First Anniversary of this Blog

7 02 2009

118424928_1dabcac6fd

This week is my one year anniversary.

I would like to thank all my readers for following along with my blog.

Thanks for your encouragements, comments and inspiration.

I’m glad I entered the web 2.0 world, but it would have been empty without you.

I hope you keep connected!

Laika (Jacqueline)


Foto credit: http://www.flickr.com/photos/charlietakesphotos/118424928/

Response From Twitter

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Laika’s MedLibLog in review: 2008

3 01 2009

This blog saw the light in February 2008, so it is almost time to celebrate its anniversary.

Maintaining this blog has been an enjoyable and fruitful -albeit time-consuming- experience.
I would like to take this opportunity to thank all readers of this blog for their visits, comments and support! I hope that you will continue to find content here that entices you to read and, even better, comment.subscribing-2

If you like the posts at this blog and you’re not doing this already you might consider:

  • subscribing to my blog by RSS by clicking here (You have to install a reader as well) or
  • subscribing by email by clicking here
  • adding this blog to your Technorati favorites here
  • following me on Twitter here

Or you can simply click on the figures in the sidebar:

I wish you all the best for 2009!

——————————————————————————————————————–

Here is a short review of this first year of blogging.

Highlights were:

———————————————————————————————————————-

An overview of (a selection of) blog posts per subject:*

Searching, Biomedical databases.
PubMed: Past, Present And Future, PART II [1]
PubMed: Past, Present And Future, PART I [10]
Finding assigned MeSH terms and more: PubReminer [16]
BMI bijeenkomst april 2008 [19] [Dutch]
PubMed: Past, Present and Future PART III [39]
New Ovidsp Release Planned August 5th will allow more flexible searching [46]

Evidence Based Searching
The best moment teaching EBM-searching skills [31]
Time to weed the (EBM-)pyramids?! [35]
New Cochrane Handbook: altered search policies [-]
Podcasts: Cochrane Library and MedlinePlus [-]
New cochrane handbook: altered search policies [-]

Evidence Based Medicine, Methodology
Nursing Myths (1): Post-operative Temperative Measurements [2]
The Best Study Design… For Dummies [3]
Huge disappointment: Selenium and Vitamin E fail to Prevent Prostate Cancer.[7]
The (un)usefulness of regular breast exam [9]
FREE online course on evidence-based health care [14]
Thesis Mariska Leeflang: Systematic Reviews of Diagnostic Test Accuracy [18]
CC (2) Duodecim: Connecting patients (and doctors) to the best evidence [49]
Podcasts: Cochrane Library and Medlineplus [-]

Clinical practice, Consumer-related Subjects, Addison’s Disease
Changing care (for Addison patients) [11]
The importance of early intervention in an Addisonian Crisis[13]
23andMe: 23notMe, not yet [15]
Anatomy Lesson 2008: Living in Fear [20]
Etiquette-Based Medicine [22]
The OpenECGproject: an admirable Web 2.0 [42]

Science
The Real Sputnik Virus [4]
Randy Pausch Last Lecture: Achieving Your Childhood Dreams [6]
#Sciblog – a bird-eye’s view from the camera
Evolution and Medicine. Cancer and adaptive immune responses as evolutions ‘within’.

Web 2.0 tools
Incorrect Google Incoming Links? [5]
Delicious Google Toolbar [9]
Google Reader and other free (learning) tools [17]
Visualize your blog (words) with Wordle [21]
Locate Your Visitors (2) [23]
Forget Hyves. Go Twitter! [24]
Possibly an announcement about possibly related posts [25]
Locate-your-visitors [30]
Technorati Rank & Authority Dropping[38]
Blog Spam and Spam Blogs (1) [44]
WikiMindMap to Organize Wiki Content [50]

Other
For Palin & Obama, Fun & Photo’s [8]
A really delicious blog …[12]

Dutch Grand Round and other blog carnivals
.: See the category Grand Round
For Spoetnik Course search for the Category Spoetnik (preliminary Dutch)
For Personal matter search for the category Personal

*([nr] indicates the popularity of the post according to WordPress stats, from 1 [most popular] to 50. Not all posts are shown.





