Social Media in Clinical Practice by Bertalan Meskó [Book Review]

How to review a book on Medical Social Media written by an author, who has learned you many Social Media skills himself?

Thanks to people like Bertalan Meskó, the author of the book concerned,  I am not a novice in the field of Medical Social Media.

But wouldn’t it be great if all newcomers in the medical social media field could benefit from Bertalan’s knowledge and expertise? Bertalan Meskó, a MD with a  Summa Cum Laude PhD degree in clinical genomics, has already shared his insights by posts on award-winning blog ScienceRoll, via Twitter and Webicina.com (an online service that curates health-related social media resources), by giving presentations and social media classes to medical students and physicians.

But many of his students rather read (or reread) the topics in a book instead of e-learning materials. Therefore Bertalan decided to write a handbook entitled “Social Media in Clinical Practice”.

This is the table of contents (for more complete overview see Amazon):

1. Social media is transforming medicine and healthcare
2. Using medical search engines with a special focus on Google
3. Being up-to-date in medicine
4. Community sites Facebook, Google+ and medical social networks
5. The world of e-patients
6. Establishing a medical blog
7. The role of Twitter and microblogging in medicine
8. Collaboration online
9. Wikipedia and Medical Wikis
10. Organizing medical events in virtual environments
11. Medical smartphone and tablet applications
12. Use of social media by hospitals and medical practices
13. Medical video and podcast
14. Creating presentations and slideshows
15. E-mails and privacy concerns
16. Social bookmarking
17. Conclusions

As you can see, many social media tools are covered and in this respect the book is useful for everyone, including patients and consumers.

But what makes “Social Media in Clinical Practice” especially valuable for medical students and clinicians?

First, specific medical search engines/social media sites/tools are discussed, like (Pubmed [medical database, search engine], Sermo [Community site for US physicians], Medworm [aggregator of RSS feeds], medical smartphone apps and sources where to find them, Medical Wiki’s like Radiopaedia.
Scientific Social media sites, with possible relevance to physicians are also discussed, like Google Scholar and Wolphram Alpha.

Second, numerous medical examples are given (with links and descriptions). Often, examples are summarized in tables in the individual chapters (see Fig 1 for a random example 😉 ). Links can also be found at the end of the book, organized per chapter.

Fig 1. Examples represented in a Table

Third, community sites and non-medical social media tools are discussed from the medical prespective. With regard to community sites and tools like Facebook, Twitter, Blogs and Email special emphasis is placed on (for clinicians very important) quality, privacy and legacy concerns, for instance the compliance of websites and blogs with the HONcode (HON=The Health On the Net Foundation) and HIPAA (Health Insurance Portability and Accountability Act), the privacy settings in Facebook and Social Media Etiquette (see Fig 2).

Fig. 2 Table from “Social Media in Clinical Practice” p 42

The chapters are succinctly written, well organized and replete with numerous examples. I specifically like the practical examples (see for instance Example #4).

Fig 3 Example of Smartphone App for consumers

Some tools are explained in more detail, i.e. the anatomy of a tweet or a stepwise description how to launch a WordPress blog.
Most chapters end with a self test (questions),  next steps (encouraging to put the theory into practice) and key points.

Thus in many ways a very useful book for clinical practice (also see the positive reviews on Amazon and the review of Dean Giustini at his blog).

Are there any shortcomings, apart from the minimal language-shortcomings, mentioned by Dean?

Personally I find that discussions of the quality of websites concentrate a bit too much on the formal quality (contact info, title, subtitle etc)). True, it is of utmost importance, but quality is also determined by  content and clinical usefulness. Not all websites that are formally ok deliver good content and vice versa.

As a medical  librarian I pay particular attention to the search part, discussed in chapter 3 and 4.
Emphasis is put on how to create alerts in PubMed and Google Scholar, thus on the social media aspects. However searches are shown, that wouldn’t make physicians very happy, even if used as an alert: who wants a PubMed-alert for cardiovascular disease retrieving 1870195 hits? This is even more true for a the PubMed search “genetics” (rather meaningless yet non-comprehensive term).
More importantly, it is not explained when to use which search engine.  I understand that a search course is beyond the scope of this book, but a subtitle like “How to Get Better at Searching Online?” suggests otherwise. At least there should be hints that searching might be more complicated in practice, preferably with link to sources and online courses.  Getting too much hits or the wrong ones will only frustrate physicians (also to use the socia media tools, that are otherwise helpful).

But overall I find it a useful, clearly written and well structured practical handbook. “Social Media in Clinical Practice” is unique in his kind – I know of no other book that is alike-. Therefore I recommend it to all medical students and health care experts who are interested in digital medicine and social media.

This book will also be very useful to clinicians who are not very fond of social media. Their reluctance may change and their understanding of social medicine developed or enhanced.

Lets face it: a good clinician can’t do without digital knowledge. At the very least his patients use the internet and he must be able to act as a gatekeeper identifying and filtering thrustworty, credible and understandable information. Indeed, as Berci writes in his conclusion:

“it obviously is not a goal to transform all physicians into bloggers and Twitter users, but (..) each physician should find the platforms, tools and solutions that can assist them in their workflow.”

If not convinced I would recommend clinicians to read the blog post written at the the Fauquier ENT-blog (refererred to by Bertalan in chapter 6, #story 5) entiteld: As A Busy Physician, Why Do I Even Bother Blogging?

SM in Practice (AMAZON)

Book information: (also see Amazon):

• Title: Social Media in Clinical Practice
• Author: Bertalan Meskó
• Publisher: Springer London Heidelberg New York Dordrecht
• 155 pages
• ISBN 978-1-4471-4305-5
• ISBN 978-1-4471-4306-2 (eBook)
• ISBN-10: 1447143051
• DOI 10.1007/978-1-4471-4306-2
• $37.99 (Sept 2013) (pocket at Amazon)

Related articles

• “Social Media in Clinical Practice” Handbook Is Published! (scienceroll.com)
• Social Media in Clinical Practice: Chapter 1, The Introduction (scienceroll.com)
• Here comes Bertalan Meskó’s book on ‘social media’ (aplaceofmind.ubc.ca)
• My Book, Social Media in Clinical Practice, To Be Released on the 8th of August! (scienceroll.com)

• Berci’s New Book Is A Winner (blogs.ubc.ca/dean/)

• Social Media in Clinical Practice: Chapter 3, Being Up-to-Date in Medicine (scienceroll.com)

Health and Science Twitter & Blog Top 50 and 100 Lists. How to Separate the Wheat from the Chaff.

Recently a Top 100 scientists-Twitter list got viral on Twitter. It was published at accreditedonlinecolleges.com/blog.*

Most people just tweeted “Top 100 Scientists on Twitter”, others were excited to be on the list, a few mentioned the lack of scientist X or discipline Y  in the top 100.

Two scientist noticed something peculiar about the list: @seanmcarroll noticed two fake (!) accounts under “physics” (as later explained these were: @NIMAARKANIHAMED and @Prof_S_Hawking). And @nutsci (having read two posts of mine about spam top 50 or 100 lists [1, 2]) recognized this Twitter list as spam:

Beware of "top 100 scientists" and similar lists passing around twitter. See @laikas posts on why http://t.co/N8dSrSD7

— Colby Vorland (@nutsci) March 18, 2012

It is surprising how easy it (still) is for such spammy Top 50 or 100 Lists to get viral, whereas they only have been published to generate more traffic to the website and/or to earn revenue through click-throughs.

It makes me wonder why well-educated people like scientists and doctors swallow the bait. Don’t they recognize the spam? Do they feel flattered to be on the list, or do they take offence when they (or another person who “deserves” it) aren’t chosen? Or perhaps they just find the list useful and want to share it, without taking a close look?

