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

26 10 2011

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

DATA, INFORMATION & COMMUNICATION

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

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

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

INDIA, WISDOM & IMAGESIMAGING

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

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

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

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

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

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

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

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

THE POWER OF WORDS, MUSIC AND VISUAL ARTS

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

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

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

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

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

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

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

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

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

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

SOCIAL MEDIA & MOBILE APPS

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

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

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

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

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

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

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

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

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

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

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

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

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

DATA, DATABASES, OPEN ACCESS, EBM

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

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

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

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

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

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

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

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

SCREENING & DIAGNOSIS. BALANCING BENEFITS & HARMS. 

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

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

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

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

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

BIOMEDICINE, BRAINS AND THE PROCESSING OF INFORMATION

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

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

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

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

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

MISINFORMATION, WRONG INFORMATION AND LACK OF INFORMATION

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

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

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

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

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

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

INFORMATION YOU NEED


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

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

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

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

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

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

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

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

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

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

Will you remind me next time?

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

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

18 10 2011

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

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

This time the theme will be “INFORMATION”.

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

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

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

Please Email your submissions to:

And include:

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

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

Jacqueline aka Laika.

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





Internet Sources & Blog Posts in a Reference List? Yes or No?

13 02 2011

A Dutch librarian asked me to join a blog carnival of Dutch Librarians. This carnival differs from medical blog carnivals (like the Grand Rounds and “Medical Information Matters“) in its approach. There is one specific topic which is discussed at individual blogs and summarized by the host in his carnival post.

The current topic is “Can you use an internet source”?

The motive of the archivist Christian van der Ven for starting this discussion was the response to a post at his blog De Digitale Archivaris. In this post he wondered whether blog posts could be used by students writing a paper. It struck him that students rarely use internet sources and that most teachers didn’t encourage or allow to use these.

Since I work as a medical information specialist I will adapt the question as follows:

“Can you refer to an internet source in a biomedical scientific article, paper, thesis or survey”?

I explicitly use “refer to” instead of “use”. Because I would prefer to avoid discussing “plagiarism” and “copyright”. Obviously I would object to any form of uncritical copying of a large piece of text without checking it’s reliability and copyright-issues (see below).

”]

Previously, I have blogged about the trouble with Wikipedia as a source for information. In short, as Wikipedians say, Wikipedia is the best source to start with in your research, but should never be the last one (quote from @berci in a twitterinterview). In reality, most students and doctors do consult Wikipedia and dr. Google (see here and here). However, they may not (and mostly should not) use it as such in their writings. As I have indicated in the earlier post it is not (yet) a trustworthy source for scientific purposes.

But Internet is more than Wikipedia and random Googling. As a matter of fact most biomedical information is now in digital form. The speed at which biomedical knowledge is advancing is tremendous. Books are soon out of date. Thus most library users confine themselves to articles in peer-reviewed scientific papers or to datasets (geneticists). Generally my patrons search the largest freely available database PubMed to access citations in mostly peer-reviewed -and digital- journals. These are generally considered as (reliable)  internet sources. But they do not essentially differ from printed equivalents.

However there are other internet sources that provide reliable or useful information. What about publications by the National Health Council, an evidence based guideline by NICE and/or published evidence tables? What about synopses (critical appraisals) such as published by DARE, like this one? What about evidence summaries by Clinical Evidence like, this one? All excellent, evidence based, commendable online resources. Without doubt these can be used as a reference in a paper. Thus there is no clearcut answer to the abovementioned question. Whether an internet source should be used as a reference in a paper is dependent on the following:

  1. Is the source relevant?
  2. Is the source reliable?
  3. What is the purpose of the paper and the topic?

Furthermore it depends on the function of the reference (not mutually exclusive):

  1. To give credit
  2. To add credibility
  3. For transparency and reproducibility
  4. To help readers find further information
  5. For illustration (as an example)

Lets illustrate this with a few examples.

