Grand Rounds: Evolving from Link-♥♥ to ♬♫-Links?

9 01 2012

Grand Rounds is “the weekly summary of the best healthcare writing online”. I’ve hosted this medical blog carnival twice and considered it a great honor to do so.

I have submitted a lot of posts to the Grand Rounds. Often I even wrote a special blog post to fit the theme if there was one. Almost all my submissions have been accepted. I really enjoyed the compilations. There was a lot of outstanding creativity and originality in how the links to the blogs were “aggregated” and highlighted.

Usually I only read those posts that seemed the most interesting to me (the summary thus works as a filter). But through the Grand Rounds I read posts that I would never have read and I learned about bloggers I never heard of.

Why am I talking in the past tense? The Grand Round is still there, isn’t it?!

Yes, it is still there (luckily), but the organizers are thinking of a “rejuvenation of  this old dinosaur”. As the previous host, Margaret Polaneczky explained

“… Grand Rounds has dropped a bit off all of our radars. Many, if not most of us have abandoned the old RSS feed to hang out on Twitter, where our online community has grown from a few dozen bloggers to feeds and followers in the hundreds and even thousands.”

One of the measures is that the Grand Rounds editions should be more concise and only include the “best posts”.

I too go for quality, and think one should carefully select contributors (and hosts), but is the 7-year-old dinosaur to be saved by chopping him in pieces? Should we only refer to 10 posts at the max and put the message in a tweet-format like Margaret did in an experiment?
I was glad that Margaret gave a good old fashioned long introduction in the Dinosaur’s style, for that was what I read, NOT the tweets. Sorry tweets are NOT a nice compilation. They are difficult to read.
It also isn’t a solution to tweet the individual links, because a lot of those individual tweets will be missed by most of the potential readers. It is not coherent either. The strength of the Grand Rounds is in the compilation, in the way the host makes the posts digestible. I would say: let the host present the posts in an attractive way and let the reader do the selection and digestion.

Also important: how many of us will write blog posts specially for the Grand Rounds if there is a chance of 2 in 3 that it will be rejected?

It is true that the Grand Rounds is less popular than a few years ago and it is harder to get hosts. But that may partly have to do with advertising. My first Grand Rounds got far more hits than the second one, mainly because we sent a notice to great blogs that linked to us, like Instapundit (853 hits alone) and there was an interview with the host announcing the Grand Rounds at MEDSCAPE. In this way the main intended audience (non-blogging lay people) were also reached. The second time my post was just found by a handful of people checking the edition plus this blog own readers.
(I have to admit that this last Grand Rounds Edition might have been better if it had been more concise, but at least one person (Pranab of Scepticemia) spend  2 hours in reading almost all the posts of the round-up. So it wasn’t for nothing)

If some busy clinicians can be persuaded to host The Grand Rounds using a shorter format, that is fine. And it is good to be more concise and leave out what isn’t of high quality. But why make it a rule to include just 10 or 12? Even more important, don’t change blog posts for tweets. For I don’t think, as Margaret passed on, that the concept of the individual blog has been sometimes “overshadowed by Twitter and Facebook, whose continual unending stream demands our constant attention, lest we miss something important that someone said or re-said…” Even I have given up to constantly follow all streams, and I suppose the same is true for most clinicians, nurses etc. Lets not replace posts by tweets but lets use Twitter and Facebook to promote the Grand Rounds and augment its radius.

The main reason for writing this post is that I disliked the description by Bryan Vartebedian (host of the next round) rather off-putting, perhaps even arrogant:

Grand Rounds is evolving as a more focused, curated publication.  Rather than a 4,000 word chain-o-links, Nick Genes, Val Jones and others felt that a focused collection of recommendations would be more manageable for both readers and hosts.  This is Grand Rounds for quality rather than link love.

Bryan loves the word link-love. Two posts back he wrote:

It isn’t contacts, followers, friends, subscriptions, readers, link love, mentions, or people’s attention.  It’s time.  With time I can have all of these things.  

“Link love” and “chain-o-links” undervalue what blog carnivals are about. Perhaps some bloggers just want to be linked to, but most want to be read, and that is the entire idea behind the blog carnival. I can’t imagine that the blog hosts aim to include as many links as possible. At the most it is love for particular posts not “link love” perse.

Changing the format to tweets (♬♫) will only increase the link/text ratio. Links will become more prominent.

I would rather go for the ♥♥-links*, because I  to blog and I  to read good stuff.

——–

* Note that ♥♥-links is not the same as link-♥

——–

Here is a short Twitter Discussion about the new approach. I fully agree with Ves Dimov viewpoint, especially the last tweet.





Grand Rounds Vol 8 nr 5: Data, Information & Communication

26 10 2011

Welcome to the Grand Rounds, the weekly summary of the best health blog posts on the Internet. I am pleased to host the Grand Rounds for the second time. The first time, 2 years ago, was theme-less, but during the round we took a trip around the library. Because, for those who don’t know me, after years of biomedical research I became a medical librarian. This also explains my choice for the current theme:

DATA, INFORMATION & COMMUNICATION

The theme is meant to be broad. According to Wikipedia:

Information in its most restricted technical sense is a message (utterance or expression) or collection of messages that consists of an ordered sequence of symbols, or it is the meaning that can be interpreted from such a message or collection of messages. Information can be recorded or transmitted (…) as signs, or conveyed as signals by waves. Information is any kind of event that affects the state of a dynamic system. (…) Moreover, the concept of information is closely related to notions of … communication.. dataknowledge, meaning, .. perception. .. and especially entropy.

I am pleased that there were plenty submissions on the topic. I love the creative way the bloggers used the theme “information”. In line with the theme the information will be brought to you according to the Rule of Entropy, seemingly chaotic. Still all information is meaningful and often a pleasure to read. Please Enjoy!

