willwade's blog http://metaot.com/blog/1/atom/feed 2007-11-21T12:26:05+00:00 Quick! Web searching tips for the Busy Therapist http://metaot.com/blogs/willwade-41 2007-07-18T22:56:12+01:00 2007-07-19T07:00:42+01:00 willwade For the past few weeks I’ve been madly busy - as well as my regular day job being quite busy due to a technical error on my part (long story - but in short I forgot that it was the end of the school term this week for 90% of the country) I have been attending some interesting conferences (more to come) and last week I was on a whole weeks course learning all about (and how to do) systematic reviews. Lots and lots of interesting stuff. So I figured I would start backwards.

First up I thought I would share with the world my tips on finding clinically useful stuff on the net. The web is a tricky one to traverse when in your in a hurry - particularly when you want to find stuff FAST and make sure its accurate. Here are some tips:

  • Get your phone all internet-ed up! Check your data plan with your mobile operator and then skip the regular browser that comes with your phone by downloading and using Opera Mini (ps: I actually prefer Opera 3.1) Then, when that odd acronym pops up in conversation, or a rare diagnosis appears in the notes you are reading and you just need to solve that “What the heck is that?” thought, you can google/wikipedia it there and then! Did I mention wikipedia? That brings me on to my next point:
  • Don’t trust all sources as the truth! OK, thats a bit strong. Use wikipedia for quick guidance to point you in the right direction. Don’t however use it to base your entire working life on. Its just plain silly. No, infact its dangerous. I once wrote a quick talk based on something (I have wiped it from my memory now so don’t ask me what it was on) off wikipedia. Different sources were conflicting with the facts or just not comprehensive enough. It was, I decided, far easier to use wikipedia but boy did I look a wally when someone says “Hmm are you sure??” Don’t be caught out!
  • Use some reliable sources So what are they? Well pubmed is a good one - although perhaps somewhat limited. Now here’s for the real tips du jour and some of the things you may not quite realise.
    • Can’t remember the (rather annoyingly long) url? Go to “pubmed.gov” in the URL bar of your web browser and it takes you to the right place
    • Medline is in essence just a component to pubmed. If its in Medline its in pubmed. So why restrict your search? Use pubmed its far easier to remember than always going through your local library web page first
    • Want to find clinically useful stuff fast? Try “Clinical Searches” on the left. Now I say “try”. Its not going to be that helpful for a lot of things. Two reasons why; 1) Its very US led - the vast majority of journals are from the states 2)Its very medically led - so it only contains a small fraction of OT journals out there. But saying that it is a very handy tool - and very comprehensive. Remember that some of the well recognised are in JAMA (e.g. well-elderly study) or the BMJ.
    • Think carefully about your topic and think how a computer may find it. For example if your real question is “I wonder what the best OT interventions are for falls in the elderly population?” Don’t write exactly that. Try simply typing in the words “older adults occupational therapy falls”. Which brings me on to my next point..
    • Pubmed is clever. Sometimes too clever. Lets take the above search “older adults occupational therapy falls” typed into the clinical search box. It actually gets converted to
    “(older adults occupational therapy falls) AND (randomized controlled trial[Publication Type] OR (randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract]))”

in the search field. So thats all its doing right? Well actually wrong. If you type anything into the search box it gets read by pubmed and then made “correct”. To see what its done click on the “details” tab. For this instance the REAL search is this:

“(older[All Fields] AND ((“adult”[TIAB] NOT Medline[SB]) OR “adult”[MeSH Terms] OR adults[Text Word]) AND (“occupational therapy”[MeSH Terms] OR occupational therapy[Text Word]) AND falls[All Fields]) AND (randomized controlled trial[Publication Type] OR (randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract]))”

Clever eh? This stuff is really important when you need to do a systematic review because you need to reproduce your search - but equally its important for yourself so you know how to tame the beast and get better results.

  • “You can’t do subset queries in Pubmed can you?” This will probably be obvious to the rest of the world - Im amazed I didn’t realise this. I know I could do this with other databases but figured it was beyond the simple design of pubmed - how silly I could be.. Lets start off with a simple example of how this works. Lets imagine your a OT wanting to investigate interventions for older adults.
  1. Type in “Occupational Therapy” (no speech marks) in the search box of pubmed. Press the Go button. Note the number returned (e.g. 103218)
  2. In place of your search term “Occupational Therapy” now write “Older Adults” Press the Go button
  3. And once more: “intervention” and press Go.
  4. Now click on the “History” tab. Here is a history of all your previous searches for this session. (NB: You will need to create an account to get pubmed to remember these searches). You will notice that each search has a “#n” where n is a incremental number of your search. Now lets imagine you want to see all results with all 3 terms in. Simply type the number of your search with the AND key word in between. e.g. for mine I did: “#1 AND #2 AND #6”. Now you have a manageable number of articles to peruse.

The thing you will realise from my ranting about pubmed is that its actually not that great for OT. My example in the previous tip only shoes 37 articles for example. So what can we do? Well there is always Google Scholar. Now some warnings:

Google scholar is Good but not great. Some problems: * You can’t do IN/AND searches like the pubmed example (i.e. chaining) * You have limited control of how the results are sorted. Remember google lists the “most relevant first” but what “relevant” is, is only what google “thinks” is relevant to you.. that top result is not the holy grail * Its out of date. Well that has been the argument from some areas of the researching sphere. I’m not sure how accurate this is still the case given that these criticism were made in 2005.. * You have no idea as to what google scholar is actually searching * Doing refined searching is hard.

Before you flame me I don’t agree fully with the above statements - its just what has been complained about elsewhere (e.g. the OM blog). So how can we make use of it the best?

  • First up to make it “Useful” make sure you set google scholar to link directly to your local library. It will save your searching to the full-text or even abstract a lot easier. To do this go to the preferences and search/add your local library (see screenshot). Note some other rather funky preferences: e.g. “Bibliography Manager” (I actually use a firefox plugin to make it talk to citeulike a whole lot easier)
  • You can do relatively clever searching with google. Here’s an example to show you a lot of them: > paediatric|pediatric|children “occupational therapy” Sitting -standing intervention author:Reid Lets break that down.
    1. The pipe: | . “paediatric|pediatric|children” basically says “find me either paediatric OR pediatric OR children”. Its the OR operator
    2. The “” . Speech marks = search for this exact phrase. Google will ignore common words such as ‘the and or’ putting the words in speech marks search for sentences exactly with this phrase. If you just enter it will look for documents with the word ‘occupational’ and ‘therapy’ anywhere in its text. Its why many pages pick up random pages about occupational health.
    3. The - . Minus sign followed immediately by the word. - = DON’T include. So for the above search where I want to search documents not mentioning standing (i.e. just articles looking at sitting) I just write -standing. Note that this is highly exclusive and not half as friendly as pubmed AND search.
    4. author: . This one is the first that is only usable in google scholar. Allows you to search for a specific author. Note this isn’t always that great. e.g if it was just author:Sm it searches for any text in the author field starting with Sm - capitals or otherwise. So it will pick up initials as well as surnames. Possibly a feature but something to be aware of. NB: You can perform exactly the same search using the “Advanced” search but hey, you might as well do it the easy way right?!

Some other places to go hunting for clinically useful/research useful information if your in a hurry. (Note: you may need to access these through your institution to access them fully)

  • OTSeeker: “database that contains abstracts of systematic reviews and randomised controlled trials relevant to occupational therapy”. NB: You can also do a search on pubmed for all RCT’s relating to OT.
  • Cochrane Reviews. A “small” (but actually quite diverse) database of reviews. Systematic reviews are of course the Gold Standard but few and far between in OT. A whole range can be found here - not just systematic reviews and its worth getting to know. NB: Cochrane reviews are listed in pubmed but may be easier to search on their own site. Just a tip.
  • OTDBase: Its a pain in the backside to search. Its butt ugly. And its slow (It runs off filemaker which is only slightly better than Microsoft access which my explain some of my complaints). But hey it has a lot of data. It is however not free.
  • Embase. Pubmed covers much of the same ground as Embase but Embase has more European journals and a more non-English journals.
  • CINAHL. Again, a lot of overlap in the Pubmed database (hence why I push pubmed first) but note that pubmed only indexes journals. CINAHL indexes journal articles, books and book chapters, dissertations, audiovisual materials, and other formats. So worth a look
  • Web of Science. Or ISI Web of Knowledge as its now known.
  • PsycInfo. Psychology based database.. worth a peek since so much OT covers others ground.
  • Google main: Or OT Google search. The latter isn’t fantastic as I need to constantly add/remove relevant sites but hey, its a good start! (One advantage of the OT only one is No ads!)
]]> For the past few weeks I’ve been madly busy - as well as my regular day job being quite busy due to a technical error on my part (long story - but in short I forgot that it was the end of the school term this week for 90% of the country) I have been attending some interesting conferences (more to come) and last week I was on a whole weeks course learning all about (and how to do) systematic reviews. Lots and lots of interesting stuff. So I figured I would start backwards.

