A host of golden daffodils

Beside the lake, beneath the trees, fluttering and dancing in the breeze.  But not near the food in supermarkets.  According to this report in the Guardian, Public Health England have issued guidance that says daffodils should not be displayed in shops near the food as daffodil bulbs are easily mistaken for onions, and daffodil stems look like a "type of vegetable popular in China".  There seems to be no sign of this announcement on the Public Health England website, but however.  

So, where is the evidence?

The Guardian quotes the British Columbia Drug and Poison Information Centre, a reputable looking site that also happens to be quite near the top of Google search results for daffodil poisoning.  Slightly lower down the results is The Poison Garden, which has a lot of detail (the site is run by someone who volunteered at the Poison Garden at Alnwick Castle, but is not connected with it).  There are plenty of stories of poisoning in this site, but as it points out, it is poisoning that usually does not require hospital treatment and so does not end up in statistics.

It seems not to end up in the medical literature either, for, I imagine, the same reason.   A search of NICE Evidence Search for daffodil poisoning finds three things, one of which is a red herring.  The first is about plant enquiries made to New Zealand's National Poisons Centre, reporting that the daffodil was the tenth most commonly reported plant.  The third is from the Pharmaceutical Journal, providing historical stories about bulb poisoning.     If you search NICE Evidence Search for just daffodils, you find items about contact dermatitis caused by daffodils, and galantamine, a drug used for treatment of cognitive impairment and Alzheimer's disease (and one of the compounds mentioned by The Poison Garden as causing problems if you eat the bulbs).  

Searching Google for daffodil poisoning site:nhs.uk finds information from NHS Choices, covering plant dangers in the garden and countryside and making a tiny but significant mention of daffodils.  
 Looking in PubMed turns this up, an article about poisoning caused by eating the stalks.  Although the study was published in an American journal, the incident involved the Chinese community in Bristol.  The daffs were indeed next to the veg.  This incident is mentioned in The Poison Garden. 

So, where's the evidence and what is it?   Not much in the peer reviewed literature, but some sites that advise of the problem and record the stories of individuals. 

Statistical literacy

Ben Goldacre (of Bad Science and Bad Pharma fame) was on BBC's Newsnight last night (Wednesday 4th) advocating severe punishments for politicians who misuse or abuse statistics.   I am not sure I would go that far, but I think the point about misuse of statistics is a good one.

One possible response to statistical misbehaviour is people being more statistically literate, so they can spot the misbehaviour.  There is a discussion of the problem in Wikipedia.

How much knowledge would we need to be statistically literate?   If we are a healthcare practitioner trying to apply the results of a piece of research to our own practice, then I suspect quite a lot, and the sort of thing that is covered in health education courses.  But someone looking at government statistics about, say, unemployment, or waiting times might just need to be able to identify things like graphs whose vertical axis doesn't start at zero, using different time periods or starting points, and the different sorts of "average".

So, what would help?  There are books, like How to lie with statistics, and The tiger that isn't.  There are revision guides on the web, for GCSE, for example, but they rather assume you know what statistical technique you need.    There is the BBC programme "More or Less", which has pages that discuss various things in the news, as well as clips and episodes.   The Open University, a partner in the programme, have a site with resources.

Making sense of statistics, from Sense about Science and Straight Statistics , looks rather useful.  It covers percentages and certainty, among other things.   

The work of Straight Statistics is now carried on by Full Facts, a fact checking organisation, whose site looks at statistics in all sorts of areas including health.  

English sweat

In the current BBC adaptation of Hilary Mantel's "Wolf Hall", Thomas Cromwell loses his wife and two daughters to a mysterious and very sudden illness.  All we see is that they all go to bed as usual, and then cannot be woken in the morning.  There is a suggestion that there were symptoms, but we don't see them.  The disease is described as "English sweating sickness", either in the programme or in something I read about it (bad note taking, can't remember my source).

What was it?   A search of PubMed for English sweating sickness brings up this very new article proposing that the guilty agent was hantavirus.  Related citations displayed include this older one from the New England Journal of Medicine, and this from Medical History.  The new one and the Medical History are free to read, the NEJM one may need a subscription.

