Friday Foolery #48 Brilliant Library Notices

13 01 2012

Today’s Friday Foolery post is handed on a silver platter by my Australian friend Mike Cadogan @sandnsurf from Life in the Fast Lane

Yes, aren’t these brilliant librarian notices from the Milwaukee Public Library?!

Note:

@Bitethedust, also from Australian rightly noticed: there’s no better place to stick @sandnsurf than in Friday foolery

Indeed at Life at the Fast Lane they have fun posts amidst the serious (mostly ER) topics. Want more Friday Fun than have a look at the Funtabulously Frivolous Friday Five Posts.





National Library Week

12 04 2011

It is National Library Week! Did you know that?

To be honest I didn’t.

Today, Tuesday, is even National Library Workers Day — a time to thank librarians and the rest of the library staff (LA-Times).

I didn’t know that either, until I received a tweet from @doc_emer which was retweeted by doctor_V (see Fig).

Now I know.

Thank you Dr. Emer and Bryan Vartabedian (Doctor V). You made my day!

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

Added:

 

@amcunningham (AnneMarie Cunningham) tweeted:
Since it’s national library week, thought I’d say thanks to all the great librarians on this list:) http://bit.ly/gkzKZm

 

 





Internet Sources & Blog Posts in a Reference List? Yes or No?

13 02 2011

A Dutch librarian asked me to join a blog carnival of Dutch Librarians. This carnival differs from medical blog carnivals (like the Grand Rounds and “Medical Information Matters“) in its approach. There is one specific topic which is discussed at individual blogs and summarized by the host in his carnival post.

The current topic is “Can you use an internet source”?

The motive of the archivist Christian van der Ven for starting this discussion was the response to a post at his blog De Digitale Archivaris. In this post he wondered whether blog posts could be used by students writing a paper. It struck him that students rarely use internet sources and that most teachers didn’t encourage or allow to use these.

Since I work as a medical information specialist I will adapt the question as follows:

“Can you refer to an internet source in a biomedical scientific article, paper, thesis or survey”?

I explicitly use “refer to” instead of “use”. Because I would prefer to avoid discussing “plagiarism” and “copyright”. Obviously I would object to any form of uncritical copying of a large piece of text without checking it’s reliability and copyright-issues (see below).

”]

Previously, I have blogged about the trouble with Wikipedia as a source for information. In short, as Wikipedians say, Wikipedia is the best source to start with in your research, but should never be the last one (quote from @berci in a twitterinterview). In reality, most students and doctors do consult Wikipedia and dr. Google (see here and here). However, they may not (and mostly should not) use it as such in their writings. As I have indicated in the earlier post it is not (yet) a trustworthy source for scientific purposes.

But Internet is more than Wikipedia and random Googling. As a matter of fact most biomedical information is now in digital form. The speed at which biomedical knowledge is advancing is tremendous. Books are soon out of date. Thus most library users confine themselves to articles in peer-reviewed scientific papers or to datasets (geneticists). Generally my patrons search the largest freely available database PubMed to access citations in mostly peer-reviewed -and digital- journals. These are generally considered as (reliable)  internet sources. But they do not essentially differ from printed equivalents.

However there are other internet sources that provide reliable or useful information. What about publications by the National Health Council, an evidence based guideline by NICE and/or published evidence tables? What about synopses (critical appraisals) such as published by DARE, like this one? What about evidence summaries by Clinical Evidence like, this one? All excellent, evidence based, commendable online resources. Without doubt these can be used as a reference in a paper. Thus there is no clearcut answer to the abovementioned question. Whether an internet source should be used as a reference in a paper is dependent on the following:

  1. Is the source relevant?
  2. Is the source reliable?
  3. What is the purpose of the paper and the topic?

Furthermore it depends on the function of the reference (not mutually exclusive):

  1. To give credit
  2. To add credibility
  3. For transparency and reproducibility
  4. To help readers find further information
  5. For illustration (as an example)

Lets illustrate this with a few examples.

  • Students who write an overview on a medical topic can use any relevant reference, including narrative reviews, UpToDate and other internet sites if appropriate .
  • Interns who have to prepare a CAT (critically appraised topic) should refer to 2-3 papers, providing the highest evidence (i.e. a systematic review and/or randomized controlled trial).
  • Authors writing systematic reviews only include high quality primary studies (except for the introduction perhaps). In addition they should (ideally) check congress abstracts, clinical trial registers (like clinicaltrials.gov), or actual raw data (i.e. produced by a pharmaceutical company).
  • Authors of narrative reviews may include all kinds of sources. That is also true for editorials, primary studies or theses. Reference lists should be as accurate and complete as possible (within the limits posed by for instance the journal).

Blog, wikis, podcasts and tweets.
Papers can also refer to blog posts, wikis or even tweets (there is APA guidance how to cite these). Such sources can merely be referred to because they serve as an example (articles about social media in Medicine for instance, like this recent paper in Am Pharm Assoc that analyzes pharmacy-centric blogs.

