willwade's blog

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!)

Due 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!

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..!

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.

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/

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.

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