Searching English sweating sickness with inverted commas "English sweating sickness" helps, as you then don't get things about other things, and searching for just English sweat is also useful (spotted from the Medical History reference).  There is also a MeSH term Sweating sickness/ and one for Hantavirus and another for Hantavirus infections, so plenty of other avenues for exploration.  


CDC advice suggests hantavirus infection is still a real possibility in the USA and a good reason for not having mice or rats in your house.  There is UK government advice too, which suggests it's much rarer in the UK, but is indeed a real issue elsewhere.  Finally, the Health and Safety Executive's page about zoonoses has general advice on zoonoses (infections transmitted from animals to humans) in agriculture, and a link to an information sheet.

 Have a read if this post has made you worried.

PEDro - evidence for physiotherapy practice

I knew about PEDro, the physiotherapy evidence database, but have actually been using it to find material about head injuries (my obsession with this is explained elsewhere!).

PEDro is a freely accessible database of RCTs, systematic reviews and practice guidelines in physiotherapy.  It gives you bibliographic details and (if permitted by the publisher) an abstract, with links to full text. These links include publisher links, which will work if you or your institution subscribe that way (and you are on campus, in the institutional case), links via DOI, and sites like PubMed Central, and links to PubMed.

Something it offers that Medline does not is an independent assessment of quality, giving a score out of 10.  The reason for the score is transparent, and when you read the record you will see how the item scored with regard to things like blinding, allocation, and intention to treat. 

On the advanced search screen you can use the drop down boxes to select therapy, problem, body part and topic.  Method is RCT/SR/practice guideline.

So, to find things about work with people who have had a head injury, you could select Body Part = Head and Neck and Topic = Neurotrauma.  This finds guidelines from NICE and SIGN and one from Australia (PEDro is Australian), three systematic reviews and a dozen or so trials.  The guidelines are not in Medline, for sure, and some of the other material might not be.

You have to move from result to the next by going back to the results screen and choosing the next one, but if you click the select link on that results page, you can then display full records of those you have selected, on one screen.   From that screen of selected records you can export to EndNote or RefWorks.

Import to EndNote involves emailing the results and saving the email as a text file. I can't work out how to do this in Gmail, but I did copy the text from the email to a plain text file and managed to import that, following PEDro's instructions.

Import to RefWorks involves copying the results, then importing using the "Import as Text" option under References > Import.  For this, you paste those copied results into a box in RefWorks.  This worked although PEDro only includes authors and title, and does not seem to include guideline number.  

PEDro is a good way to find evidence for practice in physiotherapy and perhaps beyond, and its quality assessment information is not to my knowledge matched by anything elsewhere.

Information about head injuries and seizures

Or brain injuries and epilepsy (see an earlier post).

Here are some sources of patient information about head injuries, seizures, or both:

NHS Choices - Epilepsy - Causes

NHS Choices - Severe head injury
A head injury is "severe" if it involves unconsciousness or a low score on the Glasgow Coma Scale.

Neither of these is, as they themselves will tell you, a substitute for a doctor.

Cookbook medicine

This was a criticism levelled at evidence based medicine, when it became a way of thinking some years ago.  The criticism was that your doctor would diagnose you, and then look up what to do and do just that.  There was no place for expertise or experience.   

Present day diagrams of evidence based medicine include, of course, professional expertise and patient experience, as well as the research evidence. 

I don't think that was ever a fair criticism, but having had a head injury in September (I fell off my bike), and been in receipt of doctors' advice, I think it misses the point. 

The diagnosis may not be easy.  And the evidence may be difficult to find, and when you have found more than one piece of evidence, you may have more than one recommendation.  

Following my accident, the DVLA told me I must stop driving.  I had reported the accident in late September, and they told me this in mid January.  This was because I am at an increased risk of a seizure, as a consequence of the head injury.  This is the guidance of their medical panel.

