Searching for Reliable Medical Information Online

My medical librarian buddy David Rothman created a nifty Web search box that "searches authoritative and trusted consumer health information and patient education resources recommended by the U.S. National Library of Medicine and/or by CAPHIS (the Consumer and Patient Health Information Section of the Medical Library Association)." It's techically a Google Custom Search Engine (CSE),which is a nifty opportunity to create a Google search box that searches only web sites you select.

CAPHIS maintains a page on how to evaluate health infomation, which is useful, and it also lists some of the web sites they recommend. They also list the Top 100 Health Websites You Can Trust.

I've used David's search box for my own medical searching -- I was scrolling through commercial and vaguely unreliable results thinking "hmmm, there's got to be a way to search reliable health information on the Web. Then I remembered David's search engine and tried it with great success. I was happy to easily search medical sites that I know are reputable -- like medlineplus, the mayo clinic, and others. The search looks & works like Google, but it only searches those trusted sites.

For my CogSciLibrarian readers, I thought I would search some of the health-related topics that I've blogged about, such as

• diabetes: see results from Medline and MedlinePlus, the CDC, the Harvard diabetes center, the Mayo Clinic, and familydoctor.org (the American Academy of Family Physicians). Not surprisingly, there are few results for feline diabetes, since the search engine is focused on human health.
• vision therapy: see results from Medscape/WebMD, HealthCentral, MedHelp, and more.
  
• concussion: see results from kidshealth.org (created by The Nemours Foundation's Center for Children's Health Media) and an interesting article by the CDC about their campaign with the Seattle Seahawks & the Brain Injury Association of Washington to help prevent young athletes from sustaining concussions, and information from the Medical College of Wisconsin.

Of course, there are terrific library resources for consumer health as well, such as:

• Alt HealthWatch (from EBSCO) - the "alt" stands for "alternative & complementary"
  
• Health and Wellness Resource Center and Alternative Health Module (from Cengage Gale)
• Health Reference Center Academic (from Cengage Gale)
  
• Health Source Consumer Edition (from EBSCO)

... and many more ... ask a librarian for assistance!

So ... if you or someone you know is doing consumer health research, check out David's Consumer Health and Patient Education Information Search Engine and browse the list of trustworthy general health web sites, or head to your local public library.

Pet "How To" Videos from Cornell

I found some wonderful cat videos @ Cornell University College of Veterinary Medicine which provide details on how to care for your ailing cat.


In this case, not even ailing -- but how to brush a cat's teeth. We have a cat struggling with gum health, and we have been brushing her teeth for well over a year. We don't use the implements shown in the video; rather, we use a q-tip and some veterinary oral rinse. And we didn't introduce the new health regime the way the video suggests, tho' if I had to do it over, we would have. (note: early in the video are shots of sedated cats getting their gums cleaned; be prepared to cover your eyes if you don't want to see cats in an operating theater)

They have a long series on Caring for Your Diabetic Cat, which, sadly, I no longer have to do. The video has a great explanation of what diabetes is and how it affects your cat (including some distinctions between feline and human problems related to diabetes), how to give injections, and nutritional therapy. The series on Trimming Your Cat's Claws is very helpful -- and useful if your cats like to scratch things.

If you are caring for a cat, I recommend looking at the list of videos Cornell offers and watching the ones that apply to your cat.

For More Information

• Videos for Cats, Partners in Animal Health and Cornell University College of Veterinary Medicine. 2008.
• Videos for Dogs. Partners in Animal Health and Cornell University College of Veterinary Medicine. 2008. Only one there so far; maybe they'll add more soon.
  

Managing (Medical) Complexity

Another terrific medical article by Atul Gawande in the New Yorker. This one is about doctors using checklists to decrease the amount of infections in the Intensive Care Unit (ICU). I read it when it came out in December and didn't plan on blogging it ... but the article has stayed with me, so I thought I'd blog it. a) because maybe it'll interest you, Dear Reader, and b) so I could re-read the article and cement its ideas even more firmly in my memory.