Blog posts are usually seen as lacking in factual reliability. However, there are many blogs, run by scientists, that are (or can be) a trustworthy source. As a matter of fact it would be inappropriate not to cite these sources, if  the information was valuable, useful and actually used in the paper.
Some examples of excellent biomedical web 2.0 sources.

  • The Clinical Cases and Images Blog of Ves Dimov, MD (drVes at Twitter), a rich source of clinical cases. My colleague once found the only valuable information (a rare patient case) at Dr Ves’ blog, not in PubMed or other regular sources. Why not cite this blog post, if this patient case was to be published?
  • Researchblogging.org is an aggregator of expert blogposts about peer-reviewed research. There are many other high quality scientific blogging platforms like Scientopia, the PLOSblogs etc. These kind of blogs critically analyse peer reviewed papers. For instance this blog post by Marya Zilberberg reveals how a RCT stopped early due to efficacy can still be severely flawed, but lead to a level one recommendation. Very useful information that you cannot find in the actual published study nor in the evidence based guideline
  • An example of an excellent and up-to-date wiki is the open HLWIKI (maintained by Dean Giustini, @giustini at Twitter) with entries about health librarianship, social media and current information technology topics, having over 565+ pages of content since 2006! It has a very rich content with extensive reference lists and could thus be easily used in papers on library topics.
  • Another concept is usefulchem.wikispaces.com (an initiative of Jean Claude Bradley, discussed in a previous post. This is not only a wiki but also an open notebook, where actual primary scientific data can be found. Very impressive.
  • There is also WikiProteins (part of a conceptwiki), an open, collaborative wiki  focusing on proteins and their role in biology and medicine.

I would like to end my post with two thoughts.

First the world is not static. In the future scientific claims could be represented as formal RDF statements/triplets  instead of or next to the journal publications as we know them (see post on nanopublications). Such “statements” (already realized with regard to proteins and genes) are more easily linked and retrieved. In effect, peer review doesn’t prevent fraud, misrepresentation or overstatements.

Another side of the coin in this “blogs as an internet source”-dicussion is whether the citation is always appropriate and/or accurate?

Today a web page (cardio.nl/ACS/StudiesRichtlijnenProtocollen.html), evidently meant for education of residents, linked to one of my posts. Almost the entire post was copied including a figure, but the only link used was one of my tags EBM (hidden in the text).  Even worse, blog posts are sometimes mentioned to give credit to disputable context. I’ve mentioned the tactics of Organized Wisdom before. More recently a site called deathbyvaccination.com links out of context to one of my blog post. Given the recent revelation of fraudulent anti-vaccine papers, I’m not very happy with that kind of “attribution”.

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Medical Information Matters: Call for Submissions

6 11 2010

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

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

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

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

So if that isn’t easy….

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

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

 

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





How will we ever keep up with 75 Trials and 11 Systematic Reviews a Day?

6 10 2010

ResearchBlogging.orgAn interesting paper was published in PLOS Medicine [1]. As an information specialist and working part time for the Cochrane Collaboration* (see below), this topic is close to my heart.

The paper, published in PLOS Medicine is written by Hilda Bastian and two of my favorite EBM devotees ànd critics, Paul Glasziou and Iain Chalmers.

Their article gives an good overview of the rise in number of trials, systematic reviews (SR’s) of interventions and of medical papers in general. The paper (under the head: Policy Forum) raises some important issues, but the message is not as sharp and clear as usual.

Take the title for instance.

Seventy-Five Trials and Eleven Systematic Reviews a Day:
How Will We Ever Keep Up?

What do you consider its most important message?

  1. That doctors suffer from an information overload that is only going to get worse, as I did and probably also in part @kevinclauson who tweeted about it to medical librarians
  2. that the solution to this information overload consists of Cochrane systematic reviews (because they aggregate the evidence from individual trials) as @doctorblogs twittered
  3. that it is just about “too many systematic reviews (SR’s) ?”, the title of the PLOS-press release (so the other way around),
  4. That it is about too much of everything and the not always good quality SR’s: @kevinclauson and @pfanderson discussed that they both use the same ” #Cochrane Disaster” (see Kevin’s Blog) in their  teaching.
  5. that Archie Cochrane’s* dream is unachievable and ought perhaps be replaced by something less Utopian (comment by Richard Smith, former editor of the BMJ: 1, 3, 4, 5 together plus a new aspect: SR’s should not only  include randomized controlled trials (RCT’s)

The paper reads easily, but matters of importance are often only touched upon.  Even after reading it twice, I wondered: a lot is being said, but what is really their main point and what are their answers/suggestions?

But lets look at their arguments and pieces of evidence. (Black is from their paper, blue my remarks)

The landscape

I often start my presentations “searching for evidence” by showing the Figure to the right, which is from an older PLOS-article. It illustrates the information overload. Sometimes I also show another slide, with (5-10 year older data), saying that there are 55 trials a day, 1400 new records added per day to MEDLINE and 5000 biomedical articles a day. I also add that specialists have to read 17-22 articles a day to keep up to date with the literature. GP’s even have to read more, because they are generalists. So those 75 trials and the subsequent information overload is not really a shock to me.

