I have been re-examining how to best manage my time.  My goals have been to find a better way to squeeze out every last ounce of productivity from the time alotted for work (during ‘regular work hours’, nights, and weekends) as well as how to harvest even more time from my day for work (without completely destroying any hope of balance).    

During my proscribed organic problem solving time, I came across a suggestion to check out The Secret Life of Scientists, which seems like something @2020science may have recommended.  What a great show and idea to get people to look at science differently!  The basic premise is that they show a garden variety scientist, but then they reveal their ‘secret’ life or interest as well.  A couple of faves include Microbiologist/Professional Wrestler, Game Developer/Clarinetist, and  Biochemist/Pageant Queen.  If nothing else, you should at least check out some of the clips and ’10 Questions’ such as for Mark Siddall.  Unsurprisingly, they asked this leech expert: Twilight or True Blood?  His answer?  “Are these movies? I don’t have TV.”

Ok, that’s not *that* unusual.  I went to pharmacy school with a guy who didn’t own a television.  He and his wife, a physician, thought there were better ways to spend their time.  Sure, he was easily one of the top three minds of the entire class, but he totally missed out on some pop culture references during conversations!  I also saw this same TV deficiency in a couple other Scientists videos like Climatologist/Juggler Gavin Schmidt who was asked: Al Roker or Willard Scott? His Answer?  Who? 

Perhaps I need to rethink my TV approach, in which I don’t even count watching Arsenal or Titans games because…well, that’s watching sports, not television shows.  I’ll watch some TV shows telling myself it’s a way to unwind or disengage and relax.  I do think there is some legitimate truth to that.  However, we are still (for now) in the era where TV has replaced religion as the opiate of the masses…so perhaps I should book a brief stay in television rehab.  In the meantime, I am going to go finish another manuscript and wonder if I could finish twice that many in the same time were I sans television.

@kevinclauson

There was a news item taken from an article in Pediatrics examining the issue of what happens when computerized language assistance services are imperfect.  It focused on the erroneous translation of prescription information from English to Spanish in pharmacies and possible consequences.  It is a very timely study as we are examining related problems as well including low- and high-tech solutions (e.g. automated LAS kiosks, natural language processing).  In December 2009, we presented a poster of the results of a national survey of the use of language assistance services (sometimes called language access services) in community pharmacies.

@kevinclauson

I recently gave a lecture on meta-analyses as part of a Drug Literature Evaluation course.  One example I typically use to illustrate the importance of critically evaluating literature combined with the potential impact of the media is, “Is Cybermedicine Killing You” – The Story of a Cochrane Disaster.  It is an editorial published back in 2005 in response to a fatally flawed Cochrane paper that was ostensibly published as a review of, “interactive health communication applications” (IHCAs).  The review’s plain language summary described it as “computer-based programmes for people with chronic disease”.

In my mind, there are four key observations about that situation:

1. The nature of the research being reviewed was mischaracterized from the beginning.
As pointed out by Eysenbach and Kummervold, the studies included in the meta-analysis were all interventional in nature (i.e., in addition to an informational piece, there was an accompanying, structured aspect of decision support/behavioral change).  However, most of the media headlines generated from that Cochrane review omitted the interventional aspect and presented it in terms of consumers passively looking at health-related information on the Internet.

2. The authors of the Cochrane review arrived at a flawed conclusion and admitted it.
The authors of the JMIR editorial pointed out several “stunning” mistakes in the review including: data extraction errors, and that conclusions about positive outcomes from the eHealth interventions were misinterpreted as harmful.  The editorial re-examined the work and actually found that only 2 of the 11 study interpretations were correct.  Some of them were startlingly basic errors such as classifying a reduction in hemoglobin A1c (HbA1c) in the intervention group and an increase in HbA1c in the control group as a bad outcome.

3. The retraction acknowledging the erroneous findings barely caused a ripple.
After the flurry of media stories about the supposed dangers associated with looking online for health information, very few news outlets publicized the retraction.  This is despite the retraction being issued in only 13 days.  Further, the revised conclusion archived in the Cochrane Library stated the opposite findings from the original that, “IHCAs appear to have largely positive effects on users, in that users tend to become more knowledgeable, feel better socially supported, and may have improved behavioural and clinical outcomes compared to non-users.”  Nothing nefarious here; it is pretty common to see sparse coverage allotted for retractions versus the “if it bleeds, it leads” initial coverage.  But it is still regrettable.

