The impact of an individual tutorial session on MEDLINE use among obstetrics and gynaecology residents in an academic training programme: a randomized trial

Educational interventions to improve literature searching skills in the health sciences: a scoping review

Objective:

The authors reviewed educational interventions for improving literature searching skills in the health sciences.

Methods:

We performed a scoping review of experimental and quasi-experimental studies published in English and German, irrespective of publication year. Targeted outcomes were objectively measurable literature searching skills (e.g., quality of search strategy, study retrieval, precision). The search methods consisted of searching databases (CINAHL, Embase, MEDLINE, PsycINFO, Web of Science), tracking citations, free web searching, and contacting experts. Two reviewers performed screening and data extraction. To evaluate the completeness of reporting, the Template for Intervention Description and Replication (TIDieR) was applied.

Results:

We included 6 controlled trials and 8 pre-post trials from the 8,484 references that we screened. Study participants were students in various health professions and physicians. The educational formats of the interventions varied. Outcomes clustered into 2 categories: (1) developing search strategies (e.g., identifying search concepts, selecting databases, applying Boolean operators) and (2) database searching skills (e.g., searching PubMed, MEDLINE, or CINAHL). In addition to baseline and post-intervention measurement, 5 studies reported follow-up. Almost all studies adequately described their intervention procedures and delivery but did not provide access to the educational material. The expertise of the intervention facilitators was described in only 3 studies.

Conclusions:

The results showed a wide range of study populations, interventions, and outcomes. Studies often lacked information about educational material and facilitators' expertise. Further research should focus on intervention effectiveness using controlled study designs and long-term follow-up. To ensure transparency, replication, and comparability, studies should rigorously describe their intervention.

How Canadian librarians practice and assess individualized research consultations in academic libraries

Purpose

Though we live in a digital era, libraries offer significant hours of in-person reference services, in combination with online reference services. Nevertheless, an increase in requests for in-person, individualized research consultations (IRCs) over the last few years has been observed. IRCs between librarians and students are common practice in academic institutions. While these sessions can be deemed useful for patrons, as they are tailored to their specific needs, however, they can also be time consuming for the librarians. Therefore, it is important to evaluate this service, and assess its impact in order to ensure that the users are getting the most out of their sessions. The purpose of this paper is to gather information on the evaluation and assessment tools that Canadian institutions are using to obtain feedback, measure their impact and improve their consultation services.

Design/methodology/approach

A bilingual (French and English) web-based questionnaire was issued, with a generic definition of IRCs provided. The questionnaire included general demographics and background information on IRC practices among Canadian academic librarians, followed by reflective questions on the assessment process of such practices. The questionnaire was sent to Canadian academic librarians via e-mail, using professional librarian associations’ listservs, and Twitter was used for dissemination as well.

Findings

Major findings of the survey concluded that the disciplines of health sciences and medicine, as well as the arts and humanities are the heaviest users of the IRC service model. On average, these sessions are one hour in length, provided by librarians who often require advanced preparation time to adequately help the user, with infrequent follow-up appointments. It was not surprising that a lack of assessment methods for IRCs was identified among Canadian academic libraries. Most libraries have either no assessment in place for IRCs, or they rely heavily on informal feedback from users, comments from faculty members and so on. A small portion of libraries use usage statistics to assess their IRCs service, but other means of assessment are practically non-existent.

Research limitations/implications

The survey conducted was only distributed to Canadian academic libraries. Institutions across the USA and other countries that also perform IRCs may have methods for evaluating and assessing these sessions which the authors did not gather; therefore, the evidence is biased. As well, each discipline approaches IRCs very differently; therefore, it is challenging to compare the evaluation and assessment methods between each discipline. Furthermore, the study’s population is unknown, as the authors did not know the exact number of librarians or library staff providing IRCs by appointment in academic Canadian institution. While the response rate was reasonably good, it is impossible to know if the sample is representative of the population. Also, it needs to be acknowledged that the study is exploratory in nature as this is the first study solely dedicated at examining academic librarians’ IRC practices. Further research is needed. As future research is needed to evaluate and assess IRCs with an evidence-based approach, the authors will be conducting a pre-test and post-test to assess the impact of IRC on students’ search techniques.

