Anne Brice

Accumulating Research: A Systematic Account of How Cumulative Meta-Analyses Would Have Provided Knowledge, Improved Health, Reduced Harm and Saved Resources

Background “Cumulative meta-analysis” describes a statistical procedure to calculate, retrospectively, summary estimates from the results of similar trials every time the results of a further trial in the series had become available. In the early 1990s, comparisons of cumulative meta-analyses of treatments for myocardial infarction with advice promulgated through medical textbooks showed that research had continued long after robust estimates of treatment effects had accumulated, and that medical textbooks had overlooked strong, existing evidence from trials. Cumulative meta-analyses have subsequently been used to assess what could have been known had new studies been informed by systematic reviews of relevant existing evidence and how waste might have been reduced. Methods and Findings We used a systematic approach to identify and summarise the findings of cumulative meta-analyses of studies of the effects of clinical interventions, published from 1992 to 2012. Searches were done of PubMed, MEDLINE, EMBASE, the Cochrane Methodology Register and Science Citation Index. A total of 50 eligible reports were identified, including more than 1,500 cumulative meta-analyses. A variety of themes are illustrated with specific examples. The studies showed that initially positive results became null or negative in meta-analyses as more trials were done; that early null or negative results were over-turned; that stable results (beneficial, harmful and neutral) would have been seen had a meta-analysis been done before the new trial; and that additional trials had been much too small to resolve the remaining uncertainties. Conclusions This large, unique collection of cumulative meta-analyses highlights how a review of the existing evidence might have helped researchers, practitioners, patients and funders make more informed decisions and choices about new trials over decades of research. This would have led to earlier uptake of effective interventions in practice, less exposure of trial participants to less effective treatments, and reduced waste resulting from unjustified research.

Prediction is Difficult, Especially the Future: A Progress Report

Objective - This paper reviews developments in the consolidation and diversification of the evidence based library and information practice (EBLIP) paradigm since publication of the authors’ book Evidence Based Practice for Information Professionals: a Handbook in 2004. Methods - The authors provide an updated narrative review of key themes in the development of evidence based librarianship within the context of the new consensual term ‘EBLIP.’ Sources for this thematic framework included professional literature, Internet searches, and the authors’ personal experiences. Results - While considerable achievements have been realized within a three-year period, most notably the instigation of the journal known as EBLIP, a broadening of the paradigm to other library sectors, and increased availability of implementation studies, many challenges remain. Of particular concern is the lack of international strategic foresight in determining rotation of the biennial international conferences and distribution of influential EBLIP infrastructures and initiatives. Conclusion - While the enthusiasms and energies of individual practitioners and work teams have made considerable progress in meeting short-term objectives, uncertainty remains concerning how longer-term objectives requiring infrastructure and resources might be realized. From its faltering steps as a toddler EBLIP has developed to a ‘pre-pubescent’ stage with the promise of ‘growth spurts’ and ‘emotional crises.’ The next three years should prove both challenging and demanding.

Evaluating the Development of Virtual Communities of Practice that Support Evidence Based Practice

Objective – The aim of this paper is to examine how virtual community of practice principles might be used by information professionals with emphasis on the work of the Specialist Libraries for health professionals in England, UK. An evaluation conducted in 2004-2005 examined the operation of the Specialist Libraries, which the National Library for Health had contracted out to various organisations, and assessed their stage of development as communities of practice. Methods – Evaluation methods included observation of a meeting of information specialists, interviews with clinical leads and information specialists, and evaluation of the content and format of the Specialist Library websites. The evaluation framework was based on a systematic review of the literature to determine the critical success factors for communities of practice and their role in supporting evidence based practice. An updated literature review was conducted for this paper. Results – Operational structures varied but were mostly effective in producing communities of practice that were at an “engaged” stage. Some Specialist Libraries wished to move towards the “active” stage by supporting online discussion forums, or by providing question and answering services or more learning activities and materials. Although the evidence from the literature suggests there are few clear criteria for judging the effectiveness of communities of practice, the evaluation framework used here was successful in identifying the state of progress and how information professionals might approach designing virtual communities of practice. Conclusions – Structuring library and information services around community of practice principles is effective. Careful and participative design of the information architecture is required for good support for evidence based practice.

