News, EBM, Library Resources: JAMA Evidence now available

For those interested in learning strategies for practicing evidence-based medicine, check out the latest digital subscription from UCHC Library:

JAMA Evidence

Image Credit: http://www.jamaevidence.com/ - All rights reserved – Copyright 2009

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Produced by American Medical Association editors and publisher McGraw Hill, content from the digital textbook is also available for mobile applications.

I particularly liked the JAMA Evidence glossary.

If off-campus, connect via your UCHC library proxy account.

Visualization, PBL: Visit with Wordle Occasionally

One aspect of participating in problem-based learning is that by the end of the semester, every student in the group has taken their turn at the group tasks involved, which are:

• The Reader narrates the case as it is made available online. The written case with any supporting visual materials such as radiology or histology about the patient are posted on Blackboard and are no longer distributed in paper handouts.

• The Scribe is the person with the marker who listens to the groups’ discussion and synthesis of the pertinent data about the patient such as chief complaint, presentation, past medical history, current labs values, medications, tests to be ordered, treatments to begin, etc.  They are writing down the data, hypotheses, learning issues as they become available.

• Before every student in the room brought a computer to class — which sounds like the olden days but it was less than 6 years ago — the Scribe may or may not have been the one creating hand-drawn concept maps of that week’s PBL work.  Nowadays, concept maps are created not by drawing on the whiteboard but by using CMap, a free software program from IHMC (Institute for Human and Machine Cognition).  This brings on a new role in the group: Concept Mapper.

• The Facilitators mostly listen, occasionally asking clinically-oriented questions or providing a bit of background or narrative about a patient, a procedure or a disease without being “teacherly”.

• Each week, one person bakes and brings in goodies for 9 people.  That is an important function, too.

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On a basic science or biomolecular level, concept maps can get pretty complicated.

Recently I wrote down some of the medical terms, processes or conclusions which were heard during PBL, and made a Wordle map out of them.   Here is what it looks like:

Image credit: http://www.wordle.net – All rights reserved – Copyright 2009

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This week I learned more about the function of Purkinje fibers (oh my duh – I’d never make it through medical school!).

Here are two other Wordles.

This one is based on words found on the EBM and Clinical Support Librarians@UCHC blog:

Image credit: http://www.wordle.net – All rights reserved – Copyright 2009

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The last one is formed from words taken from my Delicious account called Onc2009, a set of bookmarks about cancer, that was created for Mechanisms of Disease-Oncology:

Image credit: http://www.wordle.net – All rights reserved – Copyright 2009

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Wordle, an elegant piece of software, was created by Jonathan Feinberg.

Search Engines, Genomics, Medical Literature: Tag Clouds come to PubMed via LigerCat

“… LigerCat is a search tool for NCBI’s PubMed that uses tag clouds to provide an overview of important concepts and trends. LigerCat aggregates multiple articles in PubMed, summing their MeSH descriptors and presenting them in a cloud, weighted by frequency “.

Except from:  http://ligercat.ubio.org/about#contact_us

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LigerCat is an abbreviation for Literature and Genomics Resource Catalog, which is a free PubMed search tool developed in 2009 as part of the Biology of Aging project at the MBLWHOI Library at the Woods Hole Marine Biological Laboratory.

LigerCat is great news for geneticists or anyone involved in translational research, a fairly effortless means of data mining for dynamic links to a very complex literature.

LigerCat can be used to search in several ways: 1) to locate and select a list of individual journal titles indexed in PubMed, 2) search using terms from the National Library of Medicine’s Medical Subject Heading (MeSH) list, 3) search using keywords, 4) search on Genes found in the NCBI databases.

Following is a screenshot of the LigerCat start page:

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A screenshot of the “in process” retrieval process using LigerCat for the MeSH term “pancreatic neoplasms” and keyword term, “pain“,  is shown below.

Notice that LigerCat provides the searcher two choices for getting the results, which could take a few minutes: the option of simply waiting a few moments for the search to execute, or save the shortened URL of the search-strategy to revisit the results at a later time.  That’s nice!

