Tuesday, August 11, 2015

Mental health on, or in, film

A conversation at home about F.D.C. Willard reminded me of Ian McEwan's novel "Enduring Love", for reasons which will become apparent in a later post.  There is brief mention of this novel in an earlier post about autobiography and biography as health literature, as it is a novel that deals with mental health issues.

Looking for material on the web about the novel, I found the Minds on Film blog from the Royal College of Psychiatrists, which has an entry about the film of the novel.  This blog has been going for five years (there is an index, by health condition, of the first five years) and features structured reviews of films that deal with mental health issues, each review summarises the story and addresses its relevance to the field of mental health.

The latest films reviewed include Still Alice (I have just ordered the novel for work, following my Dementia Friends training) and the television series The Outcast.

If you are looking for film or television that deals with mental health issues, I would recommend a look at Minds on Film.

Monday, August 10, 2015

Evidence based practice for seven year olds

Or, "to rinse or not to rinse".  

Towards the end of last term, it was health week at my younger son's school.  Parents were invited in to take part in a lesson about oral health, with the teacher and pupils talking about different types of teeth and doing some tasks.  One was to use dental disclosing tablets to show how clean your teeth really were.  Sadly I could not stay for this bit, but I did watch the video about cleaning your teeth.  This included the advice not to rinse your mouth after you had brushed.  I had never thought of this, but the idea was not to wash the toothpaste away, leaving the flouride to remain working.

And then some weeks later, Dr Ranj on the very good Get Well Soon (CBeebies) had a programme about teeth, in which he was observed by my son rinsing.

So, who was right?  

I asked my lad about this.  Who was right?   Dr Ranj, he thought, was a grown up and a lot of grown ups did not know not to rinse.  His teacher had said she did not know, and so of course had I.  So, I asked, how did he know not to rinse?   The video had said so, he said.  How did he know the video was right, I asked.  Because the person in the video was a woman, he said.  

I am not sure which of Isaacs' Alternatives to evidence based medicine this is, although it occurs to me that since my lad is actually called Isaac, this may well be Isaac's Alternative!   Anyway, is there another explanation?   What is the evidence? 

NICE have a guideline on oral health, and there are recommendations relating to action that schools can take.    But nothing about rinsing (that I can see).

A search of NICE Evidence Search led me to a record in Central, about toothbrushing education, but not quite on the right topic.  It did however tell me there was a MeSH term Toothbrushing/, so I tried that in PubMed combined with the word rinsing.  This was on the right lines, and some of the related citations were useful looking.  One of those was indexed also with the MeSH term Water/Administration and Dosage (some of the other references were about mouthwash, not water).  Trying the two MeSH terms together finds five items, some rather old.  In this one, some children rinsed with water and some did not, and there was little difference in flouride retention (the abstract does mention that previous studies did indicate that there was).   This one compared rinsing methods (one involved mouthwash, and two water), but with a smaller number of people, and found there was a difference.

Then, I tried a search of PubMed using toothbrushing (water OR rins*), filtered to systematic reviews, and found this (which actually appears to be a report of a consensus meeting, thus being an example of the problem of using a preset limit!).  An examination of the full text is needed to see what the recommendations are.  The abstract suggests that studies come to various results and that the evidence is of varying quality, although international guidelines, interestingly, come to the same conclusion (the abstract does not say what this is).   The full text seems to be freely available, and says "The consistent message emerging from the guidelines in Table 2 is to spit and avoid excessive rinsing with water" (in the section headed "Clinical guidelines"), based on four referenced clinical studies, although it does say that the evidence levels and the methods used to grade the evidence vary.

Saturday, August 08, 2015

Is there something odd about this paper?

Or cats and critical appraisal.

I wrote in the previous post about F.D.C. Willard, co-author of a paper on low temperature physics, and actually sole author of another in French a few years later.   Willard, as the lead author of the first paper, J.H. Hetherington admitted some years later, was in fact a cat, added to the paper as a reaction to editorial policy about the use of "we" when there was only one author.   

