Jun 04

Kudos to Michelle Canipe and colleagues at Washburn University

This is unbelievably awful:

http://cjonline.com/news/2013-06-03/former-employee-files-suit-against-washburn-library-dean

Former Washburn University librarian Michelle Canipe contends in a recently filed lawsuit that Washburn Dean of Libraries Alan Bearman was abusive to her and other employees, even punching one in the face and head.

 

I take it back. It’s not unbelievable. I think most of us know someone who works somewhere made horrible by an abusive boss. I know a few someones who work in libraries with bosses nearly this bad.

Just wanted to take a minute to express my admiration for Michelle Canipe and her colleagues for DOING something.

 

May 22

RAND: The Evolving Role of Emergency Departments in the United States

Added to my reading list:

http://www.rand.org/pubs/research_reports/RR280.html

The research described in this report was performed to develop a more complete picture of how hospital emergency departments (EDs) contribute to the U.S. health care system, which is currently evolving in response to economic, clinical, and political pressures. Using a mix of quantitative and qualitative methods, it explores the evolving role that EDs and the personnel who staff them play in evaluating and managing complex and high-acuity patients, serving as the key decisionmaker for roughly half of all inpatient hospital admissions, and serving as “the safety net of the safety net” for patients who cannot get care elsewhere. The report also examines the role that EDs may soon play in either contributing to or helping to control the rising costs of health care.

May 20

1994 Video Predicts iPad

Via PaleoFuture, this Knight Ridder video describes the iPad (okay “the tablet”…but Apple got there first) pretty damned well. Fascinating to me that an entity created by a newspaper company had this sort of prescience…and totally failed to act on it.

“Tablets will be a whole new class of computer, they’ll weigh under two pounds. They’ll be totally portable. They’ll have a clarity of screen display comparable to to ink on paper. They’ll be able to blend text, video, audio and graphics together and they’ll be part of our daily lives around the turn of the century. We may still use computers to create information, but we’ll use the tablet to interact with information.”

 

 

Thanks to On the Media for the heads-up on PaleoFuture.

 

Apr 25

Zebra Hunting

Photo credit: Lesage Stefaan http://tinyurl.com/bpprqn6

Non-clinicians may not be familiar with “zebra” as a medical slang term.

Zebra is a medical slang term for a surprising diagnosis.[1] Although rare diseases are, in general, surprising when they are encountered, other diseases can be surprising in a particular person and time, and so “zebra” is the broader concept.

The term derives from the aphorism ”When you hear hoofbeats behind you, don’t expect to see a zebra”, which was coined in a slightly modified form in the late 1940s by Dr. Theodore Woodward, a former professor at the University of Maryland School of Medicine in Baltimore.[2] Since horses are the most commonly encountered hoofed animal for most people and zebras are comparatively rarely encountered, logically one could confidently guess that the animal making the hoofbeats is probably a horse. By 1960, the aphorism was widely known in medical circles.[3]

http://en.wikipedia.org/wiki/Zebra_(medicine)

There are times, though, when it makes sense to go looking for zebras.

Search engines like Google and database search (PubMed, EBSCO, whatever) rely on frequency and/or co-occurrence to rank search results, so common conditions are going to be easy to find and rank high in search results, while a rare disease/diagnosis  will not.

Enter FindZebra.

FindZebra is a specialised search engine supporting medical professionals in diagnosing difficult patient cases. Rare diseases are especially difficult to diagnose and this online medical search engines comes in support of medical personnel looking for diagnostic hypotheses. With a simple and consistent interface across all devices, it can be easily used as an aid tool at the time and place where medical decisions are made. The retrieved information is collected from reputable sources across the internet storing public medical articles on rare and genetic diseases.

FindZebra indexes 31,000 articles on rare and genetic diseases from these sources:

