Thursday, September 01, 2016

What's in a name?

You have waited a long time for this post, I notice!   I am sure you have had plenty to do while waiting.

In their article Chronic renal confusion, Chi-yuan Hsu and Glenn Chertow looked at the wide variety of terms used to describe the same level of kidney function, and the wide range of renal function described by the use of a term like "chronic renal failure".   They examined a sample of literature to reach their conclusions (1).

They argue that some terms should be dropped - a term like "chronic renal failure" has negative connotations for patients, and a term like "pre-dialysis" might discourage practitioners from attempting other sorts of treatment.   They argue for the use of "chronic renal insufficiency" instead. 

I am not sure people have been listening in the intervening 15 years!    Maybe it is too big an "ask".  There are still lots of terms for the same thing, and people do use terms interchangeably (their example is "chronic renal failure" and "end stage renal disease").

Their article shows two things:

1.  The wide variety of terms used to describe the same thing demonstrates why you need to include synonyms in a search.  This is particularly important if you are doing a systematic review, or other sort of systematic search.  You must try to use all the terms that authors might have used, however odd that usage might be.
2. It is important to review your search results, to remove those where the authors' definition of that condition does not match yours.   There is not a lot you can do in the search strategy to deal with this.

I think point 2 is the responsibility of the requestor of the search, or the reviewer of the results, and not the information specialist/librarian.

Point 1 is definitely the responsibility of the searcher, so often, the librarian, with help from the requestor or reviewers.

As an example, I devised a search strategy for chronic kidney disease, which is on the UHL Clinical Librarian Blog.

(1) Hsu CY, Chertow GM. Chronic renal confusion: insufficiency, failure, dysfunction, or disease. Am J Kidney Dis. 2000;36(2):415-8

Monday, February 15, 2016

Appraising information in a language not your own

I was looking for information in Portuguese or Spanish about the Zika virus. 

I had shared the National Library of Medicine's page of resources on the lis-medical discussion list, and had a response from  Neil Pakenham-Walsh of the splendid HIFA2015 group to say there were few items in Portuguese or Spanish, the languages of the areas most affected. HIFA have a Portuguese discussion group and they had been discussing it. 


According to the WHO's ePortuguese project,  Portuguese is the sixth most spoken language in the world and the most widely spoken in the Southern Hemisphere, but is not an official UN language, so there is often a lack of information in it.


So I started to look and ask around.  I have included my findings into the March Internet sites of interest column for the Health Libraries Group Newsletter, sent last week to the editor.


I got some useful sites from colleagues on the EAHIL discussion list, many of whom are course in Portugal or Spain.


But I also googled it. found some material in English (well cited or linked to, I imagine, and the virus has the same name in both languages), but of course some things in Portuguese, which was the point.  But I don't speak Portuguese, so now would I know which sites to trust?


Actually it is an interesting question how much I can check the information in medical websites in English for accuracy, given that I am not a medic, but I certainly can't do it for Portuguese language sites!


 But I can check: 
  • the date it was last changed;
  • the scope of the information - what aspects of the subject does it cover? With this example, at this time, does it give advice for travellers or pregnant women?;
  • who writes or edits the information and their qualifications;
  • the references and links, and how up to date they are. Are there any?  What are they?  News items, official information, or peer reviewed articles? Are there links to the latest research about, say, Zika and microcephaly?
  • whose site it is.  A Brazilian site had .gov in the URL.  One from Portugal did not, but an inspection revealed it was a government ministry.  It was subsequently mentioned to me by another EAHIL member, which confirmed my thought about it. 
  • what sort of site it is - this assumes that a popular news site will look as I expect it, but could there be clues in layout, presence of advertisements, and perhaps the topics of other stories that appear?  Are those stories world news, celebrity stories, or all health or science related?
 Is it possible to be satisfied with all these things, and still end up with inaccurate information?  Is this actually much different from what you do to evaluate information in your own language(s)?
There might be a cultural aspect too.  In theory I could write an information sheet in another language, but I would not have knowledge of that culture and might produce something unhelpful or inappropriate.  Information from a country where the language is a first or major language, or from a global concern like the WHO should be a good starting point.
Then there is Google Translate, which offers its services if you use Chrome to read a page in a  language not your default.  That is a topic best saved for another post!

Saturday, February 13, 2016

Culture (2)

At the Graves Gallery in Sheffield today.  I was struck as always by the 17th century Dutch art, scenes of the sea and ships, and of frozen lakes with people skating and playing what appeared to be golf.  But I was struck too by "Kiss", by Marc Quinn.

