RESEARCH

Cardiovascular risk factors in ethnic populations within Canada: results from national cross-sectional surveys. Richard Liu, Lawrence So, Sailesh Mohan, Nadia Khan, Kathryn King  http://www.openmedicine.ca/article/view/372/343

CAST YOUR VOTE FOR OPEN MEDICINE

The legendary music festival South by Southwest has added a Health track to the Interactive portion of the fest in 2011. We've submitted a panel proposal called “Breaking Out of the Straitjacket” on the future of biomedical publishing. Your vote can help send Open Medicine to Austin.

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BLOG Female doctors and students from “Across the World Unite”. A guest post from the 28th International Congress of the Medical Women

International Association in Munster, Germany http://blog.openmedicine.ca/node/276

OM IN THE NEWS

Claire Kendall, one of the founding editors of Open Medicine, is featured in a story on open-access pioneers at the University of Ottawa. Take a minute to get to know Claire. http://www.uottawa.ca/articles/open-access

Photo Credit: Mr Thomas Sandfort, Munster Germany

Kristin DeGirolamo and Pamela Verma reporting

"Globalization is not only out there, it is both here and there”. These remarks from keynote Speaker Dr. lona Kickbusch, Graduate Institute Geneva, set the tone for this year's formidable congress of women doctors and trainees regarding the scope of global medicine for developed and developing countries alike.

The 28th International Congress of the Medical Women International Association (MWIA) was hosted in Munster, Germany, from July 27th-31st. The quaint town attracted ~600 delegates to the conference from more than 15 countries with strong representation from Europe and Africa. Founded in 1919, MWIA is one of the oldest international medical bodies that remains active today. Its mandate is to provide a forum for the issues of women’s health and the existence of women in the profession.

The triennial meeting was themed Globalization in Medicine-Challenges and Opportunities and featured plenaries on Gender Strategies and Violence, Addiction, Epidemic Plagues, Health Care, and Nutrition. A highlight was the special program for students and young doctors which included a poster session, lectures and discussion meetings. Young women discussed issues such as work life balance, medical education, and current networks for dialogue in the profession.

With a rigorous scientific program of posters, lectures, and workshops the MWIA General Assembly discussed future activities for the society and the campaigns on Female Genital Mutilation and Cervical Cancer Screening and Prevention. “This meeting is not only an opportunity for great scientific information, but also for medical women from around the world to discuss common problems such as gender discrimination in the medical profession”, Secretary General Dr Shelley Ross said. Ross is a family practitioners who has been involved in Association since her days as a medical student.

For more information about MWIA (http://mwia.webtop.de/) and the Congress (http://www.mwia2010.net).

Kristin DeGirolamo and Pamela Verma

Faculty of Medicine, University of British Columbia

Open Medicine supports The Vienna Declaration, an official declaration of AIDS 2010, currently underway in Vienna. The statement supports the incorporation of scientific evidence into illicit drug policy, with the aim to improve community health. Canadian researchers, particularly those at the British Columbia Centre for Excellence in HIV/AIDS (www.cfenet.ubc.ca) and the International Centre for Science in Drug Policy (www.icsdp.org), were instrumental in developing this landmark statement.

Find out more—and join us in endorsing The Vienna Declaration at: http://www.viennadeclaration.com

Follow The Declaration onTwitter: http://twitter.com/vdecl

Follow The Declaration on Facebook: http://www.facebook.com/pages/The-Vienna-Declaration/108611532515232?ref=ts

The Quality of Death: Ranking end-of-life care across the world

2010 The Economist Intelligence Unit

Available online PDF [39p.] at: http://bit.ly/9ToVuw

 “…………..“Quality of life” is a common phrase. The majority of human endeavours are ostensibly aimed at improving quality of life, whether for the individual or the community, and the concept ultimately informs most aspects of public policy and private enterprise.

Advancements in healthcare have been responsible for the most significant quality-of-life gains in the recent past: that humans are (on average) living longer, and more healthily than ever, is well established. But “quality of death” is another matter. Death, although inevitable, is distressing to contemplate and in many cultures is taboo.

Even where the issue can be openly discussed, the obligations implied by the Hippocratic oath—rightly the starting point for all curative medicine—do not fit easily with the demands of end-of-life palliative care, where the patient’s recovery is unlikely and instead the task falls to the physician (or, more often, caregiver) to minimise suffering as death approaches. Too often such care is simply not available: according to the Worldwide Palliative Care Alliance, while more than 100m people annually would benefit from hospice and palliative care (including family and carers who need help and assistance in caring), less than 8% of those in need access it.