To help you to recognize and avoid such spammy lists, here are some tips to separate the wheat from the chaff:

1. Check WHO made the list. Is it from an expert in the field, someone you trust? (and/or someone you like to follow?)
2. If you don’t know the author in person, check the site which publishes the list (often a “blog”):
   1. Beware if there is no (or little info in the) ABOUT-section.
   2. Beware if the site mainly (only) has these kind of lists or short -very general-blogposts (like 10 ways to….) except when the author is somebody like Darren Rowse aka @ProBlogger [3].
   3. Beware if it is a very general site producing a diversity of very specialised lists (who can be expert in all fields?)
   4. Beware if the website has any of the following (not mutually exclusive) characteristics:
      1. Web addresses like accreditedonlinecolleges.com, onlinecolleges.com, onlinecollegesusa.org,  onlinedegrees.com (watch out com sites anyway)
      2. Websites with a Quick-degree, nursing degree, technician school etc finder
      3. Prominent links at the homepage to Kaplan University, University of Phoenix, Grand Canyon University etc
   5. Reputable sites less likely produce nonsense lists. See for instance this “Women in science blogging”-list published in the Guardian [4].
3. When the site itself seems ok, check whether the names on the list seem trustworthy and worth a follow. Clearly, lists with fake accounts (other then lists with “top 50 fake accounts” ;)) aren’t worth the bother: apparently the creator didn’t make the effort to verify the accounts and/or hasn’t the capacity to understand the tweets/topic.
4. Ideally the list should have added value. Meaning that it should be more than a summary of names and copy pasting of the bio or “about” section.
   For instance I have recently been put on a list of onlinecollegesusa.org [b], but the author had just copied the subtitle of my blog: …. a medical librarian and her blog explores the web 2.0 world as it relates to library science and beyond.
   However, sometimes, the added value may just be that the author is a highly recognized expert or opinion leader. For instance this Top Health & Medical Bloggers (& Their Twitter Names) List [5] by the well known health blogger Dean Giustini.
5. In what way do these lists represent *top* Blogs or Twitter accounts? Are their blogs worth reading and/or their Twitter accounts worth following? A nobel price winner may be a top scientist, but may not necessarily be a good blogger and/or may not have interesting tweets. (personally I know various examples of uninteresting accounts of *celebrities* in health, science and politics)
6. Beware if you are actively approached and kindly requested to spread the list to your audience. (for this is what they want).It goes like this (watch the impersonal tone):
   

   Your Blog is being featured!

   Hi There,

   I recently compiled a list of the best librarian blogs, and I wanted to let you know that you made the list! You can find your site linked here: […]

   If you have any feedback please let me know, or if you think your audience would find any of this information useful, please feel free to share the link. We always appreciate a Facebook Like, a Google +1, a Stumble Upon or even a regular old link back, as we’re trying to increase our readership.

   Thanks again, and have a great day!

While some of the list may be worthwhile in itself, it is best NOT TO LINK TO DOUBTFUL LISTS, thus not  mention them on Twitter, not retweet the lists and not blog about it. For this is what they only want to achieve.

But what if you really find this list interesting?

Here are some tips to find alternatives to these spammy lists (often opposite to above-mentioned words of caution) 

1. Find posts/lists produced by experts in the field and/or people you trust or like to follow. Their choice of blogs or twitter-accounts (albeit subjective and incomplete) will probably suit you the best. For isn’t this what it is all about?
2. Especially useful are posts that give you more information about the people on the list. Like this top-10 librarian list by Phil Bradley [6] and the excellent “100+ women healthcare academics” compiled by @amcunningham and @trishgreenhalgh [7].
   Strikingly the reason to create the latter list was that a spammy list not recognized as such (“50 Medical School Professors You Should Be Following On Twitter”  [c])  seemed short on women….
3. In case of Twitter-accounts:
   1. Check existing Twitter lists of people you find interesting to follow. You can follow the entire lists or just those people you find most interesting.
      Examples: I created a list with people from the EBM-cochrane people & sceptics [8]. Nutritional science grad student @Nutsci has a nutrition-health-science list [9]. The more followers, the more popular the list.
   2. Check interesting conversation partners of people you follow.
   3. Check accounts of people who are often retweeted in the field.
   4. Keep an eye on #FF (#FollowFriday) mentions, where people worth following are highlighted
   5. Check a topic on Listorious. For instance @hrana made a list of Twitter-doctors[10]. There are also scientists-lists (then again, check who made the list and who is on the list. Some health/nutrition lists are really bad if you’re interested in science and not junk)
   6. Worth mentioning are shared lists that are open for edit (so there are many contributors besides the curator). Lists [4] and [7] are examples of crowd sourced lists. Other examples are truly open-to-edit lists using public spreadsheets, like the Top Twitter Doctors[11], created by Dr Ves and  lists for science and bio(medical) journals [12], created by me.
4. Finally, if you find the spam top 100 list truly helpful, and don’t know too many people in the field, just check out some of the names without linking to the list or spreading the word.

*For obvious reasons I will not hyperlink to these sites, but if you would like to check them, these are the links

[a] accreditedonlinecolleges.com/blog/2012/top-100-scientists-on-twitter

[b] onlinecollegesusa.org/librarian-resources-online

[c] thedegree360.onlinedegrees.com/50-must-follow-medical-school-professors-on-twitter

Related articles

1. Beware of Top 50 “Great Tools to Double Check your Doctor” or whatever Lists. (laikaspoetnik.wordpress.com)
2. Vanity is the Quicksand of Reasoning: Beware of Top 100 and 50 lists! ((laikaspoetnik.wordpress.com)
3. Google+ Tactics of the Blogging Pros (problogger.net)
4. “Women in science blogging” by Martin Robbins ( http://www.guardian.co.uk/science)
5. Top Health & Medical Bloggers (& Their Twitter Names) List (blog.openmedicine.ca)
6. Top-10 librarian list by Phil Bradley (www.blogs.com/topten)
7. 100+ women healthcare academics by Annemarie Cunningham/ Trisha Greenhalgh (wishfulthinkinginmedicaleducation.blogspot.com)
8. Twitter-doctors by @hrana (listorious.com)
9. EBM-cochrane people & sceptics (Twitter list by @laikas)
10. Nutrition-health-science (Twitter list by @nutsci)
11. Open for edit: Top Twitter Doctors arranged by specialty in alphabetical order (Google Spreadsheet by @drves)
12. TWITTER BIOMEDICAL AND OTHER SCIENTIFIC JOURNALS & MAGAZINES (Google Spreadsheet by @laikas)

Friday Foolery #48 Brilliant Library Notices

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

brilliant library notice | The Poke: http://t.co/cz5aa6K9 cc @laikas

— Mike Cadogan (@sandnsurf) January 12, 2012

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.

Related articles

• Friday Foolery # 47 WTF, the True Spirit of Christmas (laikaspoetnik.wordpress.com)
• Friday Foolery #46 Bad Science: The Psychology Behind Exaggerated & False Results (laikaspoetnik.wordpress.com)
• Friday Foolery #44. The Shortest Abstract Ever. (laikaspoetnik.wordpress.com)
• Friday Foolery #45. What have you got in your head? (laikaspoetnik.wordpress.com)

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

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.

https://twitter.com/#!/DrVes/statuses/155697725134995456

https://twitter.com/#!/rlbates/statuses/155698766945587200

@laikas Even if you submit to Grand Rounds, the post may not be included. Selection criteria are unclear, and change from host to host.

— Ves Dimov, M.D. (@DrVes) January 7, 2012

https://twitter.com/#!/Bongi1/statuses/155719544613240832

Related articles

• Medical Grand Rounds is Coming to 33 charts (33charts.com)
• A personal reflection on 2011 – the importance of diagnosis (medrants.com)
• Grand Rounds Vol 8 nr 5: Data, Information & Communication (laikaspoetnik.wordpress.com)
• Studying alternative medicine with federal dollars – latimes.com (gruntdoc.com)
• Physician online professionalism in social media (kevinmd.com)
• Twitter will eat itself (howtosurvivesocialmedia.wordpress.com)

Friday Foolery # 47 WTF, the True Spirit of Christmas

The true spirit of Christmas is in “loving” and to “do good for others”, ” thinking of” and “helping the less fortunate”.

