EBM and Clinical Support Librarians@UCHC

A blog for medical students, faculty and librarians about their use of evidence based medicine, clinical literature, Web 2.0, sources and search strategies

Category Archives: Consumer/Patient Health

News, Health Disparities, Americans, Politics: The Health Care Safety Net

Image Source: http://www.thesaurus.com/nope –  All rights reserved – copyright 2011

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If you are an American who reads news articles or listens daily to TV, then the budgetary skirmishes being played out between the two governing parties in Washington this month is enough to keep you up at night.

Do our elected government representatives deserve congratulations for haggling for days about and then (at the last minute) passing yet another temporary budget in order to keep the Federal government functioning on a daily basis? No. I say: Skip the drama and get back to governing the country in a cooperative, fair manner that represents the wishes of the people from your home state who voted for you. Sadly, long-term strategical thinking as well as respectful debate seem in short supply in our capital nowadays.

Am I a tea-partier? Nope. Is this blog about politics? Nope. What this blog is about is clinical education, health science research, instruction, trends in searching, public health, epidemiology, health care environments… and the infrastructure supporting these ideas and practices.

This month – from a public health viewpoint – it is troubling to read and hear about challenges to the health care safety net that the 2012 budget proposals being set forth by House Republicans have raised.  If their version of health care reform is enacted, the health care delivery system for children, disabled individuals or senior citizens will be very different by year 2021.

Families USA, a nonprofit policy group, published a report last week that examines the Republicans’ health care reform proposals; it is available online at no cost by clicking here.  It is highly critical of the proposals. Below are two screenshots from this report:

Image Sources: http://tinyurl.com/3bhsjf5 – All rights reserved – copyright 2011

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At this link, the proposed 2012 budget set forth by the current administration can be read online via the Congressional Budget Office (216-page PDF).  Also see a link to the Health Care section for specific numbers and rebuttals to the Republican proposals.


Thanks to Matthew Sturdevant, insurance reporter for The Courant (Hartford, CT newspaper website) for the link to the Families USA report.

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News, Patient Education, Teaching & Learning in Medicine: October is Health Literacy Month

 

October is National Medical Librarians Month in the U.S.

The theme for 2010 is Health Literacy

Here is a screenshot of the poster created by Medical Library Association for this event:

Image credit: Medical Library Association – All rights reserved – Copyright 2010

Health science librarians are in a unique position to work with patients and their families who seek current, credible and authoritative medical information in order to learn more about their recent diagnosis, review options for choosing treatments, or to anticipate changes in their lifestyle or living situations after treatment has ended (as examples).

Medical Library Association (MLA), a nonprofit educational organization with 5,000 members worldwide, has devoted time and care over the past decade to develop websites and resource guides specifically targeted at training librarians who provide information services to patients or family members. Their Health Information Literacy page can be viewed at http://www.mlanet.org/resources/healthlit/

One of the larger special interest sections sponsored by MLA is Consumer and Patient Information Section (or CAPHIS). A related program directed by MLA staff is the Consumer Health Information initiative, and in 2007, the association created a formal certificate program in that specialty for information professionals.

Open to everyone on the MLA website are topic pages about educational resources. Here are two examples: Resources for Health Consumers and Deciphering Medspeak which links to medical terminology handouts (in English or Spanish languages), online medical dictionary, a prescription shorthand guide and a list of the “Top Ten Most Useful Medical Websites” for patients.

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For those pursuing research on strategies to address Low Health Literacy, Health Disparities or Health of Minority Populations, some valuable step-savers are available on the PubMed Special Queries” which provide links to pre-formulated, highly specific search statements (or search queries) that can be run singly in PubMed or combined with other relevant subject searches.

Below are screenshots from two Special Queries websites: Health Literacy and for Health Disparities & Minority Health Populations

and

Image credit(s): National Library of Medicine – All rights reserved – Copyright 2010

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Other teaching or service organizations that offer patient-centered tutorials, podcasts or written information addressing disparities in health care delivery can be found on this very brief list:

  • From a workshop in 2008 sponsored by Society for General Internal Medicine (SGIM), read a 3-page handout on teaching “Health Literacy for the Clinician Educator“at this link. There are many useful links in the bibliography section of this report.