Indeed the authors start with saying that “Keeping up with information in health care has never been easy.” The authors give an interesting overview of the driving forces for the increase in trials and the initiation of SR’s and critical appraisals to synthesize the evidence from all individual trials to overcome the information overload (SR’s and other forms of aggregate evidence decrease the number needed to read).

In box 1 they give an overview of the earliest systematic reviews. These SR’s often had a great impact on medical practice (see for instance an earlier discussion on the role of the Crash trial and of the first Cochrane review).
They also touch upon the institution of the Cochrane Collaboration.  The Cochrane collaboration is named after Archie Cochrane who “reproached the medical profession for not having managed to organise a “critical summary, by speciality or subspecialty, adapted periodically, of all relevant randomised controlled trials” He inspired the establishment of the international Oxford Database of Perinatal Trials and he encouraged the use of systematic reviews of randomized controlled trials (RCT’s).

A timeline with some of the key events are shown in Figure 1.

Where are we now?

The second paragraph shows many, interesting, graphs (figs 2-4).

Annoyingly, PLOS only allows one sentence-legends. The details are in the (WORD) supplement without proper referral to the actual figure numbers. Grrrr..!  This is completely unnecessary in reviews/editorials/policy forums. And -as said- annoying, because you have to read a Word file to understand where the data actually come from.

Bastian et al. have used MEDLINE’s publication types (i.e. case reports [pt], reviews[pt], Controlled Clinical Trial[pt] ) and search filters (the Montori SR filter and the Haynes narrow therapy filter, which is built-in in PubMed’s Clinical Queries) to estimate the yearly rise in number of study types. The total number of Clinical trials in CENTRAL (the largest database of controlled clinical trials, abbreviated as CCTRS in the article) and the Cochrane Database of Systematic Reviews (CDSR) are easy to retrieve, because the numbers are published quaterly (now monthly) by the Cochrane Library. Per definition, CDSR only contains SR’s and CENTRAL (as I prefer to call it) contains almost invariably controlled clinical trials.

In short, these are the conclusions from their three figures:

  • Fig 2: The number of published trials has raised sharply from 1950 till 2010
  • Fig 3: The number of systematic reviews and meta-analysis has raised tremendously as well
  • Fig 4: But systematic reviews and clinical trials are still far outnumbered by narrative reviews and case reports.

O.k. that’s clear & they raise a good point : an “astonishing growth has occurred in the number of reports of clinical trials since the middle of the 20th century, and in reports of systematic reviews since the 1980s—and a plateau in growth has not yet been reached.
Plus indirectly: the increase in systematic reviews  didn’t lead to a lower the number of trials and narrative reviews. Thus the information overload is still increasing.
But instead of discussing these findings they go into an endless discussion on the actual data and the fact that we “still do not know exactly how many trials have been done”, to end the discussion by saying that “Even though these figures must be seen as more illustrative than precise…” And than you think. So what? Furthermore, I don’t really get their point of this part of their article.

 

Fig. 2: The number of published trials, 1950 to 2007.

 

 

With regard to Figure 2 they say for instance:

The differences between the numbers of trial records in MEDLINE and CCTR (CENTRAL) (see Figure 2) have multiple causes. Both CCTR and MEDLINE often contain more than one record from a single study, and there are lags in adding new records to both databases. The NLM filters are probably not as efficient at excluding non-trials as are the methods used to compile CCTR. Furthermore, MEDLINE has more language restrictions than CCTR. In brief, there is still no single repository reliably showing the true number of randomised trials. Similar difficulties apply to trying to estimate the number of systematic reviews and health technology assessments (HTAs).

Sorry, although some of these points may be true, Bastian et al. don’t go into the main reason for the difference between both graphs, that is the higher number of trial records in CCTR (CENTRAL) than in MEDLINE: the difference can be simply explained by the fact that CENTRAL contains records from MEDLINE as well as from many other electronic databases and from hand-searched materials (see this post).
With respect to other details:. I don’t know which NLM filter they refer to, but if they mean the narrow therapy filter: this filter is specifically meant to find randomized controlled trials, and is far more specific and less sensitive than the Cochrane methodological filters for retrieving controlled clinical trials. In addition, MEDLINE does not have more language restrictions per se: it just contains a (extensive) selection of  journals. (Plus people more easily use language limits in MEDLINE, but that is besides the point).

Elsewhere the authors say:

In Figures 2 and 3 we use a variety of data sources to estimate the numbers of trials and systematic reviews published from 1950 to the end of 2007 (see Text S1). The number of trials continues to rise: although the data from CCTR suggest some fluctuation in trial numbers in recent years, this may be misleading because the Cochrane Collaboration virtually halted additions to CCTR as it undertook a review and internal restructuring that lasted a couple of years.

