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.