Grand Rounds: Evolving from Link-♥♥ to ♬♫-Links?

9 01 2012

Grand Rounds is “the weekly summary of the best healthcare writing online”. I’ve hosted this medical blog carnival twice and considered it a great honor to do so.

I have submitted a lot of posts to the Grand Rounds. Often I even wrote a special blog post to fit the theme if there was one. Almost all my submissions have been accepted. I really enjoyed the compilations. There was a lot of outstanding creativity and originality in how the links to the blogs were “aggregated” and highlighted.

Usually I only read those posts that seemed the most interesting to me (the summary thus works as a filter). But through the Grand Rounds I read posts that I would never have read and I learned about bloggers I never heard of.

Why am I talking in the past tense? The Grand Round is still there, isn’t it?!

Yes, it is still there (luckily), but the organizers are thinking of a “rejuvenation of  this old dinosaur”. As the previous host, Margaret Polaneczky explained

“… Grand Rounds has dropped a bit off all of our radars. Many, if not most of us have abandoned the old RSS feed to hang out on Twitter, where our online community has grown from a few dozen bloggers to feeds and followers in the hundreds and even thousands.”

One of the measures is that the Grand Rounds editions should be more concise and only include the “best posts”.

I too go for quality, and think one should carefully select contributors (and hosts), but is the 7-year-old dinosaur to be saved by chopping him in pieces? Should we only refer to 10 posts at the max and put the message in a tweet-format like Margaret did in an experiment?
I was glad that Margaret gave a good old fashioned long introduction in the Dinosaur’s style, for that was what I read, NOT the tweets. Sorry tweets are NOT a nice compilation. They are difficult to read.
It also isn’t a solution to tweet the individual links, because a lot of those individual tweets will be missed by most of the potential readers. It is not coherent either. The strength of the Grand Rounds is in the compilation, in the way the host makes the posts digestible. I would say: let the host present the posts in an attractive way and let the reader do the selection and digestion.

Also important: how many of us will write blog posts specially for the Grand Rounds if there is a chance of 2 in 3 that it will be rejected?

It is true that the Grand Rounds is less popular than a few years ago and it is harder to get hosts. But that may partly have to do with advertising. My first Grand Rounds got far more hits than the second one, mainly because we sent a notice to great blogs that linked to us, like Instapundit (853 hits alone) and there was an interview with the host announcing the Grand Rounds at MEDSCAPE. In this way the main intended audience (non-blogging lay people) were also reached. The second time my post was just found by a handful of people checking the edition plus this blog own readers.
(I have to admit that this last Grand Rounds Edition might have been better if it had been more concise, but at least one person (Pranab of Scepticemia) spend  2 hours in reading almost all the posts of the round-up. So it wasn’t for nothing)

If some busy clinicians can be persuaded to host The Grand Rounds using a shorter format, that is fine. And it is good to be more concise and leave out what isn’t of high quality. But why make it a rule to include just 10 or 12? Even more important, don’t change blog posts for tweets. For I don’t think, as Margaret passed on, that the concept of the individual blog has been sometimes “overshadowed by Twitter and Facebook, whose continual unending stream demands our constant attention, lest we miss something important that someone said or re-said…” Even I have given up to constantly follow all streams, and I suppose the same is true for most clinicians, nurses etc. Lets not replace posts by tweets but lets use Twitter and Facebook to promote the Grand Rounds and augment its radius.

The main reason for writing this post is that I disliked the description by Bryan Vartebedian (host of the next round) rather off-putting, perhaps even arrogant:

Grand Rounds is evolving as a more focused, curated publication.  Rather than a 4,000 word chain-o-links, Nick Genes, Val Jones and others felt that a focused collection of recommendations would be more manageable for both readers and hosts.  This is Grand Rounds for quality rather than link love.

Bryan loves the word link-love. Two posts back he wrote:

It isn’t contacts, followers, friends, subscriptions, readers, link love, mentions, or people’s attention.  It’s time.  With time I can have all of these things.  

“Link love” and “chain-o-links” undervalue what blog carnivals are about. Perhaps some bloggers just want to be linked to, but most want to be read, and that is the entire idea behind the blog carnival. I can’t imagine that the blog hosts aim to include as many links as possible. At the most it is love for particular posts not “link love” perse.

Changing the format to tweets (♬♫) will only increase the link/text ratio. Links will become more prominent.

I would rather go for the ♥♥-links*, because I  to blog and I  to read good stuff.

——–

* Note that ♥♥-links is not the same as link-♥

——–

Here is a short Twitter Discussion about the new approach. I fully agree with Ves Dimov viewpoint, especially the last tweet.