As I recall it , the situation is like this: till 2005 the Cochrane Collaboration did the so called “retag project” , in which they searched for controlled clinical trials in MEDLINE and EMBASE (with a very broad methodological filter). All controlled trials articles were loaded in CENTRAL, and the NLM retagged the controlled clinical trials that weren’t tagged with the appropriate publication type in MEDLINE. The Cochrane stopped the laborious retag project in 2005, but still continues the (now) monthly electronic search updates performed by the various Cochrane groups (for their topics only). They still continue handsearching. So they didn’t (virtually?!) halted additions to CENTRAL, although it seems likely that stopping the retagging project caused the plateau. Again the author’s main points are dwarfed by not very accurate details.

Some interesting points in this paragraph:

  • We still do not know exactly how many trials have been done.
  • For a variety of reasons, a large proportion of trials have remained unpublished (negative publication bias!) (note: Cochrane Reviews try to lower this kind of bias by applying no language limits and including unpublished data, i.e. conference proceedings, too)
  • Many trials have been published in journals without being electronically indexed as trials, which makes them difficult to find. (note: this has been tremendously improved since the Consort-statement, which is an evidence-based, minimum set of recommendations for reporting RCTs, and by the Cochrane retag-project, discussed above)
  • Astonishing growth has occurred in the number of reports of clinical trials since the middle of the 20th century, and in reports of systematic reviews since the 1980s—and a plateau in growth has not yet been reached.
  • Trials are now registered in prospective trial registers at inception, theoretically enabling an overview of all published and unpublished trials (note: this will also facilitate to find out reasons for not publishing data, or alteration of primary outcomes)
  • Once the International Committee of Medical Journal Editors announced that their journals would no longer publish trials that had not been prospectively registered, far more ongoing trials were being registered per week (200 instead of 30). In 2007, the US Congress made detailed prospective trial registration legally mandatory.

The authors do not discuss that better reporting of trials and the retag project might have facilitated the indexing and retrieval of trials.

How Close Are We to Archie Cochrane’s Goal?

According to the authors there are various reasons why Archie Cochrane’s goal will not be achieved without some serious changes in course:

  • The increase in systematic reviews didn’t displace other less reliable forms of information (Figs 3 and 4)
  • Only a minority of trials have been assessed in systematic review
  • The workload involved in producing reviews is increasing
  • The bulk of systematic reviews are now many years out of date.

Where to Now?

In this paragraph the authors discuss what should be changed:

  • Prioritize trials
  • Wider adoption of the concept that trials will not be supported unless a SR has shown the trial to be necessary.
  • Prioritizing SR’s: reviews should address questions that are relevant to patients, clinicians and policymakers.
  • Chose between elaborate reviews that answer a part of the relevant questions or “leaner” reviews of most of what we want to know. Apparently the authors have already chosen for the latter: they prefer:
    • shorter and less elaborate reviews
    • faster production ànd update of SR’s
    • no unnecessary inclusion of other study types other than randomized trials. (unless it is about less common adverse effects)
  • More international collaboration and thereby a better use  of resources for SR’s and HTAs. As an example of a good initiative they mention “KEEP Up,” which will aim to harmonise updating standards and aggregate updating results, initiated and coordinated by the German Institute for Quality and Efficiency in Health Care (IQWiG) and involving key systematic reviewing and guidelines organisations such as the Cochrane Collaboration, Duodecim, the Scottish Intercollegiate Guidelines Network (SIGN), and the National Institute for Health and Clinical Excellence (NICE).

Summary and comments

The main aim of this paper is to discuss  to which extent the medical profession has managed to make “critical summaries, by speciality or subspeciality, adapted periodically, of all relevant randomized controlled trials”, as proposed 30 years ago by Archie Cochrane.

Emphasis of the paper is mostly on the number of trials and systematic reviews, not on qualitative aspects. Furthermore there is too much emphasis on the methods determining the number of trials and reviews.

The main conclusion of the authors is that an astonishing growth has occurred in the number of reports of clinical trials as well as in the number of SR’s, but that these systematic pieces of evidence shrink into insignificance compared to the a-systematic narrative reviews or case reports published. That is an important, but not an unexpected conclusion.

Bastian et al don’t address whether systematic reviews have made the growing number of trials easier to access or digest. Neither do they go into developments that have facilitated the retrieval of clinical trials and aggregate evidence from databases like PubMed: the Cochrane retag-project, the Consort-statement, the existence of publication types and search filters (they use themselves to filter out trials and systematic reviews). They also skip other sources than systematic reviews, that make it easier to find the evidence: Databases with Evidence Based Guidelines, the TRIP database, Clinical Evidence.
As Clay Shirky said: “It’s Not Information Overload. It’s Filter Failure.”

It is also good to note that case reports and narrative reviews serve other aims. For medical practitioners rare case reports can be very useful for their clinical practice and good narrative reviews can be valuable for getting an overview in the field or for keeping up-to-date. You just have to know when to look for what.

