Friday, 28 March 2008

Save our searches

If you have been using library databases through Dialog Datastar you will have noticed the ominous red writing on the main page advising you that Dialog Datastar is being replaced with Search 2.0.

Hopefully this will be good news. It means that the way the databases look wont change every time a tender with a particular provider changes. The new interface will hopefully be nice and easy to use. It will also mean that the National Library for Health really is a one stop shop for all your online information needs so you need only bookmark, or remember, the one website address.

So that was the good news. The bad news is that if you have saved searches in Dialog they cannot be automatically transferred to Search 2.0. This may be a good opportunity to have a chuck out, rid your life of unwanted saved searches, and perhaps start afresh with some better quality searches. Heck - you could even ask a librarian for help on devising top notch searches to save.

The folks at NLH have drawn up some instructions. Sadly, I can't work out a way of attaching an ordinary Word file to this blog. Perhaps the instructions will be posted on NLH, in the meantime, please contact us (or your nearest NHS library) if you would like a copy.

Wednesday, 26 March 2008


I thought I'd have a return to ethics today. However, I'm avoiding the hybrid embryo debate in favour of something a little more directly clinical. A family has complained to the GMC because they said an order not to resuscitate was on their mother's notes, and they had not been consulted on this.

Initial (knee jerk) reaction is that this is a case of poor communication. The facts are scant, so it's impossible to say in this case.

Are there circumstances under which a DNR could be put on notes, and the family not informed? Suppose a patient asked not to be resuscitated, but wanted that decision to be kept from their family, to avoid distressing them or to avoid argument. Can a DNR be a private matter between patient and their care team? Does a member of the care team have a right to tell the family what the patient wishes to be kept from them? This seems to be the flip side of the question of what the patient has a right to know. If my relative is terminally ill, but I believe they can't cope with knowing that, do I have any right to ask the care team not to tell my relative how ill they are?

Part of the issue is whether a person refusing resuscitation is competent to make that decision. A person may be deemed competent to make some decisions about their care, but not others. A person has the right to make a decision that a healthcare professional might feel to be against their own, personal code of morals and beliefs.
A DNR decision can be made before we are even unwell, as part of a "living will" or advanced directive.

All trusts should have a policy on DNR orders. The BMA, RCN and Resuscitation Council (UK) issued a joint statement last year on "Decisions relating to Cardiopulmonary Resuscitation". Many of the main points of this document involve communication, capacity and the right of the patient to make decisions about their care. It specifically says (on p18) that "refusal by a patient with capacity to allow information to be disclosed to family or friends must be respected." In other words, a DNR, agreed by a competent patient and a care team, can legitimately be on a patient's notes, without the family and friends being consulted or informed.

Thursday, 20 March 2008


The library will be closed for the whole of the Easter Bank Holiday weekend. Go easy on the chocolate...

Feeling groovy

New(ish) to the current awareness page is a section on Long Term Conditions, which is one of the government's current hot topics.

What are long term conditions? According to the London Health Observatory these are defined by WHO as all health problems that need ongoing management over years or decades. It encompasses everything from mental illness to cancer, and from HIV to blindness. Seventeen and a half million people in the UK have such a condition. The BMA, which has resources for GPs on long term conditions, says the figure is 15 million.

If you are commissioning services for these conditions there is a website just for you, while the King's Fund brings together a variety of resources for managing conditions, including reading lists. If you want to avoid working alone or reinventing the wheel then try the NHS network for long term conditions.

Linked to long term conditions is the concept of the expert patient, who is actively involved in the management of his or her condition, because patients can understand their illness better than their carers, according to the Department of Health. Self-management is linked to patient education, which can help people manage their conditions.

Some conditions have their own National Service Frameworks - cancer, diabetes, COPD and mental health. There is a NSF for long term conditions, and one for long term neurological conditions.
Many conditions have specialist libraries devoted to them in the National Library for Health - cancer, diabetes, cardiovascular, musculoskeletal diseases, neurological conditions, mental health and genetic conditions.

