Experience versus Evidence [1]. Opioid Therapy for Rheumatoid Arthritis Pain.

5 12 2011

ResearchBlogging.orgRheumatoid arthritis (RA) is a chronic auto-immune disease, which causes inflammation of the joints that eventually leads to progressive joint destruction and deformity. Patients have swollen, stiff and painful joints.  The main aim of treatment is to reduce swelling  and inflammation, to alleviate pain and stiffness and to maintain normal joint function. While there is no cure, it is important to properly manage pain.

The mainstays of therapy in RA are disease-modifying anti-rheumatic drugs (DMARDs) and non-steroidal anti-inflammatory drugs (NSAIDs). These drugs primarily target inflammation. However, since inflammation is not the only factor that causes pain in RA, patients may not be (fully) responsive to treatment with these medications.
Opioids are another class of pain-relieving substance (analgesics). They are frequently used in RA, but their role in chronic cancer pain, including RA, is not firmly established.

A recent Cochrane Systematic Review [1] assessed the beneficial and harmful effects of opioids in RA.

Eleven studies (672 participants) were included in the review.

Four studies only assessed the efficacy of  single doses of different analgesics, often given on consecutive days. In each study opioids reduced pain (a bit) more than placebo. There were no differences in effectiveness between the opioids.

Seven studies between 1-6 weeks in duration assessed 6 different oral opioids either alone or combined with non-opioid analgesics.
The only strong opioid investigated was controlled-release morphine sulphate, in a single study with 20 participants.
Six studies compared an opioid (often combined with an non-opioid analgesic) to placebo. Opioids were slightly better than placebo in improving patient reported global impression of clinical change (PGIC)  (3 studies, 324 participants: relative risk (RR) 1.44, 95% CI 1.03 to 2.03), but did not lower the  number of withdrawals due to inadequate analgesia in 4 studies.
Notably none of the 11 studies reported the primary and probably more clinical relevant outcome “proportion of participants reporting ≥ 30% pain relief”.

On the other hand adverse events (most commonly nausea, vomiting, dizziness and constipation) were more frequent in patients receiving opioids compared to placebo (4 studies, 371 participants: odds ratio 3.90, 95% CI 2.31 to 6.56). Withdrawal due to adverse events was  non-significantly higher in the opioid-treated group.

Comparing opioids to other analgesics instead of placebos seems more relevant. Among the 11 studies, only 1 study compared an opioid (codeine with paracetamol) to an NSAID (diclofenac). This study found no difference in efficacy or safety between the two treatments.

The 11 included studies were very heterogeneous (i.e. different opioid studied, with or without concurrent use of non-opioid analgesics, different outcomes measured) and the risk of bias was generally high. Furthermore, most studies were published before 2000 (less optimal treatment of RA).

The authors therefore conclude:

In light of this, the quantitative findings of this review must be interpreted with great caution. At best, there is weak evidence in favour of the efficacy of opioids for the treatment of pain in patients with RA but, as no study was longer than six weeks in duration, no reliable conclusions can be drawn regarding the efficacy or safety of opioids in the longer term.

This was the evidence, now the opinion.

I found this Cochrane Review via an EvidenceUpdates email alert from the BMJ Group and McMaster PLUS.

EvidenceUpdate alerts are meant to “provide you with access to current best evidence from research, tailored to your own health care interests, to support evidence-based clinical decisions. (…) All citations are pre-rated for quality by research staff, then rated for clinical relevance and interest by at least 3 members of a worldwide panel of practicing physicians”

I usually don’t care about the rating, because it is mostly 5-6 on a scale of 7. This was also true for the current SR.

There is a more detailed rating available (when clicking the link, free registration required). Usually, the newsworthiness of SR’s scores relatively low. (because it summarizes ‘old’ studies?). Personally I would think that the relevance and newsworthiness would be higher for the special interest group, pain.

But the comment of the first of the 3 clinical raters was most revealing:

He/she comments:

As a Palliative care physician and general internist, I have had excellent results using low potency opiates for RA and OA pain. The palliative care literature is significantly more supportive of this approach vs. the Cochrane review.

Thus personal experience wins from evidence?* How did this palliative care physician assess effectiveness? Just give a single dose of an opiate? How did he rate the effectiveness of the opioids? Did he/she compare it to placebo or NSAID (did he compare it at all?), did he/she measure adverse effects?