First up I thought I would share with the world my tips on finding clinically useful stuff on the net. The web is a tricky one to traverse when in your in a hurry - particularly when you want to find stuff FAST and make sure its accurate. Here are some tips:

  • Get your phone all internet-ed up! Check your data plan with your mobile operator and then skip the regular browser that comes with your phone by downloading and using Opera Mini (ps: I actually prefer Opera 3.1) Then, when that odd acronym pops up in conversation, or a rare diagnosis appears in the notes you are reading and you just need to solve that “What the heck is that?” thought, you can google/wikipedia it there and then! Did I mention wikipedia? That brings me on to my next point:

  • Don’t trust all sources as the truth! OK, thats a bit strong. Use wikipedia for quick guidance to point you in the right direction. Don’t however use it to base your entire working life on. Its just plain silly. No, infact its dangerous. I once wrote a quick talk based on something (I have wiped it from my memory now so don’t ask me what it was on) off wikipedia. Different sources were conflicting with the facts or just not comprehensive enough. It was, I decided, far easier to use wikipedia but boy did I look a wally when someone says “Hmm are you sure??” Don’t be caught out!

  • Use some reliable sources So what are they? Well pubmed is a good one - although perhaps somewhat limited. Now here’s for the real tips du jour and some of the things you may not quite realise.

    • Can’t remember the (rather annoyingly long) url? Go to “pubmed.gov” in the URL bar of your web browser and it takes you to the right place
    • Medline is in essence just a component to pubmed. If its in Medline its in pubmed. So why restrict your search? Use pubmed its far easier to remember than always going through your local library web page first
    • Want to find clinically useful stuff fast? Try “Clinical Searches” on the left. Now I say “try”. Its not going to be that helpful for a lot of things. Two reasons why; 1) Its very US led - the vast majority of journals are from the states 2)Its very medically led - so it only contains a small fraction of OT journals out there. But saying that it is a very handy tool - and very comprehensive. Remember that some of the well recognised are in JAMA (e.g. well-elderly study) or the BMJ.
    • Think carefully about your topic and think how a computer may find it. For example if your real question is “I wonder what the best OT interventions are for falls in the elderly population?” Don’t write exactly that. Try simply typing in the words “older adults occupational therapy falls”. Which brings me on to my next point..
    • Pubmed is clever. Sometimes too clever. Lets take the above search “older adults occupational therapy falls” typed into the clinical search box. It actually gets converted to

    “(older adults occupational therapy falls) AND (randomized controlled trial[Publication Type] OR (randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract]))”

in the search field. So thats all its doing right? Well actually wrong. If you type anything into the search box it gets read by pubmed and then made “correct”. To see what its done click on the “details” tab. For this instance the REAL search is this:

“(older[All Fields] AND ((“adult”[TIAB] NOT Medline[SB]) OR “adult”[MeSH Terms] OR adults[Text Word]) AND (“occupational therapy”[MeSH Terms] OR occupational therapy[Text Word]) AND falls[All Fields]) AND (randomized controlled trial[Publication Type] OR (randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract]))”

Clever eh? This stuff is really important when you need to do a systematic review because you need to reproduce your search - but equally its important for yourself so you know how to tame the beast and get better results.

  • “You can’t do subset queries in Pubmed can you?” This will probably be obvious to the rest of the world - Im amazed I didn’t realise this. I know I could do this with other databases but figured it was beyond the simple design of pubmed - how silly I could be.. Lets start off with a simple example of how this works. Lets imagine your a OT wanting to investigate interventions for older adults.

1. Type in “Occupational Therapy” (no speech marks) in the search box of pubmed. Press the Go button. Note the number returned (e.g. 103218) 2. In place of your search term “Occupational Therapy” now write “Older Adults” Press the Go button 3. And once more: “intervention” and press Go. 4. Now click on the “History” tab. Here is a history of all your previous searches for this session. (NB: You will need to create an account to get pubmed to remember these searches). You will notice that each search has a “#n” where n is a incremental number of your search. Now lets imagine you want to see all results with all 3 terms in. Simply type the number of your search with the AND key word in between. e.g. for mine I did: “#1 AND #2 AND #6”. Now you have a manageable number of articles to peruse.

The thing you will realise from my ranting about pubmed is that its actually not that great for OT. My example in the previous tip only shoes 37 articles for example. So what can we do? Well there is always Google Scholar. Now some warnings:

Google scholar is Good but not great. Some problems: * You can’t do IN/AND searches like the pubmed example (i.e. chaining) * You have limited control of how the results are sorted. Remember google lists the “most relevant first” but what “relevant” is, is only what google “thinks” is relevant to you.. that top result is not the holy grail * Its out of date. Well that has been the argument from some areas of the researching sphere. I’m not sure how accurate this is still the case given that these criticism were made in 2005.. * You have no idea as to what google scholar is actually searching * Doing refined searching is hard.

Before you flame me I don’t agree fully with the above statements - its just what has been complained about elsewhere (e.g. the OM blog). So how can we make use of it the best?

  • First up to make it “Useful” make sure you set google scholar to link directly to your local library. It will save your searching to the full-text or even abstract a lot easier. To do this go to the preferences and search/add your local library (see screenshot). Note some other rather funky preferences: e.g. “Bibliography Manager” (I actually use a firefox plugin to make it talk to citeulike a whole lot easier)

  • You can do relatively clever searching with google. Here’s an example to show you a lot of them:

    > paediatric|pediatric|children “occupational therapy” Sitting -standing intervention author:Reid

    Lets break that down.

    1. The pipe: | . “paediatric|pediatric|children” basically says “find me either paediatric OR pediatric OR children”. Its the OR operator
    2. The “” . Speech marks = search for this exact phrase. Google will ignore common words such as ‘the and or’ putting the words in speech marks search for sentences exactly with this phrase. If you just enter it will look for documents with the word ‘occupational’ and ‘therapy’ anywhere in its text. Its why many pages pick up random pages about occupational health.
    3. The - . Minus sign followed immediately by the word. - = DON’T include. So for the above search where I want to search documents not mentioning standing (i.e. just articles looking at sitting) I just write -standing. Note that this is highly exclusive and not half as friendly as pubmed AND search.
    4. author: . This one is the first that is only usable in google scholar. Allows you to search for a specific author. Note this isn’t always that great. e.g if it was just author:Sm it searches for any text in the author field starting with Sm - capitals or otherwise. So it will pick up initials as well as surnames. Possibly a feature but something to be aware of. NB: You can perform exactly the same search using the “Advanced” search but hey, you might as well do it the easy way right?!

Some other places to go hunting for clinically useful/research useful information if your in a hurry. (Note: you may need to access these through your institution to access them fully)

  • OTSeeker: “database that contains abstracts of systematic reviews and randomised controlled trials relevant to occupational therapy”. NB: You can also do a search on pubmed for all RCT’s relating to OT.
  • Cochrane Reviews. A “small” (but actually quite diverse) database of reviews. Systematic reviews are of course the Gold Standard but few and far between in OT. A whole range can be found here - not just systematic reviews and its worth getting to know. NB: Cochrane reviews are listed in pubmed but may be easier to search on their own site. Just a tip.
  • OTDBase: Its a pain in the backside to search. Its butt ugly. And its slow (It runs off filemaker which is only slightly better than Microsoft access which my explain some of my complaints). But hey it has a lot of data. It is however not free.
  • Embase. Pubmed covers much of the same ground as Embase but Embase has more European journals and a more non-English journals.
  • CINAHL. Again, a lot of overlap in the Pubmed database (hence why I push pubmed first) but note that pubmed only indexes journals. CINAHL indexes journal articles, books and book chapters, dissertations, audiovisual materials, and other formats. So worth a look
  • Web of Science. Or ISI Web of Knowledge as its now known.
  • PsycInfo. Psychology based database.. worth a peek since so much OT covers others ground.
  • Google main: Or OT Google search. The latter isn’t fantastic as I need to constantly add/remove relevant sites but hey, its a good start! (One advantage of the OT only one is No ads!)
]]> Conversion Table(s) (Cheatsheet) http://metaot.com/conversion-table 2007-07-08T18:46:13+01:00 2007-07-08T19:29:16+01:00 willwade screenshot of conversion table cheatsheetDue to a recent enquiry for a handy list of height/weight conversions (and not an online one) I quickly hacked together the attached table. Note that I have formatted it for a sheet of A5 paper (to make nice and handy for a work diary!). If you would like to hack around with it then feel free to play with the original excel document - however if they are changes that the rest of the world may find useful please comment below and I can amend it to make it better for all of us.
Enjoy!