However, many of today’s children,  weaned on luxury goods and gadgets, consider themselves as the “less fortunates” and thus are on the  “receiving” rather than the “giving” site. And are easily disappointed… and crossed if they don’t get the expected $$$ gift.

Am I exaggerating? I truly hope so.

But if you had searched Twitter for popular expensive gits “car”, “i-pad” or “i-phone” like comedy writer Jon Hendren (@fart) did, you had seen numerous dissatisfied tweets of extremely spoiled kids and adolescents:

https://twitter.com/#!/Tonimoretto/status/150701909479661569

https://twitter.com/#!/Bossybeegee/status/150985722730512384

https://twitter.com/#!/SamStandsFoSwag/status/150993796312739840

http://twitter.com/LeemyLeem_/status/150978171200745472

https://twitter.com/#!/dizzydentgirl/status/150980418718543872

https://twitter.com/#!/guhrace_/status/151039463672397824

My parents are the worst mother Fucking parents in the world fuck you mom and dad for not getting me a Iphone. FUCK YOU. FML. #Iphone

— MA, Glory (@vvvvv___vvvvv) December 25, 2011

https://twitter.com/#!/paulyandmolly/status/151053132498087936

———–

The tweets have even been compiled in a song by Jonathan Mann, the “Song a Day Man“. After seeing the tweets it should be no surprise that it is called “WTF?! I wanted an iPhone!”

———–

It makes me kind a sad. It is quite an anti-Christmas attitude.

The kids in this video below have every right to be disappointed though. (via Mashable)

———–

Sources

• ‘WTF?! I Wanted an iPhone!’ Entitled Christmas Tweets Put to Music [VIDEO] (mashable.com)
• Ungrateful Kids React to Bad Christmas Presents (mashable.com)

Related articles

• Friday Foolery #46 Bad Science: The Psychology Behind Exaggerated & False Results (laikaspoetnik.wordpress.com)
• Friday Foolery #45. What have you got in your head? (laikaspoetnik.wordpress.com)
• Friday Foolery #44. The Shortest Abstract Ever. (laikaspoetnik.wordpress.com)
• WTF! I Wanted an iPhone [Video] (collegecandy.com)
• Wanted an iPhone 4S / iPad / Pair of Jordans for Christmas And Didn’t Get It? (gottabemobile.com)

Medical Black Humor, that is Neither Funny nor Appropriate.

Last week, I happened to see this Facebook post of the The Medical Registrar where she offends a GP, Anne Marie Cunningham*, who wrote a critical post about black medical humor at her blog “Wishful Thinking in Medical Education”. I couldn’t resist placing a likewise “funny” comment in this hostile environment where everyone seemed to agree (till then) and try to beat each other in levels of wittiness (“most naive child like GP ever” – “literally the most boring blog I have ever read”,  “someone hasn’t met many midwives in that ivory tower there.”, ~ insulting for a trout etc.):

“Makes no comment, other than anyone who uses terms like “humourless old trout” for a GP who raises a relevant point at her blog is an arrogant jerk and an unempathetic bastard, until proven otherwise…  No, seriously, from a patient’s viewpoint terms like “labia ward” are indeed derogatory and should be avoided on open social media platforms.”

I was angered, because it is so easy to attack someone personally instead of discussing the issues raised.

Perhaps you first want to read the post of Anne Marie yourself (and please pay attention to the comments too).

Social media, black humour and professionals…

Anne Marie mainly discusses her feelings after she came across a discussion between several male doctors on Twitter using slang like ‘labia ward’ and ‘birthing sheds’ for birth wards, “cabbage patch” to refer to the intensive care and madwives for midwives (midwitches is another one). She discussed it with the doctors in question, but only one of them admitted he had perhaps misjudged sending the tweet. After consulting other professionals privately, she writes a post on her blog without revealing the identity of the doctors involved. She also puts it in a wider context by referring to  the medical literature on professionalism and black humour quoting Berk (and others):

“Simply put, derogatory and cynical humour as displayed by medical personnel are forms of verbal abuse, disrespect and the dehumanisation of their patients and themselves. Those individuals who are the most vulnerable and powerless in the clinical environment – students, patients and patients’ families – have become the targets of the abuse. Such humour is indefensible, whether the target is within hearing range or not; it cannot be justified as a socially acceptable release valve or as a coping mechanism for stress and exhaustion.”

The doctors involved do not make any effort to explain what motivated them. But two female anesthetic registrars frankly comment to the post of Anne Marie (one of them having created the term “labia ward”, thereby disproving that this term is misogynic per se). Both explain that using such slang terms isn’t about insulting anyone and that they are still professionals caring for patients:

 It is about coping, and still caring, without either going insane or crying at work (try to avoid that – wait until I’m at home). Because we can’t fall apart. We have to be able to come out of resus, where we’ve just been unable to save a baby from cotdeath, and cope with being shouted and sworn at be someone cross at being kept waiting to be seen about a cut finger. To our patients we must be cool, calm professionals. But to our friends, and colleagues, we will joke about things that others would recoil from in horror. Because it beats rocking backwards and forwards in the country.

[Just a detail, but “Labia ward” is a simple play on words to portray that not all women in the “Labor Ward” are involved in labor. However, this too is misnomer.  Labia have little to do with severe pre-eclampsia, intra-uterine death or a late termination of pregnancy]

To a certain extent medical slang is understandable, but it should stay behind the doors of the ward or at least not be said in a context that could offend colleagues and patients or their carers. And that is the entire issue. The discussion here was on Twitter, which is an open platform. Tweets are not private and can be read by other doctors, midwives, the NHS and patients. Or as e-Patient Dave expresses so eloquently:

I say, one is responsible for one’s public statements. Cussing to one’s buddies on a tram is not the same as cussing in a corner booth at the pub. If you want to use venting vocabulary in a circle, use email with CC’s, or a Google+ Circle.
One may claim – ONCE – ignorance, as in, “Oh, others could see that??” It must, I say, then be accompanied by an earnest “Oh crap!!” Beyond that, it’s as rude as cussing in a streetcorner crowd.

Furthermore, it seemed the tweet served no other goal as to be satirical, sardonic, sarcastic and subversive (words in the bio of the anesthetist concerned). And sarcasm isn’t limited to this one or two tweets. Just the other day he was insulting to a medical student saying among other things:“I haven’t got anything against you. I don’t even know you. I can’t decide whether it’s paranoia, or narcissism, you have”. 

We are not talking about restriction of “free speech” here. Doctors just have to think twice before they say something, anything on Twitter and Facebook, especially when they are presenting themselves as MD.  Not only because it can be offensive to colleagues and patients, but also because they have a role model function for younger doctors and medical students.

Isolated tweets of one or two doctors using slang is not the biggest problem, in my opinion. What I found far more worrying, was the arrogant and insulting comment at Facebook and the massive support it got from other doctors and medical students. Apparently there are many “I-like-to-exhibit-my-dark-humor-skills-and-don’t-give-a-shit-what-you think-doctors” at Facebook (and Twitter) and they have a large like-minded medical audience: the “medical registrar page alone has 19,000 (!) “fans”.

Sadly there is a total lack of reflection and reason in many of the comments. What to think of:

“wow, really. The quasi-academic language and touchy-feely social social science bullshit aside, this woman makes very few points, valid or otherwise. Much like these pages, if you’re offended, fuck off and don’t follow them on Twitter, and cabbage patch to refer to ITU is probably one of the kinder phrases I’ve heard…”

and

“Oh my god. Didnt realise there were so many easily offended, left winging, fun sponging, life sucking, anti- fun, humourless people out there. Get a grip people. Are you telling me you never laughed at the revue’s at your medical schools?”

and

“It may be my view and my view alone but the people who complain about such exchanges, on the whole, tend to be the most insincere, narcissistic and odious little fuckers around with almost NO genuine empathy for the patient and the sole desire to make themselves look like the good guy rather than to serve anyone else.”