Creating a database of internet-based clinical trials to support a public-led research programme: A descriptive analysis

Background Online trials are rapidly growing in number, offering potential benefits but also methodological, ethical and social challenges. The International Network for Knowledge on Well-being (ThinkWell™) aims to increase public and patient participation in the prioritisation, design and conduct of research through the use of technologies. Objective We aim to provide a baseline understanding of the online trial environment, determining how many trials have used internet-based technologies; how they have been used; and how use has developed over time. Methods We searched a range of bibliographic databases to March 2015, with no date limits, supplemented by citation searching and references provided by experts in the field. Results were screened against inclusion and exclusion criteria, and included studies mapped against a number of key dimensions, with key themes developed iteratively throughout the process. Results We identified 1992 internet-based trials to March 2015. The number of reported studies increased substantially over the study timeframe. The largest number of trials were conducted in the USA (49.7%), followed by The Netherlands (10.2%); Australia (8.5%); the United Kingdom (5.8%); Sweden (4.6%); Canada (4%); and Germany (2.6%). South Korea (1.5%) has the highest number of reported trials for other continents. There is a predominance of interventions addressing core public health challenges including obesity (8.6%), smoking cessation (5.9%), alcohol abuse (7.7%) and physical activity (10.2%); in mental health issues such as depression (10.9%) and anxiety (5.6%); and conditions where self-management (16.6%) or monitoring (8.1%) is a major feature of care. Conclusions The results confirm an increase in the use of the internet in trials. Key themes have emerged from the analysis and further research will be undertaken in order to investigate how the data can be used to improve trial design and recruitment, and to build an open access resource to support the public-led research agenda.

Self-Management Open Online Trials in Health (SMOOTH): Methods and public involvement survey of corresponding authors of existing online trials

Background: The Self-Management Open Online Trials in Health (SMOOTH) survey reports methods as well as researcher preferences in online trials and explores to what extent public and participant involvement in online trials occurs. This survey queried researchers’ experience in online trials and their perceived value in terms of public and patient research involvement. The preparation, consideration and publication of research involvement require the use of resources by the authors. The survey explores whether authors consider resources to be sufficient or useful to improve online trials about self-management of health. Objective: To identify the present state of public research involvement in online trials concerning health self-management and to explore the needs of researchers when contemplating the building and writing up an online trials protocol. Methods: The ORCID database of online trials was used to survey corresponding authors concerning trial methods and preferences including the frequency, format and quality of citizen involvement in online trials about health self-management. Results: Blended trials were reported as online trials. Remote recruitment and communications were less common than local recruitment even when participants signed up online. Research volunteers helped more with recruitment and as advisors than with trial design, analysis, or outcome setting. Forty-seven percent of corresponding authors report that an online trial was the best way of answering their research question. Conclusions: Detailed reporting of online methods and volunteer researcher involvement was hindered by role confusion between research volunteers and trial participants. Respondents were responsive to the development of protocol and reporting suggestions, but were not in favor of adopting complex new frameworks that require extensive time, training, space and funding.

What's in a name: putting the skills of librarianship back into circulation.

Anne Brice, recipient of the 2014 Cyril Barnard Memorial Prize, reflects on the themes of names and skills of the health library and information professions. She questions whether service users share the same concerns of librarians that this nomenclature is too narrow and too closely associated with the buildings that provide its name. She proposes that in mediation between the users and their required knowledge sits a unique opportunity to place the profession in the centre of knowledge translation.

Remote Access to a Library and Information Resource for Primary Health Care Professionals

The Primary Care Sharing the Evidence (PRISE) Project lasted for 2 years, finishing in March 1998. It followed on from the Primary Healthcare Needs (PHIN) Project1 that concluded that there were a number of areas where further research would be useful. PHIN highlighted the generation, communication and use of information by general practitioners (GPs), showing that one quarter of GPs had unmet information needs in their daily practice. This information was required for a range of primary health care activities. PRISE aimed to develop a pilot information service to test the requirements of primary care teams, in order to enable and support those who wish to find evidence that can support their provision of patient care.