Monday, July 27, 2015

Middle Eastern Respiratory Syndrome (MERS-CoV)

In the last hour or so up popped an alert on my phone from the Guardian, reporting that Manchester Royal Infirmary has closed its A and E department while it investigates two possible cases of this syndrome.

A search of Google for news shows that many other news sources are reporting the same story.

According to the Guardian, reporting Public Health England, there have been no new cases of MERS-CoV in the UK since February 2013.  This is PHE's guidance, first produced in 2012, but still being updated.     

NCBI have a MERS-CoV Resource Page, giving links to their MERS coronavirus database and other NCBI resources, including publications.  There are also links to WHO, CDC and other external resources, and also to HealthMap, which presents a map of cases, and includes the two in Manchester reported today.   You can click a country and see where in that country cases have been reported.

Here are some resources about MERS-CoV.   As well as the list, also try NICE Evidence Search - more comes up if you look for MERS-CoV than if you look for the full name.  

Other UK guidance

Having said that, guidance from Health Protection Scotland comes up if you use the full name, guidance produced in 2013, to raise awareness of the possibility of MERS-CoV in people returning from the Hajj.

Public Health Wales - a summary of symptoms, with links to other information, some advice for travellers, and (if you are in Wales and have a login) information for clinicians.

Guidance from elsewhere in the world

ProMed-Mail - at the moment (1830 BST, 27/7/15) there is nothing there about these possible UK cases, but ProMed-Mail is a good place to get up to date information about cases across the world.

Centers for Disease Control and Prevention - information about MERS and for clinicians and travellers, from this US Federal agency.

World Health Organization - a wealth of information, including an infographic of signs and symptoms, news, multimedia, current outbreak information, and links to information from WHO regions.  There is currently an outbreak in China and the Republic of Korea, and there are up to date figures on the WHO site.

European Centre for Disease Control and Prevention.

Thursday, July 23, 2015

Post Ebola syndrome, and choice of search terms

On the BBC news recently was an interview with a survivor of Ebola, which made reference to "post Ebola syndrome".  A search of the web finds a lot of news items mentioning this term, a short Wikipedia page and an article from Medecins Sans Frontieres.  According to that MSF article, joint pain, eye problems and depression, among other things, can follow Ebola.

Another item found by a web search for "post Ebola syndrome" is this blog post on the H5N1 blog. It refers to an editorial in Lancet Infectious Diseases (the link in the blog post goes to the Lancet but here is the PubMed record):

Bausch DG.
Lancet Infect Dis. 2015 Apr 21. pii: S1473-3099(15)70165-9. doi: 10.1016/S1473-3099(15)70165-9.
PMID: 25910638
A search of PubMed for post ebola syndrome finds only 6 items, which are perhaps not the most relevant.  A search for ebola sequelae, taking the hint from this editorial, finds 89.   Among them is this, which is mentioned in that blog post:

Clark DV, Kibuuka H, Millard M, Wakabi S, Lukwago L, Taylor A, Eller MA, Eller LA, Michael NL, Honko AN, Olinger GG Jr, Schoepp RJ, Hepburn MJ, Hensley LE, Robb ML.
Lancet Infect Dis. 2015 Apr 21. pii: S1473-3099(15)70152-0. doi: 10.1016/S1473-3099(15)70152-0.
PMID: 25910637
PubMed's Automatic Term Mapping maps post ebola syndrome to both relevant MeSH terms, virus and disease.  Searching for ebola sequelae does the same, but also to the subheading Complications.   This can be applied to the disease heading (Hemorrhagic Fever, Ebola), and effectively is a floating subheading with the virus heading (Ebolavirus).  Adding complications to the search (ebola (complications OR sequelae)) finds 89 as well.

However, using MeSH alone would find neither item from Lancet Infectious Diseases, as neither has been indexed yet. 
So, the literature searching lessons here - try alternative terms, try to identify the ones that are used in the medical literature and not just ones used in the general media, and try to find terms that make best use of PubMed's Automatic Term Mapping.  

Wednesday, July 22, 2015

Be strong, be resilient

Resilience has come up a couple of times recently.  One was in the lyrics of Grace Petrie's song "Inspector Morse" (1), and the other in a meeting with academic colleagues, in the context of dealing with negative feedback.  It made me look for some resources, which are here...

Communities can have resilience.  There is a definition here, in the context of dealing with emergencies.  So can people, for example, in this resource from the American Psychological Association.

Students, more specifically, need it too.   Here is the Higher Education Academy's research briefing about the benefits of emotional resilience in health and social care students.  What competencies are associated with emotional resilience (being able to cope with the emotional demands of working in that sort of profession)?

