Baaaaad Thoughts

While Twittering this morning I came across a report that brings scientific evidence to the proposition that bad thoughts cause bad outcomes. DO NOT have these thoughts, or have as few of these thoughts as you possibly can.

Reading Books on Teeny Screens: Good Idea or Health Hazard?

I attended a Medical Library Association-sponsored webcast last week, "Cutting the Cord: connecting to our Mobile Users". It was about providing electronic content to users via their mobile devices such as iPhones, PDAs and other handhelds. One thing I was surprised to learn was that people are actually reading books on devices with little bitty screens such as iPhones and iPod Touchs. I can understand Kindles and Netbooks, but iPhones?

Just to prove how ridiculous the idea was I went to the iPhone app store and installed both Amazon's Kindle and Lexcycle's Stanza (both free apps) and downloaded a book (free, of course) from each to see how I liked it. Surprise...I liked it! I don't particularly like reading on my desktop monitor, but this is different, and I'm not sure why. Now I can read books on my iPhone while I'm on Muni trying to ignore the shootings and muggings. Just have to remember not to read while driving. Someone might video me and put it on YouTube.

Health Journalism and the Patient Safety Movement

UCSF's own Robert Wachter has published another well-written, thought-provoking commentary, this time on the contribution that the media makes in the patient safety effort. Titled "The media: an essential, if sometimes artibrary, promoter of patient safety", it appears in AHRQ's Morbidity & Mortality Rounds on the Web and includes an interview with Charles Ornstein, Pulitzer prize-winning health care journalist.

Especially interesting to me was Ornstein's explanation of how health care reporters get their leads and how good journalists provide balance and perspective (how bad is this compared to other hospitals?) as well as just getting the facts straight on what are often very complex topics.

Front Lines

I visited one of our primary care clinics today with the goal of showing the physicians and nurse practitioners how to register for our Loansome Doc service, a full text document delivery service that's built into PubMed. As long as I don't get too long-winded (a temptation) I'm well received during these visits because what is being offered is a quick, easy-to-use service at no charge to the individuals or their clinics. Gotta like it.

Here's a secret: although I make clinic visits under the guise of registering clinicians for Loansome Doc, I always manage to propagandize a bit for some of our other library services, including my absolute all-time favorite resource: Da-da...DynaMed. Click the DynaMed link on our home page to take a look.

DynaMed is a point-of-care tool that is in a good position, I think, to knock off the current king of the hill, UpToDate. Unlike UTD, DynaMed has clearly explained graded levels of evidence, great navigation, clickable reference links to full text articles AND a very usable version for PDAs, including smart phones. Not to mention the fact that it costs approximately 1/10th of what an UTD site license costs. If you are a SFGH clinician and would like to get access to DynaMed, please contact me, jgraham@sfghdean.ucsf.edu. I'll send you the information you need to get started.

Oh yes, this post was supposed to be about Loansome Doc. You can contact me at that same email address if you want to register for Loansome Doc.

Blame vs. Accountability

This week's New England Journal of Medicine contains an article by UCSF's Robert Wachter about the delicate balance between the "no blame" approach and the sometimes overlooked need for physician accountability in regards to patient safety issues. The authors suggest that because physicians are not hospital employees they are subject to only weak enforcement of safety standards. Not wanting to alienate physicians and lose the business they bring in, hospitals have been reluctant to play the enforcer.



Citing the "no-blame" approach as the wrong tool for mature patient-safety practices, Wachter and co-author J. Pronovost (Johns Hopkins) get down to brass tacks by suggesting the circumstances under which physicians should be chastised for lack of adherence to patient safety practices and giving specific punishments such as loss of privileges and education for specific transgressions.



I imagine this article will generate a few letters to the editor, but because it bridges the gap between theory and practice, it's a valuable contribution to patient safety literature and a good starting point for further discussion.

Looking for computer software textbooks?

