Size matters

This is a cool little toy, if you’ve ever wondered about the relative sizes of a grain of rice to a skin cell, a lysosome to a carbon atom; play with the slider underneath the graphic. It’s from the University of Utah.

EBM: it’s about evidence, not physicians or patients…

There’s some chatter on the evidence-based healthcare message board about the definition of “evidence based medicine” and I have to say I get a bit fed up sometimes as people always talk of the “holy trinity” of EBM, that of: use of evidence + physicians’ experience + patient choice.

But I mean to say, it’s not really, is it? The practice of medicine is a combination of these things, sure, but evidence-based medicine is all about evidence, not experience and not patient choice. It’s not patient-centric medicine, or experience-based medicine, or authority-based medicine. In fact, it’s explicitly NOT about those things. Physicians have had plenty of authority during the long and slow development of medicine, and stil have much weight to throw about; they still harm patients too (they cure people and alleviate a lot of suffering too – I’m not anti physician – far from it, I think they’re great, particularly when I’m ill – just making the point that they’re not omnipotent). As for patient-centric medicine that is indeed important and, like any business, the client is key; the needs of patients do have to play a role in medicine. But that’s not what evidence-based medicine is about. It’s about evidence, evidence and evidence, it’s about the application of the scientific method to healthcare, and to say otherwise is just to try and sweeten the bitter pill that EBM might be to certain healthcare stakeholder groups.

Long live EBM. Long live science…

Windows 7 ‘flying off the shelves’ (well, in my local PC World)

I was in my local PC World this lunchtime buying a nice mouse for work (and as such evidently a highlight of my day) and I was interested to note that they were doing a brisk trade in MS7 – flying off the shelves it was. Who would’ve thought it? Not me, that’s for sure, but while I probably shouldn’t admit this I do hope it’s a success. The more Microsoft get kicked about by Google and Apple the more I warm to them. I guess it’s a British thing…

p.s. I bought a Logitech mouse, not a Microsoft mouse. I’ve not gone that soft.

NHS Evidence; Google without the good bits

Our other Alan wrote a piece a couple of posts ago on, amongst other things, this article in the Nursing Times. Basically it’s a press release for NICE, written by an implementation advisor for said large, powerful organisation. It describes how NHS Evidence will be so very useful for nurses, and I suppose it could be argued that it’s useful because the odd nurse (not literally you understand) may be flicking through the magazine, scan the article, and go and try out a bit of evidence hunting themselves. Surely a happy outcome.

But I fear that our odd nurse will only try out NHS Evidence once, maybe even twice, but probably not a third time. Why? Well, according to an issue of the Eyes on Evidence Newsletter (more PR from NICE) the top five most frequently used search terms were 1) asthma; 2) prostate AND cancer; 3) evidence; 4) flu OR influenza; 5) breastfeeding, so we get an idea of the level of sophistication behind most searches. Let’s try the top one, asthma. 5026 hits, including 516 guidelines and 1627 drug information pieces. You get the general idea. The first ‘guideline’ is  “Guidelines for the prevention, identification and management of occupational asthma: evidence review and recommendations”, a pretty hardcore 88 page PDF of an evidence review, complete with evidence tables, from the British Occupational Health Research Foundation. Not at all helpful, I would’ve thought, to our odd yet eager nurse. If s/he wanted a good review of what to with someone with asthma surely they’d just go to an evidence synthesis product, such as Clinical Evidence, CKS, Dynamed or the Map of Medicine.

The problem is that NHS Evidence’s obsession with Google means that their search engine suffers exactly the same problem as Google (too many hits) but does not have the same saving grace (that the one you really want is at the top). Plus, and this is still really the crux of my problem, I still don’t have a clue who NHS Evidence is meant to be for – neither, I think, do the people behind NHS Evidence. “All things to all people” often ends up as nothing to no-one.

NHS Evidence (boo) vs Guidelines Finder (hurrah)

I haven’t really got into NHS Evidence yet, so maybe I’m missing something, but it all seems something of nightmare.

I want to look for guidelines, as you do, if you’re a medical informationy whatnot thingy. Let’s say I was looking for lower back pain and related conditions. The search “Low back or lower back or spinal pain or back ache or backache or Spondylolisthesis or scoliosis or Sciatica or “Spinal stenosis” or Lumbago” gave 1320 ‘guidelines’ (i.e. using the Guidelines filter) in NHS Evidence, 208 of which are apparently from NICE. This is silly. There’s no way that there are 1320 guidelines out there, or 208 NICE guidelines. In fact, when I look through a few of the results many of the hits were duplicates or ‘empty’ references. Do I really want to spend my time going though 1320 hits for a handful of useful guidelines. No, is the answer to that.

Now then, if I searched with the same terms in the good old fashioned Guidelines Finder (now a ’specialist collection’), I get 47 hits. Forty seven useful and relevant (for the most part) hits, something I can quickly browse though and extract the few guidelines I actually want. Perfect. Does the job.

Therefore Guidelines Finder, at least for this common situation, is better than NHS Evidence. Much better. But Guidelines Finder might be under threat from the monster that is NHS Evidence. On the front page of Guidelines Finder they write: This collection is now NHS Evidence – national library of guidelines, and you will continue to be able to access all the content and features. The existing url for the collection will remain for now, but is likely to change later in the year as the specialist collections become fully integrated into the NHS Evidence portal. “Fully integrated” – sounds scary.

Now I know that NHS Evidence and the specialist collections are fundamentally different technologies, and both may have their uses, but in the age of information overload the collections rule – don’t you think? A request to NICE – please keep the specialist collections.