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Finally: In May 2010, a 73-page report detailing a National Action Plan to Improve Health Literacy was announced by the U.S. Dept. of Health & Human Resources, Division of Health Literacy. Following is an excerpt from that HHS website, explaining this public health initiative:

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Limited health literacy affects people of all ages, races, incomes, and education levels, but the impact of limited health literacy disproportionately affects lower socioeconomic and minority groups. “
” It affects people’s ability to search for and use health information, adopt healthy behaviors, and act on important public health alerts. Limited health literacy is also associated with worse health outcomes and higher costs….   ”
” This report contains seven goals that will improve health literacy and suggests strategies for achieving them: Develop and disseminate health and safety information that is accurate, accessible, and actionable ; promote changes in the health care system that improve health information, communication, informed decision-making, and access to health services ; incorporate accurate, standards-based and developmentally appropriate health and science information and curricula in child care and education through the university level ; support and expand local efforts to provide adult education, English language instruction, and culturally and linguistically appropriate health information services in the community ; build partnerships, develop guidance, and change policies ; increase basic research and the development, implementation, and evaluation of practices and interventions to improve health literacy and increase the dissemination and use of evidence-based health literacy practices and interventions“.
Text Source: http://www.health.gov/communication/HLActionPlan/ – All rights reserved – Copyright 2010

News, Blogs: 2nd Call for submitting to Medlib’s Round Blog Carnival – June 2010

This blog is hosting the June 2010 edition of Medlib’s Round Blog Carnival.

Please join this forum to share your stories about the work and value provided by health science librarians or medical library collections, especially from those involved in teaching or training others to use biomedical literature.

Who should submit to the Medlib’s Round? Health Science bloggers from around the world.

What are the main ideas?

Reference Questions (or People) I Won’t Forget.   Librarians: Please share some positive “memorable” encounters that took place in a public service/reference desk setting, over your career.

Health Science Libraries or Librarians: How Have We Helped You ? Clinicians, researchers,  pharmacists, graduate students, nurses: If your clinical or educational work as a scientist or care-provider has been positively enhanced by working with a librarian or librarian-instructors in health science library settings, please share your stories with us.

Is there a deadline to submit an entry? Yes – please write your article, post it to your blog and send it to BlogCarnival.com no later than Tuesday, June 8th.

How do I submit an article? Copy the URL of your blog post, then go to BlogCarnival.com and paste the URL into their online form.  (See screenshot below).  BlogCarnival will  manage it from there.

Image/Photo Credit: http://blogcarnival.com/ – All rights reserved – Copyright 2010

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Questions? Send an email message to ebmblog@gmail.com

Thank you!

Oncology, Statistics, Summary Reports: Treating Cancer, Living with Cancer

Ask almost anyone you know about cancer, and they will have stories to relate about parents or family, close friends or co-workers (or themselves) who have received a diagnosis of cancer, or are going through treatments, or who have been declared cancer-free.  Living as a cancer survivor has become more common, thankfully, than in previous decades, and represents one of the health success stories of our era.

This post presents a short, eclectic sample of recent cancer-related news, statistics, research or summary reports.  The final portion of the post links to video presentations given by two UCHC research faculty as they discuss clinical and translational cancer research (filmed in November 2009).

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First: The National Conference of State Legislatures (NCSL) website provides an assortment of statistics or background pieces on state-based social or economic indicators, health initiatives, legislation or other current issues.  This site is a valuable resource for reference librarians, epidemiologists, policy-makers or anyone seeking current statistics about state-sponsored programs.

NCSL provides a collection of documents about Cancer Data, Trends and Policy 2009 reports, free and open to anyone to access (although registration is required to view some of the tables).  That page is where the table describing U.S. Cancer Incidence, 2009 shown below. According to statistics from the American Cancer Association, lung, prostate or breast cancers represent the most common diagnoses in the United States in 2009:

Image Source: http://www.ncsl.org/Portals/1/Documents/magazine/articles/2009/SL0110_Statestats.pdf – All rights reserved – Copyright 2009

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Next:  Several paragraphs from a December 2009 article written by Harmon J. Eyre, formerly chief medical officer of the American Cancer Society, entitled “Winning the Cancer Fight: Looking at the Future“:

” The medical management of cancer for the past 100 years has grouped cancers by the organ in which they originate and used standard interventions such as surgery, radiation, and chemotherapy.  With the development of the cancer genome anatomy of various cancer sites, individualized cancer therapy will quickly follow.

Specific genetic profiles are being introduced to project the risk of breast cancer recurrence and to shape the choice of treatment agents. We have decades of data on outcomes using estrogen receptor, progesterone receptor, and human growth factor receptor 2 testing which dictates treatment in breast cancer. Tests such as these are needed for lung, colon, prostate, lymphoma, leukemia, and other cancers. They are beginning to be developed and disseminated, with encouraging early results.

