Anatomy Lesson 2008: Living in Fear

You may want to play this music while reading this post: Bach: Gottes Zeit ist die allerbeste Zeit (BWV 106)

The “Anatomy Lesson” has several meanings:

1. A lesson in Anatomy
2. A famous painting of Rembrandt van Rijn (of Nicolaes Tulp) (1632).
3. The homepage of the AMC, the Academic Medical Center in Amsterdam, inspired on the painting of Rembrandt.
4. A yearly symposium at the intersecting plane of medicine, art and society, organized by the AMC and the Volkskrant, a Dutch newspaper.
   

This year I was invited to the yearly “Anatomische Les” in the concertgebouw, Amsterdam’s beautiful concert hall (see Wikipedia). It is a very official happening. The audience had to take their seats long before the start. It took more than 2 hours without any break.

Anatomy Lesson 2008 in the Concertgebouw

This year’s theme was FEAR. The program was as follows:

• Welcome – Rinnooy Kan
• Presentation of new work of art of Albert van Westing (1960), recently bought by the AMC – Wim Pybes, director of the “RijksMuseum”
• “Mit Freud und Freud ich fahr dahin”- Johan Sebastian Bach. 1.”O Jesu Christ, mein’s Lebens Licht” 2. Gottes zeit ist die allerbeste Zeit – Baroque Ensemble “Follia d’ Amsterdam” together with the choir “Nuovo Musico” , conducted by Gustav Leonhardt (above is another version). The cantatas express both fear for death and faith in God.
• Audiovisual presentation of the assay ” de vertrouwenscrisis” (what went wrong with the fundamental trust in the Dutch society?), written by 19 different publicists.
• Audiovisual impression of pupils of Amsterdam High Schools attending lectures in psychiatry: funny and disarming.
• And the climax: a 50 min lecture of Prof. Arieh Y. Shalev, M.D. (Head Department of Psychiatry at the Hadassah University Hospital of Jerusalem, Israel) about living with fear.

I will try to summarize the main points of Shalev’s lecture as I remember them (no notes).

There are several factors that may influence how people react to fear:

1. DNA (fixed), inherited differences – (written composition in musical notation)
2. Epigenetic Mechanisms (mostly but not exclusively determined postnatally). (tuning of the piano, quenching the middle register)
3. (Gene) Expression (Accordion register determining ranks and timbres, determined by the accordionist)
   
4. Exogenous factors (i.e. empathy and affection) (the people singing, the acoustics)

Fear is an emotional response to threats and danger, meant to protect against a threat (fright-fight-or-flight). It is a basic survival mechanism occurring in response to a specific stimulus, such as pain or the threat of pain. Recognizing a person in agony is easy. The facial expression of fear includes the widening of the eyes (out of anticipation for what will happen next); the pupils dilate (to take in more light); the upper lip rises, the brows draw together, and the lips stretch horizontally. Muscles used for physical movement are tightened and primed with oxygen, in preparation for a physical fight-or-flight response. When the stimulus is shocking or abrupt, a common reaction is to protect vulnerable parts of the anatomy, particularly the face and head. When a fear stimulus occurs unexpectedly, the victim of the fear response could possibly jump or give a small start. The person’s heart-rate and heartbeat may quicken (from Wikipedia).

The amygdala, an almond shaped complex of related nuclei, located in the middle of the brain, is a critical processor area for fear. Connected to the hippocampus, it plays a role in emotionally laden memories. It is part of the limbic system.

Fear, begins with arousal. For instance:

1. You hear a sound. The amygdala is alerted.
2. You see a face, the amygdala is alerted to a greater extent. Your pupils enlarge, your breathing and hartbeat quicken.
3. You recognize the face; it is nobody to be afraid of: the fear response is dampened. The heartbeat drops to normal levels, because you are reassured that there was no danger.

But suppose (1) you’re walking in a dark alley and (2) you see a gun. (3) Next you see a man holding that gun. (4) He shouts something threatening. There are no breaks anymore (by prefrontal cortex/hippocampus on the amygdala) and the fear machine starts running at full speed. Thus, in case of a major threat, in a split second all alarm bells ring: the abovementioned reflexes occur immediately and with no point of return.

One’s memory of what happens consists of separate “pictures”: (1) the alley, (2) the gun, (3) the man, (4) a loud voice (and perhaps smell). Normally, moments of fear will takes it’s place along other memories, although this may take some time.

However, depending on the kind of fear, your personality and external factors, memories to the incident causing fear may stay at the foreground. It may become a memory that comes to the mind frequently and spontaneously or evoked by one of the remembered associations. For instance any alley may cause the full blown fear response again in the abovementioned example.