It seems these doctors and their fans don’t seem to possess the communicative and emphatic skills one would hope them to have.

One might object that it is *just* Facebook or that “#twitter is supposed to be fun, people!” (dr Fiona) 

I wouldn’t agree for 3 reasons:

• Doctors are not teenagers anymore and need to act as grown-ups (or better: as professionals)
• There is no reason to believe that people who make it their habit to offend others online behave very differently IRL
• Seeing Twitter as “just for fun” is an underestimation of the real power of Twitter

Note: *It is purely coincidental that the previous post also involved Anne Marie.

Other articles about this topic

• Storm brews across a pond (runningahospital.blogspot.com)
• Social Media and the Medical Profession (claireot.wordpress.com)
• What is acceptable language from health professionals online? (sarah-stewart.blogspot.com) neutral and well written piece by a midwife
• Online medics reveal secret names for patients and colleagues (telegraph.co.uk)

Related articles

• The one thing doctors can’t laugh off is bad care (telegraph.co.uk)
• Carry on, doctor (telegraph.co.uk)
• Facebook friends a no-no for doctors (guardian.co.uk)
• Etiquette Based Medicine (laikaspoetnik.wordpress.com)

FUTON Bias. Or Why Limiting to Free Full Text Might not Always be a Good Idea.

A few weeks ago I was discussing possible relevant papers for the Twitter Journal Club  (Hashtag #TwitJC), a succesful initiative on Twitter, that I have discussed previously here and here [7,8].

I proposed an article, that appeared behind a paywall. Annemarie Cunningham (@amcunningham) immediately ran the idea down, stressing that open-access (OA) is a pre-requisite for the TwitJC journal club.

One of the TwitJC organizers, Fi Douglas (@fidouglas on Twitter), argued that using paid-for journals would defeat the objective that  #TwitJC is open to everyone. I can imagine that fee-based articles could set a too high threshold for many doctors. In addition, I sympathize with promoting OA.

However, I disagree with Annemarie that an OA (or rather free) paper is a prerequisite if you really want to talk about what might impact on practice. On the contrary, limiting to free full text (FFT) papers in PubMed might lead to bias: picking “low hanging fruit of convenience” might mean that the paper isn’t representative and/or doesn’t reflect the current best evidence.

But is there evidence for my theory that selecting FFT papers might lead to bias?

Lets first look at the extent of the problem. Which percentage of papers do we miss by limiting for free-access papers?

A survey in PLOS by Björk et al [1] found that one in five peer reviewed research papers published in 2008 were freely available on the internet. Overall 8,5% of the articles published in 2008 (and 13,9 % in Medicine) were freely available at the publishers’ sites (gold OA).  For an additional 11,9% free manuscript versions could be found via the green route:  i.e. copies in repositories and web sites (7,8% in Medicine).
As a commenter rightly stated, the lag time is also important, as we would like to have immediate access to recently published research, yet some publishers (37%) impose an access-embargo of 6-12 months or more. (these papers were largely missed as the 2008 OA status was assessed late 2009).

PLOS 2009

The strength of the paper is that it measures  OA prevalence on an article basis, not on calculating the share of journals which are OA: an OA journal generally contains a lower number of articles.
The authors randomly sampled from 1.2 million articles using the advanced search facility of Scopus. They measured what share of OA copies the average researcher would find using Google.

Another paper published in  J Med Libr Assoc (2009) [2], using similar methods as the PLOS survey examined the state of open access (OA) specifically in the biomedical field. Because of its broad coverage and popularity in the biomedical field, PubMed was chosen to collect their target sample of 4,667 articles. Matsubayashi et al used four different databases and search engines to identify full text copies. The authors reported an OA percentage of 26,3 for peer reviewed articles (70% of all articles), which is comparable to the results of Björk et al. More than 70% of the OA articles were provided through journal websites. The percentages of green OA articles from the websites of authors or in institutional repositories was quite low (5.9% and 4.8%, respectively).

In their discussion of the findings of Matsubayashi et al, Björk et al. [1] quickly assessed the OA status in PubMed by using the new “link to Free Full Text” search facility. First they searched for all “journal articles” published in 2005 and then repeated this with the further restrictions of “link to FFT”. The PubMed OA percentages obtained this way were 23,1 for 2005 and 23,3 for 2008.

This proportion of biomedical OA papers is gradually increasing. A chart in Nature’s News Blog [9] shows that the proportion of papers indexed on the PubMed repository each year has increased from 23% in 2005 to above 28% in 2009.
(Methods are not shown, though. The 2008 data are higher than those of Björk et al, who noticed little difference with 2005. The Data for this chart, however, are from David Lipman, NCBI director and driving force behind the digital OA archive PubMed Central).
Again, because of the embargo periods, not all literature is immediately available at the time that it is published.

In summary, we would miss about 70% of biomedical papers by limiting for FFT papers. However, we would miss an even larger proportion of papers if we limit ourselves to recently published ones.

Of course, the key question is whether ignoring relevant studies not available in full text really matters.

Reinhard Wentz of the Imperial College Library and Information Service already argued in a visionary 2002 Lancet letter[3] that the availability of full-text articles on the internet might have created a new form of bias: FUTON bias (Full Text On the Net bias).

Wentz reasoned that FUTON bias will not affect researchers who are used to comprehensive searches of published medical studies, but that it will affect staff and students with limited experience in doing searches and that it might have the same effect in daily clinical practice as publication bias or language bias when doing systematic reviews of published studies.

Wentz also hypothesized that FUTON bias (together with no abstract available (NAA) bias) will affect the visibility and the impact factor of OA journals. He makes a reasonable cause that the NAA-bias will affect publications on new, peripheral, and under-discussion subjects more than established topics covered in substantive reports.

The study of Murali et al [4] published in Mayo Proceedings 2004 confirms that the availability of journals on MEDLINE as FUTON or NAA affects their impact factor.

Of the 324 journals screened by Murali et al. 38.3% were FUTON, 19.1%  NAA and 42.6% had abstracts only. The mean impact factor was 3.24 (±0.32), 1.64 (±0.30), and 0.14 (±0.45), respectively! The authors confirmed this finding by showing a difference in impact factors for journals available in both the pre and the post-Internet era (n=159).

Murali et al informally questioned many physicians and residents at multiple national and international meetings in 2003. These doctors uniformly admitted relying on FUTON articles on the Web to answer a sizable proportion of their questions. A study by Carney et al (2004) [5] showed  that 98% of the US primary care physicians used the Internet as a resource for clinical information at least once a week and mostly used FUTON articles to aid decisions about patient care or patient education and medical student or resident instruction.

Murali et al therefore conclude that failure to consider FUTON bias may not only affect a journal’s impact factor, but could also limit consideration of medical literature by ignoring relevant for-fee articles and thereby influence medical education akin to publication or language bias.

This proposed effect of the FFT limit on citation retrieval for clinical questions, was examined in a  more recent study (2008), published in J Med Libr Assoc [6].

Across all 4 questions based on a research agenda for physical therapy, the FFT limit reduced the number of citations to 11.1% of the total number of citations retrieved without the FFT limit in PubMed.

Even more important, high-quality evidence such as systematic reviews and randomized controlled trials were missed when the FFT limit was used.

For example, when searching without the FFT limit, 10 systematic reviews of RCTs were retrieved against one when the FFT limit was used. Likewise when searching without the FFT limit, 28 RCTs were retrieved and only one was retrieved when the FFT limit was used.

The proportion of missed studies (appr. 90%) is higher than in the studies mentioned above. Possibly this is because real searches have been tested and that only relevant clinical studies  have been considered.

