PeRSSonalized Medicine – and its alternatives

A few posts back I just discussed that Personalized Genetics has not fulfilled its promise yet. But what about PeRSSonalized Medicine, just launched by Bertalan Mesko?

Bertalan Meskó is a medical student from Hungary, who runs the award-winning medical blog Scienceroll. According to the web 2.0 model of Hugh Carpenter, mentioned in a previous post, Bertalan (Berci) just finished his journey as a Web 2.0 jedi: he started a web 2.0 company: Webicina. Webicina offers a personalized set of web 2.0 tools to help medical professionals and patients enter the web 2.0 world.

To be honest I was a bit skeptical at first. When I think of web 2.0, I think of it as *open, *collaborative, *creative commons, *networking, ****collective intelligence (Elizabeth Koch). Web 2.0 exists by the mere fact that people want to share information for free. Later I realized that this initiative is comparable to individualized courses that you have to pay for as well. Webicina will also offer some free tools, especially for patients.

One such free tool is PeRSSonalized Medicine. The RSS in PeRSSonalized Medicine stands for Real Simple Syndication, which is a format for delivering regularly changing web content, i.e. from Journals. PeRSSonalized Medicine is a free tool meant to help those users who cannot spend much time online (e.g. medical professionals). It helps them track medical journals, blogs, news and web 2.0 services really easily and creates one personalized place where they can follow international medical content without having a clue what RSS is about (see post at Scienceroll)”

PeRSSonalized Medicine has a beautiful and straightforward interface. There are 5 separate sources you can follow: (1) Medical Journals, (2) Blogs, (3) News and (4) Media (including Youtube channels, Friendfeed rooms or Del.icio.us tags), and (5) “articles” in PubMed (to setup this you have to perform a search in a separate toolbar).

The items included are partly of general interest -i.e. the Medical Journals includes 13 titles, including the BMJ, the JAMA and the Lancet-, partly it is very specialized, i.e. on the field of genetics. A lot of Journals are not included and Web 2.0 sources tend to be more represented than the official media/journals.Thus this tool seems most suited for the generalist and people wanting to follow web 2.0 tools. On the other hand – and this is a clear advantage- the content develops as wishes and suggestions are taken into account.

Each Tab can be personalized by simply hiding the titles you don’t want to include (under the button personalize it), but settings are only saved after registration.

The view of the personalized page is pleasant and neat. You see short titles of the 10 latest articles of the sources you have subscribed to. Moving your mouse over the titles will reveal more information and once you clicked the link it turns grey instead of blue. What I miss is the button: more, so you can catch up if you have missed older articles. Especially with media and journals that often have more than 10 new articles per issue, even more so if the first 10 titles consist of “obituaries” (BMJ).

The latest addition to PeRSSonalized Medicine (5) is the possibility to subscribe to a Pubmed search so “you can also follow the latest articles in your field of interest without going back to PubMed again and again and doing a search for your favourite term. Make this process automatic with PeRSSonalized Medicine.”
However, as most of you may know, you don’t have to go back to Pubmed over and over again to “do” your search, but you can easily subscribe to a search in PubMed either by email (My NCBI) or by RSS (see for instance this post in Dutch). Although the process of subscribing is not as intuitive as it is in PeRSSonalized medicine, PubMed is better suited to design a good search strategy. To keep abreast of the latest information in your field a good search forms the basis. It hurts my heart as a librarian that most web 2.0 people are more fixed on the technique of how to subscribe to a feed (RSS) than on good search results. Remember, it still is: garbage in, garbage out. RSS is just the drain.

As an example I show two RSS feeds below, one with more appropriate terms (pulmonary embolism and d-dimer) than the other (lung embolism and d-dimer). Pulmonary embolism is a MeSH. It is evident that with lung embolism articles will be missed just by choosing wrong/less optimal terms.

Again the presentation of results is pleasant. Apart from the search restrictions I don’t find it very handy to look up each paper in HubMed (for that is where the link takes you).
Personally I prefer regular e-mail-alerts at specific intervals (via MyNCBI). I would like to look up citations either individually (if there is just 1 interesting hit) or all at once (10-50 hits). In PubMed, results can be selected, PDF’s directly downloaded from the library website and citations can be kept in My NCBI Collections or imported into a reference manager system. A RSS-feed of Pubmed searches is also handy (see below).

Alternatives

The idea presented on Webicina, although fancy, is not new. Consider the following alternative web tools, also build on data collected from RSS feeds.

Amedeo

Amedeo is dedicated to the free dissemination of medical knowledge. It is an international free service that will send you weekly literature updates in medical subjects of your choosing. At the same time a personalized website is made, with subscriptions to the journals you selected. You can retrieve the articles in text or in HTML-format. The HTML format brings you to the latest results for that Journal in PubMed. This service seems most suitable for specific medical disciplines. General topics (family physician) are not available, although it is possible to subscribe to for instance the American Journal of Family Physicians. As with all these free literature services, you will have to subscribe. It is easy to select or deselect journals in a category (tick boxes).
Amedeo also has Free Books For Doctors, but no podcasts or blogs. You can search the site, but you cannot easily look up individual journals.

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MedWorm (and LibWorm)

MedWorm is a free medical RSS feed provider as well a a search engine. It is meant both for doctor and patient. There are many medical categories that you can subscribe to, via the free MedWorm online service, or another RSS reader of your choice, such as Google Reader. The number of RSS-feeds is enormous: >6000. There are a publications directory, a blog directory, a blog tag cloud, consumer health news, discussion and several specific topics, like cancers, drugs, vaccines and education. Within the publications directory there is a further subdivision in: Consumer – Info – Journals – News – Organizations – Podcasts.

Many specialties are represented, including primary care and veterinary science. I tried it out and subscribed to some Addison’s disease related topics, Reuter’s Health and my own blog, which has recently been included. When you subcribe via the Medworm-RSS all news can be read in “My River of News”. It shows the titles and part of the abstracts (see Fig. below).

You can subscribe to single items or categories, but it is not possible to in- and exclude individual feeds within a topic or category by a single action. So within Endocrinology I cannot selectively exclude all diabetes journals, but (as far as I can see) I have to subscribe to each individual journal, if I don’t want the whole package. The loading of the River of News takes long, sometimes.

Together with David Rothman the builder/owner of MedWorm, Frankie Dolan, has also launched Libworm, which is a librarian’s version of MedWorm.