INDIA, WISDOM & IMAGESIMAGING

From: IBN-live (India): Book News: “Kama Sutra is about sexual & social relations”

IMAGES are a great way to tell information, especially if you don’t understand the language. The picture above is from the Kama Sutra, an ancient Indian Hindu work on human sexual behavior in Sanskrit literature. Did you know the original Kama Sutra is not all about sex and does not have any pictures? Only words, no graphic. And sadly, as a text, it isn’t widely read.

Yes, we start our trip where it ended last week, in INDIA

Our host of last week, Sumer Sethi of Sumer’s Radiology Site, shows very clear (MRI)-images of partially recanalized internal jugular vein thrombosis, in a patient with MS, possibly supporting the theory that MS is a result of chronic venous insufficiency. As readers of this blog know Laika is not impressed by n=1 data, although it may be a good starting point. However, Sumer underpins this link with a paper in J Neurol Neurosurg Psychiatry 2009. Still, a quick look at the citing papers shows many new studies don’t confirm the association of MS with cerebrospinal venous insufficiency…

Another great radiologist, also from India, isVijay Sadasivam (@scanman). No recent posts, but at Scanman’s Casebook you will find an archive of interesting radiological cases, in the form of case reports.

The quite tech savvy surgeon Dr. Dheeraj (aka Techknowdoc) explores the alternatives to the invasive and uncomfortable colonoscopy procedure at Techknowdoc’s Surgical Adventures! This post is a short illustrated guide, visualizing the differences between regular colonoscopy, capsule endoscopy and Virtual Colonoscopy. It is not hard to imagine which approach people would prefer.

Pranab (aka Skepticdoctor) makes an urgent appeal to fellow Indians to help Amit Gupta and other Indian people to get a bone marrow transplant when they need one. Amit has Acute Leukemia, but South Asians are very poorly represented in bone marrow registries, so his odds of getting a match off the registries in the US are slim. The chances are even worse for the less well-off Indians. Read at Scepticemia how you can help. For Amit, for India, for you, or worse, someone you love more than yourself….

Dr. Jen Gunter ridicules Cosmo’s to-go version of the Kama Sutra in a short series! For the “sex positions of the days” are just an offensive alliteration and woeful ignorance of female anatomy… Looking up medical information is the 3rd most common on-line activity. While there are good sites with great information that can help people be empowered about their health, there are also tons of terrible sites marred by bias and rife with the stench of snake oil. In an other post at Dr. Jen Gunter (wielding the lasso of truth) Jen reveals 10 red flags that will help you separate the wisdom from the woo.

THE POWER OF WORDS, MUSIC AND VISUAL ARTS

http://www.flickr.com/photos/isfullofcrap/5147100521/

Yes, a picture is worth a thousand words. And this is also true for other audiovisual arts. 

Yet, some Medical Bloggers master the art of storytelling, they convey of events in words, images and sounds. And here, words have the same powerful strength. Often these posts of these storytellers are about communication and they know how to communicate that.

One of the master storytellers is Bongi, a general surgeon from South Africa. He submitted the post die taal (that language), which is clearly about communication but in a language (“Afrikaans”), that I can understand, but many of you don’t. Therefore I choose another post at Other Things Amanzi, which is also about communication: “It’s all in the detail”

Another great storyteller, and the winner of the best literary medical blog category of Medgadget contest in 2009 and 2010 is StorytellERdoc. In the beautiful post The Reminder – EKG #6, he tells us how the 6th abnormal EKG in a presentation of one of the residents, brought back memories to the technician who made that EKG: “There is something more important about this EKG than it’s tracing, I began” ….

Robbo (Andrew Roberts) is a pharmacist from one of the most remote parts of Australia working full time in Aboriginal Health. His blog BitingTheDust often covers topics like aboriginal art and pharmacy. There is also a category “information-resources”. His latest post in this category explains how condoms are made and how they work. A video goes with it.

Øystein of  The Sterile Eye (Life, death and surgery through a lens) uses photos throughout his blog. His latest post is about a brochure “LEICA – Fotografie in der Medizin” (Photography in Medicine) that was published by Leitz in 1961.

Another blogger, unique in its kind, “raps” his stories. Yes I’m talking about Zubin, better known as ZDoggMD. Watch how he and his mates colleagues rap “Doctors Today!” where he “informs” folks of what it’s like to actually practice primary care medicine on the front lines. Want to know more about this medical rapper, then listen to this radio interview with a med-student run radio (RadioRounds). It’s about using video to “inform” patients and healthcare providers about health-related issues in a humorous way.

Movies are also a good way to “tell a story” and pass information. Ramona Bates reviews the Lifetime’s Movie “Five” at her blog Suture for a Living. Five is an anthology of five short very emotional (but not sentimental) films exploring the impact of breast cancer on people’s lives.

We have had pictures, music, videos and movies as data carriers. But here is a post that is based on the good old book. Dr. Deborah Serani (who has a blog of her own: Dr. Deb: Psychological Perspectives) submits a review from PsychCentral about her new book “Living with Depression.” My first intuitive response: how can a psychologist or psychoanalyst write about “living with“. But it seems that Deborah Serani has faced a lifelong struggle with depression herself. This memoir/self help book seems a great resource for anyone in the health field looking for information about mood disorders, treatments and recommendations. The review makes me want to read this book.

SOCIAL MEDIA & MOBILE APPS

http://www.flickr.com/photos/verbeeldingskr8/4507350257/

What about social media as a tool for medical communication and a source of information?

At Diabetes Mine Allison B. and Amy Tenderich review numerous new mobile apps for managing diabetes. Their reviews “Diabetes? There’s An App For That” and “Glooko: iPhone Diabetes Logging Made Super-Easy” may help to choose diabetes patients among the bevvy of diabetes apps.

Twitter is seen as offering more noise than signal, but there’s valid medical data that can be uncovered. Ryan DuBosar at the ACP internist blog highlights how a researcher uses Twitter to track attitudes about vaccination and how they correlate with vaccination rates. The study adds to a growing body of evidence that social networking can be used to track diseases and other natural disasters that affect public health.

