Multi-Author Medical Blogs – At the End it is all about Credibility

9 03 2011

Recently, Bertalan Mesko (Berci on Twitter) was asking his twitter followers whether they had a favorite Web 2.0 story.  Berci needed examples for his yearly “Internet in Medicine course” at the university of Debrecen.

Doctor Ves (drVes) and Berci discussed various examples of blogs that had grown in a way: a blog that branched from blog to most popular podcast/physician-radio host (Dr. Anonymous), Kevinmd.com starting from a solo blog with 2-line snippets to a HuffPost-style conglomerate, DiabetesMine becoming a group voice with increasing popularity and industry recognition and Dean Giustini’s start from blog to the openmedicine journal based on WordPress.

And while those are all great examples, I just wondered whether growth from single to multi-authored blogs is per definition “the best” and something one should strive for. Does growth in number of authors automatically mean: “growth” of the blog? And in what respect? Is sheer growth of traffic and a greater audience the most important?

This blog regularly had guest posts in the pasts and they were surely an enrichment. Shamsha Damani was the main contributor. Her welcomed posts were in line with the theme of this blog (evidence based medicine, library-related topics), but had a fresh new look at certain topics (see for instance Grey literature time to make it systematic and  Uptodate versus Dynamed. The post were written by Shamsha, but I reviewed them before publication. Because after all, I’m responsible for the blogs content.

Guest posts/co-authorships can help to post more often. Variety in topics, style and perspectives may  further engage the readership and enhance traffic.

All good things. However, there is a big BUT, the BUT of quality and consistency.

If the blog has a theme or a focus, all authors should more or less adhere to it. Writers can have different opinions and perspectives but these should not be in conflict with the basic principles. And it surely shouldn’t be nonsense!

Good examples of blogs where authors replenish each other while adhering to a basic style are: Life in the Fast Lane (focus: emergency medicine and critical care, education, web.20 & fun) and the Health Informaticists (pretty much the scope of this blog: EBM, health 2.0, knowledge management).

Another good example is Science Based Medicine, a multi-author skeptical blog. Last year however one author (Amy Tuteur) resigned after

….”it had become clear to both the editors of SBM and Dr. Tuteur herself that, although Dr. Tuteur had routinely been able to stimulate an unprecedented level of discussion regarding the issues we at SBM consider important, SBM has not been a good fit for her and she has not been a good fit for SBM“.

Splitting up can be a good decision in case of unresolvable differences in approach. It was remarkable however that part of the  readers (167 comments to the post) were sad about Amy Tuteur’s leave, because they found her posts stimulating and engaging. Some people like (literally) thought provoking posts, while others rather see thoughtful (and sometimes predictable) posts supported by evidence.

Posts that don’t fit in can pose great credibility problems, not only for co-authored blogs, but also for blogs with guest posts. The well known KevinMD blog, cited above because it has grown from a single to a multi-author blog, recently came under fire because of a controversial guest post. Two (almost) equally famous “skeptic” bloggers devoted an entire post to this mishap, Orac of Respectful Insolence:Say it ain’t so, Dr. Pho! Credulity towards alternative medicine on KevinMD” and Steven Novella at Neurologica Blog wrote That treatment is not based on science? Don’t Worry, says KevinMD.

In his guest post “Why alternative care seems to work“, Peter Weiss assumes that people don’t try (or are even unwilling(!) to try CAM, because they don’t know the working mechanism. Weis’s post is a credulous plea for CAM:

Don’t get so hung up on the explanation that you don’t believe in, that you’re unwilling to try a practice that might actually help you.  Just keep an open mind.  You don’t have to know everything about how things work; you just have to know that they work. Just like, do I really understand electricity or do I just know that if I turn the light switch, the light comes on?

Weis tries to prove his point by saying that a highly prescribed drug as Lunesta has no known working mechanism either. Besides that this is ludicrous comparison, it isn’t true either. We do have a clue as to how Lunesta works (albeit falsifiable like everything in Science). Furthermore, Lunesta is effective whereas there is no such evidence for acupuncture or chiropractic. So should we just go and try and see instead of making an informed decision on basis of evidence  and plausibility?

This post is unlike the critical voice we usually hear from Kevin Pho. Regularly he warns against overtreatment and unnecessary screening,  for instance.

Bloggers seldom critic each other, but this quack-like post has led Steven Novella to conclude:

Weiss’s post on KevinMD is very disappointing, and unfortunately indicates that the filter on that blog for guest posts does not appear to be adequate. I hope it does not indicate a shift in philosophy away from science-based medicine, which would be worse.

Orac is much harsher.  He even devotes two posts to the topic. In style with the blog title he rages a respectful insolent rant: he will remove Kevin MD from his blogroll and will cease to recommend Kevin’s blog as a reliable source of medical information.

Orac -and many of his readers are also displeased with Kevin’s response (where he does admit they are kind of right):

Orac,

I appreciate the critique. As readers of this blog know, I often post pieces here I don’t necessarily agree with myself to promote discussion and debate. Your concerns are certainly valid, and will be taken into consideration as I choose future pieces.

Best,
Kevin

Orac even spent a second post to show the ridiculosity of  teaching the controversy in medicine by “posting pieces you don’t necessarily agree with” . What annoyed people the most was the lack of a disclaimer or an informed comment.

Basically I agree that Kevin should select more critically* and if a bad posts slips through, he should retract, openly criticize, or at least (directly) comment to the post. Indirectly saying that you will be more careful next time is not enough, IMHO. Furthermore comments were closed very soon, not giving people ample chance to respond.

On the other hand, Kevin agrees with the critique on multiple occasions. Also, I do not think that he has only traffic in mind when he includes many guest posts. He invites readers to “Submit a guest post to be heard on social media’s leading physician voice”. In line with this, Kevin once rejected a nomination in the Medgadget blog contests, probably so that some lesser known blogger would get more recognition out of the awards (roguemedic.com). Furthermore, many of the guest posts are interesting and of high quality. Thus, hopefully, this is an exception.

Anyway, this incident illustrates a pitfall of multi-author or multi-guest blogs. Posts should not be in conflict with  the basic principles of the blog. This will be directly noticed by experts in the field and certainly by skeptics), who immediately pounce on any contradictory message. But eventually conflicting standpoints may also dismay or -even worse- confuse other readers (patients, lay people).

In the end blogging is not only about the traffic. It is about credibility. It is not even about your own reputation, it is about the credibility of medical blogs in general.

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

*Earlier, in a short discussion on Twitter dr Ves pointed out: “Well, Kevin is the publisher and he decides what deserves to get in, readers decide whether to follow… Similar to newspaper”. He also stresses we can’t tell KevinMD what to publish. Which is true. However, Kevin Pho and other prominent medical bloggers have a great responsibility towards an audience consisting of people  who seek to be well-informed. Medical statements should be accurate and assumptions should be plausible.
By the way, even newspapers make corrections now and then.

Related Articles





Don’t forget to vote for your favorite Medical Weblog at Medgadget!

13 02 2011

I almost forgot to vote for the best medical blogs in the Seventh Annual Medical Weblog Awards Contest, organized by Medgadget.

But, I voted just in time, and so can you if you haven’t done so. Please support your favorite blogs!

Voting will close 23:59:59 this Sunday, February 13, 2011 (EST).

You can vote here at Medgadget

There are several categories:

  • Best Medical Weblog
  • Best New Medical Weblog (established in 2010)
  • Best Literary Medical Weblog
  • Best Clinical Sciences Weblog
  • Best Health Policies/Ethics Weblog
  • Best Medical Technologies/Informatics Weblog
  • Related Articles





    Webicina Presents: PeRSSonalized Medical Librarianship: Selected Blogs, News, Journals and More

    13 08 2010

    One and a half-year ago I wrote about PeRSSonalized Medicine, developed by Bertalan Mesko or Berci. It is part of Webicina, which “aims to help physicians and other healthcare people to enter the web 2.0 era with quality medical information and selected online medical resources”.

