Wednesday, November 26, 2008

Friday Foolery #10: Dem bones


One of my friends alerted me to the fact that both of her sisters are among the workers in a recent local news video magazine feature about their incredibly cool employer, Sawbones.

Bonus: see the staff spirit around 1:15 and 1:59 in the video link?

I had no idea that Vashon Island was cranking out over 4,000 bones a day for the greater medical & orthopedic training needs of the world! To the left is a full skull, yours for $54.75, or without a mandible for $39.00.

Is it so wrong that I want one of these for Christmas to put on my desk?

In sickness & in health: Engage With Grace

On Monday I shared my family's story about the importance of discussing health information over the Thanksgiving holiday. Unbeknownst to me until today, there is also a healthcare blog effort encouraging discussion of end-of-life decisions with family as well that I wholeheartedly support.

My thirtysomething husband & I are extremely unusual for our age in that we've had health care power of attorney and advance health care directives written for many years, have cards on us & authorized paperwork with the People's Memorial Association, and even chosen and stood upon our own grave overlooking the Cascade Mountains.

Morbid? Perhaps. Leaving a crystal clear path so that our family doesn't have to guess what to do with us in the middle of their own deep shock & grief? Absolutely. If you don't already know how intensely painful it is to guess at these types of decisions for someone you love who is terminally ill or just died, please take my word for it: talk about these issues now. I can think of no greater blessing than doing what you can to establish peace of mind.

Thank you for your time and be safe over the holidays.

The following post was written by Alexandra Drane and the Engage With Grace team.

We make choices throughout our lives - where we want to live, what types of activities will fill our days, with whom we spend our time. These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent. But when it comes to how we want to be treated at the end our lives, often we don’t express our intent or tell our loved ones about it. This has real consequences. 73% of Americans would prefer to die at home, but up to 50% die in hospital. More than 80% of Californians say their loved ones “know exactly” or have a “good idea” of what their wishes would be if they were in a persistent coma, but only 50% say they’ve talked to them about their preferences.

But our end of life experiences are about a lot more than statistics. They’re about all of us. So the first thing we need to do is start talking. http://www.engagewithgrace.org was designed with one simple goal: to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it. Five questions designed to help get us talking with each other, with our loved ones, about our preferences. And we’re asking people to share this One Slide - wherever and whenever they can - as a presentation, at dinner, at their book club. Just One Slide, just five questions. Let’s start a global discussion that, until now, most of us haven’t had.

Here is what we are asking you to do: go to http://www.engagewithgrace.org/- download The One Slide - and share it at any opportunity - with colleagues, family, friends. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end of life experience for yourself, and for your loved ones. Then commit to helping others do the same. Get this conversation started.

Let’s start a viral movement driven by the change we as individuals can effect…and the incredibly positive impact we could have collectively. Help ensure that all of us - and the people we care for - can end our lives in the same purposeful way we live them.

Just One Slide, just one goal. Think of the enormous difference we can make together. To learn more please go to www.engagewithgrace.org. Thanks.

Tuesday, November 25, 2008

President-elect Obama & healthcare: Stand and deliver

What worries you the most about the healthcare system in our country?

Want to bend the future administration's ear about this topic?

...and you don't have to be a doctor like my friend Dora here to participate in our online discussion.
Please, go for it!

Reading the Obama-Biden Health Care agenda would probably be a good idea too, especially noting that things may change from what's currently at the bottom of the page:

A Commitment to Fiscal Responsibility: Barack Obama will pay for his $50 - $65 billion health care reform effort by rolling back the Bush tax cuts for Americans earning more than $250,000 per year and retaining the estate tax at its 2009 level.


Here is what the media stated on Nov. 23rd:

In the presidential campaign, Obama focused largely on tax cuts for low-wage and middle-class workers and tax breaks for small businesses. But as part of a stimulus package, his advisers have discussed letting the Bush tax cuts for the wealthiest Americans expire after 2010 as scheduled.

That, in effect, would delay the tax increases that rich taxpayers would have faced had Obama repealed the Bush tax cuts a year or two early, as he had suggested in his campaign.

Another thing that I hope is that whatever video program is embedded on the Change.gov website is accessible to the deaf and hard of hearing so they receive the message that all are welcome to participate. They'd better be more aware of Section 508 than I am!

'Staff infections': Where to turn for online information?

Last week a three part investigative journalism series (1, 2, and 3) was published by the Seattle Times about methicillin-resistant Staphylococcus aureus, or MRSA. This details how they did it when "state and federal governments don't bother to count MRSA cases." The Department of Health in Washington announced that they would begin tracking the incidence of MRSA in hospitals here as a result of the series.