I was looking for how-to manuals for Microsoft Access recently when I discovered that UCSF has licensed a database called Safari Books Online
" over 8,000 vetted learning and reference resources from leading publishers like O'Reilly Media, Addison-Wesley, Peachpit Press, Apress, Manning and Talented Pixie"

The collection focuses on computer technology and also includes graphic design, and business management titles. You can browse by category or search for books on everything from Adobe Photoshop to Unix. From the Safari website: http://search.safaribooksonline.com/home, you can read and even download chapters from any computer on the UCSF network or thorough your VPN@UCSF remote access account.

You can also find links to these online books by searching the UCSF Library catalog by keyword. Example: search keyword 'photoshop' - look for [electronic resource] in your search results. You can also search by title and use the option on the results page to limit your search to "Online Books"

Now, I really have no excuse not to learn how to use Photoshop.

Senator Ted Kennedy and good endings

I just read this article in the NYT and it got me thinking :

After Diagnosis, Determined to Make a ‘Good Ending’

By MARK LEIBOVICH

Published: August 27, 2009

From the time his brain cancer was diagnosed 15 months ago, Senator Kennedy spoke of having a “good ending for myself.”

http://www.nytimes.com/2009/08/27/us/politics/27year.html

The Kennedy family's contributions to policies and impact on the lives of all Americans are profound and will shape the stories we tell about what it is to be a "good" American for years to come. With the death of both Eunice and Ted this month,I 'm glad to see so much media attention being paid to their positive examples of public service as a reminder that 'government' is not a four letter word.

What struck me about this article were the specific details about what a good death meant to Senator Kennedy, sailing, dinner parties when he felt up to it, eating mocha chip ice cream and watching James Bond movies with his wife. Yes, he was the 'Lion of the Senate' but he was also a simple human who found comfort in the same things we all do. Even without the money, influence and prestige he enjoyed, most of us have someone who will bring us ice cream and watch a movie with us. No one is exempt from suffering but luckily most of us can find enjoyment in small things.

I also like that the article pointed out that having brain cancer gave Ted Kennedy time to be with his family and say goodbye, time to work on his memoir and receive appreciation from his colleagues and friends. Of course it's in comparison to the untimely assassinations of his his two brothers; still this is the first time I've seen death by brain cancer mentioned with a positive slant in the mainstream media, as something other than a dread and terrifying monster of a disease.

I'm glad Senator Kennedy got his "storybook ending" even as I know that the living of it for him was something different, more messily human than the story, but no less grand.

Instaneously...if not sooner

That's how quickly people expect to receive their news in this era of online connectivity and social networking. Example: a photo of the United Airways plane "landing" in the Hudson River was up on Flickr before network news could say "webcam". Physicians have similar expectations. Although they may not be techno-wizzards, they're interested in receiving data on patient outcomes ASAP, before investigators have had time to prepare it for publication, and certainly before the manuscript has made it through the peer review process.

In a commentary in this week's JAMA titled "Registries for Robust Evidence", authors Nancy Dreyer and Sarah Garner called for the establishment of data registries organized around specific conditions, exposures, or products to fill the critical gap between knowledge generation and scholarly journal publication.


In parallel event, PLoS (Public Library of Science) announced today a beta version of a new database devoted to the rapid reporting of research related to influenza, PLoS Currents . According to their news release, it will be a "moderated collection for the rapid and open sharing of useful new scientific data, analyses, and ideas in the field of influenza". It's about time.

Don't you just hate it when they do that?

This falls into the "Don't you just hate it when they do that?" category of petty annoyances associated with daily life at the library that, because I have a blog, I can rant about. Here it is: medical reporters have picked up on, no, jumped on, a Lancet study reporting the disproportionate effect of the H1N1 virus on pregnant women in the US.

Okay, good work, EXCEPT that in order to get the PDF of the article at this moment you have to pay $31 for it or HAPPEN to know that it's available from ScienceDirect, an information platform on which UC HAPPENS to provide this particular journal.