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.Here is a screenshot of the retrieval from LigerCat - which took about 20 seconds to execute:

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.Next:  I used LigerCat do a Gene Search for specific protein sequences.  This is how the site authors described the process of searching genes:

” LigerCat is performing a live BLAST to find similar sequences to your query. Once the sequences are identified, LigerCat will use its indices to map the genes into a set of PubMed articles that reference those genes, and extract all the MeSH terms for those articles. “

” When all the MeSH descriptors are gathered, LigerCat uses a statistical model to identify relevant descriptors, then sums them by frequency to create the MeSH tag clouds. “

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I went to NCBI to  find the Entrez Protein page and then searched FASTA for P53 and Homo Sapiens.  The search statement I found looked like this:

>gi|14993572|gb|AAK76358.1| P53 [Homo sapiens]
VGSDCTTIHYNYMCNSSCMGGMNRRPILTIITLEDS

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This string was copied-and-pasted into the LigerCat Gene search box for the following result:

All images above – Courtesy  of LigerCat – All rights reserved – Copyright 2009

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As a medical librarian, I think LigerCat is a great step forward — but because the value of information lies in the eye of the beholder — I’ll wait to hear the opinions of geneticists and research scientists as they weigh in on this new search engine.

For a different example of using this resource, see this link from the blog Biology of Aging, dated Aug 21 2009.

News, Searching the Medical Literature: Two Expert Opinions on Searching, or PubMed and Beyond

Today is a great day to highlight the recent posts of two fellow medical bloggers:  the first is from Laika’s MedLibLog, written by a Dutch research-scientist/medical-librarian; the second post is from Life in the Fast Lane, a blog written collectively by a group of Australian physicians.

Each author has written definitive posts about the mechanics – and utility – of searching the medical literature, and evaluating what has been found.

These posts should be seen as instant classics – and required reading for new graduate students in medicine, dental medicine or biomedical research or just about anyone with an interest in finding more-pertinent clinical information (in less time).

Their descriptive clarity in explaining what to search, and how to search is pitch-perfect.

Thank you – Laika and SandNSurf – for writing them!

Please read:

• Laika’s MedLibLog: 10+1 PubMed Tips for Residents (and Their Instructors) (Jun 30 2009)

• Life in the Fast Lane: Medical Search for Physicians (Jun 16 2009).

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Next: Following are several quite different compilations of medical information resources written by librarians.

Elena Giglia, a medical librarian from Central Library of Medicine, University of Turin, Italy,  wrote in 2007 an excellent overview of the medical literature entitled “Beyond PubMed: Other Free Biomedical Databases“.  This 11-page article was published in the European Journal of Physical and Rehabilitation Medicine (Europa Medicophysica) – Vol. 43(4):563-9 (Dec 2007). It is available online for anyone to read.

Ms. Giglia is the author of a very recent article, “Medline/PubMed revisited: new, semantic tools to explore the biomedical literature“, published June 2009 in Eur J Phys Rehabil Med – Vol. 45(2):293-7 (subscription required).

Law librarian Gloria Miccioli wrote a summary of medical sources targeted for legal professionals, entitled  “Researching Medical Literature on the Web” (published Sept 22 2008), found on LLRX.com.

The LLRX website also offers a list of links for librarians (or others) doing legal research.

My own Home Week: Evidence Based Medicine Resources page on Libguides.com was created – and is updated annually – as a source-sheet for third-year medical students at UCHC as they rotate throug h their clinical clerkship year.

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Finally:  Librarians working in academic health science libraries offer a variety of digital training tutorials or subject lists for orienting their students, residents and faculty to the technical aspects of searching the literature of medicine.

A quick search on Google for “tutorials searching medical literature” brings up an eclectic group of 968,000 retrievals.

The same search using Bing f0und 1,530,000 well-filtered retrievals.

News, Public Health, Emerging Technologies: Delivering the News… Online We Are

It’s been a big news week.  Global health developments have occurred with such rapidity that reporting the news of this week  gives additional meaning to the use of the term “viral” as in… tracking the global spread of a novel virus:  A/H1N1 – swine influenza.

After writing this post, I then noticed that only one of items on the list below refers to materials which are in print (that of the journal Public Health Reports).  It is online that we are.

• DynaMed, an evidence based medicine resource which UCHC Library subscribes to, announced this week that an online section for current clinical information on Swine Influenza A/H1N1 will be available to anyone in the world at no cost – at this link.  The database, produced by Ebsco, is updated daily.