If you are looking to do a literature search for information on care at home and in the community, then as well as the usual sources try the Social Care Online Database from the Social Care Institute for Excellence. The Department of Health has resources for social care, too.

Another aspect of self care is telecare or telehealth, which is about using technology to help people live independently, and "virtual wards" ensure conditions don't turn into the sort of problems that end up with patients being hospitalized. Croydon PCT is leading the field in this area.

If you are interested in the financial cost of long term conditions Audit Scotland has a report, and even a podcast.

A simple Google search for any of these aspects of long term conditions will find lots of results. For any research on long term conditions, think about also looking for "chronic illness" or for the specific illness or condition.

Wednesday, 19 March 2008

You'll never walk alone

It's a long and lonely trail from being a bright eyed medical student to the dizzy heights of becoming a consultant. Luckily the library is here to guide you on your way.

The first obstacle is the Foundation Programme. It has its own dedicated website that explains the mysteries from career path and curriculum to FAQs and a forum to talk to other Foundation newbies.

It's always helpful to have a guidebook when you are going somewhere new, and naturally we have several in the library.

"The Foundation Programme: the medics' practical guide to thriving and surviving" has an introduction from Phil Hammond. It advises on everything from surviving the first few months to life after the programme.

"The Foundation Programme for Doctors: getting in, getting on and getting out" is written by two students and an FY1 doctor. It covers everything from filling out your application forms to developing your portfolio.

"The Foundation Years: a handbook for junior doctors" includes some experiences of a FY2, and looks at writing a CV, and all the nitty gritty around shifts and rotas.

More generally we have books on writing the best CVs and getting through interviews, and if you fancy spending time in exotic locations we have "The Medics' Guide to Work and Electives Around the World". Don't forget to gen up on travel medicine before you go.

If you are looking to clamber further up the greasy pole then consider "The Specialist Registrar and New Consultant Handbook". It offers enlightenment on how the NHS works, clinical governance, training and assessing others, as well as the management skills you will need.

Even those at the top of the tree cannot rest on their laurels (admittedly a slightly mixed metaphor, but at least sticks to a horticultural theme). We have books on revalidation and appraisal.

Along the way you may find books on coping with stress, working in teams, ethics, communication and law useful. You could even read books or papers on your clinical speciality to help you keep up to date, or use our current awareness service.

So there you have it - your complete survival kit for a top notch medical career - contents, one library.

(c) creative commons attributed

Tuesday, 18 March 2008

I want to ride my bicycle

One of my vices is reading detective fiction. Not the hard, edgy stuff that involves rape, drugs, sink estates and forensic details, but the old fashioned books, involving broken hearts, blackmail, servants and quirky detectives.

My current favourite is Miss Maud Silver. Miss Silver loves the poetry of Lord Tennyson and knitting. However, she is not as fluffy as you might think. When she takes on a case it is normally because the fiance/wife/nephew of the accused begs her to prove their loved one's innocence. Miss Silver becomes very stern at this point. Earlier in life she was a governess, so she does stern very well. She can, and will set out to find the truth, she says, but she cannot and will not set out to prove this or that person innocent. Of course, the truth always turns out to be that the person she is defending turns out to be innocent, and a happy ending is guaranteed.

I thought about Miss Silver today when I caught site of Guardian Headline about bike stabiliser wheels. The headline as it appeared in my newsfeed (although not actually in the article itself) was "Stabilisers slow down baby bikers: a new study aims to prove that parents shouldn't use training wheels when introducing youngsters to their first bike". Research of any kind should be setting out to discover or demonstrate a truth, not to prove guilt or innocence.

Occasionally I am contacted by people wanting me to do a literature search for them. I am always more than happy to do searches for people - just ask us. I do worry, however, when I am asked to find evidence to prove that a certain piece of equipment ought not to be used, or that nurse led clinics are best. What I will search for, and present to the enquirer, is the evidence. And if the evidence mostly shows that nurse led clinics make no difference to outcomes, or that the equipment is perfectly safe, then so be it. I will not pass on just those bits of evidence that support the argument.

