A Web 2.0 Review in the Medical Journal of Australia Mentions This Web Site

David Rothman links to a comprehensive review of the use of different Web 2.0 tools in medicine in the Medical Journal of Australia: The effect of Web 2.0 on the future of medical practice and education: Darwikinian evolution or folksonomic revolution?

In the section about blogs, the authors mention this web site along with Dean Guistini’s UBC Academic Search — Google Scholar Blog, David's blog, and ScienceRoll.

The article provides a good overview of most of the basics of what I call the 6 axes of medical education in Web 2.0 style:

1. Web feeds (RSS)
2. Podcasts
3. Blogs
4. Wikis
5. Custom search engines
6. Second Life virtual world

Unfortunately, the review failed to mention AskDrWiki which is, in my opinion at least, one of the best medical wikis providing high-quality and unique content. AskDrWiki features more than 140 coronary angiogram videos from the number one heart center in America for 13 years in a row -- Cleveland Clinic.

Such omissions can be fixed in the future by using an approach similar to the newly-launched Google News comments -- if you are included in a news story and you want to clarify a point, comments can be added directly to the news report.


My presentation on Web 2.0 in Medicine from December 2006.

References:
The effect of Web 2.0 on the future of medical practice and education: Darwikinian evolution or folksonomic revolution? Rick McLean, Brian H Richards and Janet I Wardman. MJA 2007; 187 (3): 174-177.
MedLib Blogs (including this one) in the Medical Journal of Australia. DavidRothman.net, 08/08/2007.
Google News Adds (Special) Comments. Google Blogoscoped, 08/08/2007.

Baby Einstein DVDs May Slow Language Development? Also, Please Cite Your Sources

A new study showed that for every hour per day spent watching educational DVDs like Baby Einstein, infants understood 6-8 fewer words than those who did not watch them. Children with larger vocabularies had parents who read to them or told them stories.

The American Academy of Pediatrics recommends against watching television by children under 24 months.

There are at least 31 news reports on the story found on Google News but none of them links to the original source -- supposedly, an article in the Journal of Pediatrics. I checked the online version of the journal twice but I was still not able to find the study in question. After performing a PubMed search, it became clear the study was actually published in the Archives of Pediatrics & Adolescent Medicine and not in the Journal of Pediatrics.

Linking to the original source of the story should be one of the gold standards of the web journalism and it was obviously not done in this case.

References:
DVDs Don't Produce Brainy Babies. U.S. News & World Report.
Baby Einsteins: Not So Smart After All. Time.
'Baby Einstein' Videos Ineffective, Study Finds. NPR (audio).
Audio: Study hits at the heart of Baby Einstein. MarketWatch.com.
Study: Babies Raised By Videos Approximately As Dumb As Expected. Gawker.com.

Health Organizations and Journals Show More Interest in Blogs

My colleagues and I presented posters/abstracts on different aspects of blog use in medicine at the 2006 American Society of Nephrology (ASN) Meeting, the 2007 American College of Cardiology (ACC) Meeting, the 2006 Annual Perioperative Summit at the Cleveland Clinic, and the 2007 Annual Research ShowCASE at Case Western Reserve University. The interest by the attendees has always been great.

A dentist blogger was recently asked to present on "Blogs and Their Use in Dentistry" at the American Acdemy of Pediatric Dentistry's Annual Session.

The Annals of Emergency Medicine recently featured a summary of popular blogs authored by EM physicians (link via GruntDoc). What is next? The Annals of Internal Medicine with an article about popular IM blogs? The Annals of Allergy, Asthma, and Immunology with the summary of popular allergy blogs? The blogs are gradually hitting main stream in the minds of medical publishers about a year after they became commonplace in the general media. Most major newspapers and TV stations now have blogs. Medical journals and hospitals cannot be far behind.

Blogs offer a unique way to connect with readers/customers. They are instant and look spontaneous. Subscription via web feeds creates a relationship. This is just one aspect of why blogs are influential. The other is their popularity. Google changed our world. When I teach case-based management of DKA to residents at the Cleveland Clinic, I do not give them the web address anymore. I just tell them "search Google for "DKA case" and you will find the case we discussed today at number 1 or 2 in the search results."

