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An algorithmic approach to the ECG differentiation of narrow QRS tachycardias

medical student — Sat, 07 Jan 2012 22:22:29 +0000

In contrast to some previously published approaches this one asks the clinician to choose among three algorithms, depending on how much information is available. The algorithms lead the clinician through the same diagnostic steps that the ordinary logical and common sense thought process of a reasonably experienced clinician would take, but provide them in a more systematic form and in a series

Angioedema

medical student — Thu, 05 Jan 2012 00:22:11 +0000

A wonderful repository of links here.

What were the most important issues in hospital medicine in 2010?

medical student — Tue, 03 Jan 2012 12:22:00 +0000

St. Louis City Hospital

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It’s popular right about now to look at the year in review. For the field of hospital medicine I have traditionally posted a top ten list. Although I’m dropping the top ten format this year (it tends to be artificial) I’m preparing some posts for the next few days on what I think

More on the differential diagnosis of wide complex tachycardia

medical student — Tue, 27 Dec 2011 02:22:57 +0000

A commenter on my last post on this topic pointed me to a search that uncovered two interesting and helpful papers I was not aware of.
This review traces the history of methods distinguishing between VT and aberrancy on the surface electrocardiogram. The tried and true method, which assesses for AV dissociation (including that evidenced by fusion and non aberrant capture) or VA conduction with

How to cite twitter, how to cite tweets, how to archive tweets

medical student — Thu, 22 Dec 2011 13:22:01 +0000

As twitter and microblogging is gaining momentum as a social phenomenon, a number of researchers start wondering how to cite tweets (for example here) and how to cite a whole thread (series of tweets).
A related issue is how to digitally preserve and archive tweets. For example, using twitter search, one can currently only search a few months back, older tweets are not retrievable. And while it is difficult to imagine that twitter won′t be around for a while, it is not certain that the site still exists in 5, 10 or 20 years, making it impossible for future scholars to access the same information the author accessed.
A third related issue is dynamically changing content on twitter. For example, it doesn’t make much sense to cite a search URL like http://search.twitter.com/search?q=twitter, because obviously the content is changing all the time.

For all these reasons, the WebCite tool comes in handy (http://www.webcitation.org) [3]. WebCite, which is endorsed by hundreds of scholarly journals, is a member of the International Internet Preservation Consortium (other members include for example the Internet Archive/Wayback machine) and works with libraries to make scholarly important digital material (including cited webpages, websites, online datasets etc) permanently accessible and “citable”.

Here is how I use the WebCite tool to cite and archive tweets:

1. If I want to search all tweets by a given user, or tweets matching a hashtag or keyword, I use the search interface at http://search.twitter.com/ (or advanced: http://search.twitter.com/advanced) to generate a query searching for the username, a given hashtag etc, for example http://search.twitter.com/search?q=eysenbach

If I want to cite a specific tweet, I simply enter the entire tweet into the search interface, for example “http://search.twitter.com/search?q=Wondering+about+copyright+and+twitter.+Who+owns+intellectual+property+%2F+ideas+posted+on+twitter%3F+”.
This is a workaround, as archiving the direct URL of the post (http://twitter.com/eysenbach/statuses/1457158115) currently seems to fail (http://www.webcitation.org/5foQZ3stR) (WebCite is working on this).

2. Copy and paste the search URL ( http://search.twitter.com/search?q=eysenbach) into the archive form of WebCite under “URL to Archive [url]:” and enter your email adress under “Your (citing author) E-mail Address [email]:”, so that WebCite can email you a success/failure notice.

If you use WebCite regularly to cite other webpages etc., add the “WebCite this” bookmarklet to your browser. You can then archive any URL by just clicking the bookmarklet on your browser without having to navigate to the archive form of WebCite.

3. You’re done! Cite the tweet or tweet thread as follows:

Eysenbach G (03-04-2009). wondering about how to archive my tweets (and friends′ tweets) locally – any solutions out there? Retrieved from twitter.com, archived at http://www.webcitation.org/5foXLҲsm

[Multiple authors]. How to cite tweets. Search result retrieved on 2009-04-05 12:08pm from http://search.twitter.com/search?q=how%20to%20cite%20tweets, archived at http://www.webcitation.org/5foMuVHgy

As a side note, forget the APA or NLM styles [2] on how to cite blogs and websites. These citation styles leave out the most important aspect of citing a webpage or blog (which can change every minute or – in the case of twitter – every second), which is to archive it and to cite a permanent, archived snapshot – at least if the intention is that the reader sees the same as the author when he cited the tweet or series of tweets. In addition to the original URL, always cite the WebCite URL which links to a stable snapshot of the cited page.

For example, a URL like http://search.twitter.com/search?q=twitter is showing a different result every second. Only by “freezing” and archiving the result, (http://www.webcitation.org/5foX⻼BB) the URL can and should be cited.

Limitations
Currently, the WebCite team is working on a few fixes, to make archiving and citing of tweets easier.

A current limitation is that the “show conversation″ links in search results do not work if the search results are archived by WebCite (see e.g. http://www.webcitation.org/5foMuVHgy), presumably because javascript is used to retrieve that additional information.