S. aureus
is also known as 'staph', so patients can have either a nasty MRSA infection or a regular old 'staph infection.' I always question how much time clinical staff are being able to spend with their patients to make sure they understand a diagnosis when they email family & friends about their 'staff infections'. I've seen this happen with enough frequency to suspect it isn't a fluke, so I decided to do a little research of my own along these lines.

It absolutely kills me as a medical librarian to admit that Google is on the ball with this common mishap, look what happens when you search for 'staff infection' there:



Google 'knows' you mean staph infection and redirects you accordingly in a fairly straightforward way.

Does consumer health gold standard MedlinePlus? Unfortunately, no. The 6th search result makes the connection only as a pronunciation key:

"... infection that is usually caused by staph (pronounced: staff ) bacteria. What Is a Staph Infection? Staph is the shortened name..." All the other search results on the front page talk about medical staff preventative measures.

WebMD? Their advertisers are but not their resources. All three Yahoo ads mention Staph Infections before a Hepatitis B resource, a video where staph infections are mentioned as a possible tattoo side effect (listed twice in a row), then a MRSA-titled resource that doesn't mention staph or staff but does mention infection in the preview.

One .gov that gets the 'staff infection' search right? Healthfinder.gov! Check it out:



Healthfinder is also making the staff and infection connection but at least pulling a Staph Infection article to the top of the resource list. We know that the Health News article to the right about MRSA screening for health workers would be of interest but someone searching for a 'staff infection' may not.

Google Flu Trends is helping to identify search patterns for that particular topic, what do the data look like for 'staff infection' in addition to MRSA & staph infection?



There is additional subregion data that gives some clues about health literacy needs in certain areas.. but is anyone else thinking and monitoring along these lines?

Monday, November 24, 2008

In remembrance: Talk about health over the holidays

Dorothy Irene 4/26/24 - 11/24/98
(yours truly as the not-politically-correct blonde Indian in 1970s attire)

It has been ten years since I disembarked from a plane in my homeland with my "new boyfriend who sounds so nice" (now incredible husband & father of our son) to learn that, instead of having a joyous Thanksgiving with my grandma, we would be making arrangements for her at the funeral home and beginning the awful process of settling her estate. Thanksgiving has never been truly happy for me since. Spending time with her was every Thanksgiving my entire life up until that year.

I could drive myself crazy with the 'what ifs.' Both she and her neighbors did not know that the symptoms of a heart attack for women do not always include pain. She spent the morning resting as the neighbors changed the oil in her car before an afternoon doctor's appointment to check what she thought was pneumonia... just mild chest tightness, feeling winded and fatigue after a cold. No emergency at all, of course. By the time she was seen then immediately sent by ambulance to the emergency room it was too late. She died at the same time I left work for the airport. My grandma didn't call to tell me she was feeling ill in the first place since she didn't want me to worry about her.

In 2004, the American Heart Association launched the Go Red for Women campaign to increase awareness of the fact that heart disease is the #1 killer of women & promote preventative measures for cardiovascular health.

My grandma's hypertension was under control with medication, she ate well, and she either swam laps (she & her high school team often won competitive Pacific Ocean & other swim meets and I have all the pictures & articles about them in the papers) or walked for an hour daily depending on the weather though. It concerns me that Go Red doesn't include well-marked links to information about the actual symptoms of heart disease in women, so here's one from the Mayo Clinic
Women are more likely than men to have signs and symptoms unrelated to chest pain, such as:
  • Neck, shoulder, upper back or abdominal discomfort
  • Shortness of breath
  • Nausea or vomiting
  • Sweating
  • Lightheadedness or dizziness
  • Unusual fatigue
As a mom, I understand not wanting to worry other members of the family... plus there's always so much to do. We work hard, both in and out of the home. We juggle countless after-school clubs, activities and events in our kids', family's and maybe even our own personal time schedules. We try to pull off picture-perfect Rockwellian holidays for everyone to enjoy, without the deranged look of the 1950s cigarette ad. I admit I forget about my own health sometimes in the rush to keep up with life. I suspect with our current economic climate even more moms will choose health care for their children first and postpone their own due to the expense.

As you're getting together with your family this week for the holidays, take the time to talk with those you love to make sure they're getting the health care they need. I'm taking my own advice too: Take care of yourself first.

I only wish I had a chance to have that talk with my grandma a decade ago. In retrospect, this is probably part of why I'm so passionate about consumer health education now.