Clinical Reader: Malicious or just stupid?

I’d never heard of Hanlon’s razor before. Apparently it is an adage that reads “Never attribute to malice that which can be adequately explained by stupidity”. I rather like that; I’ll have to remember it. It is a nice way to look at the world, as we can all be stupid sometimes. Take for example the new company Clinical Reader. The company has an online product that basically seems to be an RSS reader but that they decide which RSS feeds they’re going to track, not you. I came across it a few days ago as some clinicians were discussing what a good service it was on some mailing list. Well, I thought, that’s clinicians for you. The product didn’t seem bad enough to comment on, but likewise certainly didn’t seem interesting enough to comment on either – at least not from my point of view. So I thought to myself “well, our handsome and fragrant readership will probably come across it soon enough, and they can make their own perfectly balanced minds up about it…”, and left it there.

But today I see another twist on the Clinical Reader story, and what happens when you get involved in social networking tools without really knowing what you’re doing. The thing was that Nicole Dettmar (evidently a fan of The Prisoner) had pointed out in her blog that Clinical Reader were implying that they had been awarded ‘five stars’ by institutions such as the British Library, the NLM, Imperial College, The Lancet etc. She pointed out to them on Twitter than the NLM does not endorse anything, and that they ought to do something about it, and promptly received a reply threatening legal action (I love the use of ‘kindly’):

I mean to say, what a stupid (or malicious) thing to do. Of course everyone picked up on it and they received a barrage of tweets and blog commentary. As of writing they have since backed down, which they should do because they are plainly in the wrong, saying “We are keen to engage the twitter community the tweet made by a junior member of the team was poor judgment”. However the “five stars according to…” graphic remains throughout their site once you get past the first page.

Malicious or stupid? You decide. Either way it doesn’t reflect well on Clinical Reader.

Using Twitter to track disease outbreaks

A few months ago I wrote a short post on Phil Baumann’s 140 healthcare uses for Twitter. Well, Chris Thorman over on Software Advice has written a longer piece on the potential of Twitter for identifying and tracking disease outbreaks in real-time. To get some vaguely reliable data from Twitter, rather than the mess of misinformation with the occasional piece of truth thrown in which is Twitter as of today (oh, cynic that I am), it would  be necessary to have a uniform set of diagnostic codes, “hash tags” and a proper authentication system, e.g. as Chris writes:

“…This adoption by doctors would need include a verification system that only allows trusted or authenticated users to tweet about information contained in the EMRs. What we’re trying to avoid is aggregating a whole mess of data related to a particular disease. Authenticating users to make sure they are who they say they are avoids this problem. With a uniform set of diagnosis codes and a proper authentication system, suddenly the trending data sent out by these verified doctors’ tweets goes from speculative to extremely reliable.”

I do actually think that Twitter or a similar technology could be very useful in tracking the early signs of a condition, or any other “rare event” pattern. In fact I’d be amazed if we weren’t using it this way very soon. What is required however, as always, in some kind of central, trustworthy institution to organise, analyse, study and disseminate the data that comes in, as well as ensuring the diagnoses are correct and not just false positives. That’s the hard part, not some Dr in a clinic in Great Yarmouth tweeting that one of their patients has a sniffle. Anyway, take a look and see what you think. Twitter fans will like it at least. Another step towards world domination.

NHS health records to private sector?

Personally, I’d be delighted if the Tories got Google or Microsoft or someone to build the NHS records system. Might actually work. Read the news story on the HSJ here. That nice (?) Mr Cameron also says he will review all quangos should they come into government, including the bloated (did I say bloated?) NICE and Care Quality Commission. Keep the public sector on their toes eh David? Mind you, the opposition always says they’ll get rid of quangos, until they get into office then they just create a whole lot more. Jobs for the boys (and girls).

fefoo – not another search engine

I’m not sure why it’s called fefoo, but it’s quite a nice little tool. It’s not another search engine. Rather, it’s a tool through which you can search a whole range of different search engines – Google, Bing, Yahoo, of course, but also many of those funny little ones you’ve never heard of, like Viewzi (fun graphical interface), Spezify (yet more fun graphical interfaces) and LexxeAlpha (no fun graphical interfaces, but rather powered by “advanced natural language technology”, though still returns Wikipedia first).  The search pages give a little tool bar at the top that allows you quickly to try your search in another search engine. You can also look for blogs, images, torrents, people, movies etc. It’s all quite useful, to tell the truth. And finally, if you’re truly hardcore, rather than specifying in the drop down menus that you want to search Yahoo, say, you can use command line searches, in this case, for a search on ‘Tom Baker’, “:yahoo Tom Baker”, though unfortunately it does not seem that you can combine command lines searches, e.g. “:yahoo :images Tom Baker” for, you guessed it, images of Tom Baker. Oh well. It’s a nice little tool nonetheless, and helps ensure you venture beyond just Google from time to time.

First PC with Google Android coming soon

Interesting. The FT reports that: “Acer, the world’s third biggest PC maker, on Tuesday said it would start producing the world’s first mainstream notebook computer using Google’s Android operating system before the end of September.” Everyone’s doing everything. Search engines make operating systems, and manufacturers of operating systems make search engines. And everyone makes browsers. I guess it’s a reflection of the gradual breaking down of barriers between hardware and software, online and offline, your local C: drive and the World Wide Web, the cloud and terra firma. But are these companies who try and do everything not just sowing the seeds of their own destruction? Can you really do everything well? Are they only viable because of their ability to dominate the market and buy up/elbow out any new contenders? Answers on a postcard please to…