Originality/value

Evidence-based practice for IRCs is limited. Very few studies have been conducted examining the evaluation and assessment methods of these sessions; therefore, it was believed that a “lay of the land,” so to speak, was needed. The study is exploratory in nature, as this is the first study solely dedicated at examining the evaluation and assessment methods of academic librarians’ IRC practices.

Interventions to increase the use of electronic health information by healthcare practitioners to improve clinical practice and patient outcomes

BACKGROUND

There is a large volume of health information available, and, if applied in clinical practice, may contribute to effective patient care. Despite an abundance of information, sub-optimal care is common. Many factors influence practitioners' use of health information, and format (electronic or other) may be one such factor.

OBJECTIVES

To assess the effects of interventions aimed at improving or increasing healthcare practitioners' use of electronic health information (EHI) on professional practice and patient outcomes.

SEARCH METHODS

We searched The Cochrane Library (Wiley), MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), and LISA (EBSCO) up to November 2013. We contacted researchers in the field and scanned reference lists of relevant articles.

SELECTION CRITERIA

We included studies that evaluated the effects of interventions to improve or increase the use of EHI by healthcare practitioners on professional practice and patient outcomes. We defined EHI as information accessed on a computer. We defined 'use' as logging into EHI. We considered any healthcare practitioner involved in patient care. We included randomized, non-randomized, and cluster randomized controlled trials (RCTs, NRCTs, CRCTs), controlled clinical trials (CCTs), interrupted time series (ITS), and controlled before-and-after studies (CBAs).The comparisons were: electronic versus printed health information; EHI on different electronic devices (e.g. desktop, laptop or tablet computers, etc.; cell / mobile phones); EHI via different user interfaces; EHI provided with or without an educational or training component; and EHI compared to no other type or source of information.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed the risk of bias for each study. We used GRADE to assess the quality of the included studies. We reassessed previously excluded studies following our decision to define logins to EHI as a measure of professional behavior. We reported results in natural units. When possible, we calculated and reported median effect size (odds ratio (OR), interquartile ranges (IQR)). Due to high heterogeneity across studies, meta-analysis was not feasible.

MAIN RESULTS

We included two RCTs and four CRCTs involving 352 physicians, 48 residents, and 135 allied health practitioners. Overall risk of bias was low as was quality of the evidence. One comparison was supported by three studies and three comparisons were supported by single studies, but outcomes across the three studies were highly heterogeneous. We found no studies to support EHI versus no alternative. Given these factors, it was not possible to determine the relative effectiveness of interventions. All studies reported practitioner use of EHI, two reported on compliance with electronic practice guidelines, and none reported on patient outcomes.One trial (139 participants) measured guideline adherence for an electronic versus printed guideline, but reported no difference between groups (median OR 0.85, IQR 0.74 to 1.08). One small cross-over trial (10 participants) reported increased use of clinical guidelines when provided with a mobile versus stationary, desktop computer (mean use per shift: intervention group (IG) 3.6, standard deviation (SD) 1.7 vs. control group (CG) 2.0 (SD 1.9), P value = 0.033). One cross-over trial (203 participants) reported that using a customized versus a generic interface had little impact on practitioners' use of EHI (mean difference in adjusted end-of-study rate: 0.77 logins/month/user, 95% confidence interval (CI) CI 0.43 to 1.11). Three trials included education or training and reported increased use of EHI by practitioners following training.

