current awareness: quality vs currency or current quality?

Current Awareness:Quality Vs Currency or

Current Quality?

Steve Sharp, Information Specialist

Overview

• Why do we need current awareness?

• Evidence updating

• Cardiovascular Specialist Library approach

• Addressing quality Issues

• The future – awareness or bewareness?

NLH Specialist Libraries

• 2001 “Virtual Branch Libraries” Launched on NeLH

• 2003 3 year contracts awarded

• 2003 Re-branded “Specialist Libraries”

• 2006 2 year extensions

• 2007 Currently 28 SLs and 3 more in development.

• A key element of NLH

User Categories

• Generalists – requiring access to common core of knowledge

• Specialists – requiring common core of knowledge + access to key journals and the latest research

Evidence Updating

Prevalent (pre-existing) knowledge

Incident (new) knowledge

• Authoritative document used as benchmark • Clear Inclusion and exclusion criteria • Process repeated annually to capture new

evidence• How to monitor new, emerging evidence?

Specialised Knowledge

• “Specialised knowledge consists of the common core of knowledge supplemented by access to all the key journals in that specialty and relevant research protocols, because NeLH has to support research as well as clinical practice.”

NeLH Content and Quality of Specialist Libraries 2004

Survey of 80 ENT SL Users

• 55% spend 1-2 hours a week reading current or recent journals

• 24 % spend 2-4 hours a week reading current or recent journals

• 79% spend ≥ 1 hour a week reading current or recent journals

Growth of Web based CA services

• Zetoc TDNET• Publisher alerts e.g. BMJ Updates• Database platforms: Dialog,Ovid,Pubmed• Individual journal alerts• RSS feeds

• Any Need for more Current Awareness?

Why do we need CA?

• Instant alerting on publication

• Convenience - amalgamate resources

• Support research as well as clinical practice

• Bridge currency gap of outdated core knowledge

• PR for Library

Cardiovascular Approach

One of most studied specialties in Medicine:

• 1.5 million papers in Medline

• High knowledge incidence

• Risk of outdated/superseded core knowledge

Format – Hot off the Press• Big Four Journals Scanned :

– BMJ– JAMA– Lancet– NEJM

• New references posted on site immediately• Retained for 8 weeks, then deleted• Some high level evidence studies added

permanently• Links to specialist journals:

– Current Issues– Articles in press

Quality Issues

• Publication Bias• Inadequate reporting • Flawed Peer review • Variable quality

(Ioannidis 2006)

• Addressing Challenges– Explicit Disclaimer– Links to Critical

Appraisal Checklists– Ensuring journals

conform to reporting standards

– explicit indication of level of evidence

• Does Current Awareness compromise service

quality or does it add value ?

The death of current awareness?

• Why bombard users with every new study published?

• Market saturation – alerting overload?

• Annual updating better than daily?

• New research rarely changes clinical practice?

Cumulative meta-analysis of aprotinin for perioperative bleeding: Odds ratio of benefit in 64 randomised trials.

Young C and Hort R. Putting clinical trials into context The Lancet 2005;366:107-108

After trial 12 (white), benefit was clear and subsequent 52

trials (red) were unnecessary.

The Future: Aware, Beware or Who Cares?

• Inform not overload – SDI with emphasis on Selective

• Be prepared for the “informed” patient

• Avoid duplication and needless research

• Combat publication bias

• Highlight therapeutic uncertainties - DUETs

• Alerting does not imply advocacy…

Over to you!

• Does Current Awareness compromise service

quality or does it add value ?