Despite keeping records in cancer registries for many decades, widespread evaluation of the level of quality care in cancer is lacking. We know that large variations in the delivery of care occur by hospital, city, state, and region. There are a number of groups working to develop indicators of quality cancer care, but there is a lack of agreement on these indicators and they are not being widely collected. For optimal outcomes, quality care has to be delivered nationwide to all cancer patients. ”

Text Source: Page 863 – Primary Care, Vol. 36:859-865 (December 2009) – All rights reserved – Copyright 2010

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An 18-page annual report from American Society of Clinical Oncology entitled “Clinical Cancer Advances 2009: Major Research Advances in Cancer Treatment, Prevention, and Screening—A Report
From the American Society of Clinical Oncology
” was published in December, 2009.  Following is an excerpt from this report:

This report [from ASCO] now it its fifth year, was developed under the guidance of a 18-person editorial board made up of leading oncologists and other cancer specialists… The editors reviewed research published in peer-reviewed scientific journals and the results of research presented at major scientific meetings over a 1-year period (October 2008 to September 2009).

Only studies that significantly altered the way a cancer is understood or had an important impact on patient care were included. Research in each section is divided into “major advances” and “notable advances,” depending on the impact of the advance on patient care and survival. “

Excerpt from ” Clinical Cancer Advances 2009: Major Research Advances in Cancer Treatment, Prevention, and Screening—A Report“, published Dec 10 2009 in Journal of Clinical Oncology – Vol. 27, No. 35:6052-606

ASCO provides links to reference information about current cancer treatments for physicians or other clinical staff, called Cancer Portal, which can be accessed at this link.

The society also provides free cancer information targeted for people living with cancer on their website, Cancer.net.

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Next: Two segments from a lecture series given in 2009 by UCHC faculty.  Oncologist Susan Tannenbaum is Medical Director of the Clinical & Translational ResearchProgram at UCHC, is shown in a 54-minute presentation on trends and improvements in the treatment of metastatic breast cancer.

The second video is a presentation on translational research given by Kevin P. Claffey, PhD, who is co-director of the UConn Health Center Breast Cancer Translational Research Group and an associate professor in Cell Biology, Center for Vascular Biology.

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Video Credits: http://mediasite.uchc.edu/Mediasite41/Viewer/?peid=22f078e3c075411380af60acdab8da83 – All rights reserved – Copyright UCHC 2010

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Next: Regarding a May 6 2010 New York Times editorial written by Nicholas D. Kristof:

In “New Alarm Bells About Chemicals and Cancer” (column, May 5 2010) writer Nicholas D. Kristof drew attention to a document being released by the President’s Cancer Panel that warns that – in Mr. Kristof’s words – “our lackadaisical approach to regulation may have far-reaching consequences for our health. ”

Text Source: The New York Times – All rights reserved – Copyright 2010

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I found readers’ comments as (or more) interesting to read as the original editorial.  There are 200+  comments which can be read at this link:  http://www.nytimes.com/2010/05/08/opinion/l08kristof.html

News, Medical Students, Charity Fundraiser ~ Tonight! Monday May 3

Every year since 2006, a group of medical students from UConn School of Medicine volunteer to ride 4,000 miles on a bicycle over 50+ days to raise money for Lea’s Foundation for Leukemia Research, a Connecticut charity.  This event is named Coast to Coast for a Cure.

Tonight – Monday, May 3, 2010 – a fund-raising event for Lea’s Foundation will be held at UCHC: the world premier of  an original comic opera entitled “The Far-Flung Empire of the Soul“, complete with puppets and live orchestra!

The opera was composed by the Health Center’s four 2010 Coast to Coast Riders for a Cure riders: Loreen Fournier, Stacy White, Arturo Montano, and Alex Ocampo.

A screenshot of the poster announcing details about tonight’s live performance, which starts at 7:30pm in Keller Auditorium at UCHC, is shown below.

Please attend!

Photo credit: http://www.uchc.edu – All rights reserved – Copyright 2010

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Ben Ristau and Jeremiah Tracy were the first UCHC medical students to make the trip from San Francisco to the Connecticut shoreline in June 2006.  They raised $20,000 for Lea’s Foundation that year.

This year – on June 16 2010 – the four bicyclists will fly to California with their equipment to begin their cross-country trek from San Francisco to Connecticut.

On their journey east-ward, they’ll travel approximately 4,000 miles over eight weeks; daily travel progress will be dependent on climate, traffic and road conditions (and their own personal energies).  My goodness, that’s a lot of miles on two skinny tires!

