National Health Service Libraries Research Articles

NHS knowledge and library services in England in the digital age.

National Health Service (NHS) knowledge and library services in England are integrating digital advances into their systems and services. Health Education England (HEE) leads on the development of NHS library services. A key workstream focuses on (1) improving the infrastructure to enable discovery and management of digital knowledge resources; (2) collaborating with local teams to establish regional library management systems that are integrated with the new national discovery service for healthcare staff and learners. This article explores initiatives on resource discovery as well as the need for system-wide partnership working to ensure that biomedical knowledge in computable form is findable, accessible, interoperable and reusable. Low levels of health and digital literacy pose a significant barrier to using health information and accessing health services. A range of interventions are aimed at enhancing citizens' digital and health literacy skills. The education and life-long learning needs of the knowledge and library services workforce are considered. Working with CILIP and higher education institutions, HEE delivers a range of educational offers through its Learning Academy. As Artificial Intelligence and automation are implemented in health systems, knowledge and library staff form a crucial bridge between technology and those who use it.

Electroconvulsive Therapy in Multiple Sclerosis: A Review of Current Evidence.

To review the published literature over the last 5 years on the use of electroconvulsive therapy (ECT) in multiple sclerosis (MS), focusing on efficacy, safety, and tolerability. MS commonly has neuropsychiatric comorbidity. ECT is used in MS for severe and life-threatening forms of mental illness when other treatment options have failed or when a rapid response is required. English-language literature published in the last 5 years (January 2015-June 2, 2020) was searched using the terms: ECT, electroconvulsive therapy, shock therapy, electroshock therapy, electroconvulsive therapies, multiple sclerosis, chronic progressive multiple sclerosis, acute relapsing multiple sclerosis, and multiple sclerosis, relapsing and remitting. KnowledgeShare, a National Health Service library application providing updates on evidence-based practice, was used along with EMBASE, PsycInfo, MEDLINE, PubMed, the TRIP database (which offers a complete and updated list of evidence-based online resources), HDAS (Healthcare Databases Advanced Search), CRDWeb (Centre for Reviews and Dissemination), and the Cochrane Library. Reference lists of articles identified in the search were also reviewed. Our initial search revealed 30 articles of potential relevance. However, after individually evaluating these articles, only 6 case studies and 1 review article detailing the use of ECT in MS were included. The studies were analyzed by both authors to obtain clinical information relevant to meeting the objectives of the review. The efficacy and safety in using ECT for MS is derived only from case series and case reports. There were no controlled trials or systematic reviews, and the evidence collated was of low quality. The consensus is that ECT is an effective treatment for specific mental disorders in MS including catatonia. We have used ECT successfully in our clinic for patients with MS. However, there are concerns about the potential effects of ECT on neurologic and cognitive function. There are also possible risks with using anesthetic agents and particularly neuromuscular blockers.

Fashioning the future: Shane Godbolt's leadership of the NHS regional library and information service in North Thames and London 1992-2003.

This paper reviews Shane Godbolt's work as the National Health Service (NHS) Regional Librarian in North Thames and London between 1992 and 2003. It was a challenging time for both the NHS and the world of health care librarianship, and this article describes how the opportunities presented by continual organisational change and new ways of working were fully grasped by Shane and her colleagues to move library and information services forward in the capital, working in partnership with NHS partners and Higher Education - and laying the foundations for today's NHS library and knowledge service.

Gamification for health promotion: systematic review of behaviour change techniques in smartphone apps.

