Wednesday, September 30, 2015


Mindfulness is paying attention to your thoughts and feelings in the present moment.   It can be a way to develop resilience and cope with the demands of an academic or clinical course. 

Here is a not very systematic selection of useful looking links:

NHS Behind the Headlines, on mindfulness to prevent a relapse of depression.

NHS Choices: Mindfulness for mental wellbeing

Useful looking articles include this systematic review of systematic reviews, published in PLoS One by Dutch and American researchers, and a systematic review of mindfulness for reducing stress in health individuals, published in the Journal of Psychosomatic Research by American and Canadian researchers, and this British Journal of General Practice introduction to using mindfulness in general practice.

The US Department of Veterans Affairs have an "evidence map".

Monash University in Australia has major interests in mindfulness, and includes it in health curricula.   Nearer home (mine, anyway, as of course I don't know where you are!) is this page at Bangor University in North Wales.

I only looked in PubMed, and have not looked at individual studies or reviews of mindfulness' uses in particular specific conditions.   I suspect looking in the psychological and psychiatric literature using PsycInfo would be beneficial.


Not the bee, but unmanned aerial vehicles.

Drones as a PubMed search finds 255 but some relate to bees.


unmanned aerial vehicle* OR unmanned aerial system* OR uav* OR unmanned aircraft

finds 310.  

UAV is also "unicuspid aortic valve", which will be a few of that total.  UAS is another possible acronym, but this is also a gene, so adding it into the search multiplies the number of results by 10!

If you want to buy a small drone, with a range of a few metres and a battery life of a few minutes, you can do so at the Apple Store (I now know, following a trip to one for something else!).  

Many of the drones in the news at the moment are there because of their military uses, but they do have medical, health and scientific uses.  Here are some, from a quick scan of those PubMed results:

  • Sampling the air, or dust;
  • Mapping weeds, tern colonies, chimpanzee nests;
  • Transporting laboratory specimens or drugs;
  • Monitoring environmental hygiene;
  • Major incident management;
  • Monitoring infectious diseases.  

One reference uses the term "multicopter", an unused synonym - adding 1 more to the 310!

Two people in academia with interests in drones are Noel Sharkey, of the University of Sheffield, and Andy Miah, of the University of Salford.

Tuesday, September 29, 2015

Critical appraisal: not just seeing what you agree with

It's the Labour Party Conference this week, and so on the Andrew Marr Show on the BBC on Sunday last, Jeremy Corbyn, party leader, was interviewed.   I was pleased to see some of the interview, and remarked to the family how good it was and how much sense I thought was in what Mr Corbyn said (see declaration of interest below!).   Ah, well, said someone close to me, you would think that, because you agree with him.

This set me thinking.  Did I have a biased view of what he said because I only saw those things that I agreed with?   Did I have a biased view because I overlooked things that I did not agree with?   And that set me thinking about critical appraisal.

Reading the whole paper

One reason for critically appraising a research article is to see if it applies to your research or clinical practice.   Is another to make sure that you don't see only the things in it that you agree with?   I do think (and have said so to students) that critically appraising a paper is a way to make sure that you read the whole thing, and not just the bits that you find easiest.  For me, the statistical parts of a paper are more difficult, and are likely to be the bits I skip over.   If I am reading with a checklist like CASP, then I am made to read those bits, as I can't complete the checklist if I don't.   Does a checklist help you see all things in a paper and not just those things you agree with?

Which papers to read?

Is there a danger that when selecting papers from a list of search results, that I will still choose those items that I agree with, whose titles reinforce things I already "know" or have decided?

Are there criteria to use to select references from a list to read in full?   If you are doing a systematic review, then you look for things that match your inclusion criteria.  If you are looking for high quality evidence to inform patient care or clinical practice, then you critically appraise the evidence.  But if your search finds 50, how do you choose which to select for that detailed critical appraisal?   I have talked in teaching sessions about looking at titles, and then abstracts, to decide which to look at in full, but what are you looking for when you review titles and abstracts?   You are comparing them with your answerable question, the search question you formulated using PICO or a similar scheme.  Do you think they may contain an answer to that question?

Declaration of interest: as you might be suspecting by now, I am a party member (I joined a year ago or so) and I did vote for Jeremy Corbyn. 


When we lived in Aberdeen, we quickly learned that eating fish and chips outdoors was dangerous.  The seagulls would come to help themselves, and steal scraps.  If you did not drop scraps, they would steal from you without asking.  And the seagulls were Enormous.  In Tobermory on the Isle of Mull, they wait around the excellent fish and chip van on the harbour, although they don't steal in the same way.  Not yet, anyway. 