However, after I was declared fit for work, and while I was waiting to hear from the DVLA, I asked my GP for advice (the DVLA recommend this, while you are waiting).  They felt I was ok to drive.  They examined me, read my notes, and talked to me (the DVLA had only been able to do the second of those), and they knew what the DVLA would be worrying about and felt I was at low enough risk.   

Why the difference?   Was someone not applying the evidence alongside the patient experience and their own expertise?  Was someone living by the cookbook method and the other one not?  Was there something wrong with the cookbook?

What does a medical librarian do when faced with a health problem?  That's right, they do a literature search. 

Guidelines do seem to agree that having a head injury makes you more at risk of a seizure.  They don't, however, quantify the risk, and they don't seem to talk about any other factors that might increase the risk.   So I searched Medline.

And that is what made me think of the second and third of my reasons.

Was it a head injury, or a brain injury?   The MeSH term Craniocerebral trauma/ covers them all, but is that too broad?  And are we talking about Epilepsy as the complication, or Seizures?   Several articles I found did indeed say that head trauma (another possible search term!) did leave you at increased risk of epilepsy, but maybe for a year, not six months, and maybe much longer.  It does not seem to be clear cut.

A textbook I found said that a seizure at the scene might actually not count as epilepsy, and that there is also an issue with who observed it.  If it was someone who had come to help, they might think it was a seizure when it was not.  I wouldn't know the difference, I am sure, and would probably tell the paramedics that I had seen a seizure.  But what if your helpers were health professionals and actually knew?

And was it a mild head injury or a serious one?   This might depend on the definitions in the paper you are reading, but is there an agreed set of definitions?


So, no cookbook medicine.

Even if the diagnosis was straightforward (seizure or not, mild or serious injury...?), finding the evidence is not, and reconciling it with other evidence is not either (is "post traumatic epilepsy" the same as a post traumatic seizure, why do different studies report different risks...?).   There is a need for the expertise of the professional alongside the evidence and knowledge of the experience of the patient.

Patient information

Simon Stevens' Five year forward plan for the NHS mentions people making more use of web based health information as an alternative to a visit to the GP or A and E ("Build the public’s understanding that pharmacies and on-line resources can help them deal with coughs, colds and other minor ailments without the need for a GP appointment or A&E visit." - http://www.england.nhs.uk/ourwork/futurenhs/5yfv-ch3/, Box 3.1).

This could help some people avoid having to use hospitals, unless they need to hear something from a health professional rather than read it.  But perhaps if people knew how to find and appraise web based information, they would feel more confident in their own discoveries and more confident in the advice they have read, and not want to get professional input.  And they could look for information to add to information they have received from a health professional.

There's an interesting potential role for health information professionals in this task of building understanding that online resources are an alternative to securing and sitting waiting for an appointment, or waiting in A and E.  Could we work with the NHS or with patient organisations to help people to realise that online resources are useful, and how to find material you can trust?  

On Facebook recently, two people I know have reported family health problems, both with children.  Should I have offered some information?  Or is that presumptuous, as I don't really know the whole story.   In fact, in one case, I did, as it was something we had encountered in our family and there was information we had looked at.  I had known that information was reliable (it was from NHS Choices) and we had found it useful. The other case was nothing we had encountered, and so I did not offer anything.   You cannot possibly get the whole story on Facebook, although maybe I assumed in the first case that because we knew about the condition, we did have the full story.

And is there a potential role for health information professionals in "training" people in general, perhaps patient groups (who might be receptive to the idea of web based information, and already be doing it), or community groups?   I imagine those groups themselves are already offering support in finding information, or actually providing trustworthy information, and some have health information professionals working for them, but perhaps others of us can offer our skills.

NHS Choices Information Prescriptions is an interesting service for all sorts of conditions - enter a condition and a postcode and receive information about the condition and local services.

Classroom observation

I get to take my younger son to school three mornings a week, not something every parent gets to do.  On the way home recently I found myself thinking about levels of understanding and evidence based practice.    As you do.

