Grand Rounds Vol. 6 No. 2

29 09 2009


Welcome to the latest edition of Grand Rounds, the weekly compilation of the best of the medical blogosphere! I presume you would rather take a tour through the Netherlands, visiting windmills and tulips, but we will save this for another time. Right now, let’s take a trip around the library.

Library_book_shelvesBecause you know what William Osler, the Father of Modern Medicine said:
“For the teacher and the worker a great library… is indispensable.
They must know the world’s best work and know it at once. They mint and make current coin the ore so widely scattered in journals, transactions and monographs.”
– William Osler, in Books and Men, in Aequanimitas, 210.

( Thanks to Chris alias @precordialthump for this quote, as a response to a Medical Librarian Round I just finished).

Although books are the library brand, libraries -including medical libraries- have been changing dramatically from book shelves to learning centers, print storage to digital storage, from loaning at the desk to loading from the web, from catalog-centered to database searching and education.PAR-TIC-I-PA-TION, or 37 pieces of library fla...

Well librarians adapt as well. We are also Internet-dependent.
Now let me take you by the hand and lets go through the first steps of searching.
Of course, if you have no time for this guided tour, feel free to skip the introductory sentences and read the posts that have been submitted to this round…

Readers of this blog know that I mostly search for Systematic Reviews and Evidence Based Guidelines. Although not really applicable to the submitted posts, I will briefly mention the way such subjects could have been structured for a search.

We don’t search for this…

73655708_366cd3c35b horses made of stoneOn most occasions there is no need to look up literature. A patient needs empathy of the ones he/she loves, wants to be well informed by ready-to-use and understandable information, needs to be in the hands of a skillful doctor and is happy with some useful tips. For a doctor experience and (social and technical) skills are a prerequisite.

The National Invisible Chronic Illness Awareness Week is held annually in September. The “How to cope with pain blog” gives  10 tips to make your invisible illness visible. This post proposes ways to educate others, decrease isolation and stigma, and allow others to help, when you have an invisible illness such as pain.

Jolie Bookspan of the “The Fitness Fixer” shows a simple mechanical stretching technique that can be applied by a partner to ease symptoms of menstrual cramps.

Moving books or whole labs requires some effort. But how much more effort does it take to move to a new children’s hospital, and at Christmas-time? Beth (Elizabeth Nelsen) of  “Not Terribly Ordinary” wrote down her thoughts on the night before the move.

Ramona Bates at “Suture for a Living” writes down her thoughts on the increase of suicides in ‘our soldiers’ and the way to prevent this. Thoughts that were generated by events close to her heart. A sad subject, but beautifully written.

Background  questions.

Foreground BackgroundThere’s a distinction between background and foreground questions. A background question asks for general knowledge or “facts” (questions often starting with who, what, when, why, which). “What is type 2 diabetes?” “How can one  diagnose appendicitis?” “Which treatments are available for advanced prostate cancer?”  These questions can be best answered by books, databases like UpToDate and good quality websites. The novice in a field usually has more background questions than the expert.

More and more doctors use the Internet to quickly access or to keep abreast of new information. “Clinical Cases and Images Blog” describes how doctors can add expert insights and comments about websites in the recently launched Google Sidewiki.

Books are good for background questions, and are especially useful if they debunk long existing myths. Amy Tenderich at “Diabetes Mine” describes one such book, “Diabetes Rising”. She received this book (coming out in 2010) as an advance review copy and simply could not put it down. Read her review of the book and an overview of some of the diabetes-causes-and-cure-myths here.

An excellent review allowing the readers to get good background knowledge about antiplatelet agents is offered by Flavio Guzman at “Pharmamotion”. His post gives an overview on the currently used agents in clinical practice, their classification, mechanisms of action and therapeutic use. It includes charts, figures and a video that reviews the most relevant aspects of antiplatelet therapy.

Foreground  questions: Domain Therapy2463850234_6a9851b622

Foreground questions ask specific clinical questions that try to find relationships between a patient and their condition, an exposure (therapeutic, diagnostic), and an outcome. They are generally very detailed questions that can best be answered with the information contained in published research studies (website UMDJ) or syntheses therof.
Foreground Questions are usually structured in 5 parts: P I C O and domain (or study type) and are answered by searching for the best available evidence.

The most common domain is Therapy/Prevention. The PICO stands here for Patient/Population/Problem, Intervention, Comparison/Control and Outcome

When looking for the best evidence one searches for a few (not all) components and for the best study design, in the case of therapy: controlled clinical trials in the first place and -if not found- for cohort and case control studies.

104311636_d8f2be6a7e P wit zwart“P” is definitively the most important letter in the PICO. It is the person suffering from a disease, the patient one desires to cure, the problem a doctor wants to solve. All health care should be ‘about them': Patients.

The patient-centered and sympathetic Rob Lamberts (alias Dr. Rob) of “Musings of a Distractible Mind” muses about The Medically Homeless. He summarizes his post as follows: There’s much ado about the quality of medical care and the plight of the patient in all of this (it’s about them, remember?), but what’s the central problem? In this post I put forth the concept of “Medical Homelessness,” which is a description of the patient who doesn’t have any one place where things are in order. Data is scattered all over the place and confusion comes at a high cost. Why does this happen? What can be done about it?

The number of people affected by Alzheimer’s is growing at a rapid rate, and the increasing personal costs will have significant impact on the world’s economies and health care systems, according a new report on Alzheimer’s predicted rates. Alvaro Fernandez at “Sharp Brains” thinks that this report should act as wake-up calls for healthcare systems to focus on education & risk reduction initiatives and shares the main recommendations from an upcoming report prepared for the City of San Francisco. Recommendations include risk reduction (promote cognitive health and create a culture of “brain fitness” through mental stimulation, social engagement, physical exercise, and diet, early identification of dementia and ensuring that caregivers are aware of and have access to community resources, training and support.

247846944_a24020fa54 LETTER I “I” is also an important component of the PICO. In case of a therapeutic or preventive question the I stands for Intervention.

Dr Shock, a psychiatrist from the Netherlands has an outstanding blog with the electrifying name “Dr Shock MD”. With respect to interventions, the emphasis is not only on electroconvulsive therapy, but also on sex, drugs and….. chocolate! Which may or may not be typically Dutch. It should be noted, however, that the large number of posts mentioning a positive effect of chocolate, may imply a positive publication bias towards chocolate in favor of “good” results.  Last week he claimed that  Chocolate Saves Your Teeth, but his current submission is about the strong reverse association between (one year) chocolate consumption and cardiac mortality after a first acute myocardial infarction. It should be noted that this was a retrospective study, thus the evidence is much less convincing than would be obtained by  long-term, randomized controlled trials.

Another post about nutrition, but more about the direct “Special Nutrition Needs for the Rescued (and the Rescuer!)” can be found at the “Medicine for the Outdoors blog”. Here, Paul Auerbach summarizes the key points from a presentation given at the Wilderness Medical Society Annual Meeting. The medical and psychological importance of providing proper nourishment to rescued individuals is of utmost importance.

I don’t know whether it is our (Dutch) reputation, but there were (relatively speaking) an awful lot of sex-related submissions: almost 15%…
First Daryl Rosenbaum at “Listed as Probable” looks at the pros and cons of “sex before the match”, as has been advocated by the coach of India’s cricket team; the coach tells his players to have more sex in order to improve performance on the field. But is this really the case? Well everything preceded by “too” is “too much”, my mother used to say…

Dr. Val at “Better Health” is wondering whether Francis Collins, former director of the Human Genome Project and new director of the NIH is “bringing sexy back to science” In an age where celebrities are treated as credible sources of health information, scientists need to find a way to communicate with the public in a new and more engaging way. Collins, has started a new initiative called “Rock Stars of Science” to promote the field, protect people from misinformation, and get the public excited about science again.  “Whatever works”, dr Val concludes.

The “UN Guidelines for Sex Education” are stirring opposition (before they are even published) from conservative and religious groups who are attacking the guidelines because of their portrayal of issues like sex education, abortion and homosexuality. Nancy Brown of “Teen Health 411″ mentions 9 convincing reasons why these guidelines should not be blocked. Nancy concludes with: “Need I see more?” No, you don’t Nancy.