The authors rightly conclude that consistently missing high-quality evidence when searching clinical questions is problematic because it undermines the process of Evicence Based Practice. Krieger et al finally conclude:

“Librarians can educate health care consumers, scientists, and clinicians about the effects that the FFT limit may have on their information retrieval and the ways it ultimately may affect their health care and clinical decision making.”

It is the hope of this librarian that she did a little education in this respect and clarified the point that limiting to free full text might not always be a good idea. Especially if the aim is to critically appraise a topic, to educate or to discuss current best medical practice.

References

1. Björk, B., Welling, P., Laakso, M., Majlender, P., Hedlund, T., & Guðnason, G. (2010). Open Access to the Scientific Journal Literature: Situation 2009 PLoS ONE, 5 (6) DOI: 10.1371/journal.pone.0011273
2. Matsubayashi, M., Kurata, K., Sakai, Y., Morioka, T., Kato, S., Mine, S., & Ueda, S. (2009). Status of open access in the biomedical field in 2005 Journal of the Medical Library Association : JMLA, 97 (1), 4-11 DOI: 10.3163/1536-5050.97.1.002
3. WENTZ, R. (2002). Visibility of research: FUTON bias The Lancet, 360 (9341), 1256-1256 DOI: 10.1016/S0140-6736(02)11264-5
4. Murali NS, Murali HR, Auethavekiat P, Erwin PJ, Mandrekar JN, Manek NJ, & Ghosh AK (2004). Impact of FUTON and NAA bias on visibility of research. Mayo Clinic proceedings. Mayo Clinic, 79 (8), 1001-6 PMID: 15301326
5. Carney PA, Poor DA, Schifferdecker KE, Gephart DS, Brooks WB, & Nierenberg DW (2004). Computer use among community-based primary care physician preceptors. Academic medicine : journal of the Association of American Medical Colleges, 79 (6), 580-90 PMID: 15165980
6. Krieger, M., Richter, R., & Austin, T. (2008). An exploratory analysis of PubMed’s free full-text limit on citation retrieval for clinical questions Journal of the Medical Library Association : JMLA, 96 (4), 351-355 DOI: 10.3163/1536-5050.96.4.010
7. The #TwitJC Twitter Journal Club, a new Initiative on Twitter. Some Initial Thoughts. (laikaspoetnik.wordpress.com)
8. The Second #TwitJC Twitter Journal Club (laikaspoetnik.wordpress.com)
9. How many research papers are freely available? (blogs.nature.com)

Related articles

• I Got the Wrong Request from the Wrong Journal to Review the Wrong Piece. The Wrong kind of Open Access Apparently, Something Wrong with this Inherently… (laikaspoetnik.wordpress.com)
• Review of Open Access: What You Need to Know Now (walt.lishost.org)
• PHTWITJC on 11 Sept: case-control study (phtwitjc.wordpress.com)
• PubMed’s Higher Sensitivity than OVID MEDLINE… & other Published Clichés. (laikaspoetnik.wordpress.com)
• OA Rhetoric, Economics, and the Definition of “Research” (scholarlykitchen.sspnet.org)
• Three Biomedical Funders to Launch Open Access Journal (news.sciencemag.org)

#FollowFriday #FF @DrJenGunter: EBM Sex Health Expert Wielding the Lasso of Truth

If you’re on Twitter you probably seen the #FF or #FollowFriday phenomenon. FollowFriday is a way to recommend people on Twitter to others. For at least 2 reasons: to acknowledge your favorite tweople and to make it easier for your followers to find new interesting people.

However, some #FollowFriday tweet-series are more like a weekly spam. Almost 2 years ago I blogged about the misuse of FF-recommendations and I gave some suggestions to do #FollowFriday the right way: not by sheer mentioning many people in numerous  tweets, but by recommending one or a few people a time, and explaining why this person is so awesome to follow.

Twitter Lists are also useful tools for recommending people (see post). You could construct lists of your favorite Twitter people for others to follow. I have created a general FollowFridays list, where I list all the people I have recommended in a #FF-tweet and/or post.

In this post I would like to take up the tradition of highlighting the #FF favs at my blog. .

This FollowFriday I recommend:  

Jennifer Gunter

Jennifer Gunter (@DrJenGunter at Twitter), is a beautiful lady, but she shouldn’t be tackled without gloves, for she is a true defender of evidence-based medicine and wields the lasso of truth.

Her specialty is OB/GYN. She is a sex health expert. No surprise, many tweets are related to this topic, some very serious, some with a humorous undertone. And there can be just fun (re)tweets, like:

LOL -> “@BackpackingDad: New Word: Fungry. Full-hungry. “I just ate a ton of nachos, but hot damn am I fungry for those Buffalo wings!””

Dr Jen Gunter has a blog Dr. Jen Gunther (wielding the lasso of truth). 

Again we find the same spectrum of posts, mostly in the field of ob/gyn. You need not be an ob/gyn nor an EBM expert to enjoy them. Jen’s posts are written in plain language, suitable for anyone to understand (including patients).

Some titles:

• How safe is the HPV vaccine? New data available.
• Some birth control pills have a higher risk of blood clots. Is yours one of them?

In addition, There are also hilarious posts like “Cosmo’s sex position of the day proves they know nothing about good sex or women“,where she criticizes Cosmo for tweeting impossible sex positions (“If you’re over 40, I dare you to even GET into that position! “), which she thinks were created by one of the following:

A) a computer who has never had sex and is not programmed to understand how the female body bends.
B) a computer programmer who has never has sex and has no understanding of how the female body bends.
C) a Yogi master/Olympic athlete.

Sometimes the topic is blogging. Jen is a fierce proponent of medical blogging. She sees it as a way to “promote” yourself as a doctor, to learn from your readers and to “contribute credible content drowns out garbage medical information” (true) and as an ideal platform to deliver content to your patients and like-minded medical professionals. (great idea)

Read more at:

• Blogging with integrity: what does that mean for doctors?
• To blog or not to blog? What’s the answer for you and your practice? (At OBG-management)

You can follow Jen at her Twitter-account (http://twitter.com/#!/DrJenGunter) and/or you can follow my lists. She is on:  ebm-cochrane-sceptics and the followfridays list.

Of course you can also take a subscription to her blog http://drjengunter.wordpress.com/

Related articles

• Twitter’s #FollowFriday #FF – Over the Top. Literally (laikaspoetnik.wordpress.com: 2009/09/11/)
• Laikas Followfriday #FF Twitter List (laikaspoetnik.wordpress.com 2009/11/13/)
• #FollowFriday #FF Dutch @Nutrigenomics @Beatis @TheSofa @DrShock @digicmb (laikaspoetnik.wordpress.com 2009/11/21/)
• #FollowFriday #FF the EBM-Skeptics @cochranecollab @EvidenceMatters @oracknows @ACPinternists (laikaspoetnik.wordpress.com 2009/11/27/)
• How safe is the HPV vaccine? New data available. (drjengunter.wordpress.com/ 2011/06/17/)
• Some birth control pills have a higher risk of blood clots. Is yours one of them? (drjengunter.wordpress.com 2011/05/24/)
• Cosmo’s sex position of the day proves they know nothing about good sex or women” (drjengunter.wordpress.com (2011/08/19)
• To blog or not to blog? What’s the answer for you and your practice? (OBG-management August 2011 · Vol. 23, No. 8)
• Follow Friday Has Become Spam Weekly (5minutesforblogging.wordpress.com)
• Stop Doing Follow Friday Wrong (chris.pirillo.com)

The Second #TwitJC Twitter Journal Club

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Related articles

• The #TwitJC Twitter Journal Club, a New Initiative on Twitter. Some Initial Thoughts. (laikaspoetnik.wordpress.com)
• Rose G. Strategy of prevention: lessons from cardiovascular disease. Br Med J (Clin Res Ed). 1981 Jun 6;282(6279):1847-51. PubMed PMID: 6786649; PubMed Central PMCID: PMC1506445.
• Introduction: Rose’s Prevention Paradox (twitjc.wordpress.com: 2011/06/12/)
• Week Two: Points of Discussion for this Evening’s #TwitJC (twitjc.wordpress.com: 2011/06/12/)
• Gamma Rays From The Galactic Center and the WMAP Haze: a brief summary (astrojournalclub.wordpress.com)
• Twitter journal club #twitjc (http://twsy.posterous.com)

Kaleidoscope #3: 2011 Wk 12

It has been long since I have posted a Kaleidoscope post with a “kaleidoscope” of facts, findings, views and news gathered over the last 1-2 weeks. There have been only 2 editions: Kaleidoscope 1 (2009 wk 47) and 2 (2010 wk 31).

