The Second #TwitJC Twitter Journal Club

14 06 2011

In the previous post I wrote about  a new initiative on Twitter, the Twitter Journal Club (hashtag #TwitJC). Here, I shared some constructive criticism. The Twitter Journal Club is clearly an original and admirable initiative, that gained a lot of interest. But there is some room for improvement.

I raised two issues: 1. discussions with 100 people are not easy to follow on Twitter, and 2. walking through a checklist for critical appraisals is not the most interesting to do (particularly because it had already been done).

But as one of the organizers explained, the first session was just meant for promoting #twitjc. Instead of the expected 6 people, 100 tweople showed up.

In the second session, last Sunday evening, the organizers followed a different structure.

Thus, I thought it would only be fair, to share my experiences with the second session as well. This time I managed to follow it from start to finish.

Don’t worry. Discussing the journal club won’t be a regular item. I will leave the organization up to the organizers. The sessions might inspire me, though, to write a blog post on the topic now and then. But that may only work synergistic. (at least for me, because it forces me to rethink it all)

This time the discussion was about Rose’s Prevention Paradox (PDF), a 30 year old paper that is still relevant. The paper is more of an opinion piece, therefore the discussion focused on the implications of the Prevention Paradox theory. It was really helpful that Fi wrote an introduction to the paper, and a Points of Discussion beforehand. There were 5 questions (and many sub-questions).

I still found it very hard to follow it all at Twitter, as illustrated by the following tweet:

  • laikas I think I lost track. Which question are we? #twitjc Sun Jun 12 20:07:03
  • laikas @MsPhelps ik werd wel helemaal duizelig van al die tweets. Er zijn toch wel veel mensen die steeds een andere vraag stellen voor de 1e is beantwoord -9:47 PM Jun 12th, 2011 (about instant nausea when seeing tweets rolling by and people already posing a new question before the first one is answered)

I followed the tweets at http://tweetchat.com/room/twitjc. Imagine tweets rolling by and you try to pick up those tweets you want to respond to (either bc they are very relevant, or because you disagree). By the time you have finished your tweet, already 20 -possibly very interesting tweets- passed by, including the next question by the organizers (unfortunately they didn’t use the official @twitjournalclub account for this).

Well, I suppose I am not very good at this. Partly because I’m Dutch (thus it takes longer to compose my tweets), partly because I’m not a fast thinker. I’m better at thorough analyses, at my blog for instance.

But this is Twitter.  To speak with Johan Cruyff, a legendary soccer-player from Holland, “Every disadvantage has its advantage”.

Twitter may not favor organized discussions, but on the other hand it is very engaging, thought-provoking and easy accessible. Where else do you meet 100 experts/doctors willing  to exchange thoughts about an interesting medical topic?

The tweets below are in line with/reflect my opinion on this second Twitter Journal Club (RT means retweeting/repeating the tweet):

  • laikas RT @themattmak@fidouglas @silv24 Congratulations again on a great #twitjc. Definitely more controversial and debate generating than last week’s! -9:18 PM Jun 12th, 2011
  • laikas @silv24 well i think it went well (it is probably me, I’m 2 slow). This paper is broad, evokes much discussion & many examples can B given -9:45 PM Jun 12th, 2011
  • DrDLittle Less structure to #twitJC last night but much wider debate 7:41 AM Jun 13th, 2011
  • amitns @DrDLittle It’s obviously a very complex topic, more structure would have stifled the debate. A lot of food for thought.#twitJC -7:45 AM Jun 13th, 2011

Again, the Twitter Journal Club gained a lot of interest. Scientist and teachers consider to borrow the concept. Astronomers are already preparing their first meeting on Thursday… And Nature seems to be on top of it as well, as it will interview the organizers of the medical and the astronomy journal club for an interview.

Emergency Physician Tom Young with experience in critically appraisal just summarized it nicely: (still hot from the press):

The two meetings of the journal club so far have not focussed in on this particular system; the first used a standard appraisal tool for randomised controlled trials, the second was more laissez-faire in its approach. This particular journal club is finding its feet in a new setting (that of Twitter) and will find its strongest format through trial and error. indeed, to try to manage such a phenomenon might be likened to ‘herding cats’ that often used description of trying to manage doctors, and I think, we would all agree would be highly inadvisable. Indeed, one of its strengths is that participants, or followers, will take from it what they wish, and this will be something, rather than nothing, whatever paper is discussed, even if it is only contact with another Tweeter, with similar or divergent views. 