477120721_db7f83921f CMost intervention studies compare an “I” with a “C”, Comparison or Control. Preferably efficacy should be tested in a randomized controlled trial (RCT), which has the least form of bias if well performed.

Only one submitted post presents evidence that has been gathered through an RCT. Faith Martin of “Highlight Health” highlights a recent RCT published in the journal Health Technology Assessment (HTA). Results of this non-inferiority trial showed that home-based care in the United Kingdom is no worse than attendance at a day hospital for older adults. Surprisingly, the cost of the home-based rehabilitation provision was not significantly different to that of day hospital rehabilitation, Indeed, given there is no difference found in outcomes or costs, patients could potentially be given the choice.249722873_1b417cdb3a blauwe O

The “O” in interventions is the outcome. It is important to look for outcomes that matter most to the patients and not for surrogate markers.

Once it has been established that a treatment is effective it is important that there is compliance and the patients know “what to do”. With two videos “Allergynotes” shows how MDIs, Spacers, and Dry Powder Inhalers should and should not be used. Patients often use them wrong.

It is in itself not enough to show the effectiveness of an interventions Costs aspects also come into play, politics, insurances, and decision support systems. The following 3 posts kinda fit in this subject. Since my knowledge of these US-specific subjects is poor I will stick to the descriptions given.

Elyse Nielsen at “Anticlue” wrote “Using Rules to support clinical decisions. “It is all about using the CDS 5 rights model to plan to have the right rule based support in the right place in the systems.”

“InsureBlog”‘s Henry Stern makes the case that CMS (The Centers for Medicare & Medicaid Services) overstepped its bounds by slapping down Humana’s efforts to educate its policyholders.

Jeffrey Seguritan at “Nuts for Healthcare” writes about the Baucus bill. The Baucus bill being considered in the Senate Finance Committee is depending on an excise tax on high-end (“Cadillac”) plans as the biggest revenue driver for reform. While President Obama and health economists agree that this tax discourages wasteful health spending, many Democrats are pointing out how the tax would easily hit the middle-class. According to Jeffrey, this issue touches on the greater problem of our highly regressive and unfair tax subsidy on health benefits.

Domain Diagnosis

733162553_d694bb56d0 diagnosisIn EBM, diagnosis studies are mostly diagnostic accuracy study: one wants to know how good a test can predict or exclude a suspected disease. No examples of diagnostic accuracy studies here, but two examples of when diagnostic tests should be applied or not.

At “Life in the Fast Lane” Toxicology Conundrum 018 (written by Chris Nickson) deals with the myth that “necrotizing arachnidism” can be caused by a spider bite of white-tailed spiders. A wrong diagnosis (i.e. a patient thinking a nasty sore is due to a spider bite) may lead to other disorders, often infections or cancers, being mistreated.  One of the embedded videos is typical of the misinformation about white-tailed spiders in Australia (presented by an exported Dutchman no less!).

Bongi feels bad about the time when a registar “forced” him and another fourth year medical student to perform a useless “diagnostic test” on a stillborn baby just as a precautionary measure against the anticipated rage of her professor at handover: “you!” she indicated my friend and i, “you are going to go down to the morgue and get that baby’s blood. and you’d better move it. the sun will be up soon.”
Soon the juniors found out that sampling of blood from a dead baby is not that easy. A very morbid story indeed.
The best description is given by Bongi in South-African – a language I can understand (thanks Bongi):
“dis ‘n storie van die ou dae tydens my mediese opleiding to iets gebeur het met ‘n oorlede baba wat nooit moes gebeur nie.
ek is ‘n chirurg in nelspruit in suid afrika. die spesifieke ervarings van hierdie deel van die wereld voorsien baie interessante stories.”
Please read the entire story (in English) at “Other Things Amanzi”.

Domain: Etiology/Harm

3880192862_6d0f931e64 HARMOtherwise than regularly suggested the best evidence of harm or causality is often not provided by RCT’s, but by observational studies (preferably prospective cohort studies).  RCT’s are either not ethical, or are not suited to detect rare or late harmful effects. The same is true for the domain prognosis, which studies the influence of prognostic factors in the natural course of disease

Other than with interventions the Outcome in this domain is the disease and the P is the population. The I is the causative factor.

Although  “causation” can seldom be demonstrated by controlled clinical trials, care must be taken that any conclusions are based on sound observational studies. Anne Marie Cunningham, a doctor from the UK with interest in the use of social media and technology in education wondered whether a news article on the BBC with the Headline “Tech addiction ‘harms learning'” was based on good evidence. Downloading (at $24.99) and reading the report confirmed her suspicions that the BBC-conclusion about the relationship between Internet and mobile phone addiction and poor learning was based on poor science. Read the details on her blog “Wishful Thinking in Medical Education”.

Sometimes new studies reveal that causes are different than thought. The failure of the U.S. to match longevity statistics of other developed countries is well-known, but Stacey Butterfield of the “ACP Internist blog” points at a study of the demographer Dr. Preston (reviewed in a column in the New York Times) that offers a different explanation for the gap. Stacey explains: “To put it simply, the study shows that it is lifestyle (particularly smoking) that sets Americans apart from other countries, not the quality of the health care. Other researchers have calculated that if deaths due to smoking were excluded, the United States would rise to the top half of the longevity rankings for developed countries. However, the good news is that many Americans have quit smoking in the past decade, so we should be seeing continuing gains in health. The bad news is that we’re working hard to make up the difference by getting fatter.”

Indeed obesity is becoming a pandemic. Astoundingly, WHO figures from 2005 suggested that there are more people suffering from overweight-related problems than malnutrition. David Bradley Science Writer based in Cambridge, UK, reviews  a recent study on his blog  “ScienceBase” showing evidence from the UK with respect to the effects of current dietary trends and consumption patterns on health. Although the rewards of developing a safe and effective anti-obesity medication will be in the tens of billions of dollars, David regards it “highly unlikely that the growing epidemics of overweight and obesity are to be solved by popping a pill”.

Sometimes harm is caused by mistakes.  In Fertility Clinic Mistake Ends Up Good Toni Brayer of “EverythingHealth” tells about the accidental implantation of an in-vitro embryo into another woman at the clinic. But some lemons can be made into lemonade: the woman with the wrong embryo kept the baby (without demanding custody) and recently gave birth to a healthy baby boy.

Adverse conditions in a patient can result from the activity of physicians. Mostly this will be unintentional, but sometimes “doctors” deem other  factors more important than what is best for the patient. Technology consultant and blogger, Sarah Cortes, went by ambulance to a rural Hospital after she suffered a serious spinal fracture after diving. The hospital staff  intimidated and coerced her into accepting unnecessary reconstructive spinal surgery. Unnecessary, because she was able to swim and thus mobile, after the diving accident.  Sarah thinks that boosting of accreditation was the main motive for the hospital. This story, too, has a happy ending: with the help of Twitter, Sarah was able to leave for Boston, where she was successfully treated without the need for surgery. Without Twitter it might have had a less happy ending. Read her story here at her blog “Security Watch”.

Thoughts about social media and patient safety can also be found on “Florence dot com”, the blog of  Barbara Olson. She wrote the post to suggest that social networking sites can help reveal beliefs, practices, and norms in healthcare systems that undermine patient safety. She noted that these might not be readily visible using more traditional means.

An article in last month’s New England Journal of Medicine documented some disturbingly high exposures of Low-Dose Ionizing Radiation from Medical Imaging Procedures among patients. David Williams has been writing about patients getting too much radiation from diagnostic imaging for years.  At least in the US, patients and physicians have no way of tracking their lifetime dose. At the “Health Business Blog” David applauds a local initiative of a Boston hospital to track radiation exposure. He reasons that Personal Health Records could help keep track and also reduce the need for excessive scans.

Well this concludes the official part of the Grand Rounds. I hope you enjoyed it. Thanks for your submissions.
It was a pleasure reading them, although -I must admit- quite an effort writing them down….