  • Orphanet: an online rare disease and orphan drug data base. Copyright, INSERM 1997. Available on www.orpha.net
  • Wikipedia: The free encyclopedia. Wikimedia Foundation, Inc., Category Rare Diseases. Available on en.wikipedia.org/wiki/Category:Rare_diseases
  • NORD Rare Disease Database and Organizational Database. The National Organization for Rare Disorders (NORD). Available on rarediseases.org/
  • The Genetic and Rare Diseases Information Center (GARD). Available on rarediseases.info.nih.gov/GARD
  • Swedish Information Centre for Rare Diseases. Swedish National Board of Health and Welfare. Available on www.socialstyrelsen.se/rarediseases
  • m-Power Rare Disease Database. Madisons Foundation. Available on www.madisonsfoundation.org/
  • Health On the Net Foundation. Available on www.hon.ch/HONselect/RareDiseases/
  • Rare Diseases. About.com Health. Available on rarediseases.about.com/
  • Genetics Home Reference: A service of the U.S. National Library of Medicine. Available on: ghr.nlm.nih.gov/BrowseConditions
  • Wikipedia: The free encyclopedia. Wikimedia Foundation, Inc., Category Syndromes. Available on en.wikipedia.org/wiki/Category:Syndromes
  • Online Mendelian Inheritance in Man, OMIM. McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University (Baltimore, MD) and National Center for Biotechnology Information, National Library of Medicine (Bethesda, MD). Available on www.ncbi.nlm.nih.gov/omim/
  • Wikipedia: The free encyclopedia. Wikimedia Foundation, Inc., Selected pages on rare diseases. Available on en.wikipedia.org/

 

To test FindZebra, I decided to search using the symptoms of a not-terribly-well-known condition called “Familial Mediterranean Fever.” My search string was: peritonitis fever inflamation 

Pretty cool results:

findzebra

 

Because the site makes a point of repeating it, I’ll do the same:

WARNING! This is a research project to be used only by medical professionals.

 

Apr 11

“Social media has changed Emergency Medicine Education” (free resources)

EM Resident Jeremy Webb MD (Wake Forrest, PGYIII) lists some of his favorite resources, adding: “I promise, you will read something today that may save a life tomorrow.”

EMCrit

Website: EMCrit.org
Twitter: @emcrit

Description: Scott Weingart is a critical care fellowship trained EM doc who specializes in bringing “upstairs care (ICU) downstairs” to the ED. If it involves critically ill patients, you’ll find it discussed here.

Resus

Website: Resus.me
Twitter: @cliffreid

Description: Cliff Reid is a prehospital physician with expertise in resuscitation. His site seeks to provide up-to-date information and cutting edge techniques in the field of resus.

RegionsTraumaPro

Website: Regionstraumapro.com
Twitter: @regionstrauma

Description: Michael McGonigal MD is the Director of Trauma Services for Regions Hospital in St. Paul, MN. If you’re interested in the who, whys, and whats of trauma care, he’s your man.

HqMeded-Ecg

Website: hqmeded-ecg.blogspot.com
Twitter: @smithecgblog

Description: Dr. Stephen W. Smith is a faculty physician at Hennepin County Medical Center in Minneapolis, MN. He is known for his mastery of ECGs and his posts literally walk you through an ECG of an emergency department patient from start to finish.

CCPEM

Website: ccpem.com
Twitter: @critcareguys

Description: Mike Winters (U of Md), Peter DeBlieux (LSU), and Rob Rodriguez (UCSF). The website is a $60 investment in audio commentary by critical care experts, but the Twitter account is useful in providing and linking to critical care pearls around the net.

EKGumen

Website: ekgumen.tumblr.com
Twitter: @amalmattu

Description: The master of EM cardiology in the digital flesh. His tumblr site is awesome and he provoides weekly 15 min case presentations surrounding ECGs.

eMeducation

Website: emeducation.org
Twitter: @keepingupwithEM

iPhone app: Up-Shot Emergency Medicine

Description: Clay Smith is a clinical monster who completed IM-Peds as well as EM residencies and is now professor of all these disciplines at Vanderbilt in TN. His main push is evidence based medicine and you’ll enjoy the discussion of recent articles of interest.

UltrasoundPodcast

Website: UltrasoundPodcast.com
Twitter: @ultrasoundpod

Description: Matt Dawson and Mike Mallin, both ultrasound directors at University of KY and University of UT respectively. Great podcast that any one from interns to attendings can listen to in order to up their game.

Emlitofnote

Website: Emlitofnote.com

Twitter: @emlitofnote

Description: Want to know the hot articles that everyone in EM is reading? Look no further than Ryan Radecki’s site. You’ll find critical appraisals of current literature that typically start a discussion among other EM bloggers.

Life in the Fastlane

Website: lifeinthefastlane.com
Twitter: @sandnsurf, @kane_guthrie, @precordialthump, @eleytherius

Description: Authors at Life in the Fast Lane (Mike Cadogan, Kane Guthrie, Chris Nickson, and Michelle Johnston), one of the pre-eminent blogs on everything emergency medicine and some of the biggest proponents of FOAM (free open access medical education).