Of course any piece of research needs a question, an hypothesis, to get it started. The hypothesis has to be proved, or disproved, through the research. Generally speaking the aim is to prove the theory, but if the evidence disproves it, or fails to prove anything one way or the other, then unhelpful evidence cannot just be swept under the carpet. We should look for the evidence - whatever it shows.

Many a time Miss Silver has had to be stern with Randall or Frank, chiding them gently for letting their prejudices blind them to the facts. You cannot, says Miss Silver, just ignore those bits of evidence that are inconvenient to you because they fail to back up your pet theory.
As Frank is apt to remark, Maudie is a wonder.

Monday, 10 March 2008

Calling a spade a spade

Have you ever had a conversation with a lawyer/plumber/car mechanic and got frustrated because you didn't understand half of what they were saying? How did that make you feel? Probably like a prize idiot. Did you ask them to explain what they meant? Probably not. I'll bet you worried, too - somehow when we don't fully understand we assume the worst.

Put the shoe, if you will, on the other foot. When you speak to patients do you use medical or healthcare terminology? And how does that make your patients feel?

The problem is you don't set out to flummox anyone. It's so easy to forget that Jo Public doesn't know her excisional biopsy from her lumpectomy. When we use words every day we forget that they aren't everyday words. And of course you tell your patients that they can ask about anything they understand, but is it easy to admit ignorance? And what words do you use to explain lumpectomy? My trusty Dorland's says it's a surgical excision of only the palpable lesion in carcinoma of the breast. Yeah, right.

Luckily help is at hand from the (American) Medical Library Association. They have produced online leaflets to help people "decipher medspeak". The leaflets cover breast cancer, diabetes, heart disease, eye disease, HIV/AIDS and stroke. They also have lists of the pesky Latin abbreviations that might end up on notes.

The MLA isn't alone in feeling flummoxed. The Royal College of Obstetricians and Gynaecologists has a list of medical terms explained. A list from UCL helps decipher words by giving the origin of some of the bits of words that commonly crop up (exo, endo, angio, broncho, cardio). KidsHealth explains really basic words from acne to wisdom teeth, and the NHS Direct glossary takes you from abdomens to x-rays.
And a lumpectomy? Easy. It's a surgical procedure to remove only the cancerous breast lump.

Friday, 7 March 2008

I'll have a tall, skinny decaff fairtrade latte with wings

Isn't it nice when things are simple? Well, perhaps. But it's possible to over simplify. If you send a friend into a coffee shop with the simple instruction to "get me a coffee", what are they going to bring you? Coffee means different things to different people.

I thought about this today when I heard a discussion on the Today Programme about human rights. Now I love the European Charter of Fundamental Rights, because it is so clear and simple. You don't need a law degree to understand it. The Universal Declaration of Human Rights is equally straightforward. Article one of the European Charter states that "Human dignity is inviolable. It must be respected and protected." Simple.
Unfortunately, this simplicity has its downside. When I ask you to bring me a coffee, anticipating a lovely skinny latte, I am going to be disappointed when you interpret "coffee" as meaning a full fat cappuccino with chocolate sprinkles and two sugars. Yeuch. Similarly, when a lawyer reads that a person has "a right to found a family" they interpret that as a right of a prisoner and his middle aged wife to have IVF. It's these and other interpretations of simplicity that lead politicians to call for the UK to withdraw from human rights legislation.

Human rights are also difficult when letting me have my rights will somehow infringe your rights. A man's right not to be a father, say the courts, outweighs his former partner's right to become a mother using their frozen embryos. If the embryos were inside her instead of out then he would have no such right - a man cannot force a woman to have an abortion, although he may have a right to prevent her from having one.