  • Students who write an overview on a medical topic can use any relevant reference, including narrative reviews, UpToDate and other internet sites if appropriate .
  • Interns who have to prepare a CAT (critically appraised topic) should refer to 2-3 papers, providing the highest evidence (i.e. a systematic review and/or randomized controlled trial).
  • Authors writing systematic reviews only include high quality primary studies (except for the introduction perhaps). In addition they should (ideally) check congress abstracts, clinical trial registers (like clinicaltrials.gov), or actual raw data (i.e. produced by a pharmaceutical company).
  • Authors of narrative reviews may include all kinds of sources. That is also true for editorials, primary studies or theses. Reference lists should be as accurate and complete as possible (within the limits posed by for instance the journal).

Blog, wikis, podcasts and tweets.
Papers can also refer to blog posts, wikis or even tweets (there is APA guidance how to cite these). Such sources can merely be referred to because they serve as an example (articles about social media in Medicine for instance, like this recent paper in Am Pharm Assoc that analyzes pharmacy-centric blogs.

Blog posts are usually seen as lacking in factual reliability. However, there are many blogs, run by scientists, that are (or can be) a trustworthy source. As a matter of fact it would be inappropriate not to cite these sources, if  the information was valuable, useful and actually used in the paper.
Some examples of excellent biomedical web 2.0 sources.

  • The Clinical Cases and Images Blog of Ves Dimov, MD (drVes at Twitter), a rich source of clinical cases. My colleague once found the only valuable information (a rare patient case) at Dr Ves’ blog, not in PubMed or other regular sources. Why not cite this blog post, if this patient case was to be published?
  • Researchblogging.org is an aggregator of expert blogposts about peer-reviewed research. There are many other high quality scientific blogging platforms like Scientopia, the PLOSblogs etc. These kind of blogs critically analyse peer reviewed papers. For instance this blog post by Marya Zilberberg reveals how a RCT stopped early due to efficacy can still be severely flawed, but lead to a level one recommendation. Very useful information that you cannot find in the actual published study nor in the evidence based guideline
  • An example of an excellent and up-to-date wiki is the open HLWIKI (maintained by Dean Giustini, @giustini at Twitter) with entries about health librarianship, social media and current information technology topics, having over 565+ pages of content since 2006! It has a very rich content with extensive reference lists and could thus be easily used in papers on library topics.
  • Another concept is usefulchem.wikispaces.com (an initiative of Jean Claude Bradley, discussed in a previous post. This is not only a wiki but also an open notebook, where actual primary scientific data can be found. Very impressive.
  • There is also WikiProteins (part of a conceptwiki), an open, collaborative wiki  focusing on proteins and their role in biology and medicine.

I would like to end my post with two thoughts.

First the world is not static. In the future scientific claims could be represented as formal RDF statements/triplets  instead of or next to the journal publications as we know them (see post on nanopublications). Such “statements” (already realized with regard to proteins and genes) are more easily linked and retrieved. In effect, peer review doesn’t prevent fraud, misrepresentation or overstatements.

Another side of the coin in this “blogs as an internet source”-dicussion is whether the citation is always appropriate and/or accurate?

Today a web page (cardio.nl/ACS/StudiesRichtlijnenProtocollen.html), evidently meant for education of residents, linked to one of my posts. Almost the entire post was copied including a figure, but the only link used was one of my tags EBM (hidden in the text).  Even worse, blog posts are sometimes mentioned to give credit to disputable context. I’ve mentioned the tactics of Organized Wisdom before. More recently a site called deathbyvaccination.com links out of context to one of my blog post. Given the recent revelation of fraudulent anti-vaccine papers, I’m not very happy with that kind of “attribution”.

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Stories [9]: A Healthy Volunteer

20 09 2010

The host of Next Grand Rounds (Pallimed) asked to submit a recent blog post from another blogger in addition to your own post.
I choose “Orthostatics – one more time” from DB Medical rants and a post commenting on that from Musings of a Dinosaur.