DO IT YOURSELF (or let the library do it for you)

Sometimes the library will set up a personalized start page. See for instance the Dermatology page created with Netvibes at the Central Medical Library, University Medical Center Groningen (UMCG). Doesn’t it look beautiful?

I-Google

And isn’t the tool below superb looking? Well, I constructed it myself on basis of what Ves Dimov wrote in the post “Make Your Own “Medical Journal” with iGoogle Personalized Page”, he submitted to the first MedLib”s round. And I had a little “life” help from Ves via Twitter, because things have changed a bit. All you need is a free Google mail (G-mail) account, just go to Google.com/IG (or search the web for I-Google) and subscribe. First you can create your start page with all kind of gadgets (like clock, G-mail inbox and weather forecast, see Figure below) and then you can add other tabs (encircled below). The Medical Journal and Journals Tabs I just took from Ves by clicking on the links he gave in his post: RSS feeds of the “Big Five” medical journals (NEJM, JAMA, BMJ, Lancet and Annals) plus 2-3 subpecialty journals and the podcasts of 4 major medical journals in iGoogle.

Once you have these tabs you can edit them (add, delete, move) as you like.

I-Google Medical Journals Tab

I-Google Startpage

RSS-readers

All the above tools are based on RSS, which means Real Simple Syndication. It isn’t called Simple for nothing. You can easily do it yourself, which means that you have more freedom in what you subscribe to. Because I-Google doesn’t scale well beyond 50 or so RSS feeds, other RSS-readers are advisable once you subscribe to many different feeds (see Wikipedia for list and comparison) . I use Google-Reader, shown below, for this purpose.

Generally, adding Feeds is easy. In Firefox you often see the orange RSS-logo in the web browser (just click on it to add the feed) and most Journals and blogs have a RSS-button on their page, that enables subscription to their feed.

As detailed in another (Dutch) Post, numerous Pubmed searches can be easily added to your RSS-reader. You build up a good search in Pubmed, for instance: (pulmonary embolism[mh] OR pulmonary embolism* OR lung embolism*) AND (“Fibrin Fibrinogen Degradation Products”[Mesh] OR d-dimer). In “the Results” you click on “Send To” and choose RSS-Feed and add it to your reader. That’s all.

Summary

PeRSSonalized Medicine is a free tool which lets you subscribe to a small and rather skewed selection of journals, news, media and blogs and (straightforward) PubMed searches. The strong points of this tool are: the beautiful design, the ease of use for people not used to web 2.0 tools including RSS, and its continuous development, seeking active input from its users. To speak with dr Shock’s: It is meant for a physician who is not web savvy, never heard of RSS and never wants to, not a geek, nerd, and still wants to stay up to date with health 2.0 or medicine 2.0.”

But there are other free tools around with more (subscription) possibilities and with a little more investment of time you can do it yourself and make subscriptions really perssonalized. Once you know it is simple, believe me.

You may also want to read:

http://laikaspoetnik.wordpress.com/2008/05/05/1-may-rss-day/ (about RSS)

http://laikaspoetnik.wordpress.com/2008/02/15/rss-feed-en-pubmed/ (about RSS and Pubmed – Dutch)

Grand Round is being served at The Blog That Eat Manhattan.

Come enjoy the wonderful menu that is being served today at The Blog That Eat Manhattan, that is run by Margaret Polaneczky, MD who introduces herself as follows:

I practice medicine, cook and wax prolific in NYC.
You can call me Peggy. Or Dr P.
Just don’t call me late for dinner.

Grand Round nr 5.23 is being served as a full course dinner, so take care not to consume it at once, because this will surely cause indigestion.

Next week’s Grand Rounds will be served payed off hosted at Health Business Blog.

MnSOD, Carotenoids & Prostate Cancer – “You are what you eat” depends on who you are.

When you type Cancer Food Prevention in Google you get about 9 million hits, many of them dotcom sites telling you which nutrients, pills or extracts you should take to prevent cancer. Much of this information is unreliable at least.

Although it is true that numerous observational studies (cohort and case-control) do indicate a relationship between diet and cancer incidence, it is difficult to pinpoint the exact nutrients that may be responsible for a beneficial effect. Furthermore, as explained in “The Best Study Design for Dummies” observational studies provide weaker empirical evidence than RCT’s (randomized controlled trials).

For prostate cancer observational (and preclinical) data indicate that diets high in cruciferous vegetables, soy lecithins and other phytoestrogens, vitamins E and C, lycopene, Selenium, green tea (to name a few) are associated with a lower risk of prostate cancer [1].

However, recent randomized trials did not confirm positive effects of vitamin E and C and Selenium (see previous post on the negative SELECT and the PHS II-trial) and data from the PLCO (Prostate, Lung, Colorectal, Ovarian) Trial [2] suggest that the benefit of lycopene (a powerful anti-oxidant that gives tomatoes their red color) is small and that beta-carotene, an antioxidant related to lycopene, even increases the risk for aggressive prostate cancer.

There may be many reasons why these results discords with the many observational studies performed (3)

• Earlier positive observational studies have less methodological rigor than (large) RCT’s. In controlled trials, the random assignment of subjects to the intervention eliminates the problems of dietary recall and controls the effects of confounding factors.
• RCT’s test one or two nutrients in isolation and sometimes in high doses assuming that a single compound may reproduce the beneficial effects of the whole foods.
• RCT’s are often not stratisfied, differences between individuals are often not taken into account.

That this may be important is shown in a recent study on the manganese superoxide dismutase (MnSOD) polymorfism, prostate cancer and lycopene (4)

The manganese superoxide dismutase (MnSOD) gene encodes an antioxidant enzyme (SOD2) that may protect cells from oxidative damage (which may play an important role in prostatic carcinogenesis). A polymorphism [valine (V) -> alanine (A)] of MnSOD has been recently associated with a higher risk of prostate cancer.

The present study performed by Mikhak et al was a nested case-control study in the Health Professionals Follow-up Study (HPFS) with 612 incident prostate cancer cases and 612 matched controls.

The study not only investigates the role of the MnSOD gene Ala16Val polymorphism in prostate cancer risk, but also measures its interactions with baseline plasma carotenoid concentrations.

In line with several other studies (5), no overall association between MnSOD polymorphism and prostate cancer risk was found. However, a 3-fold [95% confidence interval: 1.37-7.02] increased risk of aggressive prostate cancer was observed among men with the Ala/Ala genotype in the presence of low long-term lycopene status (P-value, test for interaction = 0.02) as compared with men with the Ala/Val+Val/Val genotypes with low long-term lycopene status. In other words when the lycopene blood level is low, the Ala/Ala genotype confers a higher risk of aggressive prostate cancer compared with individuals with the other genotypes.