And what is “The palliative care literature”  the commenter is referring to? Apparently not this Cochrane Review. Apparently not the 11 controlled trials included in the Cochrane review. Apparently not the several other Cochrane reviews on use of opioids for non-chronic cancer pain, and not the guidelines, syntheses and synopsis I found via the TRIP-database. All conclude that using opioids to treat non-cancer chronic pain is supported by very limited evidence, that adverse effects are common and that long-term use may lead to opioid addiction.

I’m sorry to note that although the alerting service is great as an alert, such personal ratings are not very helpful for interpreting and *true* rating of the evidence.

I would rather prefer a truly objective, structured critical appraisal like this one on a similar topic by DARE (“Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects”)  and/or an objective piece that puts the new data into clinical perspective.

*Just to be clear, the own expertise and opinions of experts are also important in decision making. Rightly, Sackett [2] emphasized that good doctors use both individual clinical expertise and the best available external evidence. However, that doesn’t mean that one personal opinion and/or preference replaces all the existing evidence.

References 

  1. Whittle SL, Richards BL, Husni E, & Buchbinder R (2011). Opioid therapy for treating rheumatoid arthritis pain. Cochrane database of systematic reviews (Online), 11 PMID: 22071805
  2. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, & Richardson WS (1996). Evidence based medicine: what it is and what it isn’t. BMJ (Clinical research ed.), 312 (7023), 71-2 PMID: 8555924
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I’ve got Good News and I’ve got Bad News

26 01 2010

If someone tells you: “I’ve got Good News and I’ve got Bad News”, you probably ask this person: “Well, tell me the bad news first!”

Laika’s MedLibLog has good and bad news for you.

The Bad News is, that this blog didn’t make it to the Finals of the sixth annual Medical Weblog Awards, organized by Medgadget. (see earlier post)

The Good news is that this keeps me from the stress that inevitably comes with following the stats and seeing how your blog is lagging more and more behind. Plus you don’t have to waste time desperately trying to mobilize your husband to just press the *$%# vote button (choosing the right person: me), no matter how many times he says he doesn’t care a bit – (“and wouldn’t it be better to spend less time on blogging anyway?”)

This reminds me of something I’ve tried to suppress, namely that this blog didn’t make it to the shortlists of the Dutch Bloggies 2009 either (see Laika’s MedLibLog on the Longlist of the DutchBloggies!)

The Good news is that many high quality blogs did make it to the finals. Including The Blog that Ate Manhattan, Clinical Cases and Images, Musings of a Distractible Mind (Best Medical Weblog) , other things amanzi (Best Literary Medical Weblog), Allergy Notes, Clinical Cases and Images, Life in the Fast Lane (Best Clinical Sciences Weblog), ScienceRoll (Best Medical Technologies/Informatics Weblog).

Best of all, the superb blog I nominated for Best Medical WeblogDr Shock MD PhD made it to the finals as well!!

But it is hard to understand that blogs like EverythingHealth and Body in Mind with many nominations are not among the finalists. That underlines that contests are very subjective, but so are individual preferences for blogs. It is all in the game.

Anyway you can start voting for your favorite blogs tomorrow. Please have a look at the finalists here at Medgadget, so you can decide who deserves your votes.

Finally I would like to conclude with positive news concerning this blog. This week’s “Cochrane in the news” features the post on Cochrane Evidence Aid. It is on the Cochrane homepage today.

Photo Credit

Best Literary Medical Weblog
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Cochrane 2.0 Workshop at the Cochrane Colloquium #CC2009

12 10 2009

Today Chris Mavergames and I held a workshop at the Cochrane Colloquium, entitled:  Web 2.0 for Cochrane (see previous post and abstract of the workshop)

First I gave an introduction into Medicine 2.0 and (thus) Web 2.0. Chris, Web Operations Manager and Information Architect of the Cochrane Collaboration, talked more about which Web 2.0 tools were already used by the Cochrane Collaboration and which Web 2.0 might be useful as such.