    The RSS in PeRSSonalized Medicine stands for Real Simple Syndication, which is a format for delivering regularly changing web content, i.e. from Journals. However, if you use PeRSSonalized Medicine, you don’t need to have a clue what RSS is all about. It is easy to use and you can personalize it (hence the name)

    In the previous post I discussed several alternatives of PeRSSonalized Medicine. You can never tell how a new idea, or project or a new business will develop. We have seen Clinical Reader come and disappear. PeRSSonalized Medicine however really boomed. Why? Because it is free, because it has an altruistic goal (facilitate instead of earning money), because users are involved in the development and because it keeps evolving on basis of feedback.

    PeRSSonalized Medicine develops fast. There is not a week that I don’t see a new section: Nephrology, Genetics, Diabetes whatever.

    And this week tada tada tada … it is the turn of the Medical Librarianship, with Journals, Blogs, News and Web 2.0 tools. Please have a look yourself. You can personalize it at wish, and if you miss something, please mail to Webicina.

    Related articles by Zemanta





    Laika’s MedLibLog on the Longlist of the Dutch Bloggies!

    3 11 2009

    dutchbloggies_copy7Laika’s MedLibLog is nominated for the Dutch Bloggies-awards. The Dutch Bloggies is a  yearly contest by the foundation “Dutch Bloggies” that awards weblogs from Dutch-speaking regions.

    Besides the overall Most Popular Weblog and Best Microblog, there are longlists for 15 categories. There are 10 blogs on each longlist. Laika’s Medliblog is nominated for best blog in category Best health & sport weblogs.

    These are the blogs in this category:

    Ajax Life | Catenaccio.nl | De Hardloper | Gezondheid.blog.nl | Green Jump | Laika’s MedLibLog | Marijn Fietst | Medicalfacts | SuikerWijzer | Zorg Beter Maken

    I do feel like Tom Thumb amidst the giants. Apart that this site serves a small niche, it is hosted by one person in spare time on a WordPress domain. I’m getting a little intimidated by the professional looks and frequent updates of some of the self hosted blogs. But being nominated is already a great honor.

    After publication of the shortlists the final winners will be announced in “het Paard van Troje” in The Hague, December 1th.

    Nice to know: Colleague Librarian and fellow blogger Edwin Mijnsbergen (http://twitter.com/zbdigitaal) of the Wonderful blog ZB Digitaal was previous year’s winner in the category Education (see his blogpost)

    All longlists can be viewed on http://www.dutchbloggies.nl/2009/?e=16

    A better overview (without the need for clicking) is presented at JeroenMirck (link), the blog of Jeroen Mirck, journalist and chairman of the jury.

    NRC-next blog (a blog of a Dutch newspaper) -nominated four times itself- also refers to the contest here.

    The Volkskrant mentions the Dutch Bloggies nominations here


    dutchbloggies2009-jury-totaal

    The deliberation of the jury. Originally there were 5000 nominations.

    Reblog this post [with Zemanta]




    Spoetnik Symposium

    27 11 2008

    Yesterday the Spoetnik Symposium was held (see my previous announcement here).

    SPOETNIK was a 17 week course on NEW (web 2.0) internet communication methods for librarians. The main target group consisted of UBA (University Library of Amsterdam) librarians. In total, there were more than 160 course members, each having his own blog.

    The organizing UBA-spoetnik team, organized the Spoetnik symposium to learn from each other what has been done with the knowledge obtained a half after the course had finished.

    The program was as follows:

    14.00 Opening by Robin van Schijndel
    14.10 Since SPOETNIK – part1: Blogging after SPOETNIK by Jacqueline (alias Laika)
    14.25 Since SPOETNIK – part2: Colleagues about SPOETNIK by Alice Doek
    14.40 Group discussions
    15.30 Koffie- en theepauze
    15.45 Feedback from the discussion groups
    16.15 Since SPOETNIK – part 3: New applications by Pascal Braak
    16.30 Closure and drink

    spoetnikThe symposium started a few minutes later because Jacqueline was a bit late: she had to take off Laika’s astronaut suit (well kind of, she torn her new pantyhose and had to find a new one (that didn’t fit), she dubbelchecked whether she took her USB-stick with her and she forgot her glasses). It could have been worse, because it was just a few hours in advance that Jacqueline found out that the meeting was not in THE Doelenzaal at the Kloverniersburgwal but in the (also beautiful and old) Doelenzaal (zaal = room) in the UBA (main library of the University of Amsterdam). Of course, everyone else just knew this. That underlined the feeling that the Academical Medical Center and most other departments of the UBA are both physically and mentally apart, although still connected.

    The atmosphere was very relaxed. Before the speeches, there was a lot of rumor or as Alice said: it is like a reunion. And that ‘s how it felt! Finally I had the chance to meet my colleague bloggers in real life. I met Boekenvlindertje, Duijfje, Dyoke of Zygomorf (which I had always wrongly pronounced as Díe Joke, should be Dieuwke) and Turquoois, and I had long chat with Bert of “Een beetje adjunct” and finally with my blogmate George of Brughagedis, the one with whom I shared Google Docs, but never a drink, before. Both Bert and George have written a blogpost about this meeting (see here and here)

    Although George doesn’t want to be in the picture, he was mentioned in the introductory speech of Robin as one person that ‘meant a lot for the course’. That is certainly true. You need some active contributors to inspire the rest. Besides George was the first to create an OPML-feed of all blogs (together with Pascal) which made it a lot easier to keep up with all Spoetnik blogs.

    My talk was next. In 15 minutes I had to outline “Blogging after Spoetnik”. How did I continue when the course was finished? Here is my powerpoint presentation.

    The theme I choose was “Blogging is navel gazing?!”. I notice that many people (including myself in the pre-web 2.0 phase) consider blogging as something egocentric, just an outlet for one’s feelings and frustrations, or hobbies and thoughts. What I hoped to show is that web 2.0 is not just a set of web 2.0 tools, but it is a whole philosophy. It is the philosophy of gaining momentum when sharing. But to do this you have to be patient, you must have a story to tell (content) and than you have to find readers, else you will remain ‘lonely’. I recommended twitter as a very good source to build up a community, if you use it the right way (find people to share things with). Although I have to say that it is a lot easier for me, as a health 2.0 blogger to find a large global community than someone specialized in Dutch linguistics.
    Thus I feel committed to write an introduction on how to use Twitter effectively. Preferably in Dutch: at least 2 UBA colleagues spontaneously said they regret that I had changed to English.

    Alice told us the origin of Spoetnik and gave an overview of the opinions of many other well known Dutch librarians about the course. The comment of Wowter was missing however, possibly because he expected Alice to use a web 2.0 way of finding it (Feeds and Twitter). (You can read his -Dutch- comment here). Many other libraries will follow the example of Spoetnik and 23 Dingen, although in a shorter version.

    Pascal showed us that there were many new web 2.0 tools ( a few slides with last week’s additions), but according to Pascal none of them was really new, but all variations on a theme. He did whisper that he had a new twitter-firefox api for me, so I hope he will provide me with further details.

    In between we discussed in groups what we had learned from the course, what we liked and didn’t like about different tools. Using Google Docs, we brainstormed about how we could implement web 2.0 tools in our library, UBA-wide. A very interesting part of the program, this exchange of thoughts. Robin gave a quick overview of the ideas, but shortly all input will be available at the Spoetnik-website together with the presentations.

    The Spoetnik course has been a success, this meeting was a success and hopefully the implementation will also be a success. As Bert said: step by step. Rome wasn’t build in a day. Besides most UBA people are now involved in the implementation of a new program: Aleph. This has to be handled first.





    Co-comment faster than light?

    1 10 2008

    Just a very short note on something I stumbled upon in co-comment.

    As I wrote previousy (in Dutch) I use co-comment to keep track of my comments, comments to interesting items and comments to posts of my favorites.

    Today I got a red envelope in my Firefox toolbar notifying me there was a new comment.

    Looking at co-comment I saw my comment of 43 min ago at PIMM, Partial Immortalization. However when I took a look at his site the comment was still awaiting moderation.

    I noticed this before when some-one else (Wowter) posted a comment at my site: that comment already showed up at my co-comment before I even read it, let alone approved it!

    This is kind of odd: what is moderation worth if the the comment is already made public elsewhere?

    Is this one of the reasons that there are so many double or triple entries of the same comment in Co-comment, one after placing the comment, the copies after approval or editing??