Hot from the press, I can’t resist to include a post from the web 2.0 pioneer Dr. Ves at CasesBlog. Ves Dimov usually writes many short posts, but today he explains Social media in Medicine in depth and guides you “How to be a Twitter superstar and help your patients and your practice”. According to his interesting concept two Cycles, the cycle of Patient Education and the Cycle of Online Information and Physician Education, work together as two interlocking cogwheels.

Mayo Clinic started using social media for communication with patients well before all the recent hype and it organized tweetcamps back in 2009. David Harlow made the pilgrimage to Rochester, MN and spoke at the Mayo Clinic Center for Social Media’s Health Care Social Media Summit last week. According to David “A ton of information was presented, through traditional channels and through some multimedia demos as well”. He shares conference highlights in this post at HealthBlawg, like “It is impossible to transplant a successful program from one location to another without taking into account myriad local conditions”. And “health care providers will have to do more with less”. Therefore e-Patient Dave suggests in his closing keynote to “Let Patients Help”.

Nicholas Fogelson of Academic OB/GYN notes that an operating room without incentives is very expensive. He proposes to install a cheap digital toteboard in every operating room in the USA, that would read how many dollars have been spent on that case at that moment. The idea is that surgeons who know exactly what they are spending, would compete to spend less wherever they could.

According to Bryan Vartabedian the social and technological innovations cause doctors to slowly change from analog physicians to digital physicians. He mentions 6 differences between these doctors. The first is that the information consumption of the digital physician is web-based, while the analog doctor consumes information through paper books and journals, often saying curious things like, “I like the smell of paper” or “I’ve gotta be able to hold it.” By the way, Bryan’s blog 33 Charts is all about social media and medicine.

Blogging doctors are digital doctors per definition, but that doesn’t mean they don’t want to discuss things and see each other in real life. Dr. Val of Better Health and cofounder of this Grand Rounds announces a blog conference in Los Angeles, the Blog World Expo, on November 4th, 2011. Her talk is about “physicians engaging online in social health”, but she is actually hoping that many members of the medical blogging community will be out there IRL! At her blog you can get discount tickets.

The online presence of doctors at social media places can have serious drawbacks. The post of Anne Marie Cunningham about derogatory and cynical humour as displayed by medical personnel at Twitter and Facebook has made it to the Daily Telegraph, other UK newspaper, and to my blog…. This post at Wishful thinking in medical education is a must read for healthcare providers embracing social media.

Many physicians have an online presence, but do they really use social media for decision making, wonders Chris Nickson. From his post and the ensuing reactions at Life in the Fast Lane it appears that tools like Twitter and the comments sections on blogs enable a constant, ongoing dialogue with emergency physicians and critical care experts around the world regarding puzzling clinical issues. Rarely, however, there is a direct ‘tweet’ for clinical help. Rather Twitter contributes to the serendipitously finding of relevant and significant information.

Perhaps direct clinical questions are not asked because Twitter (and Facebook to some extent) are open social media. Bertalan Mesko of ScienceRoll mentions that some French doctors actually perform case presentations on Google+, taking advantage of the very simple privacy settings of Google+. They upload information about the case, discuss it with other peers and get to a final diagnosis.

E-Patient Dave announced a seven hour event about information transfer during transitions of care. This event was webcasted, tweeted and discussed on Google+. (also see Brian Ahier’s post about it on Government Health IT). Dave gives some examples that highlight that without reliable information transition, the care transition can become dangerous. Yes, good IT can help.

DATA, DATABASES, OPEN ACCESS, EBM

http://www.flickr.com/photos/verbeeldingskr8/4029292954/

We now arrive at a clinical librarian topic, medical information via databases, journals and the role of EBM.

The first post bridges this and the previous topic. Jon Brassey is co-founder of  the TRIP-database, a clinical search tool designed to rapidly identify the highest quality clinical evidence for clinical practice. At his blog Liberating the Literature he expresses his view that search is -at best- a partial solution. He is passionate about answering clinician’s questions and would rather see an answer machine than a search engine. Jon is very tempted to allow users to upload their own Q&As, thereby creating an open repository of clinical Q&As. I am more skeptical, because this kind of EBM sharing might be at the expense of the quality of evidence.

What do you think? Can social media and EBM reinforce each other or not? Please tweet your ideas to Anabel Bentley (@doctorblogs at Twitter) who is giving a talk at Evidence 2011 (#ev2011) tomorrow on social media & EBM and asks for your input. You might also want to read my older post about The Web 2.0-EBM Medicine split.

Dean Giustini reviews PubMed Health at The Search Principle Blog. Dean describes PubMed Health as follows. It is as a consumer version of PubMed – a metasearch tool that gathers evidence from Cochrane Collaboration, Nice and other EBM sources to see clinical studies and “what works” in human health. One major benefit of PubMed Health is that any search performed on PubMed Health also runs in PubMed.” Sounds like worth trying.

The invitation to join the editorial board of a relatively new online, open access journal, without receiving any compensation triggered Skeptic Scalpel to ponder about the tangible benefits of open access publishers (coined as “predatory open access” by a commenter) and about how many journals are really needed? Who has the time or interest to read 25 journals on a relatively specialized topic? And what about the quality of the articles in all these journals?

Indeed as The Krafty Librarian explains  the “good guys” (open access) are making just as much profit as the “bad guys.”  They both are for profit. Open Access is not the panacea that many think it is.

Tasha Stanton of Body in Mind asks the intriguing question what to do if systematic reviews on the same topic don’t all give us the same conclusions, whereas you would expect they would collate the same evidence. Tasha finds this disconcerting as for some conditions this could take ages before we could ‘trust’ the evidence. In the example discussed here an Umbrella review was helpful in assessing the evidence. Also the quality of systematic reviews is improving.

SCREENING & DIAGNOSIS. BALANCING BENEFITS & HARMS. 

From: http://www.naturalnews.com/025768_radiation_cancer_mammograms.html as seen at Science Based Medicine

Many people think screening is always a good thing and will prevent or cure a disease. But not every test is a good test and often there are both harms and benefits. It is difficult for patients to understand the true value of tests. 