Photo credit: http://www.coasttocoastforacure2010.blogspot.com – All rights reserved – Copyright 2010

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Below are links to news articles or videos about previous Coast to Coast for a Cure participants.

  • One of the 2009 bicyclists, med student Drew Cathers, created this video about their trip, posted on YouTube:

Photo credit: http://www.youtube.com – All rights reserved – Copyright 2010
  • A blog written by Daniel Morris about the 2008 trip offers up the following cumulative statistics about their journey:  “ Total Miles: 3889.  Most miles in one day (Pueblo-Eads, CO): 125.  Fewest miles in one day (Rico-Telluride, CO): 36.  Days to get from San Francisco to Farmington, Connecticut: 53.  Seven rest days.  One day of rain.  Twelve states crossed.  Eight nights in Utah, the longest time in one state.  One night each in Illinois and New York, the shortest states “.

Public Health, Medically Underserved in Connecticut, UCHC Students, News: Migrant Health Workers Clinic

It’s a measure of how behind at work I am, that I missed posting the following article during Public Health Week (April 5-11 2010) and – yikes – also forgot that last week was officially National Library Week as declared by the American Library Association Sorry!

This post describes a unique public service and community outreach effort provided by individuals who volunteer their clinical services to staff the Migrant Health Workers Clinic (MHWC), a medical-dental clinic for seasonal farm-workers in Connecticut.

This traveling health clinic was founded in 1997 by UCHC professor Dr. Bruce Gould (shown in the photo below with two patients at a clinic in 2008):

Photo Credit:  http://publichealth.uconn.edu/aboutus_mfwc.php – All rights reserved – Copyright 2010

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Here is are some facts and background about the mission of the Migrant Health Workers Clinic:

Migrant farm workers are among the most economically disadvantaged and most medically vulnerable groups in the United States having little, if any, access to health care or medication. In addition to barriers to access to health care that many citizens meet like affordable health insurance, language barriers, and lack of transportation, migrant workers also experience additional barriers such as fear of deportation, loss or garnished wages, and being dismissed or not invited back to work by the employer due to missed work or health issues.  A coalition of local organizations, along with the University of Connecticut, has formed a network to overcome these barriers and attend to the health care needs of migrant and seasonal farm workers. “

The UConn Migrant Farm Worker Clinic opened its doors in 1997, with the aid of the Connecticut Area Health Education Program (CT-AHEC).… the clinic operates annually from June to October offering diagnostic and treatment options [to workers] for a variety of conditions, both acute and chronic, including primary care screenings, oral health screenings, distribution of medications for mild and self-limiting conditions, as well as preventive health education“.

Text Source: http://publichealth.uconn.edu/aboutus_mfwc.php – All right reserved – Copyright 2010

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Click here to view a list of health or social services agencies and non-profit organizations from throughout Connecticut that contribute funding, advisory services and personnel to staff the rotating schedule.

Many students from the University who are enrolled in professional programs in medicine, dentistry, pharmacology or nursing volunteer at the MHWC; some have chosen to participate in the Urban Service Track.

There is a special need for volunteers who are native Spanish speakers.  For those graduate students interested in primary care – as well as developing their (medical) Spanish language skills – it is an excellent opportunity to practice hands-on health care, advising and counseling.

Next, a 2-minute video filmed in 2008, narrated by a UCHC medical student which shows a typical visit with patients at the end of their workday, held at a local farm:  click here to watch.

Image Source: http://publichealth.uconn.edu/images/MFWC_video/index.html – All rights reserved – Copyright 2010

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Open a schedule showing 2009 locations in Connecticut where the medical and dental Migrant Health Worker Clinics were held (PDF file).

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This week on the Public Health @ UConn Facebook page, the following announcement was posted (Apr 15 2010):  “The 11th Annual UConn Migrant Farm Worker Clinic Symposium will be held on Tuesday, June 29th from 8:30-2:30 at the UConn Health Center in Massey Auditorium…  Students – Mark Your Calendars!

If you’re interested in keeping up-to-date with public health/service program announcements about activities at UConn Storrs or UConn Health Center, become a friend of Public Health@ UConn.