These results are consistent with findings from an earlier study (6) that reported when total antioxidant status is low, the MnSOD Ala/Ala genotype may be associated with an increased risk of aggressive prostate cancer. In contrast, men with the Val allele were much less sensitive for prediagnostic plasma levels of the anti-oxidants selenium, lycopene and {alpha}-tocopherol.

Thus reasoned the other way around: the anticancer effects of supplemented lycopene and other anti-oxidants may depend on the the MnSOD genotype and the levels of both endogenous and exogenous antioxidants. Similarly, a positive effect of {alpha}-tocopherol (vitamin E) observed in earlier trials appeared to be limited to smokers and/or people with low basal levels of vitamin E (see previous post).

SOURCES

1. E-medicine/Medscape: prostate cancer and nutrition (2008) (free e-txt)
   
2. Peters U, Leitzmann MF, Chatterjee N, Wang Y, Albanes D, Gelmann EP, Friesen MD, Riboli E, Hayes RB. Serum lycopene, other carotenoids, and prostate cancer risk: a nested case-control study in the prostate, lung, colorectal, and ovarian cancer screening trial. Cancer Epidemiol Biomarkers Prev. 2007 May;16(5):962-8. (free PDF)
   
3. Byers T. What can randomized controlled trials tell us about nutrition and cancer prevention? CA Cancer J Clin. 1999 Nov-Dec;49(6):353-61. Review (free PDF)
   
4. B. Mikhak, D. J. Hunter, D. Spiegelman, E. A. Platz, K. Wu, J. W. Erdman, E. Giovannucci (2008). Manganese superoxide dismutase (MnSOD) gene polymorphism, interactions with carotenoid levels and prostate cancer risk Carcinogenesis, 29 (12), 2335-2340 DOI: 10.1093/carcin/bgn212
5. Bag A, Bag N. Target sequence polymorphism of human manganese superoxide dismutase gene and its association with cancer risk: a review.
   Cancer Epidemiol Biomarkers Prev. 2008 Dec;17(12):3298-305. Review. (Abstract)
6. Li H, Kantoff PW, Giovannucci E, Leitzmann MF, Gaziano JM, Stampfer MJ, Ma J. Manganese superoxide dismutase polymorphism, prediagnostic antioxidant status, and risk of clinical significant prostate cancer.Cancer Res. 2005 Mar 15;65(6):2498-504.

You may also want to read:

• The best study design for dummies (2008/08/25/)
• Huge disappointment: Selenium and Vitamin E fail to Prevent Prostate Cancer.(post on this blog about the SELECT trial – 2008/11/16)
• Yet another negative trial with vitamins in prostate cancer vitamins c and e (2008/12/15)

Photo Credits

• http://commons.wikimedia.org/wiki/File:Tomaten_im_Supermarktregal.jpg
• http://commons.wikimedia.org/wiki/File:Lycopene_in_DCM.jpg

The 21st Century Librarian

In a previous post “You don’t look like a librarian” I shortly described a book dealing with Librarian stereotypes and what can be done to defeat tired old perceptions and create positive new images…

I really liked the comments of Jenny and Creaky, basically confirming that there is something like a librarian “subtype”: “we look like nice people – curious, friendly, social” (Jenny) and “approachable” (Creaky, who is often spontaneously asked for help when she steps into a Border’s or a Barnes & Noble Bookstore.)

However, although THE stereotypical librarian does not really exist any longer in this information age, the picture continues to exist in some people’s mind (Ruth, the author of the book).

Quite coincidentally @AllergyNotes (Ves Dimov) pointed that same day to an article in the New York Times about the “Twenty-First Century Librarian” highlighting that

“librarians are no longer just reshelving books but play a new role in the information age, since technology has brought out a whole new generation of practices.”

The article describes school librarians who connect kids not only with books but also with information. As an example a video is shown of Stephanie Rosalia, a librarian at an elementary school (see below). Stephanie does do the usual librarian things, but also learns kids how to surf the net and how to search databases using boolean operators(!) and she teaches them website literacy. For instance, a completely fake web site is shown to the kids, who have to learn what information they can trust and what information is suspect. They learn what to do when their search for Christopher Columbus yields 99 million returns in Google. “Kids are overwhelmed, they are swimming in an information ocean.. and they’re drowning”. Librarians like Stephanie guide the kids though the flood of information that confronts them on a daily basis.

Really impressive what crucial skills young kids learn these days, at least in the VS*. Yet as school librarians increasingly teach students crucial skills needed not only for school, but also on the job and in daily life, they are often the first casualties of school budget crunches. Certainly with the global recession kicking in.

* I wonder as how far these 21st century school librarians are specific for the US. My kids (elementary and high school) are not trained in web literacy by a school librarian. But I wish they were.

more about “The 21st-Century Librarian – Video Li…“, posted with vodpod
permanent link to the New York Times Video is here

By the way, there is a funny blogpost confirming Ruth’s idea that a few (?) people still think “that librarians, they don’t know nothin’ ’bout them complicated computer thingamajigs” on Caveat Lector by Dorothea Salo (hattip @eagledawg – “Nikki”)

Grand Rounds 5.22 – Napoleon’s Dynamite – GOSH!

Ever heard of Napoleon’s Dynamite? Ever seen Napoleon’s Dynamite? According to nurse Kim it is “pretty much the coolest movie ever made” and therefore chosen as theme for the Grand Round she hosts today at Emergiblog.
And Gosh what an excellent Grand Round she compiled. And Gosh am I relieved that I just got 10 submissions for the first MedLib’s Round (she had to deal with 45 submissions or so). And Gosh am I glad she announced the Grand Round as follows (LoL):

“No theme, and I’m not doing anything that has to do with Presidents or Valentines, so send in any and all topics!

I will say this: “It’s Grand Rounds, what do you think! GOSH!”

Thank you Kim, for this wonderful round, and for including all submissions, including mine.

I have to admit that I have never seen Napoleon’s Dynamite, but reading Kim’s Grand Round I probably should.

Next Grand Round will be hosted by Dr. Peggy at “The Blog that ate Manhattan“.

You don’t look like a librarian [book]

I just read an interesting book suggestion at the Dutch Blog “MOQUB’s Bibliotheek der Dingen” (2009/02/15): “Jij lijkt helemaal niet op iemand die in een bibliotheek werkt” or “You don’t look like a librarian“.