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

26 10 2011

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

DATA, INFORMATION & COMMUNICATION

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

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

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

INDIA, WISDOM & IMAGESIMAGING

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

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

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

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

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

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

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

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

THE POWER OF WORDS, MUSIC AND VISUAL ARTS

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

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

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

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

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

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

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

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

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

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

SOCIAL MEDIA & MOBILE APPS

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

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

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

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

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

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

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

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

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

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

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

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

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

DATA, DATABASES, OPEN ACCESS, EBM

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

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

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

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

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

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

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

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

SCREENING & DIAGNOSIS. BALANCING BENEFITS & HARMS. 

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

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

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

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

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

BIOMEDICINE, BRAINS AND THE PROCESSING OF INFORMATION

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

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

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

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

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

MISINFORMATION, WRONG INFORMATION AND LACK OF INFORMATION

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

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

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

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

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

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

INFORMATION YOU NEED


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

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

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

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

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

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

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

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

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

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

Will you remind me next time?

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

Related articles





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

18 10 2011

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

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

This time the theme will be “INFORMATION”.

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

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

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

Please Email your submissions to:

And include:

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

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

Jacqueline aka Laika.

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





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

6 09 2011

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

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

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

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

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

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

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

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

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

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

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

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

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

Six futures.

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

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

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

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





Stories [8] How Not to Reassure (or Treat) a Patient

23 08 2010

The host of the next edition of the Grand Rounds is Fizzziatrist at A Cartoon Guide to Becoming a Doctor. Thus it is no surprise that the theme of this edition is “Humor in Medicine”. The Fizzziatrist:

When I host Grand Rounds, I will post the links in order of how many times each one made me go “ha!” (…) It’s all quite scientific.

Well that’s a tough job. First both as a medical librarian and  a patient, I’m not in the situation to experience a lot of the humorous aspects of a doctors job. Furthermore I’m not the HA-HA-HA LOL-REAL SCREAM type. I’m more of the smile and the grin.

So what to do? I hope you find the following enjoyable. And perhaps many little ha’s do make one big HA.

——————–

How not to reassure (or treat) your patients (own experience)

My GP (the leading character in this story; he resembles a bull in a china shop, sometimes, but other than that, he is o.k.)

  • At one of my first visits he was trying to (manually) find the card of my husband. 
    When he thought he found it, he muttered:
    “that old guy?”
    Apparently he had mistaken my father (I still had my maiden name) for my partner.
    Lucky (both for me and my gp)  he was wrong. But how embarrassing if he
    had been right.

    wikipedia (CC)

  • Once I phoned him for I don’t know what and he said:
    “I’m not seeing  you often”
    “Why, is that bad?”
    “Well, it is exceptional”
    “Exceptional?”
    “Yes, I see women of your age regularly”

    “For what kind of disease, if I may ask”.
    “Well, the flu .. and for pill or IUD-controls”
    [sneering] “Sure, but I’m never seriously ill and I have a gynecologist for the latter”.
  • When I was pregnant of my second child, I phoned him for a prescription for anti-Rh antibodies, which I needed for prenatal testing. Since I hadn’t visited my gynecologist after my first child, and the hospital nurses had assured me that gp’s and midwives normally prescribed, this should not be a problem.
    I began: “I’m a few weeks pregnant and ….”
    He interrupted me, confused: “but that..….. but ….. you were pregnant a few months ago“.
    He was half right. I had had a miscarriage then. (Dang! A heavy blow)
    After a curt explanation, I hung up.
  • Later he phoned me back (with a thin excuse) and I asked him for the anti-Rh antibodies, but he just didn’t get it.
    Ask your  midwife”.
    “But I don’t have a midwife”
    “Everyone has got a midwife, nowadays”
    “No, I got a gynecologist”
    “Then  ask your gynecologist”
    “But  I’m not his patient anymore”
    “Then ask him to be your doctor again”
    “But I need the prescription right now“.

    I tried to convince him in vain. He finally mumbled something like: That is of my beat, I don’t do pregnancies and deliveries anymore.
    [luckily one phone call to the gynecologists’ wife was enough to get the prescription. She passed the message immediately, and said that if I liked him to take care of me again, it was best to make an appointment soon after the test.]
  • My gp had the same attitude another time.  I had signs of a Addison crisis. I tried to explain to him what might be wrong. He asked one or two things, shrugged and then said: “You better make an appointment with your specialists. This disease is beyond my practice.”
    At the time it seemed ok to me, but my endocrinologist said it was irresponsible: “Suppose he wouldn’t immediately refer someone with an acute crisis: that could be fatal. [I was hospitalized in this case, but it was not that urgent] See also “the Doctor and the Patient”
The Doctor, by Sir Luke Fildes (1891)

Image via Wikipedia

My gynecologist/obstetrician [a friend of mine recommended him, because he was kind and puts you at ease. It really is a wonderful doctor, and after all those deliveries he still considered birth a miracle. However, his way of reassuring was not always effective]. 

