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)





3rd Call for Submissions for “Medical Information Matters”: Tools for Searching the Biomedical Literature

8 05 2011

It takes some doing to breathe life into Medical Information Matters” (blog carnival about medical  information).
A month ago I wrote a 2nd call for submissions post for this blog carnival. Unfortunately the next host, Martin Fenner, didn’t have time to finish a blog post and has come up with a new (interesting) variation on the theme “A Wish list for better medical information”.

Martin asks you to philosophize, blog and/or comment about “Tools for Searching the Biomedical Literature.

You can base your contribution on a recent (editable) survey of 28 different PubMed derivative tools by Zhiyong Lu (NCBI) [1].

Thus, write your thoughts on the various PubMed derivative tools mentioned here or write about your own favorite 3rd party PubMed tool (included or not).

For details, see Martin’s blog post announcing this upcoming edition. The Blog Carnival FAQs are here.

And if you don’t have time to write about this topic, you may still find the survey useful, as well as the views of others on this topic. So check out Martin’s blog Gobbledygook once in a while to see if the blog edition has been posted.

Note [1]: If you have already submitted a post to the carnival, or would like to write about another theme, we will take care that your post (if relevant)  will be included in this or the next edition. You can always submit here.

Note [2]: Would you like to host “Medical Information Matters” at your blog? Please comment here or write to: laika dot spoetnik at gmail dot com. We need hosts for June, July, August and September (submission deadline first Saturday of every month, posting on the next Tuesday)

  1. Lu Z. PubMed and beyond: a survey of web tools for searching biomedical literature. Database. 2011 Jan;2011. doi: http://dx.doi.org/10.1093/database/baq036




Medical Information Matters: Call for Submissions

6 11 2010

I would like to remind you that it is almost the first Saturday of the Month and thus submission time for Medical Information Matters, the former MedLibs round.

Medical Information Matters is a monthly compilation of the “best blog post in the field of medical information”, hosted by a different blogger each time. The blogger who will host the upcoming edition is Dean Giustini.

I am sure that every librarian, and many doctors, know Dean. As a starting blogging librarian, I knew 2  international librarian bloggers: Dean Giustini and Krafty Librarian (make that 3, I forgot to mention David Rothman*) . I looked up to them and they did (and do) inspire me.
It is nice that blogging and Social Media can make distances shorter, literally and figuratively…

As far as I know, Dean has no theme for this round. But you can always submit any good quality post about medical information to the blog carnival. Whether you are a librarian, a doctor, a nurse, a patient and/or a scientist and whether your post is on searching, reference management, reliability of information, gaps in information, evidence, social media or education ( to name a few).
You can submit your own post or a good post of someone else, as long as it is in English.

So if that isn’t easy….

Please submit the URL/permalink of your post at:
http://blogcarnival.com/bc/submit_6092.html

If everything goes according to plan, you can read the Medical Information Matters 2.9 at the blog of Dean Giustini next Tuesday.

 

* Thanks to @DrVes via Twitter. Social Media is sooo powerful!





MedLibs Round 2.6

11 07 2010

Welcome to this months edition of MedLib’s Round, a blog carnival of “excellent blog posts in the field of medical information”.

This round is a little belated, because of late submissions and my absence earlier this week.
But lets wait no longer …..!

Peer Review, Impact Factors & Conflict of Interest

Walter Jessen at Highlight HEALTH writes about the NIH Peer Review process. Included is an interesting video, that provides an inside look at how scientists from across the US review NIH grant applications for scientific and technical merit. These scientists do seem take their job seriously.

But what about peer review of scientific papers? Richard Smith, doctor, former editor of the BMJ and a proponent of open access publishing, wrote a controversial post at the BMJ Groups Blog called scrap peer review and beware of “top journals. Indeed  the “top journals” publish the sexy stuff, whereas evidence comprises both the glamorous and the unglamorous. But is prepublication peer review really that bad and should we only filter afterwards?

In a thoughtful post at his Nature blog Confessions of a (former) Lab Rat another Richard (Grant) argues that although peer review suffers terribly from several shortcomings it is still required. Richard Grant also clears up one misconception:

Peer review, done properly, might guarantee that work is done correctly and to the best of our ability and best intentions, but it will not tell you if a particular finding is right–that’s the job of other experimenters everywhere; to repeat the experiments and to build on them.

At Scholarly Kitchen (about what is hot and cooking in scholarly publishing) they don’t think peer review is a clear concept, since the list of ingredients differ per journal and article. Read their critical analysis and suggestions for improvement of the standard recipe here.