The Red Cross have some teaching materials about "building resilience", with scenarios.  Students are encouraged to think about what they would do in the situation described.   Their checklist of resilient behaviours looks very useful, and is:

  • Not necessarily doing the first thing that comes into your head.
  • Not freezing or panicking.
  • Getting a good perspective on the situation – seeing it for what it is, neither exaggerating nor minimising its impact.
  • Assessing the available resources, including non-obvious ones, for their potential to minimise harm or discomfort.
  • Being creative with those resources.
  • Asking those most affected, such as a first aid casualty, for their ideas and preferences. It sounds obvious, but it's often neglected.
  • Calling on past experience, your own or other people's, of similar situations and using that as a guide or help.
  • Reassuring others around you who may be dispirited or doom-laden while calming those who are over-reacting. 

Then there is "mathematical resilience", in this report from the Centre for Research in Education and Educational Technology at the Open University.  The report says, "Many people find it difficult to take part in mathematical learning, to the point where they exhibit anxiety or at least avoid engaging in any activity that could require mathematical reasoning. In this research we work with teachers in school to seek to develop a positive construct in learners, we call this construct mathematical resilience". (p.1)

Back to the negative feedback.  This is another blog post that mentions my older son (sorry, son).  At his school, he has been involved in gathering data from younger students, including about resilience in the face of negative feedback.  To make feedback less negative, the school uses the "WWW EBI" scheme to give feedback - "what worked well", "even better if". 

(1) the reference is at the end of the song.  I feel I ought to warn you that it is near a word that some would consider rude, and which is not a word to use in feedback!

Tuesday, July 14, 2015

Biological datasets

This moth spent most of the afternoon sitting on the frame of the front door at home.  I could not see it in our (admittedly rather compact) moth book, so posted it on iSpot. This yielded the suggestion, with several agreements, that it is a Riband Wave moth, to be precise, Riband Wave (non-banded form), Idaea aversata ab. remutata.  

iSpot links to a map on the National Biodiversity Network.  The map suggests that this particular moth is rather rare, or at least, not very often sighted or reported.   iSpot also links to the Encyclopedia of Life, which contains images but no description.   Had we found something rare in Sheffield?

So I Googled it, and found this page on the UK Moths site.  It also shows a map, from NBN, which gives a whole different picture.

Why is this?

Well, one reason is that the map on UK Moths shows both forms of Idaea aversata.   So, I went back to NBN and found the map for Idaea aversata, which presumably does not include ab. remutata.  More coloured squares than before, but still not as many as the UK Moths map.

The reason?  Following links from both maps reveals the datasets used.  Click Datasets acknowledgements on the UK Moths map, and you see that the data comes from Butterfly Conservation - Macro moth provisional distribution.   Scroll down on the NBN map and you see a long list of datasets that are included in their map.  Keep going and you see further relevant datasets that there is no access to, and there it is, the Butterfly Conservation Macro moth provisional distribution.

So, possibly not so rare, and not the first sighting in Sheffield!   What have I learned from this?  One - always check the data sources that go into a map.  Two - you may need to look in more than one place to get all the data.

Sunday, July 12, 2015

Famous nurses (3): Edith Cavell

Edith Cavell (according to the first site mentioned below, her name rhymes with "travel" and does not have the stress on the second syllable) appears (today, at any rate) next to a Google search for Mary Seacole, as someone people also looked for. But I have been aware of her for ages.  Boyhood trips to Norwich went past the memorial to her near the Anglican Cathedral, and her tomb in the Cathedral, and when I lived in London, I quite often went near the memorial to her near St Martin in the Fields.  

Edith Cavell was born near Norwich in 1865, and was executed by firing squad in 1915 for helping allied soldiers escape from Belgium.   She had been in Belgium for some time at this point, and is viewed by at least some as one of the founders of modern nursing there. 

There is a pub named after her in Norwich, hospital wards and schools in all sorts of places, and the University of East Anglia has named the administrative building that deals with its nursing and health courses the "Edith Cavell Hub". This year is the centenary of her death, and there is to be a coin with her portrait on it.

Here are some sites about Edith Cavell:

This one is based on a booklet published in 1985 by the Parochial Church Council of the Anglican parish church in Swardeston, near Norwich, where she was born and where her father was vicar.  

The Royal Norfolk Regimental Museum, in Norwich Castle, has an exhibition about Cavell

There is film of her funeral in Norwich (following the repatriation of her body) in 1919 in the East Anglian Film Archive.  

A search for Belgian sites shows how many clinics and hospitals have been named after her, and also that there is a road named after her in Brussels.  But there is this site in this site in Flemish from RoSa in Brussels.  RoSa is a library and archive dedicated to feminism and gender.  There is also this site in French, on a website about "Medecins de la Grande Guerre".  There is a long page about "Infirmieres", which lists the page about Cavell. 

