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07/29/2024
profile-icon Kallen Rutledge

For many Nova Scotia Health team members, sharing documents is an essential part of the workday. But as you may have noticed, there are many ways to link to documents or share URLs. In this post, we’ll share best practices to help make sure the links you share are inclusive, accessible, and most importantly, usable!

Before we dive in, let’s make sure we understand some key words:

  • As a noun, 'a hyperlink' (often shortened to 'link'), refers to a digital link from a file to another file or location. The hyperlink is activated when the user selects the hyperlinked word(s) or image on the screen.
  • As a verb, 'to hyperlink' refers to creating a digital link between different documents or locations.
  • 'URL', or uniform resource locator, refers to the web address of a specific internet web page (such as, www.nshealth.ca). 

Best practices

1. When adding a hyperlink, be sure the linked text appropriately describes what you are linking to.

Don’t hyperlink non-informative phrases like, “click here”, “read more”, or “view here”, etc.
Example:
Want to learn more about accessibility? Click here!

Do hyperlink the title or description of the link.
Example:
Want to learn more about accessibility? Check out: Best practices for accessible links

Why does it matter?

When we hyperlink instructions, like adding a link to the words “click here” or “read more,” we are not giving the user enough information about where the link goes. When these types of links appear one after one another, it’s difficult to differentiate between them, which can create a frustrating user experience.

This practice makes it more difficult for those using screen readers to identify the link’s purpose. When a screen reader comes across a URL, it reads the associated text aloud, as well as the written URL. Often, these URLs are lengthy and an unpredictable combination of characters and numbers. Appropriately labeling your URLs can help screen reader users know exactly what to expect when selecting your link (Microsoft, n.d.).

Descriptively naming your hyperlinks also allows search engines (like Google) to use your descriptive text as metadata to appropriately rank search results. This means you will get more intentional visitors to your content because the information stored about your URL is accurate.

You may have noticed that Microsoft Office 365 products have already started doing this for you. For instance, when you copy and paste a hyperlink into the body of an email, Outlook now automatically changes the visible text associated with the hyperlink to the title of the document (A) instead of the URL (B). The same is true when adding URLs within other Microsoft Office 365 products like Word or PowerPoint. These links look something like this:

2. For printed resources, include the written URL as well as your descriptive hyperlinked text.

If you are creating content that will be used both in print and online, including the descriptive link and the written URL ensures equal access for all users to the resource you are linking to. Those using the print copy may need to enter the URL manually into a computer, tablet, or smartphone, but having the written URL provides them with enough information to access the resource.

Don’t assume everyone is reading your content online. Be mindful of the digital divide and add written URLs for those using print resources.

Do add the written URL beside or below the hyperlinked descriptive text.

Why does it matter?

In this day and age, it’s easy to assume everyone has access to reliable internet. Unfortunately, a ‘digital divide’ still exists in many communities in Canada (Currie, Ronquillo. & Dick, 2014; Latulippe, Hamel, & Giroux, 2017). Researchers note that this divide “persists along lines of social inequalities (i.e., education, urban versus rural, income, age, and immigration status)” (Ismond et al., 2021).

When creating print resources for the public (like patients, families, and support persons), including a descriptive hyperlink and a written URL allows all readers to access the same information. The written URL (C) gives them sufficient information to find the resource at a later time, when they have access to the internet (like at a public library, community center, or loved one’s home, for example).

Remember, if you are creating print resources and the software you are using automatically changes the URL to match the title of the document (like Outlook, Word, or PowerPoint), be sure to add the written URL beside or below it so that your hard-copy readers can use your links, too.

3. Use ScreenTips

When hyperlinking within a Microsoft product, you can also change what text appears when the cursor hovers over a link (D). In the ‘Insert Hyperlink’ pop-up window, select, ‘ScreenTip…’ in the top right. Use this window to edit the URL addess, the descriptive text that will be hyperlinked, as well as what will appear when the user hovers over the link.

As technology evolves, there are bound to be new ways to share links and URLs. Keeping up to date on how to make your links usable and accessible helps ensure your intended audience can access whatever resource you’re sharing, reducing user frustration and broken links.

Happy sharing!

