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An innovative model of evidence-based practice for other professions.

Our profession could very well become a model for other professions wishing to become more evidence based. At this moment, autonomous teams of our colleagues are conducting systematic reviews to address the fifteen top-ranked research questions in the current Medical Library Association (MLA) research agenda [1]. These systematic review teams include mostly US members, although a third of the teams' members hail from other nations such as Australia, Canada, Iran, Ireland, Qatar, and the United Kingdom. Readers probably know one or more members of these teams. Most of these groups have been working in relative obscurity. That is, until now.

Several other professions have defined their research agendas [2-4]. Researchers representing the health professions and a wide range of other professions as diverse as the behavioral, social, policy, environmental, and management sciences have also conducted systematic reviews [5-14]. To the authors' knowledge, however, only our profession has linked these two discrete activities coherently into a potentially potent strategy. This linkage could draw attention to our profession as an innovative leader in evidence based practice. We predict that other professions likely will want to adapt our approach to address the needs of their own respective memberships.

Each systematic review team has refined its focused research question at this time and is at a different stage of completion of the respective systematic reviews. Recently, one team published its findings in the Journal of the American Medical Informatics Association (JAMIA) [15]. Some teams reported on their progress at the MLA 2014 annual meeting [16-18]. Other teams are still closer to the formative stages of their reviews. Constituting the MLA Research Section's Research Agenda Committee, we have developed general guidelines for forming and managing the teams [19]. When necessary, or as requested, we have provided guidance on conducting the systematic reviews. Table 1 (online only) lists the subject areas of the reviews, team leaders' names, and team leaders' contact information.

Background

This systematic review initiative traces its origins to the renewal of the MLA research policy by leaders in our profession [20]. The 2007 MLA research policy, The Research Imperative, set bold directions for our profession's generation and use of applied research for making decisions. Two recommendations, appearing in the first section of the action plan for the policy, catalyzed a process that has now led to the systematic review initiative. These recommendations are that MLA will:

* Ask the MLA Research Section to create a forum for identifying research priorities in the field.

* Ask the Research Section to recommend annually to the MLA Board of Directors an MLA research agenda that suggests research topics of highest priority to the association [21].

The first MLA research agenda, which appeared during 2009, offered twelve key research questions [22]. The MLA Research Section asked the authors to conduct a second delphi study during 2011 to identify new top-ranked research questions [1]. The authors thought that these fifteen new questions needed to be addressed with systematic reviews. They developed a process that would allow them to coordinate the formation and monitor the progress of the fifteen teams aligned to each of the fifteen questions [19]. The authors decided to grant near-complete autonomy to the teams. This autonomy, coupled to the authors' encouragement that teams manage themselves with relatively flat organizational structures, seemed to enable the teams to conduct the systematic reviews in ways that the teams thought to be most appropriate. The authors expect that, over the coming year, most of the teams will submit their systematic reviews for publication. This initiative will help populate a growing list of nearly fifty systematic reviews affecting our profession [23]. As most Journal of the Medical Library Association readers know, systematic reviews represent potentially the highest form of evidence in evidence-based library and information practice (EBLIP) [24, 25].

What you can do

There are three arenas in your practice where you can act upon this information: individual, institutional, and professional association.

Individual. On the individual level, you can model EBLIP by using systematic reviews to make important decisions. When systematic reviews are not available, you can still use the highest forms of evidence such as a randomized controlled trial or cohort study. You also can encourage colleagues who are conducting systematic reviews by thanking them for their efforts. Most importantly, you can identify vital questions that remain unanswered, formulate effective EBLIP questions [26], and alert colleagues about these gaps. Whenever possible, you should urge MLA leaders to contribute questions for future MLA research agenda formulation processes.

Institutional. Groups of colleagues making joint decisions on important matters can use systematic reviews or other forms of high-level evidence. We can identify and discuss gaps in the existing evidence base and alert our colleagues to these gaps. Whenever possible, we can encourage MLA leaders to contribute questions for future MLA research agenda formulation processes. Institutionally, we can create incentives for interested colleagues to join teams conducting systematic reviews through granting research leave. We also can encourage agencies to fund systematic review teams through grants or contracts.

