching, wishing to develop high level of competency in clinical question answering. • Based on highly successful FOLIO courses, provides range of skills essential to developing evidence-based answers to clinical questions, e.g. filtering, appraising & digesting high-quality literature. • Open to anyone interested in developing advanced searching skills, anyone developing clinical question and answer service and for provision of clinical librarian role • Materials delivered via ‘Moodle’ virtual learning environment with ‘rest days’. • Unique, flexible online format enables participants to work at own pace and to fit learning around working patterns. • Face-to-face workshops across UK (2008) to ensure as accessible as possible. (Netherlands, 2009)

32. Conclusion • Evidence Based Practice has provided (and still provides) many opportunities for health librarians • Cochrane Collaboration exemplifies many of these opportunities • A wide range of technical, contextual and interpersonal skills are required • These require a wide range of training approaches • Blended learning/e-learning provides one possible vehicle for such training

33. References - 1 • Bastian H, Glasziou P, & Chalmers I. Seventy-five trials and eleven systematic reviews a day: how will we ever keep up? PLoS Med. 2010 Sep 21;7(9):e1000326. • Lacey, T., & Booth, A. (2003). Education, training and development for NHS librarians: supporting e-learning. A review commissioned by the National electronic Library for Health Librarian Development Programme. Sheffield: University of Sheffield, ScHARR (School of Health and Related Research • Mallett S & Clarke M (2002). The typical Cochrane Review. International Journal of Technology Assessment in Health Care 18:820-823.

34. References - 2 • Mallett S & Clarke M (2003) How many Cochrane reviews are needed to cover existing evidence on the effects of healthcare interventions? Evidence Based Medicine8: 100-1. • Petrinic, T., & Urquhart, C. (2007). The education and training needs of health librarians - the generalist versus specialist dilemma.  Health Information and Libraries Journal, 24(3), 167-176.

35. What might Training Programme look like? - 1 Module Zero[Local] - Understanding the Health Service Module One [Core] - Understanding context of clinical questions Module Two [Core] - Formulating the question Module Three [Core] - Finding Evidence – Bibliographic Databases Module Four [Core] - Finding Evidence – Specialist Sources Module Five [Core] - Filtering the Evidence Module Six[Core] - Critical Appraisal

36. What might a Training Programme look like? - 2 Module Seven (Pt 1) [Core] Synthesising/ Reconciling Messages Module Seven (Pt 2) [Optional] Interpreting/Explaining Numerical Results Module Eight [Core] Presenting/Communicating Results Module Nine [Optional] Organising/Delivering a CQAS Module Ten[Optional] Evaluating Your Service