  • March 31, late afternoon: “It is time to get your baby ( 2,5 weeks post-term), but we better postpone it for two days. It is not such a nice day to celebrate the child’s birthday, don’t you think” (meaning April Fools day)
  • When I had my first check-up he warmed the speculum, trying to break the ice with some humor: “they do warm the cutlery for each course at the Chinese”, don’t they?
    (I found it rather tasteless, but remained silent: he meant it well)
  • When we discussed where I would deliver, he said that that would be in his hospital. I sighed with relief. As any new mother I was nervous about it.
    But he didn’t want me to have false expectations:
    Of course I hope I can personally deliver your baby. However, the chances are real that someone else will be around at that time. But believe me, if the moment is there, you don’t care who stands at the foot of your bed. Even if it is a gorilla..”

My Dentist (the best, most skillful, pleasant dentist there is, but still ….  a dentist)

  • Once, just finished drilling, she said carefully: “Don’t be scared when you look into the mirror….. I just touched your tongue”.

This concludes my experiences.  If you would like to read more serious stuff about “how (not) to reassure”, then you can read this old article The Art Of Reassurance (PDF) or this recent blog post at « HealthSkills WeblogIs reassurance reassuring?

One main advise (from the latter blog):

Never reassure a patient about something they are not already worried about. It would be a mistake, for example, to earnestly reassure patients that they do not have cancer when the thought had never entered their minds!”

Related Articles





Health Care Reform 2010- Obama, USA, Bill, Dutch, Plan, Doctors, Letterman, Pills, $ & other Random Thoughts

30 03 2010

“I do believe the only way we can end all preventable deaths and the suffering of millions is to provide decent health care to all.”
Hilary Benn, 2006
———————

The next Grand Rounds will be hosted by Evan Falchuk at SEE FIRST (Insights into the Uncertain World of Healthcare).  Evan’s theme is Health Care Reform.

How will it affect your life, your medical practice, your experience as a patient, as an insured, an employer, an employee, someone without insurance?  What are your reactions to the politics, and what do you think will happen next?  I’m asking for your candid views on health care reform seen from whatever perspective you bring.  Medicine, politics, business, humor, left, right, center, up, down, you name it.

Health Care Reform has been a theme more than once in this Grand Rounds, i.e. February 10th at the Health Care Blog, and at Obama’s inauguration day (Ten Suggestions For Healthcare Reform) by Val Jones, MD.

The question is which health care reform? Because after all, this is an international Grand Round with bloggers from the US, Europe, Africa, Australia & Asia.
Probably, just as Google.nl (Dutch) already suggests the theme is meant to be about the USA health care bill of Obama, the future plan, and its costs (see Google Fig).

Since I’m from the Netherlands my non-US readers probably need an introduction first:

Recently  the Patient Protection and Affordable Care Act (known as the “Senate bill”) became law on March 23, 2010 and was shortly thereafter amended by the Health Care and Education Reconciliation Act of 2010 and passed by both houses on March 25 without any support from republicans (source: Wikipedia).  Please see Reuters and CNN for an overview of the March 2010 reforms and the year in which they take effect  and the New York Times [1] for the effect per types of household (i.e. Fig. at the right)

The legislation will tighten regulation of insurance companies and is expected to extend medical coverage to more than 30 million uninsured Americans. As explained by Barack Obama in the CNN-video [2] below, it will take 4 years to implement fully may of these reforms, but some desperately needed reforms will take effect right away.  For instance, having a child with a pre-existing medical condition will no longer be the basis for denial of coverage or higher premiums in the old system.

Vodpod videos no longer available.
more about “Health Care:What happens when”, posted with vodpod

As a Dutch citizen, I simply can’t imagine that an insurance would be refused because my girl has asthma and I would to have pay a lot more because I happen to have a chronic disease. I can’t imagine that so many people (from a rich country) are uninsured.

As of January 2006 Our Dutch Health Care has been reformed as well. (Officially) there is no longer a fragmented system with compulsory social insurance for the majority and private health care insurance for people with a higher income. Now there is a standard insurance for all, where the insurers have to accept all patients, with no difference in premium, and no surcharges. Children up to the age of 18 years are insured for free.
Both employer and  government will contribute to the Health Insurance fund, and the insured will pay a nominal premium for their standard insurance directly to the health insurer. People with a low income can apply for a care allowance.
To avoid that health insurers seek to avoid less healthy clients, insurers are entitled to compensation for expensive customers. Although not as ideal as conveyed by the Dutch Government in their commercial-like video [3] (a too central role for the insurers, considerably less covered by the basic health insurance) it still is a pretty good and affordable health care system.

Vodpod videos no longer available.

more about “MinVWS | The new health care system i…“, posted with vodpod [press T for English translation]

It is often difficult to imagine how things work in another country unless you’ve been there or hear it through somebody else.

A Dutch correspondent in the US, Tom-Jan Meeus wrote a eye-opening article in the Dutch NRC newspaper [4] about the US health care.