Shalev telling this, I suddenly understood my reactions to a car accident. While driving on the highway, the driver lost control of the vehicle, causing it to skid and finally ending against a huge concrete wall. I was sitting in the back and while the car was turning I saw “the wall hitting us”. My “last thought” was “that was it”. The car was total loss, but luckily all 5 (members of a dancing group) survived. Apparently because of the “fear of death”, the impression of that very moment staid long with me. For almost a year I felt frightened not only in a car, but also when I saw a car or motor turning fast around the corner or when moving sideways in an airplane during landing. It must have been a similar feeling as when the car turned and hit the wall. The resemblance of that moment brought the memory and the fear back in quite un uncontrollable way. But as time passed by, so did this emotional reaction. The memory itself was still there, but at the background and slowly all intense associations with that frightful moment faded.

This is what normally happens with frigtening experiences. Fear can be retriggered by a memory (smell, picture, situation) linked to what happened, but can extinguish over time. Thus responding to a conditioned stimulus (CS) spontaneously recovers with the passage of time indicated that extinction does not erase the conditioned memory, but is a form of (active) inhibition. The brain (prefrontal cortex/hippocampus) learns how to coop with it and suppress the emotional fear reflex (amygdala).

However, some fears don’t extinguish and have a lifelong impact. For instance in post-traumatic stress disorder (PTSD), which is a severe and ongoing emotional reaction to extreme physical or psychological trauma.

Shalev gave several examples of people with PTSD other than PTSD in war veterans . For instance, a mother who lost her daughter on the complications of a simple (and unnecesary) intervention. The daughter died of sepsis and from that moment on the mother continued to live in the past, persistently reexperiencing the traumatic event.

This was what the mother remembers as the most frightful moment:

I entered the door, my hand still holding the knob. There she lied staring with pupils so dilatated that her irisses were no longer visible. Death was inevitably approaching. I wanted to scream for help, but there were no doctors present and nurses were all running around. I could do nothing about it.

That was a recurrent theme in all examples: feeling desparate and helpless while facing the inevitable.

In PTSD patients the normal extinction mechanisms don’t work. PTSD patients remain in a state of arousal.

In a longitudinal MRI study Shalev showed that a smaller hippocampal volume is not a necessary risk factor for developing PTSD and does not occur within 6 months of expressing the disorder, thereby dismissing the widely held belief that the volume of the hippocampus is reduced in PTSD patients . (Bonne O et al. Am J Psychiatry. 2001 Aug;158(8):1248-51. Longitudinal MRI study of hippocampal volume in trauma survivors with PTSD.)

Shalev also emphasized that the mere reiteratation of the traumatic event doesn’t help the patient. If the patient is in fear it doesn’t help to bring him to an alley all over again, and to leave the alley again as soon as the patient gets frightened. This only reinforces fear. What should be done is to learn the patient to associate the alley with positive events through psychotherapy. Trust, empathy, friendship can all help as well.

Because extinction is a form of learning some medical treatments given soon after the trauma will not help to reduce the PTSD. In a Randomized Controlled Trial presented at the American College of Neuropsychopharmacology 46th Annual Meeting (December 8-12, 2007), Shalev and coworkers showed that cognitive therapy or prolonged exposure therapy (a type of cognitive behavioral therapy) within 1 month had a reduced prevalence and severity of PTSD at 5 months to 20%, whereas early treatment with a selective serotonin reuptake inhibitor (SSRI) fared no better than individuals randomized to placebo or spontaneous recovery (wait-list) groups (60%). According to Shalev this is a phantastic effect. (Source: Medscape ).

Still, although cognitive therapy is effective, many PTSD patients remain symptomatic despite initial treatment.
————-

This post was (also) written for next Grand Round hosted by Mexican Medical Student. Enrico had a tentative theme in mind (with some flexibility to change it ) but these words should be applicable: renewal, metamorphosis, change, transformation. Well, this story was about how extreme fear can transform you in another person. Furthermore death, referred to in the Bach cantate, is our ultimate transformation.
Finally I hope that Enrico, being both a medical student and a classical pianist likes Bach.

Spoetnik Symposium

Yesterday the Spoetnik Symposium was held (see my previous announcement here).

SPOETNIK was a 17 week course on NEW (web 2.0) internet communication methods for librarians. The main target group consisted of UBA (University Library of Amsterdam) librarians. In total, there were more than 160 course members, each having his own blog.

The organizing UBA-spoetnik team, organized the Spoetnik symposium to learn from each other what has been done with the knowledge obtained a half after the course had finished.