Bastian et al have several suggestions for improvement, but these suggestions are not always underpinned. For instance, they propose access to all systematic reviews and trials. Perfect. But how can this be attained? We could stimulate authors to publish their trials in open access papers. For Cochrane reviews this would be desirable but difficult, as we cannot demand from authors who work for months for free to write a SR to pay the publications themselves. The Cochrane Collab is an international organization that does not receive subsidies for this. So how could this be achieved?

In my opinion, we can expect the most important benefits from prioritizing of trials ànd SR’s, faster production ànd update of SR’s, more international collaboration and less duplication. It is a pity the authors do not mention other projects than “Keep up”.  As discussed in previous posts, the Cochrane Collaboration also recognizes the many issues raised in this paper, and aims to speed up the updates and to produce evidence on priority topics (see here and here). Evidence aid is an example of a successful effort.  But this is only the Cochrane Collaboration. There are many more non-Cochrane systematic reviews produced.

And then we arrive at the next issue: Not all systematic reviews are created equal. There are a lot of so called “systematic reviews”, that aren’t the conscientious, explicit and judicious created synthesis of evidence as they ought to be.

Therefore, I do not think that the proposal that each single trial should be preceded by a systematic review, is a very good idea.
In the Netherlands writing a SR is already required for NWO grants. In practice, people just approach me, as a searcher, the days before Christmas, with the idea to submit the grant proposal (including the SR) early in January. This evidently is a fast procedure, but doesn’t result in a high standard SR, upon which others can rely.

Another point is that this simple and fast production of SR’s will only lead to a larger increase in number of SR’s, an effect that the authors wanted to prevent.

Of course it is necessary to get a (reliable) picture of what has already be done and to prevent unnecessary duplication of trials and systematic reviews. It would the best solution if we would have a triplet (nano-publications)-like repository of trials and systematic reviews done.

Ideally, researchers and doctors should first check such a database for existing systematic reviews. Only if no recent SR is present they could continue writing a SR themselves. Perhaps it sometimes suffices to search for trials and write a short synthesis.

There is another point I do not agree with. I do not think that SR’s of interventions should only include RCT’s . We should include those study types that are relevant. If RCT’s furnish a clear proof, than RCT’s are all we need. But sometimes – or in some topics/specialties- RCT’s are not available. Inclusion of other study designs and rating them with GRADE (proposed by Guyatt) gives a better overall picture. (also see the post: #notsofunny: ridiculing RCT’s and EBM.

The authors strive for simplicity. However, the real world isn’t that simple. In this paper they have limited themselves to evidence of the effects of health care interventions. Finding and assessing prognostic, etiological and diagnostic studies is methodologically even more difficult. Still many clinicians have these kinds of questions. Therefore systematic reviews of other study designs (diagnostic accuracy or observational studies) are also of great importance.

In conclusion, whereas I do not agree with all points raised, this paper touches upon a lot of important issues and achieves what can be expected from a discussion paper:  a thorough shake-up and a lot of discussion.

References

  1. Bastian, H., Glasziou, P., & Chalmers, I. (2010). Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up? PLoS Medicine, 7 (9) DOI: 10.1371/journal.pmed.1000326

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May I Introduce to you: a New Name for the MedLibs Round….

30 09 2010

A couple of weeks or even months ago I asked you to vote for a new name for the MedLibs Round, a blog carnival about medical information.

The decision was clear.

Hurray!

And the winner is……

Drumroll….

Medical Information Matters!

…………………

I’m very pleased with the results because the name reflects that the blog carnival is about medical information and is not purely a carnival for medical librarians.

I hope that Robin of Survive the Journey is still willing and able to make the logo for Medical Information Matters.

Well it will not be long for Medical Information Matters will be “inaugurated”.
We won’t restart the counting. So it will be Medical Information Matters 2.8

There are only a few days left from submitting.
Daniel Hooker at Danielhooker.com: Health libraries, Medicine and the Web is eagerly awaiting your submissions.

You can submit the URL of your post HERE at the Blog Carnival.

Daniel at his call for submissions post:

I’d love to see posts on new things you’re trying out this year: new projects, teaching sessions, innovative services. Maybe it’s something tried and true that you’d like to reflect on. And this goes for anyone starting out fresh this term, not just librarians! We should all be brimming with enthusiasm; the doldrums of winter have yet to set in. If you can find the time to reflect and even just write up your busy workday, I’ll do my best to weave them all together. I, for one, hope to describe some of the projects that I’m involved with at my new workplace. But remember, this “theme” is only a suggestion, we’d be happy to see any contributions that you think would be of interest.

Educators, librarians, doctors or scientists please remember: your submission matters…. No interesting blog carnival without your contribution. I’m looking forward to the next MedLibs round, the first Medical Information Matters Edition (it is a mouth full isn’t it?)