The title of the blog post just dragged me in. As many librarians I don’ t think I look like a librarian, and I don’t think I behave like one (except for the occasional “shhht”). In fact I know little nothing of cataloguing, interlibrary loans and other typical librarian things (I started my career as researcher).

“You don’t look like a librarian” appeared to refer to a book with that title and the subtitle. “Shattering Stereotypes and Creating Positive New Images in the Internet Age”, written by Ruth Kneale

The following questions are addressed: “How pervasive are such stereotypes in the digital era, how are they changing, and how do they affect our daily work, our careers, and the future success of the profession? What can we do to defeat tired old perceptions and create positive new images? In addition to presenting the results of a 1,000+-respondent survey and interviews with opinionated librarians across the spectrum, Kneale draws on published literature and lively discussions from her website” (www.librarian-image.net). According to the publisher, the result is a unique, entertaining, and eye-opening look at librarian stereotypes and their real-world consequences in the Internet Age. As off March 30 (2009) you can order it at http://books.infotoday.com. It costs less than $30

ISBN 978-1-57387-366-6

MedLib’s Round, First Edition

Welcome to the first edition of MedLib’s Round, a blog carnival of the “best blog posts in the field of medical librarianship”.

Starting a new blog carnival is often difficult. You have to recruit bloggers, who want to participate by submitting blogposts and/or hosting future editions. (see this older post on Scienceroll - Thanks @hleman).

I didn’t sound out people to find if they were interested, but just gave it a try. — Therefore, I was very pleased that the idea was so enthusiastically received by many medical librarians ànd physicians from all over the world. Emergency physician Mike Cadogan (@sandnsurf) of Life in the First Lane already added the MedLib’s Round to his listing of Blogs Rankings and Rounds before it had even started.

Blog carnivals are meant to spread the word not only about established, but also about new bloggers. I’m therefore delighted that several librarians were inspired to (re)start blogging.

Shamsha Damani (@shamsha) accepted the invitation to become a guest writer on this blog to be able to submit a post (see below).

Alisha Miles (@alisha764) who start tweeting in Januari started her own blog Alisha 764 with the post “I am a Tree” saying: “I am no longer a mushroom, I am now a tree. Thank you to all of the other librarians’ posts & tweets that inspired me to start this blog.” Which clearly refers to the comment of @sandnsurf to the blogpost “What I learned in 2008 (about Web 2.0)“: “the most important thing is that you are actually a tree in this ecosystem, you are out there experimenting, thinking and trying to drive the revolution further…Most of my colleagues are still mushrooms…“

The Pilgrimthinker of Learn to Live (a librarian explores health literacy, patient education and consumer health issues) even wrote a blogpost entitled “Cheers to Laika” stating:“Thank you, Laika, for taking the initiative to start up a MedLib Blog Carnival. It was just the kick in the pants I needed to get back to blogging, with the added promise of some increased interest and posting from everyone.”

Thus apart from being a post-aggregator, a blog carnival can also inspire people with similar interests and connect them. From my own experience I know you can feel lonely as a blogger. So please  take a look at the above mentioned blogs/twitter accounts and help them to flourish into full grown trees, so we can all enjoy their fruits (and vice versa).

AND NOW FOR…..THE FIRST MEDLIB’S ROUND

The MedLib’s Round is about medical librarian stuff. This field is much broader than searching PubMed or interlibrary loaning; it is related to all stages in the publication and medical information cycles (searching, citing, managing, writing, publishing, social networking).

This carnival covers many facets of that cycle.

SEARCHING THE WEB

For medical librarians searching is an important facet of their job. There are different sources to search, including “the World Wide Web” and bibliographic databases like PubMed.

Hope Leman of AltSearchEngines has compiled a list of Top 10 Health Search Engines of 2008. She urges all those interested in medical search to give these tools a spin. Her Top 10 bares great resemblance to the Top 8 Bedside Health Search Engines 2008 of @sandnsurf (Mike Cadogan), indicating that the same engines are appreciated and used by physicians as well.
GoPubMed ranks 2 in both lists. According to Hope “GoPubMed is a useful complement to PubMed proper, particularly to determine who the leading authorities are on particular topics.
For further details on how to use GoPubMed see an earlier post of Mike and several posts of David Rothman (here and here).

On first position in both lists is the federated search engine Mednar. Hope submitted a second post merely devoted to this health search engine: Mednar Search…and Hope said, “It is good.” Well, if Hope, an expert in search engines, recommends Mednar it must be good. According to Hope Mednar is useful for (medical) librarians, as well as busy front-line clinicians and clinical researchers. Its main advantages are its ease of use, its elegant interface and “the access to an array of databases that are simply not mined by other health search engines, also called “The Invisible Web” (gray literature and similar hard-to find content)“. It is an useful complement to PubMed in that there is a shorter lag time before the very latest articles can be found.
Recently others have also reviewed Mednar, including (of course) @sandnsurf , as well as Creaky of EBM and Clinical Support Librarians@UCHC who concluded “I liked the results well-enough, but won’t give up using the precise technical limits and search filters available in PubMed, or the comprehensive, deep searches available by using the 15,000 journals indexed in Scopus”.

SEARCHING PUBMED (and Widgets)

Guus van den Brekel of DigiCMB , who just won the Alliance Virtual Library Golden Leaf Awards 2009 (Second Life), told me that PubMed is by far the most frequently used search database by the hospital staff and students of the University Medical Center Groningen, where he works. In 2007, EVERY 2 MINS somebody used the Pubmed link, and every 30 seconds somebody clicked the SFX-link resolver in PubMed. Guus believes that such a tool needs to be published to as many platforms as possible, and in any format the patrons would like them. So far a Toolbar, Widget, HTML-box, OpenSearch pretty much covers that wish. The Widgets can be found at PubMed Search & News Widget

PubMed has introduced (or rather continuously introduces) several changes, that have been amply discussed here. Major changes include the Advanced Search, the citation sensor and the way terms typed in the search bar are translated. Non-librarians often don’t know that PubMed automatically maps the words, but the way this is done has changed, i.e. multi-term words are split. In her post Mapping door PubMed, written in Dutch and English, de Bibliotheker shows that this altered mapping can have both unexpected positive and negative effects, and that it is always important to check the Details Tab.

Among the things that Nicole Dettmar (Eagle Dawg) of the Eagle Dawg Blog addresses at her post Eagle Dawg Blog: Hidden in the Bookshelf: PubMed & Discovery Initiative is the new Discovery Initiative of the NCBI, which is an effort to make the full potential of the NCBI Web services and underlying databases more available to users. Nicole gives various interesting links, which will tell you more about the upcoming changes.

