Older people using the Wii

This *is* health related, and informationy, but is heartwarming too–a veritable Friday smorgasbord for you!  It will sound conceited, but when Wiis first came out, I really hoped (and hopefully predicted) that they would catch on with older adults.  The reason?  Because it is a nice, civilised and light-moderate form of exercise.  Except the boxing which is a bit barbaric and hard-going.  Also, Wiis can be used with a minimum of frustration as they are intuitive to set up (i.e. choose your character; make it look like you, or not; and start playing).

The BBC reports that Wiis are being used in care homes in the North East of England. 

Managing director of Helen McCardle Care, Mark McArdle, said they gave residents extra mental and physical stimulation.  He said: “Some people were sceptical as to whether the residents would cope with such new technology but they’ve taken to it like ducks to water.”

Hope they remind folks to use the wrist strap to avoid any Wii accidents (pun intended).

public health observatories in the NHS

I’m always interested in the structure of the NHS, as 1) it seems fiendishly complicated with a endless range of overlapping institutes and societies and observatories and groups and hubs etc., and 2) because it never seems to stay the same for five minutes – it is most certainly a moving target. Here’s some brief information I culled about public health observatories, who for one reason or another came to my attention the other day…

There are 12 public health observatories (PHOs) throughout the UK and Ireland represented as a group by The Association of Public Health Observatories (APHO).

East Midlands PHO
Eastern Region PHO
Ireland and Northern Ireland’s Population Health Observatory
London Health Observatory
North East PHO
North West PHO
Scottish PHO
South East PHO
South West PHO
Wales Centre for Health
West Midlands PHO
Yorkshire and Humber PHO

The roles of PHOs include:

1) monitoring trends in health status and disease
2) showing how health inequalities are being tackled
3) assessing the effects of health care interventions, giving Commissioners and service providers the evidence and data they need to reduce inequalities both in access and health outcomes

Commissioning
“PHOs in England are engaged in a wide range of work to support different elements of the commissioning cycle as set out in NHS reform in England. Much of the work of PHOs is relevant to the wider commissioning pathways envisaged in the more recent guidance from DH in A Framework for Commissioning Health and Well-being. The unique contribution of the PHOs is their ability to provide timely, comparative information at a local (PCT/LA) level and at smaller area – including practice level – comparing with regional and national levels. This is a vital element of the picture if we are to ensure effective implementation of evidence-based pathways of intervention and care. Work to support commissioning can be divided into broad categories:

1) regularly updated, comparative indicator sets
2) complex analyses and reports using multiple data sources
3) regional capacity-building work
4) bespoke local analytical work for PCTs, LAs, SHAs, academe and others
5) web tools and signposting of useful resources to support commissioners
6) commissioned work by national and other bodies”

Their prototype commissioning support website can be found at: http://www.commissioningsupport.org.uk/

Example PHO outputs

PHOs are co-ordinated by the APHO to produce reports of national-level work including:

- Indications reports (where possible to cover the whole of the UK and Ireland)
- Health Profiles (HPs)
- Targeted outputs in support of key policy lead areas (not otherwise covered by the Indications series);

Individual PHOs themselves also support regional commissioning by producing outputs including:

- Website – acting as a portal to other sites and gradually becoming the ‘public health desktop’
- Specific reviews of issues by region, in collaboration with other agencies, including the academic sector
- Joint project work with other regional information providers – e.g. cancer registries, Health Protection Agency
- Project work with NHS commissioning organisations, local authorities and local strategic partnerships
- Needs assessment with local stakeholders
- Responsive work for service commissioners (e.g. using HES data)
- Analysis and reporting of new child height and weight surveillance data
- Analysis and reporting of GP data on lifestyle and health risks;

Comment: The APHO (est. June 2000) and the PHOs themselves are progressively involved in aiding commissioning, but mostly this involves supplying Joint Strategic Needs Assessments (“Joint Strategic Needs Assessment describes a process that identifies current and future health and wellbeing needs in light of existing services, and informs future service planning taking into account evidence of effectiveness”). Most of their work, including their needs assessments, seem to be data reports with little synthesis or analysis.

Coming soon, Quality Observatories…

Surgeons: elitist know-it-alls or defenders of patient values?