Margaret Polaneczky, MD was touched by a beautiful essay in the NY Times written by a mother of a child born with Tay Sachs disease. While the mother in her loved the essay, the doctor in her cringed, because a single paragraph about the mother’s experience with prenatal screening had the potential to misinform and even frighten readers. Margaret writes a bit of a primer on Tay Sachs screening at the Blog That Ate Manhattan, mainly to set realistic expectations about what prenatal testing can and cannot accomplish.

David Williams at the Health Business Blog reasons that the US Preventive Services Task Force (USPTF) recommendations against routine use of the PSA blood test in healthy men should not have been delayed because of the the firestorm of controversy created by the 2009 screening mammography guidelines… Because uh-oh well, PSA testing is different (and David is right)…  It’s all about what kind of info we can expect from screening and where it leads us.

This month is breast cancer awareness month, meant to highlight issues of breast cancer and try to call attention to new discoveries about breast cancer. Personally I have mixed feelings about the pink ribbon exploitation of this month”, but David Gorky at Science Based Medicine points at a worse misuse: quacks seize the opportunity to spread their message against science-based modalities for the detection and treatment of breast cancer and to promote their “alternative” methods. (see Fig. above).

BIOMEDICINE, BRAINS AND THE PROCESSING OF INFORMATION

http://www.flickr.com/photos/caseorganic/3675792814/ [CC]

Dr Shock MD PhD reviews a Dutch trial that shows that availability bias contributes to diagnostic errors made by physicians. Availability bias means that a disease comes more easily to the mind of a doctor who diagnoses this disease more often. This study also suggests that analytical or reflective reasoning may help to counteract this bias.

In an intriguing post counseling psychologist Will Meek, PhD covers some of the recent research on two information processing systems as identified by Daniel Kahneman: Intuition and Reasoning. A simple experiment confirms (in my case) that we use intuition for most of the day, and occasionally use reasoning to answer more complex problems. Some people may also frame this as “head vs heart”. Both systems have their pros and cons and both are needed to make good decisions. Otherwise common problems can arise.

David Bradley of ScienceBase discusses recent research by Gallant and colleagues who were able to reconstruct a video image presented to a subject in a functional MRI machine. David dreams of uploading our dreams to Youtube and of developing a mind-machine interface to allow people with severe disabilities to communicate their thoughts and control a computer or equipment. But David is more of a scientist than a dreamer and he interviews Gallant to find out more about the validity of the technique.

Computational Biologist Walter Jessen highlights “National Biomedical Research Day” at Highlight HEALTH. “National Biomedical Research Day” was proclaimed by Bill Clinton in 1993 on the 160th anniversary of Nobel’s birth. This day celebrates the central role of biomedical research  in improving human health and longevity.

MISINFORMATION, WRONG INFORMATION AND LACK OF INFORMATION

http://www.flickr.com/photos/truthout/3901813960/
This image was paired with the story: Insurers Shun Those Taking Certain Meds

Philip Hickey at Behaviorism and Mental Health discusses homosexuality. Philip: “homosexuality is a complex phenomenon which defies simplistic explanations. Unfortunately in this field valid information and communication often take a back seat to bigotry and prejudice.”

In his post “Want go Dutch…or German…or French?” at HUB’s LIST of medical fun facts Herbert Mathewson, MD argues that “Before trying to copy other nation’s health care systems we should probably actually learn about them.” The outcomes of the Dutch switch from a system of mandatory social insurance administered by nonprofit sick funds to mandatory basic insurance that citizens had to buy from private insurance companies (“managed competition”) are appalling! I can imagine that the idea that the Dutch reforms provide a successful model for U.S. Medicare seems bizarre. (Herbert’s post is based on a NEJM article “Sobering Lessons from the Netherlands”).

Henry Stern of InsureBlog notes that as far as RomneyCare© (Massachusetts health care reform) is concerned it’s not so much lack of information per se that’s the problem. It’s information that’s wrong that gets you in trouble.

Robert Centor of Medrants simply submitted one sentence:
“I am a physician, not a provider, and Groopman agrees. – http://www.medrants.com/archives/6505″
This distinction between physicians and providers is similar to the distinction between consumers and patients, and I agree.

Rich Fogoros (DrRich) of The Covert Rationing Blog discusses recent article in the New York Times about whether nurses with a doctorate degree ought to be addressed as “doctor.” Most doctors think calling a nurse “doctor” is not appropriate and confusing for patients.
A medical student running the blog The Reflex Hammer agrees: medical students with a doctoral degree don’t introduce themselves as “Doctor” to a patient either, don’t they?
Dr Rich, an old hand, thinks otherwise. While it is indeed comforting that doctors should be so concerned about patients knowing everything they’re supposed to know, the fact (according to dr. Rich) is that the doctor-nurse controversy is a distraction.

INFORMATION YOU NEED


http://www.flickr.com/photos/nirak/1386793065/
credit: mattahan.deviantart.com/
Note: this is a librarian!!

And of course you always hope that you find the information you need or that you can inform people the right way.

Medaholic wonders whether you still would be a medical doctor if you knew that it didn’t pay as much? What sorts of information would help you determine whether this is a career worth pursuing?

The post, by Chris Langston, at the John A. Hartford Foundation blog, Health AGEnda details how interested health professionals can get information about how to apply for a new fellowship with the Center for Medicare & Medicaid Innovations office, and urges health professionals interested in improving health care for older adults to apply.

Hospital antimicrobial stewardship programs are prompting more appropriate prescribing of antibiotics, leading to improved patient care, less microbial resistance and lower costs, three studies show. The trick is how to convey this information so hospitals will implement these programs, as only one-third of U.S. facilities currently do. Read more at ACP Hospitalist, in the second contribution of Ryan DuBosar to this round.

We all know that adherence to prescriptions is a problem. But will the Star Ratings system increase adherence? The big question, according to Georg van Antwerp, author of Enabling Healthy Decisionsis whether consumers care about Star Ratings or just focus on lowest price point and access to pharmacies or specific medications.