Adding insult to injury, the article is not in the print version of the journal and it's not available in PubMed yet, so you can't get it by clicking on the full text link that your library has so graciously added to PubMed to facilitate your fulltext access. If you'd like to see the full text of this article, just put your email address in the comments box and I'll PDF you a copy, pronto.

Cloud Computing

I've been hearing a lot about the computing cloud lately. Cloud storage software, cloud nodes, cloud architecture, cloud apps...references to cloud computing abound. The NewsHour with Jim Lehrer did a piece on it a few weeks ago,so you know it has entered popular culture.

Although the idea is still a little hazy to me (with a 50% chance of clearing), I've figured out that it's a way of conceptualizing the trend away from storing and using information on your own PC or organization's network to doing everything online via whatever device may be handy...your smart phone, your laptop, what-have-you.

Actually, this is a concept that I've been thinking about alot lately, although I didn't know it was called cloud computing. Here are some possible ways to use the cloud: Don't host your site on your network server, put it up on the open web in a wiki format where everyone can get to it and contribute content. Create your presentation in Slideshare, don't carry it around on some thumb drive you'll lose or forget to bring to the presentation. Write your report as a Google Doc, not in a docx file format that no one can open unless they happen to have the correct version of Microsoft Office. It goes without saying, of course, that you are aware of HIPAA rules and regulations and are sensitive to your organization's privacy and proprietary issues. So don't be hanging around on the ground if you can take it to the cloud. Up, up and away.

The Personal is Professional?

I remember the slogan ' the personal is political' from the feminist movement in the 70's. It has certainly played out in some twisted ways. I find myself wondering, in these toddler days of online social networking, how the blurring of the boundaries between public and private life will play out over the next few decades.

Have you 'googled' yourself recently? Find anything you wouldn't want a prospective employer to see? Patients can google their physicians, students their teachers, and vice versa. I know my curiosity sometimes leads me to information that, I'm probably better off not knowing. If I'm facing a complex surgery how does it affect my peace of mind to know that my surgeon is a big fan of slasher movies?

Things should get even more interesting as new tools like Google Wave emerge which will take email where it has never gone before. Here's a post about it from Roy Tennant's blog, Digital Libraries: "Google Wave" Aims to Transform Online Communication

Apple Developers Converge

They're everywhere you look: nerdy guys (where are the girls?) in black-rimmed glasses, rumpled cotton shirts and cut-off cargo pants, pockets overflowing with what?...stuff. They've descended on San Francisco's Moscone Center to learn about how to develop applications for Apple's iPhone.

And not just a few of them are developing health care apps. They're not dumb, these developers. They know that the percentage of us in the geriatric category will be will be increasing over time and that our physicians will want instant, seamless, anywhere/anytime, HIPAA-compliant transmission of the data necessary to take care of us. I want them to have that...I want my providers to be able see my real-time ECG strip, my MRIs, my lab values, my blood gases, and whatever else they might want want to see. Let 'em see it all, instantly, from wherever the heck they might be.

Take a look at one of the new iPhone apps that will let them do just that.

Blogging from my iPhone

And they said it couldn't be done. Well, maybe it should't be done. But at least I know it can be done. I'm at MLA (Medical Library Assoc) meeting in Honolulu and didn't feel like bringing my laptop. Hence the need to blog via iPhone.

There is some actual work being done here by a few select individuals. See the official meeting blog: http://npc.mlanet.org/mla09

Oops, gotta run. Can't be late for the luau.

The Who, What & Where of Swine Flu Information

I'm on a disaster outreach listserv that deals with the role of libraries and librarians in dispensing disaster and pandemic information on topics such as the recent swine flu outbreak. The librarians on this listserv are particularly proactive and see the dissemination of disaster-related information as something that they are uniquely suited to do because of their technical expertise in web content posting as well as their ability to find, evaluate and synthesize information.

