This document provides an overview of library resources and services available to NHS staff to help practice evidence-based medicine. It discusses the library collections, databases, and training programs available. Key services include access to books, journals, databases through OpenAthens, reference management support, and a four part information skills training program covering induction, searching, current awareness, and critical appraisal. The training program teaches skills for finding and evaluating evidence using a systematic approach to answer clinical questions and apply results to practice.

1. Practicing Up To
Date Medicine
An overview of things that can
make it easier
Andrew Milne, NHS Librarian

2. Today we’ll cover:
• What the Library can offer you
• What NHS OpenAthens offers you
• How to use those services as part of the
Evidence Based Medicine cycle
• Sources of additional support

3. Working at Imperial College
Healthcare NHS Trust means
access to an Imperial College
network of libraries.
That’s the book stock of six
libraries instead of just one
hospital library.

5. Opening hours vary by site
Hammersmith
9am – 9pm Monday to Friday
Plus out of hours access to PCs
until midnight and on weekends

6. Opening hours vary by site
Charing Cross
9am – 9pm Monday to Friday
Plus 10am – 5pm Saturdays

7. Opening hours vary by site
St. Mary’s
9am – 9pm Monday to Friday
1:30pm – 5pm Saturday
Plus access to the upper gallery
every day from 7am til midnight

8. Joining is simple
1. Show Commonwealth
Building security your hospital
ID to get an Imperial College
ID card.
2. Fill in a registration form at
the library.

9. Now that you’ve
joined you get:
books e-books
journals e-journals
printing and copying quiet study space
PC access
group study rooms
databases free interlibrary loans
help and training from library staff

10. We offer thousands of books covering
general medicine, medical specialisms,
nursing, allied health, and research skills.

11. Central Library also has books on other
topics, including fiction.

12. We arrange our books
based on NLM – National
Library of Medicine
classification.
This means books
are grouped by
subject at general
and specific levels.

13. We arrange our books
based on NLM – National
Library of Medicine
classification.
This means books
are grouped by
subject at general
and specific levels.

14. WJ = general subject
39 = specific subject
OXF = title or first author

15. The library website has a
dedicated section for NHS users.
This offers information and links
to a variety of resources and
services.

16. You can also search the
catalogue for books and
journals or specific journal
articles directly from library
web pages.

18. For the most up to date current awareness
and primary sources of evidence, you
should be looking at journal articles.

19. We keep some current issues of journals in
the library, with older issues available on
request.
Many are now provided electronically
instead and can be viewed at one of our
PCs.

20. As well as journal articles, our PCs give you
access to:
Internet
Microsoft Office
Additional resources
from Imperial College
London – for example
UpToDate

21. You can send work to the
B&W or colour printer from
our PCs and release it from
a printer with your Imperial
College card if it has credit.
Scanning is free.

22. OpenAthens
and why it’s a vital tool
for any health
professional

23. OpenAthens gives you
access to a wide range of
resources – from any
device, anywhere.

24. You can self-register for
OpenAthens online – if
necessary, we’ll check and
approve your account.

25. NICE Evidence search is quick
and handy ‘Google’ for health
queries.
Use it to search for clinical knowledge
summaries, guidelines, care
pathways, and more.

26. The A-Z list of journals gives you access to
the archives of a variety of journals – at the
library, the hospital, at home, and on the go.
Great when you
have a specific
journal or article in
mind.

27. The Cochrane Library
A library of meta-analyses and systematic
reviews available through NICE Evidence
website.
Systematic
reviews = the
gold standard

28. HDAS is the jewel in NICE
Evidence’s crown.
Healthcare Databases Advanced Search
gives you 8 databases to search for
articles specific to your clinical or research
query.

29. The Evidence
Based Medicine
Cycle
Uncertainty
translated into
answerable
question
Systematic
retrieval of high
quality relevant
evidence
Critical appraisal
Evaluation and
Applicable results
applied to
practice
audit

30. Step 1 – Asking the right question
• Be specific and provide as much detail as
possible
• Anticipate how you’ll use the answer
• Consider techniques like PICO

31. PICO
Population (or Patient)
Intervention
Control (or Comparison)
Outcome

32. • Is acupuncture effective?
VS
• Is acupuncture an effective treatment in
smoking cessation?

