1. The document discusses the Database of Uncertainties about the Effects of Treatments (DUETs), which compiles unanswered questions about treatment effects to prioritize future research. 2. It explains that the National Library for Health (NLH) Specialist Libraries are well-positioned to identify uncertainties for DUETs because they comprehensively collect and analyze evidence on various health topics, including systematic reviews. 3. So far, the NLH Skin Disorders Specialist Library has identified over 50 uncertainties about atopic eczema treatments by analyzing systematic reviews, and plans to continue extracting uncertainties from reviews on other skin disorders to further develop the DUETs skin module.

1. Identifying uncertainties:
DUETs and the NLH
Specialist Libraries
Douglas Grindlay
University of Nottingham
National Library for Health

2. Scope of talk
1. What is DUETs?
2. Why are the NLH Specialist
Libraries in such a good
position to compile uncertainties
for DUETs?
3. Sources of uncertainties for
DUETS, and progress so far…

3. What is DUETs?

4. DUETs:
• The Database of Uncertainties
about the Effects of Treatments
www.duets.nhs.uk
• A resource to help prioritise new
research
• Uncertainties that cannot be
answered by reliable, up-to-date
systematic reviews

5. Sources for uncertainties:
• Patients’, carers’ and clinicians’
questions about treatment effects
• Research recommendations in
systematic reviews and clinical
guidelines
• Ongoing research, both
systematic reviews in preparation
and new 'primary' studies

6. Link to the James Lind Alliance:
• DUETs set up to help meet aims
of the James Lind Alliance (JLA)
• JLA brings patients and clinicians
together in 'Working Partnerships'
to identify and prioritise
unanswered research questions

7. • No relevant systematic reviews
identified
• Relevant, up-to-date systematic
reviews do not address
continuing uncertainties
• Existing relevant systematic
reviews are not up-to-date
• Up-to-date systematic reviews
have revealed important
continuing uncertainties
Criteria for DUETS uncertainties:

8. Why are the NLH Specialist
Libraries in such a good
position to compile
uncertainties for DUETs?

9. • “One-stop” shop for quality,
evidence-based information on
skin disorders
• Scope: Diagnosis, treatment,
management & prevention of skin
diseases
• Content: Guidelines, systematic
reviews, reference resources,
CPD, patient information
Example: The NLH Skin
Disorders Specialist Library

10. The diversity of 1,000 skin
disorders

11. The NLH Skin Disorders
Specialist Library
• Based at Centre of Evidence
Based Dermatology, University of
Nottingham
• NHS-funded contract
• Close links to Dermatology
Department at Queen’s Medical
Centre, Nottingham
• HE-NHS Crossover!

12. The Centre of Evidence Based
Dermatology

13. Skin Disorders Library
community & stakeholders
• Secondary care clinicians –
dermatology, plastic surgery,
GUM
• General Practitioners – GPsWSI,
non-specialist GPs
• Nurses – Secondary and primary
care
• Other health professionals – e.g.
pharmacists

14. Skin Disorders Library
community & stakeholders
(cont.)
• Health academics
• Health students
• Health librarians
• Health information specialists
• Patients and public
• Patient support groups

15. Communication with our
community
• Stakeholders Group (formal
meetings and individual
correspondence)
• The Library
• Monthly e-mail updates
• National Knowledge Weeks
• Feedback form
• Talks and stand at conferences
• Articles

16. Annual Evidence Updates
• Part of National Knowledge
Weeks
• “Big 50”: acne, atopic eczema,
psoriasis, skin cancer
• Search for new evidence on a
disease topic
• Bring together systematic
reviews

17. Implications for DUETs
• NLH Specialist Libraries well
placed to communicate with their
communities of practice
• Centre of potential network for
collection of uncertainties and
research prioritisation
• Specialist Libraries are collecting
systematic reviews already
• Great potential for dissemination

18. Sources of uncertainties for
DUETS, and progress so far…

19. The DUETS Skin Module
Began work in January 2007
• 1st
phase – Uncertainties invited
from patient groups
• 2nd
phase – Uncertainties invited
from health professionals
• 3rd
phase – Uncertainties
identified from systematic reviews
by Skin Disorders Specialist
Library team

20. Uncertainties invited from
patient groups
• January 2007 – asked National
Eczema Society, Psoriasis
Association and Acne Support
Group for patient questions

21. Uncertainties invited from
patient groups (cont.)
• Problem: support groups may
lack resources to know if
questions = true uncertainties
• Needs search for systematic
reviews by Specialist Library
team to check – a lot of work!
• Some rejects, e.g. long-term
effects of antibiotics for acne

22. Uncertainties invited from
health professionals
• BAD asked to collect
uncertainties from their guidelines
and Committee meetings – still
awaiting results
• Contributions from individuals
invited in National Knowledge
Weeks – no response!
• Uncertainties now coming from
UK Dermatology Clinical Trials
Network

23. Uncertainties identified from
systematic reviews
• Currently main focus of work
• Tackling one disease at a time to
avoid bias in coverage
• Started with atopic eczema —
50+ uncertainties identified
• Using Cochrane and non-
Cochrane reviews
• Difficulty in judging uncertainties
– often not explicit or clear

24. Link to National Knowledge
Weeks
• Annual Evidence Updates involve
search for systematic reviews –
can be harvested for DUETs
• Searches updated annually –
update or remove (!)
uncertainties as required
• Chance to promote DUETs and
seek contributions of
uncertainties

25. Future tasks
• Acne National Knowledge Week
– detailed mapping of systematic
reviews by treatment topic
• Ideal for compiling DUETs
uncertainties
• Complete DUETs acne and
psoriasis modules
• Extend to other skin disorders

26. Conclusions
• Best approach = comprehensive
coverage topic by topic
• Systematic reviews are easiest
source for uncertainties
• Uncertainties not always made
explicit in systematic reviews
• Difficult to mobilise active
contributions to DUETs from both
individuals and organisations

27. • DUETs is a work in progress
• More modules will come on
stream as all the Specialist
Libraries become involved
• Exciting time—potential of
DUETs now being realised
• Should influence future research
AND patient care
Conclusions (cont.)