There is also a Learning Community in Public Health for undergraduates at Storrs campus. A recent newsletter from that group can be opened here

News, Healthy Communities: This is Public Health

Today – April 7 – is World Health Day

in addition to

National Public Health Week 2010

Image credit:  http://www.nphw.org/nphw10/home1.htm – All rights reserved – Copyright 2010

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First, two items about international community health projects:

The Comprehensive Rural Health Project (CRHP) has been working among the rural poor and marginalized [in rural Jamkhed, India] for over 37 years. By partnering with village communities and expanding upon local knowledge and resources, the project aims to effectively meet the immediate and long-term needs of these groups, especially women. With values of compassion, justice, respect and trust, CRHP works to empower people, families and communities, regardless of caste, race or religion, through integrated efforts in health and development. ”

Text Excerpt from http://www.jamkhed.org – All rights reserved – Copyright 2010

These videos (filmed in 2007) briefly describe two of the CRHP projects:

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Video credit: http://www.youtube.com – All rights reserved – Copyright 2010

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The CRHP in Jamkhed operates a 40-bed low-cost secondary care hospital providing quality emergency, medical, surgical, and outpatient care for the 1.5 million people residing in the surrounding 8 block catchment area. Each year about 20,000 outpatients receive treatment, 250 deliveries take place (high-risk referrals), and 400 surgical procedures are performed. Most deliveries take place in the village and because we provide extensive training for VHWs (village health workers) and birth attendants these deliveries are very safe. “

Text Excerpt from http://www.jamkhed.org – All rights reserved – Copyright 2010

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Video credit: http://www.youtube.com – All rights reserved – Copyright 2010

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Next:  A novel community mental health outreach program.

Data collected by staff at the U.S. Department of Veterans Affairs (VA) agency show that approximately 20% of American veterans returning from Iraq or Afghanistan are diagnosed with mental health disorders.

Dr. Karen H. Seal was lead author on a recent research study published in the Journal of Traumatic Stress (Vol. 23-1  Feb 2010) which examined how former combat veterans are being diagnosed and treated for mental health disorders within the Veteran Affairs health system including post traumatic stress disorder (for years 2002 through 2008).

The authors’ conclusions?  Only about 30% of the population studied received the recommended treatments for PTSD through the VA healthcare system.

Janie Lorber wrote an article in The New York Times (Apr 2 2010) entitled “For the Battle-Scarred, Comfort at Leash’s End”  which describes the mission and work of a non-profit foundation called Puppies Behind Bars (PBB) that selects and trains volunteer prisoners to provide 24×7 care and training for puppies chosen to become companion-service animals for disabled veterans whose mental or physical disabilities have prevented them from easing back into the practical daily challenges of civilian life.

View this video link from the New York Times website for interviews with prisoners who are now actively caring for and training service puppies. 

PBB has established canine training programs for inmates housed in six prisons in New York, New Jersey or Connecticut;  there are currently 90 animals in the program.  PBB also trains dogs to serve a very different aspect of public health and safety: detection of explosive devices.

This therapeutic community effort extends benefits to both disabled veterans and the groups of incarcerated men and women training the dogs.  The dogs look like they are enjoying themselves too.

Photo credit: http://www.newyorktimes.com – All rights reserved – Copyright 2010

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Finally: Here’s a link and calendar to special events at UConn this week that celebrate National Public Health Week 2010.

News, Health Care, Public Health, Statistics, Demographics: A Healthcare Bill and County Health Rankings

An important change in the health of current and future generations of Americans is shaping up today – March 23 2010 – as President Barack Obama signed into law the H.R. Bill #4872Health Care and Education Affordability Reconciliation 4 Act of 2010“.

A copy of the 153-page PDF version of the bill as written 3-18-2010 can be viewed here; note that this copy is only a working version.  There will likely be modifications made by legislators to the Act in the coming days and weeks. 

Link here to view a 3-page PDF document outlining the details of the “Patient Protection and Affordable Care Act“.  Many of the benefits described in this document will become effective in calendar year 2010.

Rivers of bandwidth and digital ink have been used up over this piece of legislation.  My (non-0fficial and personal) view of the events of this day is that it will be seen as a landmark day for future generations, very much like the passage of the Civil Rights Act of 1964 or the 1973 Supreme Court decision for Roe-v-Wade.  But as this isn’t a political blog, let’s move on to the topic of statistical resources about the health of Americans.

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Recently mentioned on Twitter* was County Health Rankings which offers up a valuable collection of current statistical data on the health of Americans or their access to health care, organized at a county-level by state.  This is exactly the type of local, microcosmic health measurement/outcome data that our MPH students and faculty often ask for.  Nice.