ObjectiveSmartphone games that aim to alter health behaviours are common, but there is uncertainty about how to achieve this. We systematically reviewed health apps containing gaming elements analysing their embedded behaviour change techniques.MethodsTwo trained researchers independently coded apps for behaviour change techniques using a standard taxonomy. We explored associations with user ratings and price.Data sourcesWe screened the National Health Service (NHS) Health Apps Library and all top-rated medical, health and wellness and health and fitness apps (defined by Apple and Google Play stores based on revenue and downloads). We included free and paid English language apps using ‘gamification’ (rewards, prizes, avatars, badges, leaderboards, competitions, levelling-up or health-related challenges). We excluded apps targeting health professionals.Results64 of 1680 (4%) health apps included gamification and met inclusion criteria; only 3 of these were in the NHS Library. Behaviour change categories used were: feedback and monitoring (n=60, 94% of apps), reward and threat (n=52, 81%), and goals and planning (n=52, 81%). Individual techniques were: self-monitoring of behaviour (n=55, 86%), non-specific reward (n=49, 82%), social support unspecified (n=48, 75%), non-specific incentive (n=49, 82%) and focus on past success (n=47, 73%). Median number of techniques per app was 14 (range: 5–22). Common combinations were: goal setting, self-monitoring, non-specific reward and non-specific incentive (n=35, 55%); goal setting, self-monitoring and focus on past success (n=33, 52%). There was no correlation between number of techniques and user ratings (p=0.07; rs=0.23) or price (p=0.45; rs=0.10).ConclusionsFew health apps currently employ gamification and there is a wide variation in the use of behaviour change techniques, which may limit potential to improve health outcomes. We found no correlation between user rating (a possible proxy for health benefits) and game content or price. Further research is required to evaluate effective behaviour change techniques and to assess clinical outcomes.Trial registration numberCRD42015029841.

Delivering a shared library management system for Wales

Purpose A case study of the Wales Higher Education Libraries Forum (WHELF) project to procure and implement a shared library management system (LMS) for all universities in Wales, together with the National Health Service Libraries in Wales and the National Library of Wales. In particular, the purpose of this paper is to explore the drivers to this collaboration, outline the benefits achieved and the framework to realise further benefits. Design/methodology/approach Case study review of the process, together with a review of literature on consortia and LMSs. Findings WHELF has developed into a more mature consortium through procuring and implementing a shared LMS. The process has delivered tangible benefits and is driving more work to realise further benefits. Research limitations/implications As the WHELF Shared LMS project is only nearing the end of the implementation phase, many of the anticipated operational benefits cannot be reported. Practical implications Useful case study for other consortia or potential consortia. Originality/value WHELF is in vanguard of consortia developments in the UK, and this is the first case study of the project.

Bivalirudin for Alternative Anticoagulation in Extracorporeal Membrane Oxygenation: A Systematic Review.

Extracorporeal membrane oxygenation (ECMO) offers therapeutic options in refractory respiratory and/or cardiac failure. Systemic anticoagulation with heparin is routinely administered. However, in patients with heparin-induced thrombocytopenia or heparin resistance, the direct thrombin inhibitor bivalirudin is a valid option and has been increasingly used for ECMO anticoagulation. We aimed at evaluating its safety and its optimal dosing for ECMO. Systematic web-based literature search of PubMed and EMBASE performed via National Health Service Library Evidence and manually, updated until January 30, 2016. The search revealed 8 publications relevant to the topic (5 case reports). In total, 58 patients (24 pediatrics) were reported (18 received heparin as control groups). Bivalirudin was used with or without loading dose, followed by infusion at different ranges (lowest 0.1-0.2 mg/kg/h without loading dose; highest 0.5 mg/kg/h after loading dose). The strategies for monitoring anticoagulation and optimal targets were dissimilar (activated partial thromboplastin time 45-60 seconds to 42-88 seconds; activated clotting time 180-200 seconds to 200-220 seconds; thromboelastography in 1 study). Bivalirudin loading dose was not always used; infusion range and anticoagulation targets were different. In this systematic review, we discuss the reasons for this variability. Larger studies are needed to establish the optimal approach with the use of bivalirudin for ECMO.