Louise of the Colorado Health Insurer Insider summarizes her submission quite aptly: “Our submission is about the new Health Insurance Exchanges that will be starting here in the US soon. This post discusses how consumers will get INFORMATION about the health plans through the exchanges. Currently, consumers get their information through health insurance brokers or directly through the insurance carrier. If there are people to answer questions for consumers with the exchanges, how will the plans be more or less expensive”

The post that Reflex Hammer submitted (the one above was just picked by me) concerns informing young children about vegetables. A few weeks ago he and a classmate were invited to give a presentation to 1st graders at an inner-city school. Wishing to combat obesity, they developed a lesson plan about vegetables. They were heartened by how much the adorable kids already knew about vegetables and how enthusiastic they became about eating their greens. An adorable initiative and a great post to end this Grand Rounds, since it illustrates the importance of doctors who enjoy to take their time to inform people.

I just want to mention one other post, by Mike Cadogan at Life at the fast Lane. Mike doesn’t blog a lot lately, because he is preparing presentations for an important Emergency Medicine meeting. But Mike does share some of this journey with us in The 11 Phases Of Grief  Presentation Preparation. Reading these 11 stages, the similarities between writing a lecture and writing for Grand Rounds struck me. Except that beer had to be replaced by wine….

Mike is in stage 7-9, I am in stage 10-11. Stage 11 is Evaluation: What will I do different next time? First, I won’t go for two blog carnivals at the same time, I won’t plan a Grand Round when I’m away for the weekend* (I just need a lot of time) and I should refrain from adding posts that weren’t even submitted….

Will you remind me next time?

I hope that you enjoyed this Grand Rounds and that it wasn’t too much information. I enjoyed reading and compiling all our posts!

Related articles





Call for Submissions: Medical Grand Rounds at Laika’s MedLibLog

18 10 2011

Grand Rounds is a weekly round up of the best health blog posts on the Internet. Each week a different blogger takes turns hosting and summarizing the best submissions of the week.

October 25th I will be your host. Again…. for I have hosted Grand Rounds once before. Then we made a trip around the library.

This time the theme will be “INFORMATION”.

Difficult? Not at all. Almost anything may fit into this theme. Examples:  Searching for information, information overload, lack of information, misinformation, the hardest information you had to share, the way the doctor (mis)informed you about a disease, how pharma deals with information…. The way information is interpreted (you can also choose psychiatric topics here). Nice or noteworthy articles or books you read. Or you may review an app. Web2.0 tools. Social Media. Data carriers. Ah well, if you sell it the right way and your post is of good quality, I will accept almost everything…..

I have one slight problem though. Grand Rounds is traveling all the way from India to the Netherlands this week and I am away for the weekend. You would help me tremendously if you submit your post this Tuesday or Wednesday!

Official Deadline: Sunday October 23rd, 20.00 pm Central European Time. This is 14.00 EDT (NY)

Please Email your submissions to:

And include:

  •  “Submission for Grand Rounds” in the subject line of your e-mail.
  • Your name (blog author), the name of your blog, and the URL of your specific blog-post submission.
  • A short summary (1 to 3 sentences) of your blog post.

I look forward to receiving your submissions and featuring them here next week. Thank you!

Jacqueline aka Laika.

Photo Credits (CC):  Picture by mag3737 (Flickr)





Grand Rounds 7-50: Dr. Rich Did a Great Job… Jobs, Jobs, Jobs…

6 09 2011

In the old days, bloggers whose posts were included in the Grand Rounds would link to that post from their own blog. Grand Rounds, for those who are not familiar, is a  weekly compilation of the best of the medical blogosphere.

I used to refer to the Grand Rounds once in a while, but quit this habit to prevent that my own posts would get lost amidst the summarizing and/or referring posts.

But I will make an exception for a Grand Rounds edition that is written by a man who combines modern practice along with classic craftsmanship (rather called “old fartness” by the author concerned).

Anyway, Dr Rich of the latest edition of Grand Rounds did a great job with his Grand Rounds 7-50: The Jobs! Jobs! Jobs! Edition.

First of all I was surprised to find a very good summary of my own post. A post about a search topic, which I was rather surprised to find included in the first place. Please let me share this excellent & quite funny plain language summary of my post.

Jaqueline writes Laika’s MedLiblog, a blog dedicated to medical information science. She submits a post entitled, “PubMed’s Higher Sensitivity than OVID MEDLINE… & other Published Clichés,” in which she shows how medical researchers doing literature searches for, among other things, meta-analyses, will stumble upon various “anomalies” in their searches of the PubMed and OVID databases, and then write additional, CV-padding papers about those anomalies. Jaqueline points out that these so-called “anomalies” are actually well-documented “clichés,” which are well-known to information specialists and anyone else who is competent in doing comprehensive literature searches. In other words, Jaqueline has documented that these meta-analysis researchers are rank amateurs at doing the most critical step in conducting meta-analyses – searching the literature for all the appropriate published studies. DrRich has always mistrusted meta-analyses, and Jaqueline has helpfully identified yet another reason to justify such mistrust. He thanks Jaqueline, and whoever planted those database anomalies which allow us to identify potentially incompetent meta-analysis researchers. 

Second, I am always happy if a Grand Round not only quotes the posts of the great medical bloggers I already know, but also includes posts of bloggers who are new to me. Today I’ve found two new blogs I’ve subscribed to.

The First is Sharp incisions (… random cuts in the life of a fledgling medical student), a blog started in 2010 by a second year medical student. He/she wrote an affecting post in 5 parts about the harvesting of six vital organs for transplantation from a patient who has been declared brain dead. (First part starts here)

Here is a quote from the last (5th) part:

Now, all that was left was to close his incision.

I stood beside the surgeon, watching, but through the sterile drape, I reached for the patient’s hand, squeezed it, and silently said,

‘Thank you. Your legacy lives on in these lives you’ve saved.’

One heart.
Two lungs.
A liver.
Two kidneys.