We had half an hour for discussion which was easily filled. There was no doubt about the usefulness of Web 2.0 for the Cochrane in this group. Therefore, there was ample room for discussing technical aspects, like:

  • Can you load your RSS feed of a PubMed search in Reference Manager? (According to Chris you can)
  • How can you deal with this lot of information (by following a specific subject, or not too much people – not many updates on a daily basis; you don’t have to follow it all, just pick up the headlines, when you can)
  • Are you involved in a Wiki that is successful? (it appears very difficult to involve people)
  • What happens if people comment or upload picture on facebook (of the Cochrane collaboration) in an appropriate way (Chris: didn’t happen, but you have to check and remove them)
  • How do you follow tweets (we showed Tweetdeckhashtags # and #followfridays)
  • What is the worst thing that happened to you (regarding web 2.0)? Chris and I thought a long time. Chris: that I revealed something that wasn’t officially public yet (though appeared to be o.k.). Me: spam (but I remove it/don’t approve it).
    Later I remembered two better (worse) examples, like the “Clinical Reader” social misbehaviour, a good example of how “branding” should not be done, and sites that publish top 50 and 100 list of bloggers just to get more traffic to their spam websites

Below is my presentation on Slideshare.

The (awful) green blackgound color indicates I went “live” on the web. As a reminder of what I did, I included some screendumps.

The current workshop was just meant to introduce and discuss Medicine 2.0 and Cochrane 2.0.

I hope we have a vivid discussion Wednesday when the plenary lectures deal with Cochrane 2.0.

The answers to my question on Twitter

  1. Why Web 2.0 is useful? (or not)
  2. Why we need Cochrane 2.0? (or not)

can be found on Visibletweets (temporary) and saved as: Quoteurl.com/sggq0 (permanent selection).

I think it would be good when these points are taken into account during the Cochrane 2.0 plenary discussions.

* possible WIKI (+ links) might appear at http://medicine20.wetpaint.com/page/Cochrane+2.0

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#CECEM Bridging the Gap between Evidence Based Practice and Practice Based Evidence

15 06 2009

cochrane-symbol A very interesting presentation at the CECEM was given by the organizer of this continental Cochrane meeting, Rob de Bie. De Bie is Professor of Physiotherapy Research and director of Education of the Faculty of Health within the dept. of Epidemiology of the Maastricht University. He is both a certified physiotherapist and an epidemiologist. Luckily he kept the epidemiologic theory to a minimum. In fact he is a very engaging speaker who keeps your attention to the end.

Guidelines

While guidelines were already present in the Middle Ages in the form of formalized treatment of daily practice, more recently clinical guidelines have emerged. These are systematically developed statements which assists clinicians and patients in making decisions about appropriate treatement for specific conditions.

Currently, there are 3 kinds of guidelines, each with its own shortcomings.

  • Consensus based. Consensus may be largely influenced by group dynamics
    Consensus = non-sensus and Consensus guidelines are guidelies.
  • Expert based. Might be even worse than consensus. It can have all kind of biases, like expert and opinion bias or external financing.
  • Evidence based. Guideline recommendations are based on best available evidence, deals with specific interventions for specific populations and are based on a systematic approach.

The quality of Evidence Based Guidelines depends on whether the evidence is good enough, transparent, credible, available, applied and not ‘muddled’ by health care insurers.
It is good to realize that some trials are never done, for instance because of ethical considerations. It is also true that only part of what you read (in the conclusions) has actually be done and some trials are republished several times, each time with a better outcome…

Systematic reviews and qualitatively good trials that don’t give answers.

Next Rob showed us the results of a study ( Jadad and McQuay in J. Clin. Epidemiol. ,1996) with efficacy as stated in the review plotted on the X-axis and the Quality score on the Y-axis. Surprisingly meta-analysis of high quality were less likely to produce positive results. Similar results were also obtained by Suttorp et al in 2006. (see Figure below)

12066264  rob de bie CECEM

Photo made by Chris Mavergames

There may be several reasons why good trials not always give good answers. Well known reasons are  the lack of randomization or blinding. However Rob focused on a less obvious reason. Despite its high level of evidence, a Randomized Controlled Trial (RCT) may not always be suitable to provide good answers applicable to all patients, because RCT’s often fail to reflect the true clinical practice. Often, the inclusion of patients in RCT’s is selective: middle-aged men with exclusion of co-morbidity. Whereas co-morbidity occurs in > 20% of the people of 60 years and older and in >40% of the people of 80 years and older (André Knottnerus in his speech).

Usefulness of a Nested Trial Cohort Study coupled to an EHR to study interventions.