Friday, November 21, 2008

Friday Foolery #9: How to Survive Thanksgiving

(Lucky Strike Cigarettes Thanksgiving Ad, 1950 by roadsidepictures)

Just in case you and your loved ones aren't under the influence of something stronger than tobacco 'happy-go-lucky' conversationalists this upcoming holiday season, here is my favorite among the Topics to Avoid at Thanksgiving Dinner

Passive-Aggressive Suggestions
Your cousin and his wife know they’re a bit overweight. There’s no need for someone to casually drop hints about how Jessica Alba lost all that baby weight so quickly when they go in for that second helping of pumpkin pie. And, please, steer clear of your balding Uncle Bob who worked so hard to buy that Corvette -- he doesn’t want to be asked if he’s “compensating for something.”


They suggest discussing happy neutral topics such as 'funny characters at work' and 'recent vacations', then 'And when all else fails: puppies!'

I don't think saving the puppies for last is a good strategy. Assuming Grandma or Mom has internet access, why not share the adorable cuteness of the Shiba Inu puppies you've been watching all month instead of doing your work? Just make sure your overweight cousin grabs you some extra pie for running interference on the passive-aggressive comments!


Live TV : Ustream

Monday, November 17, 2008

HEAL-WA now live in beta

It has been a long road with a phenomenal amount of work done by many (especially coordinator Valerie Lawrence) that is still continuing on, but I wanted to wish the Health Evidence Resource for Washington (HEAL-WA) a happy public beta launch day today!

HEAL-WA was created in response to legislation passed in Washington back in May 2007 and has been a source of a great amount of confusion ever since. Let me clear one up immediately: HEAL-WA access does not equal UW Health Sciences Library access. Are we all on the same page about that? Great!

Even if you aren't among the covered professions who will have access (or even live in the state for that matter) I encourage you to browse the A-Z database list and eBooks sections for any of the free goodies you may not be aware of for your own reference. As of January 1, 2009 access will be restricted to those in the covered professions with a login and password to the site, which will contain many licensed resources. Check it out now while you can!

Research talk: What is the role of informatics in cancer care?

One of the greatest delights of working in an academic environment is never knowing what fascinating research may unexpectedly cross paths with you each week. Last year I held a lunar meteorite, which will probably retain the OMG COOL award for life because how often do you get to wrap your arms around a very heavy chunk of the Moon? I will never forget how I and everyone else around me was beaming with happiness approaching rapture at being able to do so.

While not quite as exciting as a lunar meteorite, being invited to research discussions by those who are passionate about their field and how their projects can help people is equally interesting to me. On Friday I was pleased to be able to attend a research conversation with Dr. Kent Unruh, a senior fellow with the Division of Biomedical and Health Informatics at the School of Medicine here at the University of Washington.

This was a reprise of his 2008 American Medical Informatics Association (AMIA) symposium presentation earlier this month of Barriers to Organizing Information during Cancer Care: I don't know how people do it, abstract of

People organize their personal information to conceptualize what they know,
enhance information retrieval in the future, and cue or remember tasks in
everyday life. However, studies also suggest that organizing is difficult and
people fail to use their information effectively for emergent tasks. In the
health-care domain, patients face grave consequences if they cannot access and
use information effectively. Arguably, patients have access to more information
about their health than at any previous point in history. However, information
access is only the first step to managing health care needs. Patients must
organize it effectively to support the underlying tasks required to manage their
health proactively. Ironically, ever-increasing access to information
exacerbates the challenges patients face in using information effectively. In
this paper, we describe five barriers patients encounter when organizing their
information for use during cancer care. We describe each barrier using rich
examples from our triangulated data set, and conclude with four recommendations
to help patients organize information more effectively during active treatment.

I'm not too sure we followed the abstract presentation to the letter, but the implications I came away with for ways to help with information organization for cancer patients were

  • Provide a rich intermediate structure (embed pre-organized links to other related information on insurance, necessary customization that is highly personalized)
  • Leverage assistance from others (support co-management model, enable assistance from others & organization strategies for their particular situation)
  • Provide a functional view of information (integrate descriptive & procedural info (who/what/where/when/who), distinguish information for active tasks, represent patient's view of cancer care system) Discovery of time-sensitive financial info in the stack added significantly to emotional stress, sort information/bills by date due instead of date services given.
  • Incorporate emotional considerations (negative feedback loop of not being able to retrieve information when needed for patient involvement in own care)
  • What is the role of informatics in cancer care? Clinicians and designers can explore stress reduction techniques, embed cognitive cues & known stress reduction techniques for stress relief in managing information
For the research study background that led to these implications & a great discussion, my notes are over here. I asked about Health Insurance Portability and Accountability Act (HIPAA) & Protected Health Information (PHI) concerns and he responded that he's currently a co-primary investigator (co-PI) on a portal for patients to manage cancer care information that involves portable workstations where clinicians enter & annotate information. I want to know much more about that although it wasn't really the focus of this particular talk, and will definitely keep an eye out for more of his findings in the future.