References

1. Currie, L. M., Ronquillo, C., & Dick, T. (2014). Access to internet in rural and remote Canada. Studies in Health Technology and Informatics, 201, 407–412.https://pubmed.ncbi.nlm.nih.gov/24943574/

2. Latulippe, K., Hamel, C., & Giroux, D. (2017). Social Health Inequalities and eHealth: A Literature Review With Qualitative Synthesis of Theoretical and Empirical Studies. Journal of Medical Internet Research, 19(4), e136. https://doi.org/10.2196/jmir.6731

3. Ismond, K. P., Eslamparast, T., Farhat, K., Stickland, M., Spence, J. C., Bailey, R. J., Abraldes, J. G., Spiers, J. A., & Tandon, P. (2021). Assessing Patient Proficiency with Internet-Connected Technology and Their Preferences for E-Health in Cirrhosis. Journal of Medical Systems, 45(7), 72. https://doi.org/10.1007/s10916-021-01746-3

4. Microsoft. (2024, July 25). Make your Word documents accessible to people with disabilities. https://support.microsoft.com/en-us/office/make-your-word-documents-accessible-to-people-with-disabilities-d9bf3683-87ac-47ea-b91a-78dcacb3c66d?ui=en-us&rs=en-us&ad=us

 

Kallen Rutledge

Librarian Educator, Patient Education Pamphlets Lead
Nova Scotia Hospital, Central Zone

 

Dynamic Health round-up posts keep you informed about implementation and use of Dynamic Health at Nova Scotia Health. They highlight any new priority projects and events, as well as updates to our Workplace Notes and Custom Workplace Skills.

Updates: Reviewed Skills and Workplace Notes

We receive feedback submissions about Dynamic Health skills on an ongoing basis through the Suggest an Edit form and through partnerships with departments and teams.

We continue to process skill reviews received as a part of our second skill review push up to and including March 8th, 2024.

Reviewed: New Workplace Note

Reviewed: No Workplace Note

New Custom Skills

Health Promotion in March and Dynamic Health Topics

March 2024 marks the promotion of:

In recognition of these health promotion events, we encourage you to engage with the curated list of Dynamic Health content below.

If you spot any Skills below that you feel need a Workplace Note, consider being a reviewer! Fill out our Suggestions for Skills form with your notes and we will get in touch!

Colorectal Cancer Awareness Month

National Poison Prevention Week

The Atlantic Canada Poison Centre provides our local guidance on poisoning information. Dynamic Health content may be used in combination with their recommendations.

Dynamic Health Project Team

Gloria Connolly, RN, BScN, NCA, WOCC(c), GNC(c)
Clinical Nurse Educator, (CNE)
Interprofessional Practice & Learning

Leah MacDonald
Professional Practice Leader
Interprofessional Practice & Learning, COVID-19 Response

Katie McLean
Librarian Educator
Interprofessional Practice & Learning, Library Services

Margaret Meier
Policy Lead
Policy Office

Ann Slaunwhite
Library Technician
Interprofessional Practice & Learning, Library Services

The results are in: Nova Scotia Health staff and physicians are making great use of the BMJ Best Practice Comorbidities point-of-care tool!

Did you know you can access the same content, including the Comorbidities Manager, on the BMJ Best Practice app

BMJ Best Practice, including the Comorbidities Manager, is available 24/7 to support health care providers with making informed clinical decisions.

In the first 12 months after launching the BMJ Comorbidities Manager add-on at Nova Scotia Health:

  • Use of the BMJ Best Practice database increased by 150%
  • Views of the treatment management section increased by an average of 73%
  • 40% of the top ten most-used topics fall within the Comorbidities section

The BMJ Comorbidities Manager allows health care providers to treat the whole patient using a patient’s comorbidities to inform a more tailored treatment plan. This tool is integrated into BMJ Best Practice and is the only clinical decision support tool of its kind (BMJ Best Practice, 2023).

Usage statistics show that at Nova Scotia Health, sessions on the app have increased by 40% since 2021. Having access to the Comorbidities Manager on the go means you have access to clinical decision support anytime, anywhere!

BMJ Best Practice App Benefits

  • The ability to tailor treatment plans with the Comorbidities Manager
  • Access more than 1,000 conditions summaries offline. Clinical decision support is available on your mobile device even when you are not connected to your network and do not have access to the Internet
  • Access over 200 interactive medical calculators
  • Automatic tracking of your activity for CME/CPD purposes

BMJ Best Practice, 2023

How to Get the App

Downloading the app is quick and easy. It only uses minimal storage on your device. You must have a personal account in order to use the app. To create an account:

  1. Access BMJ Best Practice via the library’s Databases A-Z page.
  2. Create a BMJ Best Practice personal account through the pop-up box – “Create your FREE personal account in one step”.
  3. Download and install the app from the App Store or from Google Play.
  4. Select "Log in" and enter your BMJ Best Practice personal account details to sign in.

