In remembrance year 2: Know the signs

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

My yearly Thanksgiving post to increase awareness of the signs of a heart attack, still the #1 killer for women. Here's why, and here's the source for the information below.

Here are some signs a heart attack may be happening:

• Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
• Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
• Shortness of breath. This feeling may occur with or without chest discomfort.
• Other signs of discomfort. These may include breaking out in a cold sweat, nausea or lightheadedness.
• As with men, women's most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

If you or someone you are with has chest discomfort, especially with one or more of the other signs, don't wait longer than five minutes before calling 9-1-1 for help.

Please, please don't wait. It is far better to have a family member's chest pain and discomfort turn out to be pneumonia in an ambulance than to inherit your grandma's car knowing her last time driving it was to the hospital where she died within hours. Trust me.

Crashing the #hcsm party

I can never attend the designated Healthcare Communication Social Media (abbreviated hcsm, affix a hashtag and you get #hcsm) community chat on Twitter in real time on Sunday nights, but have usually seen several medical librarians actively engaged and I enjoy catching up on the conversation when I can.

Tonight I also noticed mention of a blog entry entitled The Pew Internet/Health FAQ by Susannah Fox on epatients.net about how people search for quality health information that contained a shoutout to the Medical Library Association (MLA), a comment from medical librarian Luke Rosenberger with an explanation about how the 'Google as diagnostician' article isn't necessarily accurate, and offered a comment of my own with more quality health information evaluation resources.

Part of the #hcsm discussion?



Bring it on!

While I'm happy about steps that MLA is taking to advocate for the role of hospital librarians, such as the recent Vital pathways for hospital librarians: present and future article and others from the October 2009 Journal of the Medical Library Association, I'd love to see the profession take a more active role for medical librarian advocacy in non-traditional settings as well. There are plenty of us there already at @medlibs on Twitter and elsewhere.

Foreshadowing: Women *are* cutting back on healthcare due to cost

In the pre-Thanksgiving blog post where I encouraged you to talk about health with your family (you did, right?) I theorized

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.

Little did I know that there was a survey in progress by the National Women's Health Resource Center (NWHRC, at healthywomen.org) about this very topic that was released yesterday with some sobering news about women and healthcare.

• 45% of the women have failed to seek medical care in the past year (including doctor's visits, recommended medical procedures & medications) because the cost was too high, with Hispanic women more likely (58%) than white (43%) or African-American (42%) women.
  
  
• More than 40% reported their health had declined over the past 5 years, mostly due to stress and weight gain.
  
  
• Only 42% mentioned feeling prepared to grow older in terms of financial security, with financial (51%), retirement (46%), medical (42%) and health insurance options (41%) given as information needs.

On the positive side, women feel more positive about aging and named Tina Turner as the celebrity over age 50 that they admired most. Rock on!

NWHRC has created an online wellness information resource for women in response to the findings of the survey. At a quick glance I'm finding a few broken links in this consumer health resource, but I definitely encourage checking out De-stress the Holidays. It's a bit too late for all the long range planning tips (10 weeks) but there are gems in there that could still be done such as "If certain rituals trigger sadness, change them or create new traditions to replace them."

'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?

In remembrance: Talk about health over the holidays

Dorothy Irene 4/26/24 - 11/24/98

(yours truly as the culturally misappropriated one)

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.

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.

Terminology turpitude: New York Times & the Pew Internet 'report' gaffe

I hadn't yet read all of the 13 articles in Decoding Your Health, a September 30th insert that was in the New York Times, and had bookmarked only one (You're Sick. Now What?) because I liked the title.

When Patients Looking for Second, Third Opinions Online popped up in the Seattle Times with the New York Times original byline yesterday morning, I figured I'd give it a read... and was promptly frustrated.

And 75 percent of online patients with a chronic problem told the researchers "their last health search affected a decision about how to treat an illness or condition," according to a Pew Report released last month, "The Engaged E-Patient Population."

What?! The Engaged E-Patient Population is not a (high caliber, comprehensive & identifiable source of survey information) Pew Internet report. It is a (completely undefined term, this time a verbatim perspective column written for a company) memo.