Academic Life in EM

Website: academiclifeinem.blogspot.com
Twitter: @m_lin

Description: Michelle Lin leads a team of Physician writers in providing tips for EM. She is legendary for her Paucis Verbis cards — great quick reference cards that you can link to your dropbox and evernote account for free.  Her blog is great for in depth lit reviews as well.

In addition to the twitter handles, podcasts, and blogs of these social media patrons, you can also find feeds by eminent journals and emergency medicine colleges as well (i.e. @JAMA_current, @NEJM, @AnnalsofEM, @EmergencyDocs (ACEP)). You may also want to visit http://www.foamem.com/ which is an RSS feed that collates many of these resources together.

Other free resources for medical education: iMedicalApps top 10 free iPad medical Apps list . The following is a link to all the Emergency Medicine specific medial apps reviewed on iMedicalApps: iMA EM apps

Oct 03

Data Compare for Oracle

I’ve been doing a lot of Web development since I started a new job in June. This has been (pleasantly) challenging for a number of reasons. The environment is brand-new to me and, in comparison to other places I’ve worked, large and complex.

For instance, I’ve never developed in ColdFusion before and one of my Web applications needs to have the front end (a public-facing side on the public-facing server for users) on a ColdFusion8 server and the back-end of (used by members of my own department) lives behind the firewall, in our intranet, and runs ColdFusion9…so I’m learning two version of ColdFusion at the same time.

And I’ve worked with Sybase and MySQL databases, but Oracle is new to me. The Database Administrator I work with is a friendly, immensely helpful guy who I try to avoid bugging unless I’m really, really stuck. Developers far more experienced and skillful than me have all admonished me: “Be very, very nice to your DBA.”

So when I run into problems, I tend to head back to the manuals for the software I’m using (Oracle’s SQL Developer, PL/SQL Developer), but sometimes that doesn’t give me the sort of quick, painless solutions I crave.

Last week, I wanted to compare the data in a restored backup to the data in our production database and generate a script to copy the missing restored data to the production database. I asked my DBA and a far more experienced developer what tool I could use to accomplish this quickly and easily.

Neither had any suggestions- though both agreed that it would be wonderful if such a tool existed.

It turns out that such a tool DOES exist- and is awesome. A little Googling turned up Data Compare for Oracle from Red Gate Software- which is part of their Deployment Suite for Oracle.

I downloaded the free, fully functional trial and was so blown away by it that I emailed Red Gate to tell them so.

The interface is intuitive and well-designed- without spending a single second on any manual or help files, I made my comparisons and generated a deployment script within minutes of installing the application. Go check out the screen shots on Red Gate’s site to see how simple it is to use.

I was able to compare two databases on two different servers, limit the comparison to specific tables and criteria, drill down for details on the comparison, and generate a script to make the changes I needed. In minutes. Seriously.

Blown. Away.

To my delight, I was able to wrangle a license for my own use at work. This was an enormous relief, as the thought of losing it at the end of the 14-day trial brought tears to my eyes.

Download the trial and try it.

(Does anyone recall the last time I so nakedly endorsed a product? I don’t. That’s how much I like it.)

Oct 03

The NNT

Just realized that I have not yet mentioned here that I don’t work in a medical library any longer.

A few months ago, I took a job as the geek (technologist-generalist?) for the Department of Emergency Medicine at SUNY Upstate. I love the job. Love it. The people are great and the work is both challenging and interesting.

While I have really enjoyed shifting more to the mechanics of health information than the content, I’ve found certain librarianish habits and interests haven’t faded.

For instance, TheNNT.com fascinates me.

http://www.thennt.com/

“There is a way of understanding how much modern medicine has to offer individual patients. It is a simple statistical concept called the “Number-Needed-to-Treat”, or for short the ‘NNT’. The NNT offers a measurement of the impact of a medicine or therapy by estimating the number of patients that need to be treated in order to have an impact on one person. The concept is statistical, but intuitive, for we know that not everyone is helped by a medicine or intervention — some benefit, some are harmed, and some are unaffected. The NNT tells us how many of each.”

Here’s a great example: Anticoagulation for Venous Thromboembolism

Or check out Mediterranean Diet for Secondary Prevention After Heart Attack.

Is it just me, or is this site crazy awesome? I’ve encountered a handful of physicians who like the site a lot, but I’ve heared next to nothing from medical librarians. Any thoughts?

Jul 14

Voltaire & Information Services: “Good Enough” – “Excellence” – “Perfection”

I once worked with a CIO who, on my first day, told me that his philosophy was: “never let ‘perfect’ get in the way of ‘good enough’”

I thought this was a curious philosophy and something about it seemed familiar, so I dug around a bit and found many versions of this line.