    What about spam-comments?





    Blog Spam and Spam Blogs (2)

    14 09 2008

    In a previous post I gave two examples of Health Blogs that are really pills-selling-sites. In this post I will show two examples of real Spam Blogs.

    Spam blogs or splogs are usely fake weblogs where content is often either inauthentic text or merely stolen (scraped) from other websites. All spam artificially increases the site’s search engine ranking, increasing the number of potential visitors.

    Database-management blog: no longer exists

    Original post at this blog above and comment below.

    One Spam blog that I wanted to show you, is no longer available. It is called Database Management.

    Technorati-profile (authority=51)

    This blog had no own content, but scraped it from blogposts having the (WordPress?) tag “database”. Although the post does link to the original site, it doesn’t refer to the author’s proper name, but some automatically generated fake name. For instance Shamisos instead of Laikaspoetnik (see Fig).

    When I tried to place a comment on their site I had to login into the WordPress-account (although I was already logged in into mine). That’s when I began to really distrust it.

    It’s technorati profile still exists (see Fig.). It is clear that the blog has rapidly increased it’s “authority” in the few months it existed. From zero to 51.
    Many blogs linking to this blog are also gone or peculiar. Other blogs might have just linked to the spam blog because they assumed that this was the original post, not the copy. Presumably by having so much content on ‘database management’ the splog gets more traffic (of the preferred kind). This might be an example of a splog that backlinks to a portfolio of affiliate websites, to artificially inflate paid ad impressions from visitors, and/or as a link outlet to get new sites indexed (Wikipedia).

    The second example of a spamblog is a very interesting site for Medical Librarians: Generic Pub, with the webadress: http://genericpubmed.com/pub/ with posts about PubMed. Really high quality information. Why? Because the posts derive from elsewhere. All of my posts about PubMed are in there, as are those of my colleagues, and perhaps your posts as well. There is no clue as to where the post really came from. You don’t get any pingbacks, unless the (original) post linked to you. That’s how I found out. As with the other spamblogs you cannot comment. Comments are always closed.

    one of my posts on Generic Pub

    The blogroll of Generic Pub

    Blogroll of Generic Pub

    Generic PubMed homepage

    Generic PubMed homepage

    The site does not hide its real intentions. To the left is a huge pill “cialis” and the blogroll consists of only pills, as well as PubMed tag feeds of Technorati and WordPress.

    If you strip of the web adress to: http://genericpubmed.com you arive at the homepage, which is unmistakingly a pharmaceutical e-commerce website. Why is this done? Perhaps the sites looks more reliable whith all those PubMed posts or perhaps the site might be easier to find.

    One way or another, these two sites steal posts from other sites. Tags used by Technorati or by WordPress, that can be easily transformed into a feed make it very easy for these spambloggers to automatically import blogposts with a certain tag.
    By the way, did you find your post in there?

    Previous post, see here.

    ————————————————————————–

    Database-management blog: no longer exists

    In een eerder post heb ik 2 voorbeelden gegeven van blogs die eigenlijk tot doel hebben pillen te verkopen.

    Nu 2 voorbeelden van echte Spam Blogs.

    Volgens Wikipedia: Spam blogs of splogs zijn doorgaans nep-weblogs, waarvan de inhoud vaak min of meer gestolen wordt (“scraped”) van andere websites. Dit verhoogt de ranking door zoekmachines en zorgt ervoor dat het aantal bezoekers toeneemt.

    Een Spam blog dat ik jullie wilde laten zien, is niet langer beschikbaar, tw. Database Management.

    Dit blog had alle inhoud gepikt van posts met de (WordPress?) tag “database”. Er wordt wel gelinkt naar de originele site, maar de naam van de auteur wordt vervangen door een of andere automatisch gegenereerde naam, bijv. Shamisos in plaats van Laikaspoetnik (see Fig in engelstalig gedeelte).

    Toen ik een commentaar wilde plaatsen op deze site, werd ik gedwongen in te loggen in WordPress, terwijl ik nota bene al ingelogd was. Vanaf dat moment vertrouwde ik het echt niet meer.

    Het technorati profiel van deze site bestaat nog steeds (zie fig in engelstalig gedeelte). Het blog is in enkele maanden tijd van 0,0 tot 51 gestegen in “authoriteit”.
    Veel blogs die naar dit blog linken zijn ook opgeheven of zijn verdacht. Andere blogs hebben misschien slechts per ongeluk naar deze splog gelinked, omdat men dacht met de originele post van doen te hebben, niet de kopie. Waarschijnlijk krijgt de splog zo meer verkeer van mensen die juist in database management geinteresseerd zijn. Mogelijk is dit een splog die teruglinkt naar een aantal klonen en vice versa. (Wikipedia).

    Het 2e voorbeeld van een splog is een erg interessante site voor medisch informatiespecialisten, nl Generic Pub met het webadres: genericpubmed.com/pub. Allemaal kwalitatief zeer goede posts over PubMed. Maar ze zijn wel gejat. Al mijn berichten met de tag PubMed zijn er te vinden, evenals die van mijn collega’s en misschien uw berichten ook wel.
    Nergens is de ware herkomst van de berichten te herleiden. De echte auteurs krijgen normaal geen pingback, alleen als de oorspronkelijke post een link naar hen bevat. Zo kwam ik er eigenlijk achter. Evenals de andere splogs, kun je geen commentaar plaatsen.

    De website verhult zijn werkelijke bedoelingen niet. Links staat een reuzachtige pil “cialis” en de blogroll bevat alleen namen van pillen alsmede de feeds van de PubMed tags van Technorati en WordPress.
    Als je het webadres stript tot: genericpubmed.com kom je op de homepage, onmiskenbaar een e-commerce site. Waarom verschuilt men zich achter zo’n blog? Lijkt de site er betrouwbaarder door of vinden potentiele klanten de site makkelijker?

    Hoe dan ook deze 2 sites stelen van andere websites. Een feed nemen op Technorati- of WordPress-tags is een eitje, en dit maakt het deze spambloggers erg makkelijk om automatisch blogposts met een bepaalde tag te importeren.
    Tussen 2 haakjes, heeft u uw post al getraceerd?

    Vorig bericht in deze serie, zie hier.





    Blog Spam and Spam Blogs (1)

    11 09 2008

    Flickr.com cursedthing (CC)

    We all get our spam once in a while. Most of the time spamfilters block them. Askismet works well at this blog. Often you recognize spam by the hyperlinks or the words, i.e. “viagra”.

    But sometimes spam is not so obvious. In 2 separate post I would like to give some examples of less obvious blog spam, spamblogs and something in between.

    Acccording to wikipedia:

    Blog spam is done by automatically posting random comments or promoting commercial services to blogs. Any web application that accepts and displays hyperlinks submitted by visitors may be a target.

    Conversely, spam blogs are usely fake weblogs where content is often either inauthentic text or merely stolen (scraped) from other websites.

    All spam artificially increases the site’s search engine ranking, which often results in the spammer’s commercial site being listed ahead of other sites for certain searches, increasing the number of potential visitors and paying customers.

    Blogs & Spam: “Spam” by request?

    David Rothman describes at his blog how he is often mailed by people asking him to post about their site, which often is “just a lousy site solely meant for pharma marketing”. He refuses if the site isn’t really useful, but apparently many of his fellow health bloggers aren’t that fussy, since those particular sites often manage to get mentioned on other health blogs anyway. David hopes that the blog-reader will read through this, but is that really the case? The blogger may be considered an expert in the field (that’s why he receives an email) and people may be inclined to take his word for granted. Striktly taken this may not be spam, but it sure works the same way.

    Spam Blog (1). “Spam” hidden behind “Breaking Health News”

    About a week ago, I had a look at WordPress.com and saw an interesting featured post with the (WordPress) tag “Health”.
    At WordPress “Featured Posts” are at the top of a tag list -in this case “Health”-, which increases traffic to such posts). The subject captured my attention, because it was about Addison’s disease (which I have). I read it.

    Somebody with primary Addison (Primary Adrenal failure, which leads to inability to make the hormones cortisol, aldosterone and dehydroepiandrosterone (DHEA)) asked whether the menstrual irregularity she developed a year ago could be caused by the replacement therapy with Hydrocortisone and Fludrocortisone and if this could lower her fertility.

