The Sleeping Beauties of Science

26 Oct

Joan MV Pons

It appears not to have been Charles Perrault (1628-1703) who originally created this figure, later copied by the Grimm Brothers too, but that is no doubt quite a banal question for what we want to talk about here today.

Nevertheless, everybody knows the story: the princess, the spell which put her to sleep, the years and years which passed by and finally, the prince who woke her up with a kiss.

Sleeping Beauties is also said of those scientific articles which seem to go by unacknowledged until someone comes to their late rescue and gives them the recognition they deserve.

The article by Mendel of how the characteristics of the pea plant are passed down to its offspring can serve as an example. Even though the article was published in a scientific journal, in Germany I think it was, no one took any notice of it until years later when three researchers all at the same time gave him great credit for his work.

Recently, the press (El Periódico, El Mundo,, La Vanguardia) wrote about another case, that of the researcher from Alicante, Francis Mojica, who discovered repeated genetic sequences in the DNA of some microbes from a lagoon in Santa Pola 25 years ago.

The researcher called them CRISPR the acronym for “clustered regularly interspaced short palindromic repeats”.

From that point on, other researchers have been able to derive the CRISPR/cas9 genetic editing technique which, they say, will transform biology and biomedicine.

This concept later got its own MeSH in the Pubmed/MEDLINE in 2014.

A late recognition after a period of, let’s call it somnolence, is not that strange in the world of science and a way of demonstrating this is by looking at the number of citations an article receives.

Needless to say this is made very apparent in a graph.

Example of a search in Pubmed/MEDLINE for “CRISPR” in open language that ranges from 1 item in 2002 to 2590 items in 2017, as of today’s date:

2002                                                                        2017

Number of citations received in Web of Science of the article in 1993:

Analysis of citations received in Web of Science in the period ranging 2009-2017 of articles by the author published in the period 2009-2017 having “CRISPR” in the title:

During their sleep, the Sleeping Beauties receive on average few citations, but once awoken, they receive a large number of citations in the following 4 years: an exciting awakening.

We find Sleeping Beauties in all fields of science, although in a systematic study of these, it is in the fields of physics, chemistry and mathematics that they predominate.

One of the facts that explain the awakening is that another discipline discovers it and then serves as an inspiration in its field, a little further away from or distanced from the original field where it appeared.

Post written by Joan MV Pons.

Consulting the library from any place

19 Oct

Marta Millaret

Times change and sometimes we are not fully informed on the latest developments and facilities we have at our disposal. Nowadays, the staff at AQuAS can access the contents of the  Library of Health Sciences of Catalonia in a virtual manner which is very good news.

The library is a support tool for all researchers and technicians. Having access to available resources from any place is a step forward, leaving behind the model of being tied to an intranet to be able to access all the resources of the library.

Knowing that these tools exist and that they can be accessed from any place nowadays can be very useful at a particular time when researchers from AQuAS might need to use them.

We would like to present some interesting developments of the library:

Virtual Library of the Public Health System of Catalonia. It facilitates the access to the bibliographic services and resources of the Library of Health Sciences of Catalonia. Professionals that work in the general public health sector have access to the bibliographic resources that the Health Department subsidises for the entity they work for.

The professionals at AQuAS have the opportunity to register (with a user name provided by the institution) and can thus access all the bibliographic contents that are available from any physical location and device.

These available resources include e-magazines, e-books, bibliographic data bases, thematic bibliographies, the catalogue of the bibliographic funds in print of the Library, Scientia (digital information deposit of the Department of Health), collections of clinical practice guidebooks, of health legislation and health news, reference works, the press and electronic summaries.

You only need to register. By doing so, professionals at AQuAS can access a systematic review of the Cochrane Library, for example, or an article from the magazine Gaceta Sanitaria, an article from The Lancet or an article from the magazine Health Research Policy and Systems, all from any place.

