Thursday, 17 July 2008

So long, farewell, auf wiedersehen, goodbye

This is the final posting on the blog, as I am off to pastures new. The blog itself will remain as an archive. I hope you'll find useful snippets in it.

If you work in the NHS then please hot foot it down to your nearest NHS library and make use of it. You may feel that books on shelves are old hat, or that you have better studying facilities at home, or that your own laptop is preferable to library PCs. That's fine - library's are a broad church and can accommodate a variety of wants and needs. If there is only one thing you use in the library it has to be the staff. Library staff are what makes a library. Without them there would be no carefully selected and regularly updated books on shelves. There would be no one to take old books off the shelves and dispose of them. There would be no access to electronic journals because no one would set up all the behind the scenes admin for them. There would be no photocopier filled with paper, no posters on the walls. Most of all, there would be no one to guide, advise and lead you through the information maze.

If you do use your local library then three cheers for you. Please cherish it, tell your colleagues about it, support it.

Thanks for reading. Goodbye!

Wednesday, 16 July 2008

Searching and shopping

Someone recently asked me if I thought it was OK to do more than one literature search for her dissertation. Searching is not a science so much as an art. It's a puzzle, a challenge - something to come at from first one angle then another. It's a treasure hunt. It should make your brain ache, and give you a thrill when you finally find what you are looking for.

So how do you search? I like to use a shopping analogy. Going to Google and asking it tell you something about diabetes is information suicide. You'll die under the avalanche of hits, relevant and irrelevant, that it throws at you. It's the equivalent of wandering into Bluewater on a Saturday afternoon thinking that you want to buy a present for your mother. There are just too many things to buy. You can't possibly look at everything so you have to narrow your search.

Do you want to buy your mother jewellery, books, CDs, DVDs, perfume....? How about something nice to wear? Now the first question is where do you look? You can't buy clothes in Boots, Halfords, Waterstones, HMV or Jessops. On the other hand some shops sell just clothes and others while other sell clothes in among other things (Sainsbury's , Tesco, M&S).

As with shopping, so with searching. For evidence you use Cochrane, for policy you choose HMIC, for nursing issues you try Cinahl, for mental health it's Psychinfo. The Sainsbury's option (for some of everything) is Medline - it's a big database and covers most things, although perhaps not in as much depth as specialist databases.

We're going to go into the first ladies' dress shop in the mall. Now a search engine is something like a rather unhelpful shop assistant. If you are vague and say you want something for your mother to wear she will toss back her hair, examine her nails and inform you that there are five floors of ladies' fashion in the store. Too much information.

On the other hand, if you ask if she has any blouses in a size 14, cotton, with three quarter length sleeves, plain, in a dark rose, she'll just say no. She wont tell you that they have the very thing you want in red, or something similar with full length sleeves. So you need to ask a question at a time until you find what she does and doesn't have. Blouses? Yes. In a size 14? yes. Any size 14 blouses in cotton? Yes. And so on.

The same with searching. Type in "diabetes" and you'll get the look of scorn and far too many hits. Race in to Medline requesting a paper published in the UK in the last 6 months on inhaled insulin for women under 25 with children who are failing to keep their diabetes under control and you get a straight "no". You need to build up your search piece by piece.

Perhaps your mother isn't quite so fussy about her sleeves. Rather than asking for blouse, 14, cotton with 3/4 sleeves (the equivalent of using AND in a search) you could try using OR. So - I want a blouse AND it has to be size 14 AND it has to be cotton. The sleeves can be 3/4 length OR full length. The colour could be dark rose OR red. You're expanding your options with OR, your limiting your options with AND.

So, shop number one has a size 14 cotton blouse in dark red with 3/4 sleeves, or one with long sleeves in dark rose. Neither are quite what you are looking for. Do you go home? Certainly not. You treat yourself to a coffee, and maybe a pastry, and plunge into the next shop and start asking the same questions.

If Cinahl doesn't deliver the goods then try Medline. If HMIC is hopeless then try searching the Department of Health website direct.

You may need to think laterally, too. If there is nothing in cotton then do they have other natural fibres? If they say they don't stock blouses, what about women's shirts? Maybe you'd be better off asking for dark pink or crushed raspberry colour instead of dark rose.

Sometimes after a few shops you find you're going round in circles. You keep finding cotton blouses in size 14, but nothing in dark rose or nothing with 3/4 length sleeves. Finally, after visiting several shops, and asking the questions in slightly different ways you realise that 2/4 sleeves just aren't available this year, or that nowhere stocks dark rose blouses.

At this point you probably can stop. It doesn't mean that nowhere has what you are looking for, but you can feel confident that you've looked as much as possible for now, you've done your best. Sometimes we just have to accept that the particular item we had in mind doesn't exist.