Here is some recommended reading from the previous two weeks. Benlysta (belimumab) approved by FDA for treatment of lupus.

Belimumab is the first new lupus drug approved in 56 years! Thus, potentially good news for patients suffering from the serious auto-immunity disease SLE (systemic lupus erythematosus).  Belimumab needs to be administered once monthly via the intravenous route. It is a fully human monoclonal antibody specifically designed to inhibit B-lymphocyte stimulator (BLyS™), thereby reducing the number of circulating B cells, and the produced ds-DNA antibodies (which are characteristic for lupus).
Two clinical trials showed that more patients experienced less disease activity when treated with belimumab compared to placebo. Data suggested that some patients had less severe flares, and some reduced their steroid doses (not an impressive difference using “eyeballing”). Patients were selected with signs of B-cell hyperactivity and with fairly stable, but active disease. Belimumab was ineffective in Blacks, which are hit hardest by the disease. The most serious side effect were infections: 3 deaths in the belimumab groups were due to infections.
Thus, overall the efficacy seems limited. Belimumab only benefits 35% of the patients with not the worst form of the disease. But for these patients it is a step forward.

1. Press Announcement (fda.gov).
2. Navarra SV, Guzmán RM, Gallacher AE, Hall S, Levy RA, Jimenez RE, Li EK,Thomas M, Kim HY, León MG, Tanasescu C, Nasonov E, Lan JL, Pineda L, Zhong ZJ, Freimuth W, Petri MA; BLISS-52 Study Group. Efficacy and safety of belimumab in patients with active systemic lupus erythematosus: a randomised, placebo-controlled, phase 3 trial. Lancet. 2011 Feb 26;377(9767):721-31. Epub 2011 Feb 4. PubMed PMID: 21296403.
3. Belimumab: Anti-BLyS Monoclonal Antibody; Benlysta(TM); BmAb; LymphoStat-B. Drugs in R & D (Open Access): 28 May 2010 – Volume 10 – Issue 1 – pp 55-65 doi: 10.2165/11538300-000000000-00000 Adis R&D Profiles (adisonline.com)

Sleep-deprived subjects make risky gambling decisions.

Recent research has shown, that a single night of sleep deprivation alters decision making independent from a shift in attention: most volunteers moved from seeking to minimize the effect of the worst loss to seeking increased reward. This change towards risky decision making was correlated with an increased brain activity in brain regions that assess positive outcomes (ventromedial prefrontal activation) and a simultaneous decreased activation in the brain areas that process negative outcomes (anterior insula). This was assessed by functional MRI.

One co-author (Chee) noted that “casinos often take steps to encourage risk-seeking behavior — providing free alcohol, flashy lights and sounds, and converting money into abstractions like chips or electronic credits”

Interestingly, Chee also linked their findings to empirical evidence that long work hours for medical residents increased the number of accidents. Is a similar mechanism involved?

1. Venkatraman V, Huettel SA, Chuah LY, Payne JW, Chee MW. Sleep deprivation biases the neural mechanisms underlying economic preferences.  J Neurosci. 2011 Mar 9;31(10):3712-8 (free full text)
2. Sleep deprived people make risky decisions based on too much optimism (Duke Healthpress release)

Grand Rounds

Grand Rounds is up at Better Health. Volume 7, Number 26 is an “Emotional Edition” where posts are organized into emotion categories. My post about the hysteria and misinformation surrounding the recent Japanese earthquake is placed under Outrage.

There are many terrific posts included. A few posts I want to mention shortly.

First a post by a woman who diagnosed hers and her sons’ disease after numerous tests. Her sons’ pediatrician only tried to reassure, so it seems. (“don’t worry…”).

I was also moved by the South African surgeon, Bongi, who tells the tragic story of a missed diagnosis that still haunts him. “For every surgeon has a graveyard hidden away somewhere in the dark recesses of his mind…”

Bongi’s blog Other Things Amanzi is one of my favorites. Another blog that has become one of my favs is 33 Charts by Dr. Bryan Vartabedian. Included in this Grand Round is “And a child will lead them“. It is a beautiful post about the loss of a young patient:

….”And facing Cooper’s parents for the first time after his passing was strangely difficult for me.  When he was alive I always had a plan.  Every sign, symptom, and problem had a systematic approach.  But when faced with the most inconceivable process, I found myself awkwardly at odds with how to handle the dialog”….

Other Medical Blogs

Another of my recent fav blogs is the blog of cardiologist, dr. Wes. Two recent posts I would especially like to recommend.

The first asks a seemingly simple question: “So which set of guidelines should doctors use?” The answer, however,  may surprise you.

In another post dr Wes describes the retraction of an online-before-print case report entitled “Spontaneous explosion of implantable cardioverter-defibrillator” with dramatic pictures of an “exploded ICD” .(here is the PDF of the cache). This retraction took place after dr. Wes reported the case at his blog. Strange enough the article was republished this February, with another title, “Case report of out-of-hospital heat dissipation of an implantable cardioverter-defibrillator.” (no explosion anymore) and no shocking photos. Food for thought….  The main conclusion of dr Wes? Independent scientific peer-reviewed journals might not be so independent after all. Library matter

Sorry, but I had to laugh about David Rothman’s Common Sense Librarianship: An Ordered List Manifesto. As put it so well by Kathryn Greenhill at her blog Librarians Matter: “It is a hot knife of reason through the butterpat of weighty bullshit that often presses down as soon as we open our mouths to talk about our profession.”

Oh, and a big congrats to Aaron Tay for his  Library Journal movers & Shakers award. Please read why he deserves this award. What impresses me the most is the way he involves users and converts unhappy users “into strong supporters of the library”. I would recommend all librarians to follow him on Twitter (@aarontay) and to regularly read his blog Musings about Librarianship. Web 2.0

The iPad 2 is here. A very positive review can be found at Techcrunch. The iPad 2 has a camera, is thinner, lighter, and has a much more powerful dual-core chip. Still many people on Twitter complain about the reflective screen. Furthermore the cover is stylish but  not very protective as this blogger noticed 2 days after purchase.
Want to read further: You might like “iPad 2: Thoughts from a first time tablet use” (via @drVes)

It has been five years since Twitter was launched when one of its founders, Jack Dorsey, tweeted “just setting up my twttr’. Now Twitter nearly has 200 million users who now post more than a billion tweets every week. (see Twitter Blog)

Just the other week  Twitter has told developers to stop building apps. It is not exactly clear what this will mean. According to The Next Web it is to prevent confusion of consumers third-party Twitter clients and because of privacy issues. According to i-programmer the decision is mainly driven by the desire of Twitter to be in control of its API and the data that its users create (as to maximize its -future- revenue). I hope it won’t affect Twitter-clients like Tweetdeck and Seesmic, which perform much better (in my view) than Twitter.com.

Lanyrd, the Social Conference Directory

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

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

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

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

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

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

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

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

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

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

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

What can we expect the next few years?