Visit Library Services’ Mobile Apps & Resources guide for more information.

Using the Comorbidities Manager on the app

Let’s look at how you could use the Comorbidities Manager in the following clinical scenario:

An 80-year-old man presents at the emergency department with acute exacerbation of COPD. You learn from his family that he also has depression and diabetes. You need to quickly decide how to best treat his acute condition while considering his pre-existing conditions.

Search for ‘acute exacerbation of COPD’ by typing it into the search bar (1). On the app, predictive text is enabled when searching for conditions.

Under Management (2) select Treatment algorithm (3).

 

A pop-up box will appear to add your patient’s comorbidities. Check the boxes for both Diabetes and Depression (4) and select Show Treatment Algorithm (5).

 

Options that are affected or added because of the patient’s comorbidities will be indicated by the Comorbidities icon  (6). Click on each treatment option for further details (7).

NOTE Not all conditions will include the ability to add comorbidities.

 

For more information about using the BMJ Best Practice Comorbidities Manager on the app or the desktop version, book a consultation with a library team member, or email us at AskLibrary@nshealth.ca.

References

1. BMJ Publishing Group Limited. (2023). Comorbidities: Treat the whole patient. BMJ Best Practice. https://bestpractice.bmj.com/info/comorbidities.

2. BMJ Publishing Group Limited.(2023). Free access to our award-winning app for BMJ Best Practice users. BMJ Best Practice. https://bestpractice.bmj.com/info/us/download-the-app/

Amanda Andrews

Librarian Educator, Education & Training Lead
Cape Breton Regional Hospital, Eastern Zone

Current, peer-reviewed info about COVID is vital as we move into the later stages of the pandemic. Thankfully, scientists and clinicians around the world continue to answer the call, publishing record numbers of articles and sharing even more pre-prints.

You may have noticed that the majority of the results for your recent searches have a COVID focus. But what if you don’t need COVID-focused evidence? When you do not want a term included in your search and that term is clouding your ability to screen in relevant items, consider using the NOT Boolean operator.

Using NOT to exclude results

If you’ve participated in any of the Library’s education sessions about database searching, you may be familiar with how Boolean operators work:

  • Using OR between terms or searches will increase results.
  • Using AND will decrease results.
  • Using NOT will exclude concepts from search results.

Use caution when using NOT, as it is easy to unintentionally exclude potentially valuable results. For example, an item’s metadata (the info that describes the item) may use the term you are excluding alongside other terms that are relevant to your search.

Using NOT to exclude COVID in PubMed

Let’s say you’ve heard a lot about wastewater monitoring for COVID in Canada and are wondering what else is being monitored this way. If you run a quick search in PubMed for wastewater AND (monitor OR surveillance) AND Canada, you’ll notice that the top results have a strong COVID focus. To remove COVID results, you must do two things:

  1. Enclose your first search in brackets to help the database understand your request correctly.
  2. Add NOT, followed by the term(s)/search strategy that will best remove the most irrelevant items from your search.

Adding brackets around your first search, then adding NOT and any additional term(s) will make sure the database processes your original search first.

Try: (wastewater AND (monitor OR surveillance) AND Canada) NOT COVID

Step 2 is where things can get complex because we have choices about how comprehensive we want to be with our exclusion. Simply adding “NOT COVID” to the original search in brackets will exclude some COVID articles but may miss excluding some since there are many variants of the virus. If you want to be sure you are being as comprehensive as possible, what should you do?

Using COVID-19 PubMed filters: Inclusion & Exclusion

The National Library of Medicine (NLM) maintains PubMed and has created highly accurate search strategies to isolate results about COVID. These search strategies range from General to Treatment-focused and take the variable terminology inherent in COVID into account. Originally developed to let you easily include COVID content in a more comprehensive way, you can also use these strategies to exclude COVID content more accurately.

Thinking about Step 2 in the process above, you can grab the shorthand for a specific filter, Filter Name (1), and add it to your search with NOT using the Filter command (i.e. [Filter]).

Let’s add the General COVID-19 Filter: (wastewater AND (monitor OR surveillance) AND Canada) NOT LitCGeneral[Filter]

This extra step isn’t always necessary, as your own terms may be just as effective at excluding from a current search result set. However, when you are setting up a search strategy for monitoring new results over time, using these tested filters can help ensure you account for evolving terminology.

