Category Archives: Evidence-based Practice

CPD23 Thing 15: Attending, presenting at and organising seminars, conferences and other events

I’ve just read Jo Alcock’s blog post about preparing for conferences and I must say, these points are excellent! Allow plenty of time for getting there and away (include explore your surroundings time), wear comfortable clothing, pack lightly and take business cards for networking (make your own if need be). I really like the DIY business card idea. I didn’t have any on me in Brisbane at the EBP Librarians workshop and it is my experience that events generally include a card swap. At Information Online, business cards are used for competition entries quite often, so that is another point to consider! 🙂 I’ve been to quite a lot of events since I attended my first conference in 2005 (document delivery in Canberra, held at the National Library of Australia). Cost is a consideration in deciding whether to attend an event, as well as the question of whether you can get time off work. I’ve paid for a few events myself and have taken annual leave in cases where there wasn’t a direct relation to my immediate job portfolio.  Then I claim it on tax as a work expense. I will be doing that this year when I attend HTAi2012 in Bilbao, Spain. I’ve only ever applied for one grant to attend a conference – Information Online 2011. I had given up on getting news about attending so I was really surprised to get news that I had got the grant (it was way after the early bird discount and close to the end of the registration period, so I had some scrambling to do). The only thing I had to do is write about my attendance for the local health libraries association journal.

As for speaking at events, I haven’t done much of that yet. It isn’t really a matter of being afraid of speaking in front of a large crowd – at times when I am relaxed, I enjoy it! I hate it when I am nervous and how it effects my voice. My first speaking gig was in 2006 when I was invited to speak at the HTAi Information Resources Group workshop in Adelaide. Since then, I’ve done bits here and there at small events and large. This year I will be doing some speaking at HTAi2012 and I hope I won’t be too nervous as it will be in front of people I respect and admire. Way to go – start thinking about it and getting nerves already! Death by powerpoint is a useful saying to remember – and there is a reason for it! I’ll never forget a conference presentation I went to where the speaker’s head was down and she read what was on the powerpoint slide – the ppt was very text heavy. It was terrible and I’ve remembered it for a long time. And thank you Wikiman for the hilarious Stop breaking the rules of presentation ppt! I laughed heartily. For more tips on presenting effectively, visit Peter Dhu’s website. He writes about controlling anxiety, the power of the pause and structuring your speech.

I’m having a go at taking the lead in organising an event for the first time. It is the HTAi Information Resources Group workshop that will be held later this year in Spain as part of the HTAi2012 conference. The Chair-Elect, who is in Canada, is assisting me with this and we also have a local medical librarian on hand who will help us organise the annual dinner as well as other things. The had of the local organising committee is also assisting us with answering questions about the organisation of the conference – rooms, lunch provisions, etc etc. I’ve been involved in helping organising the 2 previous workshops when I was Chair-Elect of our group. Traditionally, we put out a call for workshop presenters, send the proposals to a group for evaluation, write up a workshop proposal and submit it to the local organising committee. This year though, a descriptive abstract was wanted which we didn’t have on hand, so that has been a valuable lesson learnt (include an abstract as part of the submission). It was accepted though, phew! I’m to join an international teleconference middle of this week (11.30pm my time) as Chairs of all groups are part of the interational scientific program committee. This sure has been an illuminating experience. I encourage all medical librarians to present in the medical speciality of their organisation (of course, there may be many) – it is a different experience than just attending library-related events.

Evidence Week @ Royal Melbourne Hospital

The last week of November was Evidence Week at the Royal Melbourne Hospital (my place of work). I took part in some the planning for it and participated in 3 events: the EBP Workshop, the Study Errors lecture and the grand rounds session on using evidence in practice. Some of the presentations are available by clicking here. The first session I went to was the hour long lecture about study errors with presentations from Prof Paul Glasziou, A/Prof Peter Morely and Dr Danny Liew. A small number attended – perhaps the title of the lecture could have been more encompassing? The lecture is free to listen to by clicking on this link (the squeeking is Liew writing on the whiteboard!) . Anyway, here are some of my notes from this session:

  • The errors most often encountered are Type 1 (false positive) and Type 2 (false negative) errors. Type 1 errors  can be demonstrated in a 2×2 table (see study error eg) with the real situation being the middle line between them. Type 2 errors occur when the study is underpowered.
  • Errors can occur if a trial has a primary outcome but includes secondary outcomes that are also of interest
  • A smaller effect needs a bigger sample while a bigger effect needs a smaller sample
  • There is more chance of Type 1 error when there are multple analysis (hypotheses) being made using the same data. Eg: 1-0.05=.95 CI. Per analysis multiply the CI by how many analysis there are  -> 2nd analysis 0.95 x 0.95, 3rd analysis 0.95 x 0.95 x 0.95 etc
  • Systematic reviews and meta-analysis are retrospective. Enhance these reports with preliminary data in trial registries
  • Non-inferiority trials are not that useful because really, pharma want to prove that x drug is way better than y drug so …
  • The best way to get safety info is to obtain post-marketing surveillance reports. Safety is not able to be tested in trials as trials are not long enough
  • In surgery, the evidence evolves slowly over time
  • You can’t control for all conditions in trials as there isn’t enough known about the human body

