Going down...

The National Library for Health is scheduled to be offline this evening for one hour from 5pm.

Who lives, who dies?

This morning I heard a story on the Today programme about health economics. A radiotherapist was saying that for the money spent treating 500 women with Herceptin he could treat 3000 women with radiotherapy.



The discussion was sparked by The Investigation – a programme to be broadcast this evening. It will ask why cancer survival rates are the worst in Western Europe, despite “huge government expenditure”. (Don’t worry if you can’t catch it this evening – it’s available as a podcast and through listen again.)

The problem is that no pit of money is bottomless. Yesterday’s Today programme had a discussion on the need to increase spending on defence. John Humphries asked where the money was to come from – which other budget would they slash to pay for it – education, health or transport? The interviewee tried to avoid the question, saying that the amounts were only small. Presumably they are, but if it’s your school that has to close, or your village bypass that doesn’t get built, then it really doesn’t help to say that it’s only a small amount of money.



BBC news says that Herceptin costs £200,000 per patient. In the bigger scheme of things, that’s nothing. You couldn’t buy a house with that, a city banker would be insulted to have it as his annual bonus, but to the woman who receives successful treatment it’s worth every penny. On the other hand that was £200,000 that could have bought different treatment for different people – perhaps more people. It's £200,000 that can only be spent once and represents people who missed out because of that.

One of the speakers in today’s discussion reminded us that every patient is a mother, sister or daughter and on that level it is impossible to make choices. This is reflected in the titles of books on the subject – Who Should We Treat?, Hard Choices in Health Care.

Here some other starting points for thinking about healthcare rationing or spending priorities.

A 2005 BMJ editorial looks at “A middle way for rationing healthcare resources”

The Office of Health Economics has an online resource on health economics.

The think tank Civitas asks “Why Ration Healthcare?”

Herceptin has caused controversy before and the BBC has a collection of pages looking at value for money from drugs, drug rationing and “patient power” where an articulate patient with the money to bring in lawyers and the foresight to involve the media overturns a local decision to get funding for a drug…which may or may not then save their life.

(c) creative commons - image 1, image 2, image 3

Listen up!

Where do you find time to keep up to date? It's true, you can read journals in bed, in the bath or on a train, but they are no good if you are driving or jogging. Unless you buy your own copy of the journal you'll find you are stuck with reading it in the library, and even online access ties you to your desk and PC.

One of the answers is to listen to podcasts. These are mini broadcasts on the internet that you can listen to online or using an MP3 player. You'll normally have to subscribe, register or pay to access podcasts. Listening online still ties you to your desk - it's the ability to takeaway podcasts on your MP3 player that really frees you to listen anywhere and everywhere.

Johns Hopkins University has medicine podcasts on its site. They are aimed at the general public, but don't let that put you off. The offerings for week of 23rd November included the effect of obesity on PSA readings, the benefit of pedometers and ultrasound in the diagnosis of ovarian mass.

The New England Journal of Medicine is an old hand at this technology. It offers a range or podcasts and videos. Each week there is an audio summary of the journal, as well as interviews and other material.

Closer to home Dr Mark Porter's splendid Casenotes programme on BBC radio 4 is available in podcast form.

While researching this post I came across MyMedicalPodcasts This looks quite new, and there doesn't seem to be much on it at present. The contributors and editorial board are doctors based at London hospitals.

Finally, Powys Local Health Board (part of the NHS in Wales) has links to health podcasts on its website.

Google for medical podcasts and see what you find. However, as with anything on the net, don't forget to ask where the information is coming from and what bias it may contain. Anyone with some basic kit can create a podcast, and stick it on a website, calling themselves Doctor Whoever and claiming to be a leading consultant somewhere or other. Be as cautious with podcasts as you would with any other piece of information you find on the internet.

If you're curious about podcasting the BBC has some basic information. If you don't have an MP3 player there is still plenty of time to start dropping hints to Father Christmas.

(c) creative commons

Atishoo!

It's that time of year again when we all start wondering if this is the year when we will have a huge outbreak of flu and drop like flies. Luckily there are lots of places to find the latest information.

NHS direct, which has information for patients, has an explanation of what flu is, how to avoid it, and what to do if you get it.

The Department of Health provides guidance on flu, and some useful links. Some of the guidance covers pandemic flu.

The Health Protection Agency has epidemiological information, factsheets and more guidance.

Finally CKS - Clinical Knowledge Summaries - has information to help decision making on flu vaccination.

