The journey of a medical book – from concept to completion….

Book Binding

Weekend Book Binding. Photo: Nate Steiner. Used under CreativeCommons.

Since our book has been published, colleagues, friends and family have been intrigued as to our journey to publication. For us, it is immensely satisfying to see, and feel, the final product. It is also a good time for us to reflect on how we got here…

 

As with many of these things, the book’s concept was spawned during a chance conversation between operating theatre lists. We were colleagues at a busy DGH and in the midst of our FRCA exams – Ned lining up for the primary written, and Marc for the final written. ‘Wouldn’t it be great,’ Ned mused, ‘if there was one book where all the equations for the exams were collated, explained and made sense of’. A quick Google search revealed no such texts, and thus we returned to our revision relying on the time-honoured tradition of thumbing through dog-eared text books and trusting our sage superiors’ tuition. This initial conversation had however planted somewhat of a seed for an idea and following a quick straw poll of our colleagues, we surmised that equations were one of the aspects that really exorcised FRCA candidates.

 

The next stage was to articulate our thoughts, and we decided that the best way to do this was to use a publisher’s guidelines. Having both used, and been thoroughly impressed with Cross & Plunketts’ Physics, Pharmacology and Physiology for Anaesthetists, we approached Cambridge University Press (CUP) with the opinion that our text could be a natural bed-fellow to said text.

Having browsed the FRCA curriculum, and documented every equation we came across in our revision texts, we collated the list of all the equations encountered, wrote a number of example chapters, and submitted our book proposal to CUP. A swift and very positive peer review ensued, and we were delighted, though somewhat surprised to have our idea accepted.

One important caveat had been proposed, the suggestion that we used a well-established senior colleague to both edit the text, and mentor us through the writing stages. One such colleague independently sprung to both our minds, Dr Wynne Davies. Having both worked under Wynne’s clinical guidance, his immense knowledge and ever enthusiastic willingness to teach made him the ideal candidate. This was bolstered further as Wynne had also previously been an examiner for the Royal College of Anaesthetists, such that he was ideally placed to provide ideas and opinions from ‘the other side of the table’. Thankfully he accepted, and we are both extremely grateful for all the hard work, mentorship and friendship that he has provided us with over the months of writing.

 

With the proposal accepted and contracts signed, the hard work started. The submission deadline clock had started ticking, with completion some 18 months away. Our approach to writing was to do quasi peer-review. Together we formatted a page template, decided on the format of each chapter, and subsequently divided the topics and started writing. Dropbox (other internet clouds are available) was used to store the drafted pages, thus enabling the other author (Marc for Ned, Ned for Marc) to review and edit each person’s initial endeavours. Following the undertaking of these preliminary corrections, Wynne edited each page in turn, before once again returning each to us for universal approval.

Ensuring accuracy was a top priority, as was making the book readable, relevant and clear. Arguably the most time consuming part of writing was providing the applications of each equation to clinical practice. However, this, apart from having all the equations necessary for the examinations in one place, is what we feel that the USP of our book is. Knowing the equations is one thing; understanding them and being able to derive them another. Being able to apply the equations to medical and anaesthetic practice is vital in order to negotiate the examinations, particular the oral ones, and also arguably to stay sane whilst revising and questioning the need to learn and memorise some rather obtuse concepts.

Once the text was prepared and bounced between us until we were happy with it, we sent it to Cambridge University Press for proof-reading and type-setting. It was fascinating to be involved in these processes and again, an eye for detail was mandatory. We also had our non-anaesthetist partners look over it which was invaluable.

At last the text was ready and we waited in anticipation for the final product: it was a great feeling of satisfaction when it fell through the letterbox and made all the hard work worthwhile.

 

Whilst neither of us were deluded enough to think that writing a book would be easy, one should certainly not underestimate the amount of time, effort and sacrifice required. Writing, reading, editing and re-revising comments was somewhat time consuming, especially alongside a PhD (Ned), and HEMS & NHS England Fellowship (Marc).