Changing care (for Addison patients)

19 10 2008

This post is inspired by the theme for this weeks Grand Rounds at PalliMed, a Hospice and Palliative Medicine Blog: “Changing Goals of Care”. According to Christian Sinclair, M.D. of Pallimed:

It can be changing the goals in any direction, not just the curative towards palliative route, although I expect that is a common touchstone for many in the medical field.

‘Goals of Care’ is a subject that is outside of my area of professional expertise, being a medical biologist and an information specialist.

But as a consumer and patient I can easily see how I would like health care to change.

  • affordable healthcare for everyone who needs it
  • More personal and personalized care
  • And -indeed- more attention for palliative healthcare (my mother in law has a bearable life, since low doses morphine were prescribed)

But those issues can be better addressed by persons in the field. I just simply want to restrict to “changing care in a very specific area, adrenal diseases, simply because I’m a hands-on expert, having secondary Addison’s Disease (Sheehan’s syndrome)”.

Main conclusions:
Healthcarefivers look (and act) beyond your specialty! Try to be a good generalist as well. Please adapt protocols if it suits the patients. Take the patient seriously.

Diagnosis
Primary Addison (damage or destruction of the adrenal cortex) as well as secondary Addison (absent pituitary signal(s)) often have a slow onset and are difficult to diagnose.
In theory this may be different for Sheehan’s Syndrome. According to Google Knol:

Sheehan’s syndrome (…) is a condition in which the pituitary gland is injured as result of heavy blood loss during complicated childbirth. This heavy loss of blood deprives the pituitary gland of oxygen and other nutrients and leads to necrosis (death) of pituitary tissue and therefore pituitary failure (hypopituitarism). Failure to produce breast milk after delivery (due to lack of the pituitary hormone prolactin) may be a presenting sign of Sheehan’s syndrome. Fortunately, Sheehan’s syndrome is now rare cause of pituitary failure, particularly in developed countries as a result of improved obstetric care.

Looking back I’m stunned that Sheehan was not directly diagnozed by the gynecologists themselves.
And perhaps even more surprised why it happened to me in the first place, being hospitalized in Europe, and having a previous cesarean. (For good reason it is: “Once a cesarean, always a cesarean” According to present protocols I had many negative predictors for success (no prior vaginal birth, short stature, age >40, induction of labor, gestational age almost 43 weeks, failed second stage), but worst of all they didn’t take me serious when I said I didn’t feel well and got a sudden neck pain. When standing up I fainted. So I have every reason to believe all this could have been prevented).

I lost more than 3 litres of blood (and had puerperal fever as well), developing all signs of Sheehan (and Addison crisis) in the days that followed: breast milk “disappearing”, loss of appetite, severe muscle pain, fatigue, headache, lethargy, extreme nausea, diarrhea & vomiting and finally speaking with double tongue, feeling like I fell when lying down, sensitive to cold etc. But nurses pressed to try to give breastmilk (till bleeding), reprimanded me in presence of other patients (you have to break the circle, please do your best (!) and eat something; you have to take care of your child, come on!) and a psychiatrist was being ordered. Finally (after 10 days), when I plead them to check whether I was not dehydrated, they did some tests and found out my blood Natrium was dangerously low (106; normal 140), and could apparently not be corrected by giving saline transfusion. I “missed’ this part, but when I woke up the internist told me proudly he found out I had Sheehan (practically no cortisol or any other hormones under regulation of the anterior hypophysis). Normal natrium levels were achieved after giving cortisol-replacement.

I’m by no means an exception. Addison’s disease is often missed or diagnosed late. That early diagnosis can be a challenge is frequently addressed in the medical literature and many poignant examples can be read on patient forums. In fact I know very few prompt and swift diagnoses.

For instance (from the Newsletter of “The Canadian Addison Society”, issue 27, 2002

After being admitted and discharged what seemed to feel like every weekend, I was finally admitted for bronchitis that affected my asthma. I went on Prednisone* to treat the infection. I felt much better to my surprise. After being “cured” of bronchitis, back in the hospital I went. The pain was unbearable; doctors were questioning if I was anorexic, I saw a psychiatrist who put me on Paxil because I “appeared” to be depressed. Demerol became my new best friend and was the only thing that put me at ease.
My mother continued to stay by my side the entire time. Whether it be stroking my hand, brushing my hair, or encouraging me to walk just a few steps a day. This felt like a marathon to me; in reality it was only a few steps.
After every “possible” test was completed my internist had suggested performing one more test. The results had come back positive! Addison’s Disease….**

(*Prednisone is a glucocorticosteroid that can replace cortisol; this patient also had pigmented handpalms, specific for primary Addison.)

well-ville.com/images/adrenalQA2.jpg

The same is true for other adrenal diseases. Cushing’s Disease (excess of cortisol) is often mistaken for (manic) depression. See for instance wrongdiagnosis.com or here (Dutch).

