Tom Roper's Weblog

Spiders, binge drinking, premature ejaculation and haemorrhoids

At this time of year, every medical librarian in the land will be scouring the changes to MeSH (Medical Subject Headings) announced for the new year. Every year new terms are added, and old ones winnowed, from the controlled vocabulary that sits behind and helps the searcher of the more than 22 million records, in PubMed.

I can modestly claim some credit for  suggesting a term to the indexers back in the 1990s, Infant, Very Low Birth Weight. But enough about me.

To save my colleagues time, I have read them so you don’t need to. Here are the highlights

New terms:

• The Brown Recluse Spider (Loxosceles recluse) appears for the first time as a subject heading. I don’t need to tell you that it is, ‘a spider of the genus Loxosceles, found in the midwestern and other parts of the United States, which carries a hemolytic venom that produces local necrosis or ulceration’. 
•  Premature Ejaculation. Astonishingly, MeSH had never heard of this concept, until now though it was not unreported in the literature. Previously it was all indexed, perhaps more forgivingly, under ejaculation. 
• Binge drinking. I think this may be an example of the Americans following, at last, our lead, . In case you didn’t know this is, ‘Drinking an excessive amount of ALCOHOLIC BEVERAGES in a short period of time’. Note the use of upper case. 
•  You may have thought that the decade of sparkling water was the eighties, but MeSH has just caught up and you will now find it, defines as, ‘Water naturally or artificially infused with CARBON DIOXIDE’, and linked to from Carbonated Mineral Water, Club Soda, Seltzer Water, and Soda Water 
• Although the procedure is as old as Hippocrates Hemorrhoidectomy has had to wait until now to be a term in its own right. It was previously indexed as Hemorrhoids/surgery 

As for changes to existing terms, Coprophagia has been replaced by human coprophagia, an important distinction, I’m sure you’ll agree.

 So here’s a challenge. Write something short, in prose or verse, as you wish, that mentions at least four of the above concepts in a convincing and integrated literary whole, and post it as a comment. A small prize may be awarded, at my discretion, to the best effort.

Art and Medicine

I have something of a blog backlog of posts about events I've been to lately: Patients First, New Light on Ancient Medicine, the Brighton LibTeachMeet, of course, the CILIP Sussex AGM... As time passes, my notes make less and less sense. So the sensible thing to do is to begin with those I remember best.

Yesterday, as part of the Brighton Festival Fringe, and in conjunction with their exhibition of medical students' art, Brighton and Sussex Medical School, there was a symposium on Art and Medicine. I am neither artist nor doctor, but I worked at BSMS from 2003 to 2006, possibly the most enjoyable job of my career, so I went along.

Professor Helen Smith opened the symposium with a keynote speech on the relationship between art and medicine at the theoretical level, and at BSMS. She identified ways in which art might be used in medicine:

• didactically, as in medical illustrations for teaching
• the portrayal of doctors and of medicine
• as therapy
• as an activity of doctors themselves (she illustrated this point with Roy Calne's work)
• as a stimulus to public engagement with medicine
• as a part of medical education
• art by patients, for example those with long-term illnesses

Art and design can be used in clinical settings to aid and speed recovery. She had found more than 600 articles claiming to show beneficial effects of art and design.  As Osler argued understanding of art can heighten the physician's observational skills.

BSMS developed a Student Selected Component (SSC) in the third year, Learning to Look. Short-sightedly, in the 2009 version of Tomorrow's Doctors, the General Medical Council, who regulate medical education as well as the conduct of doctors, have decreed that SSCs should no longer form so large a part of the curriculum. Inter-disciplinary work offers new perspectives, communication between disciplines, cooperation, and overcoming of territoriality. Sometimes other members of other disciplines can be nervous, for example, there can be resistance to what is perceived as doctors teaching English literature.

Then Anna Dumitriu, who mentioned a bewildering array of partnerships and collaborations in which she was involved, chaired a panel on Creative Communication: Art and Medicine. Three students who had worked with Anna came forward, Lucy McCabe to tell us of her work with the Pathogenic Patisserie, Simon Hall, told us how he had been a portrait artist before he became a medical student, and James talked about how art could be a way of saying things that can't be communicated in other ways.

The next part of the symposium was led by Dr Inam Haq, who spoke on Art and Medicine: Strangers or Bedfellows. I was interested when he discussed attempts to find literature supporting the thesis that practicing the visual arts improves observational skills, He could find only two papers, Shapiro 2006 and Ousager 2010, which I think must be these:

 

Shapiro J, Rucker L, Beck J. Training the clinical eye and mind: using the arts to develop medical students' observational and pattern recognition skills.
Med Educ. 2006 Mar;40(3):263-8

 

Ousager J, Johannessen H. Humanities in undergraduate medical education: a literature review.
Acad Med. 2010 Jun;85(6):988-98

He suggested that, to be able to articulate the benefits of the arts, we need new paradigms of collecting evidence.

Tom Ainsworth talked about working with mixed groups of students to look at the application of biomechanical data to chair design, and design in the clinical environment, using the Royal Sussex County Hospital as an example.

In what was the most unusual part of the afternoon, the next speaker, Patrick Letscha, discussed the use of life drawing. He set us up into pairs and made us draw each other's eyes, once blind, that is forbidden to look at the paper while drawing, and then more conventionally. The illustration shows my eyes, as drawn by my neighbour Sue. He urged us not to be inhibited by beliefs that we couldn't draw or lacked craftsmanship. He showed us pictures from Werner Herzog's Cave of Forgotten Dreams: are these cave paintings observational, imaginative or religious? Then Philippa Lyon spoke about learning through looking.