When Meeus collected his first prescriptions from a US pharmacy, he had to pay six times as much for the same pills (same brand, logo, packing) as in the Netherlands. And he was even more surprised that the prices were negotiable. But he got used to the US health care system: he gets an expensive check-up each 2 months instead of the once yearly (when needed) doctor visit back in Holland. In this way his doctor safeguards himself against health insurance claims. Furthermore, his doctor “has to keep the pot boiling too”.
This man knows many influential people and has valuable inside information, i.e. about the health status (botox, psychoses) of some of the key players in the health care system. In addition, he was one of the doctors who thwarted Clintons Health Reform: his glory years. This friendly conservative doctor wants freedom of choice, for himself and his patients. When Meeus objects that this freedom of choice becomes a little expensive, the doctor argues that top health care costs a little (US doctors know they are “the best in the world”)  and continues: “do you really think the health care becomes any cheaper when Obama subsidizes 30 million people to get insured? Hanky Panky, that is what it is.” But he knows a way to circumvent the rules. He cut the ties with two insurance companies that reimburse too little. “Perhaps, we can’t stop Obama, but we can undermine him. Why should we help people when we don’t make money out of it…”.

Hopefully not all the doctors think this way (I’m sure the blogging doctors that I know, don’t), but lets give a moments thought to two statements: That the US Healthcare is “the best” (as it is) and that the new health care system costs too much.

We first have to find out whether the money was well spend before the health care renewal.

I’ve shown the figures before (see [5] and [6]), but here are some other representations.

1. According to the Organization for Economic Cooperation and Development (OECD), the US spent 15.3 percent of its GDP on health care in 2006 and this number is rising. As you can see this is far more than the other countries spend.

This trend was already visible in the early eighties: the last 10-20 years the US spend far more money on health care than other rich countries..


And although the U.S. Medicare coverage of prescription drugs began in 2006, most patented prescription drugs are more costly in the U.S. than in most other countries. Factors involved are the absence of government price controls (Wikipedia).

Perhaps, surprisingly, the higher health expenditure hasn’t lead o a higher life expectancy. (78 years in the US versus 82 years in Japan in 2007). The differences are huge if one plots health spending per capita against life expectancy at birth.

Just like the international comparison, higher health care expenditures in different parts of America don’t result in a better health care for all this extra spending. Miami spends 3 times as much money per person health care than Salem (Oregon). Many doctors in Miami, for instance, perform a bunch of tests, like ECG’s, after chest complaints, because they have the necessary devices, not because all these tests have proven useful. Despite all expensive tests and treatments, Miami (and comparable great spenders)  has the worst death rate following a heart attack.* [ source, video in ref 5 and the Organisation for Economic Co-operation and Development’s Health Data 2009 site.]

And this is how the US health care works:  simply more treatments and tests are available, but the incentives are wrong: physicians are paid for the quantity of care not the quality.

Just like the doctor of Tom-Jan Meeus, who did a two-monthly unnecessary check-up.

Or as the internist Lisa Bernstein suggests in the New York Times [7]:

For instance, if an asymptomatic, otherwise healthy, patient comes to me wanting a whole-body CT scan to make sure they do not have something bad hiding inside of them, I would decline and educate him or her that there is no data to show that this test has any significant benefit to offset the potential radiation or other harm and the major medical societies do not recommend this test.”

Mind you this is the situation before the current health care reform.

But there is another thing not yet addressed: the expectations of the US-citizens. Americans (and more and more Europeans too) want those check-ups and screenings, because it gives them a (false) feeling of security and because they feel they have the right. That is why it is so difficult for people to give up unnecessary CT-scans, PSA-screening and mammograms.

One reason why Americans have a higher risk for certain diseases (diabetes, overweight, cardiovascular diseases) might be their lifestyle. And lifestyle is something you can change to a certain extent and can have great effects on your health. Lifestyle is also something you can learn. You can learn to enjoy good food, you can avoid the 3 times daily coca cola  and it can be fun to do some exercise or for children to play outside. But still some people rather have a pill to stay healthy or  undergo all kind of (poor performing) tests to see how they’re doing.

Am I exaggerating?

No. This is reality. A few days ago. I saw Letterman in his show [8] telling Jamie Oliver (on his crusade to change the US diet habits) that “he believed diet pills were the only successful way to lose weight in the U.S. and that he expected humans to ‘evolve to the point where 1,000 years from now we all weigh 500-600lbs and it will be OK’ and that “If you would go to doctor they would be happy to give you as many pills as you need and you weight 80 pounds”

Do I fail to see Lettermans warped sense of humor?

Does he really belief this? And, more important, does the majority of Americans believe this?

For here is much to gain, both in health and health care costs.

* As far as I can tell these are only associations; other possible reasons are not taken into consideration: busy live in a metropolis or the population composition might also play a role.