Next, Rob showed that a nested Trial cohort study can be useful to study the effectiveness of  interventions. He used this in conjunction with an EHR (electronic health record), which could be accessed by practitioner and patient.

One of the diseases studied in this way, was Intermittent Claudication. Most commonly Intermittent Claudication is a manifestation of  peripheral arterial disease in the legs, causing pain and cramps in the legs while walking (hence the name). The mortality is high: the 5 year mortality rates are in between those of colorectal cancer and Non-Hodgkin Lymphoma. This is related to the underlying atherosclerosis.

There are several risk factors, some of which cannot be modified, like hereditary factors, age and gender. Other factors, like smoking, diet, physical inactivity and obesity can be tackled. These factors are interrelated.

Rob showed that, whereas there may be an overall null effect of exercise in the whole population, the effect may differ per subgroup.

15-6-2009 3-06-19 CI 1

  • Patients with mild disease and no co-morbidity may directly benefit from exercise-therapy (blue area).
  • Exercise has no effect on smokers, probably because smoking is the main causative factor.
  • People with unstable diabetes first show an improvement, which stabilized after a few weeks due to hypo- or hyperglycaemia induced by the exercise,
  • A similar effect is seen in COPD patients, the exercise becoming less effective because the patients become short of breath.

It is important to first regulate diabetes or COPD before continuing the exercise therapy. By individually optimizing the intervention(s) a far greater overall effect is achieved: 191% improval in the maximal (pain-free) walking distance compared to for instance <35% according to a Cochrane Systematic Review (2007).

Another striking effect: exercise therapy affects some of the prognostic factors: whereas there is no effect on BMI (this stays an important risk factor), age and diabetes become less important risk factors.

15-6-2009 3-35-10 shift in prognostic factors

Because guidelines are quickly outdated, the findings are directly implemented in the existing guidelines.

Another astonishing fact: the physiotherapists pay for the system, not the patient nor the government.

More information can be found on https://www.cebp.nl/. Although the presentation is not (yet?) available on the net, I found a comparable presentation here.

** (2009-06-15) Good news: the program and all presentations can now be viewed at: https://www.cebp.nl/?NODE=239





#CECEM David Tovey -the Cochrane Library’s First Editor in Chief

13 06 2009

cochrane-symbolThis week I was attending another congress, the Continental European Cochrane Entities Meeting (CECEM).

This annual meeting is meant for staff from Cochrane Entities, thus Centre Staff, RGC’s (Review Group Coordinators), TSC’s (Trial Search Coordinators) and other staff members of the Cochrane Collaboration based in Continental Europe.

CECEM 2009 was held in Maastricht, the beautiful old Roman city in the South of the Netherlands. The city where my father was born and where I spend many holidays.

One interesting presentation was by Cochranes’ 1st Editor in chief, David Tovey, previously GP in an urban practice in London for 14 years and  Editorial Director of the BMJ Group’s ‘Knowledge’ division (responsible for BMJ Clinical Evidence and its sister product Best Treatments, see announcement in Medical News Today)

David began with saying that the end user is really the key person and that the impact of the Cochrane Reviews is most important.

“How is it that a Senior health manager in the UK may shrug his shoulders when you ask him if he has ever heard of Cochrane?”

“How do we make sure that our work had impact? Should we make use of user generated content?”

Quality is central, but quality depends on four pillars. Cochrane reviews should be reliable, timely, relevant and accessible.

Cochrane Tovey wit

How quality is perceived is dependent on the end users. There are several kinds of end users, each with his own priorities.

  1. doctor: wants comprehensive and up-to-date info, wants to understand and get answers quickly.
  2. patient: trustworthiness, up-to-date, wants to be able to make sense of it.
  3. scientist: wants to see how the conclusions are derived.
  4. policy and guideline-makers.

Reliable: Several articles have shown Cochrane Systematic Reviews to be more reliable then other systematic reviews  (Moher, PLOS BMJ)*

Timely: First it takes time to submit a title of a Cochrane Review and then it takes at least 2 years before a protocol becomes a review. Some reviews take even longer than 2 years. So there is room for improvement.

Patients are also very important as end user. Strikingly, the systematic review about the use of cranberry to prevent recurrent urinary tract infection is the most frequently viewed article,- and this is not because the doctors are most interested in this particular treatment….