The program was as follows:

14.00 Opening by Robin van Schijndel
14.10 Since SPOETNIK – part1: Blogging after SPOETNIK by Jacqueline (alias Laika)
14.25 Since SPOETNIK – part2: Colleagues about SPOETNIK by Alice Doek
14.40 Group discussions
15.30 Koffie- en theepauze
15.45 Feedback from the discussion groups
16.15 Since SPOETNIK – part 3: New applications by Pascal Braak
16.30 Closure and drink

The symposium started a few minutes later because Jacqueline was a bit late: she had to take off Laika’s astronaut suit (well kind of, she torn her new pantyhose and had to find a new one (that didn’t fit), she dubbelchecked whether she took her USB-stick with her and she forgot her glasses). It could have been worse, because it was just a few hours in advance that Jacqueline found out that the meeting was not in THE Doelenzaal at the Kloverniersburgwal but in the (also beautiful and old) Doelenzaal (zaal = room) in the UBA (main library of the University of Amsterdam). Of course, everyone else just knew this. That underlined the feeling that the Academical Medical Center and most other departments of the UBA are both physically and mentally apart, although still connected.

The atmosphere was very relaxed. Before the speeches, there was a lot of rumor or as Alice said: it is like a reunion. And that ’s how it felt! Finally I had the chance to meet my colleague bloggers in real life. I met Boekenvlindertje, Duijfje, Dyoke of Zygomorf (which I had always wrongly pronounced as Díe Joke, should be Dieuwke) and Turquoois, and I had long chat with Bert of “Een beetje adjunct” and finally with my blogmate George of Brughagedis, the one with whom I shared Google Docs, but never a drink, before. Both Bert and George have written a blogpost about this meeting (see here and here)

Although George doesn’t want to be in the picture, he was mentioned in the introductory speech of Robin as one person that ‘meant a lot for the course’. That is certainly true. You need some active contributors to inspire the rest. Besides George was the first to create an OPML-feed of all blogs (together with Pascal) which made it a lot easier to keep up with all Spoetnik blogs.

My talk was next. In 15 minutes I had to outline “Blogging after Spoetnik”. How did I continue when the course was finished? Here is my powerpoint presentation.

The theme I choose was “Blogging is navel gazing?!”. I notice that many people (including myself in the pre-web 2.0 phase) consider blogging as something egocentric, just an outlet for one’s feelings and frustrations, or hobbies and thoughts. What I hoped to show is that web 2.0 is not just a set of web 2.0 tools, but it is a whole philosophy. It is the philosophy of gaining momentum when sharing. But to do this you have to be patient, you must have a story to tell (content) and than you have to find readers, else you will remain ‘lonely’. I recommended twitter as a very good source to build up a community, if you use it the right way (find people to share things with). Although I have to say that it is a lot easier for me, as a health 2.0 blogger to find a large global community than someone specialized in Dutch linguistics.
Thus I feel committed to write an introduction on how to use Twitter effectively. Preferably in Dutch: at least 2 UBA colleagues spontaneously said they regret that I had changed to English.

Alice told us the origin of Spoetnik and gave an overview of the opinions of many other well known Dutch librarians about the course. The comment of Wowter was missing however, possibly because he expected Alice to use a web 2.0 way of finding it (Feeds and Twitter). (You can read his -Dutch- comment here). Many other libraries will follow the example of Spoetnik and 23 Dingen, although in a shorter version.

Pascal showed us that there were many new web 2.0 tools ( a few slides with last week’s additions), but according to Pascal none of them was really new, but all variations on a theme. He did whisper that he had a new twitter-firefox api for me, so I hope he will provide me with further details.

In between we discussed in groups what we had learned from the course, what we liked and didn’t like about different tools. Using Google Docs, we brainstormed about how we could implement web 2.0 tools in our library, UBA-wide. A very interesting part of the program, this exchange of thoughts. Robin gave a quick overview of the ideas, but shortly all input will be available at the Spoetnik-website together with the presentations.

The Spoetnik course has been a success, this meeting was a success and hopefully the implementation will also be a success. As Bert said: step by step. Rome wasn’t build in a day. Besides most UBA people are now involved in the implementation of a new program: Aleph. This has to be handled first.

Grand Round 5.9 at Dr Deb’s

This week’s Grand Round is up at Dr Deb. She made figuratively and literally a very swinging Round, by putting the post into several playlists, including a medical, a mental health and a patient playlist. You can read them while listening to real music: Doctor my eyes etc.