MANAGING INFORMATION AND REFERENCES

Like many of her colleagues medical librarian Anne Welsh First Person Narrative noticed clinicians prefer to perform one word Google-style searches (hé, does that sound familiar!). However, realizing that her medical library “expert opinion” was based on nothing more than a series of anecdotes, Anne decided to have a  fish around for research on clinicians’ search strategies and information needs. Curious about the outcome? Then read the summary of the evidence in her well written research blogging post “Limiting the Dataset“.

Indeed it is hard to keep up with the literature. Apart from specific (often Google-style searches), most clinicians also try to read a few interesting journals, for instance the BMJ and the Lancet. Instead of going to the library it is also possible to take an email alert or a RSS feed to the journals of your choice. You can generate custom RSS feeds in PubMed for you favorite search and/or Journal, but this is a kind of cumbersome procedure for most people not used to it (see for instance my earlier post in Dutch and this post of David Rothman – a must-read for people not acquainted with the use of RSS for this purpose).
Physician and medicine2.0 pioneer Ves Dimov of the Clinical Cases and Images – Blog has another solution to set up a RSS feed to journals, which I found astonishing simple and pretty awesome, because of the conveniently arrangement of the results. All you need is a free Google account to create Your Own “Medical Journal” with iGoogle Personalized Page. Want to know how it works, then please read his easy-to-follow post, which he has specially updated for this occasion. Ves has also included some ready made RSS feeds of the “Big Five” medical journals (NEJM, JAMA, BMJ, Lancet and Annals) plus 2-3 subspecialty journals as well as several podcasts in iGoogle.

Now, once you have the PDF’s of the papers you like you would like to store them in a handy way. Another physician, the Dutch psychiatrist Dr Shock MD PhD with a very eloguent blog of the same name, explores the use of Mendeley, a free social software for managing and sharing research papers and a Web 2.0 site for discovering research trends and connecting to like-minded academics (see Mendeley Manage Share and Discover Research Papers). Dr. Shock didn’t make up his mind yet whether he prefers Mendeley or Labmeeting (described in another post) as an online library. But offline he uses Sente, which he finds absolutely perfect. A chimera between Sente and one of the other tools would be his ideal management system.

PUBLISHING

Michelle Kraft of The Krafty Librarian was totally blown away by a presentation on Interactive Science Publishing at PSP 2009 Annual Conference (where she also gave a presentation herself). I didn’t know what interactive science publishing really meant, but Michelle can illustrate things so well, that you can readily imagine it all. This was needed as I could not access the examples she referred to without the risk of my computer becoming too slow or worse. But I understand from Michelle that it is a revolutionary new method of viewing online journals, although there are some answers to be addressed as well (see her post)

Imagine having the “PDF” of an article on congenital heart defects and be able to hear the heart sounds plus the video recording of the heart. The video would be more than just a snippet, it would be the entire video sectioned into “chapters” referenced within the various areas of the article. So while you are reading the article you can click on the link within the text referencing the image, sound, etc. and the image immediately jumps to that section the video. Imagine the data behind a large randomized controlled trial available in its entirety to all readers to be manipulated, reused, and viewed.

Another new publishing format is discussed by Shamsha Damani (@shamsha) on this blog (see: “How to make EBM easy to swallow“). Shamsha informs us that the BMJ will be publishing two summaries for each research article published. One called BMJ PICO, prepared by the authors, breaks down the article into the different EBM elements. The other called Short Cuts is written by BMJ itself. Here she hopes BMJ will shine, providing an easy to follow unbiased view of the article. Indeed, it would be very welcomed if more papers were in the ready-appraised-format, similar as found in the ACP-Journal Club. However, in the BMJ, it is the PICO-format written by the authors themselves which has the EBM structure, and is most preferred by the readers. According to some (including me) the Short Cuts are a bit woolly. Or as Shamsha says: “Personally I think it would have been better to have the BMJ reviewers write the PICO format, and do a bit more thorough critiquing”.

SOCIAL MEDIA & NLM, GOVERNMENTAL ORGANIZATIONS AND MEDICAL LIBRARIANS

In the same blogpost as mentioned above @Eagledawg mentions that the recent introduction of the #pubmed tag in Twitter (with the aim that you can later search for messages with this tag, see real time results here) led to various responses, which are not really appreciated as useful by the NLM because of the extreme short length of the tweets (140 characters including tag). It strikes Nicole that the NLM is not present on twitter (in contrast to the FDA and the CDC, also see a post of David Rothman). A good example of how the government could use using social media to respond to citizens is given by Andrew Wilson, a member of the recently introduced social-media team of the Department of Health and Human Service, who responded to the peanut-butter-and-salmonella recall issue on Twitter.

An interview with Andrew Wilson can be found here.
And, by the way The Library of Congres (see Dean Giustini’s blog) and the Cochrane Collaboration have also joined Twitter.

Health 2.0 people are well represented on Twitter. See for instance this list of Twitter Doctors, Medical Students and Medicine-related. made by @medicalstudent There is also a great slideshare presentation of @PhilBaumann on 140 health care uses for Twitter.

But how is Twitter used by medical librarians? David Rothman is not a huge fan of Twitter (he prefers friendfeed), but he does refer to a list of Great & growing resource for libraries/librarians on Twitter!
Dean Giustini of UBC Academic Search – Google Scholar Blog wonders why there aren’t More Canadian (mapple Leaf) Librarians on Twitter? Well, I don’t know whether this is typical for Canadians, I don’t see many Dutch medical librarians either.
Dean plans to write something for an upcoming issue of a health library journal about Twitter. Want to have an idea what Twitter is about, please read his short post on Twitter. Already on twitter but looking for twitterers in all the wrong places” than forget one bad idea and follow the half dozen good ideas Patricia gives in her excellent post on Twitter.

And what about the presence of the abovementioned contributors to this first Grand Round? Without exception they are all on Twitter and all but one use it on a regular basis. Now, assuming that most medical librarians aren’t on Twitter, doesn’t tell that something about this group? I wonder if Twitter presence is not the main reason for the swift start of this First MedLib’s Round.

That’s it for this edition.

I hope you enjoyed this first MedLib’s Round.
I surely enjoyed reading the many interesting and good quality posts that were submitted.

