1. The reflective clinical librarian June 2007 1 The reflective clinical librarian: evaluating the most effective ways of spending our searching time. prepared for 3rd Clinical Librarian Conference 11th June 2007, St William's College, York, UK Anne Parkhill

2. The reflective clinical librarian June 2007 2 Some definitions The reflective clinical librarian: evaluating the most effective ways of spending our searching time the law of diminishing returns lived experiences

3. The reflective clinical librarian June 2007 3 A recent reality check appropriate to evidence searching “Searching for relevant material is not a matter of killing an elephant with one well-aimed shot of a rifle (the MeSH / subheading combination) but rather of catching butterflies, gently and with several swoops of the net, a process best reflected by using MeSH term /subheading and textword combinations.” Reinhard Wentz, http://lists.mun.ca/cgi-bin/wa?A2=ind0604B&L=CANMEDLIB&P=R2&I=-3http://lists.mun.ca/cgi-bin/wa?A2=ind0604B&L=CANMEDLIB&P=R2&I=-3 Accessed 9th April 2006

4. The reflective clinical librarian June 2007 4 10 years of EBHC * Hicks, N. (1997) Evidence-based health care, Bandolier, 1997, May, 39. Hicks* explained evidence-based health care as taking “place when decisions that affect the care of patients are taken with due weight accorded to all valid, relevant information” 1.More and better information from an increasing number of well conducted Randomised Controlled Trials and systematic reviews 2.The better organisation of information. 3.Rapid advances in information technology 4.An improving understanding of the processes by which research findings are translated into practice

5. The reflective clinical librarian June 2007 5 And where is the evidence? Implications for systematic reviews and evaluations of healthcare: * “This review shows that handsearching alone will miss a small proportion of studies and, that a combination of handsearching and electronic searching is the most comprehensive approach in identifying reports of randomized trials.” * Handsearching versus electronic searching to identify reports of randomized trials S Hopewell, M Clarke, C Lefebvre, R Scherer Cochrane Database of Systematic Reviews 2007 Issue 2 (Status: New) Handsearching 92 -100% Electronic databases 49 – 67%

6. The reflective clinical librarian June 2007 6 Australian National Stroke Foundation – Clinical Guidelines for Acute Stroke Management 89 clinical questions in ten groupings 1. Organisation of care 2. Discharge planning, transfer of care and integrated community care 3. Pre hospital care 4. Early diagnostic assessment 5. Management in the emergency phase 6. Assessment and management of consequences of stroke 7. Prevention and management of complications 8. Early secondary prevention 9. Palliation and death 10. Trans Ischemic Attack 10 Economic questions Search objective: To add value to previous knowledge

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11. The reflective clinical librarian June 2007 11 What value was added to previous knowledge? From a large number of references found, few were chosen as potentially useful and fewer were used in compiling the final report Sources for both clinical and economic were many. Sources for the economic and clinical questions were of different proportions.

12. The reflective clinical librarian June 2007 12 so what?... …for the reflective librarian How could you reflect on your searching practice? How do you assess the effectiveness of your searching? What value do your searches add to knowledge already held? Contact information: Anne Parkhill, PO Box 2045, Hawthorn. 3122 Victoria. Australia. Website: www.aptly.com.au aparkhill@aptly.com.au