I also see social networking (such as Facebook pages) as a way to meet the need of being able to "coordinate in common information space between disparate groups" to help out in areas of emotional support, driving to appointments, bringing meals over, helping with childcare and other related activities in a patient's cancer treatment. I'm convinced Facebook is probably already being used this way and I just haven't seen it yet. Blogs are great for sharing cancer diagnosis, treatment and other information with everyone at once and receiving messages of support from loved ones in return but not so much for group coordination from what I've seen, which is sadly way too much.

Friday, November 14, 2008

Friday Foolery #8: Phishing for Donuts & Bacon

It sometimes takes drastic and unusual measures to raise student awareness about issues. At the University of Virginia, Karen McDowell (a security analyst) & her $60 custom made purple fish costume went on a march to discuss the issues of phishing during Cybersecurity Awareness Month. Lest we think that everyone in the 21st century campus environment would know that phishing means scam emails trying to lure people into revealing passwords or even more sensitive data about themselves, McDowell reports "Sometimes I introduced myself as a fraudulent e-mail because many people don’t know what a phish is."

This is timely in light of a ruckus that broke out on Twitter two days ago. A system called Twitterank asks for your Twitter username & password (while providing a disclaimer) "to determine how worthy of a person you are in Twitterverse." I saw isolated tweets about people & their twitteranks earlier in the day, then by the end of the day saw other people saying it was a phishing scam. Yesterday, the Twitterank author had a say in his defense.

Social network analysis is a real and very complicated process, as I learned in an insanely overpacked conference room in Denver last Saturday. Twitterank and Twitter Grader seem to be stabs in this direction of measuring actors in a network of arcs, trying to determine the geodesic path of least resistance and most influence... or perhaps it's far less complicated and cuts to a core question of humanity that hasn't died since 5th grade: Am I popular?

My Twitterverse answer according to both services: I am still so not popular despite ditching the Coke bottle-thick glasses for gas permeable contacts and having a sharply straight smile after way too many years of braces. That's fine by me.

(Warning: The following is not a political endorsement nor for viewing by those under 19 years of age due to the risk of aging your arteries)

I also have a 22.5 BMI, yet was sent information about Weight Watchers by a former coworker then attacked by the red exercise ball of my colleague this morning. I was beginning to feel self-conscious until another colleague came to the rescue with the ultimate vision of sweet, glorious saturated fat: The Donuts and Bacon '08 T-Shirt advertisement. If this was a button or magnet, I'd be there even as I cringe at the thought of these two wonderful food items together at the same time.

Continuing with last week's theme (no guarantee for next week), here's a free MP3: the Donuts and Bacon song by James William Roy! All the unpopular of the world, sing along with me now...

All us losers and boozers and heroes can't fall
If there's donuts and bacon in the morning!


Saturday, November 8, 2008

AEA Day 4: Ten thousand, four hundred and thirty one

That's how many words of notes I took over the duration of the American Evaluation Association 2008 conference here in Denver, not including full session & paper titles (let alone presenter names) in the mad typing rampage.

I'm tired and I want to go home now, but not before a nice breakfast with my aunt before I catch a plane tomorrow morning.

Lots of great information was shared today (social network analysis, relevant cultural information, distance education evaluation practices that make sense compared to what I endured as a grad student, etc.) I've identified the future need for me to see about modifications in Google Docs to make it easier to skip directly to relevant information, but now is not the time.

For the collective record:
Saturday, November 8th notes
Friday, November 7th notes
Thursday, November 6th notes
Wednesday, November 5th notes

I won't be able to coherently discuss any of this information for quite some time until I'm able to synthesize it a bit!

Friday, November 7, 2008

AEA Day 3: So, what's your B-HAG?

It's a reliable rule of thumb since my graduate school trips to Texas in 2006 that I go a bit insane on the third night away from my family. This conference is no exception to the rule.

My favorite line of the conference today is the discussion of the B-HAG, which stands for Big, Hairy Audacious Goal. I love this and think I'll informally begin every program or class project I have in mind with a serious B-HAG brainstorming session before going any further with it. Today I also rescued a presenter from having to verbally describe a website and its functionality because his wireless connection decided to fail. I have a camera phone pic of most of the 30 participants in the room gazing at my laptop but am having issues uploading it. I'll include it in the Google Docs when I can.