Interlending and document supply in the NHS: a North West case study

Purpose – This paper aims to report on the interlending and document supply activity across the North West of England carried out by health libraries in the National Health Service (NHS). NHS libraries provide a service to NHS staff and students on clinical placement and provide access to the latest published evidence contained in specialist periodicals and textbooks. Design/methodology/approach – Data were analysed over an extended period from 1 April 2005 to 31 March 2015. These data are provided annually in the form of a statistical return and are collated regionally. Data were obtained by all library services for both document supply activity and inter-library loans. Findings – During the period of the analysis, there has been a significant drop in activity for both document supply and inter-library loans. In 2005/2006, there were 45,147 articles supplied via document delivery networks, this had fallen to 8,642 in 2014/2015. Similarly, in 2005/2006, there were 5,627 inter-library loans supplied, this has also fallen to 3,732 in 2014/2015. Originality/value – The observed drop in document supply and inter-library loans across the NHS North West occurred during the time of significant change in how NHS staff and students access the latest evidence. In 2005/2006, many NHS libraries were still investing in print journals and textbooks. Over the past 10 years, there has been a substantial increase in access to consortia purchased online journals in addition to a growth in the availability of open access content.

Adaptation of Impact Questions from an Existing Toolkit Provided Clear Assessment of Valued Service Elements and Desirable Service Improvements in a Primary Health Care Library and Information Service

Objective – To provide an action plan for the Knowledge, Resource and Information Service (KRIS) based on an impact assessment of current services, satisfaction with current services, and views on desirable improvements to service and service delivery.
 
 Design – Questionnaire for KRIS service users and interviews with KRIS staff.
 
 Setting – Two locations served by KRIS in the north and south of Bristol City in the UK – one a health promotion service and one a National Health Service (NHS) teaching hospital.
 
 Subjects – A convenience sample of a total of 244 users of the library services at the two locations, 121 users at the health promotion service site and 123 users at the hospital site.
 
 Methods – A questionnaire designed for a previous NHS library service impact study was adapted for use with staff other than health workers, since teachers and youth workers, for example, also used the health promotion service. The researchers circulated the questionnaire by mail and email to prospective respondents. The questionnaire asked participants to reflect on the most recent time they had used KRIS services and provide details on the purpose of use, what elements of the service they used, satisfaction with the service or the information provided, the immediate impact on their work, and its probable contribution to future work. It also asked about desirable improvements and how KRIS contributed to the respondents’ work and continuing professional development. The researchers interviewed KRIS staff face to face and asked for their views on the history of the service and future developments.
 
 Main Results – The overall response rate was 62.3% (152/244), with similar responses from each site. Community nurses and midwives were the largest group of respondents (n=31, 20.4%), followed by managers and administrators (n=24, 15.8%). 
 
 Both sites reported health promotion activities as the dominant reason for use. Health promotion leaflets (n=94, 61.8%) and resources for loan (n=57, 37.5%) were the top two service elements used, with literature searching third (n=46, 30.3%). 
 
 The service completely met the needs of 93% (n=141) of respondents, with 97.4% (n=148) reporting being wholly satisfied that information was delivered in time. 
 
 In terms of the immediate cognitive impact of the information obtained, 93% (n=141) reported obtaining relevant information, 76% (n=115) current information, and 72% (n=109) accurate information. Nearly 70% were distributing information or resources to other people, and 68% were sharing or discussing information provided with colleagues. Nobody claimed that they had found little or nothing of value. 
 
 Advice to patients, clients or carers was the most frequently cited impact category (n=104, 68%), followed by advice to colleagues (n=84, 55.3%). 
 
 The main strengths of the service were the perceived reliability of the service, the current awareness and alerting service run from one site, and literature searching support for commissioning and public health enquiries. Respondents reported saving time, and the main cognitive impact was the perceived relevance of the information obtained. Service weaknesses identified related to accessibility issues such as parking, opening hours, and staff coverage, and outreach was identified as the main service development opportunity.
 