Professional association. As a profession, we can encourage the pursuit of systematic reviews by creating incentives through grants, contracts, awards, or other recognitions for team members. We can encourage MLA leaders to submit what they view to be the most important research questions and to vote on others' worthy questions. We can encourage published researchers to lend their expertise in gauging the answerability of leaders' research questions.

The authors will host a session on this systematic review project during the first section program at MLA '15 in Austin, Texas. We invite you to attend this session to learn more about this innovative project, introduce your own ideas, and raise any questions.

DOI: http://dx.doi.Org/10.3163/1536-5050.103.2.009

Received September 2014; accepted November 2014

References

[1.] Eldredge JD, Ascher MT, Holmes HN, Harris MR. The new Medical Library Association research agenda: final results from a three-phase delphi study. J Med Lib Assoc. 2012 Jul;100(3):214-8. DOI: http://dx.doi.org/10.3163/1536-5050 .100.3.012. PubMed PMID: 22879811; PubMed Central PMCI: 3411260.

[2.] Edwards LH. Research priorities in school nursing: a delphi process. J School Nurs. 2002 Jun;18(3):157-62.

[3.] Cohen MZ, Harle M, Woll AM, Despa S, Munsell MF. Delphi survey of nursing research priorities. Oncol Nurs Forum. 2004 Sep 17;31(5):1011-8. PubMed PMID: 15378103.

[4.] Burnette D, Morrow-Howell N, Chen LM. Setting priorities for gerontological social work research: a national delphi study. Gerontologist. 2003 Dec;43(6):828-38. Pub Med PMID: 14704382.

[5.] Guyatt G, Jaeschke R, Prasad K, Cook DJ. Summarizing the evidence. In: Guyatt G, Rennie D, eds. Users' guide to the medical literature: essentials of evidence-based clinical practice. New York, NY: McGraw-Hill; 2008. pp. 239-64.

[6.] Porritt K, Gomersall J, Lockwood C. JBI's systematic reviews: study selection and critical appraisal. Am J Nurs. 2014 Jun;114(6):47-52. DOI: http://dx .doi.org/10.1097/01.NAJ.0000450430 .97383.64. PubMed PMID: 24869584.

[7.] Brownson RC, Chriqui JF, Stamatakis KA. Understanding evidence-based public health policy. Am J Public Health. 2009 Sep;99(9): 1576-83. DOI: http://dx.doi.org/10 .2105/AJPH.2008.156224. Epub 2009 Jul 16. PubMed PMID: 19608941; PubMed Central PMCID: PMC2724448.

[8.] Barends E, Rousseau DM, Briner RB. Evidence-based management: the basic principles. Amsterdam, The Netherlands: Center for Evidence-Based Management; 2014.

[9.] American Psychological Association Presidential Task Force on Evidence-Based Practice. Evidence-based practice in psychology. Am Psychology. 2006 May-Jun;61(4):271-85. PubMed PMID: 16719673.

[10.] Gambrill ED. Evidence-based practice: sea change or the emperor's new clothes? J Soc Work Educ. 2003 Winter;39(1):3-23.

[11.] Castello LD, Gil-Gonzalez D, Alvarez-Dardet Diaz C, Hernandez-Aguado I. The environmental millennium development goal: progress and barriers to its achievement. Environ Sci Policy. 2010;13:154-63.

[12.] Pittaway L, Cope J. Entrepreneurship education: a systematic review of the evidence. Int Small Bus J. 2007 Oct;25(5):479-510.

[13.] Sundberg T, Taylor-Gooby P. A systematic review of comparative studies of attitudes to social policy. Soc Policy Admin. 2013 Aug;47(4):416-33.

[14.] Petrosino A, Boruch RF, Soydan H, Duggan L, Sanchez-Meca J. Meeting the challenges of evidence-based policy: the Campbell Collaboration. Ann Am Acad Pol Soc Sci. 2001;578:14-34.

[15.] Perrier L, Farrell A, Ayala AP, Lightfoot D, Kenny T, Aaronson E, Allee N, Brigham T, Connor E, Constantinescu T, Muellenbach J, Epstein HAB, Weiss A. Effects of librarian-provided services in healthcare settings: a systematic review. J Am Med Inform Assoc. 2014 May 28;21:1118-24. Review. PubMed PMID: 24872341.