After years of non-recognized Cushing one of my fellow patients was treated by many specialists. One expert (being an orthopedic, I believe) totally missed the Cushing, because she fixated on other causes of the severe osteoporosis and didn’t notice the patient’s bruises, mania, belly fat, striae to name just a few other symptoms, typical for Cushing. Missing her diagnosis means she is mostly in a wheel chair now, and not able to do the things she liked to do (for those interested and able to read Dutch she has written a book about it: “Aftakelen and Ophijsen”)

Action (in case of a crisis)
With hormone replacement therapy, most Addison patients disease are able to lead normal lives. However extreme stress can precipitate an Addison crises, which is a medical emergency. Patients therefore often wear alert bracelets or necklaces, so that emergency personnel can identify them as having adrenal insufficiency and provide stress doses of steroids in the event of trauma, surgery, or hospitalization.

Luckily I don’t seem very vulnerable to crises (still producing aldosterone), but the one time I had something like it (presumably due wrong capsules, thus more insidious), family physicians reacted inadequatly. One gave me a lab form emphasizing twice that lab tests should ONLY be done when I was really, really ill. Very stupid, because determining Natrium costs nothing compared to hospitalization, and my pride prevented me taking the test, afraid that I made a fool of myself. My own physician said a few weeks later that I should consult a endocrinologist, because he found Addison “much too difficult”. I thought that wasn’t bad, but my endocrinologist didn’t agree, because “he would have been too late in case of a real emergency”. (I had a Na of 123, but was hospitalized, because my endo (a wonderful female doctor) found I behaved differently and wasn’t ok – I also lost >18 pounds in 2 months)

But there are far more upsetting stories of other Addison crises. Even in this era there are unnecessary deaths due to  inadequate intervention. What is also worrying is that paramedics often miss the alert bracelets. A Dutch paramedic wrote on the bulletin board of our patient’s association, that paramedics don’t even look at it, because they aren’t allowed to do anything going beyond first aid and stabilization. However, if my husband may give me an intramuscular injection of corticosteroids, why can’t a paramedic? It is the most essential emergency measure that can and should be taken. He advised that we would bundle our forces with other patient groups to change the protocols of the ambulance personnel. Paramedics won’t do anything when they are not legally entitled to.

I also hear from many Addison patients that it takes ages before there is adequate action. Apparantly routine tests have to be performed first. A nurse even told me that glucose is tested first, because it is such an easy and fast test. O.k. an addison crisis is often accompanied by low blood glucose. So what? Get those corticosteroids in!!! Intravenous injection is often difficult, because of the low blood pressure. It often takes too long and often fails, at least that is what I hear from other patients.

Iatrogenic Cushing and Addison

Apart from natural causes, Cushing and Addison’s disease can have a iatrogenic cause (unintended harmful effects by a physician’s activity, manner, or therapy). It is well known that longlasting treatment and/or high doses of corticosteroids can give Cushing-like symptoms as well as Addison-crises in case of sudden withdrawal (because of feedback mechanisms the body can’t make cortisol any longer).
Laurens Mijnders has developed long lasting Addison’s Disease because of his asthma treatment. His letter in Contrastma, a paper of a Dutch Asthma Foundation (Astma fonds) evoked many responses of patients who had used high doses corticosteroids (up to 50 mg/day Prednison per day). The reactions showed that doctors had given little or no information about adverse effects of corticosteroids and had never warned against a possible Addison crisis (see here).
An endocrinologist revealed at a meeting that they still regularly see Addison crises in patients who received high-dose steroids for their asthma, rheuma, dermatologic or other inflammatory condition
Of course some of these diseases can only be controlled by corticosteroids, but the treating physician should try to sail safely between Scylla and Charybdis, and prepare the patient for any (anticipated) danger.

Wasn’t it: “Primum non nocere” (Latin for “First, do no harm”)?!