]]> screenshot of conversion table cheatsheetDue to a recent enquiry for a handy list of height/weight conversions (and not an online one) I quickly hacked together the attached table. Note that I have formatted it for a sheet of A5 paper (to make nice and handy for a work diary!). If you would like to hack around with it then feel free to play with the original excel document - however if they are changes that the rest of the world may find useful please comment below and I can amend it to make it better for all of us.

Enjoy!

]]> STOP PRESS: We don't all make tea the same way (and not all men like football!) http://metaot.com/blogs/willwade-39 2007-06-11T22:36:40+01:00 2007-06-12T18:45:11+01:00 willwade Tea This is a somewhat old post that I had been taking my time to finally post it so here goes..it is based around two letters that were submitted to the Telegraph way back about a year ago:

“Tea test

SIR - Office juniors are not the only people who have no idea how to make real tea (Letters, July 15). My mother was assessed last year by an occupational therapist as to whether she was fit to return home after a stroke. The OT considered she was not fully compos mentis. Why? She warmed the teapot with hot water, then poured it away before putting leaf tea in the pot and adding boiling water.

I was not believed when I pointed out that this method was correct and she had not been making the tea twice over.

N. Beale London, SE3”

Telegraph 18 July, 2006

I can’t of course speak on behalf of the OT in question but I know this complaint, if not directly the same, is not unheard of (from both patients and staff). The therapist in question has not been able to reply to these letters but there could of well been a reasonable reason for saying these patients in question were not “compos mentis”. Or of course they never actually said those things but hinted towards it. Whatever the case its simply not on.

So why is it that this sometimes occurs? Well the problem lies with that little thing called activity analysis which OT’s are supposedly fantastic at. The problem in particular is that we all have our preconceived idea of how a person should do something. Tea making is a classic example used by OT’s as a every day activity and as James suggests it is a somewhat subjective measure:

“One of the main criticisms of kitchen assessments in hospital - usually in the hospital OT kitchen, is that it isn’t actually the same as in the person’s own home, where they will probably be returning to. Someone might quite happily manage to do all sorts of things in their own kitchen, but appear to be confused and unable to the OT kitchen”

With much regret to my workmates I regularly provide an example of getting this activity “wrong” and that’s simply because I don’t make tea. Actually scrap that - I don’t drink tea. Infact my friends and family ban me from trying to make tea because I’m so lousy*. Yes, I am a total social outcast! God forbid the day if I have a brain injury and someone asks me to make a cup of tea - I would invariably fail with the above example.

Here’s a little side story which will let you into a little about me. I spoke to an old computer programming friend the other month and completely unprompted (regarding my current role as an OT) he said the following:

“I had to write a program for a job interview to simulate making a cup of tea. do you know it had about 200 steps?! a cup of tea is hard you know! … the worst bit was working out which order to put it all in - I’m a milk before tea man myself but realise its not the common method”

Aye, I certainly do.. there are more coincidences between computer programming and OT but that is for another post. The point is that OT’s sometimes forget the complexity of the task and more importantly the route in which it is taken. There is also another thing to remember we all have cultural differences between the way we do things. George Orwell recognises this issue when he talks about the “Russian style” of tea drinking in his essay “A Nice cup of tea”:

“Lastly, tea—unless one is drinking it in the Russian style—should be drunk without sugar. I know very well that I am in a minority here. But still, how can you call yourself a true tea-lover if you destroy the flavour of your tea by putting sugar in it? It would be equally reasonable to put in pepper or salt”

Unlike George we need to be understanding of these cultural differences, and some would argue this means learning about them. If you aren’t aware, the strange technique of warming the teapot is not unusual and infact it has been declared as the scientifically best way of making tea:

“Yesterday, he said the keys to producing the perfect cup were using soft water, warming the pot before filling and allowing the tea to brew for three minutes. It was also essential to use loose-leaf Assam tea rather than tea bags - “they slow down the infusion”.” From the Guide to the perfect cuppa starts a storm in a teacup

And now for the second letter in this posting.

“World Cup Revision

SIR - I was interested to read Neville Beale’s letter (July 18) about his mother who failed her stroke recovery test because medical staff did not understand the old-fashioned way she made tea. It does not Surprise me.

Eight years ago, during the World Cup, I had a stroke. The nurses were going to write me off because I could not answer their questions on football. They would not believe my wife when she told them I had no interest in the subject. “All men know about football” the said.

It took a visit to the hospital by my boss, to converse with me about nuclear engineering, to convince them I was actually compos mentis.

Since then, the joke every World Cup has been that I have to do my revision in case I have another stroke.

Richard Chester-Browne. Warrington, Cheshire.”

Telegraph 25 July, 2006

So what about the second letter writers experience? What can be the excuse for that? Lets imagine for a moment that the writer meant “OT’s” rather than “nurses” which could well have been the case*. Well, if that’s the case then I have to say there isn’t really any excuse - and even if they were nurses that’s still no excuse. OT’s *should be skilled in being client-centred and at the heart of this, working out what it is that engages & motivates individuals. We realise that no-one individual is the same and we are all different. Or at least we should.

In certain environments mistakes do happen and the reasons are often so numerous and complex that no one person is to blame. The football one is a classic mistake that I have kind of witnessed when you run a group five times a week, every week and your mind goes blank when trying to think of a current affairs topic to discuss and the general group seems to like football - but on a one-to-one basis? The mistake is perhaps borne out of routine and to a certain degree the human trait of stereotyping people. It can be difficult to assess a persons interests if they cannot easily communicate or their friends & relatives are not around. You could argue that if you take the average OT, their understanding of nuclear engineering would be quite limited (or perhaps “we were never taught that at college!” would be the response) - but now I’m stereotyping right?! So if you have been in this situation buck this worrying stereotype; What trouble would it take to google “nuclear engineering” and spend 5 minutes over lunch discovering that the man may be interested in that MRI scan you have recently taken of his brain! (if you haven’t worked it out, “nuclear engineering” covers a whole range of topics - one of which is nuclear medicine/physics read wikipedia for more info). What, do I hear you say “We don’t have time to look on wikipedia what nuclear engineering is!”?? Im afraid that I would equally say “this isn’t a luxury - its part of your job!”

* My Brother believes that there is a more sinister reason for me not being able to make tea: that it gets me out of making the tea. A clever approach that can get you out of doing all sorts of things but I have to say in this example its simply not true.

** I admit I hold onto this line of thought for quite sometime. If they were nurses then it could be more of an argument for OT’s on that ward which turns the argument into something entirely different..!

]]> Tea This is a somewhat old post that I had been taking my time to finally post it so here goes..it is based around two letters that were submitted to the Telegraph way back about a year ago:

“Tea test

SIR - Office juniors are not the only people who have no idea how to make real tea (Letters, July 15). My mother was assessed last year by an occupational therapist as to whether she was fit to return home after a stroke. The OT considered she was not fully compos mentis. Why? She warmed the teapot with hot water, then poured it away before putting leaf tea in the pot and adding boiling water.

I was not believed when I pointed out that this method was correct and she had not been making the tea twice over.

N. Beale London, SE3”

Telegraph 18 July, 2006

I can’t of course speak on behalf of the OT in question but I know this complaint, if not directly the same, is not unheard of (from both patients and staff). The therapist in question has not been able to reply to these letters but there could of well been a reasonable reason for saying these patients in question were not “compos mentis”. Or of course they never actually said those things but hinted towards it. Whatever the case its simply not on.

So why is it that this sometimes occurs? Well the problem lies with that little thing called activity analysis which OT’s are supposedly fantastic at. The problem in particular is that we all have our preconceived idea of how a person should do something. Tea making is a classic example used by OT’s as a every day activity and as James suggests it is a somewhat subjective measure:

“One of the main criticisms of kitchen assessments in hospital - usually in the hospital OT kitchen, is that it isn’t actually the same as in the person’s own home, where they will probably be returning to. Someone might quite happily manage to do all sorts of things in their own kitchen, but appear to be confused and unable to the OT kitchen”

With much regret to my workmates I regularly provide an example of getting this activity “wrong” and that’s simply because I don’t make tea. Actually scrap that - I don’t drink tea. Infact my friends and family ban me from trying to make tea because I’m so lousy*. Yes, I am a total social outcast! God forbid the day if I have a brain injury and someone asks me to make a cup of tea - I would invariably fail with the above example.