Well, one of the most active librarians on the list was complaining that she got her hands slapped because she was posting links to a variety of swine flu related information on her library web site. Her administration told her to cut it out because they didn't want people to panic. This kind of directive goes against the librarian grain, because we feel that, in general, more and better information makes for less panic, not more, and probable better outcomes for all concerned.

I think this controversy will die down as soon as everyone in the organization gets onto Web 2.0 technology. Or maybe it won't. Maybe it will intensify for a while. Everyone will know how to create web pages with links to information, Google Flu maps, and widgets of all flavors, and they won't have to rely on one IT-based webmaster OR one librarian who knows how to cut code or use web editing software. The underlying issue, though, will remain: who in the organization will be responsible for putting up the official content on the official web site? Through my Web 2.0-colored glasses, I'd say, "let them collaborate".

Swine Flu Alert

Click here for a comprehensive list of links relating to Swine Flu

Another page of links from the Specialized Information Services at the National Library of Medicine.

And handy box with links that you can put on your own home page using the "Get widget Now!" link

Is the Internet Making us Stupid?

In this thought-provoking podcast several brain gurus and media experts make the argument that the Worldwide Web is creating generations of information-addicted people who crave distraction, have difficulty focusing, can't analyze complex issues, and pride themselves on being multi-taskers when they're really just inefficient serial taskers, crashing their cars while chattering blythely on cell phones. I'm so glad to know this. Now I can blame the Internet for my ADD tendencies. And I'll be extra careful with my mobile telephony.

Google and User Happiness

I was interested in the presentation Daniel Russell made at Mt. Zion's H.M. Fishbon Memorial Library in November, 2008 because he's Google's main man in charge of "user happiness." Also because Google is the 800 pound gorilla in the information jungle, where librarians sometimes feel like an endangered species.

Yesterday I gave a PubMed coaching session to a physician who Googles using natural language queries to find journal articles on specific clinical topics. Most of the time he considers his searching successful; that is, he can find one or two good articles. That's all he wants anyway. His only complaint is that he can't always get full text; hence his request for a PubMed coaching session from yours truly.

I start with the unhappy news that PubMed includes links to free full text only when provided by open access publishers. Most publishers want to be paid for their content, so libraries spend millions of dollars providing that content to their affiliated users, something most people don't recognize or understand. I end with some good news/bad news: open access publishing may some day replace the existing subscription-based scholarly publishing model. But probably not in our lifetime.

Then I give my spiel about how using PubMed's controlled vocabulary MeSH (medical subject headings) can increase precision and recall and is especially useful for very complex searches or very exhaustive ones, such as when you're designing a research project and absolutely, positively have to know everything that's been published in your area of research. I could tell he wasn't buying it. Too much work for too little return. He was perfectly fine with his established system of Googling. The truth is that not everyone wants or needs to be a PubMed virtuoso. But if you'd like to add to your PubMed searching repertoire, please give me a call, 206-6639. It's free...except for your time, that is.

Experiment you can do at home

Check out this video. There may be no evidence that shows a connection between cell phones and brain cancer, but what about the brain popping problem?

Progress

A picture is worth 1,000 words. 'Nuff said.

Glass of Resveratrol Anyone?

If you're not comatose, you may have noted the recent media attention to the "evidence" that resveratrol, a substance in red wine, adds years to your life and may contribute to a happier death when your time finally does come. By the way, it also cures wrinkles which is more important than longevity, at least from a business point of view.

Health reporting happens. People read it and believe it. Whether it's good reporting or bad, people believe it equally. I've recently become aware of a web site that assigns grades in the form of stars to health articles in the news. Health News Reviews focuses on U.S. news and covers broadcast as well as print media. It is written by University of Minnesota Health Journalism program's Gary Schwitzer and grades health news on 9 no-nonsense criteria including the following: [Does the story] evaluate the quality of the evidence? Quantify the potential harms? Quantify the potential benefits? Use independent sources and identify conflicts of interest? Compare the new approach with existing alternatives? His review of the recent 60 Minutes story on resveratrol got only one star out of 9. That's okay, if it gets rid of wrinkles I can go with one star.