  • “Perfect is the worst enemy of Good Enough”
  • “Perfection is the enemy of Good Enough”
  • “Better Than Is the Enemy of Good Enough”
  • “Better Is the Enemy of Good Enough”

It didn’t take long to figure out that these were all misquotations of Voltaire:

“The Perfect is the Enemy of the Good.”

I guess I took that point reasonably well (as I understood it). In the context of this talk with the CIO, it meant that it was often not a wise use of resources to pursue perfection when we already had (or could easily achieve “serviceable.”

But whenever I thought of this talk with the CIO, the phrase “good enough” kept rubbing me the wrong way.

I’m not a perfectionist. Perfection is an ideal, not an acheivable goal. Striving for perfection, in my opinion, leads to unsociable behaviors, stress-induced health conditions, and really, really annoying people.like Phil Hartman’s The Anal-Retentive Chef I miss Phil Hartman.

On the other hand, I don’t think “good enough” is an acceptably high bar. When we deliver services to our customers/patrons/clients, should’t we be shooting for “excellence”? Excellence is do-able.

It seems to me that, most of the time, the amount of effort that would bridge the difference between “good enough” and “excellent” is small and that “excellence” pays dividends in extra-satisfied customers/patrons/clients that it is absolutely worth investing.

On the other side of that is that users/clients/customers/patrons are usually savvy enought to know “good enough” when they see it. It tells that that ther needs really aren’t the priority. Rather than paying dividends, it costs.

So. My new motto is this:

“Good enough” is the enemy of excellence. Strive for excellence and know when to stop reaching for the impossible goal of perfection.

How do you know when you’ve achieved excellence? Ask your users/clients/customers/patrons.

Apr 06

Books I Would Very Much Like to Read/Review

New(ish) or upcoming books that I would really like to read and review here

The Information: A History, a Theory, a Flood
By James Gleick

Okay, I admit I’m already reading this one- and LOVING it.  Gleick (who also wrote a great biography of Richard Feynman), writes in a fascinating, engaging way about the history of information and of information technology.  This book wonderfully illuminates how we got where we are and provides hints at where we might be going.

I would like a stack of 20 copies, please, so I can give one to each of my favorite 20 technology-resistant librarians.

Check out these reviews.

________________________________

An Introduction to Research for Health Librarians
By Barbara Sen

This looks like one I’d love to read- and it is being released in May.

“This step-by-step guide provides encouragement, support, and direction for health librarians who may be new to research and evaluation or lacking in confidence or expertise. With a focus on practice-based research, evaluation, and small projects, it guides the reader through the research process, from starting to think about the research question, through to the completion of the research and dissemination of the results. It is designed to encourage quality research from library professionals and encourage them to add to the evidence base in this sector. This timely collection considers methods and approaches that are suitable in a health library context, making it a useful tool for health library professionals and students alike.”

________________________________

Evidence-Based Medicine: How to Practice and Teach it
By Sharon E. Straus MD, Paul Glasziou MRCGP FRACGP PhD, W. Scott Richardson MD, R. Brian Haynes MD

This one was released in December, but I haven’t gotten to it yet- and I’ve been instructed quite sternly to read everything Sharon Strauss writes.

“Evidence Based Medicine provides a clear explanation of the central questions: how to ask answerable clinical questions; how to translate them into effective searches for the best evidence; how to critically appraise that evidence for its validity and importance; and how to integrate it with patients’ values and preferences.”

________________________________

Without a Net: Librarians Bridging the Digital Divide
By Jessamyn C. West

Rachel Walden taught me what a “librarian crush” is, and I have had a librarian crush on Jessamyn since I saw these signs.

Teaching novice computer users, including seniors and individuals with disabilities such as low vision or motor skills, how to do what they want and need to do online is a formidable challenge for library staff. Part inspirational, part practical Without a/the Net: Librarians Bridging the Digital Divide is a summary of techniques, approaches, and skills that will help librarians meet this challenge.

Jessamyn C. West’s experience as a librarian is deeply immersed in technology culture, yet living in rural America makes her uniquely qualified to write this book. Taking a big-picture approach to the subject, she demystifies and simplifies tech training for the busy librarian, providing an easy-to-use handbook full of techniques that can be used with all of a library’s many populations. As an added bonus, she also examines the players in the library technology arena to offer firsthand reports on what works, what doesn’t, and what’s next.