Here’s a little side story which will let you into a little about me. I spoke to an old computer programming friend the other month and completely unprompted (regarding my current role as an OT) he said the following:

“I had to write a program for a job interview to simulate making a cup of tea. do you know it had about 200 steps?! a cup of tea is hard you know! … the worst bit was working out which order to put it all in - I’m a milk before tea man myself but realise its not the common method”

Aye, I certainly do.. there are more coincidences between computer programming and OT but that is for another post. The point is that OT’s sometimes forget the complexity of the task and more importantly the route in which it is taken. There is also another thing to remember we all have cultural differences between the way we do things. George Orwell recognises this issue when he talks about the “Russian style” of tea drinking in his essay “A Nice cup of tea”:

“Lastly, tea—unless one is drinking it in the Russian style—should be drunk without sugar. I know very well that I am in a minority here. But still, how can you call yourself a true tea-lover if you destroy the flavour of your tea by putting sugar in it? It would be equally reasonable to put in pepper or salt”

Unlike George we need to be understanding of these cultural differences, and some would argue this means learning about them. If you aren’t aware, the strange technique of warming the teapot is not unusual and infact it has been declared as the scientifically best way of making tea:

“Yesterday, he said the keys to producing the perfect cup were using soft water, warming the pot before filling and allowing the tea to brew for three minutes. It was also essential to use loose-leaf Assam tea rather than tea bags - “they slow down the infusion”.” From the Guide to the perfect cuppa starts a storm in a teacup

And now for the second letter in this posting.

“World Cup Revision

SIR - I was interested to read Neville Beale’s letter (July 18) about his mother who failed her stroke recovery test because medical staff did not understand the old-fashioned way she made tea. It does not Surprise me.

Eight years ago, during the World Cup, I had a stroke. The nurses were going to write me off because I could not answer their questions on football. They would not believe my wife when she told them I had no interest in the subject. “All men know about football” the said.

It took a visit to the hospital by my boss, to converse with me about nuclear engineering, to convince them I was actually compos mentis.

Since then, the joke every World Cup has been that I have to do my revision in case I have another stroke.

Richard Chester-Browne. Warrington, Cheshire.”

Telegraph 25 July, 2006

So what about the second letter writers experience? What can be the excuse for that? Lets imagine for a moment that the writer meant “OT’s” rather than “nurses” which could well have been the case*. Well, if that’s the case then I have to say there isn’t really any excuse - and even if they were nurses that’s still no excuse. OT’s *should be skilled in being client-centred and at the heart of this, working out what it is that engages & motivates individuals. We realise that no-one individual is the same and we are all different. Or at least we should.

In certain environments mistakes do happen and the reasons are often so numerous and complex that no one person is to blame. The football one is a classic mistake that I have kind of witnessed when you run a group five times a week, every week and your mind goes blank when trying to think of a current affairs topic to discuss and the general group seems to like football - but on a one-to-one basis? The mistake is perhaps borne out of routine and to a certain degree the human trait of stereotyping people. It can be difficult to assess a persons interests if they cannot easily communicate or their friends & relatives are not around. You could argue that if you take the average OT, their understanding of nuclear engineering would be quite limited (or perhaps “we were never taught that at college!” would be the response) - but now I’m stereotyping right?! So if you have been in this situation buck this worrying stereotype; What trouble would it take to google “nuclear engineering” and spend 5 minutes over lunch discovering that the man may be interested in that MRI scan you have recently taken of his brain! (if you haven’t worked it out, “nuclear engineering” covers a whole range of topics - one of which is nuclear medicine/physics read wikipedia for more info). What, do I hear you say “We don’t have time to look on wikipedia what nuclear engineering is!”?? Im afraid that I would equally say “this isn’t a luxury - its part of your job!”

* My Brother believes that there is a more sinister reason for me not being able to make tea: that it gets me out of making the tea. A clever approach that can get you out of doing all sorts of things but I have to say in this example its simply not true.

** I admit I hold onto this line of thought for quite sometime. If they were nurses then it could be more of an argument for OT’s on that ward which turns the argument into something entirely different..!

]]> Facebook for OT - another Social Networking opportunity? http://metaot.com/blogs/willwade-38 2007-06-11T16:06:45+01:00 2007-06-11T22:12:51+01:00 willwade I’m sitting at my computer trying to write a presentation for a conference later this week but struggling to keep focused. Why? Its because I’ve been introduced to another social-networking site - this time its facebook. I figured that instead of wasting work time on it I would turn it into a reflective piece for meta-ot - so enjoy!

Now I had heard of it for ages - but largely I thought that the majority of contributors were students and I simply figured it was another myspace - full of unending tedious messages from friend to friend and random media that would have no interest in anyone other than the intended audience*. But recently I was introduced by an old school friend and on a bored Saturday afternoon I signed up. For about a week I became obsessed - I have had the amazing pleasure of “bumping” into old friends and stalking old workmates. Put simply its what friends reunited was meant to be. So then why am I writing about it on this site? Well typing in “occupational therapy” brings up a staggering 83 groups - some not actively written on but that’s beside the point. And the most interesting thing is this: they aren’t all (so it seems) students using them. But what are the discussions? Lets take a quick look at a few:

  • “Bored Of Fluffy Occupational Therapy” (55 members)
  • “Collaborating & Sharing Ideas With Other Occupational Therapists” (71 members)
  • “I’m tired of having to explain what Occupational Therapy is!” (2108 members)
  • “I wish i didn’t choose Occupational Therapy as a career” (20 members) (has the amusing address of 77 Kielhofner way) This one has, somewhat ironically, the BAOT logo as the groups logo.
  • “Yes, I am a Occupational Therapist and no we don’t wipe bums!!” (366 members)
  • “British OT’s” (83 members)
  • “LOOKING FOR A MAJOR? NOT SURE WHAT TO DO? O.T. is the way to go!!” (15 members)
  • “My OT professor wants me to do what….?!?” (57 members)
  • “Booze Drinking Occupational Therapy Students (B-DOTS)” (89 members)
  • “OTs are hot” (260 members)
  • “Why do physio’s think they are god’s gift (applies to vast majority)” (126 members)

And a whole load of “OT’s [some-college] [some-year]” which are usually specific to a particular college/university and graduation year.

Now some thoughts. If I was a recruiter I could just as easily use it for work reasons as well as social reasons and look up a potential candidate. Would a candidate who has joined “I wish i didn’t choose OT as a career” be a potentially wise choice for a post? This potential danger is not unheard of - anyone can google your name and come up with a posting from 5 years ago where you may have belittled a previous boss - but facebook makes the whole process a little easier - and, by its nature of being one of the largest social networking social sites - entirely likely that your candidate is on the site.

It is this general concern that someone I recently spoke to stated as to why they didn’t want to contribute to putting things online in such a public way. I would argue this fact shouldn’t scare OTs away from joining in with discussion. Lets put it another way, in comparison to my above recruitment problem: would someone who has posted to “Bored of fluffy Occupational Therapy” and trying to change the profession actually strengthen their position for a post?

Purely because your view may not be the same as others is not a reason to not join in with debate. For example, reflection - in whatever form you decide to use it, may involve discussing difficulties of working with colleagues, or dare I say it - clients. But in the same way that you were trying to talk to your boss about a potential working-relationship problem you would (I hope) try to be professional. Its in your own interest, and ultimately the professions (remember these groups are public! Imagine you are a potential client and find out that your OT doesn’t believe in what they are doing? what kind of image does that give?). Although I realise, more than anyone, that there are times that you just want to go “aarrgh I hate this!” doing it so publicly may be a tad dangerous. Just be careful - that’s all.

Conversley, facebook - along with blogging etc, is a easy way of getting to know your online peers. Facebook is, by its very nature, good at finding others who have your same interests and background. It can be a little stalkerish in a way - but I would be interested to see how it develops as a social-networking cum-working tool.

* myspace suffers somewhat from multiple-design-failure which doesn’t help my hatred for the service.

]]> I’m sitting at my computer trying to write a presentation for a conference later this week but struggling to keep focused. Why? Its because I’ve been introduced to another social-networking site - this time its facebook. I figured that instead of wasting work time on it I would turn it into a reflective piece for meta-ot - so enjoy!