Main References (all accessed 29 March 2010)

  1. NY-Times (2010/03/24) How Different Types of People Will Be Affected by the Health Care Overhaul.
  2. CNN.com (2010/03/23) Health care timeline (including video)
  3. Ministerie van VWS: The new health care system in the Netherlands
  4. NRC (2010/03/20) Tom-Jan Meeus: Mijn dokter won ook van Clinton (Dutch; subscription required).
  5. Laika’s MedLibLog (2009/09/10) Visualization of  paradoxes behind US Health Care.
  6. Laika’s MedLibLog (2009/09/25) Friday Foolery [4]: Maps & Mapping.
  7. NY Times.com (2010/03/27) health/27patient.html?src=twt&twt=nytimeshealth.
  8. The dail Mail UK (Last updated 210-03-25). Simon Cable. Don’t cry Jamie! Now David Letterman lectures Oliver and says his healthy eating crusade won’t work in America

Photo Credits

This map shows the ability of the health service of each territory to provide good basic health care to a number of people. The health service quality score for 1997 was applied to the population. The world average score for health service quality was 72 out of 100. This means that the equivalent of 4.5 billion people had access to good basic health care.The populations with the poorest health care provision live in Sierra Leone and the Central African Republic. The Sierra Leonean health system scored 36 out of 100 – that is half the world average score. Note that only the most basic care is measured here.
“I do believe the only way we can end all preventable deaths and the suffering of millions is to provide decent health care to all.” Hilary Benn, 2006 Territory size shows the proportion of people worldwide who receive good basic health care that live there.




Kaleidoscope 2009 wk 47

19 11 2009

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Kaleidoscope is a new series, with a “kaleidoscope” of facts, findings, views and news gathered over the last 1-2 weeks.

Most items originate from Twitter, my Google Reader (RSS) and sometimes real articles (yeah!).

I read a lot, I bookmark a lot, but only some of those things end op in a post. Since tweets have a half-life of less than a week, I thought it would be nice to safeguard some of the tweets in a post. For me to keep, for you to read.

I don’t have the time and the discipline to post daily about health news and social media as Ves Dimov does. It looks more like the compilation at blogs of dr Shock’s (see example),  dr Bates shout-outs, Health Highlights of Highlight HEALTH and Rachel Walden’s Womens health News Round-ups, but less on one subject and less structured. It will just be a mix of old and new, Social Media and science, just a kaleidoscope. Or a potpourri  if you like.

I don’t know if this kaleidoscope will live a long live. I already wrote 2 3 4 5 6 editions, but didn’t have the time to finish them. Well, we will see, just enjoy this one.

Ooh and the beautiful kaleidoscope is made by RevBean and is called: Eyeballs divide like cells. Looks very much like the eyeball-bubblewrap of a previous post but that is thus coincidence. Here is the link (Flickr, CC)

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Medical Grand Rounds

Louise Norris at Colorado Health Insurance Insider is this week’s host of Grand Rounds.(see here). There are many interesting posts again. As a mother of two teens I especially liked the insight Nancy Brown of Teen Health 411 brings us into what teens want when it comes to their relationships with their parents and the “would you rather…?” story that Amy Tenderich of Diabetes Mine shares with us. The punch line is great. Her 9 year old melts my heart.

At InsureBlog’s Hank Stern brings us an article about a British hospital that will no longer admit expectant mothers with a BMI of more than 34, because the hospital’s labor and delivery unit is not equipped to handle complicated births. Hank concludes: “Fear not, though, portly preggies have to travel but 20 miles to the next closest facility. Assuming, of course, that they can make it that far when contractions are minutes apart.”

Dr Charles of the The Examining Room wrote an in depth article about a cheerleader who was supposedly stricken with dystonia following a seasonal flu vaccine in August. Dr Charles not only highlights why (specialists) think it is not dystonia, but gives also background information about the efficacy of vaccins.

Recent editions of the Grand Rounds were at CREGRL, flight nurse (link), NonClinicalJobs (link) and Codeblog, tales of a nurse (link). You can always find previous and upcoming hosts at the Grand Rounds Archive at Blogborygmi.

3621322354_4bc3bb115e Breast cancer screening

The update of the 2002 USPSTF recommendation statement on screening for breast cancer in the general population, published in the November issue of The Annals of Internal Medicine has led to heated discussions in the mainstream media (i.e. New York Times and MedPage Today). Based on current evidence, partly based on 2 other articles in the same journal (comparison screening schedules and an systematic review) the guidelines advise scaling back of the screening. The USPSTF recommends:

  • against routine screening mammography in women aged 40 to 49 years
  • against routine screening mammography of women 75 years or older.
  • biennial (instead of annual) screening mammography for women between the ages of 50 and 74 years.
  • against teaching breast self-examination (BSE).
  • against either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities.