The Checklist describes the work of Paul Pronovost, MD, PhD (public health) who developed a checklist to routinize the roughly 178 daily tasks ICU patients need. Gawande states that the average stay of an ICU patient is 4 days, and the survival rate is 86%. Pronovost's checklist, designed specifically to lower the rate of line infections in ICU patients, was implemented at Johns Hopkins in 2001. A year later, their 10-day line infection rate had dropped from 11% of all patients to 0%. Yes, zero percent! They reran the numbers and followed patients for another year. Over the 27 months of using the checklist, they had only 2 line infections. Astonishing!

Pronovost observed two main benefits of these checklists: a) they help with memory recall. As Gawande notes, "When you’re worrying about what treatment to give a woman who won’t stop seizing, it’s hard to remember to make sure that the head of her bed is in the right position." And b) the checklist itemizes "the minimum, expected steps in complex processes." Gawande notes that nurses were empowered to enforce the doctors' adherence to the checklist, thus improving their use.

Sadly, because a checklist for physicians is not sexy, Pronovost's ideas have not been widely adopted in this country. One exception is the 2003 implementation in the inner-city Detroit hospital Sinai-Grace, where line infection rates dropped by 66%. This was estimated to have saved over 1,500 lives and $75 million dollars over three years. Pronovost and the Keystone Initiative published these results in a 2006 New England Journal of Medicine article.

Gawande personalizes the case studies with his usual flair; the article discusses the near-drowning of a 3-year old in Austria who by age 5 had "recovered her faculties completely," (her doctors had used a checklist) and a Massachusetts limo driver who suffered a serious line infection in the hospital and fortunately recovered (his doctors had not used a checklist). He also talks about the process by which the US Army Air Corps implemented flight checklists as they rolled out the B-17 in the mid-1930s, commenting that "[m]edicine has entered its B-17 phase."

I hope that more hospitals will take this checklist approach, as it certainly seems to be a sound idea.

For More Information

• Berenholtz, S. M., Pronovost, P. J., Lipsett, P. A., Hobson, D., Earsing, K., Parley, J. E., et al. (2004). Eliminating catheter-related bloodstream infections in the intensive care unit. Critical Care Medicine, 32(10), 2014-2020.(abstract in PubMed)
• Gawande, Atul. Annals of Medicine: The Checklist. The New Yorker, Dec. 10, 2007.
  
• Hales, B. M., & Pronovost, P. J. (2006). The checklist-a tool for error management and performance improvement. Journal of Critical Care, 21(3), 231-235. (abstract in PubMed)
  
• Pronovost, P., Needham, D., Berenholtz, S., Sinopoli, D., Chu, H., Cosgrove, S., et al. (2006). An intervention to decrease catheter-related bloodstream infections in the ICU. New England Journal of Medicine, 355(26), 2725-2732. (See also Erratum: An intervention to decrease catheter-related bloodstream infections in the ICU. (2007). New England Journal of Medicine, 356(25), 2660.)
• Walker, Tim. Make a list of "crucial basics" and check it twice. Hoover’s Business Insight Zone, Feb. 11, 2008.
  In researching this post, I found a Hoover's blog post by Tim Walker commenting on the checklist idea and wondering how it could be applied to business and career.

New in Health Communication

Saw a few interesting tidbits on health communication recently & thought they might be interesting:

Anti-drinking Campaign Ads May Be 'Catastrophically Misconceived': ScienceDaily reports on a British study that shows "Some anti-drinking advertising campaigns may be 'catastrophically misconceived' because they play on the entertaining 'drinking stories' that young people use to mark their social identity, say researchers who have just completed a three year study of the subject."

Instead of turning young adults off of drinking by portraying "...drunken incidents, such as being thrown out of a nightclub, being carried home or passing out in a doorway ... young people [see them] as being a typical story of a 'fun' night out, rather than as a cautionary tale."
(thanks to Bora for the link)

and

Roma Harris & Nadine Wathen interviewed 40 women living in a "highly agricultural rural county in southwestern Ontario" about how they locate health information and published the results in the October 2007 issue of Reference & User Services Quarterly.