In the recent case of the Tory peer and the nurses Lord Mancroft complained about nurses discussing their private lives across his bed. The hospital in question was not happy. Was Lord Mancroft complaining about the personal lives of nurses, or about the fact that they discussed them over him? Do nurses have a right to have full modern personal lives outside work, or should they be the angels of popular Victorian imagination? Was Lord Mancroft's right to dignity violated by the nurses discussing their private lives around him? Patients and their carers both have rights - and responsibilities.

Essence of Care focuses on the basics of care that patients can expect, privacy and dignity being two of those basics. Age Concern campaigns for dignity for the elderly in care. You'd think that ensuring the elderly retain their dignity would be a simple thing. Simple isn't always easy.

Thursday, 6 March 2008

Tie a yellow ribbon

Betcha didn't know that this is National Knowledge Week for acne vulgaris. National Knowledge Weeks are an idea from the National Library for Health. Each of the weeks highlights one of their specialist libraries and the latest information in it.

Practically every day, week or month is designated to celebrate or highlight something. Next week is Prostate Cancer Awareness Week, this week is Endometriosis Awareness Week. March is also National Bed Month and Ovarian Cancer Awareness Month. In fact there is a whole list of health awareness events on the EQUIP website, from the West Midlands Library Services Development Unit. The Department of Health, in its wisdom, no longer produces its list of events.

Awareness events aim to make people more aware of a particular disease or condition. They help raise funds for research and perhaps encourage people to come forward for screening. Awareness weeks are sometimes behind the odd stories in the press. I suspect that the recent story in the Mail on how a bad pillow can ruin your sleep makes might not have got into print were it not National Bed Month, although they didn't mention that in their article.

Do awareness campaigns work? Some people think they just give the worried well one more thing to fret about - and increase unnecessary trips to the GP's surgery. News coverage of the latest celeb to get breast cancer may send thousands of young women scuttling home to check their breasts, but it also skews their understanding of risk; the main risk factor for breast cancer is age.

With awareness comes ribbons - red for AIDs, pink for breast cancer - in fact there is a whole world of ribbon campaigns out there.

If you really want to be aware of all the latest health news then plug into our current awareness service. No ribbon required.

Tuesday, 4 March 2008

I'll be there for you

I am very fond of the older versions of the Everyman library of books. Inside each one is a lovely scrolled line drawing of Good Deeds and the comforting words of Knowledge: "Everyman, I will go with thee and be thy guide, in thy most need to go by thy side."

It' s always nice to have a friend and guide. For personal issues most of us are lucky enough to have a friend or relative who will listen to our woes, help us get some perspective, and perhaps offer some suggestions. For work issues this can be trickier. Our friends may not know the ins and outs of our organisation and our role. For a critical, unbiased, knowledgeable view some of us may turn to a mentor or coach.

Mentors are often associated with student nurses, but everyone from pharmacists to doctors can benefit from having a mentor. You don't need to be new to your career or role. A mentor can be a useful sounding board to help you face particular issues, they can also help you move from role role to another. A mentor can help support you as you move into a management post, perhaps, or help you think through what step you need to take next in your career. A good mentor doesn't tell you the answers to any of your problems - they support you as you find your own way.

The CIPD has a factsheet on mentoring which explains what it is, and how coaching is different. The Coaching and Mentoring Network also offers definitions and other resources. TIN - the Improvement Network from the East Midlands has an area devoted to mentoring, coaching and facilitating. Healthcare Workforce has a mentoring framework looking at the benefits of mentoring, how a mentoring relationship works, and what makes a good mentor.

The National Institute for Innovation and Improvement has some mentoring case studies. They also have a coaching programme for senior leaders. The Nursing Standard has stories of students' experiences of being mentored.

If you are not in need of a mentor, then do think about being a mentor yourself. You'll learn from your mentee, you'll boost your own CV, it's really good for your communication and management skills and also boosts your confidence.

We have books in the library on mentoring and coaching - Coaching for Effective Learning, Coaching and Mentoring at Work, Effective Coaching in Healthcare and Everyone Needs a Mentor are just the tip of the iceberg. The Training and Development team can also help with mentoring and coaching.