Top of the Tweets [2]

Twitter is a microblogging service initially meant as a place where people could answer the question “What are you doing?” via 140-character messages from their cellphone, laptop or desktop. But Twitter is more useful as a platform for breaking news, exchanging links, thoughts and views, and (indirectly) for social networking.

Twitter is particularly suited for oneliners that are funny or hit the mark. Below is my second selection of twitter oneliners that made me smile, grin or laugh. I hope you like them.

You can find the first edition of Top of the Tweets here.

This series is inspired by the “Selection of My Twitter Favorites” of Ves Dimov at his “Clinical Cases and Images” blog. His favorites tend also to contain more in depth discussions on a particular subject.

Training: ‘Getting The Best Out Of Search Filters’

Information Specialists, other information professionals and researchers seeking more insight into the usefulness of search filters might be interested in the following training event:

YHEC Training Event: ‘Getting The Best Out Of Search Filters’

University of York, 26 February 09 or UK Cochrane Centre, Oxford, 04 March 09

This training event will explore how to identify, critically appraise and test out search filters, focusing on health and social care.

The training day presenters will be Julie Glanville (Project Director, Information Services, York Health Economics Consortium, University of York) and Carol Lefebvre (Senior Information Specialist at the UK Cochrane Centre).

By the end of the study day, participants will have:

• An awareness of how to identify published search filters;
• An understanding of the features of search filter design to be able to critically appraise search filters;
• An awareness of the key issues to be considered in assessing the suitability of search filtesr for specific questions;
• An understanding of the challenges of translating search filters between interfaces and databases.

For more information see here To book a place please click here.

An overview of other training events can be found here

Unfortunately, both of these courses are now fully booked. YHEC will be running a further course later in the year (perhaps in November), and they may be running a course in the Netherlands in due course as well. You can contact ab588@york.ac.uk to be put on a mailing list to be kept informed of these courses.

Search Filters. 1. An Introduction

I’ll be writing a lot about search filters in the near future. Before I do, I think it would be useful to give an introduction.

First I want to stress that this series will not deal with Google, Twitter etc. search filters. Although I might write about such filters on another occasion, this series is about filters for biomedical bibliographic databases, such as MEDLINE (PubMed) or EMBASE.

Below is a short Dutch presentation on search filters I gave at a symposium on search filters in 2005.[1] (some slides don’t show well in Slideshare)

What are search filters? [1-5]

Search filters are predefined and pretested search queries designed to retrieve selections of records in specified electronic information sources. Usually they are created by librarians, but they can be run by clinicians and researchers as well.

Why are search filters useful?

It is increasingly difficult, especially for the busy clinician, to find the information he/she wants in a database like PubMed. Filters can help to narrow down the search. In this way you can reduce the number needed to read (i.e. in a quick search) and/or increase the number of relevant papers (i.e. for a systematic review).

Different classes of filters:

• Subject vs Methodological Filters
  • Subject filters are search queries for a topic, i.e. the BestBets paediatric filter (to search broadly for articles on children) or the build-in toxicity filters in ALTBIB. Both are search strategies for PubMed.
  • Methodological Filters, Qualitative Filters or Hedges are search strategies designed to find studies with a certain design or methodology. PubMed has build-in methodological filters, the so called Clinical Queries for domains (therapy, diagnosis, etiology/harm, or prognosis) and for evidence based papers (like systematic reviews and guidelines, see Systematic Review subset in Pubmed).
    
• Sensitive vs Specific Filters
  • Sensitive filters are broad filters, designed to find as much relevant papers as possible, often at the cost of much ‘noise’.
  • Specific filters are designed to find a small set of very relevant papers, with the risk of omission of a considerable number of relevant papers.
• Short vs Long Filters
  Filters may be simple -even consisting of one single term- or may be complex. They can comprise keywords, text words or both.
  
• Database and search-interface dependency
  Filters are usually designed for a specific database and interface. Not every filter that has been developed can be directly translated into another database/platform because of different keywords terms, hierarchy of keywords, structure and commands. For instance in EMBASE Case Control Study (which is not strictly a controlled study) is a Narrower term of Controlled Study, together with Controlled Clinical Trial. In MEDLINE Case-Control Studies‘ is considered an epidemiologic study, whereas Controlled Clinical Trials is a Publication Type. Note that the MESH is in the plural form: ‘Case-Control Studies‘
  The OVID platform allows separate searching of the abstract field (command: .ab.), whereas PubMed has no separate command for this ([tiab], title and abstract). Adjacency searching and non-explosion of subheadings (qualifiers of a MeSH term) is also possible in OVID, but not in PubMed.
  