References:
Web 2.0 in Medicine Presentations at Research ShowCASE in Cleveland
Cleveland Clinic Perioperative Medicine Summit
American Society of Nephrology (ASN) Renal Week 2006
Wow, I made Annals of Emergency Medicine! GruntDoc, 04/2007.
Emergency Medicine in the Blogosphere: The Irreverent Wit of the Specialty’s Unofficial Voice. Annals of EM, Vol. 49, Issue 5, Pages 612-614 (May 2007).

Flickr: Swallow Brothers

Swallow Brothers

Source: Kuribo, a Creative Commons license.

Foxit Reader is Better than Adobe Reader for PDF

Adobe Reader is a big program and takes 10-15 seconds to start. You cannot edit or add text to a PDF unless a form is embedded specifically for that purpose.

Foxit Reader deals with those limitations in a heartbeat. This small 1.7-MB program starts in just one second and the Typewrite features allows you to add text to any PDF despite the fact that the form entry may not have been embedded originally. The Foxit Reader is free and its counterparts of Adobe Acrobat (Editor, Creator) are reasonably priced at $ 50-100 compared to more than $ 500 for Adobe Acrobat Professional.

I have heard about Foxit before but never got around to try it. Last week I read that Larry Page insisted for months that Google included Foxit instead of Adobe Reader in Google Pack and decided to give it a try. The current version of Foxit Reader is a significant improvement over Adobe Reader, adds useful features, has a small foot print and is easy to use.

References:
Foxit Reader from Wikipedia, the free encyclopedia.
PDF Hammer -- edit your PDF files online for free.
Image source: Foxit

Related:
16 Free Online Tools for Working with PDFs. DavidRothman.net, 03/2008.

Updated: 03/12/2008

Clinical case: Should we stop raloxifene (Evista) prior to surgery?

A 69-year-old Caucasian female with a past medical history of hypertension, hyperlipidemia, osteoarthritis and severe osteoporosis takes the oral selective estrogen receptor modulator raloxifene. Her other medications include hydrochlorothiazide and atorvastatin. The patient takes ibuprofen and the combination of oxycodone and acetaminophen prn for knee pain.

She is seen by an internal medicine physician for preoperative evaluation three weeks prior to surgery for total knee replacement for osteoarthritis of the right knee. Physical examination reveals decreased range of motion of the right knee but is otherwise normal. The electrocardiogram recorder in her primary care physician's office shows normal sinus rhythm.

The patients and her primary care physician want to know whether she should stop taking raloxifene prior to surgery.

Should we stop Evista prior to surgery?

Yes.

Indications for use of selective estrogen receptor modulators (SERMs) such as tamoxifen and raloxifene (Evista) have expanded beyond breast cancer treatment to prevention and treatment of osteoporosis. Both tamoxifen and raloxifene increase the risk of VTE (DVT and PE).

A review in UpToDate recommends tamoxifen and raloxifene be discontinued for 4 weeks before surgeries associated with a moderate or high risk of venous thromboembolism (VTE).

If the patient takes those drugs for breast cancer treatment, a consultation with an oncologist is recommended.

This is one of the series of perioperative questions I will answer on this web site. They will be submitted as clinical vignettes to the Cleveland Clinic Annual Perioperative Summit next year. This year's summit is in September and several of the perioperative cases in nephrology will be presented as posters and published as abstracts in the Cleveland Clinic Journal of Medicine.

References:
Should selective estrogen receptor modulators be discontinued prior to noncardiac surgery? UpToDate (paid subscription required).
Hormone therapy and thromboembolic disease. Hemostasis and thrombosis. Current Opinion in Hematology. 14(5):488-493, September 2007.
The World Health Organization has an online Fracture Risk Assessment Tool.
Image source: Flickr, a Creative Commons license.

Updated: 12/14/2009

What is the difference between an internist and a family physician?

DB’s Medical Rants explores the differences between internists and family physicians in 4 postulates.

It seems like with time, as the U.S. health system evolves, internists will morph into hospitalists and family physicians into outpatient doctors. A similar arrangement, with outpatient GPs who almost never go to the hospitals and inpatient doctors, works relatively well for many European countries.

References:
Internists have different skills than family physicians. DB’s Medical Rants.

Further reading:
Retired doc's thoughts and Musings of a Distractible Mind comment on the implications of switching to hospitalist care for inpatients.
Practicing cost-effective medicine. One clinician's top 10 tips. Robert M. ACP Hospitalist, 2007.
Image source: OpenClipArt.org, public domain

Updated 09/20/2007