    The answer (see here) was rather lengthy, it discussed the causes of menstrual irregularity, primary Addison’s disease, replacement therapy, that (the often not replaced) DHEA might improve general well-being, and finally comes to possible explanations:

    • changes in menstrual cycle could be related to too much or too little of the replacement hormones
    • recurrence of menstrual cycles was reported in one patient treated with DHEA (also considered as a supplement, by the way).
    • advice: consultation of an endocrinologist.

    Nothing really wrong with this. However a more plausible explanation wasn’t mentioned, i.e. that the reduced cycling might be due to the disease itself. Nowadays the main cause for primary Addison is auto-immunity, and auto-immunity often doesn’t come alone. Gonadal failure can occur in approximately 5% of the woman with auto-immune Addison’s (Williams Textbook of Endocrinology, E-medicine).
    For instance in 100 Dutch patients the distibution was as follows

    … In 47% of the patients with autoimmune Addison’s disease at least one other autoimmune disorder was present. Primary hypothyroidism had the highest prevalence (20.5%), followed by vitiligo (9.6%), non-toxic goiter (8.4%), premature menopause (7.3% of the women) (….).
    From: P.M.J. Zelissen et al, J Autoimmun. 1995 Feb;8(1):121-30.

    I tried to place a comment. However, comments were closed (at the date of posting). Odd. I must say that I already found it weird for a patient to start with I actually have an interesting question.” No one says that, but rather:

    Help, I’ve Addison and my menses become irregular, I want to have children, so I’m afraid that I’m becoming less fertile. Can this have anything to do with the corticosteroids I take?”

    An even closer look points out that:

    • both the Q & the A are written by the same person.
    • The automatically generated “Possibly Related Posts” only link to posts at the same blog
    • as do all “so called comments” (so a kind of self-ping).
    • There is no info whatsoever about who is behind this site.
    • The tab “About” is really the tab Pharmacy Store, where a bunch of “high quality medications” are offered.
    • If I click on fosamax (which a lot of ex-Cushing (panhypopituitary) Addisonpatients need), I ‘m linked to a really (recognizable) commercial site: see here

    Is this so bad? Well at least as bad as a lot of commercial-pills-selling-sites that don’t look like commercial-pills-selling-sites. It is quite misleading to use a blog on “breaking Health news” as a cover-up for real intentions: selling. Readers cannot respond, only trackback. Furthermore, in this particular case, the information was not really adequate for patients either (although “partially prepared” by pharmD candidates). One may also wonder why such a post becomes the featured Health blog at WordPress. Well, it will have suited them (and their tag “health” is well-thought-out).

    But there are better (or really worse) examples of real spam blogs. Two examples will be given in the next post (see here).

    Flickr.com cursedthing

    ———————-

    We hebben allemaal wel eens last van spam. Meestal wordt spam wel door spamfilters geblokkeerd. Askismet houdt in ieder geval het nodige tegen op dit blog (700 spam). Vaak herken je spam wel aan de (vele) hyperlinks of termen als “Viagra”.

    Soms is echter niet zo duidelijk dat het om spam gaat. In tenminste 2 berichten wil ik voorbeelden geven van minder evidente blogspam, spamblogs en wat daar tussenin zit. Het zijn dingen waar ik toevallig tegenaan gelopen ben.

    Eerst wat definities. Volgens Wikipedia :

    Blog spam is done by automatically posting random comments or promoting commercial services to blogs. Any web application that accepts and displays hyperlinks submitted by visitors may be a target.

    Conversely, spam blogs are usely fake weblogs where content is often either inauthentic text or merely stolen (scraped) from other websites.

    All spam artificially increases the site’s search engine ranking, which often results in the spammer’s commercial site being listed ahead of other sites for certain searches, increasing the number of potential visitors and paying customers.

    Blogs & Spam: “Spam” op verzoek?

    David Rothman vertelt op zijn blog dat hij vaak een verzoek per mail krijgt om een post te plaatsen over een bepaalde site, terwijl het gewoon om een belabberde farmaceutisch e-commerce site gaat. David weigert dit als de site slecht is/zijn lezers niets biedt, maar kennelijk zijn z’n collega bloggers niet zo kieskeurig: vaak worden dergelijke sites binnen no time wel op andere gezondheidsblogs besproken. David hoopt dat de lezers van dergelijke blogs hier doorheen kijken, maar ik vraag me af of dat werkelijk zo is. Degene die erover schrijft op zijn blog wordt al gauw als expert gezien (daarom kreeg hij ook dat verzoek) en lezers zullen al gauw geneigd zijn wat hij bespreekt voor waar aan te nemen. Strikt genomen is dit wellicht geen spam, maar het resultaat is hetzelfde.

    Spam Blog (1). “Spam” verborgen achter “Breaking Health News”

    Ruim een week geleden zag ik een interessante post bij de “featured posts on Health” bij WordPress.com.
    Bij WordPress komen “Featured Posts” bovenaan de posts met een bepaalde tag, in dit geval “Health” te staan. Ze worden daarmee extra in het zonnetje gezet en krijgen extra veel bezoek. Maar in dit geval trok ook het onderwerp mijn aandacht, omdat ik het zelf heb: de ziekte van Addison.

    Iemand met primaire Addison (uitval van de bijnieren waarbij de oorzaak in de bijnieren zelf ligt, niet in de aansturing. Hierdoor worden de hormonen cortisol, aldosteron en dehydroepiandrosterone (DHEA) niet meer gemaakt) stelde een vraag over haar sinds een jaar vaak uitblijvende menstruatie. Ze wilde weten of dit iets te maken kon hebben met de substitutietherapie met Hydrocortison and Fludrocortison.

    Het antwoord (zie hier) was nogal weinig to the point. Het volgende werd breeduit besproken: de oorzaken van onregelmatige menstruatie i.h.a., primaire Addison, substitutietherapie, dat het vaak niet gesubstitueerde DHEA (eigenlijk ook vaak gebruikt als voedingssupplement) de kwaliteit van leven kan verbeteren, om tot slot met enkele mogelijke verklaringen te komen:

    • veranderingen in de menstruatiecyclus kunnen samenhangen met te weinig of te veel vervangende hormonen (maar niet door fysiologische doses, hetgeen het streven is bij vervanging).
    • één patient kreeg weer een normale cyclus na gebruik van DHEA (overigens werden ook de andere hormonen beter ingesteld)
    • tot slot een algemeen advies; ga naar je endocrinoloog.

    Hier is niet echt wat mis mee (vooral met het laatste advies). Zij het dat een voor de hand liggende verklaring niet genoemd wordt, namelijk dat een onregelmatige cyclus en verlaagde vruchtbaarheid ook kunnen samenhangen met de ziekte zelf. Tegenwoordig is de belangrijkste oorzaak voor primaire Addison autoimmuniteit (afweerreactie tegen eigen weefsels/organen) en autoimmuniteit komt vaak niet alleen. Uitval van de geslachtsorganen kan in zo’n 5% van de patienten met primaire Addison voorkomen (Williams Textbook of Endocrinology, E-medicine).
    Bij 100 Nederlandse patienten was de verdeling bijvoorbeeld als volgt:

    … In 47% of the patients with autoimmune Addison’s disease at least one other autoimmune disorder was present. Primary hypothyroidism had the highest prevalence (20.5%), followed by vitiligo (9.6%), non-toxic goiter (8.4%), premature menopause (7.3% of the women) (….).
    From: P.M.J. Zelissen et al, J Autoimmun. 1995 Feb;8(1):121-30.

    Ik probeerde een reactie te plaatsen op de blogpost, maar dat was niet meer mogelijk. Nou ja niet meer: het was de dag dat het bericht geplaatst was. Raar. Ik moet zeggen dat ik al mijn wenkbrauwen fronsde bij het zien van de aanhef I actually have an interesting question.” geen patient begint zo, maar zegt eerder:

    Help, Ik heb Addison. Mijn cycli worden onregelmatig en ik wil nog graag kinderen hebben, dus ik ben bang dat ik minder vruchtbaar wordt. Kan dit komen door de corticosteroiden die ik ter vervanging inneem?”

