The interim law librarian: Part 5 - what to do with this small amount of new knowledge?

My brief time as a law librarian is nearly over.  I have rather enjoyed it, I have to say.  I have not had to teach anything, and most of the enquiries have been about referencing, but I did look into sources of French law, liaise with a supplier about a change of database interface, and look into ebook platforms.   It has certainly been interesting to learn about the habits, resources and conventions of another subject discipline.   

With all this new found knowledge, I find myself wondering what use health students might make of law resources.     They may encounter legislation and case law referenced in articles and books.   Do they know how to decode the citations, and how to find that material?    The book on medical law and ethics that is on their reading list has a brief mention of how to decode a reference to a case in a law report, and mentions two of the law databases, but goes into no detail.

Do they need to find and read the primary source material, or is it more usual for them to rely on articles, books, and reports about legal matters, that they find through their usual sources?    We have been asked in the past about how to cite legal information in Harvard or Vancouver, so some of them have sometimes used those primary sources.

As health professionals they work within the law, laws about their registration, about consent and safeguarding, and law relating to specific procedures or circumstances.   What do they need to learn about how the law works?    In hospital practice, they would have a legal department to help them work with, and interpret, the law.   And, I assume, advice from professional bodies and Royal Colleges.

I find myself wondering too what information there is in the health journals about legal matters.      What health law journals are there, and are they indexed in the "standard" databases they use?  How useful are those databases for health law?   Would the legal databases add more?    Are the journals indexed in those standard databases enough, or are there other journals that would be useful (and not require specialist legal knowledge) but which are only in the legal databases, or in databases like Scopus and Web of Science?  

I joined some law librarianship lists, followed some legal things on Twitter, and signed up to updates from some legal blogs.  I think I will keep those as they are for now...   

Playing doctors and nurses. And medical librarians

This is a toy figure belonging to my younger son.  Working on a large model boat, he managed to fall off, and needed treatment.  

He had hurt an arm.  We know about slings - about a year ago I had one.  So my son made a sling (more like a splint, I think) out of something he had to hand (sorry), to immobilise the arm.  Then we needed to know if there were any other injuries, so we conducted an X ray (with a torch).  You can begin to see the things we talk about at home - never have a medical librarian for a parent, is possibly the lesson.

Anyway, we discovered he had a head injury.  We know about those too - about a year ago I had one of those too.  So, we kept him under observation and asked him questions from time to time about if he knew where he was, and so on.  

And we found that he had broken ribs.  What to do with broken ribs?   We did not know.  I had not had any of those.  So, we looked it up.  I managed to persuade him in a previous episode of this game (which involved dinosaurs, which is another story) that medical librarians could look things up if doctors and nurses did not know what to do.   Or, they could show the doctor or nurse how to look things up.

So, I looked it up in a first aid book.  A bit there, but nothing about how to treat them.  I tried the impressive St John's Ambulance app, with similar results.   So, off to the computer, to NICE Evidence Search.  I tried rib fractures first, thinking that more medical language might be appropriate.  Among the results, some things about whether CPR causes rib fractures, but nothing immediately that answered the question of what we could do for this poor man.  So I tried broken ribs, and the first result was from Patient (as Patient.co.uk, a favourite with our medical students, is now called), and the second from NHS Choices.   Having looked at those, we decided that we did not need to bind the ribs up, in fact we should not do so, and that painkillers, rest, ice packs and sleeping standing up were what was required.  We also had information about when he should go to A and E.

There we are.  Imaginative play, but it reminded me of one of the purposes of medical and health librarianship.  You may know what to do, because you are a doctor or nurse, or you have done it before (assuming you did the right thing then, of course), but if you do not, you have to look it up, and that is where librarians come in.

Search filters

I have been invited to do the literature searching for a research project looking at care of older people in hospital.  The first part of the project is a literature review.  It's fascinating, and very instructive - I have spent a lot of time working to support others who are doing this, and it is quite eye opening to do it for myself!

The literature review is of systematic reviews (SRs) and meta analyses.  I first of all had to devise the strategy, and that was very interesting.  And then decide how to locate the SRs.  And so is that ...

I could:

1.  Use the standard Medline search limits.  There never used to be a limit for systematic reviews, and meta analysis was the nearest fit, although it is not the same thing.  Publication type limits in Medline are not without issue.  There may be references indexed as meta analyses which are not (but which say they are), and there may be things that are meta analyses, but which are not so indexed.  Now there is a SR limit, but in PubMed anyway it is a filter, not a straightforward limit.  Certainly a search in Medline for systematic review.pt. finds zero.