Using NOT in other databases

NOT, the other Boolean operators, and brackets are core mechanics of how any database works. You can use the steps outlined here to exclude a term or search strategy in most biomedical databases supported by Library Services (such as CINAHL, Embase and more).

You can also look for COVID-19 search strategies, or other search strategies developed by each database.  You might notice these filters in pop-ups or alerts in a given database, or labelled as “evidence-based” or “clinical” filters within the Advanced search options.

If you are interested in learning more about using advanced searching techniques or tested search filters, please book an online consultation with a librarian at a time that works for you. If you’re interested in learning more on your own, visit the Search Filters page on our Searching subject guide.

Katie McLean

Librarian Educator, Outreach Lead

Dickson Building, Central Zone

“Research is something that everyone can do, and everyone ought to do. It is simply collecting information and thinking systematically about it.” (Raewyn Connell, 2021)

The research process is made up of several steps, all of which are important to effectively answer a question. Whether you are carrying out a literature search or a systematic review, the research process can seem overwhelming, even confusing. You may feel confident about your search, but then wonder how to properly evaluate what you have found. This post will help you decide on important factors for screening result sets for inclusion or exclusion.

Screening your search results is the process of weeding out any inadequate articles that you obtain after running your searches (Dalhousie Libraries, 2021). Screening is an evaluation tool that can be applied not only to literature searches and formal reviews, but also when quickly looking for best evidence on a topic. Screening can help evaluate “in the moment” search results, such as those required for patient care.

The screening process can be performed by one reviewer or a team of reviewers, depending on the information need or type of study being conducted. For example, “in the moment” research results may only have one reviewer, while a scoping or systematic review may have a team of reviewers. It is important that all reviewers on a team adhere to the same screening criteria.

When screening your results, whether for a formal research project or to gather evidence "in the moment" to inform patient care, keep these tips in mind:

  1. Establish inclusion and exclusion criteria – If you are working with a team of reviewers, all members must be clear on which criteria are going to be included and which are going to be excluded. For example, inclusion criteria could be all participants in a study must be 50 years old and over. This means that any study that discusses participants under the age of 50 will automatically be excluded from the search results.

If you are the only person screening search results to inform a patient care decision, it is useful to know the type of study that will provide evidence-based results to support a therapeutic choice, such as an adult woman deciding what blood thinners will best manage her atrial fibrillation.

  1. Review results using established inclusion and exclusion criteria – Remove items that clearly do not fit inclusion criteria and those not from a trustworthy or credible source. In the informal, patient care example above, you can screen in systematic reviews and/or randomized controlled trials. 
  1. Read the full-text – After determining which articles will be included, access and read the full-text. Read the articles using critical appraisal tools, screening for credible evidence, bias, and peer reviews. In more formal reviews, full-text screening is often categorized as the “second level of screening,” as it follows a more in-depth, rigorous process (Dalhousie Libraries, 2021).
  1. Check for and remove any duplicates – If you are searching multiple sources, make sure you haven’t included the same item more than once. Many citation managers, such as Zotero, have a feature that will check your search results for duplicates. Be sure to check out Library Services’ Citation Management guide for further instruction.

Tools that will guide your screening work

The PRISMA Flow Diagram (Moher et al., 2009) is a great tool to help more formal research projects record and summarize the screening process. There are also several other tools to help you manage evidence synthesis and aid in the screening process. The University of Toronto Libraries provide excellent step-by-step instruction on screening search results for those researchers looking to dive deeper into the process. 

Screening your results is a vital step in the research process—whether you are gathering evidence for a formal publication or using it to inform a local project or patient care. Our tips and tools will make it easier for you to put the knowledge you find into action.

Reach out to us at AskLibrary@nshealth.ca with any questions you have about screening search results, or the research process in general. You can also book a one-on-one consultation with a Library Services team member. We are always here to help!

 
References

1. Dalhousie Libraries. (2021). Knowledge Syntheses: A How-To Guide. https://dal.ca.libguides.com/systematicreviews/selectionscreening

2. Fisher, S. (2021). 17 research quotes to inspire and amuse you. Qualtrics. https://www.qualtrics.com/blog/research-quotes/ 

3. Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 6(6): e1000097. doi:10.1371/journal.pmed1000097

Amanda Andrews

Librarian Educator, Education & Training Lead
Cape Breton Regional Hospital, Eastern Zone

Library Services has several new ebooks on our virtual shelves. A selection of these ebooks have been added thanks to the generosity of the Dr. Chauhan Memorial Trust Fund (Cape Breton, Guysborough, Antigonish Strait region).