Now I had heard of it for ages - but largely I thought that the majority of contributors were students and I simply figured it was another myspace - full of unending tedious messages from friend to friend and random media that would have no interest in anyone other than the intended audience*. But recently I was introduced by an old school friend and on a bored Saturday afternoon I signed up. For about a week I became obsessed - I have had the amazing pleasure of “bumping” into old friends and stalking old workmates. Put simply its what friends reunited was meant to be. So then why am I writing about it on this site? Well typing in “occupational therapy” brings up a staggering 83 groups - some not actively written on but that’s beside the point. And the most interesting thing is this: they aren’t all (so it seems) students using them. But what are the discussions? Lets take a quick look at a few:

  • “Bored Of Fluffy Occupational Therapy” (55 members)
  • “Collaborating & Sharing Ideas With Other Occupational Therapists” (71 members)
  • “I’m tired of having to explain what Occupational Therapy is!” (2108 members)
  • “I wish i didn’t choose Occupational Therapy as a career” (20 members) (has the amusing address of 77 Kielhofner way) This one has, somewhat ironically, the BAOT logo as the groups logo.
  • “Yes, I am a Occupational Therapist and no we don’t wipe bums!!” (366 members)
  • “British OT’s” (83 members)
  • “LOOKING FOR A MAJOR? NOT SURE WHAT TO DO? O.T. is the way to go!!” (15 members)
  • “My OT professor wants me to do what….?!?” (57 members)
  • “Booze Drinking Occupational Therapy Students (B-DOTS)” (89 members)
  • “OTs are hot” (260 members)
  • “Why do physio’s think they are god’s gift (applies to vast majority)” (126 members)

And a whole load of “OT’s [some-college] [some-year]” which are usually specific to a particular college/university and graduation year.

Now some thoughts. If I was a recruiter I could just as easily use it for work reasons as well as social reasons and look up a potential candidate. Would a candidate who has joined “I wish i didn’t choose OT as a career” be a potentially wise choice for a post? This potential danger is not unheard of - anyone can google your name and come up with a posting from 5 years ago where you may have belittled a previous boss - but facebook makes the whole process a little easier - and, by its nature of being one of the largest social networking social sites - entirely likely that your candidate is on the site.

It is this general concern that someone I recently spoke to stated as to why they didn’t want to contribute to putting things online in such a public way. I would argue this fact shouldn’t scare OTs away from joining in with discussion. Lets put it another way, in comparison to my above recruitment problem: would someone who has posted to “Bored of fluffy Occupational Therapy” and trying to change the profession actually strengthen their position for a post?

Purely because your view may not be the same as others is not a reason to not join in with debate. For example, reflection - in whatever form you decide to use it, may involve discussing difficulties of working with colleagues, or dare I say it - clients. But in the same way that you were trying to talk to your boss about a potential working-relationship problem you would (I hope) try to be professional. Its in your own interest, and ultimately the professions (remember these groups are public! Imagine you are a potential client and find out that your OT doesn’t believe in what they are doing? what kind of image does that give?). Although I realise, more than anyone, that there are times that you just want to go “aarrgh I hate this!” doing it so publicly may be a tad dangerous. Just be careful - that’s all.

Conversley, facebook - along with blogging etc, is a easy way of getting to know your online peers. Facebook is, by its very nature, good at finding others who have your same interests and background. It can be a little stalkerish in a way - but I would be interested to see how it develops as a social-networking cum-working tool.

* myspace suffers somewhat from multiple-design-failure which doesn’t help my hatred for the service.

]]> OT's On the Net - UK (OTON-UK?!) http://metaot.com/blogs/willwade-37 2007-06-04T18:20:02+01:00 2007-07-08T20:21:16+01:00 willwade Wowsers. So the OT blogosphere has really taken off over the past few months. Without a doubt this is pretty much down to Merrolee's group in New Zealand but also to student's and of course a few bods like James Lamport Housing-OT Blog and Chris' ABC Therapeutics Blog in the States.
Merrolee and I were talking on GTalk just the other night and discussing ways on broadening the blogosphere / getting methods on us all talking to each other. Then something struck me. In a lot of other communities on the net these various bloggers and community members get together once in a while - yes, actually get away from a computer! Call it a meetup, blogmeet - whatever. I can't accommodate the world (although hey, your all invited!) so I have setup a upcoming group for anyone to join titled "OT's On The Net - UK" and in the upcoming future (like it?) I will organise a suitable venue/date to have a beverage and a chat. So, if your in the UK and reading this.. thinking of starting a Blog, contributing to the net in someway and your an OT (or student OT) then add yourself to the group to be informed of when/where!
Update I stupidly forgot to post the URL in the first revision of this post. To add yourself go to : http://upcoming.yahoo.com/group/3203/ (It's a yahoo application so you will need to join yahoo )
(Thanks Merrolee)
UPDATE (2) See the forum on the meetup page for some inital thoughts of this meeting and please give me your feedback! http://upcoming.yahoo.com/group/topic/1716/

]]> Wowsers. So the OT blogosphere has really taken off over the past few months. Without a doubt this is pretty much down to Merrolee's group in New Zealand but also to student's and of course a few bods like James Lamport Housing-OT Blog and Chris' ABC Therapeutics Blog in the States.

Merrolee and I were talking on GTalk just the other night and discussing ways on broadening the blogosphere / getting methods on us all talking to each other. Then something struck me. In a lot of other communities on the net these various bloggers and community members get together once in a while - yes, actually get away from a computer! Call it a meetup, blogmeet - whatever. I can't accommodate the world (although hey, your all invited!) so I have setup a upcoming group for anyone to join titled "OT's On The Net - UK" and in the upcoming future (like it?) I will organise a suitable venue/date to have a beverage and a chat. So, if your in the UK and reading this.. thinking of starting a Blog, contributing to the net in someway and your an OT (or student OT) then add yourself to the group to be informed of when/where!

Update I stupidly forgot to post the URL in the first revision of this post. To add yourself go to : http://upcoming.yahoo.com/group/3203/ (It's a yahoo application so you will need to join yahoo )

(Thanks Merrolee)

UPDATE (2) See the forum on the meetup page for some inital thoughts of this meeting and please give me your feedback! http://upcoming.yahoo.com/group/topic/1716/

]]> Breaking Down Barriers - (Prof. Lewis Appleby Interview (Transcript)) http://metaot.com/lewis-appleby-interview-transcript 2007-05-16T12:23:02+01:00 2007-05-16T13:28:49+01:00 willwade Well I'm not entirely sure what to make of the following - here are some musings and the the transcript for yourselves to ponder.

Last Friday I awoke to the Today programme on Radio 4 and hazily heard a fascinating interview with The National Clinical Director for Mental Health, Professor Louis Applepy. He spoke to the Today programme discussing the "Breaking down barriers - the clinical case for change" Document (although it was stated as "some ideas"). Above everything else what I find fascinating is the strong hinting of the word "occupational therapy" without actually saying it. Or, did I have my "wishful thinking" hat on and they are infact thinking of using doctors & nurses... hmmm. The document doesn't really state anything new in my opinion - its what OT's (and on occasion some other AHP's and to some extent nursing) have been saying for a while. I also agree that many Mental Health units - particularly those involved outreach work are doing what is outlined. So who is this for? I'm not entirely sure. What's nice is the strong undertones that we need to move towards a more social model of healthcare - but it will take more than a couple of documents from the mental health sector of healthcare to get us there.

For the record I am posting it here. You have until this Friday to listen again on the BBC's site.

Friday 11th May 2007, 0714: Edward Stoughton (ES): The National Director for Mental Health , Professor Lewis Appleby is putting forward some ideas into for the next steps into reforming Mental Health Care. As I understand it you want the NHS to become more involved in peoples ordinary lives - that is patients being treated in the community.

Professor Lewis Appleby (LA): Yes the report is about the next phase of reform of mental health care. We have had several years of strengthening what community services do and the report is about breaking down barriers in the next stage of reform, so I'm talking about barriers that that get in the way of better patients experience of care. At the moment there is a barrier between what health services traditionally do, which is clinical care, improving peoples illness', abolishing their symptoms - but what patients often tell us they want is help with quality of life. They want opportunities for training, for jobs and decent housing and we have to take on that responsibility.

ES: so the sought of thing we would call more social work than health work?

LA: Well its rooted in social care certainly. The quality of life approach to healthcare has its origins there and I suppose traditionally we in clinical services have seen that as a secondary benefit so our main aim is to make sure people no longer have symptoms and we hope of course that there will be broader benefits to that, but now we are saying really those broader benefits should be the primary aim of what services are about.

ES: And do you think that's an argument that will fly, as its conceptually quite a big leap isn't it

LA: Well the good services are already doing it I think its fair to say. Erm, its certainly a step forward from what we have done in the past but you know if a young person has a first episode of psychotic illness and previously we would help them get well and then we would return them to their families and hope that they would prosper. Its much better to be saying we will now help you get back to college, find a training place and a job - we will support you and support any potential employer so that they are prepared to offer you a job

ES: It sounds expensive

LA: I don't think it is expensive - its one of these things that is more about changing aims and professional roles. Its really about how we as clinical staff see our main responsibility

ES: Its also about staff doing things that they haven't done before? That's bound to require more resources isnt it?