Thanks to Nick Genes for starting the Grand Round and Dr. Val Jones at Better Health and Colin Son at Residency Notes for keeping the carnival up and running.
The Next Round will be hosted by Christian Sinclair, see here for the announcement


I asked the contributors to spend one line telling me their thoughts on medical information (MI) and/or medical librarians (ML). Here is a selection of answers (I will leave out too obvious examples of self-promotion). I especially liked that doctors mentioned their own librarian or somebody they knew (i.e. from Twitter). In order of appearance:

Beth (Elizabeth Nelsen) of  “Not Terribly Ordinary”  (ML): They help to bridge the gap between what We (the medical establishment know) and what They (patients and families) should know. Our new hospital will have a family resource center staffed by a medical librarian!

Ramona Bates of “Suture for a Living” (ML): Invaluable

Rob Lamberts at Musings of a Distractible Mind” (MI): chose this post because it focuses on medical information – both that of the patient and the information that informs decisions. The crux of our problem is not a lack of information, it is a lack of organization of the information we have.

Alvaro Fernandez at “Sharp Brains” (ML, MI): libraries overall, and medical libraries in particular, can play a crucial role in educating professionals and lay audiences on the cognitive health implications from growing research on cognitive neuroscience and neuropsychology. In fact, I just gave a talk yesterday at New York Public Library precisely on this topic!

Daryl Rosenbaum at “Listed as Probable” (ML): Don’t have any creative thoughts about medical librarians, just that our department has one that works with us and she is a very valuable resource.

Dr Val at “Better Health” (ML):  they are the unsung guardians of truth in medicine. We need their help to combat the tidal wave of Internet misinformation that is confusing and harming patients everywhere.

Nancy Brown at “Teen Health 411″ (MI): “Teens need adults they can talk with and medically accurate information to facilitate healthy decisions. The habits they start as teens and the choices they make will influence their adult health.”

Jeffrey Seguritan at “Nuts for Healthcare” (ML): With the rise of the Internet as the premier information portal, medical librarians are essential in helping providers navigate through sources of information that are accurate and credible. An alarming poll this year suggested that 50% doctors use Wikipedia, not the authority patients are looking for.

Chris Nickson at “Life in the Fast Lane” (ML): Well, as you well know, we love medical librarians – especially the helpful tech-savvy ones that populate the Web!

AnneMarie Cunningham at “Wishful Thinking in Medical Education” (MI): We have more publications (journals, guidelines and user-generated content) than ever but still many of those searching (clinicians and patients) can not find what they want or need. That is the challenge. Hopefully as time passes it will feel as if we are getting closer to the solution

David Bradley at “ScienceBase” (ML): Medical, and subject specialist, librarians in general now play an even more critical role in helping their “customers” keep on top of the vast quantities of information available to them. Thankfully, there are some around who are quite expert and can pin down even the rarest of information beasts.

Barbara L. Olson at “Florence dot com” (ML): I recently compiled a list of tweeps people interested in patient safety should watch on Twitter I’ve been following Sarah Vogel @sevinfo (Pharma/Biotech information researcher, librarian) for awhile and included her.

David E. Williams at the “Health Business Blog” (MI, ML): Providing information at the point of care is critical to improving quality and reducing costs. Medical librarians can help clinicians learn to access and apply these tools

Several contributors spontaneously said that they were going to, loved or had happily lived in The Netherlands. Amy even had a baby while over here!

Interview will appear at

Image Credits (CC-licence)

  1. Library Book Shelves, Wikimedia
  2. PAR-TIC-I-PA-TION, or 37 pieces of library flair trucolorsfly-611479605
  3. Stone Horses: automania-73655708
  4. The Background/Foreground picture is used everywhere, I’ve adapted it from the excellent book: Guyatt G, Rennie D, Meade M, Cook D. JAMA Evidence Users’ Guides to the Medical Literature. A Manual for Evidence-Based Clinical Practice. 2nd ed. Chicago, IL: McGraw Hill Co; 2008.
  5. Dolk-Banana Therapy imagesniper- 2463850234
  6. P
  7. I [Aye-Aye] urbanmkr-247846944
  8. C Flickr: urbanmkr-477120721
  9. O Flickr: urbanmkr-249722873
  10. Stethoscope Flickr: ponyapprehension-733162553
  11. An Honest Question Flickr: photos/hryckowian/3880192862/
  12. Another Dead Librarian by Doug! librarygeek- 741879088

You might also like:

Dear Laika,This is my suggestion for Grand Rounds:Doctors add expert insights and comments about websites in Google Sidewiki About Health Care Around the World forward to Grand Rounds on Tuesday,
Reblog this post [with Zemanta]


27 09 2009

shht-librarian-costume1Welcome to the sixth edition of MedLib’s Round, a blog carnival of “excellent blog posts in the field of medical librarianship”.

First I have to apologize for the postponement in publication. There were so few submissions (5, including one on this blog), that I needed more time to find some material myself. Time that I didn’t have at that moment.

After a flying start with many volunteering hosts and submissions the enthusiasm for the Medlib’s Round seems to have faded somewhat. There are far less submissions. Luckily there is a core of  enthusiastic people regularly submitting to the Medlib’s Round and I’m very grateful for that. However, there are many more bloggers out there, who also write very useful MedLib stuff. Why aren’t they contributing? Are they not aware of the round, do they lack time, don’t they like blog carnivals? Should the rounds be better promoted or differently organized? I know that postponement does the round no good, but it is a bit the chicken-and-egg problem. Anyway, I would like to hear your thoughts on this.

But lets start…..

Social Media

A previous host and regular contributor to the round, Nikki Dettmar (@eagledagw) of the Eagle Dawg Blog makes a good point in  “Social Media & Emergency Preparedness: Can Your Family Text?”: “Does your family know to text when there is an emergency? Traditional phone lines may be down and traditional methods of communication may not be working.” Learn about an upcoming drill conducted by a national safety foundation and the Federal Emergency Management Agency (FEMA) over the next few months to use texting and social media channels for emergency communication. And don’t forget to instruct your mother. By the way, the use of Twitter is included in the advise.

Another regular contributor to the Medlib’s round is Ves Dimov (@DrVes). Dr. Dimov is an Allergy and Immunology Fellow at Creighton University and the author of the Clinical Cases and Images – Blog. Blogging for several years and with more than 7000 RSS readers we can trust him for some good advice on blogging In What makes a blogger go on in a field where so many others stop, fail and disappear?” Dr Ves shortly gives 4 reasons and several tips from his own experience.

Google Health


Speaking about blogging, it is only a half year ago that Alisha Miles (@alisha764) started with her blog Alisha 764 saying: “I am no longer a mushroom, I am now a tree.” Which refers to @sandnsurf‘s post: Is Twitter the essential blogging nutrient and his comment on my blog: “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….
Alisha, who is a contributor to this round from the start, has definitely developed into a full blossoming tree, a top librarian blogger and tweeter,  She is featured, for instance, in Novoseek’s top 10 medical librarian list (as all current librarian submitters with a public blog).
Her submitted post is a classical post already. It is quite long (hear, hear who is saying) but offers good information. In “Google Health® Information: Surprising Facts” she describes the pros and cons of Google Health®, concluding:

“It is a good product; however, it should be used with caution. Remember Google Health® is not bound by HIPPA, resources should always be double or triple checked, the Google® Health Drug Interaction program is missing some key interactions, and the Google Health® Topics are missing the reference section, reviewer information, and date stamp.

Again, I applaud Google® for its efforts and for including links to MedlinePlus® as a trusted resource. As with any information source, even MedlinePlus®, all information should be checked against at least 1 other source.”

With regard to MedlinePlus and Google, Rachel Walden wrote a post: “Where is MedlinePlus in Google Drug Search Results?” where she notices that Google searches for drug information no longer seem to return results from MedlinePlus and FDA pages.