    Geintrigeerd ging ik verder op zoek.

    • De Q & de A bleken door dezelfde persoon geschreven.
    • De automatisch gegenereerde “Possibly Related Posts” linken alleen naar berichten op het blog zelf.
    • Dat geldt ook voor alle commentaren (een soort zelf-ping).
    • Er is nergens info over wie er achter de site zit.
    • De tab “About”/”Over” is eigenlijk de link naar de “Pharmacy Store“, waar een reeks “high quality medications” wordt aangeboden.
    • Als je bijvoorbeeld op fosamax (vaak gebruikt door ex-Cushing Addisonpatienten) klikt kom je op een duidelijk herkenbare commerciele site terecht: zie hier

    Is dit zo erg? Nou dit blog is net zo erg als die pillen-verkopende websites die er niet uitzien als pillenverkopende websites. Het is nogal misleidend om je blog te presenteren als een blog over “breaking Health news” om je werkelijke bedoelingen te verbloemen: pillenverkoop. Lezers kunnen niet reageren, alleen trackbacken. Verder was de informatie ook voor patienten niet helemaal volledig. Je kunt je ook afvragen hoe zo’n blog nou een featured Health blog bij WordPress wordt. Nou, het was wel lekker meegenomen (en ze kennen niet voor niets de tag “Health” toe).

    Maar er zijn betere (or eigenlijk slechtere) voorbeelden van echte spam blogs. In de volgende post (zie hier) zal ik er twee bespreken.





    #Sciblog – a bird-eye’s view from the camera

    2 09 2008

    Last Saturday I learned from @AJCann and @Jobadge (Twitter) that there was a Science Blogging Conference going on in London, that you could virtually attend.

    Although I planned to do something else (banking for my mom, pick up my daughter from her overnight stay; Saturday is my-shopping-&-bodyshape-sauna- & blogging-if-I-have-some-spare-time-day), I decided to follow it. In the meantime I tried to blog about something else, which didn’t work.

    I largely followed Cameron Neylon’s streamed video on Mogulus. It’s main value was the audio-stream, as well as the candid-camera function peeping at the audience from behind.

    I came in late (back from banking) and unfortunately missed the Keynote lecture of Ben Goldacre from Badscience.

    The next session didn’t do it for me, partly because the 3 blogging ladies ( Jenny Rohn, Grrl Scientist, Anna Kushnir) were almost inaudible and what they had to say about the bridging function of blogs between scientists and the general public (also figuratively) didn’t catch my ears. In the meantime the virtual attendents including, Fang (Mike Seyfang) from Australia, AJCann, some other guys and me, chatted in Cameron Neylon’s room.

    In between I followed Twitter-messages having the hashtag #sciblog (see here). I was not familiar with hashtags, but it is a predefined tag you can add to you microblogging post to easily tract what is being said about a subject (even when you don’t actually follow the persons themselves, so as a spin off you can get acquainted with some real interesting people).

    Example of a twitter message on #sciblog:

    #sciblog matt woods: friendfeed encourages discussion and closes feedback loop 9 minutes ago from TwitKit

    However, Hashtags is an opt-in service. You must follow @hashtags -and it has to follow you- for the service to index your tweets, so it took me some time to get it done (For more information, see this twitter wiki.) Althoug the procedure in itself was very effective, the twitter messages didn’t add much value for people already attending.

    Another online backchannel, the Friendfeed room appeared more lively, but I soon stopped following the threads. Furthermore I ‘m so old-fashioned that I think speakers do deserve my attention while they’re talking (but perhaps that is because I’m not yet used to chatting at the back-scene). Checking my notes afterwards with the Friendfeed comments was useful however.

    Next I followed Matt Wood’s introduction to microblogging and aggregation services and Breakout 6 “Communicating Primary Research Publicly” by Heather Etchevers (Human in Science), Jean-Claude Bradley (Useful Chemistry) and Bob O’Hara (Deep Thoughts and Silliness).

    I found these presentations interesting, but tracking my notes back I couldn’t see where Matt ended and the others began.

    During his lively presentation with a lot of gesturing, the heavy “sequencer” Matt Wood from “Green is Good” told us he had decided not to worry to be open and just send the message out to the public. You could use blogs to communicate your scientific findings, but blogposts do not handle versioning, although you can sometimes manipulate the post’s date (WordPress blog). Another tool is microblogging services. Twitter is more of a social platform, whereas Friendfeed is more apt for more information-exchange (no 140 character-limit). A new microblogging service is identi.ca. (see for instance this readwriteweb post)

    Labnote books (and wiki’s) were a recurrent subject through the 4 presentations. They are very useful to blog primary research. People should write their motives, use it as a diary (writing down all details and circumstances), recording the results (videorecording, freehand sketches, figures, prints, text), followed by periodic summing up.

    Why this is useful?

    • You don’t have to remember it (people tend to forget) (although some lab-scientists don’t like to take the notebook along to the bench)
    • Archive of ideas, (to share with people in the lab, collaborators or even ‘the world’
    • (If open) some results may be available direct outside the lab, which may be very useful for cooperation and exchange of thoughts or help (why did my blot fail?-how to proceed?)
    • It may help as a bridge to the public, i.e. by showing if public money is being spent well or for direct communication of your data to the public.
    • The info is verifiable if you link to the real data
    • Science is far more efficient this way and results are revealed instantly. Why wait till everything is distilled out? The scientist’s approach is as Hans Ricke quoted Richard Feyman from his Nobel Lecture 1966 (at Bob o’Hara ‘s blog) :

    “We have a habit in writing articles published in scientific journals to make the work as finished as possible, to cover up all the tracks, to not worry about the blind alleys or describe how you had the wrong idea first, and so on. So there isn’t any place to publish, in a dignified manner,what you actually did in order to get to do the work.”

    As Hans said blogs may fill that hole, because they are the place to publish this!

    Major Pitfall may be that journals may not accept data reported on a wiki. And another that some people may run away with your ideas. By writing it all down you make it very easy on them. Still if everybody would become open…. For Science that would be a great good.

    What I liked most of these presentations is the openness and the creativity of the presenters.
    As a (medical) librarian and a scientist these thoughts came to my mind:

    • I’m a bit jealous that I worked as a scientist in the web 1.0 era. This way of approaching science looks very stimulating to me, but maybe that’s only a romantic look from the outside?
    • How do we as librarians step in? Can we play a facilitating role? Should these primary findings be aggregated and made available in a searchable way?
      We should at least keep more in pace with the new scientific developments and the way researchers exchange and find their information. It’s entirely different to what we are used to. (we= most librarians I know, including myself)
    • I wonder if such an approach could also be used in medicine and/or in EBM. Are wiki’s like this useful for CATs for instance? Question, PICO + domain, best study type, search, critical appraisal, summary, power point presentation, pdf-files, video of CAT etc??? link to video of casus perhaps?

    To get an impression of the great features of such a wiki/open notebook, take a look at http://usefulchem.wikispaces.com/ (Jean Claude Bradley). You can also go to the Useful Chemistry blog and click at “UsefulChem wiki”. Note for instance the links to the notebooks of the individual scientists. Really impressive.

    Below you also find the (short) presentation of Heather. Hope the others will follow soon and share their presentations

    more about “Sciblog2008 Etchevers“, posted with vodpod
    Other Info





    Nature science blogging conference

    30 08 2008

    There is official forum for Science Blogging in London, today. The event is organized by Nature Networks.

    You can find the program and the attendees here.

    AJCann of Science of the Invisible has summarized in this post how you can virtually follow this conference.

    At this moment (saturday 11.45 am) you can follow the forum live here

    HATTIP: Twitter : @AJCann, @Jobadge

    ———————————-

    Vandaag is er een conferentie voor ‘wetenschapsbloggers’ in Londen.

    het wordt georganiseerd door Nature Networks

    Hier kunt u het programma bekijken.

    Op dit moment (zaterdag 11.45 uur) kunt u het programma hier live volgen.

    AJCann van Science of the Invisible heeft hier samengevat hoe u deze conferentie kunt volgen.