LA: Well not necessarily. We have had large increases in investment and very big increases in all the staff groups. And its our job now that to make best use of that money. And that means focusing on the things patients they want and in particular they tell us that they want to return to mainstream society. They don't want simply to turn up to outpatient clinics and get their regular treatment

ES: this whole area is something giving the government problems isn't it. I'm thinking of the mental health bill which is still trying to get through parliament. Do you think its the right moment to be talking about anther leap forward rather than consolidating what you have been trying to do already?

LA: Well the connection with the Mental Health Bill is that the aim of the bill is to keep people well and the main measure in the bill is community treatment border that will require some people to take their treatment

ES: But my point is that its politically proved very difficult indeed because not everyone agrees with the way the bill has been put forward

LA: Well lots of people are in support of the community treatment order although they may differ on the exactly what the criteria ought to be. But remember , if your life is one of repeated admissions to hospital and untreated mental illness you cant get a job you cant take advantage of decent housing, you cant form friendships and relationships in the way that other people can. And the bill is there to make sure that some high risk and vulnerable people get the treatment they need. "

Quite probably copyright the BBC, Radio 4, Today Programme.

]]> Well I'm not entirely sure what to make of the following - here are some musings and the the transcript for yourselves to ponder.

Last Friday I awoke to the Today programme on Radio 4 and hazily heard a fascinating interview with The National Clinical Director for Mental Health, Professor Louis Applepy. He spoke to the Today programme discussing the "Breaking down barriers - the clinical case for change" Document (although it was stated as "some ideas"). Above everything else what I find fascinating is the strong hinting of the word "occupational therapy" without actually saying it. Or, did I have my "wishful thinking" hat on and they are infact thinking of using doctors & nurses... hmmm. The document doesn't really state anything new in my opinion - its what OT's (and on occasion some other AHP's and to some extent nursing) have been saying for a while. I also agree that many Mental Health units - particularly those involved outreach work are doing what is outlined. So who is this for? I'm not entirely sure. What's nice is the strong undertones that we need to move towards a more social model of healthcare - but it will take more than a couple of documents from the mental health sector of healthcare to get us there.

For the record I am posting it here. You have until this Friday to listen again on the BBC's site.

Friday 11th May 2007, 0714: Edward Stoughton (ES): The National Director for Mental Health , Professor Lewis Appleby is putting forward some ideas into for the next steps into reforming Mental Health Care. As I understand it you want the NHS to become more involved in peoples ordinary lives - that is patients being treated in the community.

Professor Lewis Appleby (LA): Yes the report is about the next phase of reform of mental health care. We have had several years of strengthening what community services do and the report is about breaking down barriers in the next stage of reform, so I'm talking about barriers that that get in the way of better patients experience of care. At the moment there is a barrier between what health services traditionally do, which is clinical care, improving peoples illness', abolishing their symptoms - but what patients often tell us they want is help with quality of life. They want opportunities for training, for jobs and decent housing and we have to take on that responsibility.

ES: so the sought of thing we would call more social work than health work?

LA: Well its rooted in social care certainly. The quality of life approach to healthcare has its origins there and I suppose traditionally we in clinical services have seen that as a secondary benefit so our main aim is to make sure people no longer have symptoms and we hope of course that there will be broader benefits to that, but now we are saying really those broader benefits should be the primary aim of what services are about.

ES: And do you think that's an argument that will fly, as its conceptually quite a big leap isn't it

LA: Well the good services are already doing it I think its fair to say. Erm, its certainly a step forward from what we have done in the past but you know if a young person has a first episode of psychotic illness and previously we would help them get well and then we would return them to their families and hope that they would prosper. Its much better to be saying we will now help you get back to college, find a training place and a job - we will support you and support any potential employer so that they are prepared to offer you a job

ES: It sounds expensive

LA: I don't think it is expensive - its one of these things that is more about changing aims and professional roles. Its really about how we as clinical staff see our main responsibility

ES: Its also about staff doing things that they haven't done before? That's bound to require more resources isnt it?

LA: Well not necessarily. We have had large increases in investment and very big increases in all the staff groups. And its our job now that to make best use of that money. And that means focusing on the things patients they want and in particular they tell us that they want to return to mainstream society. They don't want simply to turn up to outpatient clinics and get their regular treatment

ES: this whole area is something giving the government problems isn't it. I'm thinking of the mental health bill which is still trying to get through parliament. Do you think its the right moment to be talking about anther leap forward rather than consolidating what you have been trying to do already?

LA: Well the connection with the Mental Health Bill is that the aim of the bill is to keep people well and the main measure in the bill is community treatment border that will require some people to take their treatment

ES: But my point is that its politically proved very difficult indeed because not everyone agrees with the way the bill has been put forward

LA: Well lots of people are in support of the community treatment order although they may differ on the exactly what the criteria ought to be. But remember , if your life is one of repeated admissions to hospital and untreated mental illness you cant get a job you cant take advantage of decent housing, you cant form friendships and relationships in the way that other people can. And the bill is there to make sure that some high risk and vulnerable people get the treatment they need. "

Quite probably copyright the BBC, Radio 4, Today Programme.

]]> Please help! http://metaot.com/ot-assessments-outcome-measures-info 2007-04-25T17:38:01+01:00 2007-04-29T16:31:29+01:00 willwade Help Wanted
The assessment & outcome measure database is now live!
Click here for the big hairy list! Assessment & Outcome measure database
It is by no means finished however!
As the image to the left states "We need your help!" 
If you fancy getting your feet wet and helping out then take a read of this or alternatively mail me directly 

]]> Help Wanted

The assessment & outcome measure database is now live!
Click here for the big hairy list! Assessment & Outcome measure database

It is by no means finished however!

As the image to the left states "We need your help!" 

If you fancy getting your feet wet and helping out then take a read of this or alternatively mail me directly 

]]> Glossary & Abbreviations List http://metaot.com/glossary 2007-01-21T17:58:54+00:00 2008-06-19T19:48:46+01:00 willwade Find below a (handy?) glossary of commonly used terms within medical notes and the like. Please remember that each medical institution usually has its own style of notes. Be careful when using these and try and hunt down the local Abbreviation list. For more information on SOAP notes see this article. If you have an iPod you may be interested to know that the list has been converted to a Notes Application - read more about it here.

]]> Find below a (handy?) glossary of commonly used terms within medical notes and the like. Please remember that each medical institution usually has its own style of notes. Be careful when using these and try and hunt down the local Abbreviation list. For more information on SOAP notes see this article. If you have an iPod you may be interested to know that the list has been converted to a Notes Application - read more about it here.


# | + | - | < | > | ? | @ | a | c | 0 | b | d | e | f | g | h | i | j | k | l | m | n | o | p | q | r | s | t | u | v | w | x | y | z | ? | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9

# (#ed)
fracture / fractured

+ve
positive

-ve
negative

1/12
once a month

1/14
once a fortnight

1/52
once a year

1/7
once a week

1°
Primary

1ry
primary

2
secondary

2°
Secondary

2ry
secondary

<
less than

>
more than

?
query

@
at

A
Assist

A&E
Accident & Emergency

ER (Emergency room) in USA

A&P
Anterior and Posterior (often used for x-rays)

A.Sp
Ankylosing Spondylitis

A form of chronic inflammation of the spine and the sacroiliac joints. The sacroiliac joints are located in the low back where the sacrum (the bone directly above the tailbone) meets the iliac bones (bones on either side of the upper buttocks). Chronic inflammation in these areas causes pain and stiffness in and around the spine. Over time, chronic spinal inflammation (spondylitis) can lead to a complete cementing together (fusion) of the vertebrae, a process called ankylosis. Ankylosis causes total loss of mobility of the spine.

A/A
As Above

A/L
Annual Leave

A/V
Access visit

AA
Attendance Allowance

AAROM
Active Assisted Range of Motion

Abd
Abduction

Movement away from the midline of the body.

Abdo
Abdominal

ABI
Acquired Brain Injury

An accident or trauma that causes injury to the brain. Acquired Brain Injury can also be called a Traumatic Brain Injury (TBI) and it may be caused by penetrating injuries, such as in a car accident, or a Closed Head Injury (CBI) when the brain is damaged but there is no outward sign of trauma.

ABVD
A chemotherapy regimen of Adriamycin (doxorubicin), bleomycin, vinblastine, and dacarbazine. ABVD is now one of the most common chemotherapy regimens for treating Hodgkin's Disease. May cause permanent sterility.

