Today Chris Mavergames and I held a workshop at the Cochrane Colloquium, entitled: Web 2.0 for Cochrane (see previous post and abstract of the workshop)
First I gave an introduction into Medicine 2.0 and (thus) Web 2.0. Chris, Web Operations Manager and Information Architect of the Cochrane Collaboration, talked more about which Web 2.0 tools were already used by the Cochrane Collaboration and which Web 2.0 might be useful as such.
We had half an hour for discussion which was easily filled. There was no doubt about the usefulness of Web 2.0 for the Cochrane in this group. Therefore, there was ample room for discussing technical aspects, like:
Can you load your RSS feed of a PubMed search in Reference Manager? (According to Chris you can)
How can you deal with this lot of information (by following a specific subject, or not too much people – not many updates on a daily basis; you don’t have to follow it all, just pick up the headlines, when you can)
Are you involved in a Wiki that is successful? (it appears very difficult to involve people)
What happens if people comment or upload picture on facebook (of the Cochrane collaboration) in an appropriate way (Chris: didn’t happen, but you have to check and remove them)
How do you follow tweets (we showed Tweetdeck, hashtags # and #followfridays)
Last Sunday I was an invited speaker at a national congress for interns, the LOCA congress. LOCA stands for “Landelijk Overleg Co-Assistenten”.
This congress has been initiated to facilitate the contact between interns of all Dutch universities and to cover in depth subjects that usually don’t get much attention.
The LOCA congress offered a diverse program, varying from “minimal invasive and maximal effective surgery”, “memory training” and “a dirty mind is a joy forever”. You can see the program here (Saturday; Sunday).
The previous event I gave a Search Workshop, this time the subject was “Medicine 2.0″.
I didn’t realize in advance that this wasn’t a convenient day. First it was Mother’s day. My children weren’t pleased that I wouldn’t be around. Furthermore I had to prepare an Evidence Based Searching day the following Monday and several other workshops that week. Still, Sunday morning we spent together in the garden eating home made smoothies and muffins that my eldest daughter L made, with on them in colors: “Mama blog”, “L X M”, “Laika twitter”, “Success”, etcetera, which illustrates how they see me now.
Despite that I had 40 min. instead of the expected 60 min., and just about half of the workshop subscribers (it was a very sunny day) showed up, I found it a pleasant workshop. Mostly because the audience was very interested and interactive. Within those 40 minutes, however, I could only touch upon some aspects, giving most emphasis to the web 2.0 tools which can be used in daily practice by medical professionals to find information (social networking sites, RSS also in Pubmed, personalized home pages, blogs and wiki’s)
40 minutes is short and I promised the interns to provide them with some information afterwards.
I’m too busy at the moment with my regular job, but I expect that the promised information will be available within 1-2 weeks at:
But I won’t withhold a series of tweets (Twitter messages) specifically directed to the interns of this workshop. You can view the tweets labeled with #MOVIR, here at Visibletweets. They have been tweeted by doctors, a patient, a nurse and a physiotherapist. Please see them all, the first tweets are shown last.
Yesterday @alisha alerted me to a post of Sheila Webber at the information-literacy blog about a wonderful series of YouTube videos by Llordllam with hand puppets as actors. The videos are a mix of educational videos aimed at librarians, information scientists and library readers. The leading actors are Goose the librarian and Professor Weasel the academic (patron).
The following YouTube video is really superb as well as hilarous. With a typical british sense of humor it tries to make you understand Academic Copyright. Prof Weasel struggles to understand the problems with the traditional journal publication system. Look how he is fooled by the publisher rat.
And for librarians and librarian users this one is a must. Boolean operators explained. Think the jam/bread example will work better than my epistaxis/child example, so who knows I will adapt my slides.
And finally the video “Your Library: A User Centric Experience”. This feels very familiar (the user becomes the king, see also the Flikr pictures in the side bar of our library)
Now, not a Llordllam/Goose/Weasel production, but a very useful video (by paulrobesonlibrary) to illustrate to students the (unusefulness) of Wikipedia as their primary research tool.
Seen at Phil Bradley’s Weblog (No, you can not lower the speed)
Bertalan Meskó is a medical student from Hungary, who runs the award-winning medical blog Scienceroll. According to the web 2.0 model of Hugh Carpenter, mentioned in a previous post, Bertalan (Berci) just finished his journey as a Web 2.0 jedi: he started a web 2.0 company: Webicina. Webicina offers a personalized set of web 2.0 tools to help medical professionals and patients enter the web 2.0 world.
To be honest I was a bit skeptical at first. When I think of web 2.0, I think of it as *open, *collaborative, *creative commons, *networking, ****collective intelligence (Elizabeth Koch). Web 2.0 exists by the mere fact that people want to share information for free. Later I realized that this initiative is comparable to individualized courses that you have to pay for as well. Webicina will also offer some free tools, especially for patients.