    HATTIP: Twitter : @AJCann, @Jobadge





    A Dutch Grand Round?

    10 08 2008

    If you search for “Grand Rounds” in Google Blogsearch you will find many medical blogs that regularly have a grand round, i.e. a weekly, biweekly or monthly collection of “best” blogposts in the medical blogosphere.

    Some blogs are exclusively about grand rounds or archive them, e.g. Pediatric Grand Rounds or radiologygrandrounds. Other blogs, like Scienceroll of the multitalented Bertalan (Berci) Meskó, have their own blog carnival. Other Grand Rounds like THE Grand Rounds“, founded by Nicholas Genes in 2004, are a regular compilation of the “best medical blogs”, hosted by a different blogger each week. Other participitating bloggers have to submit a recent post, with or without a theme, before a certain deadline. The posts of “Grand Rounds” are written for a general audience, thus not for other medical bloggers.

    In the Netherlands there is no real equivalent of a Grand Round (“Grote Visite”), at least not at a structural basis. Till now some individual medbloggers made their own rounds like Jan Martens of Medblog.nl in his rondje langs de medblogs.

    Recently, Dr. Jan and Dr. Shock came up with the idea to introduce a Dutch Grand Round: according to their plan each 2 weeks another participant -whether doctor, nurse, student, patient, healthcare professional, or even a medical librarian like me- will host the Grand Round at his own blog. Posts have to be submitted before a specific date, but there will be no themes and no selection (all qualitatively good posts accepted).

    Hopefully most Dutch medbloggers will accept the invitation to participate. At least there are 49 potential medbloggers at the MedBlogNL top 25 (see figures made with WORDLE, to the left weighted according to the position in the MedBlogNL top 25 in June, to the right all blogs non-weighted, see here for a previous post about Wordle ).

    Here is the original announcement at Medblognl (in Dutch). In due course the announcement of the “Grand Rounds” will appear at http://grotevisite.nl.

    Success with the excellent initiative, Dr. Shock and Dr. Jan!

    ——————————————

    Als je in Google Blogsearch op “Grand Rounds” zoekt vind je zeer veel engelstalige medisch blogs die regelmatig een “grote visite” maken langs medische blogs.

    Sommige blogs bevatten uitsluitend (een archief van) grote visites zoals Pediatric Grand Rounds of radiologygrandrounds. Andere blogs, zoals Scienceroll van de zeer veelzijdige Bertalan (Berci) Meskó hebben hun eigen “blog ronde”. Tenslotte heb je ook nog “Grand Rounds” met wisselende gastheren: elke keer schrijft een andere gastheer een samenvatting op zijn blog. Vaak moeten de deelnemende bloggers tevoren een recent bericht insturen, soms over een bepaald thema. Via dat laatste principe werkt de zeer bekende Grand Rounds“, opgezet in 2004 door Nicholas Genes van blogborygmi. De berichten worden geschreven voor een geïnteresseerd lekenpubliek, dus niet voor andere medische bloggers.

    In Nederland bestaat er nog geen officiele Grote Visite langs de Medblogs. Tot nu toe schreven een aantal bloggers een overzicht en kozen de artikelen naar eigen inzicht, zoals bijvoorbeeld het rondje langs de medblogs van Jan Martens” (laatste update in april j.l.).

    Jan Martens en Dr Shock hebben nu het plan opgevat om weer leven te blazen in de grote visite met een site voor de aankondiging: http://grotevisite.nl. Ze willen dit volgens het gastheerprincipe doen. Iedere deelnemer -arts, verpleger, student, manager en zelfs medisch informatiespecialist neemt bij toerbeurt de gastrol op zich en schrijft een overzicht van de berichten die vòòr een bepaalde datum bij hem/haar zijn aangeleverd. Alle andere deelnemers kunnen hier dan naar verwijzen. Hopelijk nemen alle Medbloggers deze uitnodiging aan. Er zijn tenminste al 49 potentiele medbloggers in de MedBlogNL top 25 aanwezig (zie bovenstaande WORDLE-creaties, links gewogen naar gelang van de positie van het blog in de MedBlogNL top 25 van Juni, rechts alle blogs even zwaar meegeteld (geinteresseerd in Wordle, kijk dan bij dit bericht))

    De officiele aankondiging van het initiatief is te vinden op Medblognl. Hier kunt u zich ook opgeven.

    Success met dit uitstekende initiatief, Dr. Shock and Dr. Jan! Hopelijk slaat het aan.





    MEDBLOG NL 5!!

    29 06 2008

    Just a little note before I leave for vacation.
    Maybe you’ve seen these blue and red widgets at the sidebar.

    They are here for a month now. It means that I’m number 5 on the MedblogNL-list in May 2008. Rather surprising because this is the first time I’m on the list.
    However, I must admit the list is not very long (30).
    (….and no 126 on the English list. This list is quite a bit longer and has WSJ.com: Health Blog at top(!)

    And since I don’t expect to stay up in the list for long, I just want to put it here… to remember. Yeah, I’m also a bit proud as a newbie in the blogosphere.

    My Technorati rate also went up to 30, but now it’s on his way down, mostly because the Spoetnik-collegues dont’link to each other anymore. Most have stopped active blogging.
    I miss it. When my vacation is over I will visit some of the Spoetnik pages. See how you’re doing. I promise.

    Back to the Medbloglog. You can see the Dutch MedblogNL here. The may-top 5 is below. Most of the other bloggers are physicians, nurses and students.

    The MedBlog log is an idea of Jan Martens. He thought it would be nice to have a list of Dutch Medical Blogs. Later he also made a list of English blogs.
    Scores are based on a number of parameters, like Google PageRank, Technorati ranking, Feedburner hits, 4) number of posts and 5) number of reactions.

    The blogpost of all the NL blogs can be seen at http://www.medbloglog.nl/.

    *********

    Sorry, heb nog 2 uur voor we met vakantie gaan (max. 2 uur slaap), dus even geen vertaling van deze post. En nog wel nu het om een NL-top25 gaat. :)





    Possibly an announcement about possibly related posts

    16 05 2008

    Related to my previous post “new related reviews in Pubmed” (which appeared possibly an anouncement) is this post on “possible announcement of possibly related post” appearing in WordPress. Are you still with me?

    Matt wrote a post “Possibly an anouncement” about the introduction of a new feature in WordPress: Related Posts. In English posts to begin with:

    “In a feature we’re calling possibly related posts we’ll now try to show posts related to yours a little section at the end. If we find any posts on your blog that are related, we’ll put those at the very top and in bold. Next we’ll show other posts from around WordPress.com, and finally we’ll check if there’s anything in the mainstream media.”

    In the ensuing discussion Matt reveals that “related thingy” as someone calls is not done via tags or keywords, but with all the content in the post. According to Matt “Sphere” creates something they call a “document genome” (LS: Wow! they sequence it!) and use it to do the matching, which can work a lot better than tags and categories”.

    It is still in an experimental stage and will be tweaked on basis of feedback and data collected. Introducing related posts may increase traffic between blogs as one can easily go from one interesting item via another to an even more interesting item. A kind of “post-hopping” or lateral navigation, as Matt calls it.

    Interesting idea, but is it working?

    Well, I surveyed some of my blog posts in a similar way as Hugh from the “I’m not actually a geek” blog to see what the possibly related posts to my posts were. They’re shown below, along with a rating of ‘++‘ for related and interesting, ‘— ?‘ for not related, ‘±’ for posts show a certain similarity. ↔ = reciprocal

    A. new-related-reviews-in-pubmed/ (Dutch/English)

    1. From Change the Display Format of Single Citations with My NCBI PubMed® User Preferences (link) ±

    (it is about PubMed, o.k. but mature and about the display format, not really about related articles and certainly not about related reviews-which are new ; the site itself is interesting -for me, but not updated for a year (Quite the opposit, Anna updates here blog daily. See somments. Sorry!)