The children enter the classroom ten minutes before registration.  On the whiteboard (electronic) is a piece of work.  They do that work on individual whiteboards (the sort that need pens).   It might be writing down the nouns they can see in a picture, or adding adjectives to a sentence.  When ten minutes is up, the bell goes, and grown ups, who are allowed to stay and help with this work, have to go.

For some grown ups, "help" is writing the questions on the whiteboard for their child (the teacher would rather they didn't), for others (including me, sometimes), it is frustration when their child does not engage with the task.

Sometimes the whiteboard work is numbers, and recently it was partitioning numbers - 25 is 2 tens and 5 units, 123 is 1 hundred, 2 tens and 3 units, for example.

My son could not remember what to do.  He had done the work before, and at the time had understood it well enough to explain it to me.  On this occasion, everyone else on his table had made columns, one for hundreds, one for tens and one for units, and then filled them in.  Reading the question on the class whiteboard made me think this was a possible way to do it, but I could not remember how he had done it before.

I suggested he try the table and columns method.  Just before I left for home, though, the teacher mentioned to me that the column way of doing it was what one parent had done, and then everyone on that table had copied it.  I am not sure who copied it - parents or children - but it was not the method they had been shown in class.  That might explain why my lad was reluctant to do it that way, even though he could not remember how he had done it in class.  I wonder where the parent had come across the method?

The child next to him offered to help, but his help was to allow my lad to copy his table of columns.  My lad obviously did not understand what he was seeing but copied it anyway.

Several things occurred to me on the way home.

First, my lad had understood partitioning when he did it the first time, and had explained it to me.  When they had partitioning to do on whiteboards at that time, he had been able to do it.  And now not.  Why not?   Had he forgotten?   Lack of practice since?  What form did his understanding at the time take? The fact that I could not remember what he had explained to me is telling, too!

Then, he did not feel able to use the method that those around him were using.  I could see it made sense, but did he remember that it was not the method they had used before, even though he could not remember that method?

Then, what did the parents see as "help"?  Completion of the task?  Doing it for their child?   However, I am not sure I saw that - even if a parent writes down the questions, they don't write the answer.   Even if it was a parent who thought of the table and columns method of partitioning, it was the child who was filling in the numbers.

As someone involved in higher education, I then started to think about medical students.   They have learnt to do something in a particular way, and they might remember that way.  For example, they have learnt to search Medline in a particular way and might remember it for an exam.  But do they remember why that way is the "best" way, or a good way, at least?  Have I covered that in my teaching?  Can they apply those skills in another context?  They learn to search to complete an exercise, and again to pass an exam, but can they use it to find information for assignments or even, in due course, for patient care?   Do they see that those skills apply in those other contexts?   Can they remember those skills for long enough to use them in another context?  Or if they can't remember those skills, do they at least remember they need them, and go and learn them again?

What do they see as the aim of learning a particular thing?  Just to pass a test or click a box?  What application does it have?  And what happens when they have spent time learning other things, do they still remember it?

Then there is the "see one, do one, teach one" model - that is copying what you have seen.  Can you teach it if you don't understand it?   If you keep up to date and find out about a new way to do it, then do you need to understand what you did before in order to be able to change your practice? 

And having thought of all that, I got home.

Finding your way

Driving somewhere?  Satnav or map reading, that is the question.

Satnav, pluses and minuses:

• - Risk that you will just follow instructions (copy what you are told);
• - You may have no idea how the route is generated;
• - You may not not know where you are in relation to your destination;
• + You don't need to make a choice over route;
• + If you go wrong, the satnav will work out what to do;
• + You can drive solo with a satnav;
• + It is easy to get started with a satnav;
•  - But better if you take time to work out how it functions.

Maps, pluses and minuses:

• + You know where you are in relation to your destination;
•  +/- You have to work out how to get there
• +/- You need to decide which route, if there is a choice to be made;
• - The map won't tell you where the potential bottlenecks are, although it will tell you which is the most major road if you know the symbol;
• - You can't read a map and drive at the same time;
• - If you go wrong, you need to work out yourself what to do.

