Lanyrd, the Social Conference Directory

24 11 2010

I’m a blogger who usually needs quite some time to write blog posts. However, I just learned about a new tool that I need not describe in detail. Firstly, because Heidi Allen just described the tool in a blog post here. Secondly, because the tool is so intuitive and easy.

I’m talking about Lanyrd, a directory of geeky events, technical conferences and social meetings.

It is really so simple and effective. Please follow me.

You go to http://lanyrd.com/, connect via OAuth to Twitter and before you can count to 3, Lanyrd shows you the conferences your friends on Twitter are going to as a speaker (blue border) or an attendee. You can also see friends who keep track of the conference (vague).

Unfortunately purely scientific or medical conferences are not included, but who knows what Lanyrd is up to.

You can track the conferences by subscribing in iCal / Outlook. It is also easy to add conferences.

I might go to Medicine 2.0, but I didn’t make up my mind yet. If I click on the link I see the following page:

You can click on “Attend” or on “Track” if this applies. Furthermore you get an overview of the conference: the location, the link to the website, the Twitter account, the hashtag used in tweets (#med2) and of the speakers.

Oh …. there are none yet, so I added a few.

It is easy to do, people who have never logged into the site can also be added. However, if helps to know the exact twitter name, if many people on Twitter share the same name (else you have to check all the profiles generated with Twitter search).

Lanyrd is the baby of the recently married couple Simon Willison and Natalie Downe. And as it goes with babies, they grow up.

What can we expect the next few years?

Simon in the Guardian:

“We have lots of exciting plans for Lanyrd’s future. One of the things we’re very keen on is gathering information on past conferences – speaker slides, videos, audio recordings and write-ups. In five years’ time, we hope we’ll have the best collection of conference coverage possible.”

Credits to Heidi Allen (@dreamingspires) and Anne Marie Cunningham (@amcunningham) who discussed Lanyrd on Twitter. As said, Heidi wrote a post on Lanyrd, and Anne Marie wrote a short blogpost at Wishful Thinking in Medical Education on the need to find list of upcoming medical or health conferences- and the hashtags that would be used to cover them on twitter. The Solution as it appeared was Lanyrd (at least for some of the conferences).

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Presentation at the #NVB09: “Help, the doctor is drowning”

16 11 2009

15-11-2009 23-24-33 nvb congressenLast week I was invited to speak at the NVB-congress, the Dutch society for librarians and information specialists. I replaced Josje Calff in the session “the professional”, chaired by Bram Donkers of the magazine InformatieProfessional. Other sessions were: “the client”, “the technique” and “the connection”. (see program)

It was a very successful meeting, with Andrew Keen and Bas Haring in the plenary session. I understand from tweets and blogposts that @eppovannispen en @lykle who were in parallel sessions were especially interesting.
Some of the (Dutch) blogposts (Not about my presentation….pfew) are:

I promised to upload my presentation to Slideshare. And here it is.

Some slides are different from the original. First, Slideshare doesn’t allow animation, (so slides have to be added to get a similar effect), second I realized later that the article and search I showed in Ede were not yet published, so I put “top secret” in front of it.

The title refers to a Dutch book and film: “Help de dokter verzuipt” (“Help the doctor is drowning”).

Slides 2-4: NVB-tracks; why I couldn’t discuss “the professional” without explaining the changes with which the medical profession is confronted.

Slides 5-8: Clients of a medical librarian (dependent on where he/she works).

Slides 9-38: Changes to the medical profession (less time, opinion-based medicine gradually replaced by evidence based medicine, information overload, many sources, information literacy)

Slides 39-66: How medical librarians can help (‘electronic’ collection accessible from home, study landscape for medical students, less emphasis on books, up to date with alerts (email, RSS, netvibes), portals (i.e. for evidence based searching), education (i.e. courses, computer workshops, e-learning), active participation in curriculum, helping with searches or performing them).

Slides 67-68: Summary (Potential)

Slide 69: Barriers/Risks: Money, support (management, contact persons at the departments/in the curriculum), doctors like to do it theirselves (it looks easy), you have to find a way to reach them, training medical information specialists.

Slides 70-73 Summary & Credits

Here are some tweets related to this presentation.

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BlogWorld Expo [SOTB]: Two Additional Videos

25 10 2009

s739843689_121258_9975 dr valToday I learned there were two more videos realted to the BlogWorld Expo, that I shouldn’t withhold you.