PubMed, MeSH and the like


Rachel Walden (@rachel_w on Twitter) is the woman behind the successful blog Women’s Health News and writer for Our bodies ourselves. She not only knows a lot about women’s health and medical information, but she is always ready to reach a helping hand or join a discussion on Twitter, which is actually a quality of all MEDLIB round contributors.  In “Improving the Findability of Evidence & Literature on DoulasRachel describes  the lack of a specific MeSH for “Doula” in PubMed. A doula is an assistant who provides various forms of non-medical and non-midwifery support (physical and emotional) in the childbirth process. MeSH (or Medical Subject Headings) are controlled terms in MEDLINE, or as explained by Rachel:

MeSH are “right” terms to use to conduct a literature search in PubMed, it can really help to start with the MeSH term database, because you know those are the official subject terms being assigned to the articles. MeSH is a hierarchy, and it can help you focus a search, or expand it when needed, by moving up and down the list of subject words. It’s a nice tool to have, when it works.

As highlighted by Rachel, this gap in the MeSH makes searching less efficient and less precise: for instance, nursing and midwivery are too broad terms. But instead of whining, Rachel decided to do something about it. Via this form she send the National Library of Medicine a request to add the “doula” concept to the MeSH terms. I would recommend others to do the same when terms they search for are not (appropriately) covered by the MESH.

Librarian Mark Rabnett agrees hartfully with Rachel as he has encountered exactly the problems and yes, “there is no question that this is a satisfactorily distinct and widely accepted term, and its entry into the MeSH pantheon is long overdue.”
On his blog Gossypobima Mark had earlier posted the “Top 5 results to improve PubMedfrom the brainstorming suggestions during the Canadian Health Libraries Association conference. These include “Adding adjacency and real string searching” (YES!) and “Improval of the MeSH database”. His group found “The MeSH database stiff and laboured , and the visual display of the thesaurus and subheadings not intuitive, the ‘Add To’ feature for inserting MeSH terms to a search box kludgy, and the searching for MeSH headings difficult and unpredictable. [..] So he concludes with: “We need a MeSH mashup.”

Wouldn’t that be wonderful indeed? Rather than the current “enhancements”, why not introduce some web 2.0 tools in PubMed? As Patricia Anderson tweeted a long time ago:

“It would be so cool to do a # search, then display word cloud of top major MESH terms in results.”

Yes I would like a visual MeSH, but even better, one that would show up in the sidebar and that you would be able to “walk up and down (and sideways) and with “drag and drop to your search possibilities”. That would be cool. My imagination runs away with me when I think of it.

Grey Literature

cappadocia1_bigger shamshaNot having a public blog @shamsha has contributed to this round by writing a guest post on this blog. This interesting post is about grey literature: what is grey literature, why do you need it and why not have guidelines for searching grey literature? She gives many tips and a wealth of references, including links to her own delicious page and a wonderful resource from the Canadian Agency for Drugs and Technologies in Health.


This concludes the official part of this MEDLIB’s September round.

The next round is hosted by Alisha Miles on her blog Alisha 764.
Officially the deadline is next Saturday
. (But it may be postponed a little. If so I will post the new deadline here)
Anyway, Alisha is looking forward to your posts. So send them in as soon as possible HERE at the Blog Carnival form.
(registration required; see the medlibs-archive for more information.

And some good news about the round: We already have hosts for November and December, namely Walter Jessen of Highlight Health and Valentin Vivier of at the Novoseek Blog.

Would you like to host the Medlibs round in 2010? It is never to early! Please dm me at twitter, comment on this post or write an email to



Here are some other posts I also found worth while to read.
(I didn’t include too recent ones, so they can be included in the next round)

Dr Mike Cadogan (@Sandnsurf) writes  frequently about medical information on his blog Life in the fast Lane (his blog has moved to, so check out old links that you may have). One of the co-authors of the blog,  Chris Nickson (precordialthump) gives emergency physicians advise how to deal withinformation-overload”. Needless to say the tips are useful to all people dealing with medical information-overload.

Dr Shock also writes a lot about medical information and web 2.0 tools. Here a video he posted about iPhone and iPod Touch as a Medical Tool.

Another good source for info about i-phones, palms can be found on Medical librarians frequently writing about this subject include the Krafty Librarian and David Rothman.

I don’t have a palm or sophisticated phone, nor does our library supports its use, so I choose some other posts from these excellent bloggers.

From the KraftyLibrarian Michelle: Rapid Research about Rapid Research Notes , a new resource developed by the National Center for Biotechnology Information (NCBI) to quickly disseminate the research results to the public in an open access archive. Michelle wonders why only PLOS-articles are included and not other quality information from for instance EBSCO and Cochrane.

From palmdoc : Evernote as your peripheral brain (Evernote is a note taking application)

Rapid Research Notes is also covered by Alison of Dragonfly, a previous host of the round. She also mentions the fact that Medlineplus is now on Twitter.

David Rothman ‘s paternity leave seems over since he posts several interesting posts per week on his blog Typically he shortly refers to a new tool or a post he encountered, like:

Dean Giustini of the The Search Principle blog published part one of a Top Fifty Twitter Users List in Medicine and has written a post on Using Twitter to manage information.

Patricia Anderson of Emerging Technologies Librarian is been very active lately with posts on social media, like “Conversation and Context in Social Media (Cautionary Tales)“, with four scenarios, including the Clinical Reader fiasco. And as always she has a lot of tips on web 2.0 tools. There is for instance a post on Listening Tools to track what your community is saying about you or to you and about Social Media Metrics

Another techy librarian working at the National University of Singapore is Aaron Tay. Aaron Tay (@aarontay) is not working in the field of medicine, but his web 2.0 tips are useful for anyone, and his blog Musings about Librarianship is certainly a must for libraries that want to use web  2.0 tools to the benefit of their users. Personally, I found the tips onViewing research alerts – full text within Google reader very useful.

Phil Bradley highlights Google Fast Flip and Bing’s Visual Search.

Alan from The health Informaticist discusses in “NHS Evidence boo vs guidelinesfinder hurrah” that a simple search for backpain in NHS Evidence yielded 1320 hits (!) of which only a handful are useful guidelines, whereas the good old Guidelines Finder (now a ’specialist collection’), yields 47 mostly useful and relevant hits. He ends this discussion with a  request to NICE: please keep the specialist collections. And I agree.

On EBM and Clinical Support Librarians@UCHC this month an overview of current news, advisories and practical information about Pandemic Flu (H1N1) .

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his imagination had run away
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Friday Foolery [4]: Maps & Mapping

25 09 2009

25-9-2009 8-11-39 world map 16..In the previous post I showed a map of the world made in 1689.
Here only half of North America was represented, because the world was “Europe-centered”.
The map was made in Amsterdam, Europe.

How different is the world according to Americans (source: Neil Bonginkosi Lawrence Taverner of the blog Other things amanzi on Facebook).

The Netherlands have even been submerged into the sea ;)

world according to americans

Countries and continents can also be extremely “big” or extremely “small” in real life. See the sometimes confronting representation “of the world as you never saw it at See for instance the world worldmapper age of death animation (CC).

25-9-2009 8-54-08

At you get a real life picture of CO2 emissions, birth rate & death rate simulation (no Figure, it is an animation).

This real-time simulation displays the CO2 emissions of every country in the world, as well as their birth and death rates.

Please remember that this real time simulation is just that: a simulation. Although the CO2 emission, birth rate and death rate data used in Breathing Earth comes from reputable sources, data that measures things on such a massive scale can never be 100% accurate. Please note however that the CO2 emission levels shown here are much more likely to be too low than they are to be too high.

Less serious, but also characteristics is the well known map of online communities from xkcd webcomics (

Map of online communities From xkcd webcomics (

Google Mashups we have seen used for many serious things, like for mapping H1N1 infections, but I had to smile about this map of exploding i-phones (via @NilsGeylen on Twitter)

25-9-2009 9-03-53 map of exploding i-phones

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The Grand Rounds is coming! Please start submitting!

22 09 2009

I have the honor to host my first GRAND ROUNDS ever on Tuesday September 29th.

For those who don’t know what the Grand Round is about,  it is the weekly rotating carnival of the best of the medical blogosphere. Today the round is up at Colin Son’s blog Residency Notes, so please take a look at this birthday edition (start of the 6th year of Grand Rounds).