Our family car recently gained a satnav, a birthday present for one of its drivers.  We have named it Sally Satnav, as it has a female voice. It (she?) has navigated one or other of us around areas we did not know, and worried for us about the correct junction to take off the motorway and what to do next.  And when we missed a turning, Sally recalculated for us.  Our youngest is amused when Sally does not know the name of a road and tells us to "turn left on road", rather than something like "turn left on Leppings Lane".  And we know what time we are likely to arrive.

I remember testing Sally Satnav on a familiar route in the town where we lived at the time.  She wanted to go a different way to the way I had always gone.  It would have worked.

We have had to learn about how Sally works in order to get the most benefit.  How much notice do you get of junctions?  How do you know if that side road is the one?  Can she tell you what lane to be in at large junctions?  Does she know about roadworks or traffic jams?

But, we have had left turns that are almost too sharp to get round, and more than one road that is only just wider than the car.  And cases where the lane markings and the signs at a roundabout say to go one way, and Sally says to go a different way.  Was it a shortcut?   These things, I imagine, are because of the way Sally calculates your route. 

I am much happier with a route if I have done it before, and not that confident at map reading, so a satnav seems ideal for me.  But to find my way around Sheffield, I have decided I prefer maps.  I want to know where I am in the city (north, south, east or west) and if I am near an area I know, and those things are easier with a map.  I begin to build up a picture of the city in my head.   And on longer trips to unfamiliar places with the satnav, I have not enjoyed the feeling of not knowing where I am on a map, not knowing where I am in relation to where I want to be.

Recently, an academic colleague used the image of satnav and map in discussions about levels of understanding of our medical students.   I have been unpacking the image since.

They learn something and can repeat it in an exam, and perhaps explain it to someone, but if they have to apply that thing in a new context, they are less sure.

With a satnav, I know when I have arrived, but don't always understand how I got there.  I am just copying what Sally Satnav is telling me to do.  Some parts of the route might have been difficult (narrow, sharp turns) and I may not know why.   If I go wrong, I can follow new directions, but I don't have to work them out. With a map, I understand how I got there, and where I went on the way, and I also know how near I am to the destination. If I go wrong, it is easier to see where and how it happened, and I have to work out what to do about it.  Both satnav and map require learning - how does Sally Satnav choose a route? - but you can use a satnav without needing to know that sort of thing, whereas maps are not a lot of good if you don't know how to read them and don't study them in advance.

So, I can follow the images in Netanatomy and know the anatomy of the collarbone.  I can answer a question about the anatomy of the collarbone, and tell you about the anatomy of the collarbone. But faced with a patient who has broken their collarbone, how am I going to use that knowledge to help it mend?   I might learn about the mechanism of fracture healing from a YouTube video, but can I use that basic science to advise the patient what they can do while the bone is mending?   And what if it doesn't mend, or they decide to ignore my advice?   How does the science help me decide what to do next?

Final thought in this ramble.  If I know the route, or have done it before, how about using the satnav as a way to follow it?  If I know I apply that basic science, watching the video or looking at the image may enable me to check my basic knowledge before proceeding.

H1N1 influenza in Aosta, Italy

I am off to Italy for a short break later this year, lucky me, so am trying to resuscitate my holiday Italian.   And so I have downloaded the Android app for La Stampa (I tried two others but the full text wasn't free to read - cheapskate!).  And I spotted this piece about cases of H1N1 influenza in Aosta, northern Italy.

Other Italian sources (like ANSA) are reporting the same, and today (18th January) I have found this in FluTrackers, linking to a local site.

It seems that one man has died, although he may have been in hospital with other conditions (the sentence in ANSA with "pluripatologie", but not sure), and a woman is ill.

FluTrackers also lists other cases in Italy here, some of them also this year.

I hope that's right - or I have just caused panic!   If you know it isn't right, or spot something in English, please add a comment! 