Canadian Medicine is hosting Grand Rounds on November 25. For details, click here.

Grand Rounds Archive & Upcoming Schedule can be consulted at: blogborygmi.blogspot.com.

Huge disappointment: Selenium and Vitamin E fail to Prevent Prostate Cancer.

October 27th the news was released that ([see here for entire announcement from nih.gov]

“an initial, independent review of study data from the Selenium and Vitamin E Cancer Prevention Trial (SELECT), funded by the National Cancer Institute (NCI) and other institutes that comprise the National Institutes of Health shows that selenium and vitamin E supplements, taken either alone or together, did not prevent prostate cancer. The data also showed two concerning trends: a small but not statistically significant increase in the number of prostate cancer cases among the over 35,000 men age 50 and older in the trial taking only vitamin E and a small, but not statistically significant increase in the number of cases of adult onset diabetes in men taking only selenium. Because this is an early analysis of the data from the study, neither of these findings proves an increased risk from the supplements and both may be due to chance.”

SELECT is the second large-scale study of chemoprevention for prostate cancer. Chemoprevention or chemoprophylaxis refers to the administration of a medication to prevent disease. The SELECT trial aimed to determine whether dietary supplementation with selenium and/or vitamin E could reduce the risk of prostate cancer among healthy men. It is a randomized, prospective, double-blind study with a 2×2 factorial design, which means that the volunteering men received either one of the supplements, both supplements or no supplements (but placebo instead), without knowing which treatment they would receive.
The trial volunteers were randomly assigned to one the following treatments:

1. 200 µg of selenium and 400 IU of vitamin E per day. (both supplements)
2. 200 µg of selenium per day and placebo
3. 400 IU of vitamin E per day and placebo
4. two different placebo’s (neither supplement)
   (µg = micrograms, IU = International Units)

Enrollment for the trial began in 2001 and ended in 2004. Supplements were to be taken for a minimum of 7 years and a maximum of 12 years. Therefore the final results were anticipated in 2013. However, but due to the negative preliminary results, SELECT participants still in the trial are now being told to stop taking the pills. The participants will continue to have their health monitored by study staff for about three more years, continue to respond to the study questionnaires, and will provide a blood sample at their five-year anniversary of joining the trial, to ensure their health and to allow a complete analysis of the study. (see SELECT Q & A).

In an interview with CBS, one of the investigators Dr Katz, said he was highly disappointed and concerned, because he had high hopes for the trial. “I”m disappointed with the study. I’m very concerned about the results of the trial.

more about “Vitamin E A Flop In Prostate Cancer T…“, (with 15 sec advertisement first) posted with vodpod. This video is derived from CBS news.

Dr. Klein, one of the principal investigators, has published as many as 14 publications on the SELECT trial (see PubMed). He has always been a strong advocate of this huge trial.

The question now is:
Was there enough evidence to support such a large trial? Could this result have been foreseen? Would the trial have had different outcomes if other conditions had been chosen?

The SELECT trial seems to add to the ever growing list of disappointing “preventive” vitamin trials. See for instance this blogpost of sandnsurf on “a systematic review of all the published randomized controlled trials (RCTs) on multivitamins and antioxidant supplements in various diseases, and their effect on overall mortality” concluding:

“Taking the antioxidant vitamins A (and its precursor beta-carotene) and E singly or in multivitamins is dangerous and should be avoided by people eating a healthy diet. On a diet like that recommended here, the intake of these and other important vitamins should be high, with no need for supplementation.”

Quite coincidentally I commented to Sandsnurf blogpost referring to the SELECT trial, 1 week before the bad outcome was announced):

Indeed, in many RCT’s vitamin supplements didn’t have the beneficial effects that they were supposed to have. Already in the early nineties, adverse effects of beta-carotene (higher mortality in smokers) have been shown in several RCT’s. Still, because vitamin E had an expected positive effect on prostate cancer in one such trial, vitamin E is now being tested together with selenium (2X2) in a very large prostate cancer trial. Quite disturbingly, 8 times higher doses vitamin E are being used (400IE) compared to the original study. If the Lawson study is right, the outcome might be harmful. Worrying.

It might be argued that it is easy to criticize a study once the outcome is known. However, this critique is not new.

Already in 2002 a very good critique was written by MA Moyad in Urology entitled: Selenium and vitamin E supplements for prostate cancer: evidence or embellishment?

