Too much information!

We hear so much these days about information overload. There are frightening statistics about the huge numbers of papers in health journals that appear every single day. We don’t have time to read everything that’s out there. “Can I have that in three bullet points?” we ask, “is there an executive summary?”

It’s just as bad when we search for information. You’re after one or two recent review papers to bring you up to speed and what you get is an avalanche of stuff. Worse, half of it isn’t even relevant stuff.

Looking for information is rather like screening for disease. You want to find everything out there that is relevant and as little as possible of what isn’t relevant.

There are various ways to ensure you find the right things. The first is to look in the right place. Wonderful as Google is it covers everything. Sometimes it’s better to look in a place that offers you less, but more relevant, stuff. Broadly speaking this means using targeted academic and scholarly search engines, using health gateways and portal or using specific bibliographic databases.

For academic and scholarly papers try Google Scholar or Scirus. The Google product looks like Google but limits its searches to journals articles. Scirus focuses on scientific information from web pages and journals. When you search it looks at results and offers likely terms you might want to use to narrow and refine your search. You can restrict your search to journals if you wish. Just to give you an idea of the difference in amount of stuff retrieved I typed “diabetes mellitus” into Google and got 4.89 million hits. Google Scholar and Scirus gave me around 550,000 each. Much more manageable, but still too much to trawl through.

The next step, then, is to look further than the basic search box on your search engine. Look closely at both Google products and you’ll see a link to “advanced search” to the right of the main search box. These offer you a variety of ways to narrow your search – words you do want, words you don’t want, language, publication dates and author names (in Scholar). Both advanced search pages give you a link to further tips on advanced searching. Neither is a perfect solution, but it’s a start.

Rather than add to your information overload I’ll cover health gateways and bibliographic databases in a future posting.

Hanging on the telephone

More good news! The phone line has finally been fixed, so please feel free to give us a ring.

Copier chaos

Good news! Yesterday (26th March) we took delivery of a brand new colour copier. The plan is that it will be networked to the PCs in the library and will also work as a printer. The prints will be excellent quality (it's a digital copier) and it will be cheaper for us to run than our current laser printer.

The bad news is that the network point to allow us to do this hasn't yet been installed, and nor has the system that allows us to charge you to use the copier. Please bear with us while we wait for the new equipment.

Why do we charge? Well, library budgets are on a downward slide. Charging you for printing and copying covers the cost of the new machine. We hope you'll feel it's worth the basic 5p per side of black and white.

Easter closure

The library will be

closed

over the long Easter weekend

6th to 9th April

Normal opening hours resume on Tuesday 10th.

Happy Easter!

Seal of approval

If you visit the library website you’ll see that we are “proud to be the first Helicon Accredited Library in the NHS in Essex”. It looks impressive - but what does it mean?

Like everything else in this modern age NHS libraries are subject to quality controls. Libraries in the NHS currently use the Helicon (Health Libraries & Information Confederation) accreditation scheme, developed in 1998 and updated in 2005. Accreditation allows the Trusts that host libraries and the SHAs that fund us to see what they are getting for their money.

Helicon is a type of peer review. A typical assessing team will consist of a senior librarian from the area, a librarian from another region, and a third person who might be from clinical governance or HR or another part of the NHS outside libraries. Some teams will also have a “shadow” who is there to see the assessing process in action, either because their own library is due to be accredited, or because they are hoping to become an assessor themselves in future.

The assessment looks at a wide range of aspects of the library service, including age and subject coverage of book stock, equality of access for all staff groups, availability of IT resources and training, the qualifications and skills of library staff and the library budget. The assessors look at what they can see in the library, talk to key people in the organisation (directors of HR, training managers, chief executives), and look over the portfolio of evidence. This will include copies of library strategies, printouts of websites, minutes of meetings, copies of leaflets, training materials, budget statements, and so on.

An assessing visit is something of a snapshot and doesn’t take into account how much the service may have changed and grown (although three yearly revisits will give some indication of this). Nor are there extra points for those libraries that have done well despite being homed in an organisation that might be less supportive than others. And, as is often the way, there is a fair amount of subjectivity in the system. However, it’s all that exists while we wait for the release of a National Service Framework for libraries.

For various reasons the East of England have been slow to take up Helicon. This library was in the first wave of services to be assessed, and since then many others have been through the process. This library is due for reaccreditation in early 2008. Sadly, some recent changes could mean that we’ll struggle to reach even the basic grade, which would make us the first library in Essex to lose accredited status.

Ring ring!

We're experiencing problems with the library phone line. Please feel free to ring the usual number and leave a voicemail message - we're checking for them regularly. We're not answering the phone as all we get is a deafening crackle. You can always email us or send a fax or even a good old fashioned letter. Contact details are on the web pages.

Living wills, comas and life after death

News comes from America this week of a woman who has been in a coma for the past six years, following a heart attack. Last week she woke up and spent three days chatting to family and friends, before slipping back into a "minimally conscious state.” What is stranger is that this is not the first time she has surfaced. Will she wake again? No one seems to know.

Earlier this year a court ruled that a woman in a coma should, despite her family’s wishes, be given the drug Zolpidem, which can briefly wake such patients. The family argued that it would be cruel to wake her; that she would be confused and frightened to wake and realise what had happened to her. In the event the pill didn’t work and a judge allowed doctors to let the woman die.

Further back a husband fought with his in-laws. He said his wife, Terry Schiavo, wouldn’t want to live in a persistent vegetative state – her parents insisted that she would. The husband received death threats, the Supreme Court was involved, the family was ripped apart. Visits to the Living Will Registry shot through the roof. In the end Mrs Schiavo’s feeding tube was removed and she died.

Would a living will or advanced directive have helped in these cases? Since we don’t know how it feels to be in a permanent vegetative state how can we write something now about what treatment we do or don’t want if we end up in such a state? Easy to say now “I’d rather die” – but suppose once in PVS you are aware of loved ones, have wonderful dreams and memories and are certain you will wake again one day. It’s too late then to change your mind – you’ll have no way to tell people that you are happy as you are and don’t want to die. Recent research suggests that families of patients with “living wills” are happier with the end of life care received than the families of those without such documents.

The GMC has guidance on patients in persistent vegetative states We have books in the library that discuss this and other ethical issues. Wikipedia has suggestions for further reading and a list of PVS cases. The UK Clinical Ethics Network has a discussion on ethical issues at end of life. The BBC has legal and ethical information on living wills and some information on how to draw one up.

There are no right and wrong answers here, and every case is different, because every case is a human being and a family. Every clinican should be prepared by thinking the questions through, challenging your own assumptions and being prepared to change your mind as new information comes to light.