Moving forwards, we eagerly await peoples’ feedback. Undoubtedly as medicine and anaesthetics progresses, there will be corrections and clarifications required in future editions. We very much hope that readers will enjoy it and find it useful and we would welcome any comments and feedback.

In the book, we have tried hard, and hopefully succeeded in the majority of cases to tick all the boxes which will give readers a head start, whether they are preparing for the examinations themselves, helping others to do so, or even, dare we say it, examining!

Top tips amassed from 18 months of toil…

  1. Know your audience and write for them, not you.
  2. Choose a mentor that you trust and can reply on.
  3. Know your market and spot the gaps. They may be very obvious such that one assumes someone else has already filled them.
  4. Don’t underestimate the amount of work involved, and ensure that your nearest and dearest are supportive of your project!
  5. Detail, detail, detail…edit, edit, edit.

Dr Marc Wittenberg and Dr Edward Gilbert-Kawai are co-authors of Essential Equations for Anaesthesia (out now).

Essential Equations for Anaesthesia

 

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Turn down the Volume? An examination of the effects of nightclubs on hearing

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There is a growing body of evidence that suggests excessive noise levels in nightclubs have an adverse effect on hearing, and may ultimately be responsible for noise-induced hearing loss.

A study by researchers at the University of Birmingham found that although students didn’t want to alter their attendance, the majority would rather see noise limits reduced to safe limits, contrary to the widely held preconception that high volume levels in nightclubs are demanded by young people.

The hearing of all employees in the music and entertainment sector is now protected by The Control of Noise at Work Regulations (2005), which require employers to prevent or reduce risks to employees’ hearing in the workplace when exposed to noise levels above 85 dB. However, this law does not apply to members of the public attending nightclubs, as it is presumed they are making an informed decision to attend such venues.

This study investigated the prevalence of symptoms related to noise-induced hearing loss that were experienced by students after attending nightclubs. It also aimed to explore students’ awareness of the association between noise-induced hearing loss and nightclub attendance, and examine their attitudes towards this.

A questionnaire was distributed to students entering or leaving the University of Birmingham Medical School over a 5-day period during March 2012, with a total of 357 individuals completing the questionnaire, with almost half the students attending a nightclub at least once per week.

Of those students surveyed in the present study (excluding those who never attended nightclubs and those with pre-existing hearing problems), 88% had experienced transient tinnitus after attending a nightclub. This finding is important because transient tinnitus can also be a precursor to other noise-induced hearing loss symptoms, including permanent tinnitus, hyperacusis or irreversible hearing loss.

The majority of students in the sample population (90%) were aware that current nightclub noise levels are potentially damaging to hearing. However, most students who attended nightclubs (73%) reported that they would not alter their attendance, despite being told that the noise levels could lead to permanent hearing loss. Nonetheless, 70% of nightclub attendees agreed that noise levels should be limited to volumes that are not damaging to hearing.

Mr Oliver Johnson, one of the paper’s authors, commented. “This is encouraging for policy makers, as noise levels could potentially be lowered below the threshold for hearing damage without nightclub attendance being significantly compromised. The implementation of relevant legislation could therefore potentially reduce the long-term risks of irreversible hearing loss in this young age group without damaging the nightclub industry.”

The study also demonstrated that 87% of students with normal hearing had never received information about noise-induced hearing loss or had earplugs recommended in the nightclub setting. The findings and those of other research groups indicate that young people attending nightclubs are at high risk of noise-induced hearing loss, and it is therefore of the utmost importance that they should be provided with adequate information regarding the potential damage that excessive music levels in nightclubs may cause.

Mr Johnson added, “We believe the current assumption implied by legislation, namely that nightclub attendees are consenting to the risks of hearing damage, is spurious, as the majority of young people in nightclubs are likely to be unaware of these risks.”

The full paper “British university students’ attitudes towards noise-induced hearing loss caused by nightclub attendance” is published in The Journal of Laryngology & Otology and can be read free of charge for a limited time here.

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