Excerpts from the article abstract:

" ... Most of the women in the study undertake considerable health-related information gate-keeping for themselves and on behalf of family members and others in their personal networks. They seek and assess information from a wide variety of sources, some of which they locate via the Internet, and they balance what they learn against their experiences with the formal health system. The women's accounts focused repeatedly on the quality of their relationship with those to whom they turn for assistance, although the actual roles of helpers, whether physicians, friends, librarians, or staff in health food stores, often appeared to be incidental. Instead, helpers' perceived effectiveness seemed to depend largely on how well they express care when information is exchanged. Several women also reported that they had diagnosed and even treated themselves, sometimes on the basis of information gathered from the Internet. ..."

The library was occasionally cited as a resource, but mostly for the Internet access; however there were some serious concerns about the rural library:

1. Some women felt that the library wouldn't have current health books
2. Some women felt that the library wasn't worth going to because the books would have to be returned
3. Some women would not ask a library staffer for help due to concerns about confidentiality, since they live in such a small community. Presumably they don't want the librarian knowing their business.
   

So. Two very different and mildly disturbing reports about communicating health information. (See also my October post Seniors & Medical Information, summarizing a JASIS&T article on the topic)

For More Information

• Anti-drinking Campaign Ads May Be 'Catastrophically Misconceived'. ScienceDaily (Dec. 14, 2007).
• Harris, Roma and Nadine Wathen. "If My Mother Was Alive I'd Probably Have Called Her." Reference & User Services Quarterly, Fall2007, Vol. 47 Issue 1, p67-79. May be available from RUSQ web site; definitely available from EBSCO's "Library, Information Science & Technology Abstracts" or @ your library.

Seniors & Medical Information

Read an interesting article yesterday from JASIS&T which covered usability for seniors in two domains: first, the article talks about how seniors get information about drugs, and then it talks about how they look for information about drugs within two specific web sites.

Given, Ruecker, et al write about an study they did on Inclusive Interface Design for Seniors: Image-browsing for a Health Information Context in the Sept. 2007 issue of the Journal of the American Society for Information Science and Technology. While seniors are prescribed drugs by their doctors, they rarely call their physicians for drug-related information, even though "seniors are particularly prone to negative drug interactions, hospitalizations, addictions, etc. as a result of improperly identifying their medications" (many recent articles support this).

Instead, seniors are more likely to get drug & drug interaction information from their pharmacist, followed by contacting "personal contacts" (friends and family, "especially those working in the health care field." Note that libraries don't show up on this list of trusted information sources.

Seniors like using the Internet for find health / drug information, but they are aware of the potential accuracy / bias problems that exist on the Web, including the "difficulties sorting out drug 'ads' from truly informational Web sites."

The authors tested a couple of interfaces with a group of 12 seniors to see how different sites met their needs with respect to identifying specific pills. A major problem that seniors have using the Web is physiological: difficulty reading small font, trouble distinguishing colors and even small shapes -- which is especially important when trying to find "their" medication on a Web site. And as frequently happens when doing usability testing, the participants often didn't see the "affordances" on the page, such as a "zoom" feature, while others didn't see the "sort" button.

The study itself was an interesting insight into how older folks use Web sites, especially one that is geared to them, and to addressing one of their serious information needs.

I read it thinking ,"how can libraries market their services to seniors?" Here are a couple of ideas: provide local pharmacists with information about the public library -- hours / phone number / contact information, maybe a handout with selected health resources available through the library -- telling the seniors, via a trusted resource -- how we in the library can help them. Perhaps we could put this in emergency rooms also? I don't know what the protocols are, but ... that's where seniors are, and when they need health information. And aren't we good at providing information to people, when they need it?