First, the ABC News Covered the Medblogger Track At Blog World Expo. Here is an interview with Dr. Val Jones with Dave Lucas of ABC.

The video “Medical Bloggers On ABC News: Empowering Patients With Accurate Information” is summarized as follows at her blog Get Better Health:

….”Dave Lucas is tired of all the false health information that fills his email inbox each day. He’s very relieved that there are physicians, nurses, and patient advocates “swimming against the tide” of pseudoscience and misleading health information online. Today Dave and I discussed how people can find accurate and potentially life-saving health information through peer-reviewed medical blogs, thanks to the health blogger code of ethics (administered by MedPage Today)”.

Another interview was with Paul Levy, President and CEO of Beth Israel Deaconess Medical Center in Boston, and author of Running a Hospital. Paul participated in a panel discussion as part of the Medblogger Track (co-sponsored by Johnson & Johnson and MedPage Today). Because the video is barely audible, I just mention his main statements (highlighted in red in the video shown here at the JNJ Health Channel):

  • Paul writes his blogposts without any prior permission or approval process
  • It is quicker to fix a mistake on a blog, than it is in traditional media
  • Biggest regret is responding to sarcastic or hostile comments in kind instead of staying above the fray

Medical Bloggers On ABC News: Empowering Patients With Accurate Information

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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 😉 :

Vodpod videos no longer available.

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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#Cochrane Colloquium 2009: Better Working Relationship between Cochrane and Guideline Developers

19 10 2009

singapore CCLast week I attended the annual Cochrane Colloquium in Singapore. I will summarize some of the meetings.

Here is a summary of an interesting (parallel) special session: Creating a closer working relationship between Cochrane and Guideline Developers. This session was brought together as a partnership between the Guidelines International Network (G-I-N) and The Cochrane Collaboration to look at the current experience of guideline developers and their use of Cochrane reviews (see abstract).

Emma Tavender of the EPOC Australian Satellite, Australia reported on the survey carried out by the UK Cochrane Centre to identify the use of Cochrane reviews in guidelines produced in the UK ) (not attended this presentation) .

Pwee Keng Ho, Ministry of Health, Singapore, is leading the Health Technology Assessment (HTA) and guideline development program of the Singapore Ministry of Health. He spoke about the issues faced as a guideline developer using Cochrane reviews or -in his own words- his task was: “to summarize whether guideline developers like Cochrane Systematic reviews or not” .

Keng Ho presented the results of 3 surveys of different guideline developers. Most surveys had very few respondents: 12-29 if I remember it well.

Each survey had approximately the same questions, but in a different order. On the face of it, the 3 surveys gave the same picture.

Main points:

  • some guideline developers are not familiar with Cochrane Systematic Reviews
  • others have no access to it.
  • of those who are familiar with the Cochrane Reviews and do have access to it, most found the Cochrane reviews useful and reliable. (in one survey half of the respondents were neutral)
  • most importantly they actually did use the Cochrane reviews for most of their guidelines.
  • these guideline developers also used the Cochrane methodology to make their guidelines (whereas most physicians are not inclined to use the exhaustive search strategies and systematic approach of the Cochrane Collaboration)
  • An often heard critique of Guideline developers concerned the non-comprehensive coverage of topics by Cochrane Reviews. However, unlike in Western countries, the Singapore minister of Health mentioned acupuncture and herbs as missing topics (for certain diseases).

This incomplete coverage caused by a not-demand driven choice of subjects was a recurrent topic at this meeting and a main issue recognized by the entire Cochrane Community. Therefore priority setting of Cochrane Systematic reviews is one of the main topics addressed at this Colloquium and in the Cochrane Strategic review.

Kay Dickersin of the US Cochrane Center, USA, reported on the issues raised at the stakeholders meeting held in June 2009 in the US (see here for agenda) on whether systematic reviews can effectively inform guideline development, with a particular focus on areas of controversy and debate.

The Stakeholder summit concentrated on using quality SR’s for guidelines. This is different from effectiveness research, for which the Institute of Medicine (IOM) sets the standards: local and specialist guidelines require a different expertise and approach.