Despite third night insanity, I've polished up most of my notes from today (6 sessions) as well as yesterday's and the day before's. Tomorrow should go very well with my scheduled Sanity Break involving shopping and a long lunch!

Friday Foolery #7: 'Cause rational discourse was not on the test

Tom Chapin puts into song (MP3 here) what I've been thinking for years, and why I am immensely thankful our son's teacher has a Master of Fine Arts and is not afraid to use it in her classroom even if it's not on the test or grading rubrics.

(Photo credit: success in standardized testing went to his head, by woodleywonderworks

Awareness credit: Gary Minron, Western Michigan University, who played the MP3 for us before a conference session about survey data)

Thursday, November 6, 2008

AEA Day 2: Those with authority may fear sharing it

The most frequent searches that unsuccessfully lead people to my blog involve my old Quizno's/EBM post with 'I fear change, I will keep my bushes.'

It was the title statement by the president of the American Evaluation Association during a plenary today that made me think about organization structures. Those in hierarchies both know and execute the flow of authoritative power because it is a controlled factor that also carries an easy amount of blame on 'the system.' I use it myself to describe how things are easily lost in the massive bureaucracies we juggle.

These flows of power don't work the same way in a horizontal organization structure, yet the latter seem to be where most social networking and collaboration occurs. Sharing is not only easy, it thrives here with substantially decreased turnaround expectations compared to the hierarchy. Why is David Rothman apologizing for what really isn't a delay? In my current conference (which is rather un-Web 2.0), the onus is on us to contact presenters via email for copies of presentations. Is part of social networking an acceleration on turnaround time and the expectation that we as creators of knowledge resources will always & immediately share our material online? I'm not certain.

In the nature of sharing, (I saw others with laptops today, yay!) today's conference notes are here containing mostly unedited raw material that I'll turn into at least one lengthy blog post in the future and possibly two. I'm too pooped to put all 5 proper session titles, all the presenter names & affiliations and will edit them later. I need sleep because I have 6 sessions on tap for tomorrow!

Wednesday, November 5, 2008

A solo laptop blogging AEA 2008?

Lately there has been plenty of coverage in the library section of the blogosphere of trendy library conferences.

Then there's me, here at the American Evaluation Association (AEA) conference in Denver, Colorado, where the plenary speaker features a Pushmi-pullyu (she had an uncited one, mine is from the Llama Rescue) in the Powerpoint.

I am distinctive here not because I'm a librarian (although I've yet to run into another one besides my colleague roommate) but because I'm becoming aware of a rather odd factor: with the exception of presenters, no one else is running around with a laptop to take notes. This is particularly odd (to me) in the session sponsored by the graduate student & new evaluator interest group.

If you're involved in library evaluation and assessment you'd probably be interested in some of the sessions. My notes from today are up here. If I can locate outlets I'll hopefully be able to cover each day but there are none alongside walls... maybe in the very back?

There is a very high acronym usage and specialized jargon level I'm completely unfamiliar with here since I've had no prior training in evaluation/assessment beyond logic models. I did manage to explain to someone from the National Institute of Health (NIH) exactly how the National Network of Libraries of Medicine (NN/LM) fits in with the National Library of Medicine (NLM) & talked with the presenter of a poster about the assessment of community foundation grants (including consumer health) who had no idea NN/LM existed & seemed rather excited by it.

Tuesday, November 4, 2008

Chapter 12 (Hint: Not Bankruptcy)

My son, who is 6, putting our ballots in

Rights of the People: Individual Freedom & the Bill of Rights - Ch. 12: The Right to Vote
(Yes, I know this is the updated america.gov source location, but that layout does absolutely nothing for me even though the original one isn't 508 compliant. Sorry.)

Truly inspiring brief quotes and context behind each of the Amendments below.

The right of citizens of the United States to vote shall not
be denied or abridged by the United States or by any state on account of race, color, or previous condition of servitude.

— Fifteenth Amendment to the U.S. Constitution (1870)

The right of citizens of the United States to vote shall not
be denied or abridged by the United States or by any state on account of sex.

— Nineteenth Amendment (1920)

The right of citizens of the United States to vote in any
primary or other election . . . shall not be denied or abridged . . . by reason of failure to pay any poll tax or other tax.

— Twenty-fourth Amendment (1964)

The right of citizens of the United States, who are eighteen years of age or older, to vote, shall not be denied or abridged by the United States or by any state on account of age.
— Twenty-sixth Amendment (1971)