The following day I went to the EBP Workshop led by Prof Glasziou. I was to help with searching exercises but things didn’t work out. Like the EBP Residential Workshop the week after, the day was split into large group lectures and small group activities. This arrangement works very well with these type of workshops. I was very lucky to be in Glasziou’s group and there was an HTA colleague who also ended up in my group (he is into population health but hasn’t done much appraisal – and of course we talked about HTAi2012 …). There were a lot of librarians in the audience and the searching for lit was not extensive as we would like, but then it was a 1-dayer and there were other clinicians in the group who needed this background. However, I got something out of it because I had totally forgotten about the ability to add your own filters in My NCBI. The appraisals were interesting and the main point is – practice!! The more you do the easier it will be. There was a handbook given out as well:  Evidence-based Practice Workbook – Bridging the gap between health care research and practice. It covers asking an answerable question, searching (screen shots need updating – PubMed has changed it’s layout again!), appraisal and applying the evidence.

The final event was the Grand Rounds lecture. It was slightly different from Glasziou’s Cochrane Symposium lecture (July 2011) which was how GPs need evidence presented to them with instructions for integration. This was more about the amount of information available as opposed to evidence, what different specialities need in terms of research evidence, and thoughts in how to integrate new technologies/change practice.

Presentations from the EBP Workshop and the Grand Rounds lecture is available on the RMH Health Sciences Library website.

Evidence-based Practice Residential Workshop for Librarians – Day 1

I’ve just returned from the first EBP Residential Workshop for Librarians in Brisbane. It was an intensive 2.5 days led by expert teachers Connie Schardt (Duke University NC USA). The first day concentrated on study design, evidence

resources and searching techniques – and the day was split into large group lectures and smaller group workshops. Luckily for me, I ended up in Connie’s group. The most useful game we had during that day was ‘put the evidenceresource where it belongs on the Haynes pyramid‘ – something many of us plan to replicate with the resources we have access to. The other was – name that study design! Some things I noted from day 1:

  • Intention to Treat (ITT): the aim of keeping people in the allocated groups
  • Case report: good for identifying new diseases but con in that there is no control
  • Case control: starts from the outcome and looks backward to exposure. Pro – outcome is already there and you don’t have to expose people to to harm; Con – cofounders (comorbidities) and recall (self report). It is also difficult to choose the control group
  • Cohort: exposure already there and is longitudinal – this is a prospective study (looks forward)
  • Randomised control trial: randomised to reduce cofounders (bias) so everyone has an equal chance of being in the intervention/placebo group (experimental design for interventions). Pro – control for bias, exposure and efficacy; Con – expensive, takes time and has ethical issues
  • Meta-analysis and systematic reviews: Pro – find evidence for general questions, summaries and validates small studies; Cons – heterogenous, publication bias, time and updating, search cut-off dates
  • Exposure + Outcome together = Cross-sectional study: this study occurs at one point in time and considers diseases and other variables
  • Diagnosis studies require the test compared to the current gold standard at the same time. These test sensitivity (how good is it in picking up disease) and specificity (how good is it in confirming the absence of disease)
  • Qualitative studies examine outcomes and behaviour: Con – poorly understood, small samples, lack of objectivity and generalisability; Pro – considers the human experience (motivations etc), important to nurses
  • Prognosis consider risk factors
  • How do you present search results to clients? Do you use reference management software and include readily available full text? You can put link to full text in reference managers
  • Cochrane = comprehensive / PubMed = can search concisely using highest level evidence
  • Using terms in PubMed maps to MeSH (automatic mapping – can see this in ‘details’. Turn this off by using “..” or truncation
  • MeSH will not bring up in-process citations
  • New MeSH headings
  • Comparative Study (MeSH term) or use ‘versus’ OR ‘vs’ in title/abstract – and don’t forget about floating subheadings
  • Can use searching number # to put in Clinical Queries
  • You can use Poll Everywhere (free clicker system) for teaching!

Some of these points I knew already but it was totally worthwhile seeing how everything fit in re: study designs and search strategies. It was a fairly humid day and everyone had slept with the windows open. Dinner was a BBQ and then a group of us went on a walk. Total darkness came on at 8pm and everyone was tired (most people also woke up at 5.30am like me).

I’ll write about Day 2 in my next post.