I used to do a drop in workshop for research postgraduates on critical appraisal, which I started after talking to one of the departments I worked with about whether there was a need for such a thing.  Because we never knew who would be there, and because there might be people from a wide range of disciplines, the session had to be fairly general.  I devised a critical appraisal checklist to work with any discipline in the (as it was then) Faculty, which covered medicine, biological sciences and psychology.

F.D.C. Willard (Chester to his family) was a way into the idea that everything is not always what it seems with a journal paper.   If Hetherington had not said, we would of course never know that there was anything unusual with this paper, and the unusual thing was not to do with the physics.  My point was that if we conduct a critical appraisal of a paper, we might well spot any unusual things.  As part of the workshop we then conducted a critical appraisal, using my checklist.  With participants potentially from such a wide range of disciplines, choosing a paper was difficult (and I also had to be able to understand it!).

So, we appraised this paper from the Annals of Improbable Research.  This quite often worked well, but there were times when the humour of it was difficult for some of the participants, coming as they did from a range of cultures.

So, how do you know that there is something unusual about a paper?

Here are some possibilities:

  • A critical appraisal.  Part of this is of course to see if the paper applies to your studies, research or patient, but part of it is to examine the methodology.  There might be cases when the paper passes the critical appraisal test, but there is still something unusual.  Maybe one of the following will help:
  • Look for an erratum, corrigendum or retraction (we talked about those in that critical appraisal session);
  • Letters and other responses, if the journal publishes them.  The BMJ allows "rapid responses", some of which become letters in the journal, something that the journal has always published;
  • Comments on the journal website.   I am not sure how many specialist journals allow this;
  • Blogs and other discussions about the article;
  • Media coverage - perhaps only after something odd has been discovered (other things that make it into the media are perhaps articles that are thought to be significant, ground breaking, or have eye catching press releases - I have no evidence for any of these statements!);
  • Check a systematic review of the topic and see if the paper in question (assuming it is a type that could be included in one) is in or out, and check how the results compare to the others in the review and to the results of the review.
If there is none of this, then I think you would need to find other studies of the same thing and compare results.  

F.D.C. Willard, the cat who wrote papers

I had forgotten about F.D.C. Willard.  

Some years back, I referred to him in a class on critical appraisal, as a way into the idea that journal articles are not always what they seem.

I was reminded, and delighted to be so, by The Scholarly Web column in today's THE (6-12 August 2015, p. 21), which was talking about the Academia Obscura blog, which mentions it.

So, this is the story.   This paper in Physical Review Letters, in low temperature physics, was written by J.H. Hetherington.  A colleague of Hetherington's pointed out that the journal's rules said that if there was one author, you could not say "we" did this or "we" found that, but you must write "I".  To avoid this, Hetherington (a real physicist and author of 40 papers indexed in Web of Science) added his cat, F.D.C. Willard as co-author.  The cat was called Chester, his father (the cat's) was Willard, and F.D. is (I used to ask the students if they could guess) for Felis domesticus.  

This paper has been cited 59 times in Web of Science, 

The story is recounted in:

Nickon A, Silversmith E.F. Organic chemistry: the name game. Modern coined terms and their origin.  Elsevier, 2013

Stall S. 100 cats who changed civilization: history's most influential felines. Quirk, 2011

Weber RL. More random walks in science.  CRC Press, 1982.  (A Google search turns up a book in German, called Kammerphysikalische Kostbarkeiten, which turns out to be a translation of this).  This, I think, is the book where I found the story.

The relevant sections are all in Google Books.   There is also an article in Wikipedia that tells the story, with a few developments I did not know about, and some references (although some are broken links).  

And (added the day after I wrote the original post, and causing some amendments), Hetherington's account of it is in this article from Physics Today from 1997 (you will need a subscription or payment to read the whole article).

Tuesday, August 04, 2015

MeSH on Demand

Does MeSH on Demand have possibilities for identifying thesaurus terms for use in a search, as I wondered if in a previous post?

MeSH on Demand is here: http://www.nlm.nih.gov/mesh/MeSHonDemand.html.  There is information about it in this NLM Technical Bulletin article

As a first test, I entered this text:

The use of antibiotics to treat otitis media in children under 5

MeSH on Demand suggests:

Anti-Bacterial Agents
Antibiotics, Antitubercular 
Dermatologic Agents
Otitis Media

There is a disclaimer that says that humans might have come up with different terms, and that MeSH on Demand might suggest terms that are not in the text, or miss ones that are.  It does not assume any prior knowledge of MeSH.