Few nations, including rich ones with cutting-edge healthcare systems, incorporate palliative care strategies into their overall healthcare policy—despite the fact that in many of these countries, increasing longevity and ageing populations mean demand for end-of-life care is likely to rise sharply. Globally, training for palliative care is rarely included in healthcare education curricula. Institutions that specialise in giving palliative and end-of-life care are often not part of national healthcare systems, and many rely on volunteer or charitable status.

Added to this, the availability of painkilling drugs—the most basic issue in the minimisation of suffering—is woefully inadequate across much of the world, often because of concerns about illicit use and trafficking. The result of this state of affairs is an incalculable surfeit of suffering, not just for those about to die, but also for their loved ones. Clearly, the deeper inclusion of palliative care into broader health policy, and the improvement of standards of end-of-life care—raising the “quality of death”—will also yield significant gains for humanity’s quality of life……….”

Contents

Executive summary

Note on definitions

Introduction: new challenges in managing the end of life

1. The Quality of Death Index

Index methodology

A high quality of death

A low quality of death

2. Cultural issues in end-of-life care

Attitudes to death and dying

Levels of debate across the globe

The law and the decision to die

Three contrasting attitudes to death

3. The economics of end-of-life care

A variety of funding models

Romania: from last to leader

Kerala: the community model

Long-stay patients shift the balance

4. Policy issues in end-of-life care

Government recognition

The availability and use of opioids

Integration of care into mainstream services

Uganda: a beacon in Africa

Building capacity for home-based care

The importance of training

5. Conclusions

Appendix: Index methodology

This report and more information on the Quality of Death Index can be found at: www.eiu.com/sponsor/lienfoundation/qualityofdeath

More information on the Quality of Death Index is also available at the website created by the Lien Foundation, the sponsor of the research: www.qualityofdeath.org

See also Men's Health Pathfinders and Women's Health (General guide) (also Canadian consumer health information (CHI) portal )

The purpose of these pathfinders is to point consumers and health professionals to leading men’s health initiatives (and digital sources of information) around the world. They are listed alphabetically (let me know if you want something added):

A to Z pathfinders

• Angina
• Atherosclerosis
• Benign Prostatic Hyperplasia (BPH)
• Cancer and Sexuality
• Cancer - Coping & Survivorship
• Cardiovascular Health & Disease (General)
• Coronary Artery Disease
• Depression
• Diabetes
• Erectile Dysfunction (ED)
• Fatherhood
• Gay Men's Health
• Health Assessment Tools
• Heart Attack
• HIV
• H1N1 (Human Swine Flu) in Canada - Information Sources
• Hypogonadism
• Lifestyle (General)
• Health">Men's Health
• Mental Health (General)
• Osteoporosis in men
• Peyronie's Disease
• Premature Ejaculation
• Preventing Cardiovascular Disease
• Prostate Cancer
• Prostate Cancer Screening
• Teens
• Testicular Cancer

What is a CoP? "...CoPs are groups of people who come together to share and learn from one another - either face-to-face or virtually - are held together by a common interest in a body of knowledge and are driven by a desire and need to share problems, experiences, insights, templates, tools, and best practices." - 

A community of practice (CoP) is a term now widely-used in several disciplines to describe groups of people who share interests, collective vision for a project or even direction for an entire field. CoPs evolve organically due to members' interests in ideas that make up their domain and may be fostered through knowledge sharing. It is through sharing information and experiences with each other that members learn and make it possible to develop personally and professionally (Lave & Wenger 1991). CoPs can also co-exist in a digital context using social media such as blogs, wikis and web 2.0 media. The cultural anthropologists, Jean Lave and Etienne Wenger, described this learning perspective in the 1990s but the practice has obviously existed for as long as people have been come together to talk, share and create things. In 2009, Wenger, White and Smith recontextualized communities of practice for digital environments in their book Digital habitats: stewarding technology for communities. Of note in the book is the idea of "technology stewards" which recalls the importance of librarians and our work in the digital age.

The question is: Can we build a digital 'community of practice' in medicine? Is it even feasible?