AUTHORS' CONCLUSIONS

This review provided no evidence that the use of EHI translates into improved clinical practice or patient outcomes, though it does suggest that when practitioners are provided with EHI and education or training, the use of EHI increases. We have defined use as the activity of logging into an EHI resource, but based on our findings use does not automatically translate to the application of EHI in practice. While using EHI may be an important component of evidence-based medicine, alone it is insufficient to improve patient care or clinical practices. For EHI to be applied in patient care, it will be necessary to understand why practitioners' are reluctant to apply EHI when treating people, and to determine the most effective way(s) to reduce this reluctance.

Effects of librarian-provided services in healthcare settings: a systematic review

OBJECTIVE

To assess the effects of librarian-provided services in healthcare settings on patient, healthcare provider, and researcher outcomes.

MATERIALS AND METHODS

Medline, CINAHL, ERIC, LISA (Library and Information Science Abstracts), and the Cochrane Central Register of Controlled Trials were searched from inception to June 2013. Studies involving librarian-provided services for patients encountering the healthcare system, healthcare providers, or researchers were eligible for inclusion. All librarian-provided services in healthcare settings were considered as an intervention, including hospitals, primary care settings, or public health clinics.

RESULTS

Twenty-five articles fulfilled our eligibility criteria, including 22 primary publications and three companion reports. The majority of studies (15/22 primary publications) examined librarians providing instruction in literature searching to healthcare trainees, and measured literature searching proficiency. Other studies analyzed librarian-provided literature searching services and instruction in question formulation as well as the impact of librarian-provided services on patient length of stay in hospital. No studies were found that investigated librarians providing direct services to researchers or patients in healthcare settings.

CONCLUSIONS

Librarian-provided services directed to participants in training programs (eg, students, residents) improve skills in searching the literature to facilitate the integration of research evidence into clinical decision-making. Services provided to clinicians were shown to be effective in saving time for health professionals and providing relevant information for decision-making. Two studies indicated patient length of stay was reduced when clinicians requested literature searches related to a patient's case.

A systematic review of how studies describe educational interventions for evidence-based practice: stage 1 of the development of a reporting guideline

BACKGROUND

The aim of this systematic review was to identify which information is included when reporting educational interventions used to facilitate foundational skills and knowledge of evidence-based practice (EBP) training for health professionals. This systematic review comprised the first stage in the three stage development process for a reporting guideline for educational interventions for EBP.

METHODS

The review question was 'What information has been reported when describing educational interventions targeting foundational evidence-based practice knowledge and skills?'MEDLINE, Academic Search Premier, ERIC, CINAHL, Scopus, Embase, Informit health, Cochrane Library and Web of Science databases were searched from inception until October - December 2011. Randomised and non-randomised controlled trials reporting original data on educational interventions specific to developing foundational knowledge and skills of evidence-based practice were included.Studies were not appraised for methodological bias, however, reporting frequency and item commonality were compared between a random selection of studies included in the systematic review and a random selection of studies excluded as they were not controlled trials. Twenty-five data items were extracted by two independent reviewers (consistency > 90%).

RESULTS

Sixty-one studies met the inclusion criteria (n = 29 randomised, n = 32 non-randomised). The most consistently reported items were the learner's stage of training, professional discipline and the evaluation methods used (100%). The least consistently reported items were the instructor(s) previous teaching experience (n = 8, 13%), and student effort outside face to face contact (n = 1, 2%).

CONCLUSION

This systematic review demonstrates inconsistencies in describing educational interventions for EBP in randomised and non-randomised trials. To enable educational interventions to be replicable and comparable, improvements in the reporting for educational interventions for EBP are required. In the absence of a specific reporting guideline, there are a range of items which are reported with variable frequency. Identifying the important items for describing educational interventions for facilitating foundational knowledge and skills in EBP remains to be determined. The findings of this systematic review will be used to inform the next stage in the development of a reporting guideline for educational interventions for EBP.