Thus physicians, look beyond the border of your specialty and always take patients seriously, please?

Addison's disease info (nvacp)




Laika’s Little Party

21 09 2008

It’s time for some reflections on this blog and for a little party. Why?

So for now I will start with the party (with some wine), the reflections will follow when I’m sober.

This week I received an unexpected email from RNCentral (“the place to learn about nursing online”), anouncing that this blog had made it to the “Top 50 Health 2.0 Blogs list ( see here).

The top 50 health 2.0 list is not based on a kind of “objective” ranking like the Healthcare 100 or MedBlogEN lists, which are a measure of how many people link to your site, find your site by searching or have subscribed to your blogposts: thus an indirect measure of “how popular you are“. In such a list I would not make the top-100.
The RNCental site gives a “subjective” top 50 list of blogs, that appear valuable to the authors. The list is introduced with a very nice definition of health 2.0 blogs, that I can subscribe to:

Health 2.0 embraces the idea of bringing health care into the community of physicians, patients, and those in the health care industry together with technology and the Internet to provide the best possible health care environment. What better way for the various parts of this community to share their thoughts and communicate ideas than through their blogs? From corporate blogs to blogs that are a part of social networks to individual blogs touching on technology or health care policy, these blogs will help bring you into the community, provide information and resources, and may perhaps help you find your voice as well.

I’m thrilled that I’m (literally) placed next to David Rothman in the “Health and Technology”-section. Although, to be honest, I see myself as a true beginner in this web 2.0 world and I learn a lot of established web 2.0 experts like David Rothman, KraftyLibrarian, Berci of Science Roll, MD Anderson on Emerging Technologies Librarian, Dean Giustini (UBC Academic Search), Sachet62 on Twitter, symtym from symtym.com, David Bradley from Sciencebase and Dutch colleagues like Wowter (with a dutch and an english blog), Dymphie (Dee’tjes) and many many more. On my blog I try to integrate what I learn elsewhere (articles, posts, twitter messages) with my own knowledge and interest.

The resultant is a rather diverse mixture of subjects in the field of (medical) librarianship, medicine, health (including consumers), evidence based medicine and web 2.0 tools.

Although such a broad mixture might not be appealing to everyone, it is appreciated by some, as is apparent from a recent blog-review in the Library + Information Gazette, 22 August 2008: p5 (UK). The Gazette is only available in print edition and I wouldn’t have known about it if Anne Welsh of “First Person Narrative” had not mentioned it at her blog (see post: “mainstreaming blogs as information sources”). Anne:

“This review is the first in a series “Blog Spotlight” authored by Danielle Worster (the Health Informaticist). It’s aim is to help separating the wheat from the chaff when it comes to blogs in LIS and health informatics.

Any blog that claims to be about information, research, Web 2.0 or health informatics is considered. Each blog discussed is described in terms of its audience, currency, informativeness, authoritativeness / credibility, readability and design, with a brief overview and summary. It’s a nice format, and starts well in this issue with UBC Academic Search , ResearchBuzz and Laika’s MedLibLog.”

With Anne I find it regretful that the gazette is not available online. I surely would like to follow this series.

Luckily I found Keith Nockels (Browsing) willing to make a scan of the Gazette’s review and send it to me.

The Gazette review sketched my blog with very flattering sentences (“colourful, engaging and relevant”, “easy to read and digest”) as well as apt descriptions, which made me grin: “while it does stray to discuss….. Although she writes copious amounts, it is as easy to skim as to read it all…. crammed full of visuals.”

And about Dean’s UBC Academic Blog:

“Very informative: has an uncanny ability to pick up on crucial issue”. …. the blogger’s energy comes through in his shorter sentences….. essential reading.” All true! Dean’s blog is a must in the librarian web 2.0 world!

Apart from these official listings and reviews I got some comments or links that were also heartwarming.

For instance Keith Nockels (a UK Librarian with a nice blog (“Browsing”), apparently familiar with at least a few Dutch words) refers so nicely in his blogpost “More about changes to Ovid”:

“I have since found a posting on Laikas MedLibLog about this, and Laika has obviously looked at this properly! So, I can now report that you (….)
Laikas posting is here (in English and ook in Nederlands) and is gratefully acknowledged. She talks about other things besides, so please read her posting for more!”