Access Visit
When the home of an inpatient is visited by the Occupational Therapist, without the patient to assess their environment

ACM
Arnold - Chiari Malformation (or just Chiari Malformation)

A benign structural problem affecting the cerebellum. Most children with these malformations who do not have spina bifida will have the form known as type I. Essentially there is extra cerebellum crowding the outlet of the brainstem/spinal cord from the skull on its way to the spinal canal. This crowding will commonly lead to headaches, neck pain, funny feelings in the arms and/or legs, stiffness, and less often will cause difficulties with swallowing or gagging. Often the symptoms are made worse with straining. When the diagnosis is suspected the study of choice is an MRI scan. These malformations are very difficult to see on CT scans and impossible to see on plain x-rays. Sometimes these malformations can be made worse by, or can cause hydrocephalus. In addition they can often lead to fluid filled cavities in the spinal cord known as syrinxes

Add
Adduction

Movement toward the midline of the body.

ADL
Activities of Daily Living

ADM
Abductor Digiti Minimi

AF
Atrial Fibrillation

Condition in which the two small upper chambers of the heart, the atria, quiver instead of beating effectively an can feel like the heart is racing. Although atrial fibrillation is not in itself considered life-threatening, people with it are at an increased risk for blood clots and stroke.

AFO
Ankle Foot Orthosis

AHP
Allied Health Professions


e.g. Arts Therapists, Chiropodists, Dietitians, Occupational Therapists, Orthoptists, Paramedics, Physiotherapists, Prosthetists and Orthotists, Psychologists, Psychotherapists, Radiographers, Speech and Language Therapists.

AIDS
Acquired Immune Deficiency Syndrome

AKA
Above Knee Amputation

AKC
Ambrose King Centre

ALL
Acute Lymphatic Leukaemia

ALS
Amytrophic Lateral Sclerosis

Also known as Lou Gehrig's Disease, is a progressive neuromuscular disorder that is caused when the motor nerve cells that control voluntary muscle movement gradually die resulting in paralysis and potentially death. It progresses at different rates in each individual, with the average time of survival being three years to five years from onset.

AML
Acute Myelogenous Leukaemia

Also known as acute myeloid leukemia, is a cancer of the myeloid line of white blood cells. It is the most commonly diagnosed type of adult leukemia, and is rare among children.

AMPS
Assessment of Motor and Process Skills.

The AMPS is an observational assessment based on MOHO that is used to measure the quality of a person's performance of domestic (instrumental) or basic (personal) activities of daily living (ADL). The quality of the person's ADL performance is assessed by rating the effort, efficiency, safety, and independence of 16 ADL motor and 20 ADL process skill items.

See del.icio.us links for the amps websites.

ANLL
Acute Non Lymphatic Leukaemia

AP
Adductor Pollicis

APB
Abductor Pollicis Brevis

APL
Abductor Pollicis Longus

Approx
Approximately

Appt
Appointment

apraxia
Loss of the ability to sequence, coordinate, and execute certain purposeful movements and gestures in the absence of motor weakness, paralysis, or sensory impairments. Apraxia is thought to result from damage to the cerebral cortex, such as due to stroke, brain tumors, head injury, or infection. It may also occur as a result of impaired development of the cortex as in certain neurodevelopmental disorders, including Rett syndrome. Apraxia may affect almost any voluntary movements, including those required for proper eye gaze, walking, speaking, or writing.

AROM
Active Range of Movement

ARV
Antiretrovirals

ASAP
as soon as possible

ASW
Approved Social Worker

ataxia
An inability to coordinate muscle activity during voluntary movement, so that smooth movements occur. Most often due to disorders of the cerebellum or the posterior columns of the spinal cord; may involve the limbs, head, or trunk.

ATLL
Adult T-Cell Leukaemia-lymphoma

ATSP
Asked to see patient

AVM
Arteriovenous Malformation

Defects of the circulatory system that are generally believed to arise during embryonic or fetal development or soon after birth. They are comprised of snarled tangles of arteries and veins. Arteries carry oxygen-rich blood away from the heart to the body’s cells; veins return oxygen-depleted blood to the lungs and heart. The presence of an AVM disrupts this vital cyclical process. Although AVMs can develop in many different sites, those located in the brain or spinal cord—the two parts of the central nervous system—can have especially widespread effects on the body.

Ax
Assessment

AXR
Abdominal X-ray

â„ž
Treatment

∆
Diagnosis

∴
therefore

∵
Because

≈
approximately

â’¶
Active, or Assistance / Assisted / Assist

â“…
Passive

♀
female / woman

♂
male / man

±
approximately

º
nil / none

BAL
Blood Alcohol Level. The concentration of alcohol (ethanol) present in blood. It is usually expressed as mass per unit volume, but different countries may express it differently or use different units; examples include milligrams per 100 millilitres (mg/100 ml or, incorrectly, mg percent), milligrams per litre (mg/1), grams per 100 millilitres (g/100 ml), grams percent, and millimoles per litre. A concentration of 8 parts per thousand would be expressed in legal terminology in USA as .08%%, in Scandinavia as 0.8 promille, and in Canada and elsewhere as 80 mg/100 ml.

BAOT
British Association of Occupational Therapists

http://www.cot.org.uk/

BB, b/b
bathboard

BCPT
Breast Cancer Prevention Trial

BD
Twice Daily (bis in die)

BG
Basic Grade

BI
Brain Injury

BIBA
Brought in by ambulance

BIL
Brother in Law

Bilat
Bilateral

BKA
Below Knee Amputation

BM
Bone Marrow

BMT
Bone Marrow Transplantation

BO
Bowels Open

BP
Blood Pressure

BPA
Bangladeshi Parent Advisor

Bangladeshi children with disabilities are usually allocated a ‘parent advisor’ from their own culture to help their parents with the difficulties of coping with a child with disabilities and to support the families in their dealings with professionals.

Initiated in Tower Hamlets PCT

BPL
Brachial Plexus Lesion

BS, b/s
bathseat

BSF
Breast Self Examination

BSHC
Barts Sexual Health Centre

BSII, BSIII
Bodley Scott II, Bodley Scott III Wards

BTS
Beatrice Tate School

Bx
Biopsy

c
With

C of E
Care of Elderly or Church of England

c/c
Care coordinator

C/N, CN
Charge Nurse, Community Nurse

C/O
Complained Of

Ca
Cancer

CABG
Carotid Artery Bypass Graft

Heart bypass surgery creating a detour or "bypass" around the blocked part of a coronary artery to restore the blood supply to the heart muscle. Pronounced "cabbage"

CAPD
Continuous Ambulatory Peritoneal Dialysis

With CAPD, dialysis continues 24 hours a day, 7 days a week. Patients are not attached to a machine. Dialysis happens inside the body, using the peritoneal membrane as a filter.

CAW
Christopher Andrewes Ward

CC
Case Conference

CCF
Congestive Cardiac Failure

CD4
"Cluster of differentiation 4" - Surrogate marker for assessing the immune system (used widely in HIV)

CDH
Congenital Dislocation of the Hip

CDT
Community Drugs Team, or Child Development Team

Cellulitis
An acute inflammation of the connective tissue of the skin, caused by infection with staphylococcus, streptococcus or other bacteria (see also cellulitis - streptococcal).

CES
Community Equipment Store

CHD
Coronary Heart Disease

Caused by narrowing of the coronary arteries that feed the heart by cholesterol and fat deposits- a process called atherosclerosis.

CHSW
Community Health Support Worker

CI
Cardiac Insufficiency

Inadequate blood flow to the heart muscles; can cause angina pectoris

CICT
Community Intermediate Care Team

CLDS
Community Learning Disability Service

Clin
Clinical psychology , clinical psychologist

CLL
Chronic Lymphatic Leukaemia

cm
centimetres

CM
Care Manager

CMCJ
Carpometacarpal Joint

CMHT
Community Mental Health Team

CML
Chronic Myelogenous Leukaemia

CMOP
Canadian Model of Occupational Performance

CMV
Cytomegalovirus

A very common virus that can cause serious disease in people with low resistance to infection. It lies dormant in many persons' bodies and frequently causes infection post-transplant. Patients who have been exposed to and still carry the virus are CMV-positive.

CMV is a genus of Herpes viruses; in humans the species is known as Human herpesvirus 5 (HHV-5). It belongs to the Betaherpesvirinae subfamily of Herpesviridae. The name means "cell very big virus".