• Time dependency
  The performance of a filter may change over time because other terms may prevail or database keywords may have been added, removed or changed. In PubMed for instance the MeSH Randomized controlled trial has been changed in the MeSH Randomized controlled trial as a topic.
  
• Subjective vs Objective Filters.[1,2]
  • The 1st generation of filters are subjectively derived, based on the expertise of the searcher.
  • 2nd generation is also subjectively derived, but then tested and validated against a gold standard, i.e. a known set of relevant records, to determine the effectiveness of the filter at retrieving relevant records.
  • 3rd generation involve objective approaches to filter design (e.g. frequency analysis or logistic regression). Search filter is tested on an independent set of known relevant records (gold standard).
    Whether filters are broadly applicable to different clinical areas will depend on the choice of the golden standard (subject, publication year, size) and the presence and composition of an extern valididity standard (a set of records different from the records used to develop the filter, against which the developed filter is tested)

Performance measures (for 2nd and 3rd generation filters), Figure adapted from [9]

Sensitivity: The number of relevant records retrieved by the search filter as a proportion of the total number of records in the gold standard.(A/A+C)
Specificity: The number of records that are not relevant and are not retrieved as a proportion of the total number of records.(D/D+B)
Precision: (or positive predictive value), fraction of returned positives that are true positives. (A/(A+B)

Is there any difference between search filters and limits?

Not really, both are search terms that can be used to narrow the search. In PubMed however limits usually consist of ONE single MeSH-term (MEDLINE Subject Headings, i.e. key words assigned by MEDLINE-indexers), thus these limits will miss recent papers that have not been indexed by MEDLINE. Therefore it is often safer to use a broader filter or no limit at all.

For instance consider the search tinnitus AND behavioral treatment (set #1 in the Fig. below). This yields 175 hits.
Most people, if they want to find the best individual studies limit for RCT, i.e. the subject search is combined (ANDed) with “randomized controlled trial[Publication Type]“. This yields 23 hits (#2).
However if they would have combined ther search with the narrow therapy-filter (#3) they would have found 3 extra hits, two of which being RCT’s, but still in process and not indexed:

1: Weise C et al Biofeedback-based behavioral treatment for chronic tinnitus: results of a randomized controlled trial.J Consult Clin Psychol. 2008 Dec;76(6):1046-57.
2: Kaldo V, et al Internet versus group cognitive-behavioral treatment of distress associated with tinnitus: a randomized controlled trial.
Behav Ther. 2008 Dec;39(4):348-59. Epub 2008 Apr 20.

The narrow therapy filter has found these very recent articles, because it not only searches for randomized controlled trial[Publication Type], but also for randomized AND controlled AND trial in title and abstract.
The broad therapy filter (#4) searches for clinical trials in general and finds many clinical trials that are not RCT’s.
The narrow (#5) and broad (#6) Cochrane RCT-filters are highly sensitive search strategies meant to identify randomized controlled filters for a Cochrane Review (see 10).

Thus for a quick search for relevant papers search #3 (narrow therapy filter) is most optimal.

References

1. Limpens J [ppt] Introductie Zoekfilters 2005 (Dutch)
   
2. Booth A (Scharr) [ppt] Quality Search Filters at http://www.le.ac.uk/li/lgh/library/ABooth.ppt
3. Jenkins M. Evaluation of methodological search filters–a review. Health Info Libr J. 2004 Sep;21(3):148-63.
4. Glanville J, Bayliss S, Booth A et al So many filters, so little time: the development of a search filter appraisal checklist.J Med Libr Assoc. 2008 Oct;96(4):356-61.
5. UBC Health LiBrary wiki: Systematic_review_searching and Filters (ie.hedges)
6. Haynes RB, Wilczynski N, McKibbon, KA et al. Developing optimal search strategies for detecting clinically sound studies in Medline. J Am Med Inform Assoc. 1994 Nov-Dec;1(6):447-58.
7. PubMed Clinical Queries
8. Systematic review subset in PubMed
9. McKibbon, KA, Wilczynski, NL, Haynes, RB Retrieving randomized controlled trials from medline: a comparison of 38 published search filters. Health Info Libr J. 2008.
10. Post: New Cochrane Handbook: Altered Search Policies.

Reference Management Software, Shut Down of 5 Google Apps and a Plane that Crashed.

Reference Management software, shut down of 5 Google apps and a plane that crashed. What have they in common? Nothing, except that these three unrelated subjects all reached me via Twitter last Thursday eve.

[1] When I checked my Tweetdeck (a twitter client) I saw a huge number of tweets (twitter messages) about the crash of a plain in the Hudson river. It now appears that Twitter and Flickr broke the news 15 minutes before the mainstream media. Below is the first crash picture which was posted on Twitter from an iPhone, taken by Janis Krums from a ferry. Earlier (Twitter as a modern tam tam) I gave some other examples of Twitter as a breaking news platform.