4. What could have been an early blow to eHealth and empowered patients was avoided.
Given the authority of Cochrane reviews, the unease of many clinicians with patients seeking health information (even more pronounced five years ago), and the relatively early stage of consumer health informatics – this inaccurate condemnation could have proved detrimental to the advancement of the specialty and efforts by what are currently referred to as e-patients.  Fortunately, a few researchers, authors, and advocates discovered the situation and acted swiftly to correct it.

It always surprises me that this story is not related more often, especially among those involved with its related fields or movements.  There are not a lot of situations that can serve so aptly as both a cautionary tale and one of promise and encouragement.

@kevinclauson

References

Links for all relevant, full-text publication are embedded in the text.  Here are the written citations just in case.

Eysenbach G, Kummervold PE. "Is Cybermedicine Killing You?"--The story of a Cochrane disaster. J Med Internet Res 2005;7(2):e21.

Murray E, Burns J, See Tai S, Lai R, Nazareth I. Interactive Health Communication Applications for people with chronic disease. Cochrane Database Syst Rev 2005; (4):CD004274.

A couple of weeks ago I read a very thoughtful post on one of my favorite blogs (authored by @laikas).  One reason I enjoy Jacqueline’s blog is that it contains evaluation (or at minimum consideration) of the information and literature that its posts are written about…rather than simply repackaging it without any context.  I do believe there is also clear value for blog posts that primarily serve current awareness, etc.  However, when a blog is augmented with the occasional reflective or methodical examination, it is elevated to a different level IMHO.  It’s somewhat akin to the difference in nominations for the medGadget Awards versus the Research Blogging Awards (chapeau tip to @DrVal).  The information found in both award contenders is valuable, but serves different purposes.     

In any event, the post about randomized, controlled trials (RCTs) and evidence based medicine (EBM) on Laika’s MedLibLog made me reconsider a lecture I had just finished putting together on trial design for a Drug Literature Evaluation course.  In that course, there are several lectures on different types of trial design as well as separate ones about EBM and clinical practice guidelines (CPGs) –  but they are all probably a little too insular.  Each lecture may be a little too focused on the technical aspects, and guilty of ignoring how each fits into the grand scheme of things.

The Point Of All This

When I first prepared my lecture on trial design, I think I was too preoccupied with conveying the importance of fundamentals to the students.  Reading the aforementioned post made me re-think my approach a bit and prompted me to revise the lecture/slides to incorporate a little more integration and application.  To that end, I posted them on Slideshare.  For me, this sequence of events is a perfect example of the underlying concepts of Web 2.0 in action…and that’s pretty cool. @kevinclauson

Note: I used the Guided Notes approach (which is why it looks like there is a preponderance of underlined text) and an audience response system in this lecture.

I was first alerted to the release of the new book Pharmacy Informatics via a blog post by @poikonen.  I took advantage of Amazon’s ‘Look Inside’ to check out the chapter titles and introduction.  That was enough for me, so I ordered it. I am really, really glad I did.

This textbook was created by three faculty members at the University of California, San Diego School of Pharmacy (along with area contributors) to accompany their forward-thinking pharmacy informatics course.  The authors bring a lot of credibility to the text as Phil Anderson is a very well known pharmacist in drug information and informatics circles, Susan McGuiness is a pharmacy librarian who is quite active in AACP, and Phil Bourne is the pharmaceutical scientist who is one of the more clever and creative fellows I have come across. 

The book basically delivers enough structure to create your own pharmacy informatics course.  It begins with a concise overview and the authors’ take on the meaning of pharmacy informatics (see Figure 1.1. above).  Then it sets the stage for why this specialty has developed and where it is going, touching on areas such as telepharmacy and personalized medicine.  The next major section “Prerequisites” helps provide a crash course in the basics surrounding computing and controlled vocabularies then finishes with a really well-done chapter on literature and the web.