The science blogosphere was buzzing in outrage about the adding a corporate nutrition blog sponsored by PepsiCo to ScienceBlog (i.e see this post at the Guardian Science Blog). ScienceBlogs is the platform of eminent science bloggers, like OracPharyngula and Molecule of the Day. After some bloggers left ScienceBlog and others threatened to do so, the Pepsico Blog was retracted.

An interesting view is presented by David Crotty at Scholarly Kitchen. He states that it is “hypocritical for ScienceBlog’s bloggers to have objected so strenuously: ScienceBlogs has never been a temple of purity, free of bias or agenda.” Furthermore the bloggers enjoy more traffic and a fee for being a scienceblogger, and promote their “own business” too. David finds it particularly ironic that these complaints come from the science blogosphere, which has regularly been a bastion of support for the post-publication review philosophy. Read more here.

Indeed according to a note of Scienceblog at the disappeared blog their intention was “to engage industry in pursuit of science-driven social change”, although it was clearly not the right way.

The partiality of business, including pharma, makes it’s presence in and use of Social Media somewhat tricky. Still it is important for pharma to get involved in web2.0. Interested in a discussion on this topic? Than follow the tags #HCSM (HealthCare Social Media) and #HCSMEU (Europe) on Twitter.
Andrew Spong, has launched an open wiki, where you can read all about #HCSMEU.

The value of journal impact factors is also debatable. In the third part of the series “Show me the evidence” Kathleen Crea at EBM and Clinical Support Librarians @ UCHC starts with an excerpt of an article with the intriguing title “The Top-Ten in Journal Impact Factor Manipulation”:

The assumption that Impact Factor (IF) is a number absolutely proportional to science quality has led to misuses beyond the index’s original scope, even in the opinion of its devisor.”

The post itself (Teaching & Learning in Medicine, Research Methodology, Biostatistics: Show Me the Evidence (Part 3)b) is not so much about evidence, but offers a wealth of information about  journal impact factors, comparisons of sites for citation analysis, and some educational materials for teaching others about citation analysis. Not only are Journal Citation Reports and SCOPUS discussed, but also the Eigenfactor, h-index and JANE.

Perhaps we need another system of publishing and peer review? Will the future be to publish triplets and peer review these via Twitter by as many reviewers as possible? Read about this proposal of Barend Mons (of the same group that created JANE) at this blog. Here you can also find a critical review of an article comparing Google Scholar and PubMed for retrieving evidence.

Social Media, Blogs & Web 2.0 tools

There are several tools to manage the scientific articles, like CiteULike and Mendeley. At his blog Gobbledygook Martin Fenner discusses the pros and cons of a new web-based tool specifically for discussing papers in Journal Clubs: JournalFire

At the The Health Informaticists they found an interesting new feature of Skype:  screen sharing. Here you can read all about it.

Andrew Sprong explains at his blog STweM how to create a PDF archive of hashtagged tweets using whatthehashtag?! and Google DocsScribd or Slideshare. A tweet archive is very useful in case of  live tweet or stream sessions at conferences. (each tweet is then labeled with a # or hashtag, but tweets are lost after a few days if not archived)

L1010201At Cool Toy of the DayPatricia Anderson posts a lot about healthcare tools. She submitted Cool Toys Pic of the day – Eyewriter“, a tool for allowing persons with ALS and paralysis to draw artwork with their eyes. But you find a lot more readworthy posts at this blog and her main blog Emerging Technologies Librarian.

Heidi Allen at Heidi Allen Digital Strategy started a discussion on the meaning of social-medicine for Physicians. The link to the original submission doesn’t work right now, but if you follow this link you see several posts on social-medicine, including “Physicians in Social Media”, where 3 well-known physicians give their view on the meaning of social-medicine.

Dr Shock at Dr Shock MD PhD, wonders whether “the information on postpartum depression in popular lay magazines correspond to scientific knowledge?” Would it surprise you that this is not the case for many articles on this topic?

The post of Guus van den Brekel at DigiCMB with the inspiring title Discovering new seas of knowledge partly goes about the seas of knowledge gained at the EAHIL2010 (European Association for Health Information and Libraries) meeting, with an overview of many sessions, and materials when possible. And I should stress when possible, because the other  part of the post is about the difficulty of obtaining access to this sea of knowledge. Guus wonders:

In this age of Open Access, web 2.0 and the expectancy of the “users” -being us librarians (…) one would assume that much (if not all) is freely available via Conferences websites and/or social media. Why then do I find it hard to find the extra info about those events, including papers and slides and possibly even webcasts? Are we still not into the share-mode and overprotective to one’s own achievements(….)