[2] Twitter is also a useful tool for up to date information and exchange of thoughts. For instance some tweeple (people on Twitter) had been asking about free reference management software. I had retweeted (RT, resend) the message and Thursday eve DrShock (of Dr Shock MD, PhD) tweeted a very useful link to Wikipedia which compared all reference management software, which was retweeted to the Twitter community.

The wikipedia article gives a comprehensive overview of the following software: 2collab, Aigaion, BibDesk, Biblioscape, BibSonomy, Bibus, Bookends, CiteULike, Connotea, EndNote, JabRef , Papers, ProCite, Pybliographer, refbase, RefDB, Referencer, Reference Manager, RefWorks, Scholar’s Aid, Sente, Wikindx, WizFolio, Zotero.

The following tables are included: the operating system support, export and Import file formats, citation styles, reference list file formats, word processor integration, database connectivity, password “protection” and network versions.

Very useful (although not always accurate). See: http://en.wikipedia.org/wiki/Comparison_of_reference_management_software.

[3] @Symtym (of the blog Symtym) had just learned me how to use Google Notebook to clip and collect information as you surf the web, organize the notes in notebooks and publish the public notes automatically to twitter via twitterfeed. I found it real handy and gathered some material to write a post about it.

But then came the news, brought to me by @Dymphie (of Deetjes (Dutch)), that Google decided to close many services, including Notebook as well as Google Video, Catalog, Jaiku, Dodgeball) or as ReadWriteWeb says it: “Google Giveth, and Taketh Away”. (see announcement on the Google Operating System blog).

Although Google Notebook itself will remain, the active development will be stopped. Of course this was shocking for many faithful users, including me, Dr. Shock and many others (see comments here)

What are the alternatives? Soon @DrCris, author of several blogs including Applequack, tweeted on a solution soon to come: “Evernote is working on a Google notebook importer“. I heard great things about Evernote, many doctors seem to use it, so I might as well give it a try.

Diigo is also planning to make a GN importer (see here). Presumably other tools will follow soon.

Note added:

Two articles in Lifehacker give tips [1] “where to go when google notebook goes down” and [2] describe how you can import the entirety of your google notebook to ubernote (Thanks Dr.Shock.)

——————-

“Reference Management software, shut down of 5 Google apps and a plane that crashed”. Wat heeft dit met elkaar te maken? Niets eigenlijk, behalve dat ik donderdagavond hiervan via twitter op de hoogte gesteld werd.

[1] Eerder gaf ik al voorbeelden dat twitter als een moderne tam tam werkt en vaak een primeur heeft. Donderdag was dat ook het geval. De eerste berichten van het neerstorten van een vliegtuig in de Hudson rivier kwamen via twitter binnen.

[2] Twitter is ook nuttig om informatie te delen. Deze week vroegen mensen naar gratis reference manager software. Ik twitterde dat door (RT of retweet) en donderdag kwam @DrShock (van Dr Shock MD, PhD) met een erg nuttige link naar een artikel in wikipedia. Vervolgens werd door ‘retweeten’ een groot aantal volgers op de hoogte gesteld

In het artikel wordt de volgende software vergeleken: 2collab, Aigaion, BibDesk, Biblioscape, BibSonomy, Bibus, Bookends, CiteULike, Connotea, EndNote, JabRef , Papers, ProCite, Pybliographer, refbase, RefDB, Referencer, Reference Manager, RefWorks, Scholar’s Aid, Sente, Wikindx, WizFolio, Zotero met betrekking tot de volgende punten: “the operating system support, export and Import file formats, citation styles, reference list file formats, word processor integration, database connectivity, password “protection” and network versions”.

Heel erg nuttig en overzichtelijk (in tabelvorm met kleurtjes). Zie: http://en.wikipedia.org/wiki/Comparison_of_reference_management_software.

[3] Van @Symtym (blog: symtym) had ik juist geleerd hoe ik Google Notebook kon gebruiken om teksten al surfende op het net te knippen, bewaren en verzamelen in kladbloks en vervolgens te publiceren op twitter via twitterfeed (berichten automatisch ingekort tot 140 lettertekens). Ik vond het ontzettend handig. Het is een ideale manier om snel informatie te organiseren om later te bekijken, om er een stukje over te schrijven en/of om direct met anderen te delen.

Maar toen kwam als donderslag bij heldere hemel het nieuws via @Dymphie (van Deetjes) tot mij dat uit verschillende Google applicaties de stekker zou worden getrokken. Ook uit Google Notebook. En daarnaast Google Video, Catalog, Jaiku, Dodgeball).