All kinds of people are involved in the development of guidelines, i.e. nurses, consumers, physicians.
Important issues to address, point by point:

  • Some may not understand the need to be systematic
  • How to get physicians on board: they are not very comfortable with extensive searching and systematic work
  • Ongoing education, like how-to workshops, is essential
  • What to do if there is no evidence?
  • More transparency; handling conflicts of interest
  • Guidelines differ, including the rating of the evidence. Almost everyone in the Stakeholders meeting used GRADE to grade the evidence, but not as it was originally described. There were numerous variations on the same theme. One question is whether there should be one system or not.
  • Another -recurrent- issue was that Guidelines should be made actionable.

Here are podcasts covering the meeting

Gordon Guyatt, McMaster University, Canada, gave  an outline of the GRADE approach and the purpose of ‘Summary of Findings’ tables, and how both are perceived by Cochrane review authors and guideline developers.

Gordon Guyatt, whose magnificent book ” Users’ Guide to the Medical Literature”  (JAMA-Evidence) lies at my desk, was clearly in favor of adherence to the original Grade-guidelines. Forty organizations have adopted these Grade Guidelines.

Grade stands for “Grading of Recommendations Assessment, Development and Evaluation”  system. It is used for grading evidence when submitting a clinical guidelines article. Six articles in the BMJ are specifically devoted to GRADE (see here for one (full text); and 2 (PubMed)). GRADE not only takes the rigor of the methods  into account, but also the balance between the benefits and the risks, burdens, and costs.

Suppose  a guideline would recommend  to use thrombolysis to treat disease X, because a good quality small RCTs show thrombolysis to be slightly but significantly more effective than heparin in this disease. However by relying on only direct evidence from the RCT’s it isn’t taken into account that observational studies have long shown that thrombolysis enhances the risk of massive bleeding in diseases Y and Z. Clearly the risk of harm is the same in disease X: both benefits and harms should be weighted.
Guyatt gave several other examples illustrating the importance of grading the evidence and the understandable overview presented in the Summary of Findings Table.

Another issue is that guideline makers are distressingly ready to embrace surrogate endpoints instead of outcomes that are more relevant to the patient. For instance it is not very meaningful if angiographic outcomes are improved, but mortality or the recurrence of cardiovascular disease are not.
GRADE takes into account if indirect evidence is used: It downgrades the evidence rating.  Downgrading also occurs in case of low quality RCT’s or the non-trade off of benefits versus harms.

Guyatt pleaded for uniform use of GRADE, and advised everybody to get comfortable with it.

Although I must say that it can feel somewhat uncomfortable to give absolute rates to non-absolute differences. These are really man-made formulas, people agreed upon. On the other hand it is a good thing that it is not only the outcome of the RCT’s with respect to benefits (of sometimes surrogate markers) that count.

A final remark of Guyatt: ” Everybody makes the claim they are following evidence based approach, but you have to learn them what that really means.”
Indeed, many people talk about their findings and/or recommendations being evidence based, because “EBM sells well”, but upon closer examination many reports are hardly worth the name.

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This week I will blog from…..

10 10 2009

35167809 singapore colloquiumPicture taken by Chris Mavergames http://twitpic.com/kxrnl

Chris and I will facilitate a web 2.0 workshop for the Cochrane (see here, for all workshops see here).
The entire program can be viewed at the Cochrane Colloquium site.

Chris Mavergames, Web Operations Manager and Information Architect of the Cochrane Collaboration will also give a plenary presentation entitled:
“Cochrane for the Twitter generation:
inserting ourselves into the ‘conversation‘”.

The session has the promising title: The Cochrane Library – brave new world?

Here is the introductory text of the session:

The Cochrane Collaboration is not unique in facing a considerable challenge to the way it packages and disseminates healthcare information. The proliferation of communication platforms and social networking sites provides opportunities to reach new audiences, but how far can or should the Collaboration go in embracing these new media? In this session we hear from speakers who are at the heart of the discussions about The Cochrane Library’s future direction, including the Library’s Editor in Chief. We finish the session with reflections on the week’s discussions with respect to the Strategic Review (…)

Request (for the workshop, not the plenary session):
If you ‘re on Twitter, could you please tell the participants of the (small) web 2.0 workshop  your opinion on the following, using the hashtag #CC20.*

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

An example of such an answer (from @Berci):

#CC20 Web 2.0 opens up the world and eases communication. Cochrane 2.0 is needed bc such an important database should have a modern platform

If you don’t have Twitter you can add your comment here and I will post it for you (if you leave a name).

Thanks for all who have contributed so far.