John Black, the head honcho of the Royal College of Surgeons, writes in an opinion piece on BBC News Health website that “the doctor-patient relationship has been damaged and [...] that a single consultant should once again oversee a patient’s care.” He does make some very valid points, for example:

“…[the] cord between GPs and surgeons has been cut by the computerised “choose & book” system, which purports to offer greater patient choice but which has had the opposite effect. You may now select the hospital based on sets of centrally gathered statistical measurements, rather than the right doctor for you with professional advice and support from your GP. How many patients know enough about the health service to make a really informed choice? I believe that patients genuinely welcome advice and input from their family doctor on which specialist may be right for them as an individual – a proper complex person not a statistic.”

This sounds great, but assumes that experts are just that, expert, and that the GP is also switched on and raring to go. But I fear that there are a lot of very average family Drs out there, who have already themselves started to cut the chord between one GP one patient, replacing it instead with one practice one patient, so that they can squeeze more people in, hit more targets and earn more money. Patients would not be demanding choice if everything was as rosy as Mr Black suggests it is (or would be, if professionals were left to their own devices). Surgeons losing control of THEIR waiting lists is something of a bugbear for Mr Black…

But to be fair to the RCS, they have welcomed the findings of the WHOs ‘checklists can stop surgeons taking out your wrong kidney’ trial. I would have assumed that they’d consider such simple activities as somehow beneath them. To gain an insight into the life of a surgeon you can watch a couple of typical, everyday sorts at work on YouTube.

Why are there not more clincial question answering services out there?

PLoS ONE have recently published an RCT that showed that ‘Just in time’ Information, provided by a librarian within 20mins of asking (via a blackberry) improved decision-making in primary care in an RCT of a trial service in Ontario, Canada. Apparently the service had a high approval rating by participants (primary care physicians) and 72% said they would continue to use the service if it were continued (a question of funding, as always). I know that Danielle is a big fan of such services, and it’s always nice to have an RCT or two to back you up.

I don’t really know why there aren’t more librarian resourced clinical answering services, as it’s not the first trial I’ve seen that suggest they are valid, valued and value for money; politics, perhaps? Answers on a postcard to…

Twitter. Let’s get a sense of perspective.

This Twitter thing. Apparently it broke the news that a plane crashed in the Hudson a full 15 mins before the mainstream media. This, by tweeters, twitters or twits (or whatever they’re called) who admire, advocate and are generally addicted to Twitter say what a great thing this is. I would ask, is it really? Isn’t Twitter merely the product of, and symptomatic of, a culture which is so obsessed with speed and brevity that it’s impossible to find a decent, informed news discussion show on tv or radio now? Fifteen minutes quicker. I mean really, who cares?

Or is that unfair? Am I sounding curmudgeonly?

I think speed of communication and the technology involved is great fun, and I don’t think Twitter is a nonsense in and of itself. But it’s just that – fun. It’s not changing the world, is it?

No doubt I’ll be a twit(ter) myself by Summer… *sigh*

Drink coffee see phantoms, drink tea, pr …

Drink coffee, see phantoms; drink tea, prevent breast cancer. Hmm–that seems to be current medical wisdom according to newspapers.

I’ve spotted an article in the Telegraph that blares: “Drinking three cups of tea a day can cut the risk of breast cancer in women under 50 by more than a third”. This statement appears to be based on a non-randomised observational study that asked 4,501 ‘healthy’ women how much tea they had consumed over the 5 years before the study interview. 5,082 women with cancer were compared to this control group in terms of tea consumption. And the result of the study? “Tea consumption was not related to breast cancer risk overall” states the abstract, published in Cancer Epidemiology Biomarkers & Prevention. Then they did some fancy analysis (sorry: not too numerate and no full text) and looked at women under 50:

…Those consuming three or more cups per day had a 37% reduced breast cancer risk when compared with women reporting no tea consumption (age and study site–adjusted odds ratios, 0.63; 95% confidence intervals, 0.44-0.89; P = 0.01) with a significant test for trend (P = 0.01).

“Further research needed” is their conclusion–one that the Telegraph journalists ignore completely when reporting the study.  Do I smell some bad science here?  Does tea drinking prevent breast cancer, or do tea drinkers eat more fruits and veg, or exercise more, or do other health-preserving activities?  Remember: this study was done in the US, where coffee is king and those who drink tea also make their own yogurt and live in yurts.