Google Notebook zelf zal nog wel even blijven, maar de ontwikkeling zal worden stopgezet. Natuurlijk is dit nogal een schok voor trouwe gebruikers. Eerst worden mensen geenthousiasmeerd om een nieuwe tool te gebruiken en vervolgens wordt deze hen weer ontnomen

Gelukkig twitterde @DrCris, auteur van o.a. Applequack, vrijwel direct dat Evernote werkt aan een Google notebook importeerfunctie. Ik heb erge goede dingen gehoord van Evernote en veel artsen gebruiken het, dus ik ga dat ook maar eens proberen. Diigo is ook bezig met het ontwikkelen van een GN importeerfunctie (zie hier). Waarschijnlijk zal dit wel navolging krijgen. Toch blijft het vervelend om steeds maar van tool te moeten veranderen. Maar misschien moet je dat op de koop toenemen bij gratis applicaties.

Achteraf toegevoegd

Twee artikelen in ‘Lifehacker’ gaan over dit laatste punt [1] “where to go when google notebook goes down” en [2] describe how you can import the entirety of your google notebook to ubernote (Met dank aan Dr.Shock.)

The Medlib’s Round – FAQs

In a previous post I announced a new Blog Carnival, specifically for Medical Librarian-related matter. I also posted an announcement to Twitter and here are some of the responses:

Now there seemed to be a consensus that a further explanation would not be superfluous. So I will try to explain a little more and be more specific. Please let me know if you have further questions.

What is a blog carnival?

Blog Carnivals are a regular compilation of a “selection of blogposts in a certain area”, hosted by a different blogger each time.

And what is the Medlib’s Round?

The Medlib’s Round is a blog carnival about medical librarian stuff. Mosts posts will be written by librarians, but non-librarians are also invited to contribute. As long as it is about librarian-related matter and relevant. It would for instance be great to have a post of GP’s telling about their way of searching. The posts should be written in English (at least partially).

What is the intended Audience?

These are primarily librarians in the medical field, but other librarians, as well as doctors, medical students and health 2.0 people may find it also very useful, especially because the posts are bundled.

Why a Medlib’s Round?

On the one hand it is difficult to keep up with all the librarian blogs, on the other hand it is difficult for new librarian bloggers to be ‘heard’. And usually this is a major purpose of blogging. By compiling the best stories on a subject one can get a quick overview and pick up the information that seems interesting. You may also find new and/or less well known blogs, that may be interesting to follow. For participating bloggers it may create more visitors, more traffic and more discussion. There are many Carnivals, but none in this field.

How frequent is the Medlib’s Round?

The current frequency is once a month. If it successful, it may become a bimonthly carnival. The publications are on Tuesday, the submissions are due at Saturdays 00.00 (Dutch Time or 18.00 EST)

Who creates a blog carnival?

• Laika’s Medliblog is the organizer. The Organizer starts the carnival, decides what it will be about, what the submission criteria are, and how often it will appear. The organizer also coordinates who will host each edition of the carnival and keeps an archive.
• The Host volunteers to host a carnival edition on their blog. They work with the organizer to pick a date that suits them. Ideally the hosts are scheduled for months in advance.
  It goes for instance like this: Laika’s medliblog hosts the first round. @aldricham offered to host on the (multi-authored) blog Dragonfly. I asked her if March would be o.k. and she agreed. Februari and March are now scheduled. Hopefully other volunteers will follow soon for April, May and June.
  In the period leading up their scheduled date, hosts usually post a “call for submissions” to draw attention to the upcoming carnival and to provide further details, for instance whether there is a theme. Because we are only just starting, my advise is not to use a strict theme or use no theme at all. But it is up to the hosts to decide.
  Hosts automatically receive submissions from bloggers. They select the posts (removing spam and sometimes posts that don’t fit in) and organize them into a single article chalk-full of links, often with their own comments. The blogcarnival already has a preformatted posts, that makes it easy to compose the carnival. The article is published on the scheduled date and people can leave comments on the blog or comment on their own blog linking back to the posts.
• Bloggers who have written a recent article on the carnival’s topic on their own blog can submit the link for inclusion in the next edition of the carnival. All the blogger needs to do (except for writing the post and keeping the deadline in mind) is to go to the Blog Carnival submission form, login, submit links to selected posts and give an optional description.The Blog Carnival submission form shows (a) when the next carnival is scheduled (this is NOT the deadline which is 3 days earlier), (b) who is hosting it, (3) any details about the submission and (4) the email-address of the host.
  Blog Carnival takes care of getting it to the right person (either the host of that week or the organizer).