Scientia. It is the institutional repository of the Department of Health. It was created with a view of storing and making the scientific production of the entities of the general public health sector of Catalonia openly accessible with the aim thereby of fostering accessibility, visibility, impact and recognition.

Presently, you can find publications from the Health Department, CatSalut and AQuAS, three of the entities which have already signed an agreement of participation.

The added value that this repository offers is the search and retrieval of results in three languages (Catalan, Spanish and English), a permanent URL of each publication, a standardised bibliographic citation and the impact index in social networks (Almetrics). The ORCID identification of each author is also included.

There are many ways you can stay informed of the latest developments which are published: by syndicating contents (RSS) available in the different sections of Scientia and from Twitter; by means of the hashtag #publicaDSalut or following the account of the library @bibliotecasalut.

One of the main aims of this tool is the safekeeping of the scientific production generated in the area of health and its effective dissemination.

An example of a search of studies and technical reports of the AQuAS in Scientia, by author:

Inquiro. It is what is known as a “discovery tool”, an intelligent tool which searches and explores within the contents of all the bibliographic, digital and printed resources available in the library stemming from a simple question using natural language.

The results that are obtained can be filtered by type of document, access (complete text or bibliographic citation), chronological period, subject and resource.

The most potent feature is that the results are obtained organised in order of relevance or by date. There is also the option of using an advanced search, and refining the search by fields, using Boolean operators (AND OR NOT).

Having a single gateway of access to all the bibliographic resources of the library, being able to explore the content of all these resources at the same time and filtering the contents organised in order of relevance is the major new development.

Example of a search for “indicators” with the results organised in order of relevance:

Example of a search for “inequalities” with the results ordered by date:

Ask us. This is the user services department and reference of the Library for Health Science of Catalonia. This tool is very practical to make a search and the answer is practically immediate. It is well worth knowing that this service exists!

That is all, for today. We are completely sure that all these tools are very useful and that they are the results of a concerted effort by the library to give answers to users, technicians and researchers that carry out research in our field.

Post written by Marta Millaret (@MartaMillaret) with the collaboration of Toni Parada and Pilar Roqué, head of the Library of Health Sciences of Catalonia (Biblioteca de Ciències de la Salut de Catalunya).

Low value clinical practices from the citizenry’s perspective

13 Oct

During the fifth edition of the international Preventing Overdiagnosis Congress, strategies for implementing solutions to avoid overdiagnosis and overuse were addressed based on the available scientific evidence.

In this year’s edition, which was held in Barcelona last year, apart from the involvement of professionals and organisations, patients had the opportunity to actively participate.

Experiences in different healthcare areas were shown in the use of best practices to communicate and to empower patients to achieve a better understanding of shared decisions.

Different world initiatives addressed the best practices to empower citizens in subjects related to low value practices, overdiagnosis and overtreatment. Experiences were shared and a debate was initiated on fundamental subjects such as the communication and participation of patients.

In recent years, the Essencial Project has studied the perspective of health professionals on low value practices, their causes and possible solutions so as to avoid them.

Essencial Project team: Cari Almazán, Johanna Caro, Liliana Arroyo and Hortènsia Aguado

For example, in a previous post, we explained the results of a survey we carried out with professionals in the field of primary care. The results of this survey highlighted the need to involve and empower the population more. Patients are also important decision makers in relation to their needs and in the demand for certain health services. Hence, the project must be accompanied by a communications strategy aimed not only at patients but also at citizens in general.

That is why we, from the Essencial Project, have been interested in finding out the opinion of patients in addition to the perspective of professionals. In the international Preventing Overdiagnosis 2017 Congress we participated explaining how an exploratory first approach was made to identify the beliefs, attitudes and perceptions of patients regarding the most important elements in consultations, low value practices and the essential components of an effective dialogue between professionals and patients. The end purpose of this was to understand the position of people before initiating possible interventions in the citizenry and to determine the most effective communicative tools and channels.

