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

26 10 2011

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

DATA, INFORMATION & COMMUNICATION

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

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

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

INDIA, WISDOM & IMAGESIMAGING

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

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

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

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

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

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

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

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

THE POWER OF WORDS, MUSIC AND VISUAL ARTS

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

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

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

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

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

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

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

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

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

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

SOCIAL MEDIA & MOBILE APPS

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

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

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

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

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

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

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

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

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

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

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

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

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

DATA, DATABASES, OPEN ACCESS, EBM

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

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

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

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

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

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

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

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

SCREENING & DIAGNOSIS. BALANCING BENEFITS & HARMS. 

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

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

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

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

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

BIOMEDICINE, BRAINS AND THE PROCESSING OF INFORMATION

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

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

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

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

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

MISINFORMATION, WRONG INFORMATION AND LACK OF INFORMATION

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

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

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

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

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

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

INFORMATION YOU NEED


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

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

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

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

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

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

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

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

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

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

Will you remind me next time?

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

Related articles





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

18 10 2011

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

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

This time the theme will be “INFORMATION”.

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

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

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

Please Email your submissions to:

And include:

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

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

Jacqueline aka Laika.

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





Grand Rounds 7-50: Dr. Rich Did a Great Job… Jobs, Jobs, Jobs…

6 09 2011

In the old days, bloggers whose posts were included in the Grand Rounds would link to that post from their own blog. Grand Rounds, for those who are not familiar, is a  weekly compilation of the best of the medical blogosphere.

I used to refer to the Grand Rounds once in a while, but quit this habit to prevent that my own posts would get lost amidst the summarizing and/or referring posts.

But I will make an exception for a Grand Rounds edition that is written by a man who combines modern practice along with classic craftsmanship (rather called “old fartness” by the author concerned).

Anyway, Dr Rich of the latest edition of Grand Rounds did a great job with his Grand Rounds 7-50: The Jobs! Jobs! Jobs! Edition.

First of all I was surprised to find a very good summary of my own post. A post about a search topic, which I was rather surprised to find included in the first place. Please let me share this excellent & quite funny plain language summary of my post.

Jaqueline writes Laika’s MedLiblog, a blog dedicated to medical information science. She submits a post entitled, “PubMed’s Higher Sensitivity than OVID MEDLINE… & other Published Clichés,” in which she shows how medical researchers doing literature searches for, among other things, meta-analyses, will stumble upon various “anomalies” in their searches of the PubMed and OVID databases, and then write additional, CV-padding papers about those anomalies. Jaqueline points out that these so-called “anomalies” are actually well-documented “clichés,” which are well-known to information specialists and anyone else who is competent in doing comprehensive literature searches. In other words, Jaqueline has documented that these meta-analysis researchers are rank amateurs at doing the most critical step in conducting meta-analyses – searching the literature for all the appropriate published studies. DrRich has always mistrusted meta-analyses, and Jaqueline has helpfully identified yet another reason to justify such mistrust. He thanks Jaqueline, and whoever planted those database anomalies which allow us to identify potentially incompetent meta-analysis researchers. 

Second, I am always happy if a Grand Round not only quotes the posts of the great medical bloggers I already know, but also includes posts of bloggers who are new to me. Today I’ve found two new blogs I’ve subscribed to.

The First is Sharp incisions (… random cuts in the life of a fledgling medical student), a blog started in 2010 by a second year medical student. He/she wrote an affecting post in 5 parts about the harvesting of six vital organs for transplantation from a patient who has been declared brain dead. (First part starts here)

Here is a quote from the last (5th) part:

Now, all that was left was to close his incision.

I stood beside the surgeon, watching, but through the sterile drape, I reached for the patient’s hand, squeezed it, and silently said,

‘Thank you. Your legacy lives on in these lives you’ve saved.’

One heart.
Two lungs.
A liver.
Two kidneys.

Six futures.

Another blog I subscribed to is In My Humble Opinion (A primary care physician’s thoughts on medicine and life), written by Jordan Grumet (@jordangrumet at Twitter), an Internal Medicine physician. This blog already started in 2008 (just like this blog).

I really enjoyed the beautiful post Sometimes We Are Doctors or as he says at the end of his post:

We are all patients sometimes… and sometimes we are doctors.”

For more summaries please read the entire Grand Rounds at the Covert Rationing Blog. You might just discover your own new favorite blog.





Medical Information Matters: Call for Submissions

6 11 2010

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

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

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

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

So if that isn’t easy….

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

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

 

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





Grand Rounds Vol. 6 No. 2

29 09 2009

grandroundsblank

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

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

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

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

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

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

We don’t search for this…

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

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

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

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

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

Background  questions.

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

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

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

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

Foreground  questions: Domain Therapy2463850234_6a9851b622

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Domain Diagnosis

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

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

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

Domain: Etiology/Harm

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

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

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

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

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

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

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

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

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

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

741879088_29d01c359b_m-another-dead-librarian

Acknowledgements

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

Bonus

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Image Credits (CC-licence)

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

You might also like:

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