I would have come up with the first and last terms, and humans, although I think that would be included implicitly if you include an age group.  I would have chosen something more specific than Child.

If you explode the first term, Anti-Bacterial Agents, you would include Antibiotics, Antitubercular.  There is no advice that I can see from MeSH on Demand about exploding.  If you use PubMed, exploding would happen by default.  

I would not have come up (at least, until I had examined some search results) Dermatologic Agents, so that is interesting and I would explore that.

There is no guidance from MeSH on Demand about how to combine terms.   There is also nothing said about freetext terms that you might use.

As a second test, I input the abstract from an reference from PubMed, and the resulting list of suggested MeSH terms had a very small overlap with the actual terms applied to that reference.  Indexers do look at more than the abstract, so there may be ideas in the article headings, conclusions and tables and figures that are not in the abstract.   Interestingly, Philippines/ is suggested (it is mentioned in the abstract) but is not actually applied to the reference. 

And as a third test, I used a search involving a drug and a condition that I had used as an example before.  MeSH on Demand identified the disease MeSH term I had chosen, and a drug MeSH term I knew about but had rejected (as too broad), plus a MeSH Supplementary Concept (the idea of those was new to me, I have to say, and I am not yet sure how you search it in Ovid!) and a MeSH term for the part of the search I had decided to deal with by means of a publication type limit or filter.   So in this case, MeSH on Demand was useful as a source of ideas.

Monday, August 03, 2015

Health vignettes

Health is everywhere, which is one reason why being a health librarian is so appealing and compelling.

I made a journey through a particular part of my home city.  At one end of the journey, shop staff were talking to each other about people they had observed through the window.  There was a man who was having what might have been a fit, who then refused the ambulance that the shop staff called for him.  There was another who tripped and fell on the tramlines.  And there was someone who had fallen from their bike on the tramlines.  If this has happened to you in Sheffield, you should put the details on this website.

And at the other end of the journey there was a parent and children walking, with the parent explaining to their children something about the health of a grandparent and how it was affecting them.

Bees and neonicotinoids, and choice of database

There are petitions circulating online at the moment about the effect of neonicotinoid insecticides on pollinators like bees, and asking for those insecticides to be banned.

Neonicotinoid insecticides were banned, it is said on scientific advice, but now are not, it is said on pressure from the manufacturers and farming interests. 

I have been signing the petitions, having become interested in bees since we had tree bumblebees living in the roof of our last house, and as part of my general pottering in the garden.  I have been involved in research into them and other pollinators by taking part in the University of Sussex's Bees 'N' Beans project (beans now harvested, keeping the results safe until I can submit them online!).   

Until we know the effects on pollinators for sure, we ought not to use neonicotionids. 

What is the evidence?

I searched PubMed for the two words bees and neonicotinoids, and as a test of its usefulness in life sciences more generally.  Limiting to review articles (although we do need to remember the potential pitfalls of review articles) finds this from 2014 by seven researchers, all at the time UK based except one, based in the Netherlands.  It summarises the evidence in several appendices and discusses laboratory experiments (where the dosage may be higher than in the field) and field experiments.

The search finds 69 items.  The search term bees is mapped to MeSH, but the other term is not.  So, I tried truncating neonicotinoid* and this finds 110.  Truncating in PubMed turns off the MeSH mapping, so is not always wise - you may find more with your search term in the title, but lose items found with MeSH mapping.  Here, though, since the first term did not map to MeSH, truncation is wiser.  

A search of Web of Science Core Collection for 

(bee or bees) and neonicotinoid* 

finds 234.  13 of these are reviews.

Importing the 110 and the 234 into RefWorks and removing close duplicates (I have to confess I did not check them all, I assumed they were indeed duplicates) leaves 157 (out of 234).    More work would be needed to see how many of those were unique to PubMed or to Web of Science. 

A general web search finds a lot of news and campaign information, but also this research review from the Xerces Society for Invertebrate Conservation, on the website of the Entomology department of Penn State University.