A and E crisis - amended 20th January

Much in the media in recent weeks about the crisis in Accident and Emergency, with articles comparing A and E unfavourably to military hospitals in the Iraq War, and about the longer and longer wait until you are seen.  Here are some things I have come across in the last few days:

Surviving a night in A and E: a doctor's story - an anonymous diary of one doctor's night duty in A and E, giving an insight into the patients and the staff.  Several patients who ought to be somewhere else, some who are there because they are drunk, and some who are in the right place.

A & E crisis: understanding health at a systems level could drive a better NHS - by Terry Young, Professor of Healthcare Systems at Brunel University, arguing that it is the complexity of the system that needs to be tackled, and arguing that it is time to use the tools that have been developed in other complex areas of life, referring to Atul Gawande's recent Reith Lectures.  This article is part of a series - go to the end of this page to see links to others.

A report in the BMJ about a recent report from the Health Foundation and the Nuffield Trust, which finds that most reasons for the problems do not explain the whole story.  You will need a subscription to read this article.

Rather older, dating from July 2013, a Lancet article by John House (I know, I thought that, but not him!), asking experts about the causes of the crisis.  You will need a subscription to read this too.


An Observer article about operations being cancelled because of the crisis.

The work of the King's Fund on urgent and emergency care. This site includes statistics, publications, and an "alternative guide" which examines the myths.

A new "finally", added 20th January - the BBC's A and E Tracker, which indicates how many patients in the four home nations were seen within 4 hours (England is hiding under "How is your local hospital doing?", at least for me, in England).   You can search by postcode to see how your local hospital is faring.

Search filters

I have been invited to do the literature searching for a research project looking at care of older people in hospital.  The first part of the project is a literature review.  It's fascinating, and very instructive - I have spent a lot of time working to support others who are doing this, and it is quite eye opening to do it for myself!

The literature review is of systematic reviews (SRs) and meta analyses.  I first of all had to devise the strategy, and that was very interesting.  And then decide how to locate the SRs.  And so is that ...

I could:

1.  Use the standard Medline search limits.  There never used to be a limit for systematic reviews, and meta analysis was the nearest fit, although it is not the same thing.  Publication type limits in Medline are not without issue.  There may be references indexed as meta analyses which are not (but which say they are), and there may be things that are meta analyses, but which are not so indexed.  Now there is a SR limit, but in PubMed anyway it is a filter, not a straightforward limit.  Certainly a search in Medline for systematic review.pt. finds zero.

2.  This leads us to the second possibility.  As a way to address the shortcomings of the standard limits, and as a way to get reproducible searches, there are search filters, not part of Medline, strategies which can be bolted on to your subject search.  But there are several SR filters.  Which one to choose?   Some have high sensitivity ("the number of relevant reports identified divided by the total number of relevant reports in existence") and others have high precision ("the number of relevant reports identified divided by the total number of reports identified" - this, and the definition of sensitivity are taken from the Cochrane Handbook). 

 The ISSG Search Filters Resource lists many filters, and evaluates many of them.  I wanted it to recommend one, but of course because it depends what you are aiming for in terms of sensitivity and precision, no one can say "this one is the best".

3.  The third option is not to use a filter or limit at all, but include or exclude things yourself.   If you do this, you know exactly what you have kept.  But, there is a practical consideration, which is that if you get 2000 results, do you have time to scan them all?  This is interesting, as I have certainly said to students I have been helping that they may end up with this sort of number of results!

So, what to do.  I think I will be running all the filters (and the "limit") separately, and merging the results.  I suspect, but don't know, that these separate result sets will overlap but that none will completely include any of the others.  We shall see.  I then plan to remove this merged set from the unlimited/unfiltered results, and then we can sample the remainder and see if any of the sample are an SR or a meta analysis.

I put out a request for experience and expertise on two Jiscmail lists, and the results (I shall summarise for the lists) have informed the above.

(Auto)biography as health literature

When I started out in health librarianship, I am sure there was a book called "At the end of all our work is a patient".  I can't find it at the moment, but I can find an article by Shane Godbolt with that title (1).  And as she was my first boss, that is an excellent thing to find, and perhaps that is what I was thinking of.   That fact attracted me to this field of work, and still does. 