Anyone wanting to know what a real flu pandemic looks like will find no shortage of information on the web about the pandemic that hit after World War l. The Health protection Agency has a page covering the history of flu pandemics, the Wellcome Trust ponders Spanish flu while Wikipedia has a comprehensive page with pictures, graphs and lots of links.

(c) creative commons licence

A good TRIP

The TRIP (Turning Research into Practice) database has been tweaked and the search facility has improved. There are also now some specialist search engines which, they say, "allow users to simultaneously search the core TRIP content plus the top 10-15 journals specific to that area". They see this as a link between TRIP and Medline.

There is also extra content in the database, including wikis and podcasts.

When you search TRIP your results are categorised as systematic reviews, guidelines, research textbooks and evidence based synopses. You can use these categories to filter your results. The final category is "more" and this is where podcasts, UK approved education resources and wikis will appear.

You can also search TRIP for patient information leaflets and for medical images (but beware - these are mostly copyrighted!)

(c) creative commons licence

New resource for neurological conditions

The National Library for Health website now has a specialist library for neurological conditions. The library covers a range of conditions including epilepsy, MS, Parkinson's, dementia, stroke and sleep disorders.

The library is one of a collection at the National Library for Health. Others cover cancer, oral health, mental health, skin disorders, later life, trauma and orthopaedics and patient and public involvement.

Each library is a one stop shop for breaking news, guidelines, NSFs, patient information and evidence.

Pretty as a picture

I've been inspired by Newham University Hospital's library blog (plus some I use for fun, at home) to add some pictures here. I'm using Flickr pictures that are under creative commons licences.

Pictures are useful, especially when trying to explain something to someone. However, most pictures are copyrighted - that is, they belong to someone. When I look at patient leaflets - a panel of us in the Trust vets all leaflets - one of the comments I am most likely to make is "who holds the copyright on this picture?"

As a rule of thumb unless you have drawn the picture yourself it does not belong to you. Writing "copyright" under the picture doesn't help. You must seek permission from the copyright holder to reproduce the picture. Don't forget that an organisation might have spent a lot of money employing someone to draw up that lovely set of diagrams and when you put those pictures on your own leaflet you are stealing them.

Many health organisations in practice do seem happy to share their pictures, so do please ask them. Make sure you get their permission in writing and keep a copy of it. There are various sources of pictures that are copyright free, although photos are easier to find than health related diagrams and drawings. Alternatively, why not get a pencil and piece of paper out and sketch something yourself.

Sometimes I find leaflets that have lifted text as well as pictures, which is plagiarism. If the leaflet you find on a website says everything you want to tell your patient then rather than typing it out again, tweaking the wording a little and sticking your name at the bottom, consider this. Do you need a leaflet at all? Can you not just tell your patient where to find a copy of the existing leaflet? You may be able to print the relevant leaflet from a website, or you may need to ring and ask for a paper copy.

(c) creative commons licence

Remember, remember

This Bonfire Night NLH version 3.1 will appear - hopefully without any bangs, but with oohs and aahs of delight.

"NLH who?" I hear you say. This is the National Library for Health, which is growing and changing at a rate of knots. Version 3.1 gives you two extra facilities. When you search for guidance you will have an extra box to allow you to search for guidance from some overseas resources. Secondly, when you search for evidence based reviews, you'll be able to include Bandolier in your search.

More changes will follow as NLH continues to develop.

(c) creative commons attributed

Best of both worlds

I understand that some of you prefer PubMed to Dialog via Athens. Fair enough. However, why not have the best of both worlds? If you sign yourself up for a “MyNCBI” account you can ensure that when you search anything you have full text access to via the NHS is flagged up.

Here’s how. Go to PubMed and set up a MyNCBI account – just register a username and password, a memorable fact and copy some letters into a box. It takes a couple of minutes.

Once registered you need to set up a filter. So, log into your MyNCBI account, select "Filters (including LinkOut)" from the left hand menu. Click on the “PubMed” link. Select the “Browse” tab. Click on “libraries”. Now scroll down, down, down until you find “NHS Core Content”. (It’s in the middle of the N section, not at the start as you might expect for an abbreviation….) Found it? Click on it!

Now select "Add a result tab for all items that match this category". Now when you search you’ll get a separate tab to show the results where your Athens password will get you free full text access.

The other ways of getting this same service is to go to PubMed via the link on the National Library for Health.

Of course, this system wont show you which journals we hold in the library. Don't forget that any paper can be requested from us - use the "request a paper" link on the quick links page of the library website.