 Conclusion – The adaptation of an existing questionnaire provided a clear assessment of the effectiveness of a primary health care information service to a broad spectrum of users. Respondents identified what they valued about the service and how it could be improved.

Supporting ‘Best Research for Best Health’ with best information

This article describes the potential role for National Health Service (NHS) libraries in supporting health research. The content is partly based on the proceedings of the 'Best Information for Best Research for Best Health' event at University of Leicester in November 2006. With reference to the UK Department of Health's Research and Development (R&D) strategy, Best Research for Best Health and the Cooksey Review of public funding of health research, the article seeks to identify areas where NHS library and information staff can become involved in supporting the research process. The authors examined the challenges and opportunities that these reports offer and looked at two areas where library and information services (LIS) staff can potentially expand their services-supporting researchers at every stage of the research process and transferring research into practice. Staff in NHS libraries need to create an environment in which their role in the research process is recognized and valued. LIS staff can develop roles within the research process and thereby improve the robustness and validity of research outputs. Training and development of LIS staff is a key priority and can be taken forward despite the limitations of budgets and staffing levels. A proactive and assertive approach is needed to achieve a cultural shift within NHS library practice from supporting research from the outside, to being fully integrated within the research process.

Collaboration on procurement of e‐content between the National Health Service and higher education in the UK

PurposeCollaboration on procurement of e‐content between health libraries in the National Health Service (NHS) and in higher education (HE) should have advantages in increasing their negotiating power to improve licence terms and avoiding unnecessary duplication of content. The aim of the paper is to examine some of the strategies for ensuring that collaboration across the two sectors works effectively. The paper is based on a report to the Joint Information Systems Committee of the Funding Councils (for higher and further education) in the UK, and the NHS Library and Knowledge Development Network, on research conducted in 2006.Design/methodology/approachThe methods included interviews (n=39) with representatives from NHS and higher education bodies, representatives of independent health libraries, the National Library for Health, collective agencies, publishers and aggregators.FindingsThere were common interests in functionality/interfaces, open access, and better metrics for estimating usage that might contribute to discussions with publishers over the licence terms. There are differences in the type of resource each sector might deem to be core. The extent of existing collaboration on purchasing and related collection management activities varied considerably across the UK. Three possible paths for cooperative activity were identified: sharing information and joint advocacy; building the technical infrastructure; and joint procurement. Mapping of the stages, roles, actors and stakeholders in some processes was done with “use cases” (Unified Modeling Language) to help identify some of the risks involved.Research limitations/implicationsPoor response from online surveys limited the validity of the forecasting of user needs. Usage statistics were difficult to obtain and compare.Practical implicationsThe paper concludes that collaborative procurement of e‐content activities should focus on health services research requirements, and open access needs across the sectors. More innovative analysis of usage statistics is required to profile usage and inform cost analyses of both the impact of new roles for health librarians, and cost analyses of e‐resources on a life cycle basis.Originality/valueThe paper develops new ways of examining the business processes required for collaborative procurement.

Creation and development of an All-Wales Health Library Catalogue.

This article focuses on the collaboration between the University of Wales College of Medicine (UWCM) libraries and the Welsh National Health Service (NHS) libraries to create a joint library catalogue. The goal was to create an all-Wales resource that gave users one access point to search for the location and availability of health-related material in any Welsh medical library. This venture grew out of the existing collaborative scheme, the All-Wales Health Information and Library Extension Services (AWHILES). Currently, all seven UWCM libraries and 17 NHS libraries contribute to the catalogue. Four more libraries are due to join in late 2003 or early 2004. All UWCM and AWHILES libraries would then be contributing members of the joint catalogue. The article discusses the background and motivation to the creation of the database. It explores the positives and negatives of the project plus what was learnt as the venture progressed. It reviews the establishment and operations of the Welsh Health Voyager User Group (WHVUG) created to involve all contributing members in the running and future development of the library catalogue.