CNS
Central Nervous System, or Clinical Nurse Specialist

Co-op
Cooperative

COAD
Chronic Obstructive Airways Disease * note do not use

COE, COTE
Care Of The Elderly

Cog
Cognition

Comm
Community

Cont
Continued

COPD
Chronic Obstructive Pulmonary Disease

COPM
Canadian Occupational Performance Measure

The Standardised Assesment tool based on CMOP

COT
College of OT

COTE, COE
Care Of The Elderly

COTNAB
Chessington Neurological Perceptual Assessment Battery

CP
Cerebral Palsy, Care Programme

CPA
Care Programme Approach

CPAP
Continuous Positive Airways PRessure

CPM
Care Programme Manager

CPN
Community Psychiatric Nurse

CS, CSIII
Clinical Specialist (III)

CSF
Cerebro Spinal Fluid

CT, CAT
Computerised (Axial) Tomography

CTS
Carpal Tunnel Syndrome

CUP
Cancer Unknown Primary

CVA
Cerebro Vascular Accident

CVID
Common Variable Immune Deficiency

CVS
Cardiovascular System

CXR
Chest X-ray

D
Dependent

D
Daughter

D/C
Discharged

D/ch
Discharged

D/W
Discussed with

DADL
Domestic Activities of Daily Living

DDU
Drug Dependency Unit

De QuTSV
De Quervain's Tenosynovitis

Inflammation of the tendon on the side of the wrist at the base of the thumb - the extensor pollicus longus tendon. De QuTSV is usually associated with pain when the thumb is folded across the palm and the fingers are flexed over the thumb as the hand is pulled away from the involved wrist area. (This is referred to as the Finklestein maneuver.)

Dept
Department

DFG
Disabled Facilities Grant

DH
Day Hospital

DHL
Diffuse Histocytic Lymphoma

DHS
Dynamic Hip Screw

DHx
Drug History

DIL
Daughter in Law

DIPJ
Distal Interphalangeal Joint

Discharge Visit
When a patient is taken home by an Occupational Therapist at the time of discharge from the hospital in place of normal transport arrangements for discharge.

DKA
Diabetic Ketoacidosis

A condition that occurs due to insufficient insulin in the body. Extremely high blood glucose levels, along with a severe lack of insulin, result in the breakdown of body fat for energy and an accumulation of ketones in the blood and urine. This can be due to illness, incorrect doses of insulin, or omitting insulin injections. The acidic state that follows causes fruity smelling breath, deep and rapid breathing, stomach pain, nausea, vomiting, and sleepiness. DKA can lead to coma and death if not treated promptly.

DLA
Disability Living Allowance

DN
District Nurse

DNA
Did Not Attend

DOA
Date of Admission

DOB
Date of Birth

DOT
Disability Options Team

DP
Day Patient, Discharge Planning

Dr
Doctor

DU
Duodenal Ulcer

DVI
Domestic Violence Incident

DVT
Deep Vein Thrombosis

Dx
Diagnosis

Dysphagia
Difficulty in swallowing. Due to problems in nerve or muscle control. It is common, for example, after a stroke. Dysphagia compromises nutrition and hydration and may lead to aspiration pneumonia and dehydration

Dysphasia
Speech disorder where there are difficulties in expression by speech or comprehension of speech. Strictly, a lesser impairment than APHASIA (qv), but otherwise the same description applies. Word has Greek background: dys- means difficult and phasis means speech.

EBM
Evidence Based Medicine

ECG
Electrocardiogram

ECRB
Extensor Carpi Radialis Brevis

ECRL
Extensor Carpi Radialis Longus

ECT
Energy Conservation Techniques or Electro Convulsive Therapy

ECU
Extensor Carpi Ulnaris

EDC
Extensor Digitorum Communis

EDM
Extensor Digitorium Minimi

EEG
Electroencephalogram

A technique for recording electrical activity in the brain.

Eg
Example

ELR
Exceptional Leave to Remain

EMF
Electro Magnetic Fields

EPB
Extensor Pollicus Brevis

EPL
Extensor Pollicus Longus

Equipt
Equipment

ETOH
Ethanol

Alcohol. An intoxicated person may be described as being ETOH or as having "ETOH on board".

Actually stands for Ethyl alcohol, also known as ethanol or grain alcohol, is a flammable, colorless chemical compound, one of the alcohols that is most often found in alcoholic beverages. In common parlance, it is often referred to simply as alcohol. Its chemical formula is C2H5OH.

Exac
Exacerbation

Ext
Extension

Ext Rot
External Rotation

FA
Fibrosing alveolitis

FAW
Frederick Andrewes Ward

FBC
Full Blood Count

FCB
Flexor Carpi Brevis

FDP
Flexor Digitorum Profundus

FDS
Flexor Digitorum Superficialis

FFD
Fixed Flexion Deformity

FHx
Family History

FIL
Father in Law

FIM
Functional Independence Measure

Flex
Flexion

Movement about a joint in which the bones on either side of the joint are brought closer together, decreasing the angle of the bones forming a joint. Flexion is the opposite of extension.

FM
Fibromyalgia

An increasingly recognized chronic pain illness which is characterized by widespread musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue and sleep disturbances. The most common sites of pain include the neck, back, shoulders, pelvic girdle and hands, but any body part can be involved. Fibromyalgia patients experience a range of symptoms of varying intensities that wax and wane over time.

Follow up visit
When an inpatient is visited by an Occupational Therapist or Therapy assistant following discharge from hospital.See also: Post Discharge home visit

FPB
Flexor Pollicus Brevis

FPL
Flexor Pollicus Longus

FROM
Full Range of Motion

FRT
Fast Response Team

Or Rapid Discharge Team

FSTF
Free Standing Toilet Frame

FU, F/up
Follow up

FV
Femoral Vein

FWB
Full Weight Bearing

GA
General Anaesthetic

GCS
Glasgow Coma Scale

The GCS is scored between 3 and 15, 3 being the worst, and 15 the best. It is composed of three parameters : Best Eye Response, Best Verbal Response & Best Motor Response

GF
Ground Floor

GHF
Gordon Hamilton Fairly Ward

GHjt
Gleno-humeral joint

GHU
Graham Hayton Unit

GI
Gastrointestinal

GIT
Gastrointestinal Tract

GP
General Practitioner

GU
Genito Urinary

GUM
Genito-Urinary Medicine

H

Husband

H/V
Home Visit, Health Visitor

H/W
Housewife

HA
Housing Association

HAART
Highly Active Anti Retroviral Therapy

Hax
Home Assessment

Hb
Haemoglobin

HC
Home Care

HCA
Health Care Assistant

HCL
Hairy Cell Leukaemia

HD
Hodgkins Disease

HDU
High Dependency Unit

HES
Home Equipment Store

HH
Home Help

HI
Head Injury

HIV
Human Immunodeficiency Virus

HO
House Officer

Home assessment
When a patient is taken home by an Occupational Therapist during their inpatient stay and returned to the hospital as part of an assessment.

Home visit
When the home of a patient is visited by an Occupational Therapist who in the normal course of their work would see people in their own home e.g. community services.

HONK
A life-threatening condition in which the blood glucose level rises to very high levels but acidosis does not develop. Severe dehydration can result.

Hosp
Hospital

HPC
History of Presenting Condition / complaint

HR
Heart rate

HRBI
HIV related brain injury

Hx
History

I or I
Independent

I, II, III, IV, V
Numbering system for fingers and thumb (do not use RF, MF etc)

IA
Initial Assessment

ICP
Intercranial Pressure

ICR
Internal Carotid Artery

ICT
Intermediate Care Team

ICT
Information and Communication Technology

ICU
Intensive Care Unit

IDDM
Insulin Dependant Diabetes Mellitus

ie
That is

IF
Index Finger

IHD
Ischaemic Heart Disease

II
Initial Interview

ILR
Indefinite Leave to Remain

IM
Intramuscular

Indep
Independent

InPt
In Patient

Int Rot
Internal Rotation

IORT
Intra Operative Radiation Therapy

IP
Inpatient, or interphalangeal

IS
Income Support

ISA
Internal Service Agreement

ISQ
No change (in status quo)

ITU
Intensive Treatment Unit

ITU
Intensive Care Unit

IV
Intravenous


The administration of a drug or fluid directly into a vein.

IVDU
Intravenous drug user. Included within IDU, injecting drug user

IVP
Intravenous Pylography (kidney function)


male


Male


increase; ed


decrease / reduce; ed

ψ
Psychology

 ∆
Diagnosis

A
Assessment/Analysis (SOAP notes)

JPT
Joint Protection Techniques

JSA
Job Seeker's Allowance

Jt
Job Seeker's Allowance

Kg
Kilograms

L or L
Left

LA
Local Anaesthetic, Local Authority

LAS
Level Access Shower

LBP
Lower Back Pain

Lbs
Pounds

LF
Little Finger

LFT
Liver Function Test

Lge
Large

LH
Long Handled

LHR
Long Handled Reacher

LHS
Long Handled Sponge or Left Hand Side

LHSH
Long Handled Shoe Horn

LHTW
Long handled Toe Washer

LL
Lower limb, or Lower lobe

LOC
Loss of Consciousness

LP
Lumbar Puncture

LT
Long Term

LTM
Long Term Memory

LVF
Left Ventricular Failure

m
metres

Man
Tomorrow

MAOI
Monoamine Oxidase Inhibitors

Max
Maximum

MCA
Middle Cerebal Artery

MCPJ
Metacarp