Update: Cheers to NHS Choices and Bazian for selecting this study for analysis and comment in Behind the Headlines.  I suppose this means my ‘Howler Detector’ is working!  Read their take on it here.

eeggi: semantic search in all but (awful) name

eeggi (engineered, encyclopedic, global and grammatical identities, apparently) is the world’s first “Information engine”, whatever that is.  Well… “eeggi implements Relational Intelligence for retrieving results based on concept and to respect the words’ proximities and relationships” Sounds rather like just another semantic search engine to me that promises much but are yet to deliver (though one day I’m sure they shall). They don’t, however, mention semantic search. Rather they use their trademarked phrases such as “Relational Intelligence”.

Anyway, unless you’re an investor you can’t try their beta engine. So not much one can say really. Just thought I ought to let you know so you can keep an eye out for it. Awful name though, don’t you think?

By the way, on one of their examples they say how you’d get different results for ‘pretty dog’, ‘cute dog’, ‘gorgeous dog’ etc., which is quite true, but we do all know about the use of tilda (~) in google, don’t we?

NYCgo.com plays host to an enhanced Goog …

NYCgo.com plays host to an enhanced Google map that give tourist-friendly directions for those who are overwhelmed or lost in the big city. The map features unique icons for sites made famous in films: Central park, the Empire state building and the Brooklyn bridge.

Nice for the Official Google Blog that they can get the mayor of NYC. Michael Bloomberg to write a post for them!  But then, Google has played a key role in the unveiling of atechnologically advanced NYC visitor information centre:

The Information Center features interactive map tables, powered by the Google Maps API for Flash, that let you navigate venues and attractions as well as create personalized itineraries, which can be printed, emailed or sent to mobile devices.

Is the future of urban tourism to go to a centre at which you can download maps, etc to your phone?  Will the human race forget how to fold up a map?  Or, worse still, neglect to ask a local for advice on where to find the nearest good pub or cafe?

I have personally found google maps to be a wonderful boon in finding my way around.  Even in London, where I do not leave home without an A-Z, I sometimes find myself straying off its pages to explore Harrow or Epping.  So bring on the gmaps, I say.

TripAnswers

From the same people who brought you TripDatabase.  Now they’ve launched “a repository of clinical questions and answers drawn from a wide number of sources around the world.”  Along with Attract, hopefully TripAnswers will plug the hole left by the NLH Question Answering service.

The role of TripAnswers is to parcel information (from textbooks, systematic reviews, guidelines and primary research) into bite-sized chunks.  Their website is organised with the help of a tag cloud.

The rating system that TripAnswers uses for each question is interesting–it rates three areas: Search, Appraisal, and Confidence.  For search and appraisal, a rating of strong is when it approaches systematic review quality (keep in mind that searchers only have a couple of hours).  Confidence is a bit more nebulous, but it essentially has to do with how well the question has been answered and the strength of the evidence in that particular topic area.  For example, having to go to a nonrandomised study or eMedicine to answer a certain question does not inspire as much confidence in the answer as finding a highly-relevant answer in a systematic review.

TripAnswers encourages feedback from clinicians on the answers they provide.

Another interesting tidbit is the Tag Cloud of Uncertainty, inspired by DUETs.

I will be sure to check back to see how this goldmine of questions and answers grows.

Why bother appraising medical info on the web?

David Rothman is amusingly upset by the stupidity of an article in the Journal of Rheumatology by a couple of Canadian academics called “Trying to Measure the Quality of Health Information on the Internet: Is It Time to Move On?” The joking, one hopes, Canadians are suggesting that rather than critical appraisal and high-quality evidence and all that sort of thing, we ought rather just rely on the ‘wisdom of the crowds’. So…,

“For example, Internet users could provide ratings or recommendations based on their own experiences to judge the quality and relevance of health information. Analogous to the peer-review process, aggregation of ratings from many individuals (a form of crowdsourcing) allows “good” information to be highlighted prominently, while “not so good” information gets pushed to the bottom.”

??? Bless. Don’t get me wrong, I love playing around with stuff like Digg, but no-one, surely, thinks that it is a high quality news source? Likewise Wikipedia is great, but would you go there for medical advice? One of the authors is the ‘Chief Innovator and Founder’ of the Centre for Global eHealth Innovation which, when I try and go there, gives me a ‘page load error’. Probably for the best.