From there the book moves onto ‘Information Systems’, breaking them down into hospital and pharmacy along with highlighting the role of informatics in avoiding medication errors.  This is also where a lot of the usual suspects make their first appearances – EHRs, bar coding, CPOE, smart pumps, etc.  I did think that this section missed a couple of opportunities.  Like many other references (and pharmacy education in general – of which I am a guilty party), it really only gave cursory attention to the community setting…despite the vast majority of pharmacists still going to that setting.  Even when it did include outpatient-specific aspects, like automated drug-dispensing machines and automated kiosks, I felt it did a bit of a disservice by not exploring the potential surrounding or psychosocial impact of these types of services.  This section also includes a couple of practically useful chapters on tertiary information sources and PDAs.  Perhaps the most interesting chapter of this section was “Pharmacy Informatics as a Career”.  While it may have been shoehorned in there, it serves as a really nice introduction to the specialty from what type of training is necessary to a pretty in-depth look at the evolution of a pharmacist with experience in different practice settings to a project leader and manager.  I also liked their 25-item informatics specialist job description.

Next was a very robust section on “Decision Support”.  It had a nice hat-tip to evidence based medicine as well as good coverage of classic clinical decision support and pharmacokinetics.  Unfortunately, I found the chapter on data mining (which I was most looking forward to in this section) was a little lacking.  The information there was superior, but I really would have liked to see additional depth, as this is such an exciting area for growth within pharmacy informatics.  The book ends with some forecasting and a peek into the near future (some of which is here now).  It provides a scenario that highlights possibilities for several Web 2.0 tools and approaches for information management and decision support.  It also hits two of my other favorite topics in social networking and open access (more on that in a moment).  The concluding chapter is a pragmatic look at where we can go and how to navigate the obstacles to get there.

Ok, back to the really cool stuff.  If you aren’t familiar with Bourne’s work and experiments with open access, peer review 2.0, and alternate/enhanced venues to disseminate scholarly work – you are missing out.  Don’t feel bad.  I stumbled across them in a variety of ways including seeing a live presentation by JOVE co-creator Moshe Pritsker at Medicine 2.0 a couple years ago, assigning my students and residents to watch some of the PLoS 10 Simple Rules collection (e.g. getting grants, getting published, making good poster and oral presentations, etc.), and reading blog posts about interactive visual posters (i.e., postercasts, pubcasts, etc.) that are housed at www.SciVee.tv.  Seriously, skip the clip of the ice skating monkey on YouTube and use those 5 minutes to go visit the 10 Simple Rules collection and SciVee!

Overall, Pharmacy Informatics is not flawless, but I found it to be as advertised or better.  It is especially timely as we are in the midst of examining education, credentialing, board certification, etc. in the ASHP SAG for pharmacy informatics education.  This book would serve as an excellent text for a course on pharmacy informatics and/or a great resource for a college of pharmacy looking to incorporate informatics into its curriculum.

@kevinclauson

I teach in our University’s Master of Science in Biomedical Informatics (MSBI) program.  We also have a Medical Informatics Certificate program, a Public Health Informatics Certificate program, and offer a MSBI in Portugal.  However, this isn’t a commercial or sponsored post.  This information is simply to provide some context as to why I am interested in seeing a centralized source of information for all post-bac informatics programs.  More importantly, our Section Advisory Group for Pharmacy Informatics Education in the American Society of Health-System Pharmacists (ASHP) is also looking at this topic and relevant issues for pharmacy.

It would be nice – if similar to the list of hospitals using social media maintained by @EdBennett, the Google spreadsheet of journals with a Twitter presence by @laikas or the Pharma and healthcare social media wiki by @jonmrich – that there was also a comprehensive list of informatics programs.  Ideally it would be broken down into searchable fields (e.g., online/live/mixed delivery models, thesis or non-thesis, clinical or non-clinical focus, college(s) at the university involved, participation in AMIA 10x10, AMIA Academic Forum membership, tuition, etc.) and program titles (e.g., bioinformatics, biomedical informatics, health informatics, health informatics management, medical informatics, security informatics, etc.).