    B. Opening UBA? (Dutch)

    the first two are from the same site and they link to each other but not to me.
    Hé: Dutch posts show the relating feature as well :)

    C. appropriate-bedside-manners (Dutch/English)

    1. Why paternalism isn’t dead « WhiteCoat Underground ± (about doctor -patient communication, but not about bedside manners or doctors crying
    2. The Art Of Medicine, kind of book review ± (same, and a book review)
    3. Building Physician Practices in Florida through Interactive Websites — ?
    4. At Bedside, Stay Stoic or Display Emotions? ++ (but it is a reference in my blog

    The last post (4) is a reference in my blog (yeah, easy!), and does not relate to me, nor do the other ones but 1 and 3 do relate again to 4.

    D. etiquette-based-medicine (Dutch/English)

    1. Een nieuw begin (uit de oude doos) — ?
    2. Een al te lange roede — ?
    3. Topartiest — ?

    No resemblance whatsoever, except perhaps some english words/an English title next to Dutch ones. The second one is again a nice blog (a dutch biologist, brughagedis!)

    Well E, I see at a glance, yields nonsense again. I don’t take the trouble to write this down.

    This trial was unsuccessful, indeed. The extremely low yield of NEW interesting posts might relate to the usage of both Dutch and English, but I can’t understand why a new subject as Etiquette based medicine (NEJM-paper) does yield only irrelevant Dutch posts. In addition the related posts do not link back. Till now I never received any hopping guest (except via the WordPress dashboard, news, or tags).

    Which brings me to a more generally uttered criticism, that is that Related Posts brings your reader(s) away from your blog, so you loose and don’t gain.

    Others criticize is that the posts linked to their blog are not remotely related and sometimes even quite contradictory (vegy food gives meat) or even link to racist and offensive material and that there is no control over the links, even a kind of intrusive to put (unrelated) links below a post without any notification. Somebody noted that It would be great if we had an easy-to-use formatting tool to list related posts of our choosing, not random word-search weirdness from the internets. Others object that tags (added yourselves) already serve this purpose of lateral navigation.

    My feelings are quite similar to those of Douglas Bell (commenting on the announcement)

    “I’m sorry, but I am astonished at how this feature was added. The particular blog that I run on WordPress.com is a professional blog with important content, and now to see something called “Possibly Related Posts” appearing in the exact same place and format as my own content, displaying links to blogs that I have no control over (and many of these links having absolutely nothing to do with my blog and linking to very inappropriate non-PG, non-English content) is quite infuriating. It’s fine that this feature can be turned off, but shouldn’t it have been opt-in, instead of opt-out?”

    Of course there are positive reactions as well, mostly very short comments : awesome, I like this, you guys are great….

    But I don’t like it, not when it works this way and I will put the feature off. I might give it a second chance later to see if it performs better.

    And the missed traffic to my blog? I don’t mind. I rather have a few interested people here, than just traffic passing by. I hate highways anyway. Prefer the quiet countryside and wait there for somebody to visit me and stay for a while. And of course I pay a visit back.

    Note added in proof: some related posts have been refreshed in the meantime.


    * The 3D WordPress Logo resembling a yoyo is created by Kate from Nineteen Labs





    BMI bijeenkomst april 2008

    21 04 2008

    Afgelopen vrijdag 18 April was de Landelijke Dag BMI, CCZ, PBZ en WEB&Z. De BMI is afdeling Biomedische Informatie van de Nederlandse Vereniging voor Beroepsbeoefenaren (NVB). De andere afkortingen staan voor werkgroepen/commissies binnen de NVB: CCZ = Centrale Catalogus Ziekenhuisbibliotheken, BPZ = Bibliothecarissen van Psychiatrische Zorginstellingenen en WEB&Z = voorheen Biomedische werkgroep VOGIN.

    Het programma bestond uit 3 ALV’s, van de CCZ, de BPZ en de BMI, afgewisseld met 3 lezingen. Een beetje lastig 3 ALV’s en 1 zaal. Dat betekende in mijn geval dat ik wel de BMI-ALV heb bijgewoond, maar tijdens de andere ALV’s (langdurig) in de koffieruimte annex gang moest wachten. Weliswaar heb ik die nuttig en plezierig doorgebracht, maar het zou wat gestroomlijnder kunnen. Ook vond ik het bijzonder jammer dat er nauwelijks een plenaire discussie was na de lezingen en dat men geacht werd de discussie letterlijk in de wandelgang voort te zetten. En stof tot discussie was er…..

    Met name de eerste lezing deed de nodige stof opwaaien. Helaas heb ik deze voor de helft gemist, omdat ik in het station Hilversum dat van Amersfoort meende te herkennen ;) . Gelukkig heeft Ronald van Dieën op zijn blog ook de BMI-dag opgetekend, zodat ik de eerste punten van hem kan overnemen.

    De eerste spreker was Geert van der Heijden, Universitair hoofddocent Klinische Epidemiologie bij het Julius Centrum voor Gezondheidswetenschappen van het UMC Utrecht. Geert is coördinator van het START-blok voor zesdejaars (Supervised Training in professional Attitude, Research and Teaching) en van de Academische Vaardigheden voor het GNK Masteronderwijs. Ik kende Geert oppervlakkig, omdat wij (afzonderlijk) geinterviewd waren voor het co-assistenten blad “Arts in Spe” over de integratie van het EBM-zoekonderwijs in het curriculum. Nu ik hem hier in levende lijve heb gehoord, lees ik zijn interview met heel andere ogen. Ik zag toen meer de overeenkomsten, nu de verschillen.

    Zijn presentatie had als titel: “hoe zoekt de clinicus?”. Wie verwachtte dat Geert zou vertellen hoe de gemiddelde clinicus daadwerkelijk zoekt komt komt bedrogen uit. Geert vertelde vooral de methode van zoeken die hij artsen aanleert/voorhoudt. Deze methode is bepaald niet ingeburgerd en lijkt diametraal te staan tegenover de werkwijze van medisch informatiespecialisten, per slot zijn gehoor van dat moment. Alleen al het feit dat hij beweert dat je VOORAL GEEN MeSH moet gebruiken druist in tegen wat wij medisch informatiespecialisten leren en uitdragen. Het is de vraag of de zaal zo stil was, omdat zij overvallen werd door al het schokkends wat er gezegd werd of omdat men niet wist waar te beginnen met een weerwoord. Ik zag letterlijk een aantal monden openhangen van verbazing.

    Zoals Ronald al stelde was dit een forse knuppel in het hoenderhok van de ‘medisch informatiespecialisten’. Ik deel echter niet zijn mening dat Geert het prima kon onderbouwen met argumenten. Hij is weliswaar een begenadigd spreker en bracht het allemaal met verve, maar ik had toch sterk de indruk dat zijn aanpak vooral practice- of eminence- en niet evidence-based was.

    Hieronder enkele van zijn stellingen, 1ste 5 overgenomen van Ronald:

    1. “Een onderzoeker probeert publicatie air miles te verdienen met impact factors”
    2. “in Utrecht krijgen de studenten zo’n 500 uur Clinical Epidemiology en Evidence Based Practice, daar waar ze in Oxford (roots van EBM) slechts 10 uur krijgen”
    3. “contemporary EBM tactics (Sicily statement). (zie bijvoorbeeld hier:….)
    4. “fill knowledge gaps met problem solving skills”
    5. EBM = eminence biased medicine. Er zit veel goeds tussen, maar pas op….
    6. Belangrijkste doelstelling van literatuuronderzoek: reduceer Numbers Needed to Read.
    7. Vertrouw nooit 2e hands informatie (dit noemen wij voorgefilterde of geaggregeerde evidence) zoals TRIP, UpToDate, Cochrane Systematic Reviews, BMJ Clinical Evidence. Men zegt dat de Cochrane Systematic Reviews zo goed zijn, maar éen verschuiving van een komma heeft duizenden levens gekost. Lees en beoordeel dus de primaire bronnen!
    8. De Cochrane Collaboration houdt zich alleen maar bezig met systematische reviews van interventies, het doet niets aan de veel belangrijker domeinen “diagnose” en “prognose”.
    9. PICO (patient, intervention, comparison, outcome) werkt alleen voor therapie, niet voor andere vraagstukken.
    10. In plaats daarvan de vraag in 3 componenten splitsen: het domein (de categorie patiënten), de determinant (de diagnostische test, prognostische variabele of behandeling) en de uitkomst (ziekte, mortaliteit en …..)
    11. Zoeken doe je als volgt: bedenk voor elk van de 3 componenten zoveel mogelijk synoniemen op papier, verbind deze met “OR”, verbind de componenten met “AND”.
    12. De synoniemen alleen in titel en abstract zoeken (code [tiab]) EN NOOIT met MeSH (MEDLINE Subject Headings). MeSH zijn NOOIT bruikbaar volgens Geert. Ze zijn vaak te breed, ze zijn soms verouderd en je vindt er geen recente artikelen mee, omdat de indexering soms 3-12 maanden zou kosten.
    13. NOOIT Clinical Queries gebruiken. De methodologische filters die in PubMed zijn opgenomen, de zogenaamde Clinical Queries zijn enkel gebaseerd op MeSH en daarom niet bruikbaar. Verder zijn ze ontwikkeld voor heel specifieke onderwerpsgebieden, zoals cardiologie, en daarom niet algemeen toepasbaar.
    14. Volgens de Cochrane zou je als je een studie ‘mist’ de auteurs moeten aanschrijven. Dat lukt van geen kant. Beter is het te sneeuwballen via Web of Science en related articles en op basis daarvan JE ZOEKACTIE AAN TE PASSEN.