Sometimes the papers you do find wont have the answer you want, but will have extra clues. It's like coming home from Bluewater and finding the Boden catalogue on your doormat. In it there is a shirt. It's blue and it's silk - but look at this. Those are 3/4 length sleeves, but what does the description say? It says those are "bracelet length sleeves". Now why didn't you think of that? Looks like you'll be going back to Bluewater tomorrow.

This mortal coil

The deathbed is a cornerstone of fiction. Miners coughing themselves to death in back rooms, Victorian ladies expiring on large, linen-draped feather beds, night nurses snoozing over their charges, doctors with whiskers and black bags recommending bed rest, tonics and purges.

These days things have changed and death is not something we do at home. Four out of five people die in hospital or hospice, although many would prefer to die at home. Now the Department of Health is preparing to outline plans for an end of life care strategy. Marie Curie have been campaigning on this issue for over four years.

One of the reasons it is difficult to organise end of life care is that we don't like to talk about death. Half the time we can't even say it. We don't die - we pass on, go home, are gathered in, go to sleep, are called to the Lord, pop our clogs, kick the bucket, croak, cross the bar or shuffle off this mortal coil. Discussing this issue on the Today programme this morning Health Secretary Alan Johnson said some programmes had refused to discuss this issue as it was "too depressing".

Death cannot be swept under the carpet. We may use surgery to make us look younger, but death will still come. It affects every one of us. We should all have a say in care of the dying because one day we will all breathe our last.

Thursday, 10 July 2008

Baby love

This morning's big health story is the latest Healthcare Commission report. Towards Better Births looks at maternity services and the news is not good. It suggests that there is a lack of choice around how and where a woman can give birth, a lack of beds and a lack of staff.

This report follows on from a King's Fund paper in February, which itself came hot on the heels of an earlier Healthcare Commission review. Both were rather negative (the review presumably provided the basis for today's report).

All this hoo-ha reminded me of article by Rowan Pelling, published in the Independent. This was early last year and speaks of a "midwife crisis". The article refers to a programme Ms Pelling made on this same topic back in 2004, when the view was no rosier.

Also in early 2007 the BBC ran a story on choice, reminding us that the government pledged in 2005 to offer choice to all expectant mums on place of birth (home, midwife-led unit or hospital) by 2009.

It is not just services during birth that are being criticised. Last March the National Childbirth Trust said there was a lack of support for pregnant women and new mothers.

I've mentioned CEMACH before. This organisation (the Confidential Enquiry into Maternal and Child Health) produces regular statistical reports on maternal deaths and perinatal mortality.

UNICEF has some comparative figures (from the early 1990s) on maternal deaths worldwide. The UK is shown as having 9 maternal deaths for every 100,000 live births. This compares with just 7 deaths in Sweden and Spain, and 6 in Switzerland and Norway. The other end of the scale in Europe shows 130 deaths in Romania. In the rest of the world Sierra Leone is at the bottom of this league with 1300 deaths - ten times the Romanian figure.

For more information on pregnancy care there is the Royal College of Midwives, the Royal College of Obstetricians and the NLH's Women's Health library.

Campaigning organisations include One Woman, One Midwife and the Independent Midwives Association. The anthropologist and campaigner Sheila Kitzinger also has a website. NHS careers has information on the varied role of midwives - a lot more to it than attending births!

Wednesday, 9 July 2008

Fat cat or wage slave?

I recently almost overlooked a round robin email from HR. It's a good job I didn't hit "delete" because it contained the good news that NHS staff on Agenda for Change pay rates (that means everyone except doctors, dentists and "very senior" managers) have been awarded an inflationary pay increase.

Actually, it wouldn't have mattered if I had missed the email. I can always find out about inflationary increases and other changes to terms and conditions in the pay circulars posted on the NHS Employers website, where I can also find the current pay rates.

This one website is a huge resource for all aspects of pay, terms and conditions. On it you'll find information on everything from equal pay and mileage allowances to your rights in case of redundancy. It is the place to go if you want to see a job profile for your role, or find out about Knowledge and Skills Frameworks.

Medical staff aren't neglected on the site - it covers everything from accommodation (an issue which has hit the headlines today) to flexible training and consultant job planning toolkits.

Obviously NHS Employers is not the only source of information on employment conditions - there is the BMA , UNISON and other unions, as well as your own HR department - but it's a good place to start.