One such free tool is PeRSSonalized Medicine. The RSS in PeRSSonalized Medicine stands for Real Simple Syndication, which is a format for delivering regularly changing web content, i.e. from Journals. PeRSSonalized Medicineis a free tool meant to help those users who cannot spend much time online (e.g. medical professionals). It helps them track medical journals, blogs, news and web 2.0 services really easily and creates one personalized place where they can follow international medical content without having a clue what RSS is about (see post at Scienceroll)”
PeRSSonalized Medicine has a beautiful and straightforward interface. There are 5 separate sources you can follow: (1) Medical Journals, (2) Blogs, (3) News and (4) Media (including Youtube channels, Friendfeed rooms or Del.icio.us tags), and (5) “articles” in PubMed (to setup this you have to perform a search in a separate toolbar).
The items included are partly of general interest -i.e. the Medical Journals includes 13 titles, including the BMJ, the JAMA and the Lancet-, partly it is very specialized, i.e. on the field of genetics. A lot of Journals are not included and Web 2.0 sources tend to be more represented than the official media/journals.Thus this tool seems most suited for the generalist and people wanting to follow web 2.0 tools. On the other hand – and this is a clear advantage- the content develops as wishes and suggestions are taken into account.
Each Tab can be personalized by simply hiding the titles you don’t want to include (under the button personalize it), but settings are only saved after registration.
The view of the personalized page is pleasant and neat. You see short titles of the 10 latest articles of the sources you have subscribed to. Moving your mouse over the titles will reveal more information and once you clicked the link it turns grey instead of blue. What I miss is the button: more, so you can catch up if you have missed older articles. Especially with media and journals that often have more than 10 new articles per issue, even more so if the first 10 titles consist of “obituaries” (BMJ).
The latest addition to PeRSSonalized Medicine (5) is the possibility to subscribe to a Pubmed search so “you can also follow the latest articles in your field of interest without going back to PubMed again and again and doing a search for your favourite term. Make this process automatic with PeRSSonalized Medicine.”
However, as most of you may know, you don’t have to go back to Pubmed over and over again to “do” your search, but you can easily subscribe to a search in PubMed either by email (My NCBI) or by RSS (see for instance this post in Dutch). Although the process of subscribing is not as intuitive as it is in PeRSSonalized medicine, PubMed is better suited to design a good search strategy. To keep abreast of the latest information in your field a good search forms the basis. It hurts my heart as a librarian that most web 2.0 people are more fixed on the technique of how to subscribe to a feed (RSS) than on good search results. Remember, it still is: garbage in, garbage out. RSS is just the drain.
As an example I show two RSS feeds below, one with more appropriate terms (pulmonary embolism and d-dimer) than the other (lung embolism and d-dimer). Pulmonary embolism is a MeSH. It is evident that with lung embolism articles will be missed just by choosing wrong/less optimal terms.
Again the presentation of results is pleasant. Apart from the search restrictions I don’t find it very handy to look up each paper in HubMed (for that is where the link takes you).
Personally I prefer regular e-mail-alerts at specific intervals (via MyNCBI). I would like to look up citations either individually (if there is just 1 interesting hit) or all at once (10-50 hits). In PubMed, results can be selected, PDF’s directly downloaded from the library website and citations can be kept in My NCBI Collections or imported into a reference manager system. A RSS-feed of Pubmed searches is also handy (see below).
Alternatives
The idea presented on Webicina, although fancy, is not new. Consider the following alternative web tools, also build on data collected from RSS feeds.
Amedeo
Amedeo is dedicated to the free dissemination of medical knowledge. It is an international free service that will send you weekly literature updates in medical subjects of your choosing. At the same time a personalized website is made, with subscriptions to the journals you selected. You can retrieve the articles in text or in HTML-format. The HTML format brings you to the latest results for that Journal in PubMed. This service seems most suitable for specific medical disciplines. General topics (family physician) are not available, although it is possible to subscribe to for instance the American Journal of Family Physicians. As with all these free literature services, you will have to subscribe. It is easy to select or deselect journals in a category (tick boxes). Amedeo also has Free Books For Doctors, but no podcasts or blogs. You can search the site, but you cannot easily look up individual journals.
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MedWorm (and LibWorm)
MedWorm is a free medical RSS feed provider as well a a search engine. It is meant both for doctor and patient. There are many medical categories that you can subscribe to, via the free MedWorm online service, or another RSS reader of your choice, such as Google Reader. The number of RSS-feeds is enormous: >6000. There are a publications directory, a blog directory, a blog tag cloud, consumer health news, discussion and several specific topics, like cancers, drugs, vaccines and education. Within the publications directory there is a further subdivision in: Consumer – Info – Journals – News – Organizations – Podcasts.
Many specialties are represented, including primary care and veterinary science. I tried it out and subscribed to some Addison’s disease related topics, Reuter’s Health and my own blog, which has recently been included. When you subcribe via the Medworm-RSS all news can be read in “My River of News”. It shows the titles and part of the abstracts (see Fig. below).
You can subscribe to single items or categories, but it is not possible to in- and exclude individual feeds within a topic or category by a single action. So within Endocrinology I cannot selectively exclude all diabetes journals, but (as far as I can see) I have to subscribe to each individual journal, if I don’t want the whole package. The loading of the River of News takes long, sometimes.
Together with David Rothman the builder/owner of MedWorm, Frankie Dolan, has also launched Libworm, which is a librarian’s version of MedWorm.