• Scientist-Librarian Laikas has posted about the uses (and mis-uses) of Twitter which makes for a really good read: http://laikaspoetnik.wordpress.com/2009/04/30/twitter-goes-viral-swine-flu-outbreak-twitter-a-dangerous-hype/

• And on Twitter (of course), is where I found this link to the “25 Best Twitter Feeds to Follow the Swine Flu” from the blog Masters of Healthcare (Apr 30 2009).

• A PubMed citation from the journal Public Health Reports refers to an article published in 2008 entitled “The Animal-Human Interface and Infectious Disease in Industrial Food Animal Production: Rethinking Biosecurity and Biocontainment“, which is all the more disturbing after reading a recent blog-post by Mike Davis (Apr 27 2009) titled “Capitalism and the Flu“.  A link found on Google News to a blog called Narco News describes large-scale industrial pig farming in the Veracruz region of Mexico, where epidemiologists have traced the initial human infections with the current A/H1N1 strain (posted Apr 29 2009).  These two items are not exactly pure-science articles, but are nonetheless disturbing.

• Finally, the cartoonist-blogger XKCD drew a great comic this week, arguing against getting one’s news of the day from Twitter and re-tweets.  Many other bloggers worldwide have featured this cartoon this week, but in case you missed it…

Photo/Source credit:http://xkcd.com/574/

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IMHO: The option of becoming a vegetarian is growing more and more attractive.

Blogs I Like: Biochemistry Questions Site

Biochemistry Questions Site is a teaching-and-learning blog whose author, Dr. H.D. Urquiza Hernandez, is a professor of biochemistry and holds a PhD in biological sciences.

This is a multi-layered Q & A site which could be useful for medical students who are immersed in micro human biochemistry, or preparing to take the USMLE.  The site is free and open to anyone to use.

His work also exhibits a sense of humor, with a section for “Moviecular Biology” and “Biochemistry at the Movies“.

Plus, where else could one find a crossword puzzle all about Amino Acids!

Photo/Source Credit: http://biochemistryquestions.wordpress.com/biochemical-puzzles/ – All rights reserved – Copyright 2009

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.Today, I’ve added the site to my Blogs I Like list.

News, Clinical Research, Educational Sites: Research Tests, Surveys or Measurements… some free, some by subscription

A frequent question at the reference desk is from nurses, physicians, epidemiologists, medical, dental or MPH students who are seeking assistance in finding clinical research instruments.  It can be a challenging and time-consuming task to find psychological profiles; while many are available at no-cost, a greater number are proprietary, copyrighted tests requiring payment to gain access to. Following are some useful commercial (i.e., paid subscription) sources as well as several free websites which may assist a user in locating the research instrument they need.

Originally this post was going to be about only an intriguing site I found recently from a research institute in Lyons, France named ProQolid: Patient Reported Outcome and Quality of Life Instruments Database (but then it got quite a lot longer).  Following is a screenshot of their front page:.

Source Credit: ProQolid – All Rights Reserved – Copyright 2009

Here is an excerpt from their About page:

” The success of Quality of Life (QOL) and Patient Reported Outcome (PRO) studies depends a great deal on the choice of appropriate instruments which must be selected according to the domains they measure and the populations and pathologies for which they are designed.  Practical issues, such as the availability of different translations, copyrights, and access to instruments are also major criteria in the choice of instruments.  From these observations, the Quality of Life Instruments Database (QOLID) project was initiated by Mapi Research Institute to provide all those involved in health care evaluation with a comprehensive and unique source of information on PRO and QOL measures available through the Internet….  QOLID was launched at the beginning of 2002. It is currently managed by Mapi Research Trust and was renamed ProQolid, short for “Patient-Reported Outcome and Quality of life Instruments Database” in January 2005. “

Please note that there are two levels of access to ProQolid (free or paid subscriber).  Here is an explanation of how the database is constructed: “For each instrument in the database, you’ll find 14 categories of basic information (e.g., author, objective, mode of administration, original language, existing translations, pathology, number of items, etc.)“.

Here’s a link to search ProQolid.

Following is a screenshot of a recent search done in the section for “Pathology – Nutritional & Metabolic Diseases: Diabetes Mellitus“:

Photo credits for ProQolid: Mapi Research Trust (MRT) – All rights reserved – Copyright 2009

.Note: I thank Mary Ryan, biomedical librarian/informationist at the National Institutes of Health Library, for writing a post about ProQolid (which is how I found the site).