I had noticed something about it and wondered if my 7 year old had noticed it too.  So I asked him what he noticed about the sculpture.   The people were kissing, he said, and they had nothing on.  Anything else?, I asked.  Yes, he said, the man has only four fingers. 

I had not noticed that.

And, he said, the woman only has one arm.

I had not noticed that either, because I had looked at the sculpture only from one angle.

What I had noticed was that the man's arms were short, but I had not noticed those two things.

The notice nearby points out how many classical sculptures have missing limbs, due to damage or just due to time.   But this sculpture has missing and differently formed limbs, as the models, and others, do. 

Culture (1)

Two asides.  The first.  I get plenty of reading time with my daily commute from Sheffield to Leicester, and very much enjoyed Remarkable Creatures, by Tracey Chevalier.  It is the story of two women who looked for and found fossils, Mary Anning and Elizabeth Philpot.  There are so many facets to the story - the attitude of men to women, of male scientists to female fossil hunters, of the landowning class to the working class.  Anning discovered new species of creature, preserved as fossils in the continually sliding Dorset cliffs, and yet it was not her name that appeared by one of them in a London collection, but the name of the local landowner who owned the land that the creature was found on, and who saw nothing wrong with his name being there and not hers.   Then there is the shock posed the fossils to people taking the account of creation in the Book of Genesis literally.  What were the fossils?  What happened to the creatures - why were there none still living?   Did God kill them off?    Or were they a puzzle to be solved.

And the scientific literature features too, written by the male scientists and not the female fossil finders, although one of them reads papers that she is sent.   

A fascinating read, which I would recommend. More about it on Tracey Chevalier's website, including a gallery of fossils.

Image from, a painting kept at the Natural History Museum in London which was owned by her brother Joseph.

I'd heard about Mary Anning a long time ago, as I used to spend my summer holiday in Lyme Regis, where she lived and where she went fossil hunting.  It was where my grandmother lived, and for a time she lived in Anning Road.

Thursday, January 28, 2016

More about Zika

At the moment it would be possible to write a new post every day, as Zika remains very much in the news and spreads wider.  It was the headline on the BBC News this evening.

One item in this post, and that is this resource page from the (US) National Library of Medicine, from their Disaster Information Management Resource Center: 

Zika Virus Health Information Resources (NLM)

Share the page with anyone who might want to know about it.

Wednesday, January 27, 2016

Depressiegala - Depression gala


I saw about this in De Volkskrant recently, and I thought was such a good idea I would share it here.

Het Depressiegala took place on "Blue Monday", 25th January, in the Theater Amsterdam, to raise awareness of depression and raise funds at the same time.  An initiative of two psychiatrists, Esther van Fenema and Bram Bakker, the gala featured singers, journalists, writers, presenters, comediansOne was the writer Marjolijn van Kooten, who has written of personal mental health experiences, and has appeared with Bram Bakker.  Also there was Edith Schippers, Minister of Health, Welfare and Sport.

The site has video and media clips, a list of symptoms of depression, and links to more information.

It's all in Dutch, of course.  Except there is a link to Sane, with the comment that in England there is attention being paid to mental health, and stigma being broken down.  

If you have Dutch (I have some, but you may have more), have a look.  And if not, the whole thing is such a good idea, so have a look!

Friday, January 22, 2016


Updated 26th January

I had never heard of this virus before cases started to appear in the media in the last week or two.  It seems, from this WHO Fact Sheet, found through NICE Evidence Search, that the consequences are a mild fever, conjunctivitis and a rash.  But of course, zika, transmitted by mosquitoes, has made it to the news because of the serious effects it has on the fetus, causing microcephaly.  It has been linked in the past to autoimmune diseases.   

NICE Evidence Search is a good place to start, and finds some of the resources below.

Here are some resources about zika.

News stories:

BBC News, 26.1.16, reporting travel advice from Travel Health Pro.

BBC News, about a WHO report that zika will spread beyond the Americas, 25.1.16

BBC News, reporting three cases in Britons, as reported by Public Health England, 23.1.16

The Guardian, reporting research into the link between zika and Guillain-Barre Syndrome, 23.1.16 

BBC News, reporting calls from health officials in South America and the Caribbean that women should delay pregnancy, 23.1.16

The Guardian, 21.1.16

BBC News, 21.1.16

If you read Dutch, De Volkskrant, 22.1.16

Stat News, 21.1.16 (Stat is a US based health news site, which I have recently discovered)

Some guidance:

Public Health England, last updated 26.1.16 .