Secondly, archiving the direct URL of a microblog (http://twitter.com/eysenbach/statuses/1457158115) and webciting the twitter homepage of a user works insofar that WebCite creates an internal copy of that page, but it doesn’t diplay very well in the WebCite frame (appears for a few seconds and then disappears: See e.g. http://www.webcitation.org/5foQZ3stR or http://www.webcitation.org/5foR9anu2. (any hints on why this is – my guess is some javascript magic on these pages-, and how it can be fixed, are welcome). Thus, use the workaround of using the twitter search interface to archive tweets from a specific user or a specific hashtag, as described above.

Thirdly, the twitter search interface currently only allows the display of max 100 microblog entries (tweets) on one page, so that one WebCite snapshot has to be taken per search results page.

Fourthly, there is an urgent need for a tool allowing researchers to prospectively monitor and archive feeds from twitter, which is also something WebCite is working on (there are relations to the Infovigil [3] project, which allows advanced analytics such as trendanalysis, geographical coding, and links to polls).

Copyright
Ok, this question always comes up.. Using and archiving webpages should be covered under fair use clauses if the intent is scholarly communication. Twitter itself raises some interesting copyright issues, including the question if tweets reach the standard for copyrightability.

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References
1. Eysenbach G, Trudel M. Going, Going, Still There: Using the WebCite Service to Permanently Archive Cited Web Pages. J Med Internet Res 2005;7(5):e60 URL: http://www.jmir.org/2005/5/e60
2. Patrias, K. Citing medicine: the NLM style guide for authors, editors, and publishers [Internet]. 2nd ed. Wendling, DL, technical editor. Bethesda (MD): National Library of Medicine (US); 2007 [updated 2009 Jan 14; cited Year Month Day]. Available from: http://www.nlm.nih.gov/citingmedicine
3. Eysenbach G. Infodemiology and Infoveillance: Framework for an Emerging Set of Public Health Informatics Methods to Analyze Search, Communication and Publication Behavior on the Internet. J Med Internet Res 2009;11(1):e11 URL: http://www.jmir.org/2009/1/e11

Comparative effectiveness video

medical student — Fri, 16 Dec 2011 10:22:01 +0000

Comparative effectiveness is discussed in this video from the Medscape one-on-one series. My own view of comparative effectiveness research was vindicated in the opening remarks by panelist Milton C. Weinstein, PhD. He said that CER is not new. We’ve been doing it for half a century—it just has a new name.

JoAnn E. Manson, MD, DrPH, made a little appreciated point (about 7:30 in): research, even research that compares treatments, doesn’t address real world situations very well. It’s all about the distinction between effectiveness (how a treatment performs in the real world) and efficacy (how a treatment performs in the hands of clinical investigators in controlled conditions). What’s popularly known as comparative effectiveness research, then, is really comparative efficacy research. Translating that into comparative effectiveness remains a challenge. True comparative effectiveness research is, almost of necessity, “lower level” on the EBM hierarchy, e.g. observational studies, before-and-after studies and the like.

Dr. Manson made another distinction (8:25): of equal importance to comparing treatments is comparing ways of doing and organizing health care. For example, are performance measures and bundles effective?

Finally, all the comparative effectiveness research and comparative efficacy research in the world (and we already have a great deal of both) won’t address the fundamental problem: doctors do a poor job of using the research information they already have. But they need tools, not coercion (see below) to help them do better.

So, well and good, you might say. Comparative effectiveness is great. Sure it is in its pure notion. But listen carefully at 9:28, where Dr. Manson reveals the true agenda of comparative effectiveness as a government sponsored movement: to leverage more involvement by policy makers and payers in clinical decisions. In other words take EBM away from the doctors. Can that work in the U.S.? Look at the history of managed care or Medicare.

There’s more. While I don’t agree with everything the panelists said, this video adds needed clarity to the often confusing discussion on CER.

Clarity regarding perioperative beta blockers

medical student — Wed, 14 Dec 2011 20:25:02 +0000

A brief evidence summary and commentary in JAMA.

Donald Berwick: let evidence based medicine take a back seat?

medical student — Tue, 13 Dec 2011 07:21:59 +0000

Donald Berwick’s radical consumerist views often trump EBM. From the Health Affairs Blog:

For example, “leaving choice ultimately up to the patient and family means that evidence-based medicine may sometimes take a back seat,” Berwick says. “One e-mail correspondent asked me, ‘Should patient “wants” override professional judgment about whether an MRI is needed?’ My answer is, basically, ‘Yes.’ On the whole, I prefer that we take the risk of overuse along with the burden of giving real meaning to the phrase “a fully informed patient.”

The Republicans, who worry that Berwick would ration and restrict care, don’t understand what he’s really about. There’s plenty to worry about, but not for the reasons they think. Related posts here and here.

Toxic epidermal necrolysis and Stevens-Johnson syndrome

medical student — Wed, 07 Dec 2011 03:22:14 +0000

The topic was recently reviewed in Critical Care Medicine. These are now considered overlapping conditions with distinctions based on the percentage skin involvement.

If you’re more interested in getting your paper cited by the New York Times than by UptoDate

medical student — Sun, 04 Dec 2011 05:22:14 +0000

—you might try this trick:

It’s always interesting the see the incredible media buzz a so-called "scientific study" can receive if its release is timed to some upcoming predictable news event. This weekend′s story is, of course, Superbowl XLV.Just in the nick of time came this study entitled "Role of Age, Sex, and Race on Cardiac and Total Mortality Associated With Super Bowl Wins and Losses"