As apparent from the “Around the World in Eighty Days” Grand Round theme at “Suture for a Living”, most Grand Round  contributors come from the North American Continent. It is quite exceptional that the Grand Round comes to the Netherlands and I’m looking forward to welcome you all.
Yeah, there will be no theme!

Please make it easy for this non-native speaker of English and submit your post as soon as possible, but not later than midnight EST (NY) at Sunday September 27th (Monday 6.00 am in the Netherlands and 4.00 UTC (GMT)). Please send your submissions to as follows:

  • “Grand Rounds” in the subject line.
  • Permalink (url) webpost
  • Title post
  • Your name
  • a short description would be of help.
  • and if time permits:
    • tell me where you’re from (town, country and/or institute).
    • spend one line telling me your thoughts on medical information and medical librarians (this may be specially featured.)

So I hope I shall welcome you all next week. For all those people who have no idea where The Netherlands are, here is an old world map produced by Gerard van Schagen in 1689 in Amsterdam. As you can see, Europe took a more prominent place in the world those days (only the half of North America is represented).

3185534518_d9d53b1f09 worldImage licenced under Creative Commons
/ CC BY-ND 2.0

* I can’t promise to include all submissions though. This will depend on the quality and on whether I can fit it in.

The Trouble with Wikipedia as a Source for Medical Information

14 09 2009

This post was chosen as an Editor's Selection for

Do you ever use Wikipedia? I do and so do many other people. It is for free, easy to use, and covers many subjects.

But do you ever use Wikipedia to look up scientific or medical information? Probably everyone does so once in a while. Dave Munger (Researchblogging) concluded a discussion on Twitter as follows:

Logo of the English Wikipedia
Image via Wikipedia

“Wikipedia’s information quality is better than any encyclopedia, online or off. And, yes, it’s also easy to use”.

Wikipedia is an admirable initiative. It is a large online collaborative, multilingual encyclopedia written by contributors around the world.
But the key question is whether you can rely on Wikipedia as the sole source for medical, scientific or even popular information.

Well, you simply can’t and here are a few examples/findings to substantiate this point.



When you search  for diabetes in Google (EN), Wikipedia’s entry about diabetes ranks second, below the American Diabetes Association Home Page. A recent study published in the J Am Med Inform Assoc [1] confirms what you would expect: that the English Wikipedia is a prominent source of online health information. Wikipedia ranked among the first ten results in more than 70% of search engines and health-keywords tested, and outranked other sources in case of rare disease-related keywords. Wikipedia’s articles were viewed more frequently than the corresponding MedlinePlus Topic pages. This corroborates another study that can be downloaded from the internet here [10]. This study by Envision Solutions, LLC, licensed under the Creative Commons License, concluded that the exposure of Internet user’s to health-related user-generated media (UGM) is significant, Wikipedia being the most reference resource on Google and Yahoo.

The following (also from, from 2007 [10]) illustrates the impact of this finding:

According to the Pew Internet & American Life Project*, 10 million US adults search online for information on health each day [1]. Most (66%) begin their research on a search engine like Yahoo or Google. In addition, Americans are saying that the information they find on the Internet is having an impact. According to Pew, “53% of health seekers report that their most recent health information session [influenced] how they take care of themselves or care for someone else.” In addition, 56% say the information they find online has boosted their confidence in their healthcare decision-making abilities.

And according to an update from the Pew Internet & American Life Project (2009) [11]:

In 2000, 46% of American adults had access to the internet, 5% of U.S. households had broadband connections, and 25% of American adults looked online for health information. Now, 74% of American adults go online, 57% of American households have broadband connections, and 61% of adults look online for health information.

Thus a lot of people look online for health care questions and are more inclined to use highly ranked sources.
This is not unique for Health topics but is a general phenomenon, i.e. see this mini-study performed by a curious individual: 96.6% of Wikipedia Pages Rank in Google’s Top 10 [12]. The extreme high traffic to Wikipedia due to search referrals has  even been been denounced by SEO-people (see here) [13]: if you type “holiday” Wikipedia provides little value when ranking in the top 10: everybody knows what a holiday is ;)

Medical students use it too.

A nightmare for most educators in the curriculum is that students rely on UGM or Web 2.0 sites as a source  of medical information. Just walk along medical students as they work behind their computers and take a quick glance at the pages they are consulting. These webpages often belong to the above category.

AnneMarie Cunningham, GP and Clinical Lecturer in the UK, did a little informal “survey” on the subject. She asked 31 first year medical students about their early clinical attachments in primary and secondary care and summerized the results on her blog Wishful Thinking in Medical Education [14]. By far and away Wikipedia was the most common choice to look up unfamiliar clinical topics.


‘Many students said I know I shouldn’t but….’ and then qualified that they used Wikipedia first because it was easy to understand, they felt it was reasonably reliable, and accessible. One student used it to search directly from her phone when on placement..

50% of the doctors use it!

But these are only medical students. Practicing doctors won’t use Wikipedia to solve their clinical questions, because they know where to find reliable medical information.


The New Scientist cites a report [15] of US healthcare consultancy Manhattan Research (April 2009), stating that that 50 percent of the doctors turn to Wikipedia for medical information.

A recent qualitative study published in Int J Med Inform [2] examined the “Web 2.0″ use by 35 junior physicians in the UK. Diaries and interviews encompassing 177 days of internet use or 444 search incidents, analyzed via thematic analysis. Although concepts are loosely defined (Web 2.0, internet and UMG are not properly defined, i.e. Google is seen as a web 2.0 tool (!) [see Annemarie’s critical review [16] the results clearly show that 89% of these young physicians use at least one “Web 2.0 tool” (including Google!) in their medical practice, with 80% (28/35) reporting the use of wikis. The visit of wiki’s is largely accounted for by visits to Wikipedia: this was the second most commonly visited site, used in 26% (115/44) of cases and by 70% (25/35) of all physicians. Notably, only one respondent made regular contribution to a medical wiki site.

The main motivation for using the Internet for information seeking was the accessibility and ease of use over other tools (like textbooks), the uptodateness, the broad coverage and the extras such as interactive immages. On the other hand most clinicians realized that there was a limitation in the quality or usefulness of information found. It is reassuring that most doctors used UGM like Wikipedia for background or open questions, to fulfill the need for more in depth knowledge on a subject, or to find information for patients, not for immediate solving of clinical questions.

The Int J Med Inform article has been widely covered by blogs: i.e. see Wishful Thinking in Medical Education [16], Dr Shock, MD, PhD [17], Life in the Fast Lane [18], Clinical Cases and Images Blog [19] and Scienceroll [20].

Apparently some doctors also heavily rely on Wikipedia that they refer to Wikipedia articles in publications (see the Int. J Cardiol. PubMed [3] abstract below)!!

8-9-2009 14-03-15 Int J cardiol wikipedia references 2


Whether the common use of Wikipedia by e-patient, medical students and doctors is disadvantageous depends on the quality and the trustworthiness of the Wikipedia articles, and that is in its turn dependent on who writes the articles.

Basically, the strength of Wikipedia is it weakness: anyone can write anything on any subject, and anyone can edit it, anonymously.

Negative aspects include its coverage (choice of subjects but also the depth of coverage), the “overlinking”, the sometimes frustating interactions between authors and editors, regularly leading to (often polite) “revision wars“, but above all the lack of ‘expert’ authors or peer review. This may result in incomplete, wrong or distorted information.

Positive aspects are its accessibility, currency, availability in many languages, and the collective “authorship” (which is an admirable concept).

The following humorist video shows how the wisdom of the crowds can lead to chaos, incorrect and variable information.

SCOPE AND ACCURACY (What has been covered, how deep and how good) :

Too much, too little, too ….

With respect to its coverage one study in the Journal of Computer-Mediated Communication (2008) [4] concludes:

Differences in the interests and attention of Wikipedia’s editors mean that some areas, in the traditional sciences, for example, are better covered than others. (…)
Overall, we found that the degree to which Wikipedia is lacking depends heavily on one’s perspective. Even in the least covered areas, because of its sheer size, Wikipedia does well, but since a collection that is meant to represent general knowledge is likely to be judged by the areas in which it is weakest, it is important to identify these areas and determine why they are not more fully elaborated. It cannot be a coincidence that two areas that are particularly lacking on Wikipedia—law and medicine—are also the purview of licensed experts.