Indeed, what I gained from these two meetings is that I met various nice and interesting people (including the organizers, @fidouglas and @silv24). Furthermore, I enjoyed the discussions, and picked up some ideas and examples that I would otherwise wouldn’t know about. The last online meeting sparked my interest in the prevention paradox. Before the meeting, I only read the paper at a glance. After the session I decided to read it again, and in more detail. As a matter of fact I feel inspired to write a blog post about this theory. Originally I planned to write a summary here, but probably the post is getting too long. Thus I will await the summary by the organizers and see if I have time to discuss it as well.

Related articles





BlogWorld Expo [SOTB] & The Status of the Medical Blogosphere

25 10 2009

During my stay in Singapore from October 9th-16th there were 2 other great events, one of them  being the Blogworld Expo, the  World largest Conference on Blogging in the Las Vegas Convention Center. As a matter of fact, I would never have the opportunity to go to such a place, because I’m blogging in my spare time and although it has many spin-offs for my work, I would never have the resources and the time to go there. So, it was with a little jealousy and envy that I followed all those cheerful tweets from my colleague medbloggers. They apparently had a lot to talk about, -also outside the context of the meeting. I even understood that Bongi came all the way from South Africa.  And I can’t say the video below eases the pain ;) :

more about “Scenes from Blog World Expo 2009 and …“, posted with vodpod
Image of Kim McAllister from Facebook
Image of Kim McAllister

It was the first time during the Blogworld Expo there was a medblogging-track. Thanks to the effort of Kim McAllister of Emergiblog. She posted a kind of a *rant* that there was nothing for medbloggers at two events. Seeing this, one organizer of Blogworld Expo commented: we have a place for you if you want to come. Johnson & Johnson were willing to sponsor, and MedPage Today offered an additional sponsorship. Below is an interview with Kim as well as with another well known blogging nurse, Gina Rybolt of Codeblog. In this interview “the conversation turns to why they blog, how they manage to do it without compromising their patient’s privacy and how they wish marketers and pharma brands would approach them.”

Rohit Bhargava who interviewed both nurses also interviewed the famous medical blogger Kevin Pho of KevinMD about why he blogs, what results he has seen and the future of the medical blogosphere the future of Medical Blogging. He makes clear why it is important for doctors to blog. However, there is one major obstacle for busy physicians, namely: TIME!

Want more information an/or pictures on the medblog-part of the conference, please see:

The opening keynote of the Blogworld Expo was delivered by Richard Jalichandra, CEO of Technorati, showing some highlights from their annual study following the growth and trends in the annual State of the Blogosphere. The report was released over five days. (See Techcruch for presentation and short explanation ; the entire report is available at Technorati)

What I found most interesting:

  • In Social Media the content is the conversation.
  • There is a rising class of “professional” bloggers.
  • But still Hobbyists represent 76% of all bloggers
    (I have some problems with the division in ‘professional bloggers’ and ‘hobbyist’ though, since professional bloggers are those regarded as “earning some money” and hobbyists are regarded as those that don’t. I think there should at least be 3 main groups: those blogging as a profession (earn money), those blogging as an expert (mostly) in their free time (professionally) and those writing about their hobbies, children etc (hobbyists).
  • The hobbyists blog for fun and to express themselves
  • 15% is part time professional, they blog to supplement their income and to share their expertise
  • 9% is self-employed, 4% is corporate (see Figure below)
  • Of the professional bloggers 2 thirds are male, 16% are 18-44, are more effluent and educated than the general population and the hobbyist bloggers (hmmm that also pleads against medbloggers not belonging to this group)
  • 73% of all bloggers use Twitter vs 14% of the general population (but nr 1 reason is to promote their blog)
  • 26% of bloggers who also use Twitter say that the service has eaten into the time they spend updating their traditional blogs – though 65% say it has had no effect.
  • on average only .83% of the page views come from Twitter referrals.
  • Advise to succeed: be passionate.
  • Bloggers believe that politics (57%) and technology/business (44%-20%) are among the fields most impacted by the blogosphere, and that they will continue to be transformed by the blogosphere going forward. Health was only mentioned by 5%.

I wonder where/whether Science/Health/Medbloggers fit in? Are they underrepresented in the study? Or do they belong to a minority anyway? See here a discussion on Twitter (catched with QuoteURL)

sotb1 technorati 209

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LOCA Congress for Interns – LOCA co-assistenten congres

14 05 2009

movir
Last Sunday I was an invited speaker at a national congress for interns, the LOCA congress. LOCA stands for “Landelijk Overleg Co-Assistenten”.