And Dr. Shock announcement of the dutch grand round number 1:

Laika Spoetnik presents The Best Study Design… For Dummies (in English).
She writes in English and Dutch so you have no excuse for not reading this excellent post. She clearly explains Randomized Controlled Trials (RCT’s) and the levels of evidence. She uses an example which is easy to follow: Does beta carotene prevent lung cancer.

At Medliblog (the official website of the BMI, Dutch Biomedical Information) Annie (writing about Evidence Based Dietetics refers to the same post, saying:

….handige bijlages met een checklist voor het lezen van wetenschappelijke artikelen en een statistische begrippenlijst, dat laatste blijft toch altijd wel moeilijke stof voor dummies of alfa’s.
Voor die categorie heeft Laika een zeer begrijpelijke blog (zowel Engels- als Nederlandstalig) geschreven, waarvoor mijn dank. Zo’n presentatie zou ik ook wel willen bijwonen.

meaning:

For that category (dummies or alpha people not understanding checklists and studytypes) Laika has written a very comprehensible blogpost (in English and Dutch), for which I would like to thank her. I would have loved to attend such a presentation. (I gave to historians about “how doctors search”).

These comments strengthen me to continue blogging. This is why I blog: that (some) people like to read what I write and learn from some of the posts.

Well that is probably enough shameless self-glorification for now. I do realize that beginners get mild critiques, but as you get more well known the expectations will grow along and the critiques as well.

Next time, at request of Wowter, I will reflect more on the 5W’s of this blog: why, when, who, what, where?





10,000!!

5 09 2008

Dear readers.

An important milestone 4 me.
10,000 hits in ~7 months.
Thanks everyone!

And the 10.000st visitor is from Wageningen, the Netherlands. Wowter? (84.87.26.#??)
Claim your price: a drink, a hug, a post, or a link!!

Laika





Close to 10,000…

3 09 2008

Still >100 to go and we will have a little party over here.
Are you number 10,000 please let me know!

Possible little gifts:

  • Eternal fame, because you may write a post on this blog (via Google Docs)
  • Eternal fame, because I will write about you (if you like)
  • Or If you’re nearby I will buy you a drink/snack or coffee/cake.

———–

Nog maar ruim 100 en we houden hier een klein feestje…
Ben jij nr 10.000 geef me dan een seintje (zelf hou ik het ook in de gaten).

Mogelijke kleine attentie die je ontvangt (naar keuze):

  • Eeuwige roem, omdat je op mijn blog een bericht mag schrijven
  • Eeuwige roem, omdat ik een bericht over jou schrijf
  • Als je in de buurt bent een drankje of koffie (niet uit de automaat) met iets erbij (je mag het ook tegoed houden)
    NL-ers hebben meer kans, dus doe je best!




MEDBLOG NL 5!!

29 06 2008

Just a little note before I leave for vacation.
Maybe you’ve seen these blue and red widgets at the sidebar.

They are here for a month now. It means that I’m number 5 on the MedblogNL-list in May 2008. Rather surprising because this is the first time I’m on the list.
However, I must admit the list is not very long (30).
(….and no 126 on the English list. This list is quite a bit longer and has WSJ.com: Health Blog at top(!)

And since I don’t expect to stay up in the list for long, I just want to put it here… to remember. Yeah, I’m also a bit proud as a newbie in the blogosphere.

My Technorati rate also went up to 30, but now it’s on his way down, mostly because the Spoetnik-collegues dont’link to each other anymore. Most have stopped active blogging.
I miss it. When my vacation is over I will visit some of the Spoetnik pages. See how you’re doing. I promise.

Back to the Medbloglog. You can see the Dutch MedblogNL here. The may-top 5 is below. Most of the other bloggers are physicians, nurses and students.

The MedBlog log is an idea of Jan Martens. He thought it would be nice to have a list of Dutch Medical Blogs. Later he also made a list of English blogs.
Scores are based on a number of parameters, like Google PageRank, Technorati ranking, Feedburner hits, 4) number of posts and 5) number of reactions.

The blogpost of all the NL blogs can be seen at http://www.medbloglog.nl/.

*********

Sorry, heb nog 2 uur voor we met vakantie gaan (max. 2 uur slaap), dus even geen vertaling van deze post. En nog wel nu het om een NL-top25 gaat. 🙂