It is not unexpected though that Wikipedia’s topical coverage is driven by the interests of its users.

Sometimes data are added to Wikipedia, that are in itself correct, but controversial. Recently, Wikipedia published the 10 inkblots (Scienceroll, [21]) of the Rorschach test, along with common responses for each. This had led to complaints by Psychologists , who argue that the site is jeopardizing one of the oldest continuously used psychological assessment tests (NY Times [22]).

The actual coverage of medical subjects may vary greatly. In one study [5], abstract-format, 2007) Wikipedia entries were screened for the most commonly performed inpatient surgical procedures in the U.S. Of the 39 procedures, 35 were indexed on Wikipedia. 85.7% of these articles were deemed appropriate for patients. All 35 articles presented accurate content, although only 62.9% (n=22) were free of critical omissions. Risks of the procedures were significantly underreported. There was a correlation between an entry’s quality and how often it was edited.

Wikipedia may even be less suitable for drug information questions, questions that one-third of all Internet health-seekers search for. A study in Annals of Pharmacotherapy [6] comparing the scope, completeness, and accuracy of drug information in Wikipedia to a free, online, traditionally edited database (Medscape Drug Reference [MDR]) showed that  Wikipedia answered significantly fewer drug information questions (40.0%) compared with MDR (82.5%; p < 0.001) and that Wikipedia answers were less complete. Although no factual errors were found, errors of omission were higher in Wikipedia (n = 48) than in MDR (n = 14). The authors did notice a marked improvement in Wikipedia over time. The authors conclude:

This study suggests that Wikipedia may be a useful point of engagement for consumers looking for drug information, but that it should be supplementary to, rather than the sole source of, drug information. This is due, in part, to our findings that Wikipedia has a more narrow scope, is less complete, and has more errors of omission versus the comparator database. Consumers relying on incomplete entries for drug information risk being ill-informed with respect to important safety features such as adverse drug events, contraindications, drug interactions, and use in pregnancy.
These errors of omission may prove to be a substantial and largely hidden danger associated with exclusive use of
user-edited drug information sources.

Alternatively, user-edited sites may serve as an effective means of disseminating drug information and are promising as a means of more actively involving consumers in their own care. However, health professionals should not use user-edited sites as authoritative sources in their clinical practice, nor should they recommend them to patients without knowing the limitations and providing sufficient additional information and counsel…

Not Evidence Based

German researches found [7], not surprisingly, that Wikipedia (as well as two major German statutory health insurances):

“…failed to meet relevant criteria, and key information such as the presentation of probabilities of success on patient-relevant outcomes, probabilities of unwanted effects, and unbiased risk communication was missing. On average items related to the objectives of interventions, the natural course of disease and treatment options were only rated as “partially fulfilled”. (..)  In addition, the Wikipedia information tended to achieve lower comprehensibility. In conclusion(..) Wikipedia (..) does not meet important criteria of evidence-based patient and consumer information though…”

Wrong, misleading, inaccurate

All above studies point at the incompleteness of Wikipedia. Even more serious is the fact that some of the Wikipedia addings are wrong or misleading. Sometimes on purpose. The 15 biggest wikipedia blunders [23] include the death announcements of Ted Kennedy (when he was still alive),  Robert Byrd and others. Almost hilarious are the real time Wikipedia revisions after the presumed death of Kennedy and the death of Ken Lay (suicide, murde, heart attack? [24).

In the field of medicine, several drug companies have been caught altering Wikipedia entries. The first drug company messing with Wikipedia was AstraZeneca. References claiming that Seroquel allegedly made teenagers “more likely to think about harming or killing themselves” were deleted by a user of a computer registered to the drug company [25], according to Times [26]. Employees of Abbott Laboratories have also been altering entries to Wikipedia to “eliminate information questioning the safety of its top-selling drugs.”(See WSJ-blog [27] , [28], and recently Kevin MD[29])

These are “straightforward” examples of fraudulent material. But sometimes the Wikipedia articles are more subtly colored by positive or negative bias.

Take for instance the English entry on Evidence Based Medicine (in fact the reason why I started this post). Totally open-minded I checked the entry, which was automatically generated in one of my posts by Zemanta. First I was surprised by the definition of EBM:

Evidence-based medicine (EBM) aims to apply the best available evidence gained from the scientific method to medical decision making. It seeks to assess the quality of evidence of the risks and benefits of treatments (including lack of treatment).

instead of the usually cited Sacket-definition (this is only cited at the end of the paper):

“the practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research”

In short, the whole article lacks cohesion: the definitions of EBM are not correct, there is too much emphasis on not directly relevant information (4 ways to grade the evidence and 3 statistical measures), the limitations are overemphasized (cf. chapter 7 with 6 in the Figure below) and put out of perspective.

Apparently this has also been noted by Wikipedia, because there is a notice on the Evidence Based Medicine Page saying:

This article has been nominated to be checked for its neutrality. Discussion of this nomination can be found on the talk page. (May 2009)

9-9-2009 9-55-04 wikipedia EBM start smal

Much to my surprise the article had been written by Mr-Natural-Health, who’s account seems not to be in use since 2004  and who is currently active as User:John Gohde. Mr Natural Health is a member of WikiProject Alternative medicine.

Now why in earth would some advocate of CAM write the Wikipedia EBM-entry? I can think of 4 (not mutually exclusive) reasons:

  1. When you’re an EBM-nonbeliever or opponent this is THE chance to misinform readers about EBM (to the advantage of CAM).
  2. The author was invited to write this entry.
  3. No EBM-specialist or epidemiologist is willing to write the entry, or to write for Wikipedia in general (perhaps because they find Wikipedia lacks trustworthiness?)
  4. EBM specialists/epidemiologists are not “allowed”/hindered to make major amendments to the text, let alone rewrite it.

According to Mr Naturopath point 2 is THE reason he wrote this article. Now the next question is “exactly by whom was he invited?” But the TALK-page reveals that Mr Naturapath makes it a tough job for other, better qualified writers, to edit the page (point 4). To see how difficult it is for someone to re-edit a page, please see the TALK-page. In fact, one look at this page discourages me from ever trying to make some amendments to any Wikpedia text.


Changes to Wikipedia’s organization

Wikipedia has long grasped that its Achilles heel is the free editability (see for instance this interview with Wikipedia’s founder [30]). Therefore, “WikiProjects” was initiated to help coordinate and organize the writing and editing of articles on a certain topic, as well as “Citizendium” which is an English-language wiki-based free encyclopedia project aimed to improve the Wikipedia model by providing a “reliable” encyclopedia. “It hopes to achieve this by requiring all contributors to use their real names, by strictly moderating the project for unprofessional behavior, by providing what it calls “gentle expert oversight” of everyday contributors, and also through its “approved articles,” which have undergone a form of peer-review by credentialed topic experts and are closed to real-time editing.”

Starting this fall Wikipedia will launch an optional feature called “WikiTrust” will color code every word of the encyclopedia based on the reliability of its author and the length of time it has persisted on the page: Text from questionable sources starts out with a bright orange background, while text from trusted authors gets a lighter shade.

9-9-2009 15-25-36 wikipedia wikiproject medicine

The Wikipedia EBM article is within the scope of these two projects, and this is good news. However, Wikipedia still clings to the idea that: “Everyone is welcome to join in this endeavor (regardless of medical qualifications!).” In my opinion, it would be better if Wikipedia gave precedence to experts instead of hobbyists/ people from another field, because the former can be expected to know what they are talking about. It is quite off-putting for experts to contribute. See this shout-out:

Who are these so-called experts who will qualify material? From what I’ve seen so far, being an academic expert in a particular field hardly protects one from edit wars–Julie and 172 are two primary examples of this. Meanwhile, the only qualification I have seen so far is that they have a B.A. Gimme a friggin’ break! (and before I get accused of academic elitism, I make it known that I dropped out of college and spend an inordinate amount of time at work correcting the BS from the BAs, MAs, and PhDs).