This congress has been initiated to facilitate the contact between interns of all Dutch universities and to cover in depth subjects that usually don’t get much attention.

The LOCA congress offered a diverse program, varying from “minimal invasive and maximal effective surgery”, “memory training” and “a dirty mind is a joy forever”. You can see the program here (Saturday; Sunday).

The previous event I gave a Search Workshop, this time the subject was “Medicine 2.0″.

I didn’t realize in advance that this wasn’t a convenient day. First it was Mother’s day. My children weren’t pleased that I wouldn’t be around. Furthermore I had to prepare an Evidence Based Searching day the following Monday and several other workshops that week. Still, Sunday morning we spent together in the garden eating home made smoothies and muffins that my eldest daughter L made, with on them in colors: “Mama blog”, “L X M”, “Laika twitter”, “Success”,  etcetera, which illustrates how they see me now.

Despite  that I had 40 min. instead of the expected 60 min., and just about half of the workshop subscribers (it was a very sunny day) showed up, I found it a pleasant workshop. Mostly because the audience was very interested and interactive. Within those 40 minutes, however, I could only touch upon some aspects, giving most emphasis to the web 2.0 tools which can be used in daily practice by medical professionals to find information (social networking sites, RSS also in Pubmed, personalized home pages, blogs and wiki’s)

40 minutes is short and I promised the interns to provide them with some information afterwards.

I’m too busy at the moment with my regular job, but I expect that the promised information will be available within 1-2 weeks at:

But I won’t withhold a series of tweets (Twitter messages)  specifically directed to the interns of this workshop. You can view the tweets labeled with #MOVIR, here at Visibletweets. They have been tweeted by doctors, a patient, a nurse and a physiotherapist. Please see them all, the first tweets are shown last.





PeRSSonalized Medicine – and its alternatives

27 02 2009

perssonalized_medicineA few posts back I just discussed that Personalized Genetics has not fulfilled its promise yet. But what about PeRSSonalized Medicine, just launched by Bertalan Mesko?

Bertalan Meskó is a medical student from Hungary, who runs the award-winning medical blog Scienceroll. According to the web 2.0 model of Hugh Carpenter, mentioned in a previous post, Bertalan (Berci) just finished his journey as a Web 2.0 jedi: he started a web 2.0 company: Webicina. Webicina offers a personalized set of web 2.0 tools to help medical professionals and patients enter the web 2.0 world.

To be honest I was a bit skeptical at first. When I think of web 2.0, I think of it as *open, *collaborative, *creative commons, *networking, ****collective intelligence (Elizabeth Koch). Web 2.0 exists by the mere fact that people want to share information for free. Later I realized that this initiative is comparable to individualized courses that you have to pay for as well. Webicina will also offer some free tools, especially for patients.

One such free tool is PeRSSonalized Medicine. The RSS in PeRSSonalized Medicine stands for Real Simple Syndication, which is a format for delivering regularly changing web content, i.e. from Journals. PeRSSonalized Medicine is a free tool meant to help those users who cannot spend much time online (e.g. medical professionals). It helps them track medical journals, blogs, news and web 2.0 services really easily and creates one personalized place where they can follow international medical content without having a clue what RSS is about (see post at Scienceroll)

persssonalized-medicine-tabs

PeRSSonalized Medicine has a beautiful and straightforward interface. There are 5 separate sources you can follow: (1) Medical Journals, (2) Blogs, (3) News and (4) Media (including Youtube channels, Friendfeed rooms or Del.icio.us tags), and (5) “articles” in PubMed (to setup this you have to perform a search in a separate toolbar).

The items included are partly of general interest -i.e. the Medical Journals includes 13 titles, including the BMJ, the JAMA and the Lancet-, partly it is very specialized, i.e. on the field of genetics. A lot of Journals are not included and Web 2.0 sources tend to be more represented than the official media/journals.Thus this tool seems most suited for the generalist and people wanting to follow web 2.0 tools. On the other hand – and this is a clear advantage- the content develops as wishes and suggestions are taken into account.

Each Tab can be personalized by simply hiding the titles you don’t want to include (under the button personalize it), but settings are only saved after registration.

The view of the personalized page is pleasant and neat. You see short titles of the 10 latest articles of the sources you have subscribed to. Moving your mouse over the titles will reveal more information and once you clicked the link it turns grey instead of blue. What I miss is the button: more, so you can catch up if you have missed older articles. Especially with media and journals that often have more than 10 new articles per issue, even more so if the first 10 titles consist of “obituaries” (BMJ).