For More Information
Given, Lisa, Stan Ruecker et al. Inclusive Interface Design for Seniors: Image-browsing for a Health Information Context Journal of the American Society for Information Science and Technology. Volume 58, Issue 11 (September 2007), pp: 1610 - 1617. Link to abstract; full-text available only with subscription, or check out Interlibrary Loan.

Studying the Placebo Effect

The August 3 episode of ScienceFriday featured an interview with Columbia psychology professor Tor Wager about his research on the placebo effect. Wager and his team use fMRIs and PET scans to study how the use of "special creams" affects pain (high heat placed on skin). They first established where this kind of pain shows up in fMRIs. Then, in Wager's words, "... we put a cream on [subjects'] skin and we say this is lidocaine. It's an effective - it's a known pain reliever. We want to see how it works in your brain. So then we give them the same stimulus, the same hot, you know, hot plate on their arm, instead of a level eight, maybe it's a level six."

And later: "We find that some of the pain responsive regions of the brain actually showed decreases in activity when you have the placebo."

Finally, Wager states: "I think one of the sort of important and interesting take-home message is is that medical science has really, so far, ignored, to a large degree, people's beliefs and expectations, and pharmacology ignores it. But, in fact, because beliefs cause chemicals to be released in your brain, those chemicals actually can combine with drugs and do things that just the drugs themselves won't do."

For More Info
* ScienceFriday, August 3, hour two. Interview with Tor Wager, Assistant Professor, Department of Psychology, Columbia University. Transcript avaialable in LexisNexis. ScienceFriday also links to lots of other interesting stuff on the placebo effect, including an article from a 2004 issue of Scientific American: Scientists See How Placebo Effect Eases Pain and a 2007 episode of NYC's Radio Lab called simply Placebo

* Wager, Tor and team. Cognitive and Affective Control Laboratory @ Columbia University.

*Benedetti, F., Mayberg, H. S., Wager, T. D., Stohler, C. S., & Zubieta, J. -. (2005). "Neurobiological mechanisms of the placebo effect." Journal of Neuroscience, 25 (45), 10390-10402.
* Wager, T. D. (2005). "The neural bases of placebo effects in pain." Current Directions in Psychological Science, 14 (4), 175-179.
* Wager, T. D., Rilling, J. K., Smith, E. E., Sokolik, A., Casey, K. L., & Davidson, R. J. et al. (2004). "Placebo-induced changes in fMRI in the anticipation and experience of pain." Science, 303(5661), 1162-1167.
(citations retrieved from Scopus)

Harry Potter in PubMed (no spoilers)

Some Librarian points us to a 2006 article in Singapore's Annals of the Academy of Medicine entitled Interesting In- and Outpatient Attendances at Hogwarts Infirmary and St Mungo's Hospital For Magical Maladies.

PubMed's abstract says
"Ailments afflicting wizarding folk are underreported in the muggle world. The recent integration of muggles and magical folk with the return of You-Know-Who (aka He Who Must Not Be Named) may result in a similar affliction of inhabitants of both worlds. We describe interesting maladies afflicting muggles and wizarding folk alike, arising from the use and misuse of magic. We also provide a basic glossary of magical ailments, and describe their muggle corollaries. Further studies will hopefully result in the development of immunity against the unforgivable curses."

And you can read the full article at the journal's web site.

For More Information
* Lim EC, Pomfrey PM, Quek AM, Seet RC. Interesting In- and Outpatient Attendances at Hogwarts Infirmary and St. Mungo's Hospital For Magical Maladies (pdf). Annals of the Academy of Medicine (Singapore). 2006 Feb; 35(2):127-9.

How Doctors Make Decisions

Interesting article in this week's The New Yorker about how doctors think / make decisions. What's the Trouble, a medical dispatch by Jerome Groopman is subtitled "How Doctors Think." I'd say it's also about how they make decisions, and specifically three kinds of thinking that lead to bad decisions on their part. Malcolm Gladwell covered this a bit in Blink : the power of thinking without thinking, but this is a personal essay on topic.