Following is an excerpt from their About page:

This web site provides access to 50 state reports, ranking each county within the 50 states according to its health outcomes and the multiple health factors that determine a county’s health.  Each county receives a summary rank for its health outcomes and health factors and also for the four different types of health  factors: health behaviors, clinical care, social and economic factors, and the physical environment. Each county can also [be]  drilled down to see specific data (as well as state bench-marks) for the measures upon which the rankings are based. “

Text Source: http://www.countyhealthrankings.org/about-project – All rights reserved – Copyright 2010


County Health Rankings is a joint project of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

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Today, starting from the main page (shown below), I clicked on the state of Pennsylvania:

Image Source: http://www.countyhealthrankings.org/ – All rights reserved – Copyright 2010

Then I used the pull-down menu to select a county in the state:  Philadelphia County (PA).  The “snapshot” of ranked data for this highly urbanized county in the south-east corner of Pennsylvania is displayed below; the numbers do not reflect favorably for the health of those residents:

Image Source: http://www.countyhealthrankings.org/ – All rights reserved – Copyright 2010

According to the health indicators ranked by County Health Rankings, Philadelphia County holds the (undesirable) distinction of the lowest score (or 67th) for the criteria measured – including “Health Factors” and “Health Behaviors”.

The data assembled on the site is not an exhaustive list of health behaviors or exposures – such as you would find on the NCHS site – but the data collected (incidence of Premature Death, Smoking Habits, Infections with Chlamydia, Births to Adolescents, Infant Mortality, etc.) serve as an approximate measure of the overall health and evidence of access to health care for that local population.

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Current statistical or demographic data as provided by County Health Rankings complements information previously made available from non-profit American foundations or organizations.

Below are only a few of the available websites that are open-access and searchable for health-related outcome measures in US populations.  If you have other great sites, please send a comment!

Image Source: http://www.statehealthfacts.org/ – All rights reserved – Copyright 2010
  • Staff from the Agency for Healthcare Research and Quality manages HCUP-NET (Healthcare Cost & Utilization Project), described as “ a free, on-line query system based on data from HCUP [which]… provides access to health statistics and information on hospital inpatient and emergency department utilization“. This page has been invaluable for answering those in-depth reference questions about hospital administration and/or patient statistics.

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Finally: Here is a link to a post I wrote in November 2009 which includes other related links to healthcare data or statistics about Americans such as Healthcare Rankings.

* And I thank the person who mentioned it on Twitter because I don’t know who did.

Academic Medicine, Teaching & Learning in Medicine: Announcing a New Series called Learning Medicine

It’s looking more like spring each morning in the Northeast, after a nasty late winter. There are daffodils poking out of the ground. The days are growing longer. This morning I saw a green bagel in the cafeteria because tomorrow is St. Patrick’s Day*.

This makes it a good time to try something new on the blog. Today marks the first post in a series which I have titled Learning Medicine: Ten Questions.

The series is intended as an open dialog between current and former medical students, educators, clinical researchers, PBL facilitators, librarians (and anyone else I can rope into answering 10+ questions!). The content or questions in the interview may vary, depending on the background and professional experience of the interviewee.

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Today, please welcome esteemed veteran blogger and physician Graham Walker!

A Background Question – Who Are You?

Graham Walker describes himself in this way:

I’m a second-year Emergency Medicine resident at St. Luke’s-Roosevelt Hospital System in New York City. I was originally a medical school blogger (at the now-defunct Over  My Med Body! ) blog. Recently I’ve returned to blogging as a contributor to The Central Line, the official blog of the American College of Emergency Physicians.

My interests include: surviving residency, technology and web design, simulation medicine, informatics, health policy and caffeine highs.  I’m originally from Kansas, went to undergrad at Northwestern in Chicago, studying social policy/health policy, then went to Stanford for med school with a concentration in Community Health.

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Making the transition from undergraduate/or pre-med to graduate medical student

Can you name 4 or 5 key things that (in retrospect) you wished you had known before you began your first day of medical school?

Oh boy. Hopefully I can still remember anything about being a premed!  Here goes:

1) Know how you study, and develop good study skills in undergrad. Medical school is tough — they say it is like trying to drink water out of a firehose — so make sure that you’ve got a system in place to organize information in your head and commit it to memory.

For some people that’s flashcards, for others it’s study groups; for me, I *still* find I have to write things down in a notebook to get them to stick.

2) Know how you relax, and don’t give up doing that. For some people, that’s going to the gym. For others, that’s playing the guitar. Or doing a hobby. Or keeping in touch with your family. Medical school (and residency even more-so) requires copious coping mechanisms so have yours ready.

3) Get by with a little help from your friends. Don’t be a gunner in medical school. You’re in — You get to be a doctor — Yay!  Med school will be much easier if you work together with your classmates rather than view them as competition — *especially* once clinics start.

4) It is normal to feel overwhelmed. Accept it and embrace it, and it won’t be so stressful. There are parts of it that you’re going to hate, that are not going to be intuitive. But it will get better!