The assessment of strategic plans of a developing country for solving barriers to access evidence-based information sources

OBJECTIVE

Most developing societies attempt to eliminate physicians and medical students' barriers to the use of evidence-based information to ensure about delivering the best practice. Hence, health sector of Iran has conducted numerous educational interventions and has provided information technology infrastructure through strategic plans to provide opportunity for physicians and medical students to use research-based information in their clinical decision from 2005. The aim of this study is to reply a question. Have the reforms of a developing country eliminated the physicians and medical assistants and students' barriers to the use of research and evidence-based information resources?

METHODS

A descriptive study was performed among 315 physicians, assistants, and medical students in the affiliated hospitals of Semnan University of medical sciences in 2012.

RESULTS

The results reflected actual world scenarios in developing countries, and obviously showed that the investments could not overcome the main obstacles to the extent that was hoped.

CONCLUSIONS

This study offers organizational and cultural approaches and information management to simplify the usage of evidence-based information sources in practice in developing countries.

Effectiveness of bibliographic searches performed by paediatric residents and interns assisted by librarians. A randomised controlled trial

BACKGROUND

Considerable barriers still prevent paediatricians from successfully using information retrieval technology.

OBJECTIVES

To verify whether the assistance of biomedical librarians significantly improves the outcomes of searches performed by paediatricians in biomedical databases using real-life clinical scenarios.

METHODS

In a controlled trial at a paediatric teaching hospital, nine residents and interns were randomly allocated to an assisted search group and nine to a non-assisted (control) group. Each participant searched PubMed and other online sources, performing pre-determined tasks including the formulation of a clinical question, retrieval and selection of bibliographic records. In the assisted group, participants were supported by a librarian with ≥5 years of experience. The primary outcome was the success of search sessions, scored against a specific assessment tool.

RESULTS

The median score of the assisted group was 73.6 points interquartile range (IQR = 13.4) vs. 50.4 (IQR = 17.1) of the control group. The difference between median values in the results was 23.2 points (95% CI 4.8-33.2), in favour of the assisted group (P-value, Mann-Whitney U test: 0.013).

CONCLUSIONS

The study has found quantitative evidence of a significant difference in search performance between paediatric residents or interns assisted by a librarian and those searching the literature alone.

Interventions for promoting information and communication technologies adoption in healthcare professionals

BACKGROUND

Information and communication technologies (ICT) are defined as digital and analogue technologies that facilitate the capturing, processing, storage and exchange of information via electronic communication. ICTs have the potential to improve information management, access to health services, quality of care, continuity of services, and cost containment. Knowledge is lacking on conditions for successful ICT integration into practice.

OBJECTIVES

To carry out a systematic review of the effectiveness of interventions to promote the adoption of ICT by healthcare professionals.

SEARCH STRATEGY

Specific strategies, defined with the help of an information specialist, were used to search the Cochrane Effective Practice and Organisation of Care Group (EPOC) register and additional relevant databases. We considered studies published from January 1990 until October 2007.

SELECTION CRITERIA

Randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before/after studies (CBAs), and interrupted time series (ITS) that reported objectively measured outcomes concerning the effect of interventions to promote adoption of ICT in healthcare professionals' practices.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed each potentially relevant study for inclusion. We resolved discrepancies by discussion or a third reviewer. Two teams of two reviewers independently extracted data and assessed the quality of included studies. A meta-analysis of study outcomes was not possible, given the small number of included studies and the heterogeneity of intervention and outcomes measures. We conducted qualitative analyses, and have presented the results in a narrative format.

MAIN RESULTS

Ten studies met the inclusion criteria. Nine of them were RCTs. All studies involved physicians as participants (including postgraduate trainees), and one study also included other participants. Only two studies measured patient outcomes. Searching skills and/or frequency of use of electronic databases, mainly MEDLINE, were targeted in eight studies. Use of Internet for audit and feedback, and email for provider-patient communication, were targeted in two studies. Four studies showed small to moderate positive effects of the intervention on ICT adoption. Four studies were unable to demonstrate significant positive effects, and the two others showed mixed effects. No studies looked at the long-term effect or sustainability of the intervention.