While anyone can still edit entries, the site is testing pages that require changes to be approved by an experienced Wikipedia editor before they show up, the so called Flagged protection and patrolled revisions. (see Wikimedia) This proposal is only for articles that are currently under normal mechanisms of protection (i.e. the Obama-article cannot be edited by a newcomer).

Although this seems logic, it is questionable whether “experienced” editors are per definition better qualified than newcomers. A recent interesting analysis of the Augmented Social Cognition group [31], (cited in the Guardian [32]) shows a slowdown in growth of Wikipedia activity, with the activity slightly declining in all classes of editors except for the highest-frequency class of editors (1000+ edits). Here is an increase in their monthly edits.

In addition the study shows growing resistance from the Wikipedia community to new content. The total percentage of reverted edits increased steadily over the years, but more interestingly, low-frequency or occasional editors experienced a visibly greater resistance compared to high-frequency editors . Together this points at a growing resistance from the Wikipedia community to new content, especially when the edits come from occasional editors.

This is more or less in line with an earlier finding [9] showing that Wikipedia members feel more comfortable expressing themselves on the net than off-line and scored lower on agreeableness and openness compared to non-Wikipedians, a finding that was interpreted as consistent with the possibility that contributing to Wikipedia serves mainly egocentric motives.

Image representing Medpedia as depicted in Cru...
Image via CrunchBase

Encouraging students, doctors and scientists (provisional)

One way of improving content, is to encourage experts to write. To achieve that the information on Wikipedia is of the highest quality and up-to-date, the NIH is encouraging its scientists and science writers to edit and even initiate Wikipedia articles in their fields [36]. It joined with the Wikimedia Foundation, to host  a training session on the tools and rules of wiki culture, at NIH headquarters in Bethesda.

A less noncommital approach is the demand to “Publish in Wikipedia or perish”, as described in Nature News [9]. Anyone submitting to a section of the journal RNA Biology will, in the future, be required to also submit a Wikipedia page that summarizes the work. The journal will then peer review the page before publishing it in Wikipedia.” The project is described in detail here [10] and the wiki can be viewed here

Wiki’s for experts.

One possible solution is that scientist and medica experts contribute to wiki’s other than the Wikipedia. One such wiki is the wiki-surgery [5]. PubDrugRxWiki , WikiProteins [11] and Gene Wiki [12] are other examples. In general, scientists are more inclined to contribute to these specialists wiki’s, that have oversight and formal contributions by fellow practitioners (this is also true for the RNA-wiki)

A medical Wikipedia

Yet another solution is a medical wikipedia, such as Ganfyd or Medpedia . Ganfyd is written by medical professionals. To qualify to edit or contribute to the main content of Medpedia approved editors must have an M.D., D.O., or Ph.D. in a biomedical field. Others, however, may contribute by writing in suggestions for changes to the site using the “Make a suggestion” link at the top of each page. Suggestions are reviewed by approved editors. Whether these medical wikipedias will succeed will depend on the input of experts and their popularity: to what extent will they be consulted by people with health questions?

I would like to end with a quote from Berci during twitterview (link in Wikipedia):

@Berci : @diariomedico And as Wikipedians say, Wikipedia is the best source to start with in your research, but should never be the last one. #DM1 9 months ago


ResearchBlogging.orgScientific Articles

  1. Laurent, M., & Vickers, T. (2009). Seeking Health Information Online: Does Wikipedia Matter? Journal of the American Medical Informatics Association, 16 (4), 471-479 DOI: 10.1197/jamia.M3059
  2. Hughes, B., Joshi, I., Lemonde, H., & Wareham, J. (2009). Junior physician’s use of Web 2.0 for information seeking and medical education: A qualitative study International Journal of Medical Informatics, 78 (10), 645-655 DOI: 10.1016/j.ijmedinf.2009.04.008
  3. Lee, C., Teo, C., & Low, A. (2009). Fulminant dengue myocarditis masquerading as acute myocardial infarction International Journal of Cardiology, 136 (3) DOI: 10.1016/j.ijcard.2008.05.023
  4. Halavais, A., & Lackaff, D. (2008). An Analysis of Topical Coverage of Wikipedia Journal of Computer-Mediated Communication, 13 (2), 429-440 DOI: 10.1111/j.1083-6101.2008.00403.x
  5. Devgan, L., Powe, N., Blakey, B., & Makary, M. (2007). Wiki-Surgery? Internal validity of Wikipedia as a medical and surgical reference Journal of the American College of Surgeons, 205 (3) DOI: 10.1016/j.jamcollsurg.2007.06.190
  6. Clauson, K., Polen, H., Boulos, M., & Dzenowagis, J. (2008). Scope, Completeness, and Accuracy of Drug Information in Wikipedia Annals of Pharmacotherapy, 42 (12), 1814-1821 DOI: 10.1345/aph.1L474 (free full text)
  7. Mühlhauser I, & Oser F (2008). [Does WIKIPEDIA provide evidence-based health care information? A content analysis] Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen, 102 (7), 441-8 PMID: 19209572
  8. Amichai–Hamburger, Y., Lamdan, N., Madiel, R., & Hayat, T. (2008). Personality Characteristics of Wikipedia Members CyberPsychology & Behavior, 11 (6), 679-681 DOI: 10.1089/cpb.2007.0225
  9. Butler, D. (2008). Publish in Wikipedia or perish Nature DOI: 10.1038/news.2008.1312
  10. Daub, J., Gardner, P., Tate, J., Ramskold, D., Manske, M., Scott, W., Weinberg, Z., Griffiths-Jones, S., & Bateman, A. (2008). The RNA WikiProject: Community annotation of RNA families RNA, 14 (12), 2462-2464 DOI: 10.1261/rna.1200508
  11. Mons, B., Ashburner, M., Chichester, C., van Mulligen, E., Weeber, M., den Dunnen, J., van Ommen, G., Musen, M., Cockerill, M., Hermjakob, H., Mons, A., Packer, A., Pacheco, R., Lewis, S., Berkeley, A., Melton, W., Barris, N., Wales, J., Meijssen, G., Moeller, E., Roes, P., Borner, K., & Bairoch, A. (2008). Calling on a million minds for community annotation in WikiProteins Genome Biology, 9 (5) DOI: 10.1186/gb-2008-9-5-r89
  12. Huss, J., Orozco, C., Goodale, J., Wu, C., Batalov, S., Vickers, T., Valafar, F., & Su, A. (2008). A Gene Wiki for Community Annotation of Gene Function PLoS Biology, 6 (7) DOI: 10.1371/journal.pbio.0060175
    Other Publications, blogposts
    (numbers in text need to be adapted)

  13. Envision Solutions, LLC. Diving Deeper Into Online Health Search – Examining Why People Trust Internet Content & The Impact Of User-Generated Media (2007) Accessed August 2009 (CC)
  14. New data available of the the Pew Internet & American Life Project are available here)
  22. Wikipedia used by 70% of junior physicians, dominates search results for health queries (
  25. (Rorschach)
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Twitter’s #FollowFriday #FF – Over the Top. Literally

11 09 2009

Last Update: Sunday (2009-13-09), text added in blue

The Twittermeme #FollowFriday (or #FF) was started January this year by Micah Baldwin (@micah) with one single Tweet: I am starting Follow Fridays. Every Friday, suggest a person to follow, and everyone follow him/her. Today its @fancyjeffrey & @w1redone.”