—–

*this is only for our small-scaled workshop, I propose to use #CC2009 for the conference itself.

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PubMed® Redesign [2] News, webcast

4 10 2009

Since last week you can try the redesigned PubMed (see post). There is a link on the PubMed homepage which will connect to a preview version. The direct link to the preview is: http://preview.ncbi.nlm.nih.gov/pubmed.

Notably, the preview version is expected to run for at least two weeks after which the old PubMed will dissapear! (see NLM technical Bulletin, Sept 11) and Twitter). Since the playing time might be very short: start trying the new interface now!

Tried it? Did you fill in the poll: What do you think of the PubMed Redesign?

As announced in the NLM Technical Bulletin (Oct 1) and on Twitter, there will be webcasts Tuesday, Oct 6: 9:00* – 9:30 am, 11:00 – 11:30 am and Wednesday, Oct 7: 1:00  – 1:30 pm, 2:00 pm – 2:30 pm Eastern Time.
(*see here for the corresponding time  in your timezone).

You are advised to read the article, PubMed® Redesign, before you attend the webcast. Only the first 300 participants will be able to attend. However, the Webcasts will later appear at: http://www.nlm.nih.gov/bsd/disted/clinics/pmredesign09.html.

Want to keep uptodate?
Take an email alert or a RSS-feed to NLM technical Bulletin and/or follow @nnlmscr and  @ncbi_pubmed on Twitter.
Twitter Librarians  who may bring you news on the subject: @pfanderson, @shamsha, @alisha764, @uconnhealthlib, @mfenner and sometimes @laikas
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#CECEM Bridging the Gap between Evidence Based Practice and Practice Based Evidence

15 06 2009

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

Guidelines

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

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

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

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

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

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

12066264 rob de bie CECEM

Photo made by Chris Mavergames

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

13 06 2009

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

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

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

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

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

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

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

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

Cochrane Tovey wit

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

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

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

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

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

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

Solutions?

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

Key challenges:

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

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

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

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

click to enlarge

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

*have to look this up

NOTE (2009-11-10).

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

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

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

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

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

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#EAHIL2009 Web 2.0 and Health Information – Chris Mavergames

4 06 2009

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

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

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

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

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

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

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

The presentations:

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

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

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

10848362 class chriss mavergames

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Examples of the two are:

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

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

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

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

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

A typical Web 2.0 scenario:

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

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

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

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

The slidecast I’ve reviewed is below.


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Web 2.0 and Health Care Reform: Two Dutch Examples (1)

18 05 2009

The theme for the next Grand Round hosted by Healthcare Technology News is Healthcare Reform.

“We’ll be publishing a wide range of articles, from those that share anecdotes about why we need to improve the health care system, to examples of innovations and care that are working well, through to the policy recommendations that we need.”

Although I easily could give some anecdotal examples from the past about “failures or shortcomings” in Healthcare, I prefer to give some positive examples of how a web 2.0 approach can bring patients and doctors together. There are numerous examples of successful application of web 2.0 tools by patients to find and share information and to improve the management of their disease. There are also many healthcare people who use web 2.0 tools to write down their experiences (blogs, social media), to get their information (RSS) and to put information on the web (wiki’s) for patients or colleagues. There are hospitals that are actively engaged in social media and that facilitate patients to use these tools to gather information, but I’ve seldom seen a real web 2.0 based patient-doctor collaboration…. till recently…. close to home in Nijmegen at the Zorg 2.0 (Health 2.0) event, organized by Lucien Engelen (twitter: zorg20; and on linkedin). In fact, the whole meeting was a success with lots of interesting lectures (i.e. from Bertalan Mesko of Scienceroll and Maarten Lens Fitzgerald of Maarten’s Journey.) and workshops.

All podcasts of the Zorg 2.0 event can be seen here

Two presentations were given by two professors on patient centered care in the so called award winning initiative MijnZorgNet (MyCareNet): Bas Bloem and Jan Kremer.

I will discuss their two presentations in separate posts.

This post will summarize the presentation of Bas Bloem, neurologist from the UMC St Radboud Ziekenhuis Nijmegen and initiator of the Parkinson Center.

Bas Bloem began with his “take home message” (with which I couldn’t agree more):

Health 2.0 is not “the world of gadgets”, but a new way of thinking in healthcare:

  1. the patient becomes centric, care becomes collaborative: the patient is not passive, he is “equal” to the healthcare provider. It isn’t “he asks, we provide”, but the patient definitively has a voice (and choice) in his own healthcare.
  2. coherent and transparent healthcare.
  3. expertise (few experts, but with very specialized knowledge).