Doctors: Doctors often rely on their colleagues for a quick and trustworthy answer. Challenge: “can we make consulting the Cochrane Library as easy as asking a colleague: thus timely and easy?”

Solutions?

  • making plain language summaries more understandable
  • Summary of Findings
  • podcasts of systematic reviews (very successful till now), .e. see an earlier post.
  • Web 2.0 innovations

Key challenges:

  • ensure and develop consistent quality
  • (timely) updating
  • putting the customer first: applicability & prioritization
  • web delivery
  • resources (not every group has the same resources)
  • make clear what an update means and how important this update is: are there new studies found? are these likely to change conclusions or not? When was the last amendment to the search?

I found the presentation very interesting. What I also liked is that David stayed with us for two days -also during the social program- and was easy approachable. I support the idea of a user-centric approach very much. However, I had expected the emphasis to be less on the timeliness (of updates for instance), but more on how users (patients, doctors) can get more involved and how we review the subjects that are most urgently needed. Indeed, when I twittered that Tovey suggested that we “make consulting the Cochrane Library as easy as asking a colleague”, Jon Brassey of TRIP answered that a lot has to be done to fulfill this, as the Cochrane only answers 2 out of 350+ questions asked by GPs in the UK, a statement that appeared to be based on his own experience (Jon is founder of the TRIP-database).

But in principle I think that Jon is correct. Right now too few questions (in the field of interventions) are directly answered by Cochrane Systematic Reviews and too little is done to reach and involve the Cochrane Library users.

13-6-2009 15-43-17 twitter CECEM discussion

click to enlarge

During the CECEM other speakers addressed some of these issues in more detail. André Knottnerus, Chair of the Dutch Health Council, discussed “the impact of Cochrane Reviews”, and Rob the Bie of the Rehabilitation & Related Therapies field discussed “Bridging the  gap between evidenced based practice and practice based evidence”, while Dave Brooker launched ideas about how to implement Web 2.0 tools. I hope to summarize these (and other) presentations in a blogpost later on.

*have to look this up

NOTE (2009-11-10).

I had forgotten about this blank “citation” till this post was cited quite in another context (see comment: http://e-patients.net/archives/2009/11/tell-the-fda-the-whole-story-please.html) and someone commented that the asterisk to the “the amazing statement” had still to be looked up,  indirectly arguing that this statement thus was not reliable- and continuing by giving an example of a typically flawed Cochrane Review that hit the headlines 4 years ago, a typical exception to the rule that “Cochrane systematic reviews are more reliable than other systematic reviews”. Of course when it is said that A is more trustworthy than B it is meant on average. I’m a searcher, and on average the Cochrane searchers are excellent, but when I do my best I surely can find some that are not good at all. Without doubt that also pertains to other parts of Cochrane Systematic Reviews.
In addition -and that was the topic of the presentation- there is room for improvement.

Now about the asterisk, which according to Susannah should have been (YIKES!) 100 times bigger. This was a post based on a live presentation and I couldn’t pick up all the references on the slides while making notes. I had hoped that David Tovey would have made his ppt public, so I could have checked the references he gave. But he didn’t and so I forgot about it. Now I’ve looked some references up, and, although they might not be identical to the references that David mentioned, they are in line with what he said:

  1. Moher D, Tetzlaff J, Tricco AC, Sampson M, Altman DG, 2007. Epidemiology and Reporting Characteristics of Systematic Reviews. PLoS Med 4(3): e78. doi:10.1371/journal.pmed.0040078 (free full text)
  2. The PLoS Medicine Editors 2007 Many Reviews Are Systematic but Some Are More Transparent and Completely Reported than Others. PLoS Med 4(3): e147. doi:10.1371/journal.pmed.0040147 (free full text; editorial coment on [1]
  3. Tricco AC, Tetzlaff J, Pham B, Brehaut J, Moher D, 2009. Non-Cochrane vs. Cochrane reviews were twice as likely to have positive conclusion statements: cross-sectional study. J Clin Epidemiol. Apr;62(4):380-386.e1. Epub 2009 Jan 6. [PubMed -citation]
  4. Anders W Jørgensen, Jørgen Hilden, Peter C Gøtzsche, 2006. Cochrane reviews compared with industry supported meta-analyses and other meta-analyses of the same drugs: systematic review BMJ  2006;333:782, doi: 10.1136/bmj.38973.444699.0B (free full text)
  5. Alejandro R Jadad, Michael Moher, George P Browman, Lynda Booker, Christopher Sigouin, Mario Fuentes, Robert Stevens (2000) Systematic reviews and meta-analyses on treatment of asthma: critical evaluation BMJ 2000;320:537-540, doi: 10.1136/bmj.320.7234.537 (free full text)