To submit you first have to sign in or register to the Blog Carnival

Submission via the form is really easy. Scroll down to find the form.

I hope you’re all enthusiastic about it and will submit a post (or really a link to a post on your blog) to the carnival in the next 3 weeks. Or perhaps you would like to host one edition.It is not difficult and you have time to see how the others do it.

A New Blog Carnival: Medlib’s Round

I’ve participated in several Blog Carnivals in the field of Medicine (and hence called Grand Round). i.e. The Grand Round, the Dutch Grand Round (i.e. see here), and SurgeXperiences. Blog Carnivals are a regular compilation of the “best blogs in a certain area”, hosted by a different blogger each time.

I enjoy participating in a Grand Round, either as submitter or as hosts, and being a medical librarian, I asked myself, why aren’t there any medical blog carnivals around?

Participating in a blog carnival is easy and informative. Why should medical librarians do this? Because you get a quick overview of the best posts in the field of medical librarianship, you learn to know other librarians, you keep well informed about what is going on and you generate traffic to your site (both as a host and a submitter).

Finally librarians not having a blog or people not being medical librarians (health 2.0, web 2.0 people, doctors) might also be interested in getting a quick overview of a field that has their interest.

These are the facts/rules:

• The Blog Carnival’s name is Medlib’s Round. Please let me now if you have a more original carnival title.
• For the time being it is a once-monthly Grand Round. The publications are on Tuesday, the submissions are due at Saturdays 00.00 (Dutch Time), or 18.00 EST.
• All submissions and the Grand Round itself should be written (at least partially) in English.
• Whether there is a theme or not is up to the host. The advice though is not to be too strict and give a nice compilation.
• The host posts a call for submissions as early as possible at his or her blog.
• The schedule and the archive are listed on Laika’s Medliblog on a separate page here.
  
• You can submit your post (the permalink) to the blog carnival here or mail the next host before the deadline
  .
• The first Grand Round (deadline February 7th) is at my place: Laika’s MedLibLog. The theme is rather loose: write about a subject that is close to your heart, whether it is about your patrons, education, PubMed, twitter …. whatever you find important.

What should you do now?

• Tell me whether you like the idea or not and whether you want to join.
• Write a post and submit it here (preferred) or mail me at laika dot spoetnik at gmail dot com.
• Tell me whether you want to host a next edition: March*, April, May or June. (comment, mail,twitter)!!
• Inform others that a Medlibrarian Grand Round is in the making.

Added:

*  We have a host for the March edition: Dragonfly. Thanks @aldricham

** For schedule see: medlibs-archive

*** Several librarians asked for a more extensive description. I will post this soon.

Top of the Tweets [1]

People who read the “Clinical Cases and Images” blog of Ves Dimov wil undoubtedly know his series “Selection of My Twitter Favorites” (i.e. see edition 30)

This is how he introduces the series:

Twitter is a microblogging service where people answer the question “What are you doing?” via 140-character messages from their cellphone, laptop or desktop. You can select the messages you find useful, amusing, or both.

I enjoy his selection of tweets. But since Ves follows other people and lives in a different timezone, I thought it would be nice to present my own favorites. I’ve chosen tweets (twitter messages) that were funny or striking. This is certainly not the only value of twitter. The greatest advantage of Twitter is that it is an easy tool to share views and thoughts and useful links. Twitter is also very valuable for social networking.

Rereading the gathered tweets made me laugh or grin and posting them here will ensure that I will treasure them.

Below are the tweets of December last year (and one of 2009). I hope you like them.

* I’m planning to write some tips for (real) twitter beginners. Please tell me if you’re interested, and -if so-, what you would like me to discuss.

—

Hierboven een aantal tweets (korte berichten van 140 leestekens op Twitter) die me aan het (glim)lachen maakte en/of die ik heel treffend vond. Twitter is niet alleen voor de “lol”. Het belangrijkste nut is dat je heel snel contact kunt leggen met geestverwanten/collega’s over de hele wereld en dat het een makkelijke bron is voor uitwisseling van nieuwtjes, ideeen en links.

Voor wie meer wil weten over Twitter: ik ben van plan een introductie over Twitter te schrijven voor de echte beginner (die Twitter beroepshalve gebruikt). Schrijf me (evt per mail) wat jij graag zou willen weten.

The 2008 Medical Weblog Awards Polls Are Open!

Just a short notice that you can start voting for your favorite finalists in the Medgadget contest for best medical blogs.

You can find all categories here.

I’m in category: “The best new medical weblog“, for which you can vote here.