Once you have these tabs you can edit them (add, delete, move) as you like.
I-Google Medical Journals Tab
I-Google Startpage
RSS-readers
All the above tools are based on RSS, which means Real Simple Syndication. It isn’t called Simplefor nothing. You can easily do it yourself, which means that you have more freedom in what you subscribe to. Because I-Google doesn’t scale well beyond 50 or so RSS feeds, other RSS-readers are advisable once you subscribe to many different feeds (see Wikipedia for list and comparison) . I use Google-Reader, shown below, for this purpose.
Generally, adding Feeds is easy. In Firefox you often see the orange RSS-logo in the web browser (just click on it to add the feed) and most Journals and blogs have a RSS-button on their page, that enables subscription to their feed.
As detailed in another (Dutch) Post, numerous Pubmed searches can be easily added to your RSS-reader. You build up a good search in Pubmed, for instance: (pulmonary embolism[mh] OR pulmonary embolism* OR lung embolism*) AND (“Fibrin Fibrinogen Degradation Products”[Mesh] OR d-dimer). In “the Results” you click on “Send To” and choose RSS-Feed and add it to your reader. That’s all.
But there are other free tools around with more (subscription) possibilities and with a little more investment of time you can do it yourself and make subscriptions really perssonalized. Once you know it is simple, believe me.
I really liked the comments of Jenny and Creaky, basically confirming that there is something like a librarian “subtype”: “we look like nice people – curious, friendly, social” (Jenny) and “approachable” (Creaky, who is often spontaneously asked for help when she steps into a Border’s or a Barnes & Noble Bookstore.)
However, although THE stereotypical librarian does not really exist any longer in this information age, the picture continues to exist in some people’s mind (Ruth, the author of the book).
The article describes school librarians who connect kids not only with books but also with information. As an example a video is shown of Stephanie Rosalia, a librarian at an elementary school (see below). Stephanie does do the usual librarian things, but also learns kids how to surf the net and how to search databases using boolean operators(!) and she teaches them website literacy. For instance, a completely fake web site is shown to the kids, who have to learn what information they can trust and what information is suspect. They learn what to do when their search for Christopher Columbus yields 99 million returns in Google. “Kids are overwhelmed, they are swimming in an information ocean.. and they’re drowning”. Librarians like Stephanie guide the kids though the flood of information that confronts them on a daily basis.
Really impressive what crucial skills young kids learn these days, at least in the VS*. Yet as school librarians increasingly teach students crucial skills needed not only for school, but also on the job and in daily life, they are often the first casualties of school budget crunches. Certainly with the global recession kicking in.
* I wonder as how far these 21st century school librarians are specific for the US. My kids (elementary and high school) are not trained in web literacy by a school librarian. But I wish they were.
Grand Round is a weekly collection of the best writing in the medical blogosphere. The coming Grand Rounds (February 3rd, 2009), hosted by Not Totally Rad has the following theme:
February is the first anniversary of my blog. Therefore, the loose theme for submissions will be anniversary-related: write about something cool or important that you’ve learned in the past year.
Well, I have learned a lot in the past year. The most profound personal experience was the death of my father. I experienced how it is to loose a beloved, but I also learned that death and grieve can affect people so deeply that it changes their behavior. I now understand this behavior (anger, mental confusion) is a manifestation of deep grief, which is transient and natural. Luckily our body and mind appear very resilient.
I will restrict to another thing I’ve learned: Web 2.0.
Just like the “Samurai Radiologist” I started a blog in February 2008. Thus Laika’s MedLibLog also celebrates its first anniversary.
Useful Web 2.0 tools
This blog was started as a tool to communicate thoughts, new found skills and ideas with other (>150) SPOETNIK course members, Spoetnik being a Learning 2.0 project to encourage library staff to experiment and learn about the new and emerging Internet technologies.
During the library 2.0 course I learned the basics of blogging, chatting, RSS, Podcasts, Wiki’s and social bookmarking. Each week another item was addressed. This learning program had a direct and positive impact. For instance, I could inform my clients how to create a RSS-feed for PubMed searches. By taking RSS-feeds/email alerts to interesting blogs, wiki’s and journals I kept better informed.
Hard to imagine (now) that I hardly new anything about web 2.0 one year ago.
Web 2.0 is not just a set of tools.
In the beginning I considered blogging largely as a selfish activity. It also appeared a lonely activity. As long as we discussed a course assignment there always was an interaction with at least a handful of other participants. But as soon as the program came to an end, I started to write more and more about medicine, EBM and medical library related matter, which didn’t appeal to most of the other course members. I wrote about things that interested me, but the writing would be absolutely useless if nobody would read it. Thus, how to get an audience?
There were I few things I had to learn and there were a few people who gave me a push in the right direction .
Wowter, who gave feedback to my posts right from the start and who encouraged me to continue blogging, posted a list with 17 tips for beginning bloggers (in Dutch) of how to increase visibility and findability of your blog. I became aware that ‘linking’ to others is what is making the web 2.0 world interconnected.