Famous nurses (2): Mary Seacole

Mary Seacole was born in Jamaica, had lived in London, and went also to the Crimea, where she ran a hospital or hostel for soldiers.  She had prior experience in nursing and herbal medicine.  History seems to have forgotten her for some time, but more recently there have been efforts to remember her again.  There seems some controversy over what she did, and a perception in some places that if she is made more important, it has to be at the expense of Nightingale.  These issues are explored here (I can't see who makes this site, but it looks to be worth mentioning).  Alongside this, seek out "A short history of Mary Seacole: a resource for nurses and students", by Elizabeth Anionwu, published by the Royal College of Nursing in 2005, to celebrate the bicentenary of her birth and bring her back into the limelight. 

The Royal College of Nursing and the NHS both have awards named after Seacole, and De Montfort University (Leicester) has a research centre for equality and diversity in health, social care and educational research named after her.

Here are some sites about Mary Seacole:

British Library, which has some extracts from her autobiography, The Wonderful Adventures of Mrs Seacole in Many Lands.  There are some other items relating to her, or to Nightingale, nearby on this timeline.

Famous nurses (1): Florence Nightingale

The first of three posts about three famous nurses.  The subject of this one, and one other, came up in revision for AS Level History, about the Crimean War (not my revision, of course, but that of my son).   Florence Nightingale went there to organise the nurses, became well known as the "lady with the lamp", and made a difference to mortality rates.

Here are some sites about Nightingale, who has, as it happens, a connection with Sheffield.  And many other places, including Leeds, where the magnificent Leeds General Infirmary, designed by George Gilbert Scott, is modelled on her designs for a hospital, and Leicester, where the Odames Ward, the site of the newly opened library at the Leicester Royal Infirmary, is a "Nightingale Ward".

The Florence Nightingale Museum in London has a biography of her.  Their digitisation programme, in association with Boston University, has digitised many of her letters. 

The MacTutor History of Mathematics site at St Andrews University, Scotland, has a page about her, because of her work with statistics.

There are online exhibitions at the National Army Museum and the Science Museum

The British Museum has two recordings of her, one made in 1854, and another made in 1890.  The earlier one was made to raise funds for the Light Brigade Relief Fund, another made at the same time for the same reason was a recording of Tennyson reading his “Charge of the Light Brigade".  

One of the things I am reading on the train at the moment is Mark Bostridge's biography of her, published by Viking in 2008 and Penguin in 2009.

And the connection with Sheffield?   Florence's father William, who was born Shore but changed his name to Nightingale when he came into a family inheritance, lived as a boy at Tapton Hall, in Shore Lane, Fulwood.  It is still there, now a wedding and dining location.  I don't yet know if Shore Lane was called that then, or whether it has been so called since.

Wednesday, July 08, 2015

The patient's family's experience

I have been learning from my wife more about what I was like following a cycling accident last September.  

I had the accident on a Tuesday morning and have no memory of anything until the following afternoon.   I fell off my bike and banged my head (moral of that story: wear a helmet!!).

After being taken to hospital, but before that following afternoon, I had trouble remembering words (I called my wife my "partner", which apparently I don't usually do, as if I knew what sort of word I needed but could not remember exactly the right word).  I was asked to remember an address, and from time to time among other questions, was asked if I could remember it.  I "seemed not to be able to", and used that kind of phrase to say so.   I also did not stop talking (this, I fear, may sound familiar to students who I teach, but there we are).

I have no memory of any of this.   I think I assumed I was unconscious until that following afternoon, although I already know there are things my family remember about visiting me that I do not remember.     But I was conscious, and responding, but don't remember what happened.

I was watching 24 Hours in A and E earlier today, and one of the patients there was having to touch his nose with his finger, and then move it to touch a nurse's finger some centimetres distant, and then move it back to his nose.  Then he had to walk along a straight line.   These tests seemed familiar, and I gather I did have to do that sort of thing. So I sort of remember it, but not so strongly that I remembered it before seeing the programme. 

Of course, the patient experience in any healthcare encounter is important.  But this makes me realise that the patient's family's experience is too.  At no point in my hospital stay do I remember wondering "how did I end up here?", or wondering if I would be ok.   But I know my family knew how I had ended up there, and were certainly wondering if I would be ok.   Their experience was different from mine.  At some points they were having an experience when I was not, or having one that they would remember.  

Thursday, July 02, 2015

Dementia books

I went to Hillsborough Public Library, and found these two books:

Graham, N. and Warner, J. (2009). Understanding Alzheimer's Disease and other dementias. Poole, Family Doctor Publications.