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Next, some other suggestions for sources of psychological or diagnostic tests or measurements.

A first-stop database to search would be the comprehensive subscription database, PsycInfo which has 2.9 million bibliographic records (from the 1880’s to 2009).  PsycInfo has its own thesaurus.  Access to PsycInfo for any Connecticut resident (including educational institutions) is provided by the Connecticut State Library through iConn.org, a group of databases that since 2002, has  “offered every citizen in Connecticut free access to information and library resources, including 25 million articles from magazines, journals and newspapers, such as The New York Times, Boston Globe, Hartford Courant and a statewide library catalog“.  (So unless you are a resident of Connecticut, access to iconn.org will be closed to you).

Another subscription database, HaPI (Health and Psychosocial Instruments), is described as “measurement instruments for any medical or medically related condition or treatment outcome that clinicians must ask a patient about“. HaPI indexes 145,000 bibliographic records and the range of coverages is years 1985 through 2009.  (UCHC library subscribes to HaPI via the OVID platform.)

Nursing faculty – or nurses enrolled in a MSN degree program – often ask reference librarians for assistance in navigating the CINAHL database (Cumulative Index to Nursing & Allied Health Literature).  MSN students are required to conduct an actual research project for credit in their graduate programs and are frequently looking for surveys or tests.  There is a Research Instrument limit field in CINAHL, which “indicates material indexed as a research instrument… To indicate the use of instruments in a body of work, search electronically using the particular name. For material about research instruments, see CINAHL subject heading: RESEARCH INSTRUMENTS or specifics“. CINAHL has its own thesaurus and is available only by subscription.

But if your library doesn’t subscribe to these sources, what advice would a librarian offer for finding what else is “out there” on the Web?  Here are list of sites which may assist you.

• The Buros Institute is the publisher of the venerable reference work, Mental Measurements Yearbook and Tests in Print (now in the 7th edition), which the institute describes as “a comprehensive bibliography to all known commercially available tests that are currently in print in the English language. TIP provides vital information to users including test purpose, test publisher, in-print status, price, test acronym, intended test population, administration times, publication date(s), and test author(s). A score index permits users to identify what is being measured by each test. Tests in Print is directly linked to the critical, candid test reviews published in the Mental Measurements Yearbook (MMY) series.“   These standard reference textbooks are not free. However, the Buros Institute offers an online Test Reviews where one can search for thousands of test reviews to locate more information about formats, test audience and cost.  The institute provides advice on how to evaluate the validity of a particular test.

• A giant repository of educational materials covering research from the pre-K through graduate level is ERIC (Educational Resources Information Center). ERIC indexes “1.2 million bibliographic records of journal articles and other education-related materials, with hundreds of new records added twice weekly“.  ERIC has its own thesaurus.
  ERIC is funded by the Institute of Education Sciences, a division of the U.S. Department of Education. There is a publication-types limit field in ERIC for Tests/Questionnaires.  Note: Access to search the ERIC database is free, although links to the actual articles or tests may – or may not – be.

• Educational Testing Service (ETS) has a large searchable Test Index page.  Note that ERIC descriptors are used in the subject fields.  As a proprietor of commercial tests, ETS requires payment to access many of the tests found on the site. **

• The American Psychological Association has a page on their site offering advice about locating published, and unpublished, psychological tests and measures.

• Developed by the Institute for Algorithmic Medicine, the Medical Algorithm Project has an extensive list of tests available to search; full access to this site requires registration (which is free).  Here’s an excerpt from their About page: “A Medical Algorithm is any computation, formula, survey, or look-up table, useful in health care. More than 10141 algorithms, organized into 45 chapters, are available as spreadsheets which can be opened in your browser“.  Here is another link for searching at that site.

• A shout out to Helen Hough, health science librarian from University of Texas Arlingon Health Sciences Library, who has written a page called “Tests & Measures in the Social Sciences“.  It is a real gem of assorted links.  Thanks!
  

• Another, similar resource is from San Diego State University, called SDSU Test Finder.

