Care of specific patients

Evidence searches for care for specific patients.

Planning

These searches should be prioritised.

If you receive the request during a clinical meeting where an immediate answer is required, you will not be able to plan your search.

Check Clinical Decision Support tools, depending on your organisation’s provision, and National Institute for Health and Care Excellence (NICE) Guidance for on-the-spot answers.

  • British Medical Journal (BMJ) Best Practice (now freely available to all NHS staff).
  • DynaMed.
  • UpToDate.
  • Visual DX.

If a specific/focused search of Clinical Decision Support Tools retrieves nothing, try searching within the text of broader entries or scanning a broader entry’s headings and sub-headings.

In addition, search high-tier evidence sources such as:

  • Cochrane Library
  • Cochrane Clinical Answers
  • Trip Database

If you cannot find an answer to the question immediately then advise the requester and offer to continue the search after the meeting.

If you receive the request outside of a clinical meeting, what is your deadline? If the search is to inform clinical decision-making, when does the decision need to be made and when is the search report required, by whom, and in what format?

If the requester needs to make a clinical decision in the next hour, that is your deadline.

In other contexts, it makes much more sense to negotiate your deadline with the requester based on when they are next seeing the patient. For example, if they are next seeing them at an outpatient clinic in a month’s time, then a fortnight’s deadline should be fine.

Check with the requester the below questions.

  • How recent the evidence should be?
  • Do they want high tier evidence only?
  • Would they like case studies/case series?
  • Would they like results from this country only?
  • Do they want to know how other Trusts would treat this patient?

Execution

Try searching guidance sources such as:

  • NICE Guidance
  • NICE Clinical Knowledge Summaries (CKS)
  • Trip Database

Search high-tier evidence sources such as:

  • Cochrane Clinical Answers
  • PubMed Clinical Queries

Search bibliographic databases and preprint servers, limiting your search results to the specific age range of the patient in question.

For clinical questions, depending on the topic, a search of at least one of the following databses is is essential and several of them, preferable.

  • Medline.
  • Embase.
  • Cumulative Index to Nursing and Allied Health Literature (CINAHL).
  • Emcare.
  • British Nursing Inde (BNI).

Limit your databases search to reviews, guidelines, meta-analyses using limits/filters (unless your requester would like case reports), at least initially.

If your search retrieves nothing then relax these limits to include all kinds of results, and all kinds of patients if you are still retrieving nothing.

Be aware that these limits exclude the most recent results that have not had indexing terms added yet and consider searching within the past year without those limits.

If you need to find out how other Trusts would treat this patient

If the requester wants to know how other Trusts would treat this patient, perform an advanced Google search for the condition/intervention limited to the UK. 

Limit by domain

Limit the search to sites ending with “…nhs.uk” URLs using the limits "site:nhs.uk" or "inurl:nhs".

Limit by file type

Limit with "doctype:doc" or "doctype:pdf" limits to pick up policy documents and guidelines from around the country.

Consider an email to mailing lists where Knowledge and Library Services (KLS) colleagues at other Trusts may be able to help, see mailing list enquiries.

Results

Include links to relevant entries from Clinical Decision Support tools, copy and paste the most important parts that answer your requester’s question into your report, or send entire entries to the user (where copyright restrictions allow).

Include instructions of how to access the full entries - to save the requester time, you can check if they have an NHS OpenAthens name/password, and create one for them if required, notifying them in your report.

If you have found no high tier evidence then state so, as this may be an answer to your requester’s question itself.

Be sure to emphasise in your report or communications with the requester that time limitations may preclude a comprehensive search, and so the results returned cannot be considered comprehensive.

As proving your service’s clinical utility is very impactful, be extra sure to request and record feedback from the requester on how your search helped.

Examples

Example 1

Dear …,

Hope this email finds you well.

Please find attached the results of your requested search on: "Guidelines (or other evidence) for what anticoagulation to use in context of thromboembolisms (especially pulmonary embolism) and intracranial haemorrhage (especially subarachnoid haemorrhage) at the same time" [results from within last 10 years with a few minor exceptions].

I regret that again I don't have a solid answer for you following a broad search of several bibliographic databases and other healthcare information sources. In the attached report I've presented the one related guidance document I found first of all, followed by BMJ Best Practice and UptoDate entries (shared by a colleague but you should be able to access - let me know if not), then review articles/meta-analyses retrieved by a sensitive/inclusive search, and finally original research retrieved by a specific/narrow search.

As always with searches with a tight turnaround, I have to advise that these results cannot be considered comprehensive - I'll be able dedicate more time to a truly exhaustive search with a greater yield if you'd like though. If you can share anything useful you found on the topic - I think you mentioned a couple of case studies - I'll use that as a sighter to try and retrieve further evidence. 

If you have any questions about the search strategy or the results, if there's anything I've miscsonstrued from your request or if you would like the results in another format, do not hesitate to get in touch.

Please let us know what impact the results of this search have had using the [feedback form] on the KnowledgeShare website (no login required). Evidence of impact is vital for the continuation of this service.

Look forward to hearing from you…

Report compiled by librarian.

Example 2

Dear…

Please find attached the results of your requested search on: Sleep apnoea + ventricular ectopy (or ectopics) + heart failure + left ventricular impairment.

The results are arranged in reverse chronological order and come from a sensitive/broad search of several healthcare databases (the full strategy used is included at the end of the report). I regret that there seems to be very little out there that features the 4 elements you specified, but results 1 and 7 are review articles (though with a slightly broader focus).

Would you expect that to be the case? Let me know if you're aware of any studies that my search has not retrieved and I'll use that information to inform a subsequent search. Alternatively, if you have any suggestions to improve the search strategy, and/or if you'd like me to search again with revised criteria (for example,, sleep apnea + eptopics more generally) then please let me know.

You can get to the full text of articles within the attached Word doc. by clicking on the hyperlinks to download them using your NHS Athens username and password. You can create an NHS OpenAthens account.

The articles we do not have direct access to can be ordered through our inter-library loans service and may take a few days to arrive. To make article requests please fill out the journal requests form on the Knowledge library services web page at: [link to webpage]

We are aiming to improve our services in line with your comments: [link to line feedback form]

Look forward to hearing from you…

Report compiled by librarian.

Page last reviewed: 4 August 2023
Next review due: 4 August 2024