He set up a program for Parkinson care delivery networks, first in the surroundings of Nijmegen and later throughout the Netherlands. Although his talk is about Parkinson, it can be seen as a model for all kinds of complex diseases.

Bas is an idealist. He believes most healtcare people choose their job to really help people. Doctors choose to care. Only the system doesn’t help them to realize this.

To change this, a paradigm shift is needed. Healthcare needs to be centered round the patient:

  1. The patient has the right to see the best specialist -in a structured way; the assessment of the patient is “CENTRAL”, in an intramural setting, i.e. by a neurologist. In the present example, people from the first line can easily contact the specialists or plan an appointment in their agenda. In this way the patient is helped promptly and he notices the good cooperation between the two lines.
  2. Daily healthcare is close to home, only performed by a handful of specialists (i.e. physiotherapists) specially trained to treat Parkinson patients. This is called the ParkinsonNet. Patients rather have someone with expertise who is within a 20 minutes distance, than a less experienced person round the corner.
  3. There is optimal communication between the “two layers”.
  4. The patient plays an active role.

parkinsonnetHow is this organized?

  1. When the patient is referred to the neurologist, he first has to fill in a screening list and has to prioritize 5-10 health problems, which he/she would like to discuss when visiting the Day Center. So one patient may want to see a sexologist, a dietitian and a physiotherapist and an other a rehabilitation physician, gerontologist and a neurologist.
  2. Doctors and patients sit round a table, each in the same position (no hierarchy).
  3. Consumer reviews are shown (anonymously) on the Internet. This makes healthcare transparent. When scores are bad some action should be taken to improve it.

How is this achieved?

  1. Selection of experts who get education (via e learning etc), on basis of geographic distribution. Patients have to travel a bit more, healthcare is canalized,
  2. All healthcare workers work according a multidisciplinary guideline. Patients were active co-producers of the guideline.
  3. Implementation (see above)
  4. Yellowpages (paper and digital version) have been made of healtcare providers, enabling patients to choose.
  5. Indicators are developed, patients are invited to give feedback and to grade the healthcare (providers). If someone performs bad, (gets the red card) he/she may ultimately be taken out of the network.

The experiment of patient empowerment in Parkinson’s Disease management has grown from very small (region Nijmegen) to almost national. The blank region (see Figure) is not included to be able to assess the effectiveness of this system compared to the traditional approach.

parkinsonnet landelijk

The next step is the creation of a virtual community. This is certainly important and not out of reach for the elderly. A transmural electronic health record is available (Parkinson dossier) both for the patient and the healthcare worker.

Slides (Dutch): http://www.slideshare.net/lucienengelen/bloem-zorg-20-maart-2009
——————————-

Vodpod videos no longer available.

more about “4. Zorg20 Event Spring 2009 | Keynote…“, posted with vodpod

* Since the video stuck half way, I may have missed part of the presentation.


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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.


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Hospitals on Twitter: Mayo Clinic and #Tweetcamp2

24 04 2009

twitterTwitter is only for people telling what they’re doing right now, like “what they eat for breakfast”. Right?
Twitter is a kind of web based Short Message Service, which is largely for ego-trippers sharing the -largely uninteresting- private parts of their life, isn’t it?
YouTube is mostly for teens and twenties enjoying music videos. And similarly Facebook and (in Holland Hyves) are just a hype. O.k.?
And blogging, ha, blogging…. Doctors shouldn’t blog, because of privacy issues and because it is a  waste of time. Doctors don’t even have time for it, nor should they have… Yes?!

Social media are useless and perhaps even “dangerous” (distracting staff, viruses, wrong info, privacy concerns) and hospitals should keep them behind their firewalls!!

Right?

Wrong!

Wrong. At least that is what many US hospitals are thinking. More and more they are embracing social media. Why? To connect, to interact, to disseminate new research, to share in-depth medical information and to gather communities of employees, patients and their families.

Examples: see this blogpost on hospitals and social media by Tony Chen.

And it seems that patients are influenced by it.