AUTHORS' CONCLUSIONS

There is very limited evidence on effective interventions promoting the adoption of ICTs by healthcare professionals. Small effects have been reported for interventions targeting the use of electronic databases and digital libraries. The effectiveness of interventions to promote ICT adoption in healthcare settings remains uncertain, and more well designed trials are needed.

The information-seeking behaviour of doctors: a review of the evidence

This paper provides a narrative review of the available literature from the past 10 years (1996-2006) that focus on the information seeking behaviour of doctors. The review considers the literature in three sub-themes: Theme 1, the Information Needs of Doctors includes information need, frequency of doctors' questions and types of information needs; Theme 2, Information Seeking by Doctors embraces pattern of information resource use, time spent searching, barriers to information searching and information searching skills; Theme 3, Information Sources Utilized by Doctors comprises the number of sources utilized, comparison of information sources consulted, computer usage, ranking of information resources, printed resource use, personal digital assistant (PDA) use, electronic database use and the Internet. The review is wide ranging. It would seem that the traditional methods of face-to-face communication and use of hard-copy evidence still prevail amongst qualified medical staff in the clinical setting. The use of new technologies embracing the new digital age in information provision may influence this in the future. However, for now, it would seem that there is still research to be undertaken to uncover the most effective methods of encouraging clinicians to use the best evidence in everyday practice.

Boolean search experience and abilities of medical students and practicing physicians

BACKGROUND

Little is known about physician ability to utilize Boolean search skills to access information.

PURPOSE

Determine the proficiency of medical students and practicing physicians to identify efficient Boolean phrases.

METHODS

Experiential survey and multiple-choice questions administered to 49 4th-year medical students and 42 practicing physicians. Subjects identified the best answer or correctly ranked 3 Boolean search phrase options.

RESULTS

Practicing physicians identified the single best query phrase significantly more often than did medical students (85.7% vs. 75.0%, p < 0.001), and both groups had significantly more difficulty correctly rank-ordering the queries (students, 75% vs. 54%, p < 0.001; practitioners, 85.7% vs. 57.1%, p < .04). Only recent MEDLINE use was an independent predictor of accuracy in both groups.

CONCLUSION

Students and physicians demonstrated deficiencies in identifying optimal Boolean phrases. Although formal instruction has not demonstrated clear improvement in skills, more creative teaching of Boolean search techniques should be undertaken and tested.

The randomised controlled trial design: unrecognized opportunities for health sciences librarianship

OBJECTIVE

to describe the essential components of the Randomised Controlled Trial (RCT) and its major variations; to describe less conventional applications of the RCT design found in the health sciences literature with potential relevance to health sciences librarianship; to discuss the limited number of RCTs within health sciences librarianship.

METHODS

narrative review supported to a limited extent with PubMed and Library Literature database searches consistent with specific search parameters. In addition, more systematic methods, including handsearching of specific journals, to identify health sciences librarianship RCTs.

RESULTS

While many RCTs within the health sciences follow more conventional patterns, some RCTs assume certain unique features. Selected examples illustrate the adaptations of this experimental design to answering questions of possible relevance to health sciences librarians. The author offers several strategies for controlling bias in library and informatics applications of the RCT and acknowledges the potential of the electronic era in providing many opportunities to utilize the blinding aspects of RCTs. RCTs within health sciences librarianship inhabit a limited number of subject domains such as education. This limited scope offers both advantages and disadvantages for making Evidence-Based Librarianship (EBL) a reality.

CONCLUSIONS

The RCT design offers the potential to answer far more EBL questions than have been addressed by the design to date. Librarians need only extend their horizons through use of the versatile RCT design into new subject domains to facilitate making EBL a reality.