Simon in the Guardian:

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

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

Related Articles

• Lanyrd (lockergnome.com)
• Elevator Pitch: Lanyrd makes conferences social, via Twitter (guardian.co.uk)
• We added conference coverage to Lanyrd.com, now collecting video/audio/slides/.. (lanyrd.com)
• Cool Websites and Tools [October 18th] (makeuseof.com)

Implementing Twitter in a Health Sciences Library

Twitter describes itself as “a service for friends, family, and co-workers to communicate and stay connected through the exchange of quick, frequent answers to one simple question: What are you doing?” [2].

The “answers” are equally simple, because the tweet (that what is being “said”) must fit in 140 characters. The tweet does not only contain plain text, but can contain short-URL’s which link to webpages, figures and videos.

However, tweets have evolved to more than everyday experiences, and take the shape of shared links to interesting content on the web, conversations around hot topics (using hashtags (#), like #cochrane OR #ev2010 (conference evidence2010)), photos, videos, music, and real-time accounts of a newsworthy event [2]. Furthermore, Twitter is now also used by institutions and companies  for branding, marketing and costumer service. This also applies to libraries, with public libraries leading the way. Health science libraries started twittering  in 2009 and as of 2010 there were (only) 24 of them. In addition, the National Library of Medicine (NLM) and most of the regional National Network of Libraries of Medicine (NN/LMs) have a Twitter presence.  I follow @NLM_LHC and @NLM newsroom, for instance.

The NYU Health Sciences Libraries (NYUHSL) began using Twitter in June 2009. The team, consisting of the Director, the Emerging Technologies Librarian and the Web Services Librarian of the NYUHSL, described their experience with the implementation of Twitter in the latest Medical Reference Services Quarterly [1]

The main aim of their Twitter account was to disseminate topics similar to what was posted on their Web site: news about facilities, resources, handy tidbits, services offered, downtime, events, and staff, as well as breaking news.

What was their approach and what were their main experiences?

• Claim your name, as soon as you vaguely consider using Twitter!
  In the case of  NYUHSL, their usual library acronym was already taken, so they took a similar name: @NYU_HSL (because of the 140-character limit, it is advisable to use as few characters as possible: this will leave more room when somebody replies to you).
• They added the library logo as a profile picture and included a link to the library website plus a short “bio”.
• First the team shared responsibility for posting on Twitter (by logging in into the NYU_HSL account and posting), but this posed coordination problems (like double postings, irregular postings). Therefore it was decided that team members would post according to a schedule. Furthermore there was a 2-week rotation. Any important news was tweeted promptly and interesting news from other Twitter users was occasionally retweeted .
• Later CoTweet was used. This is a free tool, which -as its name suggests- allows multiple people to communicate through corporate Twitter accounts and stay in sync while doing so. One person is the account owner, who creates and maintains the account and gives other people access to it. The individual members can post to Twitter via the Co_tweet account.  CoTweet uses bit.ly as an URL-shortener, displays some (rudimentary) stats, allows scheduling and archiving of tweets and has some other slick features for corporate Twitter use. (See  this post at News CNET for a comparison between CoTweet and the better known Hootsuite)
• What I most liked about the paper – besides the description of CoTweet – is the content flow diagram the authors used (adapted below). Posts from their library blog were automatically cross-posted via RSS to Twitter using Twitterfeed, whereas tweets were in their turn automatically posted on Facebook. To this end a Twitter Tab was added to the NYUHSL Facebook fan page. In addition it remained possible to post manually to the different social networking tools and to respond to followers or retweet messages of other users.

• The team also had to find the right tone for Twitter: the style of tweets is more informal than the style of blog posts. They emphasize the importance of keeping the nuances of different social networking sites in mind when establishing an institutional presence.
• They promoted Twitter in many ways:
  • A large Twitter mascot (blue bird) with the text: “Follow NYU_HSL on Twitter” was placed on the prominent Web’s site feature bar (see Fig. below). Unfortunately the twitter message only appears when you press “next”. Most users will not do this.
  • Creation of a small poster about Twitter.
  • A word of mouth campaign (in orientation presentations, and a tag line with Twitter account information in e-mail correspondence to students: according to Pew Internet [3] college graduates are among the biggest users of Twitter.
  • description and promotion of the Twitter account in the library’s e-mail newsletter and in blog posts.

And finally, we have to come up with the Key Question: was it all worth the effort?

At the time of writing the NYU-HSL had 66 followers, 27 of which were affiliated with the NYU (others being other libraries and librarians for instance). This is not a very big (target) audience, but I agree with the authors that the definition of success in social media is relative.  There were clear (subjective) benefits, like the low cost, ease of use, low effort to maintain the service on the one hand and the possibility to engage the audience, get user opinions and the opportunity to fix problems quickly on the other hand. Furthermore it’s presence on Twitter enhances the library’s reputation, as the library is making an effort to extend beyond its walls and confirms the role of librarians as technology leaders.

I also agree with the library’s basic principle “to give users as many options as possible to keep current with library news, resources, and services.” In this regard Twitter is a simple and effective method for promotion.

Thus health, medical and other libraries. I would say, if you are not twittering, give it a try and read the reviewed paper [1] for more tips. One of these tips is to connect with other libraries on Twitter as to learn from their experiences.

Credits:  @DrShock dm-ed (direct messaged) me on Twitter to alert me to the paper. Thanks Walter!

References (all assessed 2010-11-23)

1. Cuddy, C., Graham, J., & Morton-Owens, E. (2010). Implementing Twitter in a Health Sciences Library Medical Reference Services Quarterly, 29 (4), 320-330 DOI: 10.1080/02763869.2010.518915
2. Mashable http://mashable.com/guidebook/twitter/
3. Lenhart, A., and Fox, S. ‘‘Twitter and Status Updating.’’ Report: Web 2.0, Social Networking. Pew Internet & American Life Project (February 12, 2009). Pew Internet: http://www.pewinternet.org/Reports/2009/Twitter-and-status-updating.aspx

Related Articles

• Power Tweeting: Next Steps (libraryjournal.com)
• Twitter CRM Service CoTweet To Enter Japan Assisted By NTT Communications (asiajin.com)
• Libraries on Friendfeed (library20.org)

Expert Curators, WisdomCards & The True Wisdom of @organizedwisdom

Note added 2010-11-12:  Anyone who wishes to can now email info@organizedwisdom.com to let his/her profile as expert curator removed from the site of Organized Wisdom (see comments by Unity Stoakes, Co-founder OrganizedWisdom)

————————————————————————————————-

Twitter and other Social Media can be full of random rubbish, but can also contain useful information. Personally, I use Twitter for work-related tweets about 95 percent of the time, and I choose the people I follow carefully so that I’m not overwhelmed by a flood of tweets. As I’ve said before: people who I follow are my human filter to the Twitter Noise. And I hope that is vice versa.

Organized Wisdom (http://organizedwisdom.com and @organizedwisdom on Twitter) is a 3-4 year old company that uses a similar approach to filter useful health information out of the daily junk.

Or as Steve Krein, CEO of Organized Wisdom tells Matthew Holt of the Health Care Blog in an interview (video below)

Organized Wisdom has created a new way for people to use the internet to solve their health problems by using experts. We think experts are the missing gap between two worlds: heavily simplified health encyclopedias & dictionaries and complex stuff on the internet (where you are quickly overwhelmed by all the health stuff).

OrganizedWisdom® uses WisdomCards™ , a unique service which helps people easily discover great links, curated by experts and organized by topic.

Vodpod videos no longer available.

organized wisdom on healthcare blog, posted with vodpod

In principle this is an excellent idea, and that is why I originally joined Organized Wisdom.

I have a badge on my blog and I’m a so-called expert curator and contributor for Medical Education and Medical Librarian (topics)

Profile now removed from Organized Wisdom (2010-11-11)

So far so good. Besides being a creator of content (which is nothing more than being a source for automatically created links present in my health-care related tweets), I’m also a “consumer”. Because I’m interested in Endocrinology I follow @EndocrinologyOW on Twitter. There are many other OW topics on Twitter, that you can follow.