Second Dymphie, a Dutch Medical Librarian, encouraged me to start twittering. It took quite a while before I grasped the value of twitter as a networking tool. Twitter is not meant to say “what you do”, but it is a way to share information of any kind. Before you can share it, you first have to find interesting tweeple (people on twitter) and it did take a while before they followed me back (partly because my first tweets weren’t that interesting). Thus I had to learn by trial and error how to become a prolific twitterer.
Third I read a very interesting blogpost on “I’m not a geek” of Hutch Carpenter called Becoming a web 2.0 jedi, showing a simple but very accurate chart of the ever deeper levels of involvement one can have with Web 2.0 apps and the Web 2.0 ethos, as Hutch calls them.“Down are the lower levels, those of passive involvement, level 2 is giving up little pieces of yourself, while level 3 is a much bigger sharing experience. Share your own life, share your knowledge, share the stuff you find interesting. A big leap for a lot of us used to being more private. May the force be with you.” Seeing his post I realized that my journey had been quite different (figure below, made in September 2008). During the Spoetnik course emphasis was given to the tools themselves not to the ways you should use and share them and contribute to others. We skipped the reading of blogs and wiki’s, the lurking on twitter, but started with chatting, RSS and blogging. Although Web 2.0 tools are the basis, Web 2.0 is more an attitude than the usage of tools, it is about sharing information and thoughts.Or as Dean Giustini says it: It is about people.
I have learned a lot. Am I now a real web 2.0 Jedi?
I’m not sure. In the ecology-model my blog is a young tree, surrounded by many others. But some ecologic dangers are luring.
The relative success of my blog results in “an abundance of light which results in a pressure to keep producing enough good quality posts”.
I’ve subscribed to so many RSS-feeds I seldomly read them.
I have so many twitter-followers (app. 300) that I can’t keep up with all of them as much as I would like to.
I read so many things, but haven’t got the time to work them out (or I simply forget).
I find it difficult to separate chaff from wheat. Many blogposts and web 2.0 information are not very accurate and superficial. Furthermore people often echo a subject without careful checking or without adding value.
Or in the words of sandnsurf: the death of a blog can ensue due to excessive exposure and Twittaholism. I hope It will not go in that direction, but I have to figure out a way to coop with the overwhelming amount of information and find a balance. That will be part of my (web 2.0) learning process in 2009.
One other thing:
I forgot to mention one very important experience. During my web 2.0 journey I virtually met many interesting, kind and helpful people from all over the world, from US, UK, Eastern Europe to India and Australia. Closer to home I also ‘met’ many very nice Dutch and Belgian people.I never liked the idea of intentional networking, but in web 2.0 the networks arise spontaneously. In a very natural and gradual way I became a member of a large health and library community and that feels good.
Information Specialists, other information professionals and researchers seeking more insight into the usefulness of search filters might be interested in the following training event:
YHEC Training Event: ‘Getting The Best Out Of Search Filters’
University of York, 26 February 09 or UK Cochrane Centre, Oxford, 04 March 09
This training event will explore how to identify, critically appraise and test out search filters, focusing on health and social care.
The training day presenters will be Julie Glanville (Project Director, Information Services, York Health Economics Consortium, University of York) and Carol Lefebvre (Senior Information Specialist at the UK Cochrane Centre).
By the end of the study day, participants will have:
An awareness of how to identify published search filters;
An understanding of the features of search filter design to be able to critically appraise search filters;
An awareness of the key issues to be considered in assessing the suitability of search filtesr for specific questions;
An understanding of the challenges of translating search filters between interfaces and databases.
For more information see here To book a place please click here.
An overview of other training events can be found here
Unfortunately, both of these courses are now fully booked. YHEC will be running a further course later in the year (perhaps in November), and they may be running a course in the Netherlands in due course as well. You can contact ab588@york.ac.uk to be put on a mailing list to be kept informed of these courses.
This year’s theme was FEAR. The program was as follows:
Welcome – Rinnooy Kan
Presentation of new work of art of Albert van Westing (1960), recently bought by the AMC – Wim Pybes, director of the “RijksMuseum”
“Mit Freud und Freud ich fahr dahin”- Johan Sebastian Bach. 1.”O Jesu Christ, mein’s Lebens Licht” 2. Gottes zeit ist die allerbeste Zeit – Baroque Ensemble “Follia d’ Amsterdam”together with the choir“Nuovo Musico” , conducted by Gustav Leonhardt (above is another version). The cantatas express both fear for death and faith in God.
Audiovisual presentation of the assay ” de vertrouwenscrisis” (what went wrong with the fundamental trust in the Dutch society?), written by 19 different publicists.
Audiovisual impression of pupils of Amsterdam High Schools attending lectures in psychiatry: funny and disarming.
And the climax: a 50 min lecture of Prof. Arieh Y. Shalev, M.D. (Head Department of Psychiatry at the Hadassah University Hospital of Jerusalem, Israel) about living with fear.
I will try to summarize the main points of Shalev’s lecture as I remember them (no notes).