The latest addition to PeRSSonalized Medicine (5) is the possibility to subscribe to a Pubmed search so “you can also follow the latest articles in your field of interest without going back to PubMed again and again and doing a search for your favourite term. Make this process automatic with PeRSSonalized Medicine.”
However, as most of you may know, you don’t have to go back to Pubmed over and over again to “do” your search, but you can easily subscribe to a search in PubMed either by email (My NCBI) or by RSS (see for instance this post in Dutch). Although the process of subscribing is not as intuitive as it is in PeRSSonalized medicine, PubMed is better suited to design a good search strategy. To keep abreast of the latest information in your field a good search forms the basis. It hurts my heart as a librarian that most web 2.0 people are more fixed on the technique of how to subscribe to a feed (RSS) than on good search results. Remember, it still is: garbage in, garbage out. RSS is just the drain.

As an example I show two RSS feeds below, one with more appropriate terms (pulmonary embolism and d-dimer) than the other (lung embolism and d-dimer). Pulmonary embolism is a MeSH. It is evident that with lung embolism articles will be missed just by choosing wrong/less optimal terms.

pubmed-search-rss-toelichting

Again the presentation of results is pleasant. Apart from the search restrictions I don’t find it very handy to look up each paper in HubMed (for that is where the link takes you).
Personally I prefer regular e-mail-alerts at specific intervals (via MyNCBI). I would like to look up citations either individually (if there is just 1 interesting hit) or all at once (10-50 hits). In PubMed, results can be selected, PDF’s directly downloaded from the library website and citations can be kept in My NCBI Collections or imported into a reference manager system. A RSS-feed of Pubmed searches is also handy (see below).

Alternatives

The idea presented on Webicina, although fancy, is not new. Consider the following alternative web tools, also build on data collected from RSS feeds.

Amedeo

Amedeo is dedicated to the free dissemination of medical knowledge. It is an international free service that will send you weekly literature updates in medical subjects of your choosing. At the same time a personalized website is made, with subscriptions to the journals you selected. You can retrieve the articles in text or in HTML-format. The HTML format brings you to the latest results for that Journal in PubMed. This service seems most suitable for specific medical disciplines. General topics (family physician) are not available, although it is possible to subscribe to for instance the American Journal of Family Physicians. As with all these free literature services, you will have to subscribe. It is easy to select or deselect journals in a category (tick boxes).
Amedeo also has Free Books For Doctors, but no podcasts or blogs. You can search the site, but you cannot easily look up individual journals.

amadeo

—————————————————–

emergency-medicine-2x

MedWorm (and LibWorm)

MedWorm is a free medical RSS feed provider as well a a search engine. It is meant both for doctor and patient. There are many medical categories that you can subscribe to, via the free MedWorm online service, or another RSS reader of your choice, such as Google Reader. The number of RSS-feeds is enormous: >6000. There are a publications directory, a blog directory, a blog tag cloud, consumer health news, discussion and several specific topics, like cancers, drugs, vaccines and education. Within the publications directory there is a further subdivision in: Consumer – Info – Journals – News – Organizations – Podcasts.

Many specialties are represented, including primary care and veterinary science. I tried it out and subscribed to some Addison’s disease related topics, Reuter’s Health and my own blog, which has recently been included. When you subcribe via the Medworm-RSS all news can be read in “My River of News”. It shows the titles and part of the abstracts (see Fig. below).

You can subscribe to single items or categories, but it is not possible to in- and exclude individual feeds within a topic or category by a single action. So within Endocrinology I cannot selectively exclude all diabetes journals, but (as far as I can see) I have to subscribe to each individual journal, if I don’t want the whole package. The loading of the River of News takes long, sometimes.

Together with David Rothman the builder/owner of MedWorm, Frankie Dolan, has also launched Libworm, which is a librarian’s version of MedWorm.

medworm2-home-page-favs

DO IT YOURSELF (or let the library do it for you)

Sometimes the library will set up a personalized start page. See for instance the Dermatology page created with Netvibes at the Central Medical Library, University Medical Center Groningen (UMCG). Doesn’t it look beautiful?

groningen-dermatology-netvibes

I-Google

And isn’t the tool below superb looking? Well, I constructed it myself on basis of what Ves Dimov wrote in the post “Make Your Own “Medical Journal” with iGoogle Personalized Page”, he submitted to the first MedLib”s round. And I had a little “life” help from Ves via Twitter, because things have changed a bit. All you need is a free Google mail (G-mail) account, just go to Google.com/IG (or search the web for I-Google) and subscribe. First you can create your start page with all kind of gadgets (like clock, G-mail inbox and weather forecast, see Figure below) and then you can add other tabs (encircled below). The Medical Journal and Journals Tabs I just took from Ves by clicking on the links he gave in his post: RSS feeds of the “Big Five” medical journals (NEJM, JAMA, BMJ, Lancet and Annals) plus 2-3 subpecialty journals and the podcasts of 4 major medical journals in iGoogle.