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The University Library (UBA) goes Mobile.

4 04 2010
UBA mobielOur Medical Library at the AMC hospital is one of main (autonomous) libraries of the UBA, the University Library of the University of Amsterdam.

The UBA developed the Spoetnik (library 23 things-like) course -inspiring the start of this blog-, has a library-coach with chat function, a library blog (UBA-e), and is now on Twitter as @bibliotheekuva.
Plus, as I just learned, a small team of the UBA recently launched a mobile version of the library website.

I like their approach. This team consisting of Driek Heesakkers (project leader), Lukas Koster, Gre Ootjers, Roxana Popistasu en Alice Doek, realized this “perpetual beta version” in no more than 7 weeks (from first meeting till launch at April 1st). There aim was not to strive for perfection, but to develop a version first and to learn from their mistakes and the feedback from the users. Thus highly interactive.

Another excellent principle was that they designed ONE mobile app for all smart phones.

This is what UBA mobile offers right now:

  • The library catalog (searching; reserve items; renew loans)
  • Opening hours and addresses of library locations
  • Locations (on a map)
  • Contact phone numbers
  • Questions, feedback
  • News via @bibliotheekuva-tweets

The most important feature, full access to the digital library (with link to all subscriptions) is not yet realized.

I hope our medical library will follow this shining example. Many medical students and doctors use smart-phones and I’m sure a digital version of our medical library website would surely be appreciated by our clients.

Mobile is the future. What do you think?

Below a short and clear presentation by Lukas Koster at UGUL (UGame ULearn) 2010.

The web address of the mobile site is: http://cf.uba.uva.nl/mobiel.

Short notice about UBA mobile at the news section of the UBA.

Janneke Staaks (librarian for: Psychology, Cultural Anthropology and Pedagogical and Educational Sciences) has dealt more in depth with this subject. See this post at her (Dutch) blog FMG Library.





Grand Rounds Vol. 6 No. 2

29 09 2009

grandroundsblank

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

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

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

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

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

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

We don’t search for this…

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

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

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

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

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

Background  questions.

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

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

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

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

Foreground  questions: Domain Therapy2463850234_6a9851b622

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Domain Diagnosis

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

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

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

Domain: Etiology/Harm

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

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

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

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

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

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

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

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

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

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

741879088_29d01c359b_m-another-dead-librarian

Acknowledgements

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

Bonus

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Image Credits (CC-licence)

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

You might also like:

Dear Laika,This is my suggestion for Grand Rounds:Doctors add expert insights and comments about websites in Google Sidewiki
http://casesblog.blogspot.com/2009/09/doctors-add-expert-insights-and.htmlAlternative:Myths About Health Care Around the World
http://casesblog.blogspot.com/2009/09/myths-about-health-care-around-world.htmlLooking forward to Grand Rounds on Tuesday,
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Beware of Top 50 “Great Tools to Double Check your Doctor” or whatever Lists.

1 09 2009

Just the other week I wrote a post “Vanity is the Quicksand of Reasoning: Beware of Top 100 and 50 lists!”

In short this post describes that (some) Top 100 etc lists may not be as useful or innocent as they seem. Some of these lists are created by real scam-sites, who’s only goal is to make money via click-troughs and to get as much traffic as possible, via YOU (and me)!

The scam appears in many guises.

  1. As submissions for a  blog carnival, i.e. 100-weight-loss-tips-tricks.
  2. An offer of a health care student who asks you to do a guest post (you only have to link back to his/her site).
  3. In the form of a mail, dropping you a quick line that you’re included in a top 100 list, possibly worth mentioning to your audience.
  4. You just noticed a top 100 list with excellent sites, worth mentioning on Twitter or Friendfeed, so your followers become aware of the sites and pass the message.

The first two are pretty obvious scam. The latter two are more difficult to see through.

Why do I write another post? Because it happened again, today. And I think I should bring the message home more clearly.

Below you see what happens. Berci has found a list with 50 great tools to “Double check your Doctor”. He tweets the link to what he considers a great resource list, and in no time the message and the link are tweeted several times. Some people also post a link on their blog.

  1. Bertalan Meskó
    Berci 50 Great Tools to Double Check Your Doctor http://ff.im/-7q7DA
  2. Liza Sisler
    lizasisler Good resource list RT @Berci 50 Great Tools to Double Check Your Doctor http://ff.im/-7q7DA
  3. Bart Collet
    bart RT @Berci: 50 Great Tools to Double Check Your Doctor http://ff.im/-7q7DA
  4. Guy Therrien
    gtherrien RT @bart: 50 Great Tools to Double Check Your Doctor – Online Nursing Classes http://ff.im/-7q9pK
  5. zorgbeheer
    zorgbeheer DELI 50 Great Tools to Double Check Your Doctor – Online Nursing Classes: You probably know that Googling yo.. http://bit.ly/n1NXc
  6. ekettell
    ekettell RT@Berci 50 Great Tools to Double Check Your Doctor http://ff.im/-7q7DA
  7. Robert L. Oakes
    RobertLOakes RT @Berci: 50 Great Tools to Double Check Your Doctor http://ff.im/-7q7DA (via @ahier)
  8. dr. Horváth Tamás
    ENTHouse RT @Berci 50 Great Tools to Double Check Your Doctor http://ff.im/-7q7DA
  9. Sagar Satapathy
    sagar13d 50 Great Tools to Double Check Your Doctor. URL: http://tinyurl.com/mlmf47

this quote was brought to you by quoteurl

Finally this will result in more traffic to the website onlinenursingclasses and a higher rank in Google.

