Commenting on Jason Winter's post about 80-lead ECGs on his ECG blog which gave an overview of a recent paper (1).
Monday, 14 December 2009
Commenting on Jason Winter's post about 80-lead ECGs on his ECG blog which gave an overview of a recent paper (1).
Thursday, 10 December 2009
The conclusions seemed to be that trying to raise your Vitamin D levels to at least 75 nmol/L is another reason for cycling to work and if we go surfing to wear a shorty wetsuit. Marvellous.
1. Bouillon R, Carmeliet G, Verlinden L, et al. Vitamin D and Human Health: Lessons from Vitamin D Receptor Null Mice. Endocrine Reviews. 2008;29(6):726-776. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2583388/?tool=pubmed [Accessed December 10, 2009].
Friday, 13 November 2009
I think it is great to have this debate but it is more than simply working out how best to distribute regulated information on the internet. The role of the prescriber is important and it can be overlooked in the rush to create more e-patients. Open information about drugs and treatments is important as well as promoting digital literacies. However, those seeking the information must also be able to judge whether or not the treatment is indicated or relevant. This requires a broader perspective ... and is why they will still need to talk to their doctor. The challenge with bringing the prescriber into this arena is that there is a conflict between the openness required for effective social media and the confidentiality needed for a personalised consultation.
My summary of the views from the #hcsmeu session is:
Q1 What can EU healthcare learn from this week's FDA Social Media hearing?
FDA are right to engage in this way. It seems they may already have draft guidelines in mind.
How quickly will the FDA be able to publish? Will it already be out of date or will the advice be too general for the expectations of those advocates social media?
Will / should / could the EU follow the FDA?
Is it more about language since English speakers around the world will be able to access American pharma social media anyhow (unless censored)?
Q2 Google, Yahoo call for expanded online drug ads; good for patients?
Good for advertising revenue and possibly good for patients.
Better to have regulated pharmaceutical information than hearsay and misinformation.
This may translate into more direct promotion of disease portals in the EU where direct to customer promotion (i.e. drug name appearing with drug indication - thanks @FarmerFunster) is not allowed.
Blogging your CPD is a bit of a challenge when you can't discuss the details of the cases. However, suffice to say it was a very useful reminder of (1) the possible rare causes of right heart failure, and (2) to always keep sepsis in mind when there is an unusual presentation and especially when the CRP is 300.
The small cakes were very good but the coffee is barely drinkable. Haven't tried the pasties yet as they all seem to go very quickly. Will be more forthright in the future.
Friday, 6 November 2009
The debate on Health Care Social Media Europe focussed today on the three questions:
- Experiences in EU of sites rating physicians and/or hospitals? Which are the constraints?
- What are most effective ways to build a healthcare (provider and patient) community? Are there any ressources available?
- If DTC advertising to patients in EU is banned, but SM is global, can industry utilise SM to give EU patients info online (in keeping with the EC rules)?
It was quite hectic and I would have preferred a more standard chat interface as I had to reload the twitter search every now and then. My feeling was that there was a lot of direct unguarded talk (understandable with the 140 character limit) with the intent of defining what the social media business model would be in health. Gritty, informal and refreshing with lots of different perspectives. The medium favours this type of 'messy' discussion and, in a way, to understand what others think is a good introduction for making contacts but perhaps not about understanding the subject.
Analysing the themes of the first two questions (using the transcript) to me it looked like the following views were expressed:
- Change seems inevitable.
- Locality and mobility may be more important than ratings in patient choice especially in rural settings.
- There are problems with patient feedback (in a simple 'rate your doctor' setting). How can it be made more objective?
- A successful system needs the right design of community and the right mix of patient and professional, leadership and community.
- Nobody pointed to very successful doctor / hospital rating sites but it was obvious there were many successful 'community' sites. [In my view mostly disease-specific.]
- Would an emergent design be better?
- There are difficulties with sustainable business models.
- Difficult feedback from patients or communities can create even more problems with clinical governance.
This sort of discussion needs more time and consideration than a quick hour of shooting off Tweets and leaving in time for lunch. However, its focussed nature and the fact that it endures after the event allows for additional networking between the attendees (such as pharmaguy introducing me to an example of an effective community before Web 2.0 as in DIABETES-EHLB) and analysis of comments (such as above).