5) Try to get yourself all figured out. Know yourself by the time medical school starts, because while you’re in the thick of things, it’s easier to have as many of your own internal issues worked out before trying to ascend Mt. Medical School. “

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Being a Person AND a Medical Student

Please tell us about some moments in medical school or clerkship that:

Made You Angry: I remember two instances that made me upset: one was the way some OB-Gyn residents were talking disrespectfully about a terminal cancer patient. (I actually kind of understand their perspective as a resident now, but still don’t agree with it.)

The other was a grossly abnormal physical finding in a patient that I found that a group of residents chose to ignore, because I was a medical student. As the medical student, you are — more than anyone — your patient’s advocate. Know when to speak up.”

Made you wish you had Studied More: “ The Boards. But you always wish you could memorize more. Do your best, and move on “.

Brought Tears to your Eyes:  “ I remember it like it was yesterday. It was on my medicine rotation, one of the first patients that I really felt was “mine.” My residents let me “be in charge” as much as I could, and I fought for him to get a much-needed foot amputation. I was off or post-call one day, and I remember coming back the next morning and finding out he had died.

I wrote up the experience: Wonderful, Just Wonderful, Dr. Walker at: http://www.grahamazon.com/over/2006/02/wonderful-just-wonderful-dr-walker/ “.

Made you Roll on the Floor Laughing:  “ Slap-happy post-call. I’m known for being a little hyper and a bit of a morning person, which usually drives people crazy. Also any shift in the Emergency Department “.

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Learning Medicine, Becoming a Doctor. Empathy, gravitas, demeanor, honesty

Part A:  How does one learn to “act like a physician”?   (It’s not really in a textbook.)

I certainly steal bits and pieces from different mentors and heroes of mine. A phrase from this attending, a style from that one. Tips and tricks along the way.

There’s no one way to “act like a physician,” and often it changes for the situation and the patient. I’m a different type of doctor when I’m seeing an infant compared to when I’m evaluating a trauma patient or interviewing a 95 year-old. Being able to adapt and change: maybe that’s the ticket. ”

One area the third-year medical students are concerned with is effective communications with patients and their families when managing someone with a terminal illness, in palliative care or especially when attending unexpected deaths due to accidents, homicide, military, etc.

Part B:  How does a physician learn to “deliver bad news” to a patient or their family members?

Get at or below the patient or loved one’s level. Empathize. Speak in private. Speak their language, if you can. (Learn as many languages as you can.) Make eye contact. Be direct, calm, and compassionate. Tell them however they’re feeling or reacting is normal and okay: everyone reacts differently.

Be present in the moment.  This is one of the hardest things for me to do now, and I have to remind myself of it, especially in a busy emergency department. Don’t worry about what’s happening to the rest of the team, or the other patients, or the rest of the department. Just be there, if only for a few minutes.   Apply the Golden Rule “.

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Congratulations – You are now a resident!  Choosing a specialty.

Match Day is Thursday, March 18, 2010. Can you describe the process that allowed you to select a medical specialty (Emergency Medicine) and why?

Man, it’s hard to remember, because my view of the specialty has changed so much as a resident. I remember really connecting with the type of attendings and residents who went into Emergency Medicine.  My type of people, I guess.

They say it’s much easier to rule out specialties than rule any in, and that’s very true. I was the type of medical student who enjoyed most of my clerkships, but in the end, I chose the one that I thought I’d enjoy, be challenged by, and excel at. ”

What advice would you give fourth-year students as they learn their Match and prepare for residency?

Get excited, relax, and get scared. Residency is not anything like a harder version of medical school, like I imagined it to be.  Enjoy your last few free months. Travel. Get married. Spend time with the people who are important to you.

Do. NOT. Study. And most of all: learn Spanish “.

Do you ever get enough sleep?

Yes, I do. My program is pretty resident-friendly in that regard, and I think it makes us all better, happier, more efficient, and more compassionate doctors. It’s hard to go the extra mile (which is what you realize you have to do as a resident) when you’re exhausted and cranky. ”

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Since this blog is written to inform readers about health science literature, trends in medical or scholarly communications, effective search strategies and sources, the next question focuses on your experience in learning to effectively use health science literature, sources for evidence-based practice or anything digital.

Have your information needs and/or searching behavior(s) changed between medical school and residency?  Are mobile computing resources and technologies important to you?

Definitely.  In medical school it’s all about learning about the basics, and the basics of how you treat X.

In residency, it’s much more about management, when to use what, finesse, and pattern recognition. I think it’s different for every specialty, too.

