Difference between quality of life & standard of living

What’s the difference between standard of living and quality of life? I went to see a talk the other day on patient reported outcome measures (not that that bit’s important) and there was a pithy little example (at least for western, Anglo-Saxon society) that went thus:

Standard of living is “two cars, two houses, two refrigerators and one psychiatrist”, while quality of life is “one car, one house, one fridge and no psychiatrist”.

Which group do you fall into (or more to the point, would you like to fall into)?

If war is too important to be left to the generals…

“You have heard that war is too important to be left to the generals; likewise, drug development is too important to be left to the drug companies“. Discuss…

I rather like that. Snappy. Poor old pharma though. They must feel like a punch bag. One often hears the argument that because drugs are so important then pharma should be in public hands. While I’m not a big fan some of the excesses of drug marketing and their constant spin spin spinning, not to mention the creation of conditions to fit drugs rather than the other way around, the idea of having the pharmaceutical industry back in the public sector makes me shudder…! British Leyland all over again.

If you use Mozilla Firefox, then you may …

If you use Mozilla Firefox, then you may be interested in an Add-on, Drag & Drop.io, that allows one to drag and drop files to a red dot on the browser. And that’s not all! This sends them to Drop.io where they ‘magically’ appear–you have the choice of barracading them behind a password or not. It is genius when it works, however, I think our settings at the office put it a bit out of whack. I can see this being very useful for sending a large reference manager database to myself (i.e. for work at home) and other things too unwieldy for either email or USB drive.

sloppy scientists, sloppy journalism

Last Friday, at least in the UK, there was a big news story about a new study that showed that babies in buggies facing away from their mothers were more stressed than those facing towards their mums, and that those stressed babies would grow up into axe-wielding maniacs. OK, I exaggerate, but only a bit. Really, the completely unsupported claims being made by this research and the way they’ve all been picked up uncritically by the media does make one despair – read the polite but firm critique of the study on the NHS “behind the headlines” pages; they conclude that “… the results have been over-interpreted and may cause parents unnecessary anxiety.” An example of an over-zealous researcher, probably having the best of intentions, actually doing harm.

Talking of sloppy journalism a recent news story in the Times about the tories being taught the basics of the scientific method seemed happily to confuse understanding the basis of evidence-based policy (which from my conversations with people who move in those sorts of circles has a very different idea of what ‘evidence’ is) with understanding scientific principles of (e.g.) stem cell research or nuclear power. It’s all so full of sloppy thinking and a lack of acuity – scientists, the media and politicians all guilty. Oh well, though has it ever actually been any different?

But thank heavens, eh, for us bloggers; restoring some much needed accuracy and impartiality to international discourse…

Published today: Just in Time Library Service RCT

A bit more self (and colleague!) promotion–and it fits right in with all this talk of BlackBerries.  Jessie McGowan has newly published, and led on, a randomised controlled trial about a project to provide 88 clinicians with information in 20 minutes or less via their BlackBerries and a web portal.

“A randomized controlled trial (RCT) was conducted between October 2005 and April 2006. A total of 1,889 questions were sent to the service by 88 participants. The object of the randomization was a clinical question. Each participant had clinical questions randomly allocated to both intervention (librarian information) and control (no librarian information) groups…The average time for JIT librarians to respond to all questions was 13.68 minutes/question (95% CI, 13.38 to 13.98). The average time for participants to respond their control questions was 20.29 minutes/question (95% CI, 18.72 to 21.86).”

The abstract also mentions that 63% of librarian provided information was highly positively rated as compared with only 15% of their own answers (to control questions) being highly positive.

This project was very enjoyable and challenging from a informationist’s point of view.   I enjoyed the diversity of the questions and getting out to meet the doctors in their offices in and around Ottawa.  It was interesting to see, firsthand, how behaviour change happens with trying to integrate a new, in many cases, bit of technology into clinical practice.  Especially when a colleague is right around the corner.  However, clinicians attempted to answer only 40% of their unanswered (or control) questions themselves so this suggests that an information service is quite useful.  In my opinion, it is important to take into account the proper marketing of such a service (which we did) and making sure it has a face (i.e. Tamara, Doug, me and Elise).

Pat yourselves on the back, everyone!

(by the way, the fulltext of the RCT is openly available on PLoS One).

If checklists work for surgery, what else could they work for…?

Not so long ago, an error in a Boston hospital led to a patient undergoing ‘wrong-side’ surgery, and the procedure was done on the wrong body part. The hospital and its CEO, Paul Levy, was admirably transparent about the whole situation, letting staff and the wider public know what had happened. As well as an investigation they also set up a “Safety Culture Operational Task Force co-chaired by a nurse, a surgeon, and an anesthesiologist, and engaging almost two dozen other people from a variety of disciplines and positions in the hospital.”