Very interesting. Thanks Andrew Sprong and Silja Chouquet.
http://www.healthunlocked.com/ (example entrepreneur-led community site currently in beta testing)
PharmaTimes: EU drugmakers agree breakthrough on patient information. 5/Nov/2009
Imaginatik Webinar "Crowdsourcing in Healthcare"
Thursday, 5 November 2009
Oxygen therapy is still variable and suboptimal (1). The Trust will adopt saturation targets of 94 - 98% for most patients and 88 - 92% for those thought to be at risk of Type 2 Respiratory Failure. Oxygen is to be prescribed on treatment charts as this is apparently not commonly done - was routine in Bridgend when I was there. However, in Truro this is going to be with the use of stickers that make the saturation target, mode of delivery and flow rate explicit. There was an interesting discussion about how they are going to try and extend this practice across the PCT. Overall was a good informal reminder of Venturi masks, nasal canulae, reservoir bags, flow rates, oxygen dissociation curves (2) and the boundary disputes between paramedics, physicians and intensivists. Reminded of the editorial a few years ago in the BMJ (3).
I wanted to pop a question at the end to the junior docs such as "does anyone know a condition where patients present critically ill to A&E and where oxygen therapy is contraindicated? (answer = paraquat poisoning)" but thought better of it. Was my first time as a guest after all.
Sunday, 1 November 2009
Managed to catch up with the reading over the last few days and updated my concept map.
I am feeling far more satisfied with the rigour of debate that this learning theory has undergone but it is ironic (and intentional) that it is itself distributed and emergent.
There are works by Siemens and Downes that link to a lot of related theory but they are stored in many places in different forms: articles, videos, teleconference sessions, photos of whiteboards etc. The debate emerges through CCK08, CCK09 and other related networks and it is certainly impossible for any individual to find it all and know it all.
Friday, 23 October 2009
It's seems very good at storing references (just 1 click is needed when reading an abstract on PubMed) and, if you set vancouver style as the default, you can just drag and drop a fully formatted reference into a web form. Like this1. OK it doesn't do the author names exactly like we are used to on our diabetes diploma course but in the zotero record in your library the reference also includes the PMID, the DOI, the ISSN of the journal and so on. I think it is very useful.
Has anyone else had any experience with zotero? Or are there even better ones out there?
- David M Nathan et al., “Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes,” Diabetes Care 32, no. 1 (January 2009): 193-203, http://www.ncbi.nlm.nih.gov/pubmed/18945920.
Google Group: http://groups.google.ca/group/africaiet09/about?hl=en
Delicious bookmarks: http://delicious.com/search?p=AfricaIET09
Wednesday, 21 October 2009
The big question is when is this concept tool going to be available? Maybe someone has already written the iPhone app already.
Tuesday, 20 October 2009
"That's what sharing and engaging is all about, sharing ideas and information willingly, leading from the front and setting a good example for others. New technologies and social media can be a wonderful tool for finding new people, new blogs, new ideas and plenty of spirited exchange. Fresh inspiration from others can set off a new creative spark and stimulate new content and more sharing, and so on ad infinitum."
Thursday, 8 October 2009
Should we be concerned with a theory of knowing rather than theories of knowledge? Ernst von Glaserfield's 2500 year summary of sceptical thought provides a background to what he describes as radical constructivism.
Is knowledge about a thing or does it emerge from the interactions we have (without ever being a thing)? Stephen Downes goes deep into the Emergentist Alternative and builds the case for connectivism and "e-learning 2.0".
Sunday, 4 October 2009
One that struck me was the watch (number 10) but I've been going off the watch for a lot longer than the internet was around. Why wear a watch when there are plenty of places to see the time?
You need to know the time when you have to be somewhere at a certain time or do something at a certain time. This means that you are probably around people and civilisation. There are numerous clocks around you and you probably carry a mobile phone or a PDA, and there are plenty of other people around you to tell you the time. Time is less critical now with the ubiquitous connectivity that's available so you can always rearrange appointments and punctuality is something that is also being killed off (number 5). So, when you most need the time you probably don't need a watch.
When you don't have access to other ways of telling the time you are probably away from society in the country, or on a beach in your swimsuit where clocks, mobile phones, PDAs and other people may not be around. But this is when you least need to know the time because you are less likely to need to be somewhere at a particular time. So when you most need a watch to tell the time you probably don't need to know the time.