In previous posts I regularly discussed that (Merck’s Ghostwriters, Haunted Papers and Fake Elsevier Journals and One Third of the Clinical Cancer Studies Report Conflict of Interest) that pharma-sponsored trials rarely produce results that are unfavorable to the companies’ products [e.g. see here for an overview, and many papers of Lisa Bero].

Also pertinent to the abovementioned discussion at E-patient-Net is my earlier post: The Trouble with Wikipedia as a Source for Medical Information. (references still not in the correct order. Yikes!)

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#EAHIL2009 Web 2.0 and Health Information – Chris Mavergames

4 06 2009

2-6-2009 23-11-41 EAHIL 2009

I’m in Dublin to attend the EAHIL workshop 2009.
The EAHIL is the European Association for Health Information and Libraries.

The EAHIL -workshop 2009 really started Wednesday afternoon. Tuesday morning, as a foretaste of the official program I attended a Continuing Education Course, namely the Web 2.0 and Health Information course by Chris Mavergames.

Chris Mavergames is currently the Web Operation Manager/Information Architect for the Cochrane Collaboration. Before, he worked in the field of information and library science.

So Chris and I are really colleagues, but we didn’t realize until we “met” on Twitter.

On this hot day in June I was pleased that the workshop was held in the cool Berkeley Library of Trinity College.
They have chosen real good locations for this EAHIL workshop. Most presentations are in the Dublin Castle, another place at the Heart of the Irish History.

The workshop took approximately 3 hours and consisted of two presentations, followed by short Q&A’s and an open forum afterwards.

The presentations:

  • Web 2.0 and Health Information“,
  • A case study of the experiences of implementing and using these technologies in a large, non-profit organization (Cochrane Collaboration).

Eighteen people could attend. Each of us had a computer, which raised expectations that they were needed during the workshop. They were not, but they were handy anyway to look up things and to draft a post. And.. I could post this message on Twitter before Chris loaded a photo of his class on TwitPic.  LOL.

4-6-2009 9-46-55 chris is making a photo

10848362 class chriss mavergames

Web 2.0 versus web 1.0
Chris began with asking the audience how many people either have used ..or at least have heard of Facebook, LinkedIn or any other social networking service. And then he asked which tools were being used. Afterwards he admitted he had checked everyone’s presence on various social bookmarking sites. Hilarious.

To my surprise, quite a number of people were familiar with most of the web 2.0 services and sources. Indeed, weren’t librarians the first to embrace web 2.0?

I got the impression Twitter was the least well known/appreciated tools. Most people were either on Facebook or Linkedin, not on both. This presumably has to do with separation of professional and personal things.

Chris first explained the difference between Web 1.0 and Web 2.0: Web 1.0 is a one way interaction, static. Web 2.0 is: “more finding or receiving, less searching”. It has a dynamic aspect: there is more interaction, the possibility to ‘comment, subscribe, post, add, share or as Chris puts it: “Web 2.0 allows you to have information “pushed” at you vs. you having to “pull”.

Another characteristic of web 2.0 is that technology has become easier. It is now more about content.

As an example he showed the Cochrane website from 2004 (web 1.0) and the current website. The first was just a plain web site where you could search, browse and email, the second has social bookmarking tools and is more dynamic and active: you can add comments, post on websites etc.. In addition the Cochrane Collaboration is now on Twitter and Facebook and produces podcasts of a selection of systematic reviews.

Another example of web 2.0 interfaces are MyNCBI of PubMed (for saving your searches) and i-Google.

Social Networking services
These services allow you to create an online profile so that you can interact with others, share and integrate.

Examples are Facebook, LinkedIn and 2 Collab. What is used most, differs around the world. Linkedin is more a professional site, an “online resume” and Facebook is for more general stuff. “You’re mother is on facebook too, so..”. Most young people don’t realize what others can read. However, Facebook offers the possibility to select precisely who can see exactly what.