Once you have these tabs you can edit them (add, delete, move) as you like.

i-google

I-Google Medical Journals Tab

i-google-start-page-shape-top

I-Google Startpage

RSS-readers

All the above tools are based on RSS, which means Real Simple Syndication. It isn’t called Simple for nothing. You can easily do it yourself, which means that you have more freedom in what you subscribe to. Because I-Google doesn’t scale well beyond 50 or so RSS feeds, other RSS-readers are advisable once you subscribe to many different feeds (see Wikipedia for list and comparison) . I use Google-Reader, shown below, for this purpose.

Generally, adding Feeds is easy. In Firefox you often see the orange RSS-logo in the web browser (just click on it to add the feed) and most Journals and blogs have a RSS-button on their page, that enables subscription to their feed.

google-reader

rss-buttons-at-site-in-browser

As detailed in another (Dutch) Post, numerous Pubmed searches can be easily added to your RSS-reader. You build up a good search in Pubmed, for instance: (pulmonary embolism[mh] OR pulmonary embolism* OR lung embolism*) AND (“Fibrin Fibrinogen Degradation Products”[Mesh] OR d-dimer). In “the Results” you click on “Send To” and choose RSS-Feed and add it to your reader. That’s all.

pubmed-rss

Summary

PeRSSonalized Medicine is a free tool which lets you subscribe to a small and rather skewed selection of journals, news, media and blogs and (straightforward) PubMed searches. The strong points of this tool are: the beautiful design, the ease of use for people not used to web 2.0 tools including RSS, and its continuous development, seeking active input from its users. To speak with dr Shock’s: It is meant for a physician who is not web savvy, never heard of RSS and never wants to, not a geek, nerd, and still wants to stay up to date with health 2.0 or medicine 2.0.”

But there are other free tools around with more (subscription) possibilities and with a little more investment of time you can do it yourself and make subscriptions really perssonalized. Once you know it is simple, believe me.

You may also want to read:

http://laikaspoetnik.wordpress.com/2008/05/05/1-may-rss-day/ (about RSS)

http://laikaspoetnik.wordpress.com/2008/02/15/rss-feed-en-pubmed/ (about RSS and Pubmed – Dutch)





The Web 2.0-EBM Medicine split. [1] Introduction into a short series.

4 01 2009

Since the three years I’m working as a medical information specialist, I’ve embraced the concept of evidence based medicine or EBM. As a searcher I spend hours if not days to find as much relevant evidence as possible on a particular subject, which others select, appraise and synthesize to a systematic review or an evidence based guideline. I’m convinced that it is important to find the best evidence for any given intervention, diagnosis, prognostic or causal factor.

Why? Because history has shown that despite their expertise and best intentions, doctors don’t always know or feel what’s best for their patients.

An example. For many years corticosteroids had been used to lower intracranial pressure after serious head injury, because steroids reduce the inflammation that causes the brain to swell. However, in the 1990′s, meta-analyses and evidence-based guidelines called the effectiveness of steroids into question. Because of the lack of sufficiently large trials, a large RCT (CRASH) was started. Contrary to all expectations, there was actually an excess of 159 deaths in the steroid group. The overall absolute risk of death in the corticosteroid group was shown to be increased with 2%. This means that the administration of corticosteroids had caused more than 10,000 deaths before the 1990′s.[1,2,3]

Another example. The first Cochrane Systematic Review, shows the results of a systematic review of RCTs of a short, inexpensive course of a corticosteroid given to women about to give birth too early. The diagram below, which is nowadays well known as the logo of the Cochrane Collaboration, clearly shows that antenatal corticosteroids reduce the odds of the babies dying from the complications of immaturity by 30 to 50 per cent (diamond left under). Strikingly, the first of these RCTs showing a positive effect of corticosteroids, was already reported in 1972. By 1991, seven more trials had been reported, and the picture had become still stronger. Because no systematic review of these trials had been published until 1989, most obstetricians had not realized that the treatment was so effective. As a result, 10.000s of premature babies have probably suffered and died unnecessarily. This is just one of many examples of the human costs resulting from failure to perform systematic, up-to-date reviews of RCTs of health care.[4,5]

The Cochrane logo explained

Less than I year ago I entered the web 2.0-, and (indirectly) medicine 2.0 world, via a library 2.0 course. I loved the tools and I appreciated the approach. Web 2.0 is ‘all about sharing‘ or as Dean Giustini says it: ‘all about people. It is very fast and simple. It is easy to keep abreast of new information and to meet new interesting people with good ideas and a lot of knowledge.