Either way you don't need a watch.
Tuesday, 29 September 2009
"According to my review of history and theory, four forms of organization — and evidently only four — lie behind the governance and evolution of all societies across the ages:" Overview of social evolution (past, present, and future) in TIMN terms
TIMN stands for: Tribal, Institutional, Market and Network.
This is a compelling way to look at the evolution of society and wonder if it can be applied to medical teaching and learning too.
Tribal - apprentice and mentor within a particular practice
Institutional - traditional university / college teaching
Market - the open market for CME/CPD and courses
Network - courses such as the Postgraduate Diploma in Diabetes at Cardiff perhaps, Wenger's communities of practice living in digital habitats, CCK09 of course ...
My only anxiety is that evolution suggests a one-way and one correct way for a society to evolve. Working in a network with social equity, justice, information overload and rewarding connections but I'm sure there are times when the other forms of organistion would work better.
Building my own network (nature vs. nuture)
Read Imreli Aro's introduction of herself to the course and in particular her 10 rules of becoming a social mediator. Asking questions seems such an obvious way to start networking and I've found it particularly useful during this week. Have built contacts and even met one for lunch who introduced me to a new restaurant on our campus (thanks Anne-Marie)! There are a number of health professionals on CCK09 and hope to connect with them some more.
I wonder what the balance should be between actively seeking to make a network and allowing a network to develop by serendipity. Which is the more effective in terms of time and effort, efficacy of learning, complexity of knowledge etc.? It must be a balance but remembering the qualities of others in your network is something I find quite a challenge especially when the initial contacts are very brief. In 'the real world' it would take several meetings to build up a rapport and this connectivism network building feels a little like ruthless speed-dating at times. I think time and discovered shared interests will be the best means for me.
Have initiated a lot of networking outside the CCK09 course as well and will build on my role as 'broker' between different networks and communities. Found the facebook tool to map my own personal network of friends very interesting. It allowed me to visualise hubs (my sister) and brokers (a friend who introduced us to a charity we are now involved with) in my own personal network.
An interesting point has appeared when looking at the discussions of two people in my network both doctors talking about patients who read medical information on the internet and form fantastic disease-specific communities such as 'survive the journey' for Cushing's disease. You would think that doctors would be useful people in those online communities but they are not. The strength of the connections between the members of the community is much stronger than that of any doctor with the community.
Network complexity / analysis
I had read about scale-free networks previously but this week has allowed me to bring several of my own nerdy interests together. Fractals, Mandelbrot's (mis)behaviour of markets that suggests the complexity of market forces could be explained by its 'scale-free' nature, how the brain works, small-group teaching techniques, and specialist communities. This has been connection making at a conceptual level and has allowed me to look at learning with a different perspective. most interesting. Whether this is 'connectivism' or just being inspired by reading other people's opinions and challenges is the big question ... for my CCK09 thoughts. Added a lot about network properties and Downe's design principles to my concept map of connectivism.
Reading Barabasi's Scale-Free Networks: A Decade and Beyond raised a question about how common scale-free networks are. Scale-free networks are a feature of many but not all networks in nature. In particular we do not know if the central nervous system does behave like this as we have no map of its connexions (the connectome) or any way of generating an accurate model. I wrote about it in response to a thread called 'the connection' started by Ken Anderson where I said,
"The key part of this which I am not clear on is how can we be certain that network properties that exist in one system can be extrapolated to another. Not all networks are best explained by a power law for example. How can our understanding of complex networks (WWW, society, models of scale-free networks on a computer or in a maths expression) help us explain the characteristics of networks which we don't understand very well - like the CNS for example. Likewise, in the other direction, how can our insight into human cognitive processes be extrapolated to explain the dynamics of personal learning networks.
Hmm. Best leave it there with a big question mark and hope someone else pitches in to dig me out of my hole. ?"
Thursday, 24 September 2009
I remember Tony Buzan on television as a kid and used 'mind maps' quite extensively through school and university. I was quite frustrated with their use in medicine since - from my perspective - the concepts in medicine were quite easy to understand but the reams of lists and facts were not. Mind maps were not of much use. I was even more surprised at the success of a book in medicine that included the authors' mind maps to help students revise. It seemed a rather odd way of communicating knowledge since one person's mind map may be different to another's ... and isn't most of the learning in creating the map itself?