Here I will summarize the most important arguments against this particular trial (largely based on the Moyad paper)

• SELECT was based on numerous laboratory and observational studies supporting the use of these supplements. As discussed previously such study designs don’t provide the best evidence.
• The incidence, or rate of occurrence, of prostate cancer was not the primary focus or endpoint of the few randomized controlled trials studies on which the SELECT study was based.
• A 2×2 design is inadequate for dose-response evaluations, in other words: before you start the trial, you have to be pretty sure about the optimal dose of each supplement and of the interactive effect of vitamin E and selenium in the particular doses used. The interaction between two agents might be synergistic or additive, also with respect to any negative (i.e. pro-oxidant) effect.
• Eight times higher vitamin E doses (400IE) have been used than in the ATCB study showing a benefit for vitamin E in decreasing prostate cancer risk! This is remarkable, given the fact that high doses of anti-oxidants can be harmful. Indeed, a prospective study has shown, that vitamin E supplements in higher doses (> or =100 IU) are associated with a higher risk of aggressive or fatal prostate cancer in nonsmokers.
• Other forms of vitamin E and selenium have been proposed to be more effective. For instance dietary vitamin E (gamma tocopherol and/or gamma tocotrienols) might be more effective in lowering prostate cancer risk than the chemically-derived vitamin E (dl-alpha tocopherol acetate) used in SELECT. Also the used selenomethionine might be less effective than organically-bound selenium.
  
• Selenium and vitamin E supplements seem to provide a benefit only for those individuals who have lower baseline plasma levels of selenium or vitamin E.
• There may be other compounds that may be more effective, like finasteride, lycopene, statins (or with respect to food: a healthy lifestyle)
  

Katz said. “I would have hoped this would have been the way to prevent cancer in this country.”

Isn’t it a little bit naive to expect such huge effects (25% less prostate cancers) just by taking 2 supplements, given the thoughts summarized above?

In the interview, shown in the CBS-interview LaPook concludes “This is a major disappointment, but it is also progress. Because it’s also important to know what does not prevent cancer.”

Well I wonder whether it is ethical ànd scientifically valid, to do such a costly experiment with 35.000 healthy volunteers, based on such little evidence. Do we have to test each single possibly effective food ingredient as a single intervention?

SOURCES:
Official publications and information
- EA Klein: http://www.ncbi.nlm.nih.gov/pubmed/12756490
- Lippman SM, J Natl Cancer Inst. 2005 Jan 19;97(2):94-102. Designing the Selenium and Vitamin E Cancer Prevention Trial (SELECT). (PubMed record)
- The results of the SELECT trial are published in JAMA: Effect of Selenium and Vitamin E on Risk of Prostate Cancer and Other Cancers: The Selenium and Vitamin E Cancer Prevention Trial. Scott M. Lippman, Eric A. Klein et al SELECT)JAMA. 2008;0(2008):2008864-13, published online December 9th 2008.

- SELECT Q&A: www.cancer.gov/newscenter/pressreleases/SELECTQandA
- General information on SELECT http://www.crab.org/select/
- Information on Study design (from Cancer Gov.clinical trialsSWOG s0000) and from clinicaltrials.gov

- More information on study designs and the ATCB trial (on which this study was based) in a previous post: the best study design for dummies

NEWS
- CBS Evening News Exclusive: Vitamin E And Selenium Fail To Prevent The Disease In Large Clinical Trial, NEW YORK, Oct. 27, 2008
- Los Angelos Times; Vitamin E, selenium fail to prevent prostate
- Emaxhealth: NCI stops prostate cancer prevention trial. With many good links to further information

New Cochrane Handbook: altered search policies

The Cochrane Handbook for Systematic Reviews of Interventions is the official document that describes in detail the process of preparing and maintaining Cochrane systematic reviews on the effects of healthcare interventions.

The current version of the Handbook is 5.0.1 (updated September 2008) is available either for purchase from John Wiley & Sons, Ltd or for download only to members of The Cochrane Collaboration (via the Collaboration’s information management system, Archie).
Version 5.0.0, updated February 2008, is freely available in browseable format, here. It should be noted however, that this version is not as up to date as version 5.0.1. The methodological search filters, for instance, are not completely identical.

As an information specialist I will concentrate on Chapter 6: Searching for studies.

This chapter consist of the following paragraphs:

• 6.1 Introduction
• 6.2 Sources to search
• 6.3 Planning the search process
• 6.4 Designing search strategies
• 6.5 Managing references
• 6.6 Documenting and reporting the search process
• 6.7 Chapter information
• 6.8 References

As the previous versions the essence of the Cochrane searches is to perform a comprehensive (sensitive) search for relevant studies (RCTs) to minimize bias. The most prominent changes are:

1. More emphasis on the central role of the Trial Search Coordinator (TSC) in the search process.
Practically each paragraph summary begins with an advice to consult the TSC, i.e. in 6.1: Cochrane review authors should seek advice from the Trials Search Co-ordinator of their Cochrane Review Group (CRG) before starting a search.