• Link here to a search on OpenWorldCat.org for “psychological tests or measurements“.  I hesitated to include this resource on the list due to the amount of explanation (and page-space) it takes to simply describe the “What If-Then That” scenario required before a user can even begin to search it to locate any meaningful results. What is WorldCat and OCLC?  Here’s a description of requirements for individual libraries, thanks to the BCReview Blog (Nov 5 2007).  So unless you have a connection to a local public, academic or school library which is part of the OCLC consortium (or you live outside of the U.S.), this website may not  help you much at all.

• Three obvious sites to search:  Scirus, Google Scholar and a free site for EBM information, TRIP (Turning Research Into Practice).  All of these so-called gray literature sites are worth a search for this subject, IMHO.  I have written before on this blog about how valuable Scirus has been lately.

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A challenging teaching load this semester is keeping me from posting more often this month – next month will be better!

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** Correction on my ETS entry:  A representative from the Educational Testing Service sent me an email today, and she explains more fully the type of access to the documents in the ETS archive.

Here is her description of access (i.e., is it free or for a fee?) to the ETS collections: “… we do have the Test Collection at ETS which contains a listing for over 25,000 measurement instruments by authors outside ETS. Of course, only a small subset is distributed by ETS by author’s written permission and… there is a small distribution fee for those tests. In the availability field of the test records, it lists the contact person, company, journal, etc. where the student/researcher can locate a copy of the instrument. “

I strive for accuracy – but don’t always achieve it  ..Thanks for the correction.

News, Search Technologies: Give Mednar a Try

” Mednar [a federated medical search engine introduced in 2008] promises to become a standard tool of power searchers in the health sciences (e.g., medical librarians, physicians, health care researchers) and for savvy consumer searchers who seek supplements to such standard tools as MedlinePlus or PubMed “.

Quote from AltSearchEngines.com writer Hope Leman, who ranked Mednar as her Number 1 choice in the list published Dec 29 2008 entitled “Top Ten Health Search Engines of 2008“

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After reading good reviews about Mednar recently, it seemed like a good idea to try it out. Below is a screenshot of what was retrieved on a recent search  for “inoperable pancreatic cancer” using the federated search site:.

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Image credit/source: Mednar.com – All rights reserved – Copyright 2009

Once the search is processed, you’ll get a prompt asking if you want to include all sources, which I clicked Yes for.  The search is then reprocessed including all retrievals from those sources searched by the engine.

This screen capture shows some of the MEDNAR ‘top retrievals’ from all sources. It is a good sign that the most hits were found in PubMed:.

Image credit/source: Mednar.com – All rights reserved – Copyright 2009

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This fall, I began teaching a Google Scholar class.  One of the exercises I ask the group to do is to compare results from different sources by running searches using identical “same-search-terms”.  Currently Google Scholar and Scirus.com (from Elsevier) are the compare-and-analyze search sites.

The more I use Scirus, which is a free database, the more value I find there for locating material found in what librarians call “the gray literature“. It has been improved a great deal since it was first introduced. If you’re not currently using Scirus, you might want to add it into your tool-kit of clinical research sites.

Here is a quote from the Scirus “About” page:

” is the most comprehensive scientific research tool on the web. With over 450 million scientific items indexed at last count, it allows researchers to search for not only journal content but also scientists’ homepages, courseware, pre-print server material, patents and institutional repository and website information….  “

“ How Does Scirus Rank Results? Search results in Scirus are, by default, ranked according to relevance. It is also possible to rank results by date. You can do this by clicking the Rank by date link on the Results Page.

” Scirus uses an algorithm to calculate ranking by relevance. This ranking is determined by two basic values:

• Words – the location and frequency of a search term within a result account for one half of the algorithm. This is known as static ranking.
• Links – the number of links to a page account for the second half of the algorithm – the more often a page is referred to by other pages, the higher it is ranked. This is known as dynamic ranking.
  

” Overall ranking is the weighted sum of the static and dynamic rank values. Scirus does not use metatags, as these are subject to ranking-tweaking by users.“

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480 million websites indexed!  This makes for a lively comparison of results… and as they are projected on the overhead, everyone in the class room can examine (on the big screen) how results are ranked, currency of the retrievals and how results (or links) differ from these two sources. 

Scirus search results for scientific information are (IMHO) better, consistently and over time, than those found via Google Scholar.  And most of the time in this class, I manage to persuade the group to begin using Scirus over Google Scholar.