10-9-2009 23-33-49 followfriday

A friend of Micah suggested to add the hashtag (a community driven tag) #FollowFriday to the tweet, some other friends helped to spread the word and a tweetmeme was born: now, all over the world #FollowFriday is a Twitter “trending topic” on Fridays (see Mashable)

The concept of FollowFriday is that every Friday you recommend a few people to your Twitter-followers. For at least 2 reasons:

  1. it is a way to acknowledge those particular people
  2. it is a very efficient way for your followers to find other interesting Twitter people

Ideally (at least IMHO) the #FollowFriday tweets (message of 140 characters or less):

  • should consist of:
    • the hashtag #FollowFriday,  #FF or both
    • 1-3 names of people you would like to recommend (the tweet should not start with their names, because otherwise only the recommend person himself and your mutual friends will be able to read the tweet, -this doesn’t make much sense)
    • a short explanation why you recommend him/her.
  • are tweeted on Fridays
  • are more or less unique (just one or two tweets, not dozens in a row)
  • should only recommend the best people in a particular field

Two examples, one by me and one by @jpardopardo (it was my one and only #FF recommendation in two weeks)

  1. Laika (Jacqueline)
    laikas My #followfriday goes to @aarontay , a techy librarian from Singapore. Has many tips as a tweeter and a blogger #ff #fb
  2. Jordi Pardo Pardo
    jpardopardo #followfriday Cochrane tweets you can not miss: @cochranecollab @radagabriel @MESOttawa @laikas @TSC_OH @DavidTovey

this quote was brought to you by quoteurl

In these examples the hashtag #FollowFriday is followed by one or several names with the reason one should follow the person.

The general format thus would be:

#followfriday #FF @username Reason why you should follow him/her, area of interest, Their website URL, if applicable

If my followers see that I consider @aarontay a great techy librarian having a lot of good tips, they might find it worth while 2 check him by clicking @aarontay or the link to his blog If they go to his Twitter homepage and  find his tweets awesome, than they might decide to start following him.

If you’re interested in the Cochrane Collaboration, then you might try the tweople that are recommended by @jpardopardo. It takes somewhat more time, however, to check all 6 people, but it may yield some interesting new people to follow.

Thus, in principle #FollowFriday is a great tool to find other interesting people, BUT…

…suppose you’re following someone that tweets all this (x 3-5 times) every Friday?

29-8-2009 15-19-18 #followfriday

I don’t follow this person (name not shown), but if I did, these #FollowFridays are really meaningless. I don’t know why I should follow the “suggested” people, nor do I want to try all the links. Furthermore if someone produces 10 or more of these kinds of tweets (those people exist!), my twitter account gets clogged with useless clutter. Its worse than an inbox full with spam.

But some people are even worse. They not only tweet a huge amount of meaningless FollowFridays, they also retweet (RT) the FollowFridays in which they are included to let the world know how popular they are (I can’t think of any other reason than that they want to show off).

29-8-2009 15-22-28 ff dr sg

And it is counterproductive….

Instead of following the recommended people I will unfollow those kind of FollowFridaying people (at the end).

I’m not a CEO or a marketing woman. I don’t want 10000 people to follow me, and even less so do I want to follow 10.000 people back.

I only desire to follow interesting people with a high signal to noise ratio of tweets in a manageable way.

I always thought that I was exceptional in thinking like this, but last two weeks several of my Twitter friends started to talk about the downside of FollowFridays. And when I Googled, o dear, the whole Twitterverse seemed to have written about it. (glad I Googled after I had almost finished this post)

  1. Ves Dimov, M.D.
    DrVes I don’t participate in “Follow Friday” (any day is good to recommend somebody) but @Dr_Steve_Ponder offers great diabetes info as Dr/patient
  2. David Bradley
    sciencebase I think it’s time to abandon #FollowFriday as a twitter meme, unless we can make it more useful and effective.
  3. novo|seek
    novoseek agree / RT @sciencebase: I think it’s time to abandon #FollowFriday as a twitter meme, unless we can make it more useful and effective.
  4. Laika (Jacqueline)
    laikas RT @sciencebase: think it’s time 2 abandon #FollowFriday as a twitter meme, unless we can make it more useful/effective. wouldn’t agree more
  5. Walter van den Broek
    DrShock RT @laikas: RT @sciencebase: think it’s time 2 abandon #FollowFriday what about #rec?

this quote was brought to you by quoteurl

Oh and here is another one today (13-09)
pfanderson @laikas @wichor Yeah, I really hate it on Follow Friday when folks fill up a whole page nothing but people’s names. from web in reply to laikas

SO WHAT ARE THE SOLUTIONS? (blue added after publication)


  1. Abandon FollowFriday
  2. Just recommend anyone (special) whenever you like (DrVes , DrShock),
  3. @MarilynMann: “What I do find useful is when someone joins twitter and people tweet “please welcome ___ to twitter,” which can be done any day of the week”
  4. @sciencebase: “RT is the much better way to show fellow twitters that you care. If you’re RT’ing their tweets then you’re demonstrating that what they’re saying bears repeating, so recommending them indirectly…”
  5. @philbaumann ‘s tip mentioned by @problogger in the same post Mark tweets from people you want to recommend on FollowFriday by favoriting them and tweet the URL of your favorites page (i.e., see the URL of Philbaumann’s Favorites page).
  6. Share Groups of Twitter Users in One Click with TweepML (Mashable) – here are some lists from which you can choose:, including a top librarianlist. Of course there are already many lists and directories around, but the good thing is that you can personalize your own top groups and that another person can add anyone from that list by simple clicking.
  7. Use #MrTweet Instead of #FollowFriday, send your weekly recommendation there, get an overview of the most awesome people according to your friends and get recommended yourselves (see bkmacdaddy). [added 2009-09-02]


  8. Use FollowFriday sparingly and wisely, i.e. as described above. In fact the founder of FollowFriday proposes similar rules.
  9. Mention a series of people on Twitter and tell why they’re great people on your blog -there is more room there (sucomments)
  10. @problogger: (on his blog your tweets throughout the day via scheduling services like Tweetlater (currently rebranding themselves as SocialOomph, Futuretweet or Hootsuite” (while taking care of the twitteretiquette, see above).
  11. Matt Stratton proposes to use the hashtag fussy-follow-friday, to discrimate good tweets from bad ones.
  12. Maija Haavisto, again on “ask others for recommendations (such as “female sports bloggers” ..), either as a normal tweet or by posing a question to someone. They reply with names of Twitter users – preceding the initial @ with a period or something else, if they want others to see their recommendations. All tweets should be tagged with #ff or #followfriday, of course.

    EXTRA TIP TO KEEP YOUR Followfriday-recommendations

  13. Perform a Twittersearch with (your @twittername  OR your twittername) (#followfriday OR #ff OR followfriday) and take an RSS-feed to that search. You see your recommendations and who has recommended you.
    Thus my search looks like
    (laikas OR @laikas)(#followfriday OR #ff OR followfriday) (and you can also add “friday”)

To add fussy-follow-friday to the follow friday tweet [10] seems unnecessarily complex to me. Asking others for recommendations [11] is a good suggestion, but I don’t see me applying that approach each Friday. I would (and already do) use this approach on selected occasions. Why not just use FollowFriday as it was meant to be used: recommend one or two people once a week [3]. I still like the idea. Contrary to marketing people and strategists, I’m already happy and honored when I’m FollowFridayed: for me it doesn’t have to lead to tons of followers (for others this is the main goal). In my case it has lead to some new, great twitterfriends. Quality is more important to me than quantity. I’ve  “met” some new interesting people, who I might not have met otherwise.

Option 2, 3 and 4 also seem very sensible to me. I share the mild) critique of @problogger regarding 5: “Not every tweet I Favorite comes from someone I necessarily want to recommend and favorites are not necessarily tweets planned on sharing. But people not using favorites often might find this an excellent option.”

6 seems more of an adjunct, nice tool, but less personal.

What do you think?

(Solutions may be added to the above list)

suggest a list of people they followed whom they believed others would also enjoy

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Visualization of Paradoxes behind US Health Care

10 09 2009

This video nicely explains the paradoxes behind the health care in US: why the US spends more to Health Care, but doesn’t make people healthier (but instead -some- wealthier). It vividly shows why reform is needed.

The video takes data from studies by Dartmouth and the OECD, and uses Gapminder to make the graphs come alive

An introductory Healthcare data tutorial kan be viewed here or at the New Scientist (which shows both video’s and the health data graph)

More information can be found at New Scientist and Discover (blogs)

Hattip: @mrgunn via @clasticdetritus (Twitter)

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