Guus makes a good point,especially in this era, when not all of us are able to go and visit far away places. Luckily we have Guus who did a good job of compiling as much material as possible.

Wondering about the evidence for the usefulness of web 2.0, then have a look at this excellent wiki by Dean Giustini: http://hlwiki.slais.ubc.ca/index.php/Evidence-based_web_2.0.
The Health Librarianship Wiki Canada (the mother wiki) has a great new design and is a very rich source of information for medical librarians.

Another good source for recent peer reviewed papers about using social media in medicine and healthcare is a new series by Bertalan Mesko at Science Roll. First it was called Evidence Based Social Media News and now Social media journal club.

EHR and the clinical librarian.

Nikki Dettmar presents two posts on Electronic Health Records at Eagledawg.net, inspired by a recent Medical Library Association meeting that included a lot about electronic health records (EHRs). In the first part “Electronic Health Records: Not All About the Machine” she mentions the launch of an OpenNotes study that “evaluates the impact on both patients and physicians of sharing, through online medical record portals, the comments and observations made by physicians after each patient encounter.” The second post is entitled “a snapshot of ephemeral chaos“. And yes the title says it all.

Bertalan Mesko at Science Roll describes a try out of a Cardiology Resident and Research Fellow in Google Wave to see whether that platform is suitable for creating a database of the electronic records of a virtual patient. The database looks fine at first glance, but is it safe?

Alisha764′s Blog celebrated its 1 year anniversary in February. Alisha Miles aim for the next year is to not only post more but to focus on hospital libraries including her experience as a hospital librarian. Excellent idea, Alisha! I liked the post Rounding: A solo medical librarian’s perspective with several practical tips if you join the round as a librarian. I hope you can find time to write more like this, Alisha!

Our next host is Walter Jessen at Highlight HEALTH. You can already start submitting the link to a (relevant) post you have written here.

See the MedLibs Archive for more information.

Photo Credits:





The June MedLib’s Round is up & Call for Submissions.

14 06 2010

Yes, the latest edition of the Medlibs Round is up at EBM and Clinical Support Librarians@UCHC! Kathleen aka Creaky did a wonderful job compiling this round, with the main theme “service”.

Posts vary from a summary of the MLA-congress, to the first systematic review search of a librarian,  a friend’s request for help in finding information on breast cancer is, disclosure of conflicts of interest, collaborative librarianship through social media and (much) more. Read it all at Creaky’s blog!

Now it is only 2 weeks for the next deadline (Saturday, July the 3rd is the official deadline). So you better start writing and/or submit recent posts!

There is no theme, I will accept all relevant and good quality posts pertaining to medical librarianship, in the braodest sense of the word.

I would like to see posts about (for instance):

  • Social media (and medical information)
  • Searches, Search-engines & Databases (i.e. PubMed)
  • Reference Manager Systems
  • Library congresses (EAHIL?)
  • Web 2.0 tools, I-Phones, I-pads
  • Open Access, Publishing
  • Reliability of Information, Patient Information
  • Evidence Based Medicine

So NOT ONLY librarians, but also doctors and other healthcare workers, patients, pharma-people and scientists are invited to submit.

Submitting is easy, just submit the permalink (URL) of your post (at your blog) at the blog carnival here. For examples and Faqs see the MedLibs Round-ARCHIVE.

If you have no blog but would like to submit you are welcome to write a guest post at this blog.

************

I would also like to take the opportunity to ask if there are any Med- or Medlib-bloggers out there who would like to host the MEDLIBS round August, September, October or later this year!
A host for August is rather urgent as I will be on vacation the second half of July.

And if you didn’t fill in the poll below you still have the opportunity to do so. When we have a new name, the next step is to ask Robin of Survive the Journey to make a logo for us.





MedLibs Round: Update & Call for Submissions June 2010

4 06 2010

In the past months we had some excellent hosts of the round, really “la crème de la crème” of the medical information/libarary blogosphere:

2010 was heralded by Dr Shock MD PhD, followed by Emerging Technologies Librarian (@pfanderson) The Krafty Librarian (@krafty) and @Eagledawg (Nikki Dettmar).

Nikki  hosted the round for a second time, but now on her new blog: Eagledawg.net. The title: E(Patients)-I(Pad)-O(pportunities):Medlibs Round

Last Month the round was hosted by Danni (Danni4info) at The Health Informaticist, my favorite English EBM-library blog. It is a great round again, about “dealing with PubMed trending analysis, liability in information provision, the ‘splinternet’, a search engine optimisation (SEO) teaser from CILIP’s fresh off the presses Update magazine, and more. Missed it? You can read it here.