What they came up with was a checklist that all surgical teams have to go through before each surgery: “Responsibilities and the order of events is clearly laid out, even to the point of requiring that any radio in the OR is shut off during the time-out so as to avoid aural distraction. Note the forcing function at the very top of the form: No blades, needles, specula or bronchoscopes can be within reach of the surgeon until the full time-out is completed” (they have an online version to fill out too). A bunch of “secret shoppers” has also been set up to audit compliance. While I know nothing about surgery, I am a big fan of the simple process of checklists and how they can help improve even the most difficult of procedures…

Surgery checklist

… such as systematic searches. Go on, introduce one into your own working day!

Getting our heads around Ebsco Cinahl: The adjacency search is different

Thank you to my colleague Rosalind for pointing out this quirk of Ebsco Cinahl to me.  As you may know, Ovid is quite flexible with adjacency searching, allowing more than one option on either side of the ‘adj’ (the adjacency symbol).

E.g.

(meningococc$ or meningitid$) adj3 (infection? or disease? or septic?emi$).ti,ab

However, in Ebsco Cinahl, this ONE search line would require EIGHT lines to execute.  Yes, you have read that correctly!

E.g.

(TI “meningococc*” N3 “infection*”) or (AB “meningococc*” N3 “infection*”)

(TI “meningococc*” N3 “disease*”) or (AB “meningococc*” N3 “disease*”)

(TI “meningococc*” N3 “septicemi*”) or (AB “meningococc*” N3 “septicemi*”)

(TI “meningococc*” N3 “septicaemi*”) or (AB “meningococc*” N3 “septicaemi*”)

…and four more for the ‘meningitidis/es’ concept (if you were to truncate to meningitid*).

My interpretation, I think, is fairly generous, as you can see I’ve put both title (TI) and abstract (AB) on one line, whereas many people would split them on two lines apiece. I had previously searched ‘the Ovid way’ but in Ebsco and received over 10,000 hits for a line of an adjacency search–one that garnered me about 200-300 in Ovid.  Thus I found all this out the hard way!

The reason that ’septic?emi$’ cannot be translated is that we have not found a suitable wildcard symbol in Ebsco that will stand in as an optional one character wildcard (either 0 or 1 characters is present).  In Ovid, the ? fulfills this role.  Ebsco has 2 wildcards: the * is for truncating any number of characters, and ? is for a single character (but acts as an obligatory one character).

Did you notice that each term is encased in quotation marks?  These are very easy to leave out.  In fact, I had forgotten to put them into the example above, and had to go back to do this just now.  In Ebsco Cinahl if you forget them, the search will still run, but with zero hits for that line.  You then need to delete it (or each instance of this mistake if you have goofed several times), and each time a window pops up to ask you if you really want to delete the line.  I recommend you pre-book an appointment with your physiotherapist because there is plenty of clicking needed here and you’ll be at increased risk of repetitive strain injury (RSI).

25 November note: A rep from Ebsco got in touch with me after reading this post to set me straight on a couple of things:

1. There is no need to use double quotation marks around individual words–Hooray!

2. The # is not used as a wildcard nor as a trucation symbol.  Which is good, because it didn’t work!

3. They will take into account a couple of my gripes and see if it is possible to search multiple fields at a time and not have the warning pop-ups for every search line that you delete.

Bazian; EB consulting & analysis to support healthcare commissioning

Pure self-promotion. We (Bazian) have launched our new website.

Bazian provides evidence-based consulting and analysis to support the rational assessment, configuration and commissioning of healthcare services.  Bazian’s services can help your Trust:

* Develop World Class Commissioning competencies
* Get aligned with Darzi
* Engage clinicians
* Become evidence-based

An exciting, useful, insightful and short post

Hah! Fantastic advice on presentations from Seth Godin. Summed up with the difficult to argue with statement that “No audience member, in the history of presentations (written or live) has ever said, “it was exciting, useful and insightful but far too short.”

DUETs: Questioning unsubstantiated therapies

Yesterday, I attended a National Library for Health/ National Institute for Clinical Effectiveness (NLH/ NICE) information day.  The last presentation of the day was about a database called DUETs (Database of uncertainties about the effects of treatments) supported by the James Lind Alliance.  Mark Fenton, the DUETs editor, remarked on the gulf between areas of research that are heavily funded (i.e. 82% of research is done on drugs) and areas of interest and need that are passed over.  DUETs does not claim to prioritise research about uncertain therapies, but it can be useful as a political tool to suggest what needs coverage.  Basically, everything that is not in a systematic review that finds it effective, becomes a DUET.  Contributors from the UK are welcome to submit treatments that are uncertain to DUETs.  Categories for submissions are: From Patients, From Carers, From Professionals, Research Recommendations, and Ongoing Research.  Currently the database is being migrated to the NLH.

Do you remember the four categories of information?  The most intimidating one, I thought, was ‘what you don’t know you don’t know‘–turning this into ‘what you know you don’t know‘ will be a massive project indeed.  I look forward to hearing more about their content development strategy (how they plan to entice people to contribute), how they control for quality, and how they keep content current.  Will there be a celebration every time something becomes certain or at least less uncertain?