33. Step 2 – Gathering evidence
• Use a variety of databases
• Use consistent searches
• Break your question down into ‘search
chunks’
• Identify a variety of keywords and synonyms
for each chunk

34. Rather than searching everything at once as in
Google…

35. Use OR to combine keyword searches for
similar and synonymous terms – i.e. to
create chunks or groups of keywords.
Oxygen
therapy
Oxygen
delivery
Oxygen
inhalation
therapy

36. Use OR to combine keyword searches for
similar and synonymous terms – i.e. to
create chunks or groups of keywords.
Lower
respiratory
tract infection
Whooping
cough
Pertussis

37. Use OR to combine keyword searches for
similar and synonymous terms – i.e. to
create chunks or groups of keywords.
Child Infant Young

38. Use AND to combine the groups of
keywords – bringing back only results
relevant to every group.
Oxygen
therapy etc.
Lower
respiratory tract
infections etc.
Child etc.

39. How this looks in practice…

41. Map to thesaurus

42. Map to thesaurus

44. • Use your own keywords
• Use keywords you identify in relevant
literature
• Use ‘map to thesaurus’ to search the
database’s indexing system

45. • Constantly re-evaluate and develop your
search strategies.
• Don’t fall into the Google trap!

46. You’re not doing a quick Google
search (or searching for pizza)

47. Step 3 – Critical Appraisal
“the process of carefully and systematically
examining research to judge its
trustworthiness, and its value and relevance
in a particular context”
(Critical Appraisal
Support Programme)
www.casp-uk.net

48. Critical Appraisal…
…stops you being a passive reader;
…helps you to filter out low quality evidence;
…should lead to stronger research output as
you become aware of what makes evidence
robust.

49. Step 3 – Critical Appraisal
• Use checklists by organisations like CASP
• Maintain a critical eye
• Does the study ask a clear question?
• Is the study well-designed for what it tries to
investigate?
• Is it statistically significant?
• Is it clinically and locally significant?

50. Research design and methodology
• Is the study type appropriate?
• Is it ethical?
• Was blinding used?
• Were participants randomised?
• Was intention to treat analysis used?
• How many participants were lost to follow-up?
• Was collection of results consistent?

51. Results
• How large was the treatment effect?
• Is the primary outcome clearly specified?
• What results were found for each
outcome?
• How precise is the estimate of the
treatment effect? (confidence intervals;
power calculations)

52. Favours Treatment
Value of no effect
Favours Control
-4 -3 -2 -1 0 1 2 3 4
95% confidence interval

53. Stats cheat sheet
• Look for p-values of 0.05 or less
• Power calculations in the range 80-95%
• Shorter confidence intervals mean closer
pinpointing of the true result
• Confidence intervals that cross 0 mean an
inconclusive result
• Number needed to treat (NNT) – lower is better,
but avoid 0 or negative!
• Relative Risk: 1 means no difference in risk
between groups; either side favours one or the
other

54. Implications of research
• Can it be applied locally?
• Costs and harm versus benefits?
• Statistical significance does not mean
clinical significance
• Is further research needed?
• Any conflicts of interest?
• Any weasel words? (“approaching
statistical significance”)

55. Three Rs
• RIGOUR
• RESULTS
• RELEVANCE

56. • Join or set up a journal club
• Follow journal clubs online (e.g. #TwitJC)
• Attend a critical appraisal workshop
• Read new literature 
• Save searches in HDAS and create alerts for
when new literature is published

58. Steps 4 & 5
• Applying the relevant results to your practice is
up to you and your colleagues
• Evaluation and audit makes continued use of
your information skills and critical skills
• Remain reflective and don’t rely on received
wisdom or assume you’ve perfected something
• Return to step 1

59. The Evidence
Based Medicine
Cycle
Uncertainty
translated into
answerable
question
Systematic
retrieval of high
quality relevant
evidence
Critical appraisal
Evaluation and
Applicable results
applied to
practice
audit

60. In summary
• The library is here for you to use – use it
• OpenAthens is there for you to use – use it
• Apply systematic search techniques to
answer focused questions
• Set up alerts for those searches
• Critically appraise your results before
applying to practice
• Seek help when you need it

61. Library
Induction
Searching
Databases
Current
Awareness
Critical
Appraisal
The four modules of the Library’s
information skills training programme

62. Library
Induction
Searching
Databases
Current
Awareness
Critical
Appraisal
The four modules of the Library’s
information skills training programme
You might be able to skip steps if you feel
comfortable. The goal is to help you complete the
programme with the foundations necessary to make
effective use of resources with stronger information
literacy.

63. Library InductionSearching Databases
Critical Appraisal Text here
Social
Media?
Reference
Management?
Current
Awareness
New
Tech?
But eventually…
• Additional modules
• New content
• A growing set of key
skills for you to pick
and mix
• Consistent delivery
• Fresh training
responding to your
needs and wants

65. Thanks for listening!
Get in touch:
a.milne@imperial.ac.uk
020 3313 2189