One of the main roles of TSC’s is the assisting of authors with searching, although the range of assistance may vary from advise on to how run searches to designing, running and sending the searches to authors.

I know from experience that most authors have not enough search literacy to be able to satisfactory complete the entire search on their own. Not even all librarians may be equipped to perform such exhaustive searches. That is why the handbook says: “If a CRG is currently without a Trials Search Co-ordinator authors should seek the guidance of a local healthcare librarian or information specialist, where possible one with experience of conducting searches for systematic reviews.”

Another essential core function of the TSC is the development and maintenance of the Specialized Register, containing all relevant studies in their area of interest, and submit this to CENTRAL (The Cochrane Central Register of Controlled Trials) on a quarterly basis”. CENTRAL is the most comprehensive source of reports of controlled trials (~500,000 records), available in “The Cochrane Library” (there it is called CLINICAL TRIALS). CENTRAL is available to all Cochrane Library subscribers, whereas the Specialized Register is only available via the TSC.

Redrawn from the Handbook Fig. 6.3.a: The contents of CENTRAL

2. Therefore Trials registers are an increasingly important source of information. CENTRAL is considered to be the best single source of reports of trials that might be eligible for inclusion in Cochrane reviews. However, other than would be expected (at least by many authors) a search of MEDLINE (PubMed) alone is not considered adequate.

The approach now is: Specialized Registers/CENTRAL and MEDLINE should be searched as a minimum, together with EMBASE if it is available (apart from topic specific databases, snowballing). MEDLINE should be searched from 2005 onwards, since CENTRAL contains all records from MEDLINE indexed with the Publication Type term ‘Randomized Controlled Trial’ or ‘Controlled Clinical Trial’ (a substantial proportion of theses MEDLINE records have been retagged as a result of the work of The Cochrane Collaboration (Dickersin 2002)).

Personally, for non-Cochrane searches, I would rather search the other way around, MEDLINE (OVID) first, than EMBASE (OVID) and finally CENTRAL, and deduplicate the searches afterwards (in Reference Manager for instance). The (Wiley) Cochrane Library is not easy to search (for non-experienced users, i.e. you have to know the MESH beforehand, there is (yet) no mapping). If you start your search in MEDLINE (OVID) you can easily transform it in EMBASE and subsequently CENTRAL (using both MESH and EMBASE keywords as well as textwords)

3. The full search strategies for each database searched need to be included in an Appendix with the total number of hits retrieved by the electronic searches included in the Results section. Indeed the reporting has been very variable, some authors only referring to the general search strategy of the group. This made the searching part less transparent.

4. Two new Cochrane Highly Sensitive Search Strategies for identifying randomized trials in MEDLINE strategies have been developed: a sensitivity-maximizing version and a sensitivity- and precision-maximizing version. These filters (that are to be combined with the subject search) were designed for MEDLINE-indexed records. Therefore, a separate search is needed to find non-indexed records as well. An EMBASE RCT filter is still under development.

These methodological filters will be exhaustively discussed in another post.

Free HILJ 25th Anniversary Supplement

Health Information and Libraries Journal (HILJ) celebrates its 25th anniversary.

To mark the journal’s anniversary a special celebratory issue, guest edited by Andrew Booth, is being published in December 2008.
Contributors to this supplement include such well known names as Muir Gray, William Hersh, Margaret Haines, Ann McKibbon and Joanne Marshall.

These commentators and others follow the evolution of the journal from its origins on the first editor’s kitchen table in the early 1980’s to its 2008 electronic editorial office. They also survey the past 25 years of health care information services and look to what the future may hold.
The supplement in divided into various sections including:

• evolution of the journal;
• 25 years of learning and teaching in action;
• 25 years of information technology in libraries;
• 25 years of using evidence in practice;
• widening panoramas:incorporating health informatics and international perspectives;
• and future perspectives.

The issue will be available free online forthcoming December at www.blackwellpublishing.com/hilj

Nice detail: To get HILJ-readers involved a special wiki is created (http://yourjournal.pbwiki.com/) where people can submit their contributions.

Brought to my attention by: Suzanne Bakker, Editorial advisory board of HILJ

Election Day at Grand Rounds 5.7

Grand Round is now up at Nurseratchedsplace of Mother Jones, RN.