[16.] Glynn LA, Sakmar K, Lalla NJ, Berry R, Kim C, Geldenhuys PR, Lawton A, Siebert JL, McClurg C, Clemans-Taylor L, Gadd K, Ettien AL. The value to and impact of health sciences libraries and information services on academic and clinical practice: a systematic review. Presented at: MLA '14, 114th Annual Meeting of the Medical Library Association; Chicago, IL; 16-21 May 2014.

[17.] Anderson PF, Bickett S, Doucette J, Herring PR, Kammerer J, Kepsel A, Lyons T, McLachlan S, Tonnison I, Wu L. Tools for building our information future: emerging technologies vital to medical libraries. Poster presented at: MLA '14, 114th Annual Meeting of the Medical Library Association; Chicago, IL; 16-21 May 2014.

[18.] Anderson PF, Bickett S, Doucette J, Herring PR, Kammerer J, Kepsel A, Lyons T, McLachlan S, Tonnison I, Wu L. Future technological practices: medical librarians' skills and information structures for continued effectiveness in a changing environment. Presented at: MLA '14, 114th Annual Meeting of the Medical Library Association; Chicago, IL; 16-21 May 2014.

[19.] Ascher MT, Eldredge JD, Holmes HN, Harris MR. The MLA research agenda: appraising the best available evidence [Internet]. Proposed guidelines to the MLA Research Section Executive Committee. Working paper. 2012 Nov 2 [cited 2 Dec 2014]. <http://repository.unm.edu/handle/ 1928/24634..

[20.] Grefsheim SF, Rankin JA, Perry GJ, McKibbon KA. Affirming our commitment to research: the Medical Library Association's research policy statement: the process and findings. J Med Lib Assoc. 2008 Apr;96(2):114-20. DOI: http://dx .doi.org/ 10.3163/1536-5050.96.2.114.

[21.] Medical Library Association. The research imperative: the research policy statement of the Medical Library Association [Internet]. Chicago, IL: The Association; 2007 Appendix 4: action plan. Section one [cited 10 Mar 2014]. <http://www.mlanet.org/research/ policy/policy-12.html>.

[22.] Eldredge JD, Harris MR, Ascher MT. Defining the Medical Library Association research agenda: methodology and final results from a consensus process. J Med Lib Assoc. 2009 Jul;97(3):178-85. DOI: http://dx.doi .org/10.3163/1536-5050.97.3.006. PubMed PMID: 19626143; PubMed Central PMCID: PMC2706444.

[23.] Koufogiannakis D. LIS systematic reviews [Internet]. [cited 16 May 2014]. <http://lis-systematic-reviews.wikispaces .com/By+author>.

[24.] Sampson M. Welcoming systematic reviews to the Journal of the Medical Library Association. J Med Lib Assoc. 2014 Jul;102(3):143-5. DOI: http://dx .doi.org/ 10.3163/1536-5050.102.3.001.

[25.] Eldredge JD, Hannigan GG. Emerging trends in health sciences librarianship. In: Wood MS, ed. Health sciences librarianship. Lanham, MD: Rowman & Littlefield and the Medical Library Association; 2014. pp. 57-83.

[26.] Booth A. Clear and present questions: formulating questions for evidence based practice. Lib Hi Tech. 2006;24(3):355-68.

Jonathan D. Eldredge, MLS, PhD, AHIP; Marie T. Ascher, MS, AHIP; Heather N. Holmes, MLIS, AHIP

Jonathan D. Eldredge, MLS, PhD, AHIP (corresponding author), jeldr edge@unm.edu, Associate Professor, Biomedical Informatics Research, Training and Scholarship, Health Sciences Library and Informatics Center/Family and Community Medicine, 1 University of New Mexico, MSC09 5100, Albuquerque, NM 87131-0001; Marie T. Ascher, MS, AHIP, marie_ascher@nymc.edu, Associate Director, User Services, Health Sciences Library, New York Medical College, 15 Dana Road, Valhalla, NY 10595; Heather N. Holmes, MLIS, AHIP, holmesh@summahealth .org, Clinical Informationist, Medical Library, Summa Health System, Akron City & St. Thomas Hospitals, and Instructor, Department of Internal Medicine, Northeastern Ohio Medical University, 55 Arch Street, Suite G-3, Akron, OH 44304
Table 1
Medical Library Association research agenda systematic review
teams