Six futures.

Another blog I subscribed to is In My Humble Opinion (A primary care physician’s thoughts on medicine and life), written by Jordan Grumet (@jordangrumet at Twitter), an Internal Medicine physician. This blog already started in 2008 (just like this blog).

I really enjoyed the beautiful post Sometimes We Are Doctors or as he says at the end of his post:

We are all patients sometimes… and sometimes we are doctors.”

For more summaries please read the entire Grand Rounds at the Covert Rationing Blog. You might just discover your own new favorite blog.





Kaleidoscope #3: 2011 Wk 12

23 03 2011

It has been long since I have posted a Kaleidoscope post with a “kaleidoscope” of facts, findings, views and news gathered over the last 1-2 weeks. There have been only 2 editions: Kaleidoscope 1 (2009 wk 47) and 2 (2010 wk 31).

Here is some recommended reading from the previous two weeks. Benlysta (belimumab) approved by FDA for treatment of lupus.

Belimumab is the first new lupus drug approved in 56 years! Thus, potentially good news for patients suffering from the serious auto-immunity disease SLE (systemic lupus erythematosus).  Belimumab needs to be administered once monthly via the intravenous route. It is a fully human monoclonal antibody specifically designed to inhibit B-lymphocyte stimulator (BLyS™), thereby reducing the number of circulating B cells, and the produced ds-DNA antibodies (which are characteristic for lupus).
Two clinical trials showed that more patients experienced less disease activity when treated with belimumab compared to placebo. Data suggested that some patients had less severe flares, and some reduced their steroid doses (not an impressive difference using “eyeballing”). Patients were selected with signs of B-cell hyperactivity and with fairly stable, but active disease. Belimumab was ineffective in Blacks, which are hit hardest by the disease. The most serious side effect were infections: 3 deaths in the belimumab groups were due to infections.
Thus, overall the efficacy seems limited. Belimumab only benefits 35% of the patients with not the worst form of the disease. But for these patients it is a step forward.

  1. Press Announcement (fda.gov).
  2. Navarra SV, Guzmán RM, Gallacher AE, Hall S, Levy RA, Jimenez RE, Li EK,Thomas M, Kim HY, León MG, Tanasescu C, Nasonov E, Lan JL, Pineda L, Zhong ZJ, Freimuth W, Petri MA; BLISS-52 Study Group. Efficacy and safety of belimumab in patients with active systemic lupus erythematosus: a randomised, placebo-controlled, phase 3 trial. Lancet. 2011 Feb 26;377(9767):721-31. Epub 2011 Feb 4. PubMed PMID: 21296403.
  3. Belimumab: Anti-BLyS Monoclonal Antibody; Benlysta(TM); BmAb; LymphoStat-B. Drugs in R & D (Open Access): 28 May 2010 – Volume 10 – Issue 1 – pp 55-65 doi: 10.2165/11538300-000000000-00000 Adis R&D Profiles (adisonline.com)

Sleep-deprived subjects make risky gambling decisions.

Recent research has shown, that a single night of sleep deprivation alters decision making independent from a shift in attention: most volunteers moved from seeking to minimize the effect of the worst loss to seeking increased reward. This change towards risky decision making was correlated with an increased brain activity in brain regions that assess positive outcomes (ventromedial prefrontal activation) and a simultaneous decreased activation in the brain areas that process negative outcomes (anterior insula). This was assessed by functional MRI.

One co-author (Chee) noted that “casinos often take steps to encourage risk-seeking behavior — providing free alcohol, flashy lights and sounds, and converting money into abstractions like chips or electronic credits”

Interestingly, Chee also linked their findings to empirical evidence that long work hours for medical residents increased the number of accidents. Is a similar mechanism involved?

  1. Venkatraman V, Huettel SA, Chuah LY, Payne JW, Chee MW. Sleep deprivation biases the neural mechanisms underlying economic preferences.  J Neurosci. 2011 Mar 9;31(10):3712-8 (free full text)
  2. Sleep deprived people make risky decisions based on too much optimism (Duke Healthpress release)

Grand Rounds

Grand Rounds is up at Better Health. Volume 7, Number 26 is an “Emotional Edition” where posts are organized into emotion categories. My post about the hysteria and misinformation surrounding the recent Japanese earthquake is placed under Outrage.

There are many terrific posts included. A few posts I want to mention shortly.

First a post by a woman who diagnosed hers and her sons’ disease after numerous tests. Her sons’ pediatrician only tried to reassure, so it seems. (“don’t worry…”).

I was also moved by the South African surgeon, Bongi, who tells the tragic story of a missed diagnosis that still haunts him. “For every surgeon has a graveyard hidden away somewhere in the dark recesses of his mind…”

Bongi’s blog Other Things Amanzi is one of my favorites. Another blog that has become one of my favs is 33 Charts by Dr. Bryan Vartabedian. Included in this Grand Round is “And a child will lead them“. It is a beautiful post about the loss of a young patient:

….”And facing Cooper’s parents for the first time after his passing was strangely difficult for me.  When he was alive I always had a plan.  Every sign, symptom, and problem had a systematic approach.  But when faced with the most inconceivable process, I found myself awkwardly at odds with how to handle the dialog”….

Other Medical Blogs

Another of my recent fav blogs is the blog of cardiologist, dr. Wes. Two recent posts I would especially like to recommend.

The first asks a seemingly simple question: “So which set of guidelines should doctors use?” The answer, however,  may surprise you.

In another post dr Wes describes the retraction of an online-before-print case report entitled “Spontaneous explosion of implantable cardioverter-defibrillator” with dramatic pictures of an “exploded ICD” .(here is the PDF of the cache). This retraction took place after dr. Wes reported the case at his blog. Strange enough the article was republished this February, with another title, “Case report of out-of-hospital heat dissipation of an implantable cardioverter-defibrillator.” (no explosion anymore) and no shocking photos. Food for thought….  The main conclusion of dr Wes? Independent scientific peer-reviewed journals might not be so independent after all. Library matter

Sorry, but I had to laugh about David Rothman’s Common Sense Librarianship: An Ordered List Manifesto. As put it so well by Kathryn Greenhill at her blog Librarians Matter: “It is a hot knife of reason through the butterpat of weighty bullshit that often presses down as soon as we open our mouths to talk about our profession.”