There are several factors that may influence how people react to fear:
DNA (fixed), inherited differences – (written composition in musical notation)
Epigenetic Mechanisms (mostly but not exclusively determined postnatally). (tuning of the piano, quenching the middle register)
(Gene) Expression(Accordion register determining ranks and timbres, determined by the accordionist)
Exogenous factors (i.e. empathy and affection) (the people singing, the acoustics)
Fear is an emotional response to threats and danger, meant to protect against a threat (fright-fight-or-flight). It is a basic survival mechanism occurring in response to a specific stimulus, such as pain or the threat of pain. Recognizing a person in agony is easy. The facial expression of fear includes the widening of the eyes (out of anticipation for what will happen next); the pupils dilate (to take in more light); the upper lip rises, the brows draw together, and the lips stretch horizontally. Muscles used for physical movement are tightened and primed with oxygen, in preparation for a physical fight-or-flight response. When the stimulus is shocking or abrupt, a common reaction is to protect vulnerable parts of the anatomy, particularly the face and head. When a fear stimulus occurs unexpectedly, the victim of the fear response could possibly jump or give a small start. The person’s heart-rate and heartbeat may quicken (from Wikipedia).
The amygdala, an almond shaped complex of related nuclei, located in the middle of the brain, is a critical processor area for fear. Connected to the hippocampus, it plays a role in emotionally laden memories. It is part of the limbic system.
Fear, begins with arousal. For instance:
You hear a sound. The amygdala is alerted.
You see a face, the amygdala is alerted to a greater extent. Your pupils enlarge, your breathing and hartbeat quicken.
You recognize the face; it is nobody to be afraid of: the fear response is dampened. The heartbeat drops to normal levels, because you are reassured that there was no danger.
But suppose (1) you’re walking in a dark alley and (2) you see a gun. (3) Next you see a man holding that gun. (4) He shouts something threatening. There are no breaks anymore (by prefrontal cortex/hippocampus on the amygdala) and the fear machine starts running at full speed. Thus, in case of a major threat, in a split second all alarm bells ring: the abovementioned reflexes occur immediately and with no point of return.
One’s memory of what happens consists of separate “pictures”: (1) the alley, (2) the gun, (3) the man, (4) a loud voice (and perhaps smell). Normally, moments of fear will takes it’s place along other memories, although this may take some time.
However, depending on the kind of fear, your personality and external factors, memories to the incident causing fear may stay at the foreground. It may become a memory that comes to the mind frequently and spontaneously or evoked by one of the remembered associations. For instance any alley may cause the full blown fear response again in the abovementioned example.
Shalev telling this, I suddenly understood my reactions to a car accident. While driving on the highway, the driver lost control of the vehicle, causing it to skid and finally ending against a huge concrete wall. I was sitting in the back and while the car was turning I saw “the wall hitting us”. My “last thought” was “that was it”. The car was total loss, but luckily all 5 (members of a dancing group) survived. Apparently because of the “fear of death”, the impression of that very moment staid long with me. For almost a year I felt frightened not only in a car, but also when I saw a car or motor turning fast around the corner or when moving sideways in an airplane during landing. It must have been a similar feeling as when the car turned and hit the wall. The resemblance of that moment brought the memory and the fear back in quite un uncontrollable way. But as time passed by, so did this emotional reaction. The memory itself was still there, but at the background and slowly all intense associations with that frightful moment faded.
This is what normally happens with frigtening experiences. Fear can be retriggered by a memory (smell, picture, situation) linked to what happened, but can extinguish over time. Thus responding to a conditioned stimulus (CS) spontaneously recovers with the passage of time indicated that extinction does not erase the conditioned memory, but is a form of (active) inhibition. The brain (prefrontal cortex/hippocampus) learns how to coop with it and suppress the emotional fear reflex (amygdala).
However, some fears don’t extinguish and have a lifelong impact. For instance in post-traumatic stress disorder (PTSD), which is a severe and ongoing emotional reaction to extreme physical or psychological trauma.
Shalev gave several examples of people with PTSD other than PTSD in war veterans . For instance, a mother who lost her daughter on the complications of a simple (and unnecesary) intervention. The daughter died of sepsis and from that moment on the mother continued to live in the past, persistently reexperiencing the traumatic event.
This was what the mother remembers as the most frightful moment:
I entered the door, my hand still holding the knob. There she lied staring with pupils so dilatated that her irisses were no longer visible. Death was inevitably approaching. I wanted to scream for help, but there were no doctors present and nurses were all running around. I could do nothing about it.
That was a recurrent theme in all examples: feeling desparate and helpless while facing the inevitable.
In PTSD patients the normal extinction mechanisms don’t work. PTSD patients remain in a state of arousal.
Shalev also emphasized that the mere reiteratation of the traumatic event doesn’t help the patient. If the patient is in fear it doesn’t help to bring him to an alley all over again, and to leave the alley again as soon as the patient gets frightened. This only reinforces fear. What should be done is to learn the patient to associate the alley with positive events through psychotherapy. Trust, empathy, friendship can all help as well.