An example. Bertalan Mesko in a comment on his blog ScienceRoll:

I know exactly that most of these web 2.0 tools have been around for quite a long time. Most of these things are not new and regarding the software, there aren’t any differences in most of the cases. But!
These tools and services will help us how to change medicine. In my opinion, the most essential problem of medicine nowadays is the sharing of information. Some months ago, I wrote about a blogger who fights Pompe disease, a rare genetic disorder and he told me about the diagnostic delay. I try to help physicians how they can find information easier and faster. For example: I gave tips how to search for genetic diseases.

Other examples are good functioning and dedicated patient web 2.0 sites, like PatientsLikeMe.

In the medical literature, blogs and slideshare, differences between medicine 2.0 and 1.0 are already described in detail (for instance see the excellent review of Dean Giustini in the BMJ), as well as the differences between medicine 1.0 and EBM (e.g. see the review of David Sackett et al in BMJ).

However, the longer I’m involved in web 2.0, the more I feel it conflicts with my job as EBM-librarian. The approach is so much different, other tools are used and other views shared. More and more I find ideas and opinions expressed on blogs that do EBM no justice and that seem to arise out of ignorance and/or prejudice. On the other hand EBM and traditional medicine often are not aware of web 2.0 sources or mistrust them. In science, blogs and wiki’s seldom count, because they express personal views, echo pre-existing data and are superficial.

split-1231

I’m feeling like I’m in a split, with one leg in EBM and the other in web 2.0. In my view each has got his merits, and these approaches should not oppose each other but should mingle. EBM getting a lower threshold and becoming more digestible and practical, and medicine 2.0 becoming less superficial and more underpinned.

It is my goal to take an upright position, standing on both legs, integrating EBM, medicine 2.0 (as well as medicine 1.0).

As a first step I will discuss some discrepancies between the two views as I encounter it in blogs, in the form of a mini-series: “The Web 2.0-EBM Medicine split”.

Before I do so I will give a short list of what I consider characteristic for each type of medicine, EBM-, Web 1.0 (usual)- and Web 2.0- medicine. Not based on any evidence, only on experience and intuition. I’ve just written down what came to my mind. I would be very interested in your thoughts on this.

EBM – medicine

  • centered round the best evidence
  • methodology-dependent
  • objective, transparent
  • thorough
  • difficult (to make, but for many also to find and also to understand)
  • time-consuming
  • published in peer reviewed papers (except for guidelines)
  • searching: PubMed and other bibliographic databases (to produce) and guideline databases, TRIP, and PubMed (Clinical Queries) or specific sources, i.e. specialist guidelines (to find).
  • Mostly Web 1.0 (with some web 2.0 tools, like podcasts, RSS and e-learning)

Web 1.0 – traditional medicine*

  • centered round clinical knowledge, expertise and intuition
  • opinion-based
  • authority based, i.e.strong beliefs in opinion leaders, expert opinion or ‘authority opinion’ (i.e. head of departments, professor) and own authority versus patient.
  • subjective
  • fast
  • act! (motto)
  • searching: browsing ( a specific list, site or Journals), quick search, mostly via Google**, in pharmacopeia, or protocols and UpToDate seldom in Pubmed (dependent on discipline)
  • Web 1.0: mail, patient-records, quick search via Google and Pubmed

Web 2.0 medicine

  • people-centered and patient-centered (although mostly not in individual blogs of doctors)
  • heavily based on technology (easy to use and free internet software)
  • social-based: based on sharing knowledge and expertise
  • (in theory) personalized
  • subjective, nondirected.
  • often:superficial
  • fast
  • generally not peer reviewed, i.e. published on blogs and wiki’s
  • searching: mostly via free internet sources and search engines, e.g. wikipedia, emedicine, respectively Google**, health metasearch engines, like Mednar and Health Sciences Online. PubMed mainly via third-party-tools like GoPubMed, HubMed and PubReminer. (e.g. see recent listings of top bedside health search engines on Sandnsurf’s blog ‘Life in the Fast Lane’
  • heavily dependent on web 2.0 tools both for ‘publishing’, ‘finding information’ and ‘communication’

*very general. of course dependent on discipline.
** this is not merely my impression, e.g. see: this blogpost on the “Clinical Cases and Images blog” of Ves Dimov, referring to four separate interviews of Dean Giustini with Physician bloggers.