Indeed 12 hours after Berci’s tweet, searching for “50 Great Tools to Double Check Your Doctor” (between quotes) gives just 21 hits (similar hits not shown), many of which can be traced back to the twitter posts.
All but one are positive: the last hit is my warning, which was only received by ahier and TheSofa. Ahier deleted his original positive tweet from Twitter.

Also worrying is that the spam site was bookmarked by various Stumble upon visitors. And that the one person that made the Stumble upon review also “liked” similar sites, like Online Classes and Learn Gasms. So probably a whole team takes care that the site is socially bookmarked. When several people “like” a site others may be attracted to the site as well. That is the principle of social bookmarking sites. And you and I do the rest….

1-9-2009 0-55-13 Google results 50 great tools

Why is this bad? You can read more in my previous post or in the post “Affiliate sites” at Ellie ❤ Libraries.
In addition, Shamsha brought another post to my attention, again from a librarian:

Top 100 Librarian Friendfeeds to follow at cheapie online degrees com at Tame the Web.com.

which refers to

http://www.librarian.net/stax/2970/why-i-dont-accept-guest-posts-from-spammers-or-link-to-them/

Tame the web gives some very good advice

I sometimes see other libloggers linking to sites like these and I have a word of advice: don’t. When we link to low-content sites from our high-content sites, we are telling Google and everyone that we think that the site we are linking to is in some way authoritative, even if we’re saying they’re dirty scammers. We’re helping their page rank and we’re slowly, infinitesimally almost, decreasing the value of Google and polluting the Internet pool in which we frequently swim. Don’t link to spammers.

How do you know that you can’t trust that particular site?

Well here are some features I’ve noticed (for the spam sites in “my”field)

  • All the sites that publicized such list were educational, mostly directed at nurses or other health practitioners. Some even end at org. Examples:
    • nursingschools.net
    • associatedegree.org
    • rncentral.com
    • Learn-gasm
    • onlineclasses.org
    • onlinenursepractitionerschools.com
    • searchenginecollege.com
    • collegedegree.com
    • ultrasoundtechnicianschools.org
    • phlebotomytechnicianschools.com
    • MiracleFruitPlus.com.
  • All sites have a Quick-degree, nursing degree, technician school etc finder. Mostly it is the only information at the ABOUT-section (?!)
  • The home page often contains prominent links (clicks) to Kaplan University, University of Phoenix, Grand Canyon University, and/or others.
  • People behind the site often approach you actively (below are some examples) to gain your interest.
  • It is unclear how the lists are made and who is behind it.
  • There is no real information, only lists and degree finders.

So spread the word! Be careful with those list. DON’T LINK TO THEM! And if you see a possible interesting list, first CHECK the site: WHO, WHY, WHAT, WHERE AND WHEN. Once you’ve seen one, you’ve seen them all!

31-8-2009 21-23-07 online nursing

The degree finder at the about page

1-9-2009 1-32-11 about 100 list

Prominent links to some Universities

1-9-2009 2-30-23 universities online nursing

An example of a letter drawing your attention to a list

1-9-2009 2-56-49 hi we just posted an articleAn example of a letter asking to write a guest post.

31-8-2009 23-56-03 guest post

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Vanity is the Quicksand of Reasoning: Beware of Top 100 and 50 lists!

26 08 2009

During the weekend I added some links to sites referring to this blog in the sidebar. There was the 3rd place in the Medgadget competition for the Best New Medical Weblog in 2008,  a nice critique by Danielle Worster (the Health Informaticist) in the “Library + Information Gazette”, the inclusion in the Dutch Twitterguide and a place in the Top 50 Health 2.0 Blogs list of RNCentral (”the place to learn about nursing online”) in 2008.

And recently I was included in another ranking lists, to which I was alerted by a personal email of Amber, saying:

Hi,

We just posted an article, “100 Useful Websites for Medical Librarians” (http://http://www.nursingschools.net/blog/2009/100-useful-websites-for-medical-librarians/). I thought I’d drop a quick line and let you know in case you thought it was something you’re audience would be interested in reading. Thanks!

Both the RNCentral and the nursingschools.net lists are subjective ranking list of useful sites on nurses-oriented webpages. And although subjective, they contain numerous excellent and trustworthy sites. I was honored and pleased that I was included in those lists together with the Krafty Librarian, David Rothman, the MLA, the NIH, and NLM.