Groopman describes three kinds of thinking that adversely affect doctors' decision making, with three different anecdotes.
1. Representativeness errors -- you believe what you see and "fail to consider possibilities" that contradict your mental template. The opposite of Occam's razor?
2. Availability errors -- when you see six patients in a row with the flu, and the seventh presents with similar symptoms, you're more apt to diagnose the seventh with the flu too (kind of like word priming, I'd guess); first described by Tversky & Kahneman, in Availability: A heuristic for judging frequency and probability. Cognitive Psychology in 1973. (wikipedia on availability)
3. Personal feelings for a patient -- The good Dr. Groopman admits to missing a diagnosis because he was reluctant to subject his "favorite patient on the ward" to an extensive (and buttocks) exam.

This is interesting for the medical profession, but it has (less dire) implications for librarians too -- I know I make assumptions at the reference desk which color the questions I ask. Sometimes I guess right, but not always, and then I have to backtrack, and occasionally start over.


Finally, Groopman refers to Achieving quality in clinical decision making: cognitive strategies and detection of bias, by Pat Croskerry, published in the 2002 Academic Emergency Medicine for more info.

PubMed

See some notes about using PubMed at my Libraries For My Friends blog.

Science in the News Seminar @ Harvard Med School

I am listening to a great series of public lectures on various aspects of science in the news, sponsored by Harvard Medical School this past fall. Each session is approximately 90 minutes, broken into three segments (conveniently, each segment is its own podcast) and is presented by a different graduate student at HMS. The sessions are complete for the year, but there are so many of them it’ll take a while to listen to them all.

Topics included “Diet and Cancer Prevention”, “Obesity & Diabetes”, and “Mental Health.” Both pdf and mp3 files are available on their web site, or you can subscribe via iTunes or other podcasting options.

Treating Dog Cancer

Today's New York Times has an article about dog cancer. Seems some dogs are participating in clinical trials to assess the effectiveness of cancer treatment in humans and animals. Those in which the treatment succeeds are indeed lucky dogs.

If only there were such treatment for those suffering from cat cancer, like Boomer.

Business: In Trials for New Cancer Drugs, Family Pets Are Benefiting, Too
November 24, 2006
ANDREW POLLACK
Dogs are receiving groundbreaking drugs or other treatments
for cancer, a leading cause of death in older dogs.

Evaluating Health Information

I’m going to post this on my other blog, Libraries For My Friends, but I thought some of you might like it too:

MedlinePlus offers a great set of material on how to evaluate health information online. It includes links to …

• a flash tutorial called Evaluating Internet Health Information: A Tutorial from the National Library of Medicine


• 10 Things to Know about Evaluating Medical Resources on the Web (also available in Spanish) from the National Center for Complementary and Alternative Medicine


• An article from the Harvard School of Public Health on Interpreting News on Diet: Research and the Mass Media


• Tips for the Savvy Supplement User: Making Informed Decisions and Evaluating Information from the Center for Food Safety and Applied Nutrition

A votre sante!

Podcasts from MedlinePlus

Ok, so I'm still en vacanes a little, but I just saw this podcast (featured on iTunes' "New & Notable" pages, so you might have seen it too) from MedlinePlus. It's called Director's Comments, and it showcases new sites on the web site.

If you haven't seen MedlinePlus yet, you're in for a treat in the consumer health information department. They say
"MedlinePlus brings together authoritative information from NLM, the National Institutes of Health (NIH), and other government agencies and health-related organizations. Preformulated MEDLINE searches are included in MedlinePlus and give easy access to medical journal articles. MedlinePlus also has extensive information about drugs, an illustrated medical encyclopedia, interactive patient tutorials, and latest health news."

The podcast highlights new government web sites on MedlinePlus, and episodes cover Flu Vaccine; Body Maps; Bird Flu; Detached Retina; and Eye Infections; Genetic Testing; NIH MedlinePlus Magazine. They’re available via iTunes, on the MedlinePlus web site, and you can read transcripts from the web site, too.