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.