I guess that my chances of winning are slim, considering the quality of the other blogs. I’ve become a real fan of [1] Sandsnurf of ‘Life in the Fast Lane‘, and I regularly read [2] Science-Based Medicine a good quality team-blog about controversies in the relationship between science and medicine, a subject being close to my heart.

New to me are [3] Medtechinsider, another team-blog (editorial staff of Medical Device Technology and European Medical Device Manufacturer), devoted to covering the medical manufacturing industry and its suppliers. And [4] The New Health Dialogue, a policy blog of the New America Foundation.

But let’s not talk too much about the others, shall we….??!!

I truly hope I have earned your vote. But whether you do vote for me or not, please make sure you get to vote for your favorite in each of 7 categories here.

I’m already thrilled having made it to the short list.

Grand Rounds 5.16: On Profit in medicine and other cool stuff!

Edwin Leap has the honor to host the first Grand Round of 2009. The theme of this week is profit in medicine.

“The value, or detriment, of financial profit in health-care. From doctors to pharmaceutical companies, universities to insurers and everything in between; is profit good or bad?”

To summarize Edwin’s view, here is his concluding remark:

“Until we re-discover Hippocrates, and what he was saying all those years ago, we’ll just have to do one of two things: keep paying people lots of money, or learn to do without care. That’s the way I see it, anyhow!”

Although not everyone sticks strictly to the topic (or interprets profit like ‘value’, as I did) it has become a very interesting round again with many posts touching the theme in one way or another.

Next Round will be will be hosted by Barbara Kivowitz at “In Sickness and in Health“.

Foto Credit: Adrianclarkmbbs – Flickr CC

A 2008 Medical Weblog Awards Finalist…..

Some weeks ago I announced that the Medgadget 2008 nomination of the Best Medical Blogs had started.

The unexpected has happened. Laika’s Medliblog has been chosen as a finalist in the category Best New Medical Weblog (established in 2008).

As a Dutch Medical Librarian, and a novice in the web 2.0 world, I’m thrilled and very honored that I’m among the finalists for this prestigious award.

Special thanks to Wowter (with a Dutch and an English blog) who took the initiative to nominate me.

Here is a complete list of the finalists for The 2008 Weblog Awards. The final list of nominees can be found here.

The voting starts tomorrow, well Tuesday 06-01-2008 (that is today here). Please keep tuned in….

p.s. How did I found out? Via twitter, of course, where one of the other finalists, “Scanman” or Vijay congratulated some of us.Thanks Vijay.

The Web 2.0-EBM Medicine split. [1] Introduction into a short series.

Since the three years I’m working as a medical information specialist, I’ve embraced the concept of evidence based medicine or EBM. As a searcher I spend hours if not days to find as much relevant evidence as possible on a particular subject, which others select, appraise and synthesize to a systematic review or an evidence based guideline. I’m convinced that it is important to find the best evidence for any given intervention, diagnosis, prognostic or causal factor.

Why? Because history has shown that despite their expertise and best intentions, doctors don’t always know or feel what’s best for their patients.

An example. For many years corticosteroids had been used to lower intracranial pressure after serious head injury, because steroids reduce the inflammation that causes the brain to swell. However, in the 1990’s, meta-analyses and evidence-based guidelines called the effectiveness of steroids into question. Because of the lack of sufficiently large trials, a large RCT (CRASH) was started. Contrary to all expectations, there was actually an excess of 159 deaths in the steroid group. The overall absolute risk of death in the corticosteroid group was shown to be increased with 2%. This means that the administration of corticosteroids had caused more than 10,000 deaths before the 1990’s.[1,2,3]

Another example. The first Cochrane Systematic Review, shows the results of a systematic review of RCTs of a short, inexpensive course of a corticosteroid given to women about to give birth too early. The diagram below, which is nowadays well known as the logo of the Cochrane Collaboration, clearly shows that antenatal corticosteroids reduce the odds of the babies dying from the complications of immaturity by 30 to 50 per cent (diamond left under). Strikingly, the first of these RCTs showing a positive effect of corticosteroids, was already reported in 1972. By 1991, seven more trials had been reported, and the picture had become still stronger. Because no systematic review of these trials had been published until 1989, most obstetricians had not realized that the treatment was so effective. As a result, 10.000s of premature babies have probably suffered and died unnecessarily. This is just one of many examples of the human costs resulting from failure to perform systematic, up-to-date reviews of RCTs of health care.[4,5]

Less than I year ago I entered the web 2.0-, and (indirectly) medicine 2.0 world, via a library 2.0 course. I loved the tools and I appreciated the approach. Web 2.0 is ‘all about sharing‘ or as Dean Giustini says it: ‘all about people‘. It is very fast and simple. It is easy to keep abreast of new information and to meet new interesting people with good ideas and a lot of knowledge.