There are several particularly interesting informatics programs in addition to the MSBI at Nova Southeastern University.  For instance, the University of Illinois at Chicago’s Health Informatics program appears to try to cater to individual professions.  As an example, they list Pharmacy Informatics as a specialty with dedicated pages.  Minnesota also has a promising combined MD/MHI program housed in the Institute for Health Informatics (IHI).  The IHI also has the best video overview for a program I have seen so far:

My alma mater (The University of Tennessee) has a Master of Health Informatics and Information Management program, but it is offered through their College of Allied Health Sciences rather than via their college of pharmacy or medicine.  A partial list of US institutions with post-bac informatics programs I have come across thus far include: Capella University, Drexel University Online, Eastern Michigan University, Emory University, Harvard-MIT, Indiana University, Johns Hopkins University, Medical College of Georgia, Milwaukee School of Engineering, Northeastern University, Northwestern University, Nova Southeastern University, Rochester Institute of Technology, Saint Louis University, Stanford University, University of Alabama, University of California (Davis), University of Central Florida, University of Iowa, University of Maryland, University of Minnesota, University of Missouri, University of Pittsburgh, University of Phoenix, University of Tennessee, University of Texas (El Paso), University of Utah, University of Wisconsin (Milwaukee), Vanderbilt University, and Walden University.  Programs that only offer a PhD in informatics are not included in the sample of institutions above.

Some pretty cool training programs such as the CDC’s Public Health Informatics Fellowship and several pharmacy informatics residencies are also available for those in different stages of their careers.

A few websites have collected some of the post-bac informatics programs, but they generally suffer from a combination of missing programs, incomplete information, and (in some cases) are eerily reminiscent of some of the link bait ‘top 50 blog’ sites.  Maybe a comprehensive, searchable site already exists and someone will point it out to me?  Or perhaps I’ll add it to my ‘to do’ list.

@kevinclauson

Last month a Letter was published in the peer-reviewed journal Medical Teacher titled, “Is Wikipedia unsuitable as a clinical information resource for medical students? “ [1].  That paper came on the heels of a Letter published in The Annals of Pharmacotherapy on a related topic, “Evaluation of pharmacist use and perception of Wikipedia as a drug information resource“ [2].  The Annals paper had some serious shortcomings (e.g., survey response rate) which likely contributed to its abbreviated publication form.  Its most eye-opening point was that only one-third of the respondents who used Wikipedia were aware that anyone could edit the entries.  This is perhaps the real value of the Letter and why it was published – it helps illustrate the need for education about appropriate online resources in that group.

The Pender, et al. paper also has some methodological aspects that probably limited it to a Letter.  For those without access to Medical Teacher, the results were initially presented as a conference case study.  Because the work of Pender, et al. was accepted for publication, and reminiscent of the Annals Letter, it went on to generate quite a bit of interest among academics, clinicians, librarians, and social media enthusiasts.  The unfortunate thing about this interesting topic is, like all Letters, the available level of detail was below what the authors envisioned and the readers sought.  However, in this case, the dialogue it has helped stimulate may be as valuable as the research itself.  Because I am in the midst of working on a follow-up study to the Wikipedia study we did a couple years ago [3], I searched for more information about the paper – some of which is discussed below.  (As an aside, the new wiki study is the first I’ve worked on that was partially driven by ‘unsolicited, crowdsourced post-publication peer review’.  More anon.)

In the Pender, et al. study, three content experts each evaluated one medical topic according to five criteria (e.g., accuracy, suitability) in Wikipedia, eMedicine, AccessMedicine, and UpToDate.  All criteria used a three point rating scale.  For example, the accuracy scale was: 1=numerous important errors, 2 = some minor factual errors, and 3 = no factual errors.  Accuracy scores for Wikipedia on this scale were 3, 2, and 2 for the topics.  Interestingly, eMedicine scored the single lowest accuracy rating for a topic (rating of 1) of any of the resources.  It did perform well for the other two topics.  Wikipedia fared even worse for suitability with all three topics rated as ‘1’ (“unsuitable”).  An example of the full scores for the otitis media topic is complements of @LKruesi and detailed below. 