This Round, called Election Day at Grand Rounds doesn’t only give a great wrap up of this week’s medical blogposts, but also reviews the health history of former presidents. According To Mother Jones:

“The President of the United States has a few things in common with people like Joe the Plumber. From time to time, everyone gets sick and needs to see a doctor. I remember when George H.W. Bush vomited all over a Japanese Prime Minister during a state dinner. And we all remember the attempt on Ronald Regan’s life. Whatever happens, the president’s physician stands ready to care for their famous patient and members of the First Family.

My blogpost on the importance of early intervention in Addisonian crises is introduced by the story of President J.F. Kennedy who

“started taking steroids to treat colitis. This caused many long-term side effects that haunted him for the rest of his life. Kennedy suffered from Addison disease as well as chronic back pain possibly related to weakened bones caused by steroid use.”

The latter would also have fit with a previous post on Addison’s Disease showing that part of the Addison Diseases are iatrogenic, caused by treatment with high doses of corticosteroids.

For the complete review of all this week’s medical blogs ànd of presidential diseases please visit Election Day at Grand Rounds. Great Job, Mother Jones!

Who missed the previous Grand Round, well it passed by with the speed of light. Hurry up. You might catch up if you take the emergiblog speedway here.

Next Week Grand Round will be up at Musings of a Distractible Mind. Here you can find details how to submit your post.

Dutch Grand Round 1.6: Grote Visite 1.6

The 6th Dutch Grand Round (Grote Visite) is up at Dr. Shock (see here).
It’s the second time Dr Shock hosts the Dutch Grand Round.

This Grand Round is a rather complete wrap up of the Dutch medical blogosphere as Dr. Shock does not confine himself to the official Grand Round submissions, but also summarizes his own choice of other interesting Dutch posts.
Many Dutch Medblog Posts are written in English, so it may still be worth while to read most posts if you don’t understand Dutch.

The next grand will be at De gezondheidszorg leuker en effectiever of Marjolein Fermie. You can post your entries for the next Grote Visite at the Blog Carnival (here).

Symposium “Since Spoetnik”

As can be read in the ‘About’ section, this blog was started as part of the online course SPOETNIK on NEW (web 2.0) internet communication methods for librarians. The main target group consisted of UBA (University Library of Amsterdam) librarians. In total, there were more than 160 course members, each having his own blog.

Now, a half year after the course finished, the organizing team, UBA-spoetnik, organizes a symposium to learn from each other what has been done with the knowledge obtained.

Does web 2.0 knowledge matter to your work and/or daily life? Do you use RSS to keep abreast of the latest developments in your area? Did you catalog all your books in Librarything? Did you continue blogging and is your blog becoming popular? How will new applications affect library service?

These are the questions that will be addressed November 26th in a nice old building in Amsterdam, de Doelenzaal.

Program

14.00 Opening by Robin van Schijndel
14.10 Since SPOETNIK – part1: Blogging after SPOETNIK by Jacqueline (alias Laika)
14.25 Since SPOETNIK – part2: Colleagues about SPOETNIK by Alice Doek
14.40 Group discussions
15.30 Koffie- en theepauze
15.45 Feedback from the discussion groups
16.15 Since SPOETNIK – part 3: New applications by Pascal Braak
16.30 Closure and drink

I’m very excited to meet my Спутник in real life. Although we organized a small meeting directly after the course, I couldn’t attend it. I hope that many Спутник will be there now.

For those Спутник reading this posts and coming to the symposium, are there any issues you would like me to address in my short presentation “Blogging after Spoetnik”?? You can mail me or give a comment here.

See you at the symposium.

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Symposium: “Sinds Spoetnik”

Dit blog werd gestart als ‘n onderdeel van de online cursus SPOETNIK over nieuwe web 2.0 communicatiemethoden voor bibliotheekmedewerkers. De cursus werd georganiseerd door de UBA (Universiteitsbibliotheek van Amsterdam) en richtte zich vooral, maar niet uitsluitend) op UBA-medewerkers.

In totaal, deed een onwaarschijnlijk groot aantal cursisten mee: er zijn wel meer dan 160 blogs aangemaakt. De voorloper van deze cursus, 23 dingen, was even succesvol, hetgeen aangeeft dat dergelijke cursussen toch in een behoefte voorzien. Een behoefte die ik zelf niet echt onderkend had. Ik deed gewoon maar mee om te kijken of ik er wat van opstak. Wat web 2.0 of bibliotheek 2.0 nou voorstelde, ik had er geen idee van. En blogs? Niet interessant, ik las ze nooit. Maar nu ben ik 180 graden om.