An example. Bertalan Mesko in a comment on his blog ScienceRoll:

I know exactly that most of these web 2.0 tools have been around for quite a long time. Most of these things are not new and regarding the software, there aren’t any differences in most of the cases. But!
These tools and services will help us how to change medicine. In my opinion, the most essential problem of medicine nowadays is the sharing of information. Some months ago, I wrote about a blogger who fights Pompe disease, a rare genetic disorder and he told me about the diagnostic delay. I try to help physicians how they can find information easier and faster. For example: I gave tips how to search for genetic diseases.

Other examples are good functioning and dedicated patient web 2.0 sites, like PatientsLikeMe.

In the medical literature, blogs and slideshare, differences between medicine 2.0 and 1.0 are already described in detail (for instance see the excellent review of Dean Giustini in the BMJ), as well as the differences between medicine 1.0 and EBM (e.g. see the review of David Sackett et al in BMJ).

However, the longer I’m involved in web 2.0, the more I feel it conflicts with my job as EBM-librarian. The approach is so much different, other tools are used and other views shared. More and more I find ideas and opinions expressed on blogs that do EBM no justice and that seem to arise out of ignorance and/or prejudice. On the other hand EBM and traditional medicine often are not aware of web 2.0 sources or mistrust them. In science, blogs and wiki’s seldom count, because they express personal views, echo pre-existing data and are superficial.

I’m feeling like I’m in a split, with one leg in EBM and the other in web 2.0. In my view each has got his merits, and these approaches should not oppose each other but should mingle. EBM getting a lower threshold and becoming more digestible and practical, and medicine 2.0 becoming less superficial and more underpinned.

It is my goal to take an upright position, standing on both legs, integrating EBM, medicine 2.0 (as well as medicine 1.0).

As a first step I will discuss some discrepancies between the two views as I encounter it in blogs, in the form of a mini-series: “The Web 2.0-EBM Medicine split”.

Before I do so I will give a short list of what I consider characteristic for each type of medicine, EBM-, Web 1.0 (usual)- and Web 2.0- medicine. Not based on any evidence, only on experience and intuition. I’ve just written down what came to my mind. I would be very interested in your thoughts on this.

EBM – medicine

• centered round the best evidence
• methodology-dependent
• objective, transparent
• thorough
• difficult (to make, but for many also to find and also to understand)
• time-consuming
• published in peer reviewed papers (except for guidelines)
  
• searching: PubMed and other bibliographic databases (to produce) and guideline databases, TRIP, and PubMed (Clinical Queries) or specific sources, i.e. specialist guidelines (to find).
• Mostly Web 1.0 (with some web 2.0 tools, like podcasts, RSS and e-learning)

Web 1.0 – traditional medicine*

• centered round clinical knowledge, expertise and intuition
• opinion-based
• authority based, i.e.strong beliefs in opinion leaders, expert opinion or ‘authority opinion’ (i.e. head of departments, professor) and own authority versus patient.
• subjective
• fast
• act! (motto)
• searching: browsing ( a specific list, site or Journals), quick search, mostly via Google**, in pharmacopeia, or protocols and UpToDate seldom in Pubmed (dependent on discipline)
• Web 1.0: mail, patient-records, quick search via Google and Pubmed

Web 2.0 medicine

• people-centered and patient-centered (although mostly not in individual blogs of doctors)
• heavily based on technology (easy to use and free internet software)
• social-based: based on sharing knowledge and expertise
• (in theory) personalized
  
• subjective, nondirected.
  
• often:superficial
  
• fast
• generally not peer reviewed, i.e. published on blogs and wiki’s
  
• searching: mostly via free internet sources and search engines, e.g. wikipedia, emedicine, respectively Google**, health metasearch engines, like Mednar and Health Sciences Online. PubMed mainly via third-party-tools like GoPubMed, HubMed and PubReminer. (e.g. see recent listings of top bedside health search engines on Sandnsurf’s blog ‘Life in the Fast Lane’
  
• heavily dependent on web 2.0 tools both for ‘publishing’, ‘finding information’ and ‘communication’
  

*very general. of course dependent on discipline.
** this is not merely my impression, e.g. see: this blogpost on the “Clinical Cases and Images blog” of Ves Dimov, referring to four separate interviews of Dean Giustini with Physician bloggers.