So it is quite interesting to return to mind mapping using software rather than pencil and paper. XMind allows me to easily share the map with others and display it for them without the need of additional software. It also works on my laptop (Windows) and my PC (ubuntu). I'm going to try and keep it simple and not add specific XMind features so that it is compatible with FreeMind. In a year's time my choice of mind mapping tool might be very different.
I'd like to explore collaborative concept mapping and wondered if anyone on CCK09 reading this would care to comment on any particular part of the map. Does my concept map network resonate with my learning network? Do we share the same misunderstandings? Will the true insights (if any) be spread? Is there a concept map wiki version I wonder? That would be an anarchic tool.
Sunday, 20 September 2009
Was a stimulating first week. Not quite what I expected and I must say I started off as a skeptic. However, there seems to be something in the 'theory'. The observation that this sort of learning is happening and appears to generate knowledge and understanding about topics quite clear. Connectivism does explain a lot of the activities. I am reading Wenger's Digital Habitats and going over his 'communities of practice' theory at the same time and this provides an interesting diversity of viewpoints.
The pace of adoption and the range of different tools used by the other 'students' on the course is quite incredible and I feel thoroughly 'immersed' as Downes would say. Gained experience with Ning, Yahoo! Pipes, Wiki, Blogs, tag hacking, RSS, Elluminate and Friendfeed. Watching how others use them is an excellent way to learn but also the use of the learning techniques explained by connectivism is a great way to learn about connectivism itself.
There are a lot of CCK08 attendees in CCK09 and I wonder what the proportion is. I feel quite humbled to be among some very deep thinkers and maybe the whole thing will make more sense if I come back in CCK10!
Defining terms has helped my understanding and have worked on a wiki page for a Connectivism Glossary. I found that writing out the jargon and then finding or inferring the definitions from previous papers by Siemens and Downes helped me piece together what the theory meant. More established theories have plenty of books on the subject which allow plenty of time to explain the jargon. I suppose this approach is a quite a 'constructivist' style of learning and I didn't really network very much to achieve it. James Neill helped thanks!
One of the polarities of digital communities that Wenger talks about in 'Digital Habitats' is the balance between participation and reification (or the creation of objects and artifacts). I wonder what the balance is in CCK09 at the moment. From my perspective it seems to be heavily in favour of participation as shown, for example, by the two separate discussion forums http://cck2009.ning.com/ and the 'official' http://ltc.umanitoba.ca/moodle/course/view.php?id=68. I feel that I have done more reification and not enough participating so will try and do more next week.
Wondered how connectivism is related to other theories. Having last studied learning theory about 10 years ago during a diploma in medical education I felt quite out of date. It seems everyone else has been having a deep philosophical debate about theories whilst I've been happily getting along with just applying what little I knew to OnExamination.com. So taking a lead from a posting by Siemens, and this article http://www.infed.org/biblio/b-learn.htm I put together a table of learning theories to help me fill in the blanks and see how connectivism compares. There has been a lot of talk about the differences and similarities of connectivism and connectionism which has seemed far too geeky for my liking. Might be useful to return to the table at some point and put connectionism in as well.
So, after a week I think I could say I think connectivism has far more background and argument than I had initially thought. The concept of 'emergent properties' is a bit of a challenge for me at the moment. Of what use is 'understanding' or 'knowledge' in a network if it can't be utilised by one or more of the people in the network. If it can be utilised then surely it is in the people and not the network. Hopefully we'll cover that in due course!
Saturday, 19 September 2009
Found this quite a useful exercise especially where it meant searching Siemens and Downes previous writings on connectivism. There doesn't seem to be much difference in the definitions of aspects of their proposed theory but they clearly have different perspectives. Stephen is more neurones, maths and philosophy whereas George is more education through social and open media. At least that's my interpretation after knowing them for a week. Enjoyed the CCK09 Elluminate discussion 17th September 2009 but didn't catch it live. Listening to the recording allowed for a more forensic approach to the posits and responses which was good fodder for several glossary entries.
However, this glossary fetish seems to be quite an individual (and obsessive) task although had help from @jtneill in the wiki etiquette. On Siemens' taxonomy of connectivism (Awareness and receptivity, Connection-forming, Contribution and involvement, Pattern recognition, Meaning-making, Praxis) I seem to have jumped the connection-forming stage and gone straight to contribution. I'll therefore focus a little more on connection-forming.