 

Dr. Chauhan Memorial Trust Fund purchases

With funding from the Dr. Chauhan Memorial Trust Fund, Library Services has added the following titles to support the practice of physicians, nurses, and allied health providers. Many of the titles are highly recommended by Doody's Review Service

Click on a title below to view the item's record in our catalogue, then simply click 'View ebook' to open.

 

Additional ebooks added to the collection

Looking for more ebooks like the ones we've selected? Try finding related titles using the Subject (MeSH) (Medical Subject Headings) links in each record:

  1. Click on the ebook's title or the blue arrow to the left of the title to show the full catalogue record.
  2. Click on one of the Subjects (MeSH) for more items on the same topic.

As Nova Scotia Health staff and physicians, you have access to more than 11,000 ebooks! If there is an ebook or other resource that you think Library Services should add to the collection, please let us know. On your computer, click on the 'Request' drop-down arrow at the top of this web page, then click on 'Suggestions for Library Purchase' and complete and submit the electronic form. On your mobile device simply click on the grey button in the upper right corner of your screen to find the 'Request' drop-down menu.

Thanks again to the generosity of the Dr. Chauhan Memorial Trust Fund. As always, if you have any questions, please connect with Library Services.

Amanda Andrews

Librarian Educator
Cape Breton Regional Hospital, Eastern Zone

Searching for accurate, evidence-based literature can be complicated. The good news is, most medical databases have developed filters to help you retrieve more precise results.

Search filters (also called hedges) are used to narrow a search and/or focus on a specific publication type, level of evidence, and/or subject area. Filters are constructed using specific database syntax (rules and commands). Search strategies are developed using rules and commands to search a variety of databases and interfaces, including PubMed, Ovid, EMBASE®, and CINAHL. (Nova Scotia Health Library Services, 2021)

Search filters are a quick and efficient way to search for information. They usually fall into two broad categories:

  • Methodological: these help you locate specific types of studies (e.g. clinical trials, cohort studies, systematic reviews)
  • Topic or subject: these cover various subjects or disciplines (e.g. palliative care, aging, lung cancer) 

(Curtin University Library, 2020)

It is important to recognize and identify the impact that using a particular filter may have on your search results. If a particular filter works well in a given context and does not appear to produce a high number of irrelevant results or exclude relevant items, by all means use it. However, you should be mindful that filters can alter what is retrieved from your search (Nova Scotia Health Library Services, 2021).

Several trusted databases, including PubMed, have developed filters to narrow search results by methodology, publication type or question category (e.g. therapy, diagnosis, etiology, prognosis, clinical prediction guides). Reviewing the step-by-step instructions for applying filters in PubMed is a helpful way to get started.  

Applying search filters in PubMed

Let’s work with a research question to see how search filters can assist you, when used properly, to obtain relevant results.

Example research question: Does exercise help improve back pain in adults? 

To help narrow down our results in PubMed we can apply the following filters after we have conducted our search:

  • Age: Based on our example question, let’s use the age filter, specifically ‘adult’, to limit our results.
  • Publication date: A good rule of thumb is to look for evidence published in the last five years (2017-2021), unless your research question specifies otherwise.
  • Study/Publication type: You can filter to only retrieve a certain study type. For this example, let’s select systematic reviews. The best type of study may differ based on your research question.
  • Language: You can limit results to a specific language, such as English or French only.

PubMed search screenshot

Applying these filters decreases our number of results from 7,000 to 34. Although this is a much more manageable number, it is important to be aware that potential results may be missed by applying filters.

It is recommended to use filters produced by trusted groups. For a detailed list of search filters produced by reliable groups, please visit Library Services’ Search Filters page.

Remember to be critical when using filters, so that you do not produce a high number of irrelevant results or exclude relevant items. For more information on search filters, be sure to check out our Searching guide for helpful tips. As always, reach out to Library Services with any questions or requests.

References:

Curtin University Library. (2020). Search Filters. Retrieved from https://libguides.library.curtin.edu.au/c.php?g=863554&p=6631322 

Nova Scotia Health Library Services. (2021). Searching. Retrieved from https://library.nshealth.ca/Searching

Amanda Andrews

Librarian Educator
Cape Breton Regional Hospital, Eastern Zone

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