Because extinction is a form of learning some medical treatments given soon after the trauma will not help to reduce the PTSD. In a Randomized Controlled Trial presented at the American College of Neuropsychopharmacology 46th Annual Meeting (December 8-12, 2007), Shalev and coworkers showed that cognitive therapy or prolonged exposure therapy (a type of cognitive behavioral therapy) within 1 month had a reduced prevalence and severity of PTSD at 5 months to 20%, whereas early treatment with a selective serotonin reuptake inhibitor (SSRI) fared no better than individuals randomized to placebo or spontaneous recovery (wait-list) groups (60%). According to Shalev this is a phantastic effect. (Source: Medscape ).
Still, although cognitive therapy is effective, many PTSD patients remain symptomatic despite initial treatment.
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This post was (also) written for next Grand Round hosted by Mexican Medical Student. Enrico had a tentative theme in mind (with some flexibility to change it ) but these words should be applicable: renewal, metamorphosis, change, transformation. Well, this story was about how extreme fear can transform you in another person. Furthermore death, referred to in the Bach cantate, is our ultimate transformation.
Finally I hope that Enrico, being both a medical student and a classical pianist likes Bach.
Lee Le Fever, the founder and principal of the famous Common Craft video’s announced today at Twitter that the Google Reader team had hired Commoncraft to create this one minute introduction to Google Reader. (@leelefever on twitter)
It is an ultrashort but clear presentation in the well-known “Explanations in Plain English style”.
For those not familiar with Google Reader (an RSS-reader), it might be nice to see how this works. If you want to know more about RSS first see this post (again with a CC-video)
The Commoncraft video doesn’t show the new feature of Google Reader, that you can see the average posts per week and the number of subscribers, as I learned today from Gerard Bierens at Twitter. I didn’t see anything at first, but Gerard showed me that you have to look at the Expanded View Tab and click Details (see Figure).
If you’ve taste for more free learning/web2.0 tools, have a look at this 101 Free learning Tools Slide from Zaidlearn. One of the 101 Tools is Google_reader. Each slide has a link to the website where you can get/try the tool. There is more on slideshare and on Zaidlearn’s blog.
Last but not least my Belgian colleague Patrick Vanhoucke(again at Twitter) gave the nice tip of a new free music library grooveshark.com, that resembles LastFM, except that it doesn’t stop after 30 seconds. There is even a possibility that you can sell your music via grooveshark (you can load your music and if someone loads it you receive “credits”). The Grooveshark tip was not really a learning tip, but it might make learning somewhat more pleasant. You can read more here (Dutch)
Wikipedia, has become a rich and complex source of documents linked to each other. When you’re looking for a subject and you follow several links you easily loose the overview.
For instance, when I used wikipedia the other day to gather background information about Mimivirus and the origin of life (for the Sputnik virus-news, see posthere), I hip hopped from Mimivirus to Virus to Bacteriophage back to Virus and forth to Life… Origins and Lifeformdebate. Thus, it is not always straight forward to find the information you are really looking for or to keep track of where you are in the sheer bulk of information.
But now there is Wikimindmap. With this free tool you can easily make an overview of the Wiki content on a specific subject. The wikimindmap is inspired by the mindmap technique, a diagram used to represent words, ideas, tasks, or other items linked to and arranged radially around a central key word or idea. Mindmapping is often used to visualize, structure and classify ideas to aid learning.
Below is the wikimindmap for virus.
I choose the English wikipedia to make the wikimindmap. If you typ the plural form “viruses” (which is not the correct entry-term) you see the correct singular form linked to it. By clicking the green arrows you can make “virus” the main topic and you get the full mindmap shown below.
Moving you mouse over boxes, you see more information about the topic groups. Topic groups (+) can be opened by clicking at the boxes. Clicking on the text will bring you to the corresponding position in the Wiki (in a separate tab).
Another nice feature is that you can load the mindmap directly toFreemind (click here to download the software first), a free mind-mapping Java. In Freemind you can edit the mindmap to use it for educating purposes for instance. However you can no longer link to the corresponding wiki-page (without adding the link yourself). My first attempt to make a Freemind mindmap of the virus-wiki is shown below. In fact the end-result is like an organised (non-random) Wordle-graphic (see this post).
Of course you can also use Freemind to create your own mindmaps.
Wikipedia is een rijke en complexe bron van allerlei aan elkaar gelinkte pagina’s. Wanneer je aan het zoeken bent en verschillende links volgt kom je al gauw op zijpaden uit en is het moeilijk het overzicht te houden.
Toen ik laatste bijvoorbeeld in Wikipedia wat achtergrondinformatie zocht over mimi- en andere virussen en de definitie van leven (in verband met het Spoetnik virus-nieuws, zie hier voor bericht), hopte ik van Mimivirus naar Virus naar Bacteriophage terug naar Virus and verder naar Life… Origins en Lifeformdebate. Hoe al deze termen samenhangen en hoe je er doorheen bent gewandeld is vaak niet meer duidelijk.
Hierboven (engels gedeelte) de wikimindmap voor ‘virus’.
Ik koos de Engelse wikipedia om de wikimindmap te maken. Als je het meervoud “viruses” opgeeft zie je de juiste term, “virus” in enkelvoud ermee verbonden. Door op de groene pijlen te klikken maak je virus tot het centrale thema en krijg de wikimindmap van het figuur hierboven.