Twitter
Twitter is a microblogging system, that allows a 140 chracter message (tweet). At first, Chris wasn’t very much interested. He only knew Twitter through the automatic updates on Facebook, but “wasn’t really interested in a  friend in New York eating a scrambled egg.”

It is as easy to subscribe to one’s updates as it is to unsubscribe. Chris uses Tweetdeck to filter for keywords that are of interest. But as he showed me later, he uses the i-phone to easily catch what people (he follows) are tweeting.

Although Twitter was created as a social tool it is now much more than that. It creates a so called “ambient awareness” and as such it is a perfect example of “push” technology: you won‘t see every tweet, but you will l be ambiently aware of the conversation (of your “friends” or the subject you follow). Twitter is also very useful for getting a real fast answer to your question. This is how Chris learned the value of Twitter. He had a question at a meeting. Someone said: just put it on Twitter with the hashtag of the congress (an agreed upon keyword with #in front, like #EAHIL2009). He did it and within 3 minutes he got an answer. Twitter is also very useful for sharing and finding links.
There are many “Twitter apps” around. Just search Google for it.

For professional use within a company the twitter look-alike Yammer can be a useful alternative, because only people in the company are able to follow the updates.

My personal experience is also very positive. Twitter and other web 2.0 tools can work synergistically, dependent on your Twitter community and how you use it.

Social bookmarking:
Although librarians aren’t always very happy with user generated tagging, social bookmarking tools are and easy way of allowing users to share a collections of links.
Links used (directly or indirectly) for his presentation are available at del.icio.us/mavergames under the tag EAHIL.

Blogs, Wiki’s
A blog can give a good summary of interesting articles in a particular field. Chris began a blog 2 months ago (http://mavergames.net) about  a very specific subject he is involved in: Drupal. For him is it just an open notebook: a platform to share your ideas with others.
It is possible receiving updates via RSS (push).

Wiki’s are a very powerful knowledge gathering tool,  a way to collaboratively create a resource, based on the principle of “Crowd sourcing” (The Wisdom of Crowds).

Examples of the two are:

  1. http://laikaspoetnik.wordpress.com/ (this blog)
  2. http://scienceroll.com/ (of the Hungarian Medical Student Bertalan Mesko)
  3. http://www.medpedia.com/ (not yet fully developped medical wiki)
  4. http://twictionary.pbwiki.com/ (a fun wiki with the Twitter Vocabulary)
  5. cochrane.org/ideas
  6. http://mavergames.net (Chris’s blog on Drupal)

Subscription services: RSS
Via RSS Really Simple Syndication you can push information from a variety of sources:

  • Podcasts, for instance cochrane.org/podcasts
  • Saved searches, like in PubMed
  • News feeds cochrane.org/news
  • Updates to sites
  • Updates to collections of bookmarks
  • Updates to flickr photos
  • Etcetera

Platforms can vary from Google Reader, Yahoo, Bloglines, but you can also use i-Google or a specilized medical page where you can find links to all kinds of sources, like blogs, podcasts and journals. Perssonalized Medicine (http://www.webicina.com/rss_feeds/) is especially recommended.

Somebody from the audience added that Medworm is a good (and free) medical RSS feed provider as well. For an overview of several of such platforms, including Medworm, i-Google and www.webicina.com see an earlier post on this blog:  Perssonalized Medicine and its alternatives (2009-02-27).

A typical Web 2.0 scenario:

  1. Chris visits Laika’s MedlibLog and reads Cochrane PodCasts are available.
  2. He finds it interesting , goes to the Cochrane website and subscribes to the Cochrane podcasts with RSS.
  3. He want to share this finding with others, so he decides to tweet that Cochrane podcasts are available.
  4. He gets a response: Hé do you know the Cochrane is on Facebook, so he visits Facebook joins and posts the news on facebook again. And so on.

Not only did Chris give a nice overview of Web 2.0 tools, but there was ample opportunity for discussions and remarks.

The two most common questions were: [1] When can you find time for this? and [2] what can you do when the IT-departments don’t allow access to web 2.0 tools like YouTube, Facebook, RSS? It really seamed the main barrier for librarians from many countries to the use of web 2.0. Nevertheless, Chris engaging presentation seemed to encourage many people to try the tools that were new to them at home. Afterwards I only heard positive comments on this workshop.

The slidecasts of the two presentations are now online on http://www.slideshare.net/mavergames.

The slidecast I’ve reviewed is below.








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