Other references

[1] Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes at 6 months. Edwards P et al. Lancet. 2005 Jun 4-10;365(9475):1957-9.
[2] A CRASH landing in severe head injury. Sauerland S, Maegele M. Lancet. 2004 Oct 9-15;364(9442):1291-2. Comment on: Lancet. 2004 Oct 9-15;364(9442):1321-8.
[3] Corticosteroids for acute traumatic brain injury.Alderson P, Roberts IG. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD000196.
[4] http://www.cochrane.org/logo/
[5] Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.Roberts D, Dalziel SR.Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004454
[6] How Web 2.0 is changing medicine. Giustini D. BMJ. 2006 Dec 23;333(7582):1283-4.
[7] Evidence based medicine: what it is and what it isn’t. Sackett DL et al. BMJ. 1996 Jan 13;312(7023):71-2.






Grote Visite 1.5 (Dutch Grand Round)

21 10 2008

Welcome to the October 21, 2008 edition of ‘grote visite’ or Dutch Grand Rounds.

This week there were 6 submissions to the blog carnival, only 2 of which were genuine (Dutch/health-related/not-commercial/no-spam).

Jan Martens of MedBlog.nl refers to an interesting article on Reuters about teleradiology and remote medicine. During the night shift medical images of patients in for instance the United States and Singapore are sent for appraisal to Indian radiologists because of lower costs and shortage of staff at night. Jan gives various examples of other interesting applications, but wonders whether this kind of telemedicine will be easily implemented in the Netherlands.

I know what lumpers and splitters are, but I’m not familiar with lurkers. As explained by Dr Shock MD PhD, with respect to online support groups, posters are the ones actively engaged by sending postings, and lurkers the ones that use online support groups in a passive way. Dr Shock summarizes recent research, revealing that participation in an online support group had the same overall profound effect on lurkers’ self-reported feelings of being empowered as it had on posters. Please read more details about the research at Dr. Shock’s excellent post Lurkers in Health 2.0, Do They Benefit?”

By the way, Dr Shock has many other recent interesting posts as well and has an international reputation as medical blogger. For instance Pallimed hosting this week Grand Round refers to dr Shock as follows:

Dr. Shock consistently comes up with some very interesting journal articles. I really appreciated his take on impact of medical student biases towards patients with mental illness. So you may read that one as well!

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Below are my own choices from blogs form the Dutch medical blogosphere. I hope it will inspire other Dutch Medical Bloggers to participate more actively in the Dutch Grand Rounds.

The blog Health Management Rx of Jenn McCabe Gorman is already reviewed in another blog carnival, i.e.Medicine 2.0 Blog Carnival Edition #33.

People from SugarStats talked with Jennifer McCabe Gorman, one of Health 2.0’s most ‘visible’ online evangelist as they called her. By the way Jennifer wants you to know that her blog, Health Management Rx, is not dead. The reason her posts have been slow is because she is intensively preparing for Health 2.0: User-Generated Healthcare conference, which will be held in San Francisco, California from October 22nd – 23rd 2008.host

Of course we already knew that Health Management Rx was not dead, because Jenn hosted the previous Dutch Grand Round.

Many other Dutch Bloggers are also heavily involved in health 2.0, and many of them are also on Twitter. For instance apart from Jenn: @mdbraber (also in San Fransisco at the moment), @martijnhulst of martijnhulst.nl, @Zorg20 of www.azo.nl (Acute Zorgregio Oost) and @fackeldeyfinds of fackeldeyfinds.com.

October 10th, most of these twitterers were attending the master thesis presentation of Maarten Den Braber (mdbraber) about the value of business models for hospitals, either live in Enschede or virtually (livestreaming!). Interested in this subject? You can find the links to the final document and the powerpoint he used for his presentation on this blogpost.