The two articles published in Ann Intern Med add to the evidence that the propagation of breast cancer self exam doesn’t save lives (see Cochrane review discussed in a previous post) and that the benefits of routine mammography in the young (<50) or old (>75) do not outweigh the harm (also covered by a  Cochrane review before). Indeed, as put forward by Gary Schwitzer at Schwitzer health news blog this is NOT a new debate. He refers to Slate who republishes a five-year old piece of Amanda Schaffer that does a good job of explaining the potential harms of screening. However it is difficult for women (and some doctors) to understand that “When it comes to cancer screening, more isn’t always better.” Indeed -as Kevin Pho at Kevin MD states, the question is whether “patients will accept the new, evidence-based, breast cancer screening guidelines”.

In the Netherlands it is already practice to start biannual routine mammography at the age of 50. The official breast cancer screening site of the RIVM even states that the US is now going to follow the Dutch guidelines 😉 (one of assessed guidelines in one the Ann Intern Med papers is Dutch). But people still find the  long established guidelines difficult to accept: coincidentally I saw tweets today asking to sign a petition to advance the age of screening ‘because breast cancer is more and more frequently observed at young age…(??)’ Young, well educated, women are very willing to sign…

No time to read the full articles, but interested to know more, then listen to the podcast of this Ann Intern Med edition:

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Systematic Reviews, pharma sponsored trials and other publishing news

Cochrane reviews are regarded as scientifically rigorous, yet a review’s time to publication can be affected by factors such as the statistical significance of the findings. A study published in Open Medicine examined the factors associated with the time to publication of Cochrane reviews. A change in authors and updated reviews were predictive factors, but the favorability of the results was not.

Roy Poses of the Health Care Renewal Blog starts this blogpost as follows: “Woe to those of us who have been advocates for evidence-based medicine”. He mainly refers to a study published in the NEJM, that identified selective outcome reporting for trials of off-label use of gabapentin: for 8 of the 12 published trials, there was a disagreement between the definition of the primary outcome in the protocol and that in the published report. This seriously threatens the validity of evidence for the effectiveness of off-label interventions. Roy was surprised that the article didn’t generate much media attention. The reason may be that we have been overwhelmed by manipulation of data, ghostwriting and by the fact that pharma-sponsored trials rarely produce results that are unfavorable to the companies’ product (see previous posts about Ghostwriting (Merck/Elsevier, Conflict of Interest in Cancer Studies and David Tovey about Cochrane Reviews). At least two authors of the NEJM review (Bero and Dickersin) have repeatedly this to be the case [e.g. see here for an overview, and papers of Lisa Bero]. It is some relief that at least 3 of the 4 NEJM authors are also members of the Cochrane Collaboration. Indirectly better control of reporting, i.e. by clinical trials registries, can improve the reliability of pharma sponsored trials and thus systematic reviews summarizing them. As a matter of fact Cochrane authors always have to check these registries.

At Highlight Health Walter Jessen writes about Medical Journal Conflict of Interest Disclosure and Other Issues, which also discusses how money can taint objectivity in scientific publishing. Half of the post discusses the book The Trouble with Medical Journals, written in 2007 by Richard Smith, the former editor of the BMJ.
By the way, Walter just hosted MedLibs Round with the theme “Finding Credible Health Information Online”.

Good news in the Netherlands: right after international Open Access week and the launching of the Dutch Open Access website (www.openaccess.nl), the Netherlands Organization for Scientific Research (NWO) has announced that it is in favor of Open Access. (via PLOS-facebook).

The open access nature of PLOS itself gets out of hand: they even peer-review T-shirts (according to Bora Zivkovic of a Blog around the Clock, see here)

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Other Health & Science News:

Medline Plus summarizes an article in the Journal of Nutrition, that states that Selenium supplements, may pose a heart risk.

Even Folic Acid and vitamin B12, when taken in large doses, have been reported to Increase Cancer Risk (WebMD)

Luckily WebMD also reports that dark chocolate seems to help against stress, that is it reduced stress hormones in the blood. However @evidencematters and @NHSChoices cast doubt on that“Chocolate cuts stress, says newspaper. Does the study really say that? And who paid for the study?…”

Scientists made the unexpected discovery (published in Molecular Cell) that BRAF, which is linked to around 70 per cent of melanomas and seven per cent of all cancers, is in fact controlled by a gene from the same RAF family called CRAF – which has also been linked to the disease. For the first time it is shown “how two genes from the same ‘family’ can interact with each other to stop cancer in its tracks” (Source: Info Cancer Research UK)

For the first time, scientists have successfully used exome sequencing to quickly discover a previously unknown gene responsible for Miller syndrome, a rare disorder. The finding demonstrates the usefulness of exome sequencing in studying rare genetic disorders. The exome is enriched for coding (thus functional) DNA, it is only 1% of the total DNA, but contains 85% of the mutations (Published in , source: PhysOrg.com)

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Web 2.0
For information regarding the FDA hearings on internet and social media see #FDASM: http://www.fdasm.com.