In Catalonia, AQuAS carried out the first exploratory qualitative study at the end of 2016 using a focus group of parents and children assigned to a primary care team. Low value practices in paediatrics are frequently associated with an over-diagnosis regarding antibiotics, bronchodilatadors, antipyretics or imaging tests, among others. These scenarios have been transferred to the debate with patients themselves. In total, seven women, mothers and grandmother of 14 children participated.

The first point of discussion was the most important elements in a consultation with health professionals and it was found that the treatment (29%) and information received (28%) are the most important elements received by professionals (representing approximately 60% of those mentioned). The relationship with the professional comes next (15%, often related to the degree of trust), followed by the feeling that their wishes or needs are met (12%), information requested (9%) and the diagnosis (5%).

The participants did not know the concept of low value practice but did recognise situations of an excessive prescription of medication or the request of unnecessary tests, especially in emergency services and private consultations.

Regarding communication, the participants said they appreciated that professionals communicate in a simple and direct manner, explaining the reasons for decisions. Similarly, that they felt it was important to receive printed information from professionals which they could peruse later at home. They also said they would like more informative sessions or community groups where these types of subjects could be explained to them and so gain more knowledge about these types of practices.

In our context, this is the first exploratory study done to identify low value practices and the communicative strategies of the citizenry, being the start of a series of studies on the population. Nonetheless, one of the limitations with which we find ourselves was that the participation was lower than expected. Although the term ‘low value practices’ is not known, participants identify situations in which they have experienced them.

Similarly, it is important to underline how patients value the treatment and information received as well as the professional-patient relationship. In the same way, patients recognise the need for a professional’s communication skills and the need for tools to support an effective communicative exchange.

Post written by Johanna Caro Mendivelso (@jmcaro103).

The speed and relevance of assessing health products

5 Oct

Emmanuel Giménez

The European market of health products has been widely affected by the sudden emergence of a new legislative framework with the new regulations (2017/745 and 2017/746). The subtle difference between directive and regulation is paramount, they say, but we’ll leave that for another occasion. This new framework in the field of health products is characterised among other things by:

  1. A stricter control of high risk health products (for example, certain implantable products)
  2. The strengthening of rules of clinical evidence by including a coordinated procedure at a European level for the authorisation of multicentre clinical research.
  3. The reinforcement of requirements and the coordination between European countries regarding controls and after sales aspects.

In this context of important changes, the assessment community is also clearly active. Thus, on 19 June this year, there was a panel on health products at the international meeting of Health Technology Assessment HTAi, where a new and innovative Italian programme for health products was presented.

The programme, explaining the work carried out over several years in terms of definition and its pilot phase, includes three work packages: appraisal, methodology and monitoring. In another panel closely related to the previous one, in the field of methodology, the presentation of the categories to decide on what to invest in and what to disinvest win clearly stood out.

When talking about monitoring and collecting information, an example that stood out was the debate on the need for early assessments given that the life cycle of a health product tends to be short.

The significant increase in new products available and all the work objects previously mentioned are some of the things that position the importance of specific assessment in health products.

The importance of the assessment of health products is, therefore, undeniable. In the joint production work package of EUnetHTA JA3, in which AQuAS is participating, as many or more assessments of “other technologies” (health products, health interventions,…) have been planned as of the known assessments of drugs. In a sense, the numbers of one or other necessity are matched. The importance of the assessment of “other technologies” was in fact reflected in the HTAi annual meeting in a presentation by Wim Goettsch, director of EUnetHA.

The identification and prioritisation of products to be assessed (the Horizon Scanning system), as well as the balance between innovation and divestment, are also extensively discussed subjects and under continuous debate. Thus, in the REDETS network (in which the AQuAS is also actively participating) and with the leadership of Avalia-T, a public access tool was identified that helps in approaching this subject: the PriTec.

Assessment, therefore, can help directly in the use, management and sustainability of different health systems. In conclusion, new opportunities are provided for improving decision making in the area of health products and some of them will come through demonstrating efficiency by means of the adequate use and definition of health technology assessments (HTA).

Post written by Emmanuel Giménez.