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.

Bad Science?

The Guardian newspaper has a regular column on “bad science”. On 24th February that column looked at a review in a medical journal of a book on autism aimed at lay people.

Why was this “bad science”? Well, the article argued that the book’s author is an “activist” who has been “highly criticised” and who has his own agenda that is not much supported by the body of medical knowledge and opinion. The review of the book, however, was “flattering” and made no mention of the author’s history.

Quite rightly the Guardian doesn’t propose censorship. After all – where would we be now in terms of scientific knowledge if it wasn’t for those over the centuries who have dissented from mainstream opinion? The Guardian argues that some background on the author would have been helpful in enabling people to make a thoughtful and balanced reading.

A journal perhaps has some duty of care towards its readers in offering some sort of background information. But it is up to each and every one of us to read with our brains switched on, to read thoughtfully, carefully and critically.

There are various resources to help you do this. CASP (Critical Appraisal Skills Programme) has tools for appraising different types of health research. For appraising websites there are various things to look out for including the HoN (Health on the Net) logo. It’s also worth checking dates showing when material was last updated and any “about” page that might show who the author is and what particular bias they might bring to information on the site. On a lighter there is a brief animated checklist, the Quality Information Checklist . It is aimed at children but covers the basics.

The other issue that this Guardian piece raises is that of newspapers picking up on stories and giving them sensationalist, and possibly misleading, headlines. It’s best always to read beyond the headline. Most health news in papers can be tracked down to a recently published scientific paper. Don’t accept the interpretation of the Sun, the Mail – or even the Times or the Telegraph. Go straight to the source and make you own mind up. Another useful source for assessing news stories is the Hitting the Headlines section on the National Library for Health website. It looks at recent health news stories and assesses the evidence behind the headline.

For further reading on all of this, why not drop into the library? We have Trisha Greenhalgh's very readable work on the subject, How to Read a Paper, now in its third edition, and many others. We can also offer more advice and guidance. All free, as ever.

Feed me, Seymour, feed me!

One of the niftiest things about this blog is the little set of news headlines to the right of the page. Go on - have a look. Good, aren’t they? They come direct from Reuters Health, which supplies the world’s media with stories. They are constantly updated. Looks like hard work, doesn’t it? But actually, since I set up the RSS feed one afternoon I’ve had to do nothing at all. Once the feed is there news simply drops down it from the Reuters site.

I’ve put the feed on this blog for you. I use about a dozen feeds on a daily basis to check over the news for the current awareness bulletins (“Supporting Excellence”) that I create. In the old days I used to have to look at a whole heap of websites individually. Now the stories I need feed into a single page where I can keep an eye on them in one click.

To do this you need two things. At one end, a web page that offers a feed service, on the other end an aggregator to pull your chosen feeds together. I currently use Google Reader and before that I used Bloglines. (Why did I change? Because for several days Bloglines just didn’t work and I couldn’t be without news for that long). There are plenty of other free aggregators out there, and they are very simple to set up.

Phil Bradley’s website is a good place to start looking for an aggregator. The site wins no prizes for looks, but it’s very handy. Spend an hour or so picking a nice aggregator, surf your favourite sites looking for feeds (look for the dinky orange square icon and the magic letters “RSS”) and you’ll never be behind the times again. You’ll be able to look at your aggregator anywhere that you have internet access.

For more information on RSS try the National Library for Health. For a more in depth look – including and history and technical stuff – try Wikipedia.

You could even run a feed from this site blog so that you can see whenever I post something new. Go on – try it. And if you get stuck why not drop into the library and ask for help.

The title of this post? You don’t mean you’ve never seen Little Shop of Horrors…for shame!

Count 'em!

Statistics - the world is full of them. Everybody these days, government in particular it seems, has a mania for figures. We're obsessive about counting everything. Arguably there is much in life that has great value but cannot be quantified and counted. However - that's another subject. Today I just want to suggest some places to go for numbers when you need them.

National Statistics. The official UK government site for statistics. The site has illness related figures and also lots of data on health behaviour and lifestyle. Much of the data is available in Excel spreadsheet format.

Clinical and Health Outcomes Knowledge Base. The official NHS site for all the NHS "indicators". Topics covered include admissions, deaths, cancer incidence, oral heath, BMI and abortions. Available as Excel spreadsheets.

Department of Health. Includes hospital episode statistics, health and personal social services statistics and departmental statistical publications.

Nation Master. This has a range of health stats, the difference being it covers the world. So if you want to compare numbers of beds per 1000 population in Japan with those in the Czech republic, or motor vehicle deaths in Austria with those in Australia, this is the site for you. Data is presented in graph form, as pie charts and maps.

Don't forget to check health portals like BUBL and Intute. Finally, the Health and Safety Executive (HSE) has figures on work-related illness.