Other references

[1] Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes at 6 months. Edwards P et al. Lancet. 2005 Jun 4-10;365(9475):1957-9.
[2] A CRASH landing in severe head injury. Sauerland S, Maegele M. Lancet. 2004 Oct 9-15;364(9442):1291-2. Comment on: Lancet. 2004 Oct 9-15;364(9442):1321-8.
[3] Corticosteroids for acute traumatic brain injury.Alderson P, Roberts IG. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD000196.
[4] http://www.cochrane.org/logo/
[5] Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.Roberts D, Dalziel SR.Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004454
[6] How Web 2.0 is changing medicine. Giustini D. BMJ. 2006 Dec 23;333(7582):1283-4.
[7] Evidence based medicine: what it is and what it isn’t. Sackett DL et al. BMJ. 1996 Jan 13;312(7023):71-2.

Laika’s MedLibLog in review: 2008

This blog saw the light in February 2008, so it is almost time to celebrate its anniversary.

Maintaining this blog has been an enjoyable and fruitful -albeit time-consuming- experience.
I would like to take this opportunity to thank all readers of this blog for their visits, comments and support! I hope that you will continue to find content here that entices you to read and, even better, comment.

If you like the posts at this blog and you’re not doing this already you might consider:

• subscribing to my blog by RSS by clicking here (You have to install a reader as well) or
  
• subscribing by email by clicking here
• adding this blog to your Technorati favorites here
• following me on Twitter here

Or you can simply click on the figures in the sidebar:

I wish you all the best for 2009!

——————————————————————————————————————–

Here is a short review of this first year of blogging.

Highlights were:

• A very positive review in a series “Blog Spotlight” authored by Danielle Worster (the Health Informaticist) in the “Library + Information Gazette“.
• Inclusion in the Top_50_health_2.0_blogs list of RNCentral.com (both discussed here)
  
• The invitation to present a slideshow on my blogging experience at the Spoetnik (Library 2.0) Symposium (see post here).
• Nominated for the Best New Medical Weblog (established in 2008) at Medgadget. (see the list)

———————————————————————————————————————-

An overview of (a selection of) blog posts per subject:*

Searching, Biomedical databases.
PubMed: Past, Present And Future, PART II [1]
PubMed: Past, Present And Future, PART I [10]
Finding assigned MeSH terms and more: PubReminer [16]
BMI bijeenkomst april 2008 [19] [Dutch]
PubMed: Past, Present and Future PART III [39]
New Ovidsp Release Planned August 5th will allow more flexible searching [46]

Evidence Based Searching
The best moment teaching EBM-searching skills [31]
Time to weed the (EBM-)pyramids?! [35]
New Cochrane Handbook: altered search policies [-]
Podcasts: Cochrane Library and MedlinePlus [-]
New cochrane handbook: altered search policies [-]

Evidence Based Medicine, Methodology
Nursing Myths (1): Post-operative Temperative Measurements [2]
The Best Study Design… For Dummies [3]
Huge disappointment: Selenium and Vitamin E fail to Prevent Prostate Cancer.[7]
The (un)usefulness of regular breast exam [9]
FREE online course on evidence-based health care [14]
Thesis Mariska Leeflang: Systematic Reviews of Diagnostic Test Accuracy [18]
CC (2) Duodecim: Connecting patients (and doctors) to the best evidence [49]
Podcasts: Cochrane Library and Medlineplus [-]

Clinical practice, Consumer-related Subjects, Addison’s Disease
Changing care (for Addison patients) [11]
The importance of early intervention in an Addisonian Crisis[13]
23andMe: 23notMe, not yet [15]
Anatomy Lesson 2008: Living in Fear [20]
Etiquette-Based Medicine [22]
The OpenECGproject: an admirable Web 2.0 [42]

Science
The Real Sputnik Virus [4]
Randy Pausch Last Lecture: Achieving Your Childhood Dreams [6]
#Sciblog – a bird-eye’s view from the camera
Evolution and Medicine. Cancer and adaptive immune responses as evolutions ‘within’.

Web 2.0 tools
Incorrect Google Incoming Links? [5]
Delicious Google Toolbar [9]
Google Reader and other free (learning) tools [17]
Visualize your blog (words) with Wordle [21]
Locate Your Visitors (2) [23]
Forget Hyves. Go Twitter! [24]
Possibly an announcement about possibly related posts [25]
Locate-your-visitors [30]
Technorati Rank & Authority Dropping[38]
Blog Spam and Spam Blogs (1) [44]
WikiMindMap to Organize Wiki Content [50]

Other
For Palin & Obama, Fun & Photo’s [8]
A really delicious blog …[12]
Dutch Grand Round and other blog carnivals.: See the category Grand Round
For Spoetnik Course search for the Category Spoetnik (preliminary Dutch)
For Personal matter search for the category Personal

*([nr] indicates the popularity of the post according to WordPress stats, from 1 [most popular] to 50. Not all posts are shown.