Watching the excellent History Boys recently (excellent, and to some extent familiar, as I was at school then, though not in Sheffield and not looking to go to Oxbridge or do history), I was reminded of Alan Bennett's memoir Untold stories (included in a volume with the same name) (2).  In it he writes about his mother's experience of mental health problems, and his discovery that his grandfather had also had them and had in fact committed suicide.

Perhaps there is material in that memoir that didn't make it into textbooks or research papers, perhaps, I am tempted to say, particularly at the time.  And so this sort of literature adds something to the evidence that informs practice and research.

I was recently in hospital for a week following an accident.  I remember what I was doing in the moments before but not what actually happened at the moment of the accident, as I had a head injury.  I don't remember anything till the end of the following day, when some family members came to visit me.  I remember them being there, but not what we talked about - apparently I repeated myself and was not able to sustain any sort of conversation.  I remember my wife coming back to visit me the following day with a friend, and remember realising that this was not a dream, but again I don't remember what we talked about.  On one visit, family members brought a photo album and apparently I couldn't remember the holiday (in one of my favourite places).  I actually don't remember the photo album being brought, either.  My younger son remembers me talking to him on the phone, but I don't.

My experience as a patient is surely valuable to practitioners, although I cannot know if it is typical (surely it is not as we are all individuals), so therefore the experience of other patients is valuable too.   But so is the experience of families and loved ones.  My family remember things about the visits that I don't, and of course my wife had the dreaded phone call from the paramedics to say what had happened, and would she get there as soon as she could.  They have feelings about the whole thing that I do not, and could not have.  I don't remember ever wondering how I ended up in hospital, or whether I would be ok, although I know my wife wondered that last thing, particularly after that phone call.  Also, I came to realise that it could have been so very much worse. 
 
So, do I as a health librarian buy (or buy access to) biography and autobiography? I read Untold stories while off work recovering.  And fiction, like Ian McEwan's Enduring Love (3), which I read then too (elder son doing it at A level) - plenty of mental health related issues in there.  Do you as a health practitioner or student read (auto)biography and fiction to inform your work or studies?   What can we do with this sort of material as evidence?   Does it end up in reviews?  Patient experience of head injury as related in biography and fiction, that sort of thing.

Let me say that I had the most excellent care at the Northern General Hospital, Sheffield.  And very good follow up care - for an accident that took minutes, I have had a week as an inpatient, and five outpatient visits (two for physiotherapy, two to the fracture clinic and one to the maxillofacial clinic), and one more outpatient visit (to the head injury rehabilitation clinic) to come.  And two GP visits (I chose to have those, although one was for symptoms).   What a lot of health service time for one short accident, and I am grateful it is there. 

References (well, I am a librarian)

(1) Godbolt S. At the end of all our work is a patient.  LA Record, 79(2): 86-9, quoted in Carmel M. (1986). Impact and image: improving the library's contribution. Health Libraries Review, 3: 94-10.  Available from http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2532.1986.320094.x/pdf  (Accessed 9th January 2015).
(2) Bennett, A. (2005). Untold stories, in Untold stories.  London: Profile Books, p.1-125
(3) McEwan, I. (1998). Enduring love. London: Vintage.

Updates

A long time has passed since the last post, longer than ought to happen on a blog, but here goes...

Translators without Borders has funding to extend a project to produce Ebola information in local languages, to more west African languages.  Thanks to the excellent HIFA2015 list for this information.

Avian influenza in the Netherlands - De Volkskrant reported yesterday cases in Niedersachsen, Germany, which borders the Netherlands.  It is H5N8.   The Dutch government is maintaining its English language page, which seems not to have any new cases in the country, but which has added information about adjusted government measures.

Avian influenza (Vogelgriep)

Just discovered this official Dutch government site, in (of course) Dutch, which has a complete record of the affected sites in the Netherlands,  (go to Overzicht or Inhoud, then Locaties vogelgriep), as well as news and links to official publications.  As well as sites where the virus has been found, it also lists places that have been investigated but nothing found, so not every place listed has had the virus.