Free is Good

A Springer journal might not be your first choice of journals to publish in, but here's some news that might influence your decision: Springer Publishing Company has just signed an agreement with University of California's Digital Library that allows for free open access publishing for any and all of their many journals. Well, it's not exactly free because the publishing cost has been rolled into UC's journal licensing agreement, but it's free to you as author. Here are more details of what Springer is calling its Open Choice plan

Jing...a Kewl New Tewl

In about 2 nanoseconds I learned how to capture a screen shot using a free media sharing tool called Jing. This little gizmo (technical term) has far-reaching implications for creating online tutorials on the fly and for delivering customized desktop support.

Jing allows you to do static screen shots and annotate them, like the PubMed screen in the above example as well as create videos of your mouse movements and share them with people. Now I'm thinking, "Why did I spend all that time and energy on Captivate?" The answer: so I can make tutorials that are more than five minutes long, which is Jing's limit. That's okay. Most peoples' attention span is about that long anyway, mine included.

What, Me Wiki?

Some people, old people that is, will recognize the above image as Alfred E. Newman. His picture was always on the cover of Mad Magazine, which you smuggled to school when you were in the 4th grade. It was a very subversive thing. It would definitely be confiscated if seen by a teacher, and could even cause you to be kicked out of class. Alfred E. Newman's motto was: "What, me worry?

Keeping in mind the title of this article, can you guess where I got the above image? Yup...Wikipedia. If you're like most people, you've heard of Wikipedia but you don't know that much about it and wonder "Just what is this weird wiki-thing anyway?" The word comes from the Hawaiian language and means quickly, which is surprising in itself because Hawaiians hardly ever do anything quickly. Why would they need a word for it?

A wiki is a web site that anyone can read and/or contribute to. Depending on your permissions, it allows you to add, delete, or reorganize content, all without benefit of HTML or web editing skills. Its strength lies in its use as a collaborative tool.

The following are some reasons you might want to participate in a wiki:

• We need to use new and better ways to create, share, store, and retrieve knowledge, especially during the Magnet process, upon which this hospital has embarked.
• Wikis work well with any shared governance model because they make collaborating to create content really easy and sometimes even fun.
• Wikis can be private, that is, open only to members of the organization. In addition, within any given wiki, some pages can be open to all and some can be private depending on the nature of the content.
• Wikis offer content as well as discussion pages.
• Wikis break down silos, a cliche meaning organizational divisions.
• Wikis distribute the editing workload and take the pressure off the web master who probably never wanted the job in the first place.

Please leave a comment if you'd like additional information on the advantages of wikis over email or organizational intranets. This post is already way too long but hey, why should I worry?

It's Official: Librarian is a Cool Career

It must be true. I read it in U.S. News and World Report. According to a December 15, 2008 article Librarian is one of the top 30 professions for 2009 in terms of job outlook, job satisfaction, difficulty of training, prestige, and pay. Another semi-interesting factoid: special librarians are especially cool. A special librarian is someone who doesn't work in an academic or public library, so this would include yours truly, having worked in medical libraries for what is now decades.

I was interested to see that the article lists "Health Informatics Specialist" as one of "13 Ahead of the Curve Careers". This confirms my hunch that the combination of medical librarianship and health informatics is where our field is headed. I always like it when my hunches are confirmed, especially by such a highly-revered news source.

Just this week, I found myself encouraging a UC Berkeley undergraduate who was conducting informational interviews at the hospital to consider the Medical Librarian/Health Informatics option. As I was making the pitch, a musical version of William S. Borrough's Words of Advice for Young People kept running through my mind. I'm always surprised at how helpful (ahem) my subconscious is at suggesting songs that suit the situation. Maybe I should give the whole thing some more thought.