The next round will be hosted by Dragonfly, March 10.
Please submit your favorite blog article to the next edition of medlib’s round before March 8 by using the carnival submission form (here) (!). Submission to the form makes it easier for the host to summarize the articles.

p.s. Perhaps you would like to host a future edition as well. If so, please inform me which edition (off May) you would like to host.

Jacqueline (“Laika”)

Photo credits (Flickr-CC)

Librarian’s Costume by Librarian Avenger

Namro Orman, SL

Another Dead Librarian by Doug!

Personalized Genetics: Too Soon, Too Little?

Personalized Medicine is the concept that managing patient’s health should be based on the individual patient’s specific characteristics instead of on the standards of care. Often the term ‘personalized medicine’ is restricted to the use of information about a patient’s genotype or gene expression profile to further tailor medical care to an individual’s needs (see [1])

This so called Personalized Genetics is a beautiful concept. Suppose you could predict people’s risk for a certain disease and be able to prevent it by encouraging positive lifestyle changes and/or start a tailor made therapy, suppose you could predict which patients would respond to an intervention and which people should avoid certain medications. Wouldn’t that be wonderful and much better than treating everybody the same way only to benefit a few?

Research like the human genome project and recent advances in genomics research have boosted progress in the discovery of susceptibility genes and fueled expectations about opportunities of genetic profiling for personalizing.

But are the high expectations justified?

For personalized genetics to be (clinically) effective it must fulfill the following requirements (based on [2]):

1. Clear and strong association of the gene (expression) variant with the susceptibility to a disease or the outcome of a treatment
2. Improved prediction compared to other risk factors, including traditional risk factors and clinical judgment…
3. ..as determined in good quality studies with a sufficient number of events (if the events are rare you cannot accurately predict the outcome)
   (1-3 make up the predictive performance)
4. The availability of effective interventions or effective alternatives
5. Cost-effectiveness

   

According to an editorial in the January issue of the Annals of Internal Medicine “the promise of personalized genetic prediction may be exaggerated and premature” [2]. This is especially true for many complex diseases, where 1 variant alone is unlikely to make the difference.

The editorial is written by John Ioannidis, who is a professor at the University of Ioannina School of Medicine in Greece and has an adjunct appointment at Tufts University School of Medicine in Boston. His research focuses on meta-analysis and evidence-based medicine with special emphasis on research methodology. Ioannidis is a brilliant researcher, epidemiologist and inspiring lecturer (I have attended a lecture of him once at a Cochrane Colloquium). Therefore I would urge everyone interested in personalize genetics to read his editorial.

Here I will give a summary of the editorial entitled “Personalized genetic prediction: too limited, too expensive, or too soon” [2].The editorial summarizes two publications in the same issue of the journal [3,4] and gives an overview of the literature.

Ioannidis stresses that recent studies into the predictive performance of common genetic traits have several shortcomings, including an often weak design with few events (*3)*, incomplete comparison with traditional risk factors (*2) and exaggerated prediction of effects because of the models used (*1).

To date, the genotypic information does not substantially improve the prediction of future cardiovascular disease (CVD), prostate cancer and type 2 diabetes beyond traditional risk factors. In the case of age-related macular degeneration, genetic information does increase the ability to predict progression to the disease. However the predictive power to individualize risks remains relatively weak.

Indeed, a recent paper published in PLOS [5] reinforces that a strong association between single nucleotide polymorphisms (SNPs) and a multifactorial disease like age-related macular degeneration, diabetes type 2, CVD and Crohn disease may be very valuable for establishing etiological hypotheses, but do not guarantee effective discrimination between cases and controls and are therefore of little clinical value yet. For further details with regard to the methods used to determine clinical validity of genetic testing you are encouraged to read the entire (free) paper [5].

Likewise, the study of Paynter et al [3] reviewed by Ioannidis, shows that genetic variation in chromosome 9p21.3 (rs10757274) was strongly and consistently associated with incident CVD in a cohort of white women, but did not improve on the discrimination or classification of predicted risk achieved with traditional risk factors, high-sensitivity C-reactive protein, and family history of premature myocardial infarction. Thus “knowing a patient’s rs10757274 genotype would not help a clinician make better preventive or therapeutic decisions to reduce future risk for heart disease”.
This holds also true for many other potentially causal single SNPs: they have a relatively small effect on their own. Complex diseases are probably the result of numerous gene-gene and gene-environment interactions, which may differ from one population to the other and only explain a small proportion of the trait variance.

Even improved prediction (*1-3) does not necessarily make a predictive test useful. The prevalence of the disease is also an important determinant, i.e. people with high risk gene variants for a rare disease may have a significant higher-than average risk, but still a negligible probability of developing the disease.

Clinical utility of the genetic prediction also depends on the availability of effective interventions (*4) and the cost effectiveness (*5). Another paper in the same Ann. Intern. Med. issue [4] shows that although CYP2C9 and VKORC1 strongly predict the chance of bleeding as a side effect of warfarin treatment, genotype-guided dosing appeared not to be cost-effective for patients requiring initiation of warfarin therapy. Piquant detail: The FDA has approved this kind of genetic testing, although there is no good evidence that such genotyping does in fact reduce the risk of hemorrhage in everyday clinical practice. Such knowledge would require large well designed RCT’s.

Ioannidis emphasizes that despite the poor evidence, genetic testing and commercial use (direct to consumer genetic testing) have already begun and are here to stay. He proposes several safeguards, including transparent and thorough reporting, unbiased continuous synthesis and grading of the evidence and alerting the public that most genetic tests have not yet been shown to be clinically useful. He concludes the editorial as follows:

Helping patients and physicians to decide when to do genetic tests will be a tough task because neither knows much about the rapidly emerging field of genomics. We need to learn more about what our genome can tell us and, more important, what it cannot tell us.

* refers to list, points 1-5

SOURCES and FURTHER READING

1. http://en.wikipedia.org/wiki/Personalized_medicine
2: Ioannidis JP. (2009). Personalized genetic prediction: too limited, too expensive, or too soon? Ann Intern Med, 150 (2), 139-141 DOI: 19153414 {=wrong DOI researchblogs click here to be linked to PubMed)
3: Paynter NP, Chasman DI, Buring JE, Shiffman D, Cook NR, Ridker PM. Cardiovascular disease risk prediction with and without knowledge of genetic variation at chromosome 9p21.3. Ann Intern Med. 2009 Jan 20;150(2):65-72.
4: Eckman MH, Rosand J, Greenberg SM, Gage BF. Cost-effectiveness of using pharmacogenetic information in warfarin dosing for patients with nonvalvular atrial fibrillation. Ann Intern Med. 2009 Jan 20;150(2):73-83.
5: Jakobsdottir J, Gorin MB, Conley YP, Ferrell RE, Weeks DE. Interpretation of genetic association studies: markers with replicated highly
significant odds ratios may be poor classifiers. PLoS Genet. 2009 Feb;5(2):e1000337. Epub 2009 Feb 6 (free full text).
6: Janssens AC, van Duijn CM. Genome-based prediction of common diseases: advances and prospects. Hum Mol Genet. 2008 Oct 15;17(R2):R166-73. Review.