Academic librarians are reminded every day how fortunate we are, as a group, to have the financial resources that allow us to offer world-class (and costly) subscription information resources to our researchers, clinicians, hospital administrators, graduate students or the general public. There are many  resources available to answer those difficult patient care or research questions. Google Scholar and Scirus are just two of the many resources available.

So will I start using Mednar?  I liked the results well-enough, but won’t give up using the precise technical limits and search filters available in PubMed, or the comprehensive, deep searches available by using the 15,000 journals indexed in Scopus.

But maybe for the next Google Scholar class, we’ll add Mednar to the mix.

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Lastly: here is another link from AltSearchEngine.com offering up a three-part primer on the subject of the Deep Web and how federated search engines operate (Jan 12 2009).

Editors note: Deep Web Technologies, which is a for-profit corporation, is the producer of Mednar.  Deep Web also sponsors a blog called FederatedSearchBlog.com.

PBL, Instruction, Lifelong Learning: Ambiguity, Acronyms, Being Average and Preparedness

A conversation I had with a medical student years ago in PBL stays with me. She attended a top high school, graduated third in her class at Dartmouth College and came to UConn School of Medicine. She was (and is) a high-achiever, accustomed to placing well on exams and class rankings. Her name is Amy. She is now well through residency in New Hampshire.

She told me this: “By the time I showed up at medical school, I was pretty accustomed to being the smartest person in the room. Now that I’m here and have taken several exams, it turns out that there are many much smarter people in this class… and so I’ve had to reinvent myself as ‘average’. The bell curve applies to medical students, too, I guess. Also, I’ve gone from obsessing over grades most of the time to simply hoping for a 70% on that last tough exam” (which represents a pass in a pass-fail curriculum).

In observing brand-new medical students over the years in PBL, I have noticed that the first semester of medical school often requires some mental adjustments and perhaps a time of internal re-invention for them.  Some of their comments echo what Amy said years ago, about a necessary transition from placing first in their class, to getting scores solidly in the middle of the bell curve. Which is still a Pass in medical school.

Author Stephen King in his 2007 book, Lisey’s Story, writes about the critical thinking/decision-making that the two main characters go through as dire things begin to happen (as things always do in Stephen King novels). The process for gathering their courage is defined as SOWISA (an acronym for “Strap On When It Seems Appropriate”). This analogy leads me to consider other analogies or acronyms used in general life (or medicine) such as:

- SWOT: Assess the Strengths, Weakness, Opportunities and Threats of a course of action.  SWOT as opposed to SWAT (Special Weapons And Tactics) which is the polar opposite of the first line of the Socratic Oath which states “First Do No Harm”.

- PERRLA: Pupils Equal Round Reactive to Light & Accommodation

- TLC: Tube, Lavage and Charcoal (given to a poisoning victim)

- SVRI: Something Very Wrong Inside

- TLC: Tube, Lavage and Charcoal (given to a poisoning victim)

- GOMER: Get Out of My Emergency Room

- ABCDE Angina Treatment Mnemonic. The ten most important treatment elements of stable angina management are: A = aspirin & anti-anginal therapy, B = beta-blocker & blood pressure, C = cigarette smoking & cholesterol, D = Diet & diabetes, E = Education & exercise

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Ambiguity is an element in life, whether we disapprove of it or embrace it.   When a life stage or course of action is unplanned or unclear, a positive opportunity may appear in that lack of a plan. In life – as in medicine – a planned course of action never represents a guaranteed (or even a positive) outcome. Learning to become comfortable with uncertainty and ambiguity is important aptitude as we (and our loved ones) age.

A patient being told by their physician:  “With this disease [that you have] our best course is to take a Watch and Wait approach”.  That can sound pretty ambiguous.  How long does one watch and wait… a lifetime, two months, six years… ?!