Two librarians led the project, blinded the resource entries for the content experts, and assessed each resource for accessibility and usability.  They used criteria like cost, ease of finding information, and presentation quality to support their decisions.  Wikipedia did very well here, earning the distinction as the most accessible and easiest to use. 

Ultimately, I think this study adds to the literature and has already contributed to the wider community by sparking debate and discussion.  I hope this supplemental information helps address some of the questions I have seen about this study and thanks again to Lisa Kruesi for the spirit of openness and transparency in electing to make the data available.

@kevinclauson

[1] Pender MP, Lasserre KE, Del Mar C, Kruesi L, Anuradha S. Is Wikipedia unsuitable as a clinical information resource for medical students? Med Teach. 2009;31(12):1095-6.

[2] Brokowski L, Sheehan AH. Evaluation of pharmacist use and perception of Wikipedia as a drug information resource. Ann Pharmacother. 2009;43(11):1912-3.

 [3] Clauson KA, Polen HH, Boulos MN, Dzenowagis JH. Scope, completeness, and accuracy of drug information in Wikipedia. Ann Pharmacother. 2008;42(12):1814-21.

I confess.  I am not a trained reviewer.  I have reviewed a few texts for biomedical journals, but that hardly qualifies.  However, I am going to share my thoughts on Confessions of a Public Speaker by Scott Berkun (@berkun).  I hope writing this review forces me to think holistically about the value of the resource.  And, since there is a constant stream of books being published, perhaps the review will even help someone else with their decision making process. 

Most of what I blog about is informatics-centric, but I am a faculty member and thus responsible for the holy trinity of teaching, research, and service.  So the questions: what makes a good teacher AND what makes a good lecturer, are both worth posing.  To that end I have made a more concerted effort to explore aspects of educational theory, visual design, etc. over the last 18 months.  I began with a couple primers (e.g. Presentation Zen, slide:ology) and recently picked up some other ‘classics’ and a few hot off the press. 

Confessions is the first book in my latest batch and its author sets the tone pretty early on.  He appears to be a happy renegade of sorts and uses fierce injections of humor to keep the reader engaged and interested.  It is at the opposite end of the spectrum from a traditional ‘how to’ book as it is narrative in nature and pulls considerably from Berkun’s own experiences.  Maybe because I have a traditionalist streak, the opening almost seemed like he was trying a bit too hard to be a from-the-hip maverick.  I briefly found myself wondering when the snappy stories would end and it would yield some value.  Well, I had a classic ‘good things come to those who wait’ moment, and did not have to wait very long at all.  Once I opened my eyes a bit, I realized that his very attitude towards speaking was of as much value as the instructional pieces.  Some of the advice, like how to approach dealing with mistakes you make during presentations or the requisite amount of practicing, seem pretty intuitive.  However, as Berkun himself points out, seeing something you already know in print or hearing it from an external expert can lend enough weight to prompt you to finally process and implement.

The book is definitely not limited to reinforcing previous lessons (un)learned.  It presents pragmatic pieces such as a solid four step method of preparation to avoid eating the microphone.  Berkun also focuses on crafting a proper title moreso than I have seen from many other experts in the field.  One thing I particularly like about Confessions is that it touches on seemingly mundane items that can make a big difference in the presentation and the presenter’s confidence.  There are clear, practical examples and recommendations for the ideal way to position a lavalier microphone, manage audience distribution in a lecture hall, and use confidence monitors and teleprompters.  There are also some nice cameos by science in discussing the power of silence to combat the dreaded ‘ums’, the impact of interference on retention, on-stage fight or flight, and the Dr Fox study.

Review Summary

The most compelling thing I can say is that I am completely certain that I got my $16.49 worth of knowledge, new approaches, and which existing ideas merit revisiting for public speaking.  Confessions of a Public Speaker reads in a very animated style making it accessible without sacrificing quality content or value.  I believe there is at least one pearl in the book for any novice to intermediate speaker (or teacher/professor).  The outwardly lighthearted approach does not detract in the least from its value.  Instead, it reinforces the sincerity of the author who believes communication skills are vital…and admits that while the lecture arena is not the ideal way to teach – gives plenty of tips on how to improve there.

@kevinclauson

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