Below are some excerpts from other MEDNL-blogs, all in Dutch

A previous host of de Grote Visite, Marjolein Fermie of “De gezondheidszorg leuker en effectievergives a short overview of what makes working (in Healthcare) fun.
Another C3-log-ger, Frank Wolterink reflects about franchising health using the same franchise methods as fast-food chain McDonald’s (and others). Very aptly called: ‘Franchising Health Instead of French Fries’ in another (english) post on delivering health care.
Bettinepluut discusses the new “zorgplan” and wonders whether this will really improve the living environment of patients

At A day in the life of a shrink there is a very interesting post on “the” critical care physicians of today, who completely rely on scans and lab results without physical examining and sometimes without even having real contact with the patient. Apart from unnecessary long waiting for some diagnosis (i.e. prominent pancreas cancer metastases felt instantly), this can make the patient feel very lonely. People aren’t numbers!

This blog has numerous posts on music, as has Vrouwmenszorg.web-log, a very nice diary-like blog of a family physician. From Music (Pink Floyd, In a gadda da vida, Child in Time: my style!) and beautiful photo’s to ‘a day in the life of’: “No, don’t dial 911 for an ambulance, but take a taxi and see your doctor first”. Sometimes she writes for Paramedic WorldWide.

Wonder what Vrouwmenszorg or Paramedic Worldwide would think of my previous post on (acute) care (for Addison patients). Apparently paramedics are allowed to give infusions to diabetic patients with a hypo. Read the story “met gillende sirene door de stad” (here) about a young diabetic who hurries too much (and eats too little) on the first day of his new job.

Another colorful blog on acute care, music and personal matter is 100% Mike. One of his post begins with mentioning a very special legacy of his mother: ice creams she won in a contest. The same night an elderly woman came in for a paracetamol, but had to stay for pneumonia and lung embolisms.

Another blog about acute care, from an emergency nurse: ECGreetje. Easy to digest information on hobbies (shopping) and acute (heart) care. Here latest post is on the (recently published) positive effect of the song Stayin’ Alive of the Bee Gees on heart resuscitation, not only because of the text but more so because of the beat, which is exactly the rhythm one should use for a successful resuscitation attempt: ~103 beast per minute. ECGreetje, however, is afraid that she will start dancing when listening to this song.

//forthebirdsblog.blogspot.com/

The Quack (and the Scream) from http://forthebirdsblog.blogspot.com/

The provocative physicians Dr. Lutser and Creiptocheilus keep on ranting against (alternative) QUACK. Dr Lutser, who takes a blog pause for a while, is highly surprised that the advocate of the controversial anti-cancer “medicine” DCA (Dichloroacetic acid), Wim Huppes, does not use this or any other alternative medicine himself, now his cancer has returned.

Cryptocheilus mentions at his blog that he has been banned from the forum of the tv program TROS-RADAR, because he was considered too offensive against mister Braam, another ‘healer’. “C’est la ton qui fait la musique”, perhaps? Good reasoning convinces more than ranting. In his earlier post, Cryptocheilus shows some examples of selective use of evidence and ‘misinterpretation’ of a Cochrane Review by Braam. Pitty that Tros-Radar only hears the tone, without understanding the text.

Finally, clinical librarian and second life specialist Guus den Brekel of DigiCMB has some interesting post on SL, for instance about how to spend an $60,000 grant for a project entitled “AIDS Information and Outreach in the Virtual World of Second Life”. He also gives a nice overview of customizabe-widgets, i.e. for blogs, technology and education.

Liked the review of your post? Would have liked a review of your post? Like to read (some of the) posts? Then Huize Sonnendael, MedBlog, Patient en EPD, Man in de Zorg, Sister Nightfall, Zorglog, Ervaringen met een verpleeghuis, Cees Sterk, Zorg voor klanten, Manager zorg vertelt, Club Confabula, Over ZN, Zo! Communicatie, Ouderenzorg in de nieuwe werkelijkheid, De gezonde patient, Medisch Contact, Huntingtondaily.web-log.nl, MediGO, MaCoAd, Verpleeghuisarts.web-log.nl, Aria Rad, Herre Kingma, Metabool.web-log.nl, Werken in de zorg, Fontys Mediatheek, Ambupleeg, Weblog voor fysiotherapeuten, Verpleegkundige, Dokter Rob, Trimbos Online 2011, Pekke.nl, Electroconvulsive Therapy, Zorggemak.nl en Bas Leerink’s Blog as well as and some of the abovementioned bloggers become a lurker too, or perhaps a poster!

Contributing is very simple, just copy the link to the post that you would like to submit here (the blogcarnival).

Just want to read: the next carnival will be hosted November 4th at Dr Shock MD PhD.

Please contribute to the upcoming Dutch Grand Rounds, so we can advocate health blogs in the Netherlands and keep informed about each other work! Mag ook in het Nederlands, hoor! Graag zelfs!








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