Seminal works

• Lave, Jean, & Wenger, Etienne. (1991). Situated Learning; Legitimate Peripheral Participation (New York: Cambridge University Press, 1991).
  • The notion of a Community of practice was introduced in 1991; "Learning itself is an improvised practice: a learning curriculum unfolds in opportunities for engagement in practice." pg. 93
• Wenger, Etienne, White, Nancy, Smith John D. Digital habitats: stewarding technology for communities. 2009.
  • Technology has changed what it means for communities to “be together.” Digital tools are now part of most communities’ habitats. This book develops a new literacy and language to describe the practice of stewarding technology for communities.
• Wenger, Etienne. Communities of practice; Learning, Meaning and Identity (New York: Cambridge University Press, 1998).
• Wenger, E., McDermott, R., & Snyder, W.M. (2002). Cultivating communities of practice: A guide to managing knowledge. Boston: Harvard Business School Press. "How to do it" informed by theory http://hbswk.hbs.edu/archive/2855.html
• Lave, Jean, "The Practice of Learning", p 3-32 in Seth Chaiklin and Jean Lave (eds) Understanding Practice; perspectives on activity and context (Cambridge: Cambridge University Press, 1993). From preface: "Participants agreed, on the whole, on four premises concerning knowledge and learning in practice:
  • "Knowledge always undergoes construction and transformation in use
  • "Learning is an integral aspect of activity in and with the world at all times. That learning occurs is not problematic.
  • "What is learned is always complexly problematic.
  • "Acquisition of knowledge is not a simple matter of taking in knowledge; rather, things assumed to be natural categories, such as 'bodies of knowledge,' 'learners,' and 'cultural transmission,' require reconceptualization as cultural, social products."
• Wenger, E. (2001). Communities of practice: Learning, meaning and identity. http://www.co-i-l.com/coil/knowledge-garden/cop/lmi.shtml http://www.co-i-l.com/coil/knowledge-garden/cop/lmi.shtml
• Kuhn, T. (2002). Negotiating boundaries between scholars and practitioners: Knowledge, networks, and communities of practice.
• Wenger, E. (1998). Communities of Practice: Learning as a Social System. http://www.ewenger.com/pub/pub_systems_thinker_wrd.doc http://www.ewenger.com/pub/pub_systems_thinker_wrd.doc
• David Barton and Karin Tusting (eds.) Beyond Communities of Practice; Language, Power, and Social Context (Cambridge: Cambridge University Press, 2005). http://www.cambridge.org/us/catalogue/catalogue.asp?isbn=0521544920

In 2009, early findings of an international 'peer review' survey of authors and reviewers was published (see powerpoints). As many of you know, review">peer review is central to biomedical publishing and scientific enquiry -- knowledge creation that is essential in evidence-based practice. According to the report, more than 1.3 million scientific articles are published annually and with the explosion of information the current peer review system faces serious challenges: will there be sufficient numbers of experts to do the peer review? how will the system defend itself against any number of conflicts of interest and monetary pressures?

So why do scientists engage in peer review?

1. According to the study, 90% of respondents say it's because they want to be active in the scientific community; 16% say that their involvement increases their own chances of having future papers accepted
2. Peer review needs to be improved but a whole new system is not needed:

• 84% say that scientific communication relies on peer review; a third (32%) think it is the best system possible; 20% say peer review is unsustainable due to insufficient numbers of reviewers.
• 91% say their last paper was improved through peer review; discussion was the biggest area of improvement
• 73% say technology makes it easier to peer review; 86% enjoy reviewing, 56% say there is a lack of guidance on how to review; 68% say formal training would help; on average, reviewers reject two papers a year
• 15% say that 'formal' peer review could be replaced by metrics, hits and user statistics
• 61% say that they turn down invitations to review articles citing lack of expertise as the main reason - journals obviously have a hard time identifying suitable reviewers

Developing higher standards

• 79% say that peer review should identify good papers, determine originality and improve them; 43% feel peer review is too slow, 65% say that they had received a decision on their most recent paper within 3 months
• Reviewers expect anonymity: 58% are unlikely to review if their names are published. 76% favour double blinding of editors and peer reviewers
• peer review is well understood by the scientific community but just 30% believe the public understands the process
• 81% say peer review should ensure previous research is retrieved and cited; there are major concerns in the research community about cumulating the evidence
• over half feel that payment would make them more apt to review a manuscript; 41% want payment but this drops to 2.5% if the author had to cover costs

Robert Campbell, Wiley-Blackwell & Chairman, Publishing Research Consortium: "Most researchers give up time to review papers for no charge. The whole scholarly communication system is dependent on this. Why do they do it? This study helps us to answer the question. And I take heart in the finding that 85% of the around 4000 respondents quite simply do it because they enjoy being able to improve papers. "

Sir Brian Heap, Vice Chairman, European Academies Science Advisory Council: "These latest insights from researchers show why the peer review process continues to be so important - and enjoyable!"