Recently Organized Wisdom launched a new account @ActivityDigest, which -it won’t surprise you- gives an activity digest of the curators. Apparently to stimulate “engagement” (Oh wonderful CEO-terminologies).

This is why I got this tweet in my twitter stream (I don’t follow @ActivityDigest, but I see its tweets once it mentions me).

I felt flattered: “recommended as an expert curator for Organized Wisdom“…. That sounds like any scientists could only dream of.

And before I realised it, I retweeted the message (repeated the message to my twitter stream).

Immediately I felt a bit uncomfortable. And this feeling grew as I saw almost everybody in my Twitter stream being labeled as an “Expert Curator”. … and everybody retweeting his/her “pat on the back” and congratulating each other….

I don’t have the original retweets, but a search for “Expert Curator” shows that last weeks “expert-curator”-retweets still continue

1. 
   American_Heart Thanks! RT @ActivityDigest @American_Heart was recommended as an Expert Curator for quality links, expertise. Congrats!… 08 Nov 2010 from HootSuite
2. 
   rudisglutenfree Cool! RT @ActivityDigest: @rudisglutenfree recommended as Expert Curator 4 quality links, expertise. http://bit.ly/9IOHME @OrganizedWisdom 08 Nov 2010 from TweetDeck
3. 
   _EndlessBeauty Oh wow thank you @ActivityDigest!! We appreciate the recommendation for an Expert Curator 🙂 @organizedwisdom 08 Nov 2010 from web
4. 
   DrBermant Michael Bermant, MD – OrganizedWisdom Contributor Profile http://bit.ly/99hDES Learn why he is an Expert Curator, see links he has shared. 09 Nov 2010 from bitly
5. 
   shadegardener @ActivityDigest Wow, I never heard of Expert Curator for quality links before, thanks for letting me know I was awarded! 🙂 09 Nov 2010 from SocialOomph
6. 
   bambooinspired @ActivityDigest Hi and thanks for the Expert Curator for quality links mention! That’s really appreciated 09 Nov 2010 from SocialOomph
7. 
   BMJ_Group Thanks :o) RT @ActivityDigest: @BMJ_Group was recommended as an Expert Curator for quality links, expertise. Congrats! http://bit.ly/an2Vio 09 Nov 2010 from TweetDeck
8. 
   ImagineNursing Nursing Tweets: BMJ_Group: Thanks :o) RT @ActivityDigest: @BMJ_Group was recommended as an Expert Curator for qu… http://bit.ly/954uDQ 09 Nov 2010 from twitterfeed

— this quote was brought to you by quoteurl

Note (1) the real surprise of some people (Wow, I never heard of Expert Curator for quality links before) and (2) the chaff (endless beauty) between the wheat ((BMJ_Group, American_Heart). I mean: if some of these accounts would start following me, I would probably block them and report them for spam! Really!

Activity Digest  continues its activities. Now everybody knows he or she is a curator,  it tweets what the curators have achieved this week. Probably OW is hoping curators retweet their achievements and spread the word for them. We are not only used as living filters, but even more so as “living ads”!

It made me frown, but the worst thing that struck me today is that the twittered information isn’t really filtered for quality. About a quarter is what I would call SCAM or at least CRAP.

Look on which WisdomCard™ I land on when I follow a tweet “Tired Of Fake Anti-aging Creams? (Try HGH Energizer”): rubbish by natural healers etc (spread by @EndocrinologyOW)
Similar cards are antiaging medicine that gets at the hormone causes, supplements for diabetes support and what about the Type  2 Diabetes Natural Treatment-card. Cinnamon as treatment? Anyone? And of course there are also chiropractor WisdomCard™ cards where “expert curators share great links about chiropractor”.

Part of the problem may be that Organized Wisdom doesn’t only share links from “Health Centers”, but also from Wellness Centers (Aging, Diet, Exercise & Fitness etc) and Living Centers (Beauty, Cooking, Environment). Apparently one card can have information for 2 or 3 centers (diabetes and multivitamins for example)

I feel used.

Organized Wisdom uses the credibility of me and other curators, including so-called “top expert curators” as Dr Pho (Kevin MD – blog), to cover up the incredibility of others, with the intention to lure users in.

Who doesn’t believe top curators like the ones below? Who doesn’t want to be considered one?

Going through the “expert curator” Twitter search, I saw (only) one very sensible man, EdBennett, who manages web sites for a large academic medical center and creates overviews of social media usage by hospitals. Friendly, he asked to be removed from the Expert Curator list.

I think I will try the same, although (considering the answer of dr Ves), that may not be a sinecure.

Perhaps we can try a concerted action. You know, the power of the crowd….

1. 
   EdBennett Dear @OrganizedWisdom – please remove me as an “Expert Curator” from your site. Thank you. 08 Nov 2010 from web
2. 
   DrVes @EdBennett I tried this several times but I don’t think it worked… 🙂 08 Nov 2010 from web in reply to EdBennett
3. 
   EdBennett @DrVes I like to start by asking nicely. 08 Nov 2010 from web in reply to DrVes

— this quote was brought to you by quoteurl

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Added 2010-11-12: For more striking examples, please read the comments. (anti-quack people “recommending” homeopathy treatment of cancer; dr ves -true expert on asthma beaten by the author of slim-fit-health.info/newsletters/fat-loss-now/…..

Added 2010-11-12: I found a 2 year old post from TechCrunch called OrganizedWisdom, the “Mahalo For Health”, Raises $2.3 Million. Some of the commenters came to the same conclusions (why didn’t anybody pick this up? Vanity? Trust? Ignorance? -this also applies to me I must admit):

Like this one from @Holly (emphasis mine)

I am glad you brought up the “written by people who do not have a clue, let alone ANY medical training [of any kind] at all.” I have no experience with any kind of medical education, knowledge or even the slightest clue of a tenth of the topics covered on OW, yet for some reason they tried to recruit me to review cards there!?! That was my first impression of the company, if they have a bunch of people like me as the final word on their cards, the info will be so off base the site will give the big fail so quick. In my opinion, medical knowledge or advice is not something I would trust from any random joe, so why would I trust anything from random people who work there, considering they have absolutely no experience or knowledge? They advertise that a doctor reviews every card, personally I think that is a bunch of BS, considering neither me nor others that I know work higher up there have any training whatsoever, guess anyone can be a doctor now…

And Josh,

You are correct about some health sites’ contents written by people with limited or non-existent medical knowledge or training; the public at large do not know this. In fact, one of my neighbors, a “MA” or “Medical Assistant,” writes for OrganizedWisdom.com.

Related Articles

• Introducing OrganizedWisdom’s New Platform To Connect Experts’ Wisdom to People Who Need It (organizedwisdom.com)
• Sharing the OrganizedWisdom Vision at Ingenuity 2010: A New Way To Help People Solve Health Problems (organizedwisdom.com)
• Creating Order Out of Chaos, Helping People Find the Best Resources (organizedwisdom.com)
• Steve Krein talks OrganizedWisdom (thehealthcareblog.com)
• The Solution for the Enormous Problem of Filter Failure: Expert Curation (organizedwisdom.com)
• Featured Nurses, Part 8 (organizedwisdom.com)

Friday Foolery [35] A Benzene Smiley

A chemical professor by the Twittername of @Takaguchi (Tak), who describes himself as a “Chemist loving nanocarbons, supramolecules, main group elements, photoreactions, and photoproperties has this Twitter Avatar:

A benzene smiley…

Brilliant!

First seen at the Facebook Fan Page ( login required?) of Sciencebase.com (of David Bradley)

He referred to a post at The Reactive Chemistry Blog of …. uhhh again David Bradley, who is also the author of ScienceText

BTW I seem to smile /give thumbs up at David’s ScienceBase Facebook page a lot: I’m one of his top 13 Facebook fans (or likers) ever.
It is no surprise with so many funny ànd good science and tech articles.

Yeah.

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