Regarding searching for clinical evidence, which sources, journals or databases have you found most-useful in answering clinical or patient care questions over time?

Great question. If I’m going to anything, it’s usually either UpToDate or E-Medicine or straight to actual papers, via Pubmed.

I really like JAMA’s Rational Clinical Examination series, as well as BestBets, The TRIP Database, Cochrane Reviews, and often just… Google.  I also keep a private little blog of things I’ve learned and journal articles I want to hold onto for future reference.”

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What aspect of medicine/science digital communication and/or particular use of the Web for medicine or patient care interests you the most? (This is a completely open-ended question.)

I love Podcasts, Videos, Image Banks and clinically-useful blogs. It’s a whole other style of learning that helps you learn more when you’re tired of reading journal articles, review articles, or textbooks. ”

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Bonus Question: What question would you like to ask the readers? – or – What do you want medical students who read the EBM and Clinical Support Librarians@UCHC blog to learn from our interview?

I’d love to know how the students think medicine is going to change in their lifetime.

What do they think of the blurring of private/public life through [social media sites such as] Facebook?  Should we as doctors hide our private lives — that is, is it inappropriate for a patient to see a doctor, say, smoking or drinking on a site like Facebook?

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And that’s the first interview for Learning Medicine: Ten Questions series.  Special thanks again to Graham Walker for sharing his time, expertise, advice and experiences.

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Happy St. Patrick’s Day!

News, Public Health, Disease Prevention: World Cancer Day – Feb 4 2010 and a Very Special Cat

Today is World Cancer Day 2010 – Feb 4 2010

International Union Against Cancer (UICC) is the principal sponsor for World Cancer Day and is responsible for organizing the annual World Cancer Campaign and World Cancer Summit (held every two years).

The theme for the 2010 campaign is “Cancer can be prevented too”.  The public health message promotes practical lifestyle choices or modifications to lower the risk of  developing cancer, such as avoiding tobacco use, limiting alcohol consumption or exposure to the sun’s rays (or tanning booths), maintaining a healthy weight and take preventative measures against cancer-causing infections.

World Cancer Day began in 2006, and is held every year on Feb 4th.

Here are some additional facts about the International Union Against Cancer (UICC), from their “About” page:

In 1933, cancer researchers recognized the need to share knowledge and expertise globally and so founded the International Union Against Cancer (UICC). Since then, UICC has grown to embrace organizations engaged in all aspects of cancer prevention and control: voluntary cancer societies, research and treatment centres, public health authorities, patient support networks andadvocacy groups, and ministries of health “.

UICC works closely with the World Health Organization (WHO), the International Agency for Research on Cancer (IARC), and the Programme of Action for Cancer Therapy (PACT), and has consultative status with the UN Economic and Social Council. It offers corporate partners a unique opportunity to demonstrate social responsibility on a global scale. Every two years, UICC brings together key stakeholders in a World Cancer Summit. ”

Text Source: http://www.uicc.org/ – All rights reserved – Copyright 2010

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It probably isn’t correct to say that any cat has a “mission” in life… other than eating, looking for tuna, seeking out sunny spots, sleeping, batting balls around or searching for insects to chew on.  But anyone who has ever lived with a feline knows how comforting a warm, purring cat can be in times of trouble or stress.

This month, the press has picked up on the story of one spotted cat from Providence, RI  that does seem to have a purpose and meaning in his behaviors, as documented by David Dosa, MD.

Dr. Dosa is an associate professor of medicine at Brown University and a gerontologist at Steere House Nursing & Rehabilitation Center in Providence. Oscar is a therapy cat and lives at the facility on the third floor where there is a 41-bed unit for patients with dementia. The staff has noticed that, over time, Oscar has purposely chosen to enter rooms  of patients who are near death and will stay with them until they’ve passed on.

The doctor has written a book about the cat, entitled “Making Rounds with Oscar: The Extraordinary Gift of An Ordinary Cat” which was published by Hyperion Books on Feb 2 2010.  Earlier, an essay he wrote about the cat was published the New England Journal of Medicine in July 2007.

In the Medical Subject Headings List (MeSH) I found that the term “animal assisted therapy” was added to PubMed only recently (in 2010).  Link here to a group of recent citations found on Medline about therapeutic human-animal relationships.

Reporters from The Providence Journal visited with Dr. Dosa and Oscar recently, and the video link is here (Jan 31 2010). Some of the other news videos about this story are regrettably sensationalistic, even calling him the furry “angel of death” or other silly stuff.

And today, I learned that Oscar now has a Facebook page!