Friday, July 25, 2008

Part 1: Quarantine at sea - the medical record vs. reality

Oh it's just a little too much sun/that new sunscreen/some plant in their backyard we don't have/European laundry detergent combined with fifth disease...

It's amazing what a range of excuses we'll come up with for health issues with an unknown cause while on vacation, in our case a European cruise.

We had spent several days in Oxfordshire beforehand adjusting to jetlag and visiting close friends of ours. Our son looked slightly pink when we left and had a night sweat, but the kids had also spent several warm days in the English sun and my well-traveled friend said that kids react to jetlag in all sorts of bizarre ways .

Unfortunately, the first morning we awoke on the cruise ship in the Channel Islands we couldn't ignore the fact that something was very wrong. You can click to enlarge the picture and see that 'slightly pink' had turned into a bright red rash on his face, and if you look closely at his chest you can see some of the thousands of bumps that covered his torso and arms but didn't go below his waist. It was a very bizarre combination and while I knew the 'slapped cheeks' red face was typical of fifth disease (which he hadn't had before) the bumps weren't.

The italics were what came to my mind, but there was a slight hitch: I couldn't research PubMed, MedlinePlus or any other online medical resource for myself due to the infuriatingly slow latency problem with the satellite internet connection we had on board. Even checking email was such an enormous hassle that I rarely did so, and most things that took a minute to do on our broadband connection at home translated to at least 10 minutes ($5.00) at sea.

Of course we tried to call the ship's medical center first thing but they were not open til 10 am and this clearly wasn't a medical emergency. He was perfectly fine other than looking awful, maybe a slight fever but not itchy or in pain. We had a morning tour that I tried to reschedule for the afternoon but that wasn't an option because all changes/cancellations had to be done by the night before.

I do not recommend being near a medical librarian on vacation whose young child is clearly having a medical problem without reliable access to her trusted sources of health information.

This left us with a tough decision: to forfeit our first shore excursion and see the doctor that morning, or go out then see the doctor in the afternoon?

Knowing that fifth disease is most contagious before the rash appears, not so much afterwards, and that he was current on all immunizations (including varicella), we decided to hope for the best and went on tour while having him keep his hands to himself as much as possible.

The ship's doctor examined him that afternoon, called in the other ship's doctor, and while they were able to rule out the scary stuff I wasn't allowing myself to consider (like meningitis) his symptoms weren't lining up with anything they knew. They decided the best course of action was quarantine with twice-daily checks until the rash began improving to be on the safe side, with more options to be discussed the next morning.

However, while the medical record says our son was in our room the entire time for the quarantine, the first doctor gave us permission to take him out on the promenade deck for a walk and fresh air every few hours as long as we didn't go into the dining rooms and other public areas of the ship.

I believe that if the doctor was 100% convinced we had a highly contagious situation he wouldn't have allowed this, yet it made me wonder how many other medical issues on cruise ships that could affect public health may not actually be managed the way the records say they are. (see the Cruise Ships section in the Port of ToxTown for more information)

What happened next that introduced us to a world of difference between public and private health care systems and how the ship's medical team searches for health information on the same pokey satellite internet connect? Stay tuned for Part 2 next week!

Monday, July 21, 2008

PubMed Search Clinic Guide & Why the Kitchen Isn't Falling to the Sea

PubMed Search Clinic

Other than a shoutout over at for maximum reminder exposure about the July 17th Search Clinic: PubMed® Update on Automatic Term Mapping, Citation Sensor, and Advanced Search (Krafty Librarian has posted a good review of the objectives) things have been quiet around here because I was with my family on a European vacation. Things didn't quite go according to plan since we were quarantined for part of it, but more on that in another post this week.

I am a fan of guides so I can jump straight to the point when streaming video lasts for more than 3 minutes and includes more than one subject. Therefore, as with the NLM Theater presentation breakdown, here is one for the recent Search Clinic:

  • 2:35 - Citation Sensor
  • 4:37 - Old vs. New ATM (compare/contrast discussion and illustration)
  • 6:20 - Example: Burns laryngoscope 2005
  • 7:10 - July 2nd enhancements to ATM were based on user input (we do have a voice that results in additional change), details at the tech bulletin
  • 7:40 - Examples: ferrous gluconate & complement factor B
  • 8:20 - What new ATM means in general: larger retrieval
  • 8:30 - Why was it done?

    Short answer: in FAQ.

    FAQ navigation: (more direct route than the clinic but not by much) at the top of the PubMed page is the U.S. National Library of Medicine page, from there under 'The World's Largest Medical Library' banner is a link to the FAQs, select MEDLINE/PubMed and other databases, then Why was PubMed's Automatic Term Mapping (ATM) changed?

    For future sanity: Bookmark NLM FAQs at

  • 10:20 - Result of change: MyNCBI search results may be larger, check and refine as needed.
  • 10:30 - Advanced search (to the right of the search box) in beta, please provide feedback. In my opinion the features here are mostly intuitive, with the exception of the ability to set limits as ‘sticky’ or ‘unsticky’ (15:50), and may be subject to change as a beta.
  • 18:30 - Questions & Answers, with additional answers to be posted at a later date.
The bottom line, according to the ATM FAQ, is that the previous ATM “caused thousands of citation-type searches to fail every day.” Revised ATM testing found that “no significant problems were discovered, nor complaints received.” Since the ATM was changed, “the Citation Sensor is now used in several thousand searches per day. From all our available indicators, the enhanced ATM has considerably improved searching PubMed.”

I am quite happy that the NLM distance education resources page has been updated to highlight the visibility of PubMed information which must be in high demand now; I didn't know about BabelMeSH and the multi-lingual guides to PubMed!

Kitchens falling to the sea? What?

Once upon a time there was a beautiful castle on the Antrim coast of Northern Ireland (click to enlarge, thumbnail doesn't do it justice). It was everything money could buy perhaps as far back as the 13th century and definitely by the 16th century.

However, deciding to build a castle on an outcropping of unstable basalt 100 feet above the ocean wasn't exactly a smart engineering move. One day in 1639 the kitchen suddenly fell into the ocean and took the majority of the servants with it. The lady of the castle decided she no longer wanted to live there after that unfortunate event and who could blame her? Dunluce Castle was abandoned 3 years later & gradually fell into these picturesque ruins that inspired a Led Zepplin inner album cover and the setting for many local wedding photo sessions.

What does this kitchen in Ireland have to do with PubMed?

It's all about the core foundation and awareness of the environment. Building a massive building on shifting ground? Not the best of decisions that led to dire structural consequences. Having a strong foundation of biomedical information and not responding to the fact that thousands of access attempts a day aren't working for users? Also not a smart move. We are no longer in medieval times where defense is a way of life, and PubMed is not the exclusive domain of health information professionals. We have & know the tools to refine PubMed queries beyond the basic search box that we can teach to users as needed to show them there's much more than citations that scratch the surface. Lower the drawbridge instead of shouting from the tower that users are doing it wrong, then think Nordstrom's vs. majordomo to show them the value of resources inside the impressive outer walls to halt their march to Château de Google as a primary resource.