In the final session, on the Laboratory Life project, part of the Brighton Science Festival, five artists worked on five projects with sixteen partners over nine days to prepare something to show at the festival. Hellen Bullard spoke about Tattoo Traits, in which they tattooed all sorts of invertebrates with a glop made up of hybrid DNA. She came up with a Creative Commons licence for the material they created I'd never heard of before, a Creative Commons NonAttribution, Non-Commercial, Share-Alike Intellectual Property Explicit Model Release Submissive Human Research Participant License, or CCNANCSAIPEMRSHRPL for short). Rosie Sedgwick spoke about Infective Textiles, a project where they took a Regency dress and stained it with bacterial pigments and antibiotics, and Kate Genevieve, an animator, talked about the Public Misunderstanding of Science.

 

 

On set theory

I still follow the discussions on the health librarians' Jiscmail list lis-medical. I do this largely for nostalgic reasons, though I would not rule out a return to health librarianship at some point in the future, despite the fact that document supply requests for articles from the Armenian Journal of Proctology have little relevance to the bread and butter of life in a further education college.

However, a recent discussion on creative methods of teaching the basic concepts of Boolean logic caught my eye. Participants leant towards using food and drink to illustrate concepts: fruit salads, gins and tonic, fish and chips, and others even more inventive.

And yet....I do wonder, and did when I practiced it, quite what some of the brightest young minds in the country, who choose to make a career in medicine or nursing, would make of such kindergarten paedagogy. I encountered set theory at school: for some reason we were exposed to what was known, in 1965 or 66, as the 'new maths', including set theory, before reverting to the old sort in the run up to O level. I next encountered it years later on my postgraduate librarianship course when learning how to search a database.

Leaving aside theories about falling or rising educational standards, I find it hard to believe that well-educated doctors, nurses or physiotherapists have never heard of Boolean logic until presented with it by a health librarian in a stuffy library training room on a warm afternoon. I think it may be time for an approach to information literacy that credits the user with some intelligence.

Austin Gresham, 1925-2009

The time delays in obituaries are odd. Austin Gresham, the histopathologist, died in July, but has so far only had an obituary in the Telegraph and the Times. I hope Guardian and Independent ones will come soon. I knew of him, and was surprised to find that he was younger than my father, by 13 years. With my childish sense of time, I thought the whole medical establishment of Cambridge were exactly the same age, born just before the first war. His name, and that of his wife, Gweneth Leigh, who was in charge of child health in Cambridge, would often crop up at meal times. My father, a GP, was never one to leave work behind when at the dinner table. As well as kittens, a regular table decoration in our house, he took some pleasure in reading medical journals and textbooks at table. I recall in particular a lavishly illustrated dermatology text, showing syphilitic lesions, which he pored over as we tucked into the help's steak and kidney pie Professor Gresham and my father both moved in that curious Cambridge medical no-man's land, not quite fully part of the university, nor fully within the NHS. I remember lying in bed hearing parties downstairs: the smells of gin and sherry, tobacco smoke (in those days doctors smoked like anything, whatever advice they might give their patients), women's scent, when she came to kiss me goodnight, my mother would be wearing lipstick, which she only ever put on for parties and parent's evenings at school.Later, when I worked in what would now be called a gap year as a hospital porter at Addenbrooke's, one of Professor Gresham's sons was also a porter.Both obituaries mention something he deplored, that his Colour Atlas of Forensic Pathology had been an inspiration for Damien Hirst.

Why let the drug companies have all the fun?

Why indeed? David Rothman commented on the post below, and a look at his blog took me to this, the Disease Mongering Engine.
I played with it, finding that all the conditions I created sounded plausible; indeed I could identify many people I know as sufferers from this or that. My favourite, which I am sure I have, is "Transient Sexual Eating Syndrome (TSES). TSES is found in people with intermittent, rapidly-changing episodes surrounding the repeated failure to sexually perform during the consumption of food or beverages".
I was perturbed though that the creators of this splendid satirical tool have had to post a disclaimer: "the Disease Mongering Engine is a satirical commentary on various matters we believe to be of public concern and are offered as Free Speech within the protection of the First Amendment to the US Constitution". O tempora, o mores.

Googling for a diagnosis

A recent BMJ article, Googling for a diagnosis, and its press coverage, ruffled some feathers on lis-medical. But Phil Bradley correctly asks why most health librarians have been so reticent on the matter in public.

Googling for a diagnosis--use of Google as a diagnostic aid: internet based study
Hangwi Tang, Jennifer Hwee Kwoon Ng
BMJ 2006:390036405, doi:10.1136/bmj.39003.640567.AE

Technorati Tags: google

Medical blogging

I see there was a presentation on medical blogging at the Medical Humanities Conference, on 4 and 5 September at King's College London, building blogs in medicine by Giskin Day and Alexander Hamilton, authors of this medical humanities blog, which appears to be Imperial-based. I can't see that the presentation is available online though.

New blog on PDAs in medical education

This is the sort of thing I used to post on the medical education blog:

http://www.mehrkar.com/blog/

It was launched on Monday and the author, Amir Mehrkar-Asl, says he is going to post "reviews of articles pertaining to the use of PDAs [...]in the healthcare setting".

Technorati Tags: pdas

Peninsula Medical School

Yesterday I went to Exeter to visit the Peninsula Medical School. There are some photos on Flickr.

Scenes from the private life of a medical school number 3