Read Write Web summarizes the new numbers released by analytics firm Postrank that indicate that reader engagement with blogs has changed dramatically over the last three years, primarily because of the rise of online social networks.

Twitter has began to relaunch the new retweet feature, although not without controversy. What do you think about the newest feature?

The Next Web gives an overview of which Twitter application is hot and which is not.

And Finally: Top 100 tools for learning, compiled by Jane Hart from the contributions of 278 learning professionals worldwide. You can see the lists here (HT: http://blogs.netedu.info/?p=1005)

The web 2.0 part is relatively short, but it is time to conclude this edition. Till next time!

  • MEDLIB’s ROUND 1.6 (laikaspoetnik.wordpress.com)
  • Tool Talk: quick links re Facebook, GReader and GWave (socialfish.org)
  • Reblog this post [with Zemanta]




    Grand Rounds Vol. 6 No. 2

    29 09 2009

    grandroundsblank

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

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

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

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

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

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

    We don’t search for this…

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

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

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

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

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

    Background  questions.

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

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

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

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

    Foreground  questions: Domain Therapy2463850234_6a9851b622

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Domain Diagnosis

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

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

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

    Domain: Etiology/Harm

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

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

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

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

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

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

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

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

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

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

    741879088_29d01c359b_m-another-dead-librarian

    Acknowledgements

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

    Bonus

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Image Credits (CC-licence)

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

    You might also like:

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




    The Grand Rounds is coming! Please start submitting!

    22 09 2009

    I have the honor to host my first GRAND ROUNDS ever on Tuesday September 29th.

    For those who don’t know what the Grand Round is about,  it is the weekly rotating carnival of the best of the medical blogosphere. Today the round is up at Colin Son’s blog Residency Notes, so please take a look at this birthday edition (start of the 6th year of Grand Rounds).

    As apparent from the “Around the World in Eighty Days” Grand Round theme at “Suture for a Living”, most Grand Round  contributors come from the North American Continent. It is quite exceptional that the Grand Round comes to the Netherlands and I’m looking forward to welcome you all.
    Yeah, there will be no theme!
    *

    Please make it easy for this non-native speaker of English and submit your post as soon as possible, but not later than midnight EST (NY) at Sunday September 27th (Monday 6.00 am in the Netherlands and 4.00 UTC (GMT)). Please send your submissions to    laika.spoetnik@gmail.com as follows:

    • “Grand Rounds” in the subject line.
    • Permalink (url) webpost
    • Title post
    • Your name
    • a short description would be of help.
    • and if time permits:
      • tell me where you’re from (town, country and/or institute).
      • spend one line telling me your thoughts on medical information and medical librarians (this may be specially featured.)

    So I hope I shall welcome you all next week. For all those people who have no idea where The Netherlands are, here is an old world map produced by Gerard van Schagen in 1689 in Amsterdam. As you can see, Europe took a more prominent place in the world those days (only the half of North America is represented).

    3185534518_d9d53b1f09 worldImage licenced under Creative Commons
    http://www.flickr.com/photos/caveman_92223/
    / CC BY-ND 2.0

    * I can’t promise to include all submissions though. This will depend on the quality and on whether I can fit it in.





    Grand Round 5.42

    7 07 2009

    This week the Grand Round, the weekly summary of the best of the medical blogosphere, is being hosted by Flavio Guzmán at Pharmamotion, a blog about basic and clinical pharmacology.

    7-7-2009 20-45-50 sneeuw krtistalThe Round is entitled:  “Brief Grand Rounds from Argentina“. Flavio had to keep it short, because (who would think of that? – I didn’t) winter has arrived in Argentina, and Flavio was hired to cover nights shifts in a local hospital because of the current H1N1 pandemic. Despite this,  Flavio did include my post, which was submitted this very morning (thus far too late). Thank you for that, Flavio.

    Compact Rounds aren’t necessarily bad. I would say, on the contrary. Also in this case, Flavio succeeded in compiling a great and easy-to-browse round. Please go and enjoy reading the Grand Round here

    Next week the Round will be hosted by @DrJosephKim (twitter) on Medicine And Technology. The theme is to “focus on ways that technology is changing healthcare”.





    Grand Round 5.41 up at Edwin Leap

    30 06 2009

    This weeks Grand Round, the weekly rotating carnival featuring the best medical blog posts, is up at the blog of Edwin Leap, a practicing emergency physician. As announced in the previous post, the theme is ‘What would you like to say to future physicians?’ This theme was chosen, because today, June 30th, is the day before the start of the ‘residency’.

    Alas, my post (about PubMed tips) didn’t make it to the carnival because it was submitted after the Grand Round was published. 😉
    But you can always read my  tips here.

    Far more interesting are the tips given in Edwin Leap’s compilation. Most of the advice is not merely useful for residents.