European Centre for Disease Prevention and Control, rapid risk assessment of the association with microcephaly and Guillaine-Barre Syndrome.

Royal College of Obstetricians and Gynaecologists, policy briefing for pregnant women planning to travel to affected areas.

Some of this I found through a Twitter hashtag.

Sunday, January 17, 2016

Clinical trial tragedy in Rennes

Some days back, news started being reported on the BBC of the hospitalisation of six people in Rennes in Brittany.  The six were part of a Phase 1 clinical trial, and one of them was reported as suffering brain death.  That person has now sadly died.  Four others are still in a serious condition.

Le Monde reported that the drug was called BIA 10-2474, and an Internet search for that brought up the resources listed below.  I have not been able to find the trial in a registry, but am not that experienced yet with clinical trials registries, so am not sure why this is.

Here are some resources, including Le Monde, about the trial and what has happened.

Le Monde - reporting the death of one patient (17th Jan, in French)

Le Monde - earlier report on what is known about what had happened (15th Jan, in French)

Article in Science's news section about what is known (15th Jan)

Article in Science's news section with more details (16th Jan)

In the Pipeline blog, from Science Translational Medicine (15th Jan, but with more recent updates, including a link to two further articles in French, and a lot of interesting comments with possible further information).

In one of the comments in In the Pipeline is a link to a story in Porquoi Docteur, a French site which looks like it might be worth monitoring.

There is a good deal of technical information, including more about what the drug actually could be, on Chris Southan's blog.    And on the Chemical Collaboration blog, which discusses what could be predicted about what would happen.

If you read German, you can see a detailed account in Deutsche Apotheke Zeitung.

Friday, January 01, 2016

Maggots and wound debridement

I think I am enjoying CBBC's Operation Ouch rather more than my lad, who is within the target age group of CBBC!  This is a series about the body, medicine and health, and the presenters are doctors.

Today's edition included a journey with paramedics, a six year old visiting A and E having fallen on gravel, and bacteria being grown after people have kissed a Petri dish.

And sterile fly larvae being bred and used to treat wounds, with a warning before the footage was shown of a foot wound being debrided.  I remembered that this was a search topic we used to use in classes as an example to work on, as there are things to decide about search terminology (maggots, larvae?   wounds, debridement?).

I have an iPad to use in my clinical librarian post, with several apps to use on the ward.  What do they find? 

UpToDate: searching for maggots (I typed as much as "magg" and "maggots" appeared as the list of results) finds "Basic principles of wound management".  The literature review is current as of November 2015 (although there is a peer review process), and the last update to the topic was in May 2015.  The Find facility takes you to the section "Biologic", under "Wound debridement", which outlines uses of maggots.  RCTs have not found consistent reductions in the time to wound healing, although maggots compare well in terms of cost to hydrogel.  Maggots may reduce the duration of antibiotics in some patients, although there are negative perceptions associated with the use of maggots and pain may limit its use.

The NICE app: nothing found for "maggots" or "larval".   As you type a search term, results are shown, so there is nothing for "maggot" or "larvae" either.  Searching for debridement finds items (I got as far as "debrid") including "Wound care - debriding agents", from 2001.  Following this takes you to NICE Guideline CG74, "Surgical site infections: prevention and treatment", from 2008, which replaced it.  This seems more specific, and although I can't find a way to search the full text, there is no obvious sign of larvae.

PubMed for Handhelds: a quick use of the PICO search for P = wounds and I = maggots (or larvae or debridement) finds some useful looking results, although a change of search terms seems to make a lot of difference, and using "maggots or larvae" as the I finds a Cochrane review that I can't spot in searches for a single term.  I am not sure without checking what order results are shown in.  The Cochrane review turns up in a search of a final resource:

NICE Evidence Search: maggots, and filtering to systematic reviews, finds that Cochrane review (Debridement for venous leg ulcers, September 2015), as does a search for debridement.  It is also worth noting that NICE Evidence Search finds information in the BNF and about how to get hold of and dispose of maggots, which are available on the NHS.  That Cochrane review seems not be be referenced in UpToDate, but it was published very close to the last literature review, and the UTD peer review process may still be looking at it.   Having said that, it is not obvious from the abstract (viewed in PubMed itself) what the review has to say about maggots.  They are certainly investigated in some of the RCTs in the review, but in the abstract they are not clearly distinguished from other methods of debridement.

So, there is evidence there worth exploring.   You might need to use more than one source and which tool you use might determine what you find first, and what search terms you use may do the same. You will need some idea of what forms of evidence are viewed as the strongest, and will need to read the items you find in detail.