I griped about this back on August 28th.

I understand the pressure in journalism to get articles out fast. Honestly, I do. It's precisely because I feel Pew is misleading everyone from students to researchers (and now journalists) who are taught to trust them as a data source by mixing these 'memos' in with their regular reports that I'm far more frustrated with them than the New York/Seattle Times.

Would it be too much to ask to get your miscellaneous side projects into their own clearly defined section of your website and leave your excellent report data alone to avoid a repeat of this, Pew Internet?

Ooh it's another Pew Report on electronic health!.. or is it?

I first learned about Pew Internet reports in 2005 during the last evening degree class for my BA at the University of Washington. It was also from this class that a 2nd degree connection of the professor's led me exactly to where I am in medical librarianship today. Yes, I have kept in touch with my professor and thanked her and her 1st degree connection for this!

Every time I see a notification from Pew in my RSS feeds I eagerly check to see what it's about, and am always thrilled each time their research intersects with health information. The one released yesterday is The Engaged E-Patient Population. Everyone, including me, will cite the easy cut-and-paste blurb:

78% of home broadband users look online for health information, compared with 70% of home dial-up users. Home broadband users are twice as likely as home dial-up users to do health research on a typical day -- 12% vs. 6%.

High-speed, always-on connections enable frequent and in-depth information searches, which is particularly attractive if something important is at stake.

However, by digging a bit deeper we (disappointingly) find this isn't nearly as comprehensive a report as the 22-page Online Health Search 2006. It confusingly blends political campaigning data in with the health information data, such as this paragraph immediately following one about people sharing advice on how to communicate with health care providers

Along with all this engagement, however, is an understanding that the internet is not a cure-all. Some 60% of internet users agree with the following statement: "The internet is full of misinformation and propaganda that too many voters believe is accurate."

From what I have seen during my limited foray in consumer health information education thus far, I'm betting that nowhere near 60% of internet users would have similar agreement about the existance of health misinformation online nor understanding about the difference between pharmaceutical/for-profit vs. unbiased/non-profit health websites.

The report also does not give us the questions used for their survey(s). Without these, it is difficult to understand and impossible to verify the results stated... what does Pew mean by "in-depth information searches"? Searching MedlinePlus (kudos for being one of the best government websites!), Cancer.gov and BreastCancer.org for breast cancer information? Clicking on the second page of Google search results?

I was increasingly confused by this report until I saw a note at the bottom stating "This column originally appeared on iHealthBeat http://www.ihealthbeat.org/" Wait, what? A column? A report? Which is this? It is then that I noticed that while this is presented as a Health report with "This latest Pew Internet Project survey confirms that.." and 'View PDF of Report' below the blurb, there is an icon that indicates this 'report' is actually a 'Memo' although no explanation is given to differentiate the two.

Searching iHealthBeat led to their verbatim August 12th Perspectives column. iHealthBeat is a daily publication for the California HealthCare Foundation.

As a librarian I am seriously disappointed by Pew; this is not a Health report but a brief summary of at least 2 unidentified surveys written as a perspective column for a health organization. There is certainly nothing wrong in Pew doing so, but presenting and labeling a perspective column in the same manner as their reports could be considered a form of internet misinformation itself. I look forward to much clearer definitions about their report/memo information in the future!

EMRs in plain English

I had no idea that beginning last month there are now weekly MedlinePlus podcasts, let alone a MedlinePlus topic covering electronic medical records for consumers. Maybe I missed it in the data flood during our European vacation?

I particularly appreciate the instant turnaround on the transcript for today's podcast about electronic medical records. Thank you, Journal of the Medical Library Association (JMLA) blog!

As a reminder for those in the Pacific Northwest (I wouldn't recommend non-natives coming to visit in October for this, it's rather cool and soggy by then), registration is open for the Pacific Northwest Chapter of the Medical Library Association (PNC/MLA) Continuing Education Update featuring an electronic health record forum that I will definitely blog about.