Als je met de muis over de rechthoeken schuift, verschijnt er meer informatie over de term. Onderwerpsgroepen kun je open- (+) of dichtklikken (-). Door op de tekst te klikken kom je op de bijbehorende wiki.
Friday, I finally decided to write to OVID’s customer service, asking them if they could do something about the TIP-box and the way the search box and search history are placed relative to each other.
The same day I got an answer from a very kind Technical Support Engineer writing:
“I am really sorry but we can not remove the Tip box. However the interface is going to change next week, the search history box will be more customizable.”
YES!
Never mind the TIP-box (for the moment).
I’m very happy that OVID does take his users seriously. This means a real step ahead for heavy OVID-users. Thanks!
Transforming the Way You Search with More Flexibility and Customization of OvidSP Workflow Tools
Dear Ovid Customer:
The next release of OvidSP on July 31st is all about flexibility and enabling users to search the way they want to search. In our third weekly email introducing what you and your users will see on July 31st, learn more about new user-configurable customization enhancements to OvidSP’s workflow tools that further deepen the search experience and help users get to the results they need quickly.
Search Aid – Now users can expand or collapse this search refinement featurebased on their preferences for managing the results screen.
Search History– Many users perform complex searches, some involving as many as 60-80 lines of search. Now, the Search History can be placed above or below the main search box, so there’s no need to spend time scrolling up the page to review search strategies. Plus, you can sort all your searches in either ascending or descending order so that the last search statement is always viewable.
Results Manager – To accommodate for a wide variety of user behavior and to minimize scrolling when it comes to managing results, the Results Manager is now located in two places, above and below the results set. You can minimize it in both places to save valuable screen real estate.
Plus, now you can customize the “common” limits—those available on the main search page. These settings will act as defaults for users who are able to login via a personal account.
Like all of the upcoming enhancements and new features, those illustrated above are based on extensive feedback from and interviews with customers and users.
Coming soon to the OvidSP Resource Center will be screenshots, an updated training schedule, Frequently Asked Questions, and more. Be sure to contact your Ovid Account Representative or support@ovid.com with any questions.
Vrijdag besloot ik eindelijk om OVID’s klantenservice te mailen. Of ze niet de tip weg konden halen en iets aan de plaatsing van zoekgeschiedenis en de zoekregel konden doen (ik verwees daarbij naar mijn blog).
Diezelfde dag nog kreeg ik antwoord van een zeer attente mijnheer van de helpdesk (die getuige latere correspondentie ook inhoudelijk het een en ander weet). Hij schreef:
“I am really sorry but we can not remove the Tip box. However the interface is going to change next week, the search history box will be more customizable.”
YES!
Laat de OVIDsp-TIP maar even zitten (voor nu).
Erg goed dat OVID zijn gebruikers serieus neemt. Ze doen tenminste wat met de feedback! De aanpassingen zijn echt een stap vooruit. Bedankt, OVID!
Je kunt naar wens de zoekgeschiedenis boven of onder de zoekbalk plaatsen en de searches in opklimmende of dalende volgorde plaatsen. Deze flexibiliteit lost mijn probleem dus al grotendeels op!
Je kunt de “Search Aid” in- of uitklappen.
De “Results Manager” staat nu zowel boven als onder de zoekresultaten en kunnen ook weer ingeklapt worden. Hierdoor hoef je ook weer minder te scrollen als je iets met de resultaten wilt doen.
Tussen 2 haakjes: De nieuwe OvidSP version 2.0 staat VANDAAG op de planning, niet 31 juli
After I’ve learned so many new internet communication tools I’m about to discover yet another: webex.
As many other information specialists I’ve been invited to participate in a Webex meeting, organized by BMJ Clinical Evidence, a database with appr. 200 evidence based syntheses of evidence (critical appraisals of a subject). This is a kind of an online training. I have to dial in, and use the computer as well.
I’m kind of curious, because I never joined such a meeting before. I also hope to learn a lot from it. Expect that it will be rather efficient, because the training takes only 20 minutes an it will deal with the following:
“We will be showcasing the newest features that have been added to BMJ Clinical Evidence and also highlighting some of the most exciting hidden gems that your users may not know about.
What you can expect to hear about:
- Our new GRADE scoring system
- Our advanced search and browse functions
- Our published inclusion-exclusion forms for new reviews
- The extra resources that we have created for you as information specialists to help make your lives easier”
So it seems they will give as a peep behind the scenes.
Well at least I hope to take the first hurdle: being able to follow the session.
Every now and than my collegue Heleen provides me with an interesting paper (a nice web 1.0 way of sharing things). Last Friday I found this paper on my desk: “Etiquette-Based medicine” from Michael W Kahn. The paper in this week’s New England Journal of Medicine is not about the substition of “evidence based medicine” or “eminence-based medicine” by “etiquette-based medicine”. It is about the importance of a good attitude of doctors towards their patients.
When psychiatrist Dr. Khan hears patients complain about doctors, their criticism often has nothing to do with not feeling understood or empathized with. Instead, they object that “he just stared at his computer screen,” “she never smiles,” or “I had no idea who I was talking to”, he writes.
On the contrary, during his own hospitalization he noticed the professional attitude of his European-born surgeon having Old World manners (dress, body language, eye contact etc.).