Thursday, 17 September 2009
This does a lot of the work of adding the aspects of 'Communities of Practice' in to George Siemens' comparison table which is something I wanted to work on.
So I have posted it as a Google Doc with some additions.
1) Smith, M. K. (1999) 'Learning theory', the encyclopedia of informal education, www.infed.org/biblio/b-learn.htm, Last update: September 03, 2009
One of the authors submitting to BMJ Case Reports wonders if a large online collection of medical cases could assist patients or health services in finding the most appropriate medical care.
Tuesday, 15 September 2009
This is a good overview putting the aspects of Connectivism in terms of other learning theories. Maybe there is more to it than I initially thought! He models this on Mergel’s emphasis on Ertmer’s and Newby’s “five definitive questions to distinguish learning theory”. The original paper by Ertmer and Newby is also available as a PDF (Behaviorism, cognitivism, constructivism: comparing critical features from an instructional design perspective. Performance Improvement Quarterly 1993;6(4):50-72). The two additional features suggested by Ertmer and Newby on Schunk's original list of five were about instructional design in particular and it may be interesting to expand Siemen's list to include these. After all why exclude the instructional design aspect? CCK09 has undergone a process of instructional design.
Also I think it should include social learning theories in the comparisonsuch as 'communities of practice' which also talks of the learning that takes place in the connections between individuals and the knowledge that exists outside the individual.
This is a start page for the CCK09 course so that I can find all the links easily.
Week 1, Week 2
The Daily News: The Daily
Moodle LMS: Course: CCK09
Participants: CCK09: Participants
Elluminate: CCK09 Live Sessions
Elluminate: CCK09 Recorded sessions
Wiki: University of Manitoba
Wiki: at Wikiversity
Tagging makes the course easier to aggregate.
Yahoo! Pipe (of everything I can find): CCK09 tags
or, for more focussed searches ...
Google Blog Search: cck09 – Google Blog Search
Twitter CCK09: cck09 – Twitter Search
WordPress CCK09: Cck09 Blogs Posts on WordPress
Delicious Bookmarks: Recent cck09 Bookmarks on Delicious
Just listened to George Siemens talking about the origins of Connectivism in the dichotomy between his traditional teaching of students in a learning environment and his own personal CPD conducted in a more open and free way. In early 2000 he used blogs and other tools that would later be called 'social media'. He believes that learning is fundamentally 'networked' through contacts between people. He asks the questions "what could education be ... how can we change our teaching to reflect the reality [of connected learning]"?
In 2008 he and Stephen Downes launched an online course in 'Connectivism and Connected Knowledge' CCK08 which was designed to teach about Connectivism as a theory using the tools and activities of Connectivism as the mode of learning. This is quite a handy way of teaching learning theories which would otherwise be hopelessly abstract. The course was well received and they were encouraged to run it again as CCK09.
The tutors created a loose structure based on reading lists via email and Moodle, suggested tagging to pull together contributions, and provided a rhythm to the course. The students demonstrated great creativity in their use of emerging technologies to further explore the course content.
I am having difficulty seeing what is new here in terms of learning theory. People have always learned from each other through connections between peers. What is different is the number and asynchronous availability of these connections in the Internet era. Does this level of 'connectiveness' qualify as something different? Could it just be a tool that makes education more accessible and convenient?
Friday, 11 September 2009
Gregory I. Comparisons between geographies of mortality and deprivation from the 1900s and 2001: spatial analysis of census and mortality statistics. BMJ 2009;339:b3454
Is this surprising? It's not surprising that where you live determines the sort of life and opportunities you experience. What is surprising is that those same places have not changed greatly in their relative position of deprivation and mortality measures in the last 100 years. But then you'd have to look at a longer timescale to see changes in the fortune of particular localities. Postcodes remain a good predictor of deprivation and mortality.
Wednesday, 9 September 2009
From their experience they derived:
- Design for evolution.
- Open a dialogue between inside and outside perspectives.
- Invite different levels of participation.
- Develop both public and private community spaces.
- Focus on value.
- Combine familiarity and excitement.
- Create a rhythm for the community.
The 7th 'create a rhythm for the community' is particularly relevant I feel and is something we've employed in our Diabetes Diploma course at Cardiff University - the use of weekly case problems. Rhythm maintains engagement.