    Wanneer men volgens de methode van der Heijden werkt zou men in een half uur klaar zijn met zoeken en in 2 uur de artikelen geselecteerd en beoordeeld hebben. Nou dat doe ik hem niet na.

    De hierboven in rood weergegeven uitspraken zijn niet (geheel) juist. 8. Therapie is naar mijn bescheiden mening nog steeds een belangrijk domein; daarnaast is gaat de Cochrane Collaboration ook SR’s over diagnostische accuratesse studies schrijven. 13. in clinical queries worden (juist) niet alleen MeSH gebruikt.

    In de groen weergegeven uitspraken kan ik me wel (ten dele) vinden, maar ze zijn niet essentieel verschillend van wat ik (men?) zelf nastreef(t)/doe(t), en dat wordt wel impliciet gesuggereerd.
    Vele informatiespecialisten zullen ook:

    • 6 nastreven (door 7 te doen weliswaar),
    • 9 benadrukken (de PICO is inderdaad voor interventies ontwikkeld en minder geschikt voor andere domeinen)
    • en deze analoog aan 10 opschrijven (zij het dat we de componenten anders betitelen).
    • Het aanschrijven van auteurs (14) gebeurt als uiterste mogelijkheid. Eerst doen we de opties die door Geert als alternatief aangedragen worden: het sneeuwballen met als doel de zoekstrategie aan te passen. (dit weet ik omdat ik zelf de cursus “zoeken voor Cochrane Systematic Reviews” geef).

    Als grote verschillen blijven dan over: (7) ons motto: geaggregeerde evidence eerst en (12) zoeken met MeSH versus zoeken in titel en abstract en het feit dat alle componenten met AND verbonden worden, wat ik maar mondjesmaat doe. Want: hoe meer termen/componenten je met “AND” combineert hoe groter de kans dat je iets mist. Soms moet het, maar je gaat niet a priori zo te werk.

    Ik vond het een beetje flauw dat Geert aanhaalde dat er door één Cochrane reviewer een fout is gemaakt, waardoor er duizenden doden zouden zijn gevallen. Laat hij dan ook zeggen dat door het initiatief van de Cochrane er levens van honderd duizenden zijn gered, omdat eindelijk goed in kaart is gebracht welke therapieën nu wel en welke nu niet effectief zijn. Bij alle studies geldt dat je afhankelijk bent van hoe goed te studie is gedaan, van een juiste statistiek etcetera. Voordeel van geaggregeerde evidence is nu net dat een arts niet alle oorspronkelijke studies hoeft door te lezen om erachter te komen wat werkt (NNR!!!). Stel dat elke arts voor elke vraag ALLE individuele studies moet zoeken, beoordelen en moet samenvatten….. Dat zou, zoals de Cochrane het vaak noemt ‘duplication of effort’ zijn. Maar wil je precies weten hoe het zit, of wil je heel volledig zijn dan zul je inderdaad zelf de oorspronkelijke studies moeten zoeken en beoordelen.
    Wel grappig trouwens dat 22 van de 70 artikelen waarvan Geert medeauteur is tot de geaggregeerde evidence (inclusief Cochrane Reviews) gerekend kunnen worden….. Zou hij de lezers ook afraden deze artikelen te selecteren? ;)

    Voor wat betreft het zoeken via de MeSH. Ik denk dat weinig ‘zoekers’ louter en alleen op MeSH zoeken. Wij gebruiken ook tekstwoorden. In hoeverre er gebruik van gemaakt wordt hangt erg van het doel en de tijd af. Je moet steeds afwegen wat de voor- en de nadelen zijn. Door geen MeSH te gebruiken, maak je ook geen gebruik van de synoniemen functie en de mogelijkheid tot exploderen (nauwere termen meenemen). Probeer maar eens in een zoekactie alle synoniemen voor kanker te vinden: cancer, cancers , tumor, tumour(s), neoplasm(s), malignancy (-ies), maar daarnaast ook alle verschilende kankers: adenocarcinoma, lymphoma, Hodgkin’s disease, etc. Met de MeSH “Neoplasms” vind je in een keer alle spellingswijzen, synoniemen en alle soorten kanker te vinden.

    Maar in ieder geval heeft Geert ons geconfronteerd met een heel andere zienswijze en ons een spiegel voorgehouden. Het is soms goed om even wakkergeschud te worden en na te denken over je eigen (soms te ?) routinematige aanpak. Geert ging niet de uitdaging uit de weg om de 2 zoekmethodes met elkaar te willen vergelijken. Dus wie weet wat hier nog uit voortvloeit. Zouden we tot een consensus kunnen komen?

    De volgende praatjes waren weliswaar minder provocerend, maar toch zeker de moeite waard.

    De web 2.0-goeroe Wouter Gerritsma (WoWter) praatte ons bij over web 2.0, zorg 2.0 en (medische) bibliotheek 2.0. Zeer toepasselijk met zeer moderne middelen: een powerpointpresentatie via slideshare te bewonderen en met een WIKI, van waaruit hij steeds enkele links aanklikte. Helaas was de internetverbinding af en toe niet zo 2.0, zodat bijvoorbeeld deze beeldende YOU TUBE-uitleg Web 2.0 … The machine is us/ing us niet afgespeeld kon worden. Maar handig van zo’n wiki is natuurlijk dat je het alsnog kunt opzoeken en afspelen. In de presentatie kwamen wat practische voorbeelden aan de orde (bibliotheek, zorg, artsen) en werd ingegaan op de verschillende tools van web 2.0: RSS, blogs, gepersonaliseerde pagina’s, tagging en wiki’s. Ik was wel even apetrots dat mijn blog alsmede dat van de bibliotheker even als voorbeeld getoond werden van beginnende (medische bieb) SPOETNIKbloggers. De spoetnikcursus en 23 dingen werden sowieso gepromoot om te volgen als beginner. Voor wie meer wil weten, kijk nog eens naar de wiki: het biedt een mooi overzicht.

    Als laatsten hielden Tanja van Bon en Sjors Clemens een duo-presentatie over e-learning. Als originele start begonnen ze met vragen te stellen in plaats van ermee te eindigen. Daarna gaven ze een leuke introductie over e-learning en lieten ze zien hoe ze dit in hun ziekenhuis implementeerden.

    Tussen en na de lezingen was er ruim tijd om met elkaar van gedachten te wisselen, aan het slot zelfs onder genot van een borrel voor wie niet de BOB was. Zeker een heel geslaagde dag. Hier ga ik vaker naar toe!

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

    met de W: ik zie dat de bibliotheker inmiddels ook een stukje heeft geschreven over de lezing van Geert van der Heiden. Misschien ook leuk om dit te lezen.

    N.B. VOOR WIE DE HELE PRESENTATIE VAN GEERT WIL ZIEN, DEZE IS MET ZIJN TOESTEMMING GEZET OP

    http://www.slideshare.net/llkool/bmi-18-april-2008-geert-van-der-heijden/








    Follow

    Get every new post delivered to your Inbox.

    Join 610 other followers