“The impression this surgeon made was remarkably calming, and it helped to confirm my suspicion that patients may care less about whether their doctors are reflective and empathic than whether they are respectful and attentive”, wrote Dr. Kahn.
Therefore, Khan suggests that medical education and postgraduate training should place more emphasis on “etiquette-based medicine” as it forms the basis of the patient-doctor relationship. One approach would be to introduce a checklist to enforce an etiquette-based approach. A checklist for the first meeting with a patient would for instance cover items like ‘asking permission to enter the room and wait for an answer’, ‘introducing yourselve, showing your ID badge’ and ‘explaining you role on the team’.
This approach bears resemblance to the program introduced at several Academical Medical Centres in the Netherlands. For instance Maas Jan Heineman, nowadays Professor Gynaecology in the Amsterdam Medical Centre (AMC), Amsterdam, helped to introduce such a “etiquette program” in Groningen and in Amsterdam. The competences of the doctors and the integration of knowledge, skills and attitude are now central to the new curricula. As Heineman says it: “What good are doctors who have great knowledge but behave badly. Or vice versa”?! )
The reviewer, Iain Lawrie, is very positive about the content:
“The layout and language are clear and unambiguous throughout. Important points are emphasised where necessary, and at no time does reading become laborious. Far more importantly, however, the authors have employed an evidence-based approach that moves these titles from the realm of personal opinion and musings to an authoritative work. The frequent use of examples further serves to promote this series as a ‘useable’ guide. (….)
The book gives examples Skills for Communicating with Patients, the authors use a logical approach to analyse the various aspects of communication relevant throughout the consultation process, which are then explored in greater depth over six chapters. They move from the initiation of a consultation (!), through information gathering, structuring, and relationship building, to the often neglected areas of explaining and planning and, finally, closing the encounter.”
Thus it seems that the awareness within the medical community about the necessity of good communication skills is growing. The tools are there, some curricula have already embraced “etiquette based medicine” (although not called by that name) and it seems just a matter of time before “etiquette” becomes an integral part of medical education.
Lets conclude with a quote from the abovementioned book, that also applies to professions other than medical:
‘If you can’t communicate, it doesn’t matter what you know’
Van mijn collega Heleen krijg ik af en toe een artikel of een krantenknipsel toegeschoven. Nog geheel op de ouderwetse web 1.0 manier, maar eigenlijk wel zo leuk. Van de week lag er een artikel in mijn postvak getiteld “Etiquette-Based medicine”, geschreven door Michael W Kahn. Ik dacht eerst “weer een zogenaamd alternatief voor “evidence based-” of “eminence-based medicine”, maar het artikel in het laatste nummer van de New England Journal of Medicine ziet “Etiquette-Based medicine” meer als een aanvulling. Het gaat over het belang van een juiste attitude van de arts tegenover zijn patient.
De klachten die Dr. Khan als psychiater van patiënten over artsen hoort gaan meestal niet over gebrek aan empathie maar veel meer over zaken als: “hij staarde maar naar zijn computerscherm”, “er kan geen lachje af”, “ik had geen idee met wie ik nou te maken had”.
Toen Khan zelf in het ziekenhuis lag had hij precies de tegenovergestelde ervaring. De behandelend chirurg van europese herkomst kwam door zijn zogenaamde ‘Oude-Wereld’ houding (kleding, lichaamstaal, oogcontact) bijzonder professioneel en geruststellend over.
Dit sterkte Khan in zijn idee dat patiënten het veel belangrijker vinden dat hun arts hen met respect en met aandacht bejegent dan dat hij heel erg meelevend is.
Hij stelt daarom dat er in het medisch onderwijs meer aandacht moet komen voor wat hij “etiquette-based medicine” noemt, daar dit de grondslag van een goede patient-doctor relatie vormt. Een checklist zou daarbij kunnen helpen. Als een arts de patient voor het eerst ziet zou hij bijvoorbeeld eerst moeten vragen of hij welkom is en pas als de patiënt akkoord is zou hij naar binnen moeten gaan, een hand moeten geven en zich voor moeten stellen.
De recensent Iain Lawrie is erg positief over het boek. Het is helder geschreven en legt de juiste nadrukken. Verder stijgt het werk door de evidence-based benadering boven een opeensomming van feitjes en meningen uit. Het begeleidende boek geeft voorbeelden van hoe te handelen in bepaalde situaties, bijvoorbeeld tijdens het eerste consult. Het boek omvat dus precies wat Khan suggereerde.
Het lijkt er dus op dat men zich binnen de medische wereld steeds meer bewust wordt van de noodzaak van goede communicatievaardigheden. Er zijn al ‘leermethoden’ beschikbaar en in enkele curriculums is etiquette based medicine reeds verweven (zij het onder een andere naam). Het is slechts een kwestie van tijd voordat etiquette een vanzelfsprekend onderdeel van de medische vorming is.
Tot slot een citaat uit het eerder aangehaalde boek (dat eigenlijk op veel meer beroepen van toepassing is):
‘If you can’t communicate, it doesn’t matter what you know.’
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) but these words should be applicable: 
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