Team   Question

1      There are still a number of relevant questions
       from the 2008 research agenda, but to me this is
       most critical: "What is the quantifiable evidence
       that the presence of a librarian, not just
       information resources, improves patient outcomes,
       increases research dollars, improves student
       outcomes (e.g., better board scores), or increases
       hospital intelligence (e.g., if the top hospitals
       have access to hospital librarians/libraries)?"

2      Is there a significant difference in patient
       outcomes (or research output or educational
       outcomes) between institutions with and without
       libraries?

3      What is the added value that libraries bring to
       education, research, and patient care in the health
       sciences and health care fields? Even if it is not
       possible to quantify benefits, documenting
       qualitative research results rigorous enough
       to stand the scrutiny of administrators and
       researchers would be of great value.

4      Low health literacy can result in medication
       errors, noncompliance with treatment regimes,
       poor health outcomes, and even death. What is the
       role of the medical librarian with health care
       providers, community organizations, local public
       libraries, and members of the public to improve
       health literacy among entire communities?

5      What are the information needs of practicing
       physicians and other health care workers? The
       Covell article is still heavily cited but was
       published way back in 1985. The information
       environment has changed dramatically. We need to
       update that study in light of new educational
       strategies, resources, technology, and social
       networks.

6      The explosion of information, expansion of
       technology (especially mobile technology), and
       complexity of the health care environment present
       medical librarians and medical libraries with
       opportunities and challenges. To live up
       to the opportunities and challenges, what kinds of
       skill sets or information structure do medical
       librarians or medical libraries require or need
       to acquire so as to be strong partners or
       contributors of continuing effectiveness to the
       changing environment?

7      Does what we do matter? Longer form: Do the
       resources we provideumaterials, reference
       services, and educational offeringsumake a
       difference to our customers: save lives, shorten
       length of stay, improve educational outcomes,
       increase research dollars, improve research
       results?

8      How do we provide information support in a clinical
       world that functions based on electronic medical
       records systems and other similar informatics
       platforms and tools. What is the library's role,
       if any, in providing preclinical education with
       respect to informatics applications like
       electronic medical records systems?

9      Do health sciences libraries and librarians have
       any measureable (statistically significant)
       positive impacts on consumer health, the outcomes
       of medical care, the productivity of biomedical
       researchers, and the knowledge obtained by
       graduates of biomedical and health sciences
       training programs, and at what total cost?

10     How best to objectively document library/librarian
       impact on the "bottom line" (time, money saved,
       shorter length of stay, return on investment for
       expensive electronic resources, support training
       programs/Magnet status, funded research support,
       etc.)?

Team   Name                       Email

1      Laure Perrier              l.perrier@utoronto.ca

2      David Lightfoot            lightfootd@smh.ca

3      Margaret Jane Foster,      margaretfoster@tamu.edu
       AHIP

4      Mary Lou Klem              klem@pitt.edu

5      Aileen McCrillis, AHIP     aileen.mccrillis@med.nyu.edu

6      Patricia F. Anderson       pfa@umich.edu

7      Lindsay Alcock Glynn       lalcock@mun.ca

8      Brenda M. Linares, AHIP    blinares@unc.edu

9      Margaret Henderson, AHIP   mehenderson@vcu.edu

10     Anne Madden                anne.madden@ucd.ie
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Title Annotation:COMMENT AND OPINION
Author:Eldredge, Jonathan D.; Ascher, Marie T.; Holmes, Heather N.
Publication:Journal of the Medical Library Association
Article Type:Report
Geographic Code:1USA
Date:Apr 1, 2015
Words:2548
Previous Article:Proceedings, 114th Annual Meeting Medical Library Association, Inc. Chicago, IL May 16-21, 2014.
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