Seagulls have been in the news over the summer for attacking pets and people, sometimes causing nasty injuries.  I do remember news reports when we were in Aberdeen that if you had gulls nesting on your house, you needed to watch out for them attacking you if they had chicks.

The recent BBC programme Big Blue Live was very good, looking at life in the seas and on the coast around the UK and beyond.  It had a feature about gulls, looking at one man who had taken steps to make them behave by waving sticks at them when they came from neighbouring buildings into his garden.  This seemed to show them what was what, and their behaviour improved.

So, what information is out there about badly behaved gulls?   What action can you legally take?   What should you do if one tries to steal your chips?  In addition to the sites below, I think it would be worth checking the website of your local authority - several appear in the first page of Google results.

RSPB on urban gulls

RSPB on gulls and the law

NI Direct

Interestingly, there is a lot of information here about deterring gulls, but rather less on what to do if you are attacked by one.   

Skuas are known for doing the same - my parents tell stories from their visit to Shetland of getting too close to nesting sites of bonxies, as they are known there, and having to wave sticks in the air so the birds attack the stick and not their heads.   The Skuas, by Robert Furness, has a chapter about skuas diving attacks on humans, but because I have only seen what is available in Google Books (not all of the book), I don't know if he has any advice on what to do if they do attack.

(I do know there is no such thing as a seagull, as there are many species of gull, but I am hopeful that you know what I mean if I use the word!).

Media literacy, or how to read health stories in the news

I started writing this during the recent Labour Party leadership campaign, and have returned to it while doing an excellent MOOC course from Cardiff University, The Informed Health Consumer, one week of which was concerned with the reporting of health stories in the media.

Here are some of my thoughts about reading health stories in the news.

1.  Read the story, and not just the headline.   Is the headline written by the same person who wrote the story?   I am not sure it is, although this reveals my lack of media literacy!   Reading just the headline is perhaps like reading only the title or abstract of a research article.

2.  What motives do the story's authors have?    Or the newspaper?    

3.  Is what the story reports the whole story?   What are other reports saying?  

4.  Have the authors of the news story read the research study they are reporting?  Or just the press release?   And what were the motives behind the press release?

5.  What did the original research actually say or do?   Who did it?    I have memories of stories that drug A is a cure for disease B, or that eating a particular thing makes you live longer, but what did the original research say?   How many people were involved?    Or was it animal research?  Was it a "front group" (effectively a lobby group, trying to look like disinterested people).

If we are going to read a newspaper story about health critically, what should we be looking for?

One of the tutors on the Informed Health Consumer is Andy Williams, a journalism researcher.   This adds an interesting angle.   One of the units lists "science news values", things which journalists look for when reporting science and health, or things that may be shown.   These are
  • Inaccurate reporting of uncertainty, or over extension, so for example, reporting a study that shows marginal risk of cancer in mice, over-extending the results to say that the same thing causes cancer in humans.
  • Focusing on studies that report risks, thus suggesting the world is a riskier place than it is.
  • Simplification - of course it is a valuable thing about reporting that it can simplify technical things, but things can be oversimplified and in the process distorted.
  • Serious disagreements are always reported, suggesting that science has more conflict in it that it does.
  • Human interest angle - of course, this is another positive thing about news reporting, but the risk in health stories is that a report of one person drinking tea and getting cancer is used to suggest that drinking tea always causes cancer.
The course uses some news stories that were picked up by the Behind the Headlines feature on the NHS Choices website, which is an excellent place to look at how health stories are reported.  Behind the Headlines chooses a story picked up by the press, and looks at the original research reported.

Finally, some proper advice on reading health news, from NHS Choices.   This advice is also reproduced on PubMed Health.

Sunday, September 13, 2015

Marie Sklodowska Curie

Another BBC programme (see also the post about gender identity) was a programme about Marie Sklodowska Curie.   I can't find a website for the programme, which is what happens when you don't make a good enough note about something!

Anyway, I knew something about her scientific discoveries and knew that she had died of the effects of radiation, although she lived longer than I thought.

But I knew nothing of the fact that the Nobel Committee in 1903 wanted to award a prize only to Pierre, her co-worker.   And nothing of the negative reactions to her relationship with Pierre Langevin - he was married, she was not (she was a widow, as Pierre had by this point been killed in a road accident), but she seems to have been the recipient of criticism.   I also did not know that she and her daughter had provided mobile X-ray units in World War One, and that this probably contributed to her death.

An internet search for information about her is interesting.  Some of the results are of course about the organisation Marie Curie, which works with people living with terminal illness.   A lot of the results about her do not seem to mention this sort of issue at all.