Adrian Mulligan, Associate Director of Research and Academic Relations, Elsevier: "I'm impressed by the vast amount of responses to the study - it tells us just how engaged the scientific community is with peer review. Not only do they greatly value it, but they have a strong desire to enhance it. Elsevier in partnership with editors, plays an active role in developing peer review, and we are moving forward with initiatives such as Crosscheck, a pan-publisher plagiarism detection tool. We are keen to look at other ways to respond to the views raised in this survey."

The Times Online A review of peer review

Times Higher Education Peer Reviewers satisfied with the system

BBC World Service Europe Today(about 20 minutes into clip)

Nature blogs Peer review reviewed

Chemistry World Peer review under the microscope

Information World Review it">Researchers show loyalty to peer review but want a lot more from it

Physics World blog And the survey say...

1. The Peer Review Survey was an electronic survey conducted between 28th July 2009 and 11th August 2009; 40,000 researchers were randomly selected from the ISI author database, which contains published researchers from over 10,000 journals. Altogether 4,037 researchers completed the survey.
2. The full findings and report are due to be published in November 2009.
3. Bjork et al (2008) 'Global annual volume of peer reviewed scholarly articles and the share available via different Open Access options' Proceedings ELPUB2008 Conference on Electronic Publishing - Toronto, Canada - June 2008
4. Publishing Research Consortium (2007) ' community. An international study’">Peer Review in Scholarly Journals: perspective of the scholarly community. An international study'
5. Chalmers & Glasziou (2009) 'Avoidable waste in the production and reporting of research evidence' The Lancet; 374: 86-89.

See also Apple iPhone3GS for physicians, Apple iPad for physicians and Wireless

In June 2010, Apple announced its next major upgrade to the iPhone platform calling it the "iPhone 4." The iPhone 4 features an all-new design: two cameras, one on the back with an improved five (5) megapixel image capture, flash and high-definition (HD) video capture at 720p. A front-facing camera adds the ability to do video chatting/conferencing. An improved display boasts higher resolution (960x480) and brighter colours. The iPhone 4 is 9.3 millimetres thin, 24% percent thinner than the 3GS. Steve Jobs calls the iPhone 4 the "thinnest smartphone ever."

Coinciding with the release of the new hardware, Apple will be releasing the fourth version of its operating system, iOS. The new iOS allows for multitasking and running more than one application at a time; this is generally seen to be of benefit for physicians and librarians (and regular users) -- especially those wanting to search, read and write at the same time. Apple applications can be organized into folders and the new iBooks bookstore (now only available on iPad) will be accessible to the iPhone 4. iPhone users (including those with 3G and 3GS iPhones) will be eligible for the upgraded iOS.

References

• iPhone 4 features the medical community can get excited about - iMedicalApps.com
• iPhone 4 unveiled - Ars Technica
• Is the iPhone 4 Fantastic? - Slate
• FaceTime Mobile Video Conferencing - The Apple Blog
• Photo Gallery: Hands-On With the iPhone 4 - Wired Magazine
• iPhone 4 first hands-on! (video) - Engadget

The following National Library of Medicine’s presentations are from the recent 2010 Medical Library Association meeting in Washington, DC. They range in length from 14 to 27 minutes, provide overviews and updates on NLM databases and services, PubMed, MedlinePlus, ClinicalTrials.gov, Health Services Research, and more.

• ClinicalTrials.gov Update (27 min.)
• DailyMed (16 min.)
• Health Services Research & Public Health Update (21 min.)
• History of Medicine Update (25 min.)
• Introduction to NCBI Molecular Databases (16 min.)
• MedlinePlus Update (22 min.)
• MyMedicationList and RxNorm (20 min.)
• PubMed Review (24 min.)
• Resources for Disaster Planning and Response (24 min.)
• Toxicology & Environmental Health Update (14 min.)
• UMLS Update (22 min.)
• Using My Bibliography to Manage Compliance with the NIH Public Access Policy (17 min.)