For instance, a recent announcement on marketingcharts, states that:

Social media has some type of influence on nearly 40% of recent hospital or urgent-care center patients, with more than half of 25-to-34 year olds reporting they are influenced by it. (hattip: @bart)

Of the US Hospitals Mayo Clinic gives a good example of how new social media technologies can be implemented. They use many different web 2.0 tools, like YouTube videos, Slideshare, Facebook. On “Sharing Mayo Clinic. A blog with stories from families, friends, patients and Mayo Clinic Staff” they sum up 10 ways you can use Mayo clinics social media tools.

One tool they use is Twitter (@mayoclinic). First they protected their updates on Twitter, didn’t follow their followers back. Twitter was mainly used for “branding”, but later they realized that this didn’t work and that “they needed more than an audience”. By interacting with their followers they got more response. They also reached more people, because interesting tweets were retweeted by their followers. So even people that don’t follow @mayoclinic (but are followers of its followers) are alerted to the news. It is also an important virtual mouth-to-mouth-tool for new patients.

More than Facebook, Twitter enables you “to connect with people you don’t know but share the same interest with. It is for the friends you don’t know yet”

Mayo Clinic actively supports its staff and its patients to use the social media tools.

Last night Mayo Clinic organized a Tweetcamp (Tweetcamp II) for medical use on Twitter. According the announcement on their blog their aim was:

(…) to provide training for Mayo Clinic staff — and for others outside Mayo via Web cast, in how to use Twitter productively in health care. The course also will explore innovative applications for Twitter in health care, including upcoming examples such as Dr. Victor Montori’s April 27 Twitter discussion of his recent research paper on diabetes treatment, and Mayo Clinic’s National Symposium on Medical and Health Care Education Reform.

People from outside Mayo Clinic will be able to participated via the Web cast and Twitter, by following the #tweetcamp2 hashtag.

(#tweetcamp2 can still be followed to see what people following the webcast were  -and are- tweeting about #tweetcamp 2)

Other Tips on how doctors (should) use Twitter can for instance be found on this blogpost of Michael Lara MD.
Phil Baumann even made a list of 140 Health Care Uses for Twitter.

Below are the powerpoint presentation and one of the video’s they shared. It is really an useful beginners guide for everyone.

Want to know what has been said: see the first live video of the event:

More #Tweetcamp2 video’s can be found here.

All Mayoclinic You Tube videos can be found here

One question on Twitter was if one could see the Mayo Clinic guidelines of Twitter usage. They are for instance on the Blog of Ed Bennett (see this link).

And while you are visiting Ed Bennett’s blog you might as well go to his “Hospital Social Network List” which shows the U.S. Hospitals that use Social Networking tools. In summary:

  • 240 Hospitals total
  • 129 YouTube Channels
  • 88 Facebook pages
  • 155 Twitter Accounts
  • 23 Blogs

But what about the rest of the world. Europe for instance?

A list is in the making. Lucien Engelen of Zorg 2.0 took the initiative to make a similar list for Europe (see Dutch post here), starting with the Netherlands. For this he created the site: hospitalseu.

The first preliminary list of Dutch hospitals officially using social media has now been compiled by Lucien et al. It should be stressed that the list is based on what is known, but needs to be confirmed  the hospitals (a mailing is being send). See blogpost on Zorg 2.0 (Dutch) and this pdf with preliminary data.

There is reason to believe that the results will not be essentially different.

Indeed, I don’t know of any initiatives of our hospital to use social media (Academic Medical Center, Amsterdam)

Thus looking at the enormous differences between the USA and the Netherlands one wonders:

Europe (the Netherlands) isn’t it about time that you join?
At least get acquainted with Social Media and Web 2.o!
Look what others are doing and see what is in it for you, your staff ànd your patients!
You may not (want to) do it, but your patient will do it anyway.

stats-graph-eu-en-vs001

Preliminary data From: http://hospitalseu.wordpress.com/ (Hyves is the Dutch Facebook)

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

By the way, 5 days ago I personally experienced that Mayo Clinic is really interactive. I followed one of their links in their tweets to find that I could not access the news item they referred to, because it was password protected. I tweeted about it -just in general-. Mayoclinic immediately picked this message up (because they have a search for “mayoclinic” on Twitter). But more importantly they immediately responded in a pleasant way ànd immediately took care of it. This illustrates that they are not only “interactive” in words but also in deeds: they really “listen” and “respond” to their Twitter followers. Many individuals on Twitter don’t even bother.

(read the tweets from down up)

mayoclinic-laikas


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