Two that do are Wikipedia, and this site from the Chemical Heritage Foundation, which sets her in the context of oral histories of other female chemists.  

A search of finds a lot about an EU fund for career researchers, named after her, and this interesting article in Le Courrier de Pologne, which reminds me that the programme referred to the transfer of her body to the Pantheon, in the 1990s.

The same search finds this English language article in the magazine 21st Century Science and Technology, the full version of which makes reference to the controversy over awarding the Nobel Prize to a woman.

A search of the English speaking Google for her, adding the word sexism, turns up:

This, from The Mary Sue, about the Academie Francaise des Sciences turning down her application for membership in 1911, and this from Wired;

And this, from The Community Alliance; 

And finally, there is a new film in production about her life

Beyond my linguistic skills, sadly, but which perhaps would turn something up, is a search for Polish language material.  I do know that the "l" in her name needs a bar across it but the technical term for this and the technical knowledge to do it are at the moment beyond me!

Gender identity

While in Scotland recently, I caught an excellent BBC Scotland documentary, called "Transsexual stories", following five trans women.  This link is to the stories of three of them - the programme itself is still on the iPlayer, but only for ten more days.  There was a lot in the programme that I had never thought about, and I was very glad I had caught it.  One of the five was a bus driver, who had been in the Army, and had attended reunions.  Her former regimental colleagues were very supportive of her, as were her transport colleagues.   Another was 17.  Some of the other residents of her town (unnamed) were less than supportive and less than helpful, but her parents were truly on her side and as supportive as you hope parents would be.  Another was working with college students and had taken part in a stand up comedy evening, to raise awareness and to try to put an end to the prejudice she had experienced when younger.

One of things I had not thought about was the process that people go through to change from the gender that biology has given them, to the gender that they feel they have.  Another was the idea that you would actually not feel at home in the gender assigned by biology, which was definitely something that was true for these five women - they all felt they were women, and not male.  Another was language, and I follow the BBC in referring to these five people as "she" and "trans women".  They had all been biologically male at birth, but felt they were women.  Some had completed the process, others not. 

More recently, there was a fascinating article in the Guardian about transgender children.  A girl who from an early age always wanted to be referred to as "he", and a boy, who as soon as she could talk, said she was a girl.  A fascinating and informative read, which makes reference to:

NHS Choices - Gender Dysphoria

Mermaids - a charity for children and teenagers with gender identity issues

Pace - the LGBT+ mental health charity

And there is also this gender identity information for young people, from Stonewall.

Grinders' disease

What is the connection between the 1945 film Brief Encounter and Sheffield?   Not the setting, or the destination of any of the trains (although there are signs for trains to Skipton and Bradford).  But the interests of Dr. Harvey, the male character played by Trevor Howard.   There is a scene where he talks about pneumoconiosis, and mentions that it can be caused by metal dust.

And this is grinders' disease, common among Sheffield grinders.  Sheffield City Morris dance to a song about the Sheffield grinder, and a bit of further research uncovers this song, sung here by Roy Bailey. 

At what is now Abbeydale Industrial Hamlet, grinders ground scythe blades, using water powered wheels.  The blades were exported worldwide.  There is information at Kelham Island Museum as well about the grinders, many of whom ground cutlery blades.  One of the hazards was that the grinding stone would break and the grinder be injured by the pieces flying off.  This is why health and safety is important, to prevent this sort of thing happening! Another hazard was the dust.  Bailey's song records the thought that 32 was old for a grinder.  Sheffield is built on metal related industries, but the impact of these industries on the people who worked in them is quite thought provoking.  Working with hot metal and working to shape it were and are hazardous pursuits.

Searching PubMed for the phrase "grinder* disease" gives you a message that the quoted phrase is not found (although see below), but it does then find more than 80 references mentioning both words.  Some are about diseases caused by vibration, but the most recent are from July 2014, one about silicosis in agate workers in Iran and one about "cobalt asthma" in valve grinders in the English West Midlands.   The last item in the list is titled "Contributions towards the pathology of grinders' disease of the lungs", from the Provincial Medical Journal of 1843, by J.C. Waterhouse of Sheffield.   This quotes earlier work about the disease, including work that provides figures that back up Roy Bailey's song's observations about how long grinders live for.  Waterhouse's article is in PubMed Central.

A search of PubMed for sheffield grinder* turns up a series of five articles by John Charles Hall, in the British Medical Journal for 1857, about the diseases of the Sheffield grinder.   These articles were themselves the first in a series about "Diseases of special occupations" and are also in PubMed Central.