The authors are UK based psychiatrists, and the book series is published in association with the BMA.  I liked the warning in the back cover blurb about the perils of information from the web, and there is a bit before the list of useful resources at the end about web searching, which could perhaps do with repeating that advice.   The list of resources looks dated now (after only 6 years), at least one organisation has changed its name, and the UK government website has changed its address.   The book covers what dementia is, symptoms, treatments (I wonder if this has dated too), help, living with dementia, future prospects, a Q and A, and a piece about how the brain works.   There are then pages for the reader to fill in with their personal and health details, and medications.  As the title suggests, it covers Alzheimer's and other types of dementia, even saying brief things about Korsakoff's Syndrome and CJD. 

The Alzheimer's Society are selling this book from their website.  It is not clear if it is a more recent edition, but Amazon are still selling this edition.

Hatzikalminios, C. (2014). Alzheimer's: reduce your risk and revitalise.  Melbourne, Wilkinson.

The author is an American nonfiction writer, rather than a health professional, although she has been a photo researcher for university and medical books.   The publisher is Australian.  I'd be wary of drug information, but although she talks of FDA approval, she does give UK names.  It mentions one drug that the other book says is not recommended by NICE (see below!!).  The layout of the book is clear, and the "prospects for the future" part will potentially be more up to date than Graham and Warner.  There are several boxes talking about pieces of research being done (with some, but not all, detail of who and where published).  There is a "preventing" section, and I wonder about that, however, to be fair the author does say that scientists speculate that the things described might prevent it.  The list of organisations at the end of the book has only one UK based one.

The drug referred to in both books is memantine. A search of NICE Evidence Search (for alzheimer's disease drugs, and then filtered to NICE publications) finds NICE Technology Appraisal Guidance TA217, produced in March 2011.  It updates NICE Technology Appraisal Guidance 111, originally produced in 2006 but updated in 2007 and 2009.  TA217, the 2011 one, says, "memantine is now recommended as an option for managing moderate Alzheimer’s disease for people who cannot take AChE inhibitors, and as an option for managing severe Alzheimer’s disease".

This shows that evidence and advice do change, and an up to date book is a good idea!

The Reading Well Books on Prescription scheme has a list of books on dementia, undated, according to a news item, launched in January 2015.  It covers information and advice, books for carers, books on living with dementia, and books telling personal stories.  I have used this list to help check books in stock at work, to see if there is anything we do not have.   Graham and Warner is on the list.   The scheme is supported by health professionals and public libraries (Hillsborough had copies), and several dementia organisations helped compile this list.

Wednesday, July 01, 2015

Something I learned during AS level revision - sickle cell anaemia

Not my revision, as such, but helping my elder son revise for his AS level history exams.  One of the things he studied was the Civil Rights Movement in the United States.  And one of the things within that was the role of the Black Panthers in raising awareness and action about sickle cell anaemia (sickle cell disease).

The Black Panthers were set up in 1966 to protect residents of African American neighbourhoods from police brutality.  But they did more than that, including setting up breakfast clubs and other community programmes.

There is more about the Black Panthers in general on Britannica but it does not mention sickle cell anaemia at all.  The pages of information in the Marxists Internet Archive about the Black Panther Party mention it but give no detail.  There is a lot more detail on this page on treatment and political aspects of sickle cell, from the Washington University in St Louis.  Looking at the reference list on the main page suggests this is a course dating back to 2000.  It quotes from Black Panther publications of the time and includes statistics, and details what happened politically.

More recent material includes a book by Alondra Nelson, Body and soul: the Black Panther Party and the fight against medical discrimination, published in 2013 by the University of Minnesota Press.  A Google Books search suggests there are books about the Black Panthers in general that mention their work with regard to sickle cell anaemia - search Google Books for Black Panthers sickle cell.   One, The Black Panther Party: Service to the People Programs, by the Dr Huey P. Newton Foundation, has a chapter in it about the Sickle Cell Anemia Research Foundation, started by the Black Panther Party in 1971.  The book is a preview only, so make friends with a librarian to get the whole thing!

A search of PubMed for just "black panther*" as a phrase finds just five items (searching for the phrase and sickle cell finds nothing).  Four are about the big cat, the fifth does mention the Black Panther Party in the context of education.  A search for Sickle Cell Anemia/history and USA or United States of America/ turns up 45 items, which look interesting, but in a more general way.  Some of them mention the first cases in the USA, and the physicians and patients involved early on.  A search of Google Scholar for sickle cell "black panthers" turns up a number of interesting looking things outside the medical literature, although a quick search of Web of Science reveals nothing.  One of the Google Scholar findings does not mention the Black Panthers in the title and has no abstract in Web of Science.   The article in question (Gary LE. The sickle cell controversy.  Social Work 1974;19(3):263-72) is from 1974 and discusses recent increased federal and state support for sickle cell programmes. I assume Google Scholar indexes the full text, but the full text is subscription only.  There is an abstract in the journal, but it does not mention the Black Panthers.

For current medical information, try NICE Evidence Search, which finds this article in Clinical Knowledge Summaries, among other things.  There is also information in NHS Choices.