You might also want to read:

23andme 23notme not yet (post 2008/09/29/)

How to make EBM easy to swallow: BMJ PICO

Guest author: Shamsha Damani (@shamsha)

As a medical librarian, I try to instill the importance of Evidence Based Medicine (EBM) to all my users. They agree that EBM is important, and yet, still resort to shortcuts (like using Google, asking colleagues, etc). And you know what, I don’t blame them. Given the amount of medical literature published today, it is very difficult to keep up with it all. There are some very bad and poorly designed studies published, which makes it difficult to identify good ones. And once you’ve identified a good article to read, evaluating and critiquing it is another daunting task. I keep wondering if this has to be so difficult. Shouldn’t there be stricter standards for publications? Shouldn’t publishers care about the quality of research that is associated with their name? I know that some journals like ACP Journal Club critique articles but they don’t cover nearly enough topics.

As I pondered these thoughts, something very interesting happened that gives me hope. BMJ recently announced that they will be publishing two summaries for each research article published. One is called BMJ PICO, is prepared by the authors, and breaks down the article into the different EBM elements. The other is called Short Cuts, which is written by BMJ itself. This is where I hope BMJ will shine, provide an unbiased view of the article, and set itself apart from other journals by doing some extra work. Imagine reading a brief synopsis of a research article, not written by the author, which will tell you whether the study was any good and if the results were valid. What a time saver! I hope that BMJ continues this practice and that other journals follow suit. Right now BMJ is still testing the waters and trying to figure out which format would be most appealing to readers. Personally I think it would have been better to have the BMJ reviewers write the PICO format, and do a bit more thorough critiquing. The reviewers already critique the article before it gets accepted; it only makes sense that the results of such a thorough critique be published as well. An unbiased view would make it easier for readers to trust (or not!) the results and proceed accordingly.

I still believe that EBM skills are very important and should be learned.
However, busy health care providers will find value in such pre-packaged articles and will use the evidence more if it has been critiqued already. And isn’t that the point of EBM: to make more use of the evidence?

Shamsha Damani, Clinical Librarian

First Anniversary of this Blog

This week is my one year anniversary.

I would like to thank all my readers for following along with my blog.

Thanks for your encouragements, comments and inspiration.

I’m glad I entered the web 2.0 world, but it would have been empty without you.

I hope you keep connected!

Laika (Jacqueline)

Foto credit: http://www.flickr.com/photos/charlietakesphotos/118424928/

Response From Twitter

MedLib’s Round 1.1: Call for Submissions

Laika’s Medliblog will be hosting the first edition of a New Blog Carnival, the MedLib’s Round, on Tuesday Feb 10. As host, I invite you to send your submissions.

What is The MedLib’s Round?

The Medlib’s Round is a monthly blog carnival about medical librarian stuff in the broadest sense of the word.

Not only medical librarians may submit posts. Anyone interested in this subject is 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. Or to have a new database discussed, a meeting announced, an article or a book reviewed, etcetera.

The posts should at least be written in English (bilingual posts accepted).

There is a loose theme: write about a subject that is close to your heart, whether it is about your patrons, education, PubMed, twitter …. whatever you find important.(of course almost all post will fit into this).

It is really easy: just submit the permalink (url) of the post (you have already written on your blog) at the Blog Carnival submission form (you have to login, scroll down (!), submit links to selected posts and give an optional description).
Although this is preferred (archival function) you may also write me at laika dot spoetnik at gmail dot com. .

The submissions are due at Saturdays 00.00 (Dutch Time), or 18.00 EST.

For further info see here for the Announcement and here for the FAQs.

Since this is only the first round I will also make a Grand Tour of my own, visiting a selection of blogs that I know.

Don’t hesitate to ask me if you have further questions.

Jacqueline.

By the way, I’m still looking for future hosts (April, May, June, July) (just comment here or email me).

Thanks Anne Welsh for hosting the April edition!

Grand Rounds 5.20: Anniversaries and Blogosphere Scam

The latest edition of Grand Rounds is now up at Not Totally Rad.

This edition coincides almost exactly with his anniversary as a blogger.

So first of all a happy anniversary to samurairadiologist!

For this Round, he chose a loose anniversary theme, asking contributors to write about something cool or important that they had learned in the past year.

The lead-off post is written by Val Jones: How the Health Blogosphere was Scammed — Last two weeks the health blogosphere was buzzing with outrage about the fact that Wellsphere was sold to HealthCentral. Why were people pissed off? In the past, hundreds of health bloggers had received a flattering offer of the SEO of Wellssphere asking them to contribute to Wellsphere, “a free online community where regular people, enthusiasts and professionals can connect, inspire and educate each other about health”. (uh not really). This offer included the republishing of the content of their blog on the Wellsphere site. About 1700 bloggers accepted the offer, probably because they taught this would increase the traffic to their blog or because they wanted to contribute to Wellsphere or be part of its community. Those bloggers often did not realize that they in fact gave away the entire contents of their feeds for nothing. And herein lies their pain: Wellsphere made a good financial deal out of the transfer, but the bloggers who provide content for Wellsphere got no revenues at all. Some people consider this scraping, others consider it legitimate since the bloggers agreed to it.

In my view it is not really “stealing”, compared to the ripping off RSS feeds without informed consent or even knowledge, as discussed in previous posts (see here, here and here).

But you could call the recruiting Wellsphere campaign misleading and unpleasant at least. Furthermore, according to many former Wellsphere employees the Wellsphere management team behaves rather unscrupulous in general.

At least this big incident uncovers the vulnerability of the web 2.0 world and the bloggers: the concentration on traffic and getting links on the one hand and the poor protection of the intellectual property of bloggers on the other hand.

For further information look at the introduction at Not Totally Rad, the posts he refers to, i.e. the above mentioned post of Dr Val and a post of Dmitriy of the Trusted.MD blog. But there are a lot of other good posts on the subject, i.e. on the blogs of the Wall Street Journal, a psychiatrist, an athlete and patients (see here; some warrnings were already written in July 2008).