Oh, and a big congrats to Aaron Tay for his  Library Journal moversShakers award. Please read why he deserves this award. What impresses me the most is the way he involves users and converts unhappy users “into strong supporters of the library”. I would recommend all librarians to follow him on Twitter (@aarontay) and to regularly read his blog Musings about Librarianship. Web 2.0

The iPad 2 is here. A very positive review can be found at Techcrunch. The iPad 2 has a camera, is thinner, lighter, and has a much more powerful dual-core chip. Still many people on Twitter complain about the reflective screen. Furthermore the cover is stylish but  not very protective as this blogger noticed 2 days after purchase.
Want to read further: You might like “iPad 2: Thoughts from a first time tablet use” (via @drVes)

It has been five years since Twitter was launched when one of its founders, Jack Dorsey, tweeted “just setting up my twttr’. Now Twitter nearly has 200 million users who now post more than a billion tweets every week. (see Twitter Blog)

Just the other week  Twitter has told developers to stop building apps. It is not exactly clear what this will mean. According to The Next Web it is to prevent confusion of consumers third-party Twitter clients and because of privacy issues. According to i-programmer the decision is mainly driven by the desire of Twitter to be in control of its API and the data that its users create (as to maximize its -future- revenue). I hope it won’t affect Twitter-clients like Tweetdeck and Seesmic, which perform much better (in my view) than Twitter.com.





MedLib’s Round is up at DigiCMB

11 09 2010

This months MedLib’s Round is up at DigiCMB the blog of Guus van den Brekel.

The title is Emerging Technology in Medical and Health Information.

Unfortunately there were few submissions. By adding a lot of useful information and links himself, Guus succeeded in composing a rich edition on the topic. You can read it all here

His intention was that colleagues specifically posted on the theme ànd commented on his Continuing Education Course (CEC) at EAHIL2010. You can still do the latter.
Here is the public course:
http://www.netvibes.com/emergingtechnologiesinlibraries
.

Considering the small niche of the MedLibs Round, and the fact that this round is not purely meant for medical librarians alone, I wouldn’t recommend strict themes. It would be perfect if participants to the round would write a post specifically for the round on a topic specifically fitting the theme, but in reality that is seldom done.

I had hoped that it would go as easy as the weekly Grand Rounds, where people automatically start submitting and keep an eye themselves on who is hosting the rounds, but that is not the case. But perhaps this is a bit naïve.

Still it is a good round with lot of quality submissions and excellent hosts. So we surely will continue, although likely under a new name  (soon to be announced)

The next 3 hosts are cream of the crop again:

You can already start submitting the permalink of your post HERE at the Blog Carnival.

The next submission deadline is October the 3rd.





Kaleidoscope 2009 wk 47

19 11 2009

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Kaleidoscope is a new series, with a “kaleidoscope” of facts, findings, views and news gathered over the last 1-2 weeks.

Most items originate from Twitter, my Google Reader (RSS) and sometimes real articles (yeah!).

I read a lot, I bookmark a lot, but only some of those things end op in a post. Since tweets have a half-life of less than a week, I thought it would be nice to safeguard some of the tweets in a post. For me to keep, for you to read.

I don’t have the time and the discipline to post daily about health news and social media as Ves Dimov does. It looks more like the compilation at blogs of dr Shock’s (see example),  dr Bates shout-outs, Health Highlights of Highlight HEALTH and Rachel Walden’s Womens health News Round-ups, but less on one subject and less structured. It will just be a mix of old and new, Social Media and science, just a kaleidoscope. Or a potpourri  if you like.

I don’t know if this kaleidoscope will live a long live. I already wrote 2 3 4 5 6 editions, but didn’t have the time to finish them. Well, we will see, just enjoy this one.

Ooh and the beautiful kaleidoscope is made by RevBean and is called: Eyeballs divide like cells. Looks very much like the eyeball-bubblewrap of a previous post but that is thus coincidence. Here is the link (Flickr, CC)

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Medical Grand Rounds

Louise Norris at Colorado Health Insurance Insider is this week’s host of Grand Rounds.(see here). There are many interesting posts again. As a mother of two teens I especially liked the insight Nancy Brown of Teen Health 411 brings us into what teens want when it comes to their relationships with their parents and the “would you rather…?” story that Amy Tenderich of Diabetes Mine shares with us. The punch line is great. Her 9 year old melts my heart.

At InsureBlog’s Hank Stern brings us an article about a British hospital that will no longer admit expectant mothers with a BMI of more than 34, because the hospital’s labor and delivery unit is not equipped to handle complicated births. Hank concludes: “Fear not, though, portly preggies have to travel but 20 miles to the next closest facility. Assuming, of course, that they can make it that far when contractions are minutes apart.”

Dr Charles of the The Examining Room wrote an in depth article about a cheerleader who was supposedly stricken with dystonia following a seasonal flu vaccine in August. Dr Charles not only highlights why (specialists) think it is not dystonia, but gives also background information about the efficacy of vaccins.

Recent editions of the Grand Rounds were at CREGRL, flight nurse (link), NonClinicalJobs (link) and Codeblog, tales of a nurse (link). You can always find previous and upcoming hosts at the Grand Rounds Archive at Blogborygmi.

3621322354_4bc3bb115e Breast cancer screening

The update of the 2002 USPSTF recommendation statement on screening for breast cancer in the general population, published in the November issue of The Annals of Internal Medicine has led to heated discussions in the mainstream media (i.e. New York Times and MedPage Today). Based on current evidence, partly based on 2 other articles in the same journal (comparison screening schedules and an systematic review) the guidelines advise scaling back of the screening. The USPSTF recommends:

  • against routine screening mammography in women aged 40 to 49 years
  • against routine screening mammography of women 75 years or older.
  • biennial (instead of annual) screening mammography for women between the ages of 50 and 74 years.
  • against teaching breast self-examination (BSE).
  • against either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities.