Ik vind het dan ook heel leuk dat de organisatoren een half jaar na het afsluiten van de Spoetnik-cursus het “Sinds Spoetnik” Symposium (prachtige alliteratie) organiseren (zie hier).
Het enthousiaste UBA-team bestaat, voor wie het nog niet weet, uit Alice Doek, Pascal Braak en Olga Marx (welke laatste mij via Bert Zeeman het boekje “Laika tussen de sterren” -met mijn avatar als voorpagina- heeft doen toekomen).
Vragen die tijdens dit symposium aan de orde komen zijn:

Wat is er sindsdien gebeurd met de opgedane kennis ? Welke rol speelt de ‘webstof’ op het werk of in je privé-leven? Gebruik je bijvoorbeeld RSS-feeds om op de hoogte te blijven, staat je complete boekencollectie mèt omslag op LibraryThing, maak je furore met je blog? Hoe zullen de nieuwe toepassingen onze dienstverlening beïnvloeden?

Programma

14.00 Opening door Robin van Schijndel
14.10 Sinds SPOETNIK – vol.1: Bloggen na SPOETNIK, door Jacqueline (alias Laika)
14.25 Sinds SPOETNIK – vol.2: Vakgenoten over SPOETNIK, door Alice Doek
14.40 Discussie in groepjes
15.30 Koffie- en theepauze
15.45 Verslag vanuit de discussiegroepen
16.15 Sinds SPOETNIK – vol.3: Nieuwe toepassingen, door Pascal Braak
16.30 Afsluiting & borrel

Ik kijk met spanning uit naar de RL ontmoeting met mijn Спутник. Hoewel ik mede een borrel had georganiseerd na de Spoetnikcursus, heb ik het zelf toen moeten laten afweten. Erg jammer. Ik had toch heel graag mijn vaste Спутник ontmoet. Hopelijk lukt het nu.

Voor die Спутник die dit bericht lezen en naar het symposium komen: zijn er nog zaken waarvan jullie willen dat het in mijn presentatie “Bloggen na Spoetnik” aan de orde komt? Of laten jullie je liever verrassen?

Zie jullie allen real life op het symposium!!

Incorrect Google Incoming Links?

Google links are a very handy tool for becoming aware who links to you. You can also use Technorati for this purpose, but these sources overlap: some links are unique for Google Links and others for Technorati.
Google Links alert me to blogs and reactions to my posts I would have missed otherwise. I wouldn’t have known for instance that my blog had been reviewed in the Gazette (see post “Laikas-little-party”). Often this leads to a mutually follow (via an alert).

Google links are the incoming links seen at the Dashboard and the blog Stats Page of WordPress Blogs (I don’t know if they are an automatic feature in other blog types as well).

Correct Incoming Links at Dashboard

These are only the most recent links. To see them all, you have to click at “See All” at the Incoming Links at your stats page (“More” at your dashboard page).

For those not having WordPress, you can also perform a Google link search yourself. Go to Google BlogSearch and type: link:your web address, in my case link:http://laikaspoetnik.wordpress.com/

Alternatively you can make a Google Alert at google.com/alerts.

It is also possible to take a RSS feed to Google Links by simply clicking the RSS-symbol at Incoming Links at the WordPress or by taking an RSS feed to the link you created yourselves in Google Blog Search

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Since 2 weeks, approximately at the same time my Technorati Authority made a free fall from 46 to 5, some Incoming (Google) Links were lost. In addition, the links showing up were different:

1. Incoming Links at WordPress, showing correct links.
2. Incoming Links at WordPress, referring to all blogpost mentioning your website in their sidebar. The same links show up at Google Blog search. Most of these links are temporary.
   
3. Cumulative results in Google Reader (all results, whether correct or incorrect, temporary or not).

Incorrect Links showing at WordPress's dashboard (after refreshing, confer Figure above)

This seems a mutual problem. There was a Google link at my blog to this post of Biomedicine on Display (see Figures), as well as a link to my blog at their blogroll, whereas neither blog had a recent post referring to the other…..

Wrong link to Laika's MedLibLog at Biomedicine at Display

Surely this is not what Google links are meant for. I don’t want alI posts of a certain blog showing up. I already have all kinds of alerts to the blogs I like. (Google Reader, Technorati, Twitter).

This makes me wonder:

• Do you see similar incoming links that don’t really link to your post?
• What causes these “wrong links”?
• Why does WordPress show different results upon refreshing (the address, link:http etc remaining the same)
• Has this anything to do with the Technorati problems?
• Does anyone know to whom (at Google and/or WordPress) I should report these artifacts?