And now we have a few days left to submit our posts for the Next MedLibs Round, hosted by yet another excellent EBM/librarian blogger: @creaky at EBM and Clinical Support Librarians@UCHC.

She would like posts about “Reference Questions (or People) I Won’t Forget” (thus “memorable” encounters that took place in a public service/reference desk setting, over your career) or “how the library/librarian” has helped you.
But as always other relevant and good quality posts related to medical information and medical librarianship will also be considered.

For more details see the (2nd!) Call for submissions post at EBM and Clinical Support Librarians@UCHC

I am sure you all have a story to tell. So please share it with @creaky and us!

As always, you can submit the permalink (URL) (of your post(s) on your blog) here.

************

I would also like to take the opportunity to ask if there are any med- or medlib-bloggers out there who would like to host the MEDLIBS round August, September, October.

The MEDLIBs Round is still called the MedLibs round because I got too little response (6 votes including mine) to the poll with other name suggestions. Neither did I get any suggestions regarding the design of the MEDLIBS-logo, Robin of Survive the Journey has offered to make [for details see request here]. I hope you will take the time to fill in the poll below, and to think about any suggestions for a logo. Thanks!

@ links to the twitteraccounts





Three Editions of the MedLibs Rounds & Call for Submissions!

2 03 2010

I’m running behind…. Two Three editions of the MedLibs Round have already been published since my last post on the subject.
The MedLibs Round -as you may know- is a monthly blog carnival of blog posts on subjects pertaining to medical information.

At one point almost half of my posts was about a Grand Round, the MedLibs Round or whatever Round. So I decided not to summarize each round, because that might be annoying for some of my readers.

On the other hand the MedLibs Round is my child, my little toddler. It must be cherished and nurtured to let it grow. I should be a better parent.

Last three times the Round was hosted by three wonderful hosts.

December 15th the MedLibs Round was hosted by Knowledge beyond words, the blog of Novoseek, a biomedical search engine. Novoseek succeeded to host a very interesting MedLibs Round entitled: “Social media, web services and tips for health in MedLib’s Round 1.9

A sparkling New Year Edition (MedLibs Round 1.10) was hosted at Dr. Shock MD PhD, a neurostimulating blog.

Finally the second year of this blog carnival (2.1) was started by Patricia Anderson at Emerging Technologies Librarian. This edition was plagued by too few relevant submissions, and too much spam. This was a pity because the theme was really interesting: “Free Speech in Health Information, and More“. Hopefully Patricia would like to give it another try later.

Of course we don’t want this to happen to our next host, Michelle Kraft, also known as The Krafty Librarian (her blog name). Michelle doesn’t need an introduction I guess. With Patricia she is one of the first -and most well known- medical librarian bloggers.

Michelle is really looking forward to some good quality post that she can include in her blog carnival.

She doesn’t have a theme in mind, as long as your post is related to medicine and libraries in some way. Some topic examples are: library technology, librarianship, Evidence Based Medicine (EBM), PubMed, bibliographic databases, information literacy, open access, print vs. online, medical apps, library apps, mobile technology, user education.
Note that some subject need not be strictly medical either, i.e. SCOPUS, database management or open access.

So Michelle asks all of you medical, health, and library bloggers out there to consider submitting one of you posts to the carnival. Posts can be written especially for this carnival or may be recently published posts on the subject. And if you’ve read an excellent post elsewhere you can tip Michelle and/or ask the author to submit. We need your input!

Just submit the URL of your post by March 6, 2010 to the Carnival Submission form.

The post will be up Tuesday March 9, 2010 at the Krafty Librarian.

For more info see the Call for Submissions -post at http://kraftylibrarian.com/?p=418 and the MedLibs Archive here

And people who like to write a post but have no blog are invited to write a guest post here. Just leave a comment or contact me by email:

laika.spoetnik@gmail.com

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Grand Rounds Vol. 6 No. 2

29 09 2009

grandroundsblank

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

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

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

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

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

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

We don’t search for this…

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

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

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

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

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

Background  questions.