A recruitment and retention study of staff working in National Health Service libraries in the north-west of England.

A recruitment and retention study of staff working in National Health Service libraries in the north-west of England.

Learning and teaching

Learning and teaching

A first class knowledge service: developing the National electronic Library for Health

With the introduction of clinical governance and the move towards evidence-based practice, there is a growing need to provide health professionals and patients, and the public, with high quality information. Developments in the health service have added weight and urgency to this need. The National electronic Library for Health (NeLH) has a key role to play in providing health professionals with a core knowledge base of accredited and evaluated information. The Pilot NeLH was launched in November and this article outlines the progress and achievements made during this time. The NeLH is based around a central website featuring core resources and links to commissioned specialist collections. Over 70 information resources, including bibliographic databases and full text publications, are accessible via the NeLH, which aims to act as a one-stop shop to support evidence-based decision-making. Much work has been undertaken on national procurement and licensing, particularly in partnership with National Health Service (NHS) libraries. Partnerships as a whole are crucial to ensure true seamless access for health professionals. Key partners include NHS libraries, NHS Direct Online and the electronic Library for Social Care. A short glossary is included for those readers less familiar with current health service developments in the UK.

Assessing the quality of library and information services for United Kingdom health professionals and students: a comparison of the National Health Service and higher education approaches and the way forward

The paper examines the processes of evaluating the quality of two library and information services for health professionals in the UK: higher education (HE) health library and information services and those of the National Health Service (NHS). Both are principally serving the same user group – clinicians at various stages in their professional lives. Health professionals need access to services from libraries in both sectors for their initial pre‐qualification course. The concept of life‐long learning has strengthened the need for clinicians to be able to locate relevant information when and where they need it. This need for dual access is continued after becoming qualified when they undertake continuing professional development, complete research, deliver evidence‐based care and help patients with their information needs. Despite NHS and HE health libraries serving the same user group there are many differences between libraries in the two sectors. The level of difference is discussed, demonstrating that the quality processes are often diametrically opposed.

Costing medical libraries: the feasibility of functional cost analysis.

As a result of organizational changes in the National Health Service (NHS) there is a need for a coherent costing model for NHS libraries, particularly for the smaller libraries based in postgraduate medical centres. One possible model is functional cost analysis, whereby all costs are assigned to library functions representing services to users, such as loans from stock, interlibrary loans, enquiry services, etc. Using data from a 1991 survey of postgraduate centre-based libraries in the North West Thames (NWT) Region of the NHS, the feasibility and appropriateness of functional cost analysis is examined.

Getting together with compact disc: a regional MEDLINE CD-ROM initiative for libraries.

An initiative by the North West Thames Regional Information Technology Agency has resulted in the provision of some 30 CD-ROM drives and copies of the MEDLINE database in National Health Service libraries. The development of the scheme and its implementation are described and future developments outlined.

LIBRARY RESOURCE SHARING IN THE NATIONAL HEALTH SERVICE: BENEFITS AND LIMITATIONS

The United Kingdom library system has a two‐tier resource sharing network, with the regional library services operating at local level and the BLDSC at national level. Taking the National Health Service libraries as a basis, the author discusses regional co‐operation from the organizational, service and economic viewpoints. Interlibrary resource sharing is valuable not only for its tangible benefits, but also (provided it is reliable and economically sound) because it provides a basis for the sharing of specialist subject knowledge, searching skills and ideas, and it also permits more general professional interaction, thus frequently bearing unexpected fruit. Several ideas have been put forward for the extension of inter‐regional co‐operation, but the importance of cost‐benefit analysis when evaluating any such scheme cannot be over‐stressed. The true cost of staff time is an item often overlooked: an appendix here gives a method of calculating the economic benefit of a resource sharing scheme by comparing the cost of co‐operative interlibrary photocopying using a union list of serials with that of using prepaid BLDSC forms.