Information skills training: a systematic review of the literature

The objectives of this study were to undertake a systematic review to determine the effectiveness of information skills training, to identify effective methods of training and to determine whether information skills training affects patient care. A systematic review, using an iterative approach to searching, was employed. Studies selected for inclusion in the review were critically appraised using a tool used in previous reviews. A tabular approach was used to provide a summary of each paper allowing synthesis of results. One thousand, three hundred and fifty-seven potentially relevant papers were located. On the basis of titles and abstracts, 41 potentially relevant studies were identified for potential inclusion. Further reading and application of the inclusion criteria left 24 studies for critical appraisal and inclusion in the review. Study designs included randomised controlled trials, cohort designs and qualitative studies. The majority of studies took place in US medical schools. Wide variations were found in course content and training methods. Eight studies used objective methods to test skills, two compared training methods and two examined the effects on patient care. There was limited evidence to show that training improves skills, insufficient evidence to determine the most effective methods of training and limited evidence to show that training improves patient care. Further research is needed in a number of areas.

Accessing the online evidence: a guide to key sources of research information on clinical and cost effectiveness

Advice on how to access the best available online sources of research evidence on clinical and cost effectiveness published in three recent issues of Effectiveness Matters is reviewed.

Effectiveness of training health professionals in literature search skills using electronic health databases--a critical appraisal

The objective was to assess the effect on health professionals' skills of one to eight hours literature search and retrieval training from electronic health databases. We searched: Cochrane library (2002; Issue 3), MEDLINE (1977-2002/5), EMBASE (1980-2002/7); CINAHL (1982-2002/5); ASSIA (1982-2002/7), BNI (1994-2002/5), ERIC (1985-2002/6); LISA (1969--current), NRR (2002, Issue 2), the world-wide-web and references. The selection criteria consisted of randomised controlled trials, controlled before and after, and controlled cohort studies in comparison with no training. The intervention had to be one to eight hours training in literature search and retrieval skills for health professionals. The outcome was the effect on health professionals' literature search and retrieval skill levels measured through reliable instruments. For data collection and ana-lysis, one reviewer extracted data and assessed the quality of the studies and the second reviewer checked it. The results indicate that there is some evidence of positive impact on health professionals' skill levels in literature searching and they find the training useful. In conclusion, the size of the positive effect is debatable as only three small and methodologically weak studies met the inclusion criteria and out of those only two showed the positive effect.

Developing evidence-based librarianship: practical steps for implementation

Evidence-based librarianship (EBL) is a relatively new concept for librarians. This paper lays out a practical framework for the implementation of EBL. A new way of thinking about research in librarianship is introduced using the well-built question process and the assignment of librarian research questions to one of six domains specific to librarianship. As a profession, librarianship tends to reflect more qualitative, social sciences/humanities in its research methods and study types which tend to be less rigorous and more prone to bias. Randomised controlled trials (RCT) do not have to be placed at the top of an evidence 'hierarchy' for librarianship. Instead, a more encompassing model reflecting librarianship as a whole and the kind of research likely to be done by librarians is proposed. 'Evidence' from a number of disciplines including health sciences, business and education can be utilized by librarians and applied to their practice. However, access to and availability of librarianship literature needs to be further studied. While using other disciplines (e.g. EBHC) as a model for EBL has been explored in the literature, the authors develop models unique to librarianship. While research has always been a minor focus in the profession, moving research into practice is becoming more important and librarians need to consider the issues surrounding research in order to move EBL forward.

Evidence-based librarianship: what might we expect in the years ahead?

OBJECTIVE

To predict the possible accomplishments of the Evidence-Based Librarianship (EBL) movement by the years 2005, 2010, 2015 and 2020.

METHODS

Predictive. The author draws upon recent events, relevant historical events and anecdotal accounts to detect evidence of predictable trends.

RESULTS

The author develops a set of probable predictions for the development of EBL. Although incomplete evidence exists, some trends still seem discernible.

CONCLUSION

By 2020, EBL will have become indistinguishable from mainstream health sciences librarianship/informatics practices.