The two articles published in Ann Intern Med add to the evidence that the propagation of breast cancer self exam doesn’t save lives (see Cochrane review discussed in a previous post) and that the benefits of routine mammography in the young (<50) or old (>75) do not outweigh the harm (also covered by a  Cochrane review before). Indeed, as put forward by Gary Schwitzer at Schwitzer health news blog this is NOT a new debate. He refers to Slate who republishes a five-year old piece of Amanda Schaffer that does a good job of explaining the potential harms of screening. However it is difficult for women (and some doctors) to understand that “When it comes to cancer screening, more isn’t always better.” Indeed -as Kevin Pho at Kevin MD states, the question is whether “patients will accept the new, evidence-based, breast cancer screening guidelines”.

In the Netherlands it is already practice to start biannual routine mammography at the age of 50. The official breast cancer screening site of the RIVM even states that the US is now going to follow the Dutch guidelines ;) (one of assessed guidelines in one the Ann Intern Med papers is Dutch). But people still find the  long established guidelines difficult to accept: coincidentally I saw tweets today asking to sign a petition to advance the age of screening ‘because breast cancer is more and more frequently observed at young age…(??)’ Young, well educated, women are very willing to sign…

No time to read the full articles, but interested to know more, then listen to the podcast of this Ann Intern Med edition:

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Systematic Reviews, pharma sponsored trials and other publishing news

Cochrane reviews are regarded as scientifically rigorous, yet a review’s time to publication can be affected by factors such as the statistical significance of the findings. A study published in Open Medicine examined the factors associated with the time to publication of Cochrane reviews. A change in authors and updated reviews were predictive factors, but the favorability of the results was not.

Roy Poses of the Health Care Renewal Blog starts this blogpost as follows: “Woe to those of us who have been advocates for evidence-based medicine”. He mainly refers to a study published in the NEJM, that identified selective outcome reporting for trials of off-label use of gabapentin: for 8 of the 12 published trials, there was a disagreement between the definition of the primary outcome in the protocol and that in the published report. This seriously threatens the validity of evidence for the effectiveness of off-label interventions. Roy was surprised that the article didn’t generate much media attention. The reason may be that we have been overwhelmed by manipulation of data, ghostwriting and by the fact that pharma-sponsored trials rarely produce results that are unfavorable to the companies’ product (see previous posts about Ghostwriting (Merck/Elsevier, Conflict of Interest in Cancer Studies and David Tovey about Cochrane Reviews). At least two authors of the NEJM review (Bero and Dickersin) have repeatedly this to be the case [e.g. see here for an overview, and papers of Lisa Bero]. It is some relief that at least 3 of the 4 NEJM authors are also members of the Cochrane Collaboration. Indirectly better control of reporting, i.e. by clinical trials registries, can improve the reliability of pharma sponsored trials and thus systematic reviews summarizing them. As a matter of fact Cochrane authors always have to check these registries.

At Highlight Health Walter Jessen writes about Medical Journal Conflict of Interest Disclosure and Other Issues, which also discusses how money can taint objectivity in scientific publishing. Half of the post discusses the book The Trouble with Medical Journals, written in 2007 by Richard Smith, the former editor of the BMJ.
By the way, Walter just hosted MedLibs Round with the theme “Finding Credible Health Information Online”.

Good news in the Netherlands: right after international Open Access week and the launching of the Dutch Open Access website (www.openaccess.nl), the Netherlands Organization for Scientific Research (NWO) has announced that it is in favor of Open Access. (via PLOS-facebook).

The open access nature of PLOS itself gets out of hand: they even peer-review T-shirts (according to Bora Zivkovic of a Blog around the Clock, see here)

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Other Health & Science News:

Medline Plus summarizes an article in the Journal of Nutrition, that states that Selenium supplements, may pose a heart risk.

Even Folic Acid and vitamin B12, when taken in large doses, have been reported to Increase Cancer Risk (WebMD)

Luckily WebMD also reports that dark chocolate seems to help against stress, that is it reduced stress hormones in the blood. However @evidencematters and @NHSChoices cast doubt on that“Chocolate cuts stress, says newspaper. Does the study really say that? And who paid for the study?…”

Scientists made the unexpected discovery (published in Molecular Cell) that BRAF, which is linked to around 70 per cent of melanomas and seven per cent of all cancers, is in fact controlled by a gene from the same RAF family called CRAF – which has also been linked to the disease. For the first time it is shown “how two genes from the same ‘family’ can interact with each other to stop cancer in its tracks” (Source: Info Cancer Research UK)

For the first time, scientists have successfully used exome sequencing to quickly discover a previously unknown gene responsible for Miller syndrome, a rare disorder. The finding demonstrates the usefulness of exome sequencing in studying rare genetic disorders. The exome is enriched for coding (thus functional) DNA, it is only 1% of the total DNA, but contains 85% of the mutations (Published in , source: PhysOrg.com)

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Web 2.0
For information regarding the FDA hearings on internet and social media see #FDASM: http://www.fdasm.com.

Read Write Web summarizes the new numbers released by analytics firm Postrank that indicate that reader engagement with blogs has changed dramatically over the last three years, primarily because of the rise of online social networks.

Twitter has began to relaunch the new retweet feature, although not without controversy. What do you think about the newest feature?

The Next Web gives an overview of which Twitter application is hot and which is not.

And Finally: Top 100 tools for learning, compiled by Jane Hart from the contributions of 278 learning professionals worldwide. You can see the lists here (HT: http://blogs.netedu.info/?p=1005)

The web 2.0 part is relatively short, but it is time to conclude this edition. Till next time!

  • MEDLIB’s ROUND 1.6 (laikaspoetnik.wordpress.com)
  • Tool Talk: quick links re Facebook, GReader and GWave (socialfish.org)
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