    For instance Clinical Cases and Images blog reminds us to write for ourselves, not for anyone else’s benefit (even Twitter and Facebook ‘use’ those who write for them, in a sense.) We should share our unique perspectives by independent blogging.

    Isn’t that true for every blogger?

    Please read other tips here

    Next round will be hosted by Pharmamotion





    Grand Rounds 5.36 at See First

    27 05 2009

    See FirstThis week’s edition of Grand Rounds is up at See First.

    You can see the posts here.

    Evan Falchuck (@efalchuk on Twitter) thinks nothing of it. [1] no theme, {2] accept any (appropriate) post and [3] allow people to submit a few hrs before publishing the Round!!!
    I bet he got my post last. Great job.

    Next week’s “June Is Busting Out All Over” edition will be at HealthBlawg of David Harlow.You can already see the announcement here. No theme again. Hurray!





    Grand Rounds 5.35 at Healthcare Technology News

    19 05 2009

    healthcare technology News GRAND ROUND may 19Grand Rounds is up at Healthcare Technology News. This edition of Grand Rounds, the Best of the Medical Blogosphere, focuses on Health Care Reform.

    The Grand Round begins with a stunning quote of type 1 diabetic blogger Kerri Sparling that really hits the mark with her post at Six Until Me:

    “Why, Insurance Company, are you so against proactive care? Why do I need to pay more for a brace or a shot or an extra visit when you’re more content paying for a several thousand dollar surgery instead? Not enough bang for your buck? Why do you fight me tooth and nail against coverage for a continuous glucose monitoring device?* Is my life not worth the investment to keep my legs on instead of paying 100% to amputate them in a few decades? I know I’m expensive as a chronic disease patient, but I’m healthier than 85% of the people I know. I eat well, I exercise regularly, and I am on top of my disease. Yet you deny me life insurance, you won’t let me purchase a private health insurance policy, and you would rather see me on an operating table than taking up a doctor’s time in an office visit. (And it’s not like I’m taking up more than 5 – 7 minutes of a doctor’s time, because that’s about all we get, on average. Pathetic.)”

    After a few more examples of the Patient and Consumer Perspective on why we do need reform, this edition continues with:

    • Providers, Prevention and Self-Management
    • Meaningful Use and Enabling Technology
    • Dollars and Sense
    • What’s Working Elsewhere?

    Please read the whole edition here

    Next Grand Round will be hosted by See First, Insights into the uncertain world of Healthcare.

    ————————-

    * I saw the same problem mentioned on a Dutch Blog “Diabetesblog“, where the story was told of a patient who has hypo-unawareness: she can’t feel when her blood glucose is low. Therefore she suffers many complications of diabetes, i.e she has poor sight and has recently fainted in front of the children. The only thing which she feels would work is the (FDA approved) continuous glucose monitoring device (CGMS). The problem is that the her insurer won’t cover CGMS, as it’s efficacy has yet to be proved.

    Coincidentally I’m gathering the evidence on “the effectiveness of the CGMS in the management of type I diabetes” for a Cochrane Protocol (not approved yet). However, it will take some time for the authors to finish the review after the protocol has been approved.

    See the full Story on Diabetesblog (in Dutch) here

    Some excerpts:

    Sinds een jaar of vijf draagt ze daarom een insulinepomp die continue een klein beetje insuline afgeeft. ‘Maar dat zegt natuurlijk niks over mijn bloedsuikergehalte op dat moment’, zegt Judith. Meer baat zou de Losserse volgens haar internist hebben bij een continue glucosemeter met implanteerbare sensor, een apparaat dat is overgewaaid uit de Verenigde Staten. De sensor meet 24 uur per dag de bloedsuikerspiegel en geeft een waarschuwingssignaal als de waarde te laag dreigt te worden.

    Het probleem is echter dat de zorgverzekeraar van Judith, Menzis, het apparaat – kosten: 40 à 50 euro per stuk; één exemplaar gaat maximaal drie dagen mee – niet wil vergoeden, ook niet nadat de internist van Judith daarop heeft aangedrongen. Te duur, oordeelt Menzis. En bovendien, zo motiveert een woordvoerder het standpunt van de zorgverzekeraar, ‘heeft het College voor zorgverzekeringen (CVZ) onlangs besloten de sensor niet te vergoeden’.

    Ook een tweede verzoek dat de arts onlangs indiende heeft niets opgeleverd. Volgens de woordvoerder van Menzis is de zorgverzekeraar zelfs strafbaar als het apparaatje vergoed zou worden, omdat het onvoldoende getest zou zijn. Onzin, zegt Getkate. ‘Niet voor niets heeft de Diabetesvereniging Nederland een positief advies gegeven. Er zijn bovendien andere zorgverzekeraars die het al wèl vergoeden.’

    En dus ligt de Losserse in de clinch met haar zorgverzekeraar. Wat haar nog het meeste steekt is ‘dat Menzis eigenlijk op de stoel van de arts gaat zitten’…..