2.  This leads us to the second possibility.  As a way to address the shortcomings of the standard limits, and as a way to get reproducible searches, there are search filters, not part of Medline, strategies which can be bolted on to your subject search.  But there are several SR filters.  Which one to choose?   Some have high sensitivity ("the number of relevant reports identified divided by the total number of relevant reports in existence") and others have high precision ("the number of relevant reports identified divided by the total number of reports identified" - this, and the definition of sensitivity are taken from the Cochrane Handbook). 

 The ISSG Search Filters Resource lists many filters, and evaluates many of them.  I wanted it to recommend one, but of course because it depends what you are aiming for in terms of sensitivity and precision, no one can say "this one is the best".

3.  The third option is not to use a filter or limit at all, but include or exclude things yourself.   If you do this, you know exactly what you have kept.  But, there is a practical consideration, which is that if you get 2000 results, do you have time to scan them all?  This is interesting, as I have certainly said to students I have been helping that they may end up with this sort of number of results!

So, what to do.  I think I will be running all the filters (and the "limit") separately, and merging the results.  I suspect, but don't know, that these separate result sets will overlap but that none will completely include any of the others.  We shall see.  I then plan to remove this merged set from the unlimited/unfiltered results, and then we can sample the remainder and see if any of the sample are an SR or a meta analysis.

I put out a request for experience and expertise on two Jiscmail lists, and the results (I shall summarise for the lists) have informed the above.

(Auto)biography as health literature

When I started out in health librarianship, I am sure there was a book called "At the end of all our work is a patient".  I can't find it at the moment, but I can find an article by Shane Godbolt with that title (1).  And as she was my first boss, that is an excellent thing to find, and perhaps that is what I was thinking of.   That fact attracted me to this field of work, and still does. 

Watching the excellent History Boys recently (excellent, and to some extent familiar, as I was at school then, though not in Sheffield and not looking to go to Oxbridge or do history), I was reminded of Alan Bennett's memoir Untold stories (included in a volume with the same name) (2).  In it he writes about his mother's experience of mental health problems, and his discovery that his grandfather had also had them and had in fact committed suicide.

Perhaps there is material in that memoir that didn't make it into textbooks or research papers, perhaps, I am tempted to say, particularly at the time.  And so this sort of literature adds something to the evidence that informs practice and research.

I was recently in hospital for a week following an accident.  I remember what I was doing in the moments before but not what actually happened at the moment of the accident, as I had a head injury.  I don't remember anything till the end of the following day, when some family members came to visit me.  I remember them being there, but not what we talked about - apparently I repeated myself and was not able to sustain any sort of conversation.  I remember my wife coming back to visit me the following day with a friend, and remember realising that this was not a dream, but again I don't remember what we talked about.  On one visit, family members brought a photo album and apparently I couldn't remember the holiday (in one of my favourite places).  I actually don't remember the photo album being brought, either.  My younger son remembers me talking to him on the phone, but I don't.

My experience as a patient is surely valuable to practitioners, although I cannot know if it is typical (surely it is not as we are all individuals), so therefore the experience of other patients is valuable too.   But so is the experience of families and loved ones.  My family remember things about the visits that I don't, and of course my wife had the dreaded phone call from the paramedics to say what had happened, and would she get there as soon as she could.  They have feelings about the whole thing that I do not, and could not have.  I don't remember ever wondering how I ended up in hospital, or whether I would be ok, although I know my wife wondered that last thing, particularly after that phone call.  Also, I came to realise that it could have been so very much worse. 
 
So, do I as a health librarian buy (or buy access to) biography and autobiography? I read Untold stories while off work recovering.  And fiction, like Ian McEwan's Enduring Love (3), which I read then too (elder son doing it at A level) - plenty of mental health related issues in there.  Do you as a health practitioner or student read (auto)biography and fiction to inform your work or studies?   What can we do with this sort of material as evidence?   Does it end up in reviews?  Patient experience of head injury as related in biography and fiction, that sort of thing.

Let me say that I had the most excellent care at the Northern General Hospital, Sheffield.  And very good follow up care - for an accident that took minutes, I have had a week as an inpatient, and five outpatient visits (two for physiotherapy, two to the fracture clinic and one to the maxillofacial clinic), and one more outpatient visit (to the head injury rehabilitation clinic) to come.  And two GP visits (I chose to have those, although one was for symptoms).   What a lot of health service time for one short accident, and I am grateful it is there. 

References (well, I am a librarian)

(1) Godbolt S. At the end of all our work is a patient.  LA Record, 79(2): 86-9, quoted in Carmel M. (1986). Impact and image: improving the library's contribution. Health Libraries Review, 3: 94-10.  Available from http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2532.1986.320094.x/pdf  (Accessed 9th January 2015).
(2) Bennett, A. (2005). Untold stories, in Untold stories.  London: Profile Books, p.1-125
(3) McEwan, I. (1998). Enduring love. London: Vintage.