Tuesday, 8 July 2008

Britain needs lerts

Keeping up to date - being alert to new things coming up - can be quite straightforward using the alert service on Search 2.0 at the National Library for Health. The nice people at Shrewsbury and Telford Health Libraries have put together a short guide, but a guide is barely needed. There is (once you have logged in and run your first search) a pair of buttons "save selected rows" and "save all". Select rows, or click "save all" and the next screen has a "save and create alert" button. Then all you need to do it give it your email address and tell it how often you want to be emailed. The system will then run that search for you once a week, month or fortnight, and email you the results. The search can be as basic or as complex as you like, focus on a topic, or an author, or even a particular journal.

If you are asking the system to email alerts to you at work then you must give it your full email address. So if you are at Colchester Hospital University NHS Foundation Trust, and your name is Rafael Nadal then your email address is If you'd rather give it your Hotmail, Gmail, BT or other address, then feel free.

For other ways to keep up to date (our own current awareness service aside) think about using RSS feeds. This is a ways of making headlines or new items from news sites or journals or even blogs pop up on a single page. It saves you having to look at lots of other pages. You can gather together as many - or as few - feeds as you like through a "news reader" or "feed reader" service. NLH has a tutorial using the example of Bloglines as a feed reader.

A second option is to personalise your home page (the page you see when you first go in to the internet) to include news feeds. If you use the personalised version of Google (just sign up for a free account) you can "add stuff" using the link at the right hand side of your page and then "add a feed" using the link on the left of the page.

If you have Internet Explorer 7 on your PC then you can add feeds as you would favourites, and you can look at those no matter which page on the internet you are on. However, this only works on a PC where you have Explorer 7 and have set up the feeds. A news reader or personalised Google can be reached whichever PC you are using, at work or home.

Keeping up to date is a "little and often" activity. If you leave it for months you've got more to look at and it becomes a huge chore. If you make a date in your diary every Thursday morning, or every other Tuesday afternoon, or whatever suits you, you'll keep on top of it much more easily.

As we used to say at school - "be alert - Britain needs lerts."

Wednesday, 2 July 2008

A walk in the woods

A return to ethical issues today. As ever, what makes a story interesting is when a second story causes you to look at the first in a new way.

The papers today have been looking at a Joseph Rowntree Foundation report that claims a single person needs a minimum of £13,400 gross a year to maintain a good standard of living. That standard will include bottles of wine, film tickets, bird feeders, a mobile phone and a bicycle. It excludes access to a car - apparently this is a luxury, not a necessity.

Meanwhile, in Cardiff, a small girl has Infantile Tay-Sachs disease. In her short life (she's only six) she has needed intensive care five times to get her through chest infections. Doctors apparently want the option not to treat her aggressively when she falls ill. Her parents say she has a right to life. They say (here is where the two stories collide) that she has a "marvellous" quality of life that includes foreign holidays, Centre Parcs and woodlands near by.

Standard of living is not the same as quality of life, of course, but the two are intertwined. You can be poor and happy, being rich doesn't necessarily make you happy. Back in April this year the Telegraph ran a story showing that although Britain is the world's 5th biggest economy it ranks only 17th in the world for quality of life. The Evidence Based Medicine series from the Hayward Group doesn't mention money at all in its definition of quality of life. The Quality of Life Challenge looks only at environmental issues - energy efficiency, lower taxes for "green" homes.

Psychologists consider that there is a heirarchy of needs. Basic needs come first. If you don't have a home and don't know if you'll eat this evening those needs are more pressing that whether or not you've seen the latest film or own a bird feeder. Certain basics need to be in place before we start to focus on the fancier things. Indeed, psychologust Oliver James says this very hankering after the fancier things can actually make us less happy.

So what makes good quality of life and standard of living? Is it a bottle of wine a week, a bird feeder and a trip to the pictures? Is it fast cars , fame and fortune? Or is it a walk in the park? The Telegraph reminds us today that the happiest people on the planet are the Danes. They quote Professor Ron Inglehart as saying "Ultimately, the most important determinant of happiness is the extent to which people have free choice in how to live their lives."

For me, this is the key in all this. Because your idea of happiness, quality of life, standard of living (and these aren't quite synonymous, but are surely intertwined) might be my idea of hell, and vice versa. You may feel that to be happy and have a good quality of life you need the fitness to climb mountains, bungee jump, hang glide, or just go jogging. I'd hate to be subjected to any of those things and would be happy to think I never had to do any of them. So if I were paralysed I might consider my life still to be worth living, but in the same situation you might wish yourself dead.

So you might look at the story of the little girl in Cardiff and feel sorry for her parents who think that having woodland nearby constitutes good quality of life when their daughter has epilepsy, is unable to speak and is almost totally paralysed. Or you applaud a couple who can see happiness in small things.
In the end it perhaps means that only an individual can decide what makes good quality of life for them; to decide when life is worth fighting for or when they would rather die. There can be no formula, policy or guideline to define these decision, which is why the Cardiff case will not be an easy one for the courts to consider.