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

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

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

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

Foreground  questions: Domain Therapy2463850234_6a9851b622

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Domain Diagnosis

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

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

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

Domain: Etiology/Harm

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

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

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

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

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

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

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

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

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

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

741879088_29d01c359b_m-another-dead-librarian

Acknowledgements

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

Bonus

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Interview will appear at http://www.medscape.com/index/section_2624_0

Image Credits (CC-licence)

  1. Library Book Shelves, Wikimedia
  2. PAR-TIC-I-PA-TION, or 37 pieces of library flair Flickr.com: trucolorsfly-611479605
  3. Stone Horses: Flickr.com: automania-73655708
  4. The Background/Foreground picture is used everywhere, I’ve adapted it from the excellent book: Guyatt G, Rennie D, Meade M, Cook D. JAMA Evidence Users’ Guides to the Medical Literature. A Manual for Evidence-Based Clinical Practice. 2nd ed. Chicago, IL: McGraw Hill Co; 2008.
  5. Dolk-Banana Therapy Flickr.com: imagesniper- 2463850234
  6. P Flickr.com:duncan-104311636
  7. I [Aye-Aye] Flickr.com: urbanmkr-247846944
  8. C Flickr: urbanmkr-477120721
  9. O Flickr: urbanmkr-249722873
  10. Stethoscope Flickr: ponyapprehension-733162553
  11. An Honest Question Flickr: photos/hryckowian/3880192862/
  12. Another Dead Librarian by Doug! Flickr.com: librarygeek- 741879088

You might also like:

Dear Laika,This is my suggestion for Grand Rounds:Doctors add expert insights and comments about websites in Google Sidewiki
http://casesblog.blogspot.com/2009/09/doctors-add-expert-insights-and.htmlAlternative:Myths About Health Care Around the World
http://casesblog.blogspot.com/2009/09/myths-about-health-care-around-world.htmlLooking forward to Grand Rounds on Tuesday,
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MEDLIB’s ROUND 1.6

27 09 2009

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

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

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

But lets start…..

Social Media

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

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

Google Health

Alisha

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

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

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

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

PubMed, MeSH and the like

Rachel

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

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

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

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

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

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

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

Grey Literature

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

**********************************************************************************

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

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

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

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

**********************************************************************************

Bonus

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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his imagination had run away
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Grand Round 5.42

7 07 2009

This week the Grand Round, the weekly summary of the best of the medical blogosphere, is being hosted by Flavio Guzmán at Pharmamotion, a blog about basic and clinical pharmacology.

7-7-2009 20-45-50 sneeuw krtistalThe Round is entitled:  “Brief Grand Rounds from Argentina“. Flavio had to keep it short, because (who would think of that? – I didn’t) winter has arrived in Argentina, and Flavio was hired to cover nights shifts in a local hospital because of the current H1N1 pandemic. Despite this,  Flavio did include my post, which was submitted this very morning (thus far too late). Thank you for that, Flavio.

Compact Rounds aren’t necessarily bad. I would say, on the contrary. Also in this case, Flavio succeeded in compiling a great and easy-to-browse round. Please go and enjoy reading the Grand Round here

Next week the Round will be hosted by @DrJosephKim (twitter) on Medicine And Technology. The theme is to “focus on ways that technology is changing healthcare”.





Gene Genie #44

24 03 2009

genegenie_logoThe latest issue of Gene Genie (nr 44) is now up at Mary Meets Dolly. Please enjoy reading the posts here

Gene genie is the “blog carnival of genes and genetic conditions“, initiated and maintained by Bertalan Mesko of Scienceroll.

You can subcribe to Gene Genie by email or RSS feed and as you may know there is also an aggregated feed of credible, rotating health and medicine blog carnivals available (which contains the Grand Round (due today) and the Medlib’s Round as well).

Please mail Bertalan if you want to contribute to the next carnival as a writer or a host (berci.mesko at gmail.com).






Email/RSS feed to the MedLib’s Round and other Medical Blog Carnivals.

5 03 2009

There are several noteworthy medical blog carnivals (Grand Rounds) around, but it is difficult to make (and thus take) an email/RSS feed to these carnivals, because the editions are hosted by different bloggers each time.

Recently Walter Jessen of the Highlight HEALTH Network has managed to make a feed to all important medical blog carnivals (based on bookmarks).

I’m very pleased that Walter also took the initiative to make a feed to the MedLib’s Round. You can subscribe to it by clicking this link. This is a superb way to keep up to date with the latest MedLib’s Round.

carnival-rss

It is also possible to take one subscription to all medical blog carnivals at once by clicking here.

Alternatively you can take RSS/email feeds to individual blog carnivals at Walter Jessen’s Highlight HEALTH Network:

Presently the following 10 carnivals are included:

  1. Grand Rounds Blog Carnival
  2. Encephalon Blog Carnival
  3. SurgeXperiences Blog Carnival
  4. Medicine 2.0 Blog Carnival
  5. Change of Shift Blog Carnival
  6. Cancer Research Blog Carnival
  7. Health Wonk Review Blog Carniva
  8. Gene Genie Blog Carnival
  9. MedLibs Round
  10. Palliative Care Grand Rounds

Thanks Walter for this initiative.

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