Steel City Science also has a piece about the issue.  There is much more about Hall in Plarr's Lives of the Fellows (of the Royal College of Surgeons of England), 

That was indeed a brief encounter with grinder's disease!

But it is not over yet.  Here is a photo taken in September 2015 at Shepherd's Wheel, on the Porter Brook in Sheffield.  This grinding wheel was reconstructed and is now open at weekends.  Like workers in the 19th century, no protective clothing, but unlike them, the demonstration lasted seconds, enough to show how it was done and how loud it was, another thing that affected grinders, perhaps.

Wednesday, September 09, 2015

Playing doctors and nurses. And medical librarians

This is a toy figure belonging to my younger son.  Working on a large model boat, he managed to fall off, and needed treatment.  

He had hurt an arm.  We know about slings - about a year ago I had one.  So my son made a sling (more like a splint, I think) out of something he had to hand (sorry), to immobilise the arm.  Then we needed to know if there were any other injuries, so we conducted an X ray (with a torch).  You can begin to see the things we talk about at home - never have a medical librarian for a parent, is possibly the lesson.

Anyway, we discovered he had a head injury.  We know about those too - about a year ago I had one of those too.  So, we kept him under observation and asked him questions from time to time about if he knew where he was, and so on.  

And we found that he had broken ribs.  What to do with broken ribs?   We did not know.  I had not had any of those.  So, we looked it up.  I managed to persuade him in a previous episode of this game (which involved dinosaurs, which is another story) that medical librarians could look things up if doctors and nurses did not know what to do.   Or, they could show the doctor or nurse how to look things up.

So, I looked it up in a first aid book.  A bit there, but nothing about how to treat them.  I tried the impressive St John's Ambulance app, with similar results.   So, off to the computer, to NICE Evidence Search.  I tried rib fractures first, thinking that more medical language might be appropriate.  Among the results, some things about whether CPR causes rib fractures, but nothing immediately that answered the question of what we could do for this poor man.  So I tried broken ribs, and the first result was from Patient (as, a favourite with our medical students, is now called), and the second from NHS Choices.   Having looked at those, we decided that we did not need to bind the ribs up, in fact we should not do so, and that painkillers, rest, ice packs and sleeping standing up were what was required.  We also had information about when he should go to A and E.

There we are.  Imaginative play, but it reminded me of one of the purposes of medical and health librarianship.  You may know what to do, because you are a doctor or nurse, or you have done it before (assuming you did the right thing then, of course), but if you do not, you have to look it up, and that is where librarians come in.

Friday, September 04, 2015

Narrative medicine

We recently had a very good fortnight at the lovely Treshnish and Haunn Cottages on the beautiful Isle of Mull, and among the books on the shelves there was a copy of an issue of Granta about medicine (issue 120, Summer 2012, see here for a contents list  - full articles only available to subscribers). 

One of the pieces was by Chris Adrian, a published novelist who is also a paediatrician in the USA.  It was (or appeared to be) an address to students at his old medical school, about narrative medicine, but interspersed with his own story (of that of his character, but either way demonstrating the use of narrative).

Narrative medicine is the use of patients' or practitioners' stories in health care, or the use of fiction to explore health issues.  (Thanks to a slide presentation from the East Scotland Postgraduate GP Training Unit for that).

In the piece, there is mention of two articles in Academic Medicine, a real journal.  I was interested to check to see if these were real articles, and they appear to be. 

First, an article by Dasgupta of Columbia University.   This is PMID 15044169, about empathy, although PMID 25945967 is much more recent and by the same author.  (PubMed puts these two in a box at the top of the search results, as well as among the search results, which include results containing the word academic and the word medicine, as well as those results in the journal of that name).

And then, one by Kumagai of the University of Michigan.   Because foolishly I have forgotten to make any more detailed note about what the article was about, I am not sure which of the 20 odd results it is!

A PubMed search using the journal abbreviation (Acad Med) still looks for acad and med separately, but finds fewer red herrings than using the full words. 

A few links for more information:

Columbia University Medical Center's Program in Narrative Medicine - as well as details of the activities and courses of the Program, there is a bibliography of work by Program members.

King's College London has a Centre for the Humanities and Health, which has been involved in setting up an International Network of Narrative Medicine.

The BMJ has published a short series of articles about narrative based medicine (you will need a subscription to read the articles).  Trisha Greenhalgh and Brian Hurwitz, the authors of at least some of these articles, also wrote a book called Narrative based medicine: dialogue and discourse in clinical practice (ask your librarian, unless you are one, of course!).