Bob Center’s (@medrants) posts was about the value of orthostatic vital sign measurements (I won’t go into any details here), and about who should be doing them, nurses or doctors. In his post, Bob Center also mentioned briefly that students were seeing this as scut work similar as drawing your own bloods and carrying them to the lab.

That reminded me of something that happened when I was working in the lab as a PhD, 20 years ago.

I was working on a chromosomal translocation between chromosome 14 and 18. (see Fig)

The t(14;18) is THE hallmark of follicular lymphoma (lymphoma is a B cell cancer of the lymph nodes).

This chromosomal translocation is caused by a faulty coupling of an immunoglobulin chain to the BCL-2 proto-oncogene during the normal rearrangement process of the immunoglobulins in the pre-B-cells.

This t(14;18) translocation can be detected by genetic techniques, such as PCR.

Using PCR, we found that the t(14:18) translocation was not only present in follicular lymphoma, but also in benign hyperplasia of tonsils and lymph nodes in otherwise healthy persons. Just one out of  1 : 100,000 cells were positive. When I finally succeeded in sequencing the PCR-amplified breakpoints, we could show that each breakpoint was unique and not due to contamination of our positive control (read my posts on XMRV to see why this is important).

So we had a paper. Together with experiments in transgenic mice, our results hinted that t(14;18) translocations is necessary but not sufficient for follicular lymphoma. Enhanced expression of BCL-2 might give make the cells with the translocation “immortal”.

All fine, but hyperplastic tonsils might still form an exception, since they are not completely normal. We reasoned that if the t(14;18) was an accidental mistake in pre B cells it might sometimes be found in normal B cells in the blood too.

But then we needed normal blood from healthy individuals.

At the blood bank we could only get pooled blood at that time. But that wasn’t suitable, because if a translocation was present in one individual it would be diluted with the blood of the others.

So, as was quite common then, we asked our colleagues to donate some blood.

The entire procedure was cumbersome: a technician first had to enrich for T and  B cells, we had to separate the cells by FACS and I would then PCR and sequence them.

The PCR and sequencing techniques had to be adopted, because the frequency of positive cells was lower than in the tonsils and approached the detection limit. ….. That is in most people. But not in all. One of our colleagues had relatively prominent bands, and several breakpoints.

It was explained to him that this meant nothing really. Because we did find similar translocations in every healthy person.

But still, I wouldn’t feel 100% sure, if so many of my blood cells (one out of 1000 or 10.000) contained t(14:18) translocations.

He was one of the first volunteers we tested, but from then on it was decided to test only anonymous persons.

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Silly Saturday #22 – A Picture is Worth a 1000 Words.

17 04 2010

This post is my submission for the Grand Rounds to be hosted at Sterile Eye.
This upcoming edition has the theme VISUAL COMMUNICATION.

You know I love visualizations, they are so easy to understand.

No lengthy post here, because a picture is worth a 1000 words…..

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I

250lbs versus 120 lbs

The body scans side by side of 250 lb. woman versus 120 lb. woman.
Source: Bored Panda

Hattip: @EvidenceMatters, @rlbates & @streetanatomy who referred to a repost on LikeCool

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II

Planes or Volcano?

We were wondering this today (April 16, 2010)

Source: Information is Beautiful

Hattip: Bitethedust & @mpesce “Turns out that a little volcanic action is surprisingly good for planet Earth They referred to a repost at The Daily Wh.at.

I’m a real fan of Information is Beautiful with its beautiful visualizations. See previous post on evidence for health supplements

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III

Real Eyeballing

Source: Wolfram Demonstrations Project

Contributed to Sterile Eye ;) : An interactive project showing hows the interaction between an eyeball and two of the muscles connected to it. Muscles deform as the eyeball rotates. You can download a live version.








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