In all fairness, there are also many list (in fact far more such lists) that do not include me. I remember that there was a list of 100 top librarians with quite a number of Australians and no @laikas. I found one post at Lucacept – intercepting the web saying:

BestCollegesonline.com has posted a list of the Top 100 Librarian Tweeters and I’m honoured to say I appear on the list. In fact, there are five Australian Librarians who made it on the list. The other four were heyjudeonline, neerav, bookjewel, gonty.

Unfortunately, they didn’t include Kathryn Greenhill, an amazing librarian who is currently in the US and putting out some very helpful tweets from conferences she is attending while there. She is sirexkathryn on Twitter.

Other great Teacher-Librarians to follow include …..

Check out the list and see who else is there you might like to follow. I know that my professional learning has benefited from the generous nature of Librarians who are active on Twitter.

This shows that people are pretty serious about those lists and sensitive to who is included or not.
There were some mild protests from a few people on Twitter, i.e. from Shamsha here (RT means you repost a tweet, so @shamsha retweets my retweet of @philbradley‘s tweet of the bestcollegesonline list) and from @BiteTheDust (here) regarding @laikas’  omission from the list. However, I’m sure there were many others studying the top 25, 50 or 100 lists with a frown. But wouldn’t any list look different?

25-8-2009 13-32-32 shamsha

25-8-2009 17-40-09 bitethedust

Apparently it concerns the same bestcollegesonline.com-list as referred to by Lucacept.

Back in April there was also a Top 50 Librarian Blogs- list published at the getdegrees.com. This provoked a blogpost from the UK-blog Cultural Heritage ” Top 50 (insert topic of choice here). Quote:

The colleague who alerted me to this noted that all of the blogs listed were published by librarians in the US and wondered whether we should be doing our own list of top UK librarian blogs. Further, she wondered, if we did, who would we be putting at the top and why?

Who (are on the list)? and Why? Those are good questions!

This reminded me of a recent remark of @aarontay on Twitter, He sighed something like. “Now I’ve seen 3 of those list. Who makes those lists anyway?” That is a 3rd relevant question.

I couldn’t find @aarontay’s original Tweet (Booh!, these are not archived), but here is a message I found on FriendFeed:

25-8-2009 14-31-57 aarontay 3 lists

Friendfeed not only keeps the messages but also shows the comments. Apparently Ellie (from Ellie ❤ Libraries) found evidence that such sites were dodgy as @aarontay had suggested. Some quotes from her post:

Both this site (http://associatedegree.org) and Learn-gasm – who has the top 100 blogs post going around currently (www. bachelorsdegreeonline. com) are sites designed solely to earn revenue through click-throughs.

The “bachelorsdegreeonline” at the end is a tracking mechanism to allow collegedegrees.com to reward sites that send them visitors.
While all the schools linked to are legitimate schools, both are misleading sites since they only link to schools that offer an affiliate kickback. They also only link to forms to enter your contact information at third party sites, not to the actual school websites.

While the content of the top 100 blogs and 25 predictions lists is completely non-objectionable, the fact that librarians are taking these sites seriously is.

What the author is doing is trying to increase his traffic and SEO. He likely does some minimal investigation to determine what sites would have the biggest impact – so in that sense, the lists are probably somewhat representational of influential sites – like I said, the content isn’t the objectional part. He creates the page with the links to the 100 top whatever, then emails all of them to let them know they’re on the list. Every one of them that posts that they’ve made a top 100 list and links back to him increases his site’s page ranking. The more important your site is, the more it helps him, both in search engine algorithm terms (being linked to by someplace important counts for more than being linked to from less popular sites) and because it brings him more incoming traffic. Which also increases his site’s page ranking (and the chance of someone clicking through in a way that gets him paid).

…But, this particular little batch of sites that is currently targeting higher education – they are ones that are ostensibly trying to help people find colleges, choose degrees, etc., when in fact they are only linking to forms to enter your contact information for a small subset of online only colleges that offer affiliate linking programs.

…on the surface they seem related to education, some have .org addresses, but when we start looking at them critically they fail every test easily – no about page (or at least nothing informative on it), unauthored posts,  little to no original content. One of the main components of being a librarian is teaching people to think critically about information, so when we fail to do so ourselves I find it incredibly frustrating.

O.k. that hit the mark.

A good look at the sites that linked to my blog showed they were essentially the same as those mentioned by @aarontay and Ellie. With links to the same schools.

Vanity or naivety, I don’t know. I didn’t pay much attention, but I still (wanted to) quot(ed) them and didn’t doubt their intentions. Nor did I question Clinical Reader’s intentions at first (see previous post).
In some respect I really dislike to be so suspicious. But apparently you have to.
So, I hope you learned from this as well. Please be careful. Don’t link to such sites and/or remove the links from your blog.

Vanity is the quicksand of reason George Sand quotes (French Romantic writer, 1804-1876)


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