I can find nothing new about avian influenza in the UK.  The UK government site about the discovery of the virus in Yorkshire was updated today (3rd December) but that seems to be relating to rules about transport of eggs.

Could I get Ebola?

I had already seen this Top 10 things you really need to know about Ebola from the CDC in the United States.  I was in two minds whether to blog about it, as some of the points it makes apply to the USA.  But, of course, the basic medical science applies everywhere.   And also, of course, you the reader might well be in the USA!

I mention it now because last night the BBC broadcast a television programme called "Could I get Ebola?", looking at how likely it is to spread to and  in the UK.  That programme has a similar approach to the CDC poster.  There are links from this iPlayer site to further resources from the BBC and elsewhere.  The programme presenter, Dr Chris van Tulleken, works at one of the hospitals that will receive Ebola cases and has been trained in the management of Ebola.

The basic conclusion of both is that, if you are in the UK or USA, the chances of catching Ebola are very very small and it is very very unlikely that you will catch it.  

The BBC have a regular News about Ebola slot - in addition to World Service radio programme, this also includes downloadable podcasts.

Avian influenza in the Netherlands - new case in Zouterwoude

I get daily emails from Dutch newspaper De Volkskrant.  So De Volkskrant is the first place that I saw reports of another outbreak of avian influenza in the Netherlands.  The outbreak is in Zoeterwoude (South Holland, south of Leiden),   Exactly which strain of the virus it is is not yet known, with results expected tomorrow (Monday).

Read the article (in Dutch).

The article mentions (if my Dutch is ok!) that this is the fifth case, with five businesses affected, but names only four places  - Hekendorp, Ter Aar, Kamperveen and now Zouterwoude.  The NOS says that there were two businesses affected in Kamperveen, which makes everything add up.

There are English language reports of the Zouterwoude outbreak:  the Guardian and the Dutch government - in English here.  And the Avian Flu Diary blog also has a piece.

Added 2nd December - De Volkskrant reports that the strain found in Zouterwoede is H5N8 (introductory paragraph), something confirmed in the English language news site of the Dutch government.

Not meeting Campylobacter

Much recently in the press about campylobacter in supermarket chicken, for example, here.  That article seems to talk about just supermarket chicken, whereas this one, refers to Food Standards Agency research from a few years ago, research which looked at supermarkets and butchers.  It seems from a quick reading of that second article that there are certain points in the process which make the problem worse.   Campylobacter is present in the chicken anyway.

If that's the case, how can we reduce the risk when cooking?

Food Safety Week 2014 had advice on preparing chicken - http://www.food.gov.uk/news-updates/campaigns/campylobacter/fsw-2014/;

and this Patient.co.uk leaflet about treating infection lists the FSA's 4Cs designed to reduce the risk of food poisoning - http://www.patient.co.uk/health/campylobacter-leaflet.  Cleanliness, cooking, chilling and cross-contamination, but read the whole thing to find out exactly what!

Ebola update - two being tested in the UK

The Guardian is reporting in not a lot of detail that two children are being tested in Newcastle upon Tyne for Ebola and malaria, as a precautionary measure.  They have arrived from Africa but it is not clear where, and Public Health England are of the opinion that Ebola is very unlikely.

The Guardian is also reporting that trials of a vaccine look promising, according to the manufacturer.

Here might be a good time and place to mention the BMJ's news piece from a few weeks ago reminding NHS staff to be on the lookout for Ebola.  The news item refers to a BMJ letter from Bruce Keogh.  Access to the BMJ's content about Ebola is currently free.

Avian influenza and Ebola update

Avian influenza has been found at a second and third location in the Netherlands:

The second is in Ter Aar - Guardian
The third is in Kamperveen, confirmed as H5N8 - De Volkskrant (in Dutch)

De Volkskrant is also reporting a new case of Ebola in Mali, and has a graphic showing the present situation.  The captions are of course in Dutch, and English language alternatives for current statistics are CDC and WHO.  The CDC site has a graphic on the right.