This leads me to describe an acronym used in my life, which is Holy Crap! Straighten Posture, Stand and Deliver, or HC!StDeliv.  Following are some instances when this acronym has come in handy:

• 19-year old know-it-all enrolls in Large University.  Parents drive her (4-hour trip from small hometown) to campus, unpack car, start ignition, drive away.  19-year old (in tears) says, I don’t know a single person here!  This turns out to be a positive element, as one moves from having everyone knows your name, your mom and dad, your brother, your grandmother and all your business, to being anonymous – at last!  Good deal, straighten posture, make some friends, HC!StDeliv.
• Former know-it-all, now a 22-year old graduate student in Fine Arts.  Dean of Fine Arts walks her down the hall, into an empty classroom and hands over a sheet: “Here is your class list.  There are 22 freshmen students in your basic design course, they’ll be here in about ten minutes, good luck”.  Holy Crap — think fast! What do they need to know about learning to draw?  Straighten posture, take a deep breath, HC!StDeliv.
• Some years later. Young mother gives birth, baby is beautiful and healthy. A week later, at 7:11 am, anxiety sets in when tired husband puts coat on. “Where are you going?  Well. I’m going to work for the day… I’m the sole breadwinner now. Bye”.  Door closes, ignition starts, car and husband drive away. Gulp. Babies don’t come with written instructions, so figure it out.  Straighten posture, look at adorable newborn.  HC!StDeliv.
• Fast forward.  A long illness, a parent’s funeral, the hardest thing.  Come back to the family home, where two generations have lived.  Stoical brother says, “No Naps.  Time to pack it up, take what you want, the new owners will be here in 2 days”.  HC!StDeliv.  Goodbye, childhood home.
• Fast forward again. Husband comes home, says “I was laid off today after 12 years at the company.  Now you’re the primary breadwinner”.  Former adorable baby is now Kid in College!  Holy Crap! Straighten posture, stand and deliver (and go to work).

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A veteran oncology nurse once said to me, “We lose a lot of people in this business.  Some we cure.  Those are our success stories.  For some patients there is no therapy that we can offer that will help them in the long-term.  Mostly it’s the youngest patients who are the hardest to lose…“

Numbers needed to treat, responders, non-responders, few guarantees.  Type 1 Errors versus Type 2 errors.  Patients (like babies) who haven’t read the clinical textbooks and don’t come with instructions.  Some patients can’t be helped. If their early results are favorable, over time a different patient will die from an unrelated illness, or be lost to follow up.  A clinician may never learn of their long-term outcome.

A physician once explained in PBL: “ 80% of the time, the patients’ presentation is straightforward, the treatment is standard and well-documented, we can have confidence in a fairly certain outcome.  20% of the time: the patient hasn’t read any of the textbooks, he presents totally unlike any other previous case you’ve seen…. that’s when you get into the uncertain territory, without a standardized course of action “.

Holy Crap, straighten posture, Stand and Deliver.

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Following are a few reference sites which were used for details about  Medical Acronyms:

• Doctors’ Slang, Medical Slang & Medical Acronyms
• Extremish (via Scienceroll – Thanks Berci!)
• Medical Eponyms at WhoNamedIt?
• WDISF (What Does It Stand For?) – A scientific/engineering list
• And a screenshot from MedicalMnemonics:

Image courtesy: http://www.medicalmnemonics.com/ – All rights reserved – Copyright 2009

Instruction, Teaching & Learning in Medicine: WeBSurg

Four surgeons from Strasbourg, France got together to create WeBSurg which describes itself as “the largest collection of educational programs in laparoscopic surgery“.

Here is an excerpt from their About page:

” WeBSurg is a virtual surgical university, accessible from anywhere in the world through the Internet. The WebSurg concept was launched by Professor Jacques Marescaux and his team at the European Institute of TeleSurgery (EITS) in Strasbourg, France. Our goal is to provide the surgical community, scientific societies, medical teaching centers and industries with the first, worldwide, online training in surgery, information on the latest surgical breakthroughs and the possibility to chat with surgeons and experts from all over the world.”

WeBSurg is currently available in English, Japanese, traditional Chinese, Spanish and French languages.  Access to the site is free and open to anyone.

The easiest way to navigate this large site is to search by organ system or clinical specialty in order to grab lists of the videos, podcasts, CME and training/simulations on the WebSurg site.  A good place to start is:  http://www.websurg.com/search/index.php which takes you to the screenshot (shown below):

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Image/Source Credit:  WebSurg.org – All rights reserved – Copyright 2009

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For a less serious approach to laparoscopy, check out the tutorial on Virtual Knee Surgery from Edheads at http://www.edheads.org/activities/knee/index.htm and http://www.edheads.org/activities/knee/knee2/index.htm (media player required).