But apart from this specific theme there are many others worth reading: Anniversaries, lessons learned, Diabetes blogs and Other Chronic Diseases, Humor in Medicine, Ethics and Other Delicacies.

Next Round will be will be hosted by The Health Care Blog

What I learned in 2008 (about Web 2.0)

Grand Round is a weekly collection of the best writing in the medical blogosphere. The coming Grand Rounds (February 3rd, 2009), hosted by Not Totally Rad has the following theme:

February is the first anniversary of my blog. Therefore, the loose theme for submissions will be anniversary-related: write about something cool or important that you’ve learned in the past year.

Well, I have learned a lot in the past year. The most profound personal experience was the death of my father. I experienced how it is to loose a beloved, but I also learned that death and grieve can affect people so deeply that it changes their behavior. I now understand this behavior (anger, mental confusion) is a manifestation of deep grief, which is transient and natural. Luckily our body and mind appear very resilient.

I will restrict to another thing I’ve learned: Web 2.0.
Just like the “Samurai Radiologist” I started a blog in February 2008. Thus Laika’s MedLibLog also celebrates its first anniversary.

Useful Web 2.0 tools

This blog was started as a tool to communicate thoughts, new found skills and ideas with other (>150) SPOETNIK course members, Spoetnik being a Learning 2.0 project to encourage library staff to experiment and learn about the new and emerging Internet technologies.

During the library 2.0 course I learned the basics of blogging, chatting, RSS, Podcasts, Wiki’s and social bookmarking. Each week another item was addressed. This learning program had a direct and positive impact. For instance, I could inform my clients how to create a RSS-feed for PubMed searches. By taking RSS-feeds/email alerts to interesting blogs, wiki’s and journals I kept better informed.

Hard to imagine (now) that I hardly new anything about web 2.0 one year ago.

Web 2.0 is not just a set of tools.

In the beginning I considered blogging largely as a selfish activity. It also appeared a lonely activity. As long as we discussed a course assignment there always was an interaction with at least a handful of other participants. But as soon as the program came to an end, I started to write more and more about medicine, EBM and medical library related matter, which didn’t appeal to most of the other course members. I wrote about things that interested me, but the writing would be absolutely useless if nobody would read it. Thus, how to get an audience?

There were I few things I had to learn and there were a few people who gave me a push in the right direction .

• Wowter, who gave feedback to my posts right from the start and who encouraged me to continue blogging, posted a list with 17 tips for beginning bloggers (in Dutch) of how to increase visibility and findability of your blog. I became aware that ‘linking’ to others is what is making the web 2.0 world interconnected.
• Second Dymphie, a Dutch Medical Librarian, encouraged me to start twittering. It took quite a while before I grasped the value of twitter as a networking tool. Twitter is not meant to say “what you do”, but it is a way to share information of any kind. Before you can share it, you first have to find interesting tweeple (people on twitter) and it did take a while before they followed me back (partly because my first tweets weren’t that interesting). Thus I had to learn by trial and error how to become a prolific twitterer.
• Third I read a very interesting blogpost on “I’m not a geek” of Hutch Carpenter called Becoming a web 2.0 jedi, showing a simple but very accurate chart of the ever deeper levels of involvement one can have with Web 2.0 apps and the Web 2.0 ethos, as Hutch calls them. “Down are the lower levels, those of passive involvement, level 2 is giving up little pieces of yourself, while level 3 is a much bigger sharing experience. Share your own life, share your knowledge, share the stuff you find interesting. A big leap for a lot of us used to being more private. May the force be with you.”
  Seeing his post I realized that my journey had been quite different (figure below, made in September 2008). During the Spoetnik course emphasis was given to the tools themselves not to the ways you should use and share them and contribute to others. We skipped the reading of blogs and wiki’s, the lurking on twitter, but started with chatting, RSS and blogging. Although Web 2.0 tools are the basis, Web 2.0 is more an attitude than the usage of tools, it is about sharing information and thoughts.Or as Dean Giustini says it: It is about people.

http://bhc3.wordpress.com/2008/04/10/becoming-a-web-20-jedi/

The Ecosphere of Twitter and blogs.

I also experienced that all web 2.0 tools are not stand-alone tools, but can reinforce each other. This is for instance true for RSS, bookmarking tools , blogs, but also twitter (a microblogging service). A recent post of Sandnsurf (Mike Cadogan) at Life in the fast Lane uses a brilliant ecosystem metaphore to describe the twitter-blogging relationship. He describes the blogging ecosphere, where twitter decomposes information from journal articles and long blog posts into readily digestible information (nutrients and humus). See Figure from his post below (but read his post here for the whole story). Just like the Jedi chart this diagram illustrate exactly what web 2.0 is about.

http://sandnsurf.medbrains.net/2009/01/twitter-essential-blog-nutrient/

Lessons to be learned

I have learned a lot. Am I now a real web 2.0 Jedi?
I’m not sure. In the ecology-model my blog is a young tree, surrounded by many others. But some ecologic dangers are luring.

• The relative success of my blog results in “an abundance of light which results in a pressure to keep producing enough good quality posts”.
• I’ve subscribed to so many RSS-feeds I seldomly read them.
• I have so many twitter-followers (app. 300) that I can’t keep up with all of them as much as I would like to.
• I read so many things, but haven’t got the time to work them out (or I simply forget).
• I find it difficult to separate chaff from wheat. Many blogposts and web 2.0 information are not very accurate and superficial. Furthermore people often echo a subject without careful checking or without adding value.

Or in the words of sandnsurf: the death of a blog can ensue due to excessive exposure and Twittaholism. I hope It will not go in that direction, but I have to figure out a way to coop with the overwhelming amount of information and find a balance. That will be part of my (web 2.0) learning process in 2009.

One other thing:

I forgot to mention one very important experience. During my web 2.0 journey I virtually met many interesting, kind and helpful people from all over the world, from US, UK, Eastern Europe to India and Australia. Closer to home I also ‘met’ many very nice Dutch and Belgian people. I never liked the idea of intentional networking, but in web 2.0 the networks arise spontaneously. In a very natural and gradual way I became a member of a large health and library community and that feels good.

You might also want to read:

• 2008/11/27/:  Blogging after Spoetnik: my experiences presented at the  spoetnik-symposium.
• Embedded in this post is a powerpoint which can also be viewed directly at slideshare (click here). The ppt is in Dutch but has many pictures that speak for itself.