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 rafael.nadal@colchesterhospital.nhs.uk. 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."

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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.

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Darzi, Darzi, give me your answer do

At long last Lord Darzi, surgeon and Parliamentary Under Secretary of State, has published his report on the future of the NHS.

For those of you who can't face reading the entire 92 pages, complete with a preface by the Prime Minister and a foreword by the Secretary of State for Health, various newspapers and other sources have digested it for you and published nuggets and highlights. The BBC manages to sum up the report in 14 bullet points. It offers reactions from a range of people and focuses on how quality of care will be linked to payments.

The Guardian offers a brief review on what the report says, and focuses on the NHS constitution, with some Q&As. The Times lists rights and pledges found in the constitution and also has plenty to say in its analysis column.

NHS Choices - the site for patient information - has a run down of the key points of the constitution and background to the review. The same page offers links to guides and leaflets, for staff and patients, on the constitution.

The Daily Mail tells us that funding in future will be dependant upon patient happiness. Professor Sikora says we must "stop treating the NHS like a national religion." The comment page isn't happy - it opens its remarks with mutterings around deckchairs ands the Titanic. Comment in the Telegraph comes from John Appleby of the King's Fund, who feels it's a step in the right direction.

For those of you after basic facts about the NHS the BBC has a rundown covering life expectancy, vaccinations, budgets and staff numbers. There is a brief history of the NHS and a fuller history and archive include clips from programmes and even an audio clip of Nye Bevan talking about his creation.

For a thorough, balanced and considered set of links to Darzi-related material, visit Newham library's excellent blog.



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Same old, same old

Research and Development had a bit of a spring clean recently and found some notes for a library user group meeting held back in March 2001. Much has changed since then - not least the library user group closing - but much has stayed the same.

The notes show that 24 hour access was the top of the agenda. The situation now is the same as it was then - we're housed in an old building that is a little off site, and is vulnerable to break in and vandalism. There is therefore no out of hours access. Eventually there will be a new library, and rooms offering 24 hour access are right at the top of the wish list. They will probably be study rooms or computer rooms, rather than access too books and journals. Some books and journals are, of course, available 24 hours online with Athens.

In 2001 we proudly announced 12 (yes - twelve) online full text journals. Now we have over 1000 to offer you. In 2001 there were concerns over lack of databases for literature searching, now we offer you seven different databases through NLH.

In those days databases were bought on CD and copied onto the library servers for use on the library network. Eventually a select few pilot sites were granted access outside the library! The user group was busy discussing pay as you surf internet access. Now, of course, the library is on the Trust next work and everyone can access intranet and internet for free, and all the databases you need are internet-based. What progress!

In 2001 we were just finding our feet with offering training for you on literature searching. We started advertising courses in the Trust Training Prospectus and and handing out certificates to people who completed training. Now we offer very little training, as a team restructure left us without the relevant team members to train.

The issue of quiet study space over a space where people can chat still rumbles on. Again, we still lack the space to offer separate areas for different uses. Keep your fingers crossed for that new library where break out rooms are heading the wish list.

Finally, the user group asked about bibliographic software including Reference Manager or Endnote. We declined to buy it then, and don't buy it now, simply because demand is very low.

We no longer have a user group - sadly, it died young. However, its ghost lives on as we are always happy to have feedback, suggestions, compliment and complaints from you through any of our contact channels. You could even leave a comment on the blog!

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Anyone for tennis elbow?

Ah - Wimbledon. There's nothing like it. The crowds, the strawberries, the top players, the strapped knees, the ice packs, the players forced to withdraw due to injury. We're constantly reminded, it seems, of the dangers of exercise. So now seems a good time to have a look at resources for sports medicine and physiotherapy.

For literature searches of any kind around physiotherapy issues Cinahl is always useful. This is one of the databases you can access through the National Library for Health with your Athens password.

NLH has no dedicated library for sports medicine, but there is a section in the orthopaedics and trauma library dedicated to sports injuries.

Visit the Intute website and type "sports medicine" into the search box and you'll find links to various journals, clinics and institutes of sports medicine.

There is the Association of Chartered Physiotherapists in Sports Medicine - complete with a call for physios to work at the 2012 Olympics, and the British Association of Sport and Exercise Medicine.

Sports injury is a real problem, with guidelines being issued to American schools to ensure they enable their athletes to remain healthy and fit. NICE is currently working on guidance for promoting physical activity in children, although the scoping paper doesn't suggest that injury prevention will be a big part of the guidance.

The BBC has information for people wanting to do some sport without injuring themselves, including advice on warming up. NHS Direct has a sports injuries section.

Beware when Googling for sports injury information - a lot of results are private clinics advertising their services. While they may produce good quality information don't forget that they might have reasons to be biased toward suggesting treatment is necessary.

It's no surprise that a third of us prefer not to do any sport. Most of those blame poor health - perhaps sports injuries preventing them being active? Even sitting at home playing imaginary sport on computers can be bad for you. Best sit still on the sofa, crack open a punnet of strawberries and watch the rain fall on centre court.

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Dead or alive?

The BBC is running story today about a family in Mumbai who were taking their "stillborn" baby to the cemetery and when she began to gurgle. They were apparently "astonished". There is no indication as to how a man in Paris felt when he woke up on the operating table to find he was being prepared for surgery to remove his organs for transplantation.

In both cases the issue was around defining and diagnosing death. In the second case, which happened in Paris, the man had been diagnosed as dead under new experimental rules brought in to ensure that more organs are available for transplant. The article is vague about the rules, but refers to "heart stopped" which I assume is similar to "non-heart-beating organ donation" described in the Journal of Hospital Medicine. In the UK the criteria is brainstem death.

UK Transplant has a number of FAQs, including "how do they know you are really dead?" I'm surprised not to see listed as an FAQ "will doctors make an attempt to save my life if I am a donor or will they be more worried about having my organs?" It's certainly an objection I've heard from people- a fear of being used as a source of organs rather than being treated as a patient in need of care. It's a question more people will ask while incidents such as this French case continue to appear in the news.

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Guess how much I love you

Some things in life can be counted, weighed and measured. Two books, half a bar of chocolate, three pounds of cherries, 50g of hand dyed cashmere yarn, a metre of string. Or perhaps two hours wait in in A&E, one hairline fracture, three beds, fifteen stitches.

Other things are less measurable, expect perhaps by comparison. How funny is Jeremy Hardy? Does he make you laugh more or less than Andy Hamilton? Is an oak tree lovelier than a copper beech? Is Brief Encounter the saddest film you've ever seen?

The government thinks nurses should be more compassionate. It also thinks this is something that can be measured. How do you measure compassion? If I am compassionate towards one old lady in the morning can I treat a second old lady like second class citizen in the afternoon and still reach my compassion target? How many times do I need to say "there, there" before I can record it as compassionate activity? Is mopping a brow more or less compassionate that fetching someone a cup of tea? What is compassion, anyway? What happens if I feel as though I am being compassionate, but the recipient of my compassion feels I am being patronising, maudlin, overly familiar or intrusive?

Compassionate care is a good idea - as is treating patients with dignity. We should also treat our colleagues with compassion and dignity. We know what these things are - we certainly recognise when they are absent. But there are some things in life that just can't be measured (Elizabeth Barrett Browning not withstanding) or made into targets. They are the very things that are most important.

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