________________________________

The Atlas of New Librarianship

Libraries have existed for millennia, but today the library field is searching for solid footing in an increasingly fragmented (and increasingly digital) information environment. What is librarianship when it is unmoored from cataloging, books, buildings, and committees? In The Atlas of New Librarianship, R. David Lankes offers a guide to this new landscape for practitioners. He describes a new librarianship based not on books and artifacts but on knowledge and learning; and he suggests a new mission for librarians: to improve society through facilitating knowledge creation in their communities.

The vision for a new librarianship must go beyond finding library-related uses for information technology and the Internet; it must provide a durable foundation for the field. Lankes recasts librarianship and library practice using the fundamental concept that knowledge is created though conversation. New librarians approach their work as facilitators of conversation; they seek to enrich, capture, store, and disseminate the conversations of their communities.

To help librarians navigate this new terrain, Lankes offers a map, a visual representation of the field that can guide explorations of it; more than 140 Agreements, statements about librarianship that range from relevant theories to examples of practice; and Threads, arrangements of Agreements to explain key ideas, covering such topics as conceptual foundations and skills and values. Agreement Supplements at the end of the book offer expanded discussions. Although it touches on theory as well as practice, the Atlas is meant to be a tool: textbook, conversation guide, platform for social networking, and call to action.

[More here]

________________________________

What new books are you reading or looking forward to?

Apr 04

SciPlore Combines Mind Maps with Reference and PDF Management

SciPlore is an interesting tool that I just started playing with.

“Are you using mind mapping tools such as MindManager, FreeMind or XMind? And reference management tools such as JabRef, Endnote, or Zotero? And do you sometimes even create bookmark in PDFs? Then you should have a look at SciPlore MindMapping.”

My need for PDF management tools is really pretty specific and infrequent. What about you academic folks? Is this something you could use?

Mar 18

Patient Handouts at the Point of Care

My Primary Care Physician is a good guy.  His practice implemented an EMR a few years ago- each time I see him, I ask him how that’s going and he lets me see how it looks on the tablet PC he carries into the exam room.

My last visit was for an annual checkup a few weeks ago and we were talking about point-of-care tools and integration with his EMR.  It turns out that their EMR has no useful functionality to help find or produce patient education handouts he can quickly sent to a printer

I told him it would not be difficult to make a tool that would enable him to find authoritative handouts quickly and easily from the paid resources his practice has available, and he expressed interest in that idea.

He hasn’t followed up, but I found the idea interesting, so I started thinking about what sort of tool could be built for this purpose that could be integrated into any EMR using only patient handouts that are available at no cost on the Web.

With that in mind, I came up with a Google Custom Search Engine for use by providers at our hospital, but I see no reason why it couldn’t be used by any institution or practice.

The idea behind this is that any search result is not only authoritative, but that it is within a click of a “print” button.

There are built-in refinements for large print, pediatrics, Spanish language, Seniors, and low literacy.

Please give it a try here.

Internists and medical libraryfolk: I’d be grateful for your feedback!

Mar 03

Spelling it out for HarperCollins

This is my favorite thing anyone has said or done in response to the HarperCollins / Overdrive baloney.

“The Virtual Library of the Pioneer Library System decided to take a look at the print editions of HarperCollins titles.

We ask the question, What does wear and tear look like on a print book? Is 26 checkouts a realistic standard to apply to ebooks?

Visit our Open Letter to the Publisher to know our thoughts

http://bit.ly/e0SeBi

Let HarperCollins know what you think.”

Mar 02

Common Sense Librarianship: An Ordered List Manifesto

Common Sense Librarianship

1. The world of information has always been in a constant state of flux. As technology continues to change the world of information, it is preferable for information professionals and the institutions they serve to adapt rather than perish.

This is not a new idea.

2. The most important qualities an information professional can posses are adaptability, resourcefulness, a habit of looking for better/easier/more efficient ways to do things, creativity, and a love for solving problems.

This is not a new idea.

3. Organizations providing information services should pay as close attention as possible to the needs of those whose information needs they serve. Where these needs can be measured, they should be measured. If you can find something that your library is regarding as more important than user needs, something is very wrong.

This is not a new idea.

4. Whenever possible, obstacles between users and the information they seek should be removed.  Among these obstacles are academic jargon and expecting users to care about cataloging minutia (it is minutia to them, get over it).  Information professionals should be champions of clarity and concision who find accessible ways to describe complex topics.

This is not a new idea.

Much of the above comes from conversations with really smart and insightful people like Amy Buckland, Kathryn Greenhill, Jenica Rogers, and Maurice Coleman.

Any good stuff above should be credited to them. Any stupid stuff should be blamed on me.
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