Canadian Medicine

"I'm getting kind of tired of seeing history repeat itself," a weary . "People need to learn from it now."

Dr Gardam was drafted in to help clean up Burlington's Joseph Brant Memorial Hospital following a C difficile outbreak that's killed 62 people and infected many more. He says simple mistakes like not charting cases and using ineffective disinfectants contributed to the Jo Brant outbreak. His (PDF) of the outbreak was released on Wednesday.

Dr Gardam - director of Infection Prevention and Control at the University Health Network at U of T and a veteran of the SARS outbreak - has previously taught hospitals in Sault Ste Marie, Barrie and Mississauga how to clean up their infection control messes after C diff outbreaks. . It was the same deal then: inadequate cleaning, crowded facilities, slow lab results, poor case tracking.

The tracking problem should soon be a thing of the past, according to Ontario health minister George Smitherman. Speaking in the , Mr Smitherman promised

"[W]e're going to take measures, working with the Ontario Hospital Association to add C difficile as a reportable circumstance. This will dramatically enhance the transparency associated with these challenges which do occur from time to time in Ontario's hospitals."

A VIA rail train has been quarantined following the onboard death of a woman in her sixties. Ten other passengers on the train travelling from Vancouver to Toronto are also reported ill, suffering from "flu-like" symptoms. One has been airlifted to Timmins, about a 100km away from where the train has been stopped in Foleyet, Northern Ontario.

There's a lot of pretty outlandish speculation at this point about what the mystery illness could be (SARS, Norwalk, food poisoning, plague...), but some good old medical deductive reasoning produces a much saner theory: the flu.

"The thing that makes influenza more likely is that someone has died," Mount Sinai infectious disease specialist Dr Allison McGeer . "My guess is at this time of year Via trains are mostly taken by retired people and in an older population things will happen. You don't know what chronic illnesses she had."

UPDATE May 9, 5PM: The woman airlifted from the VIA rail train to a Timmins hospital has tested negative for influenza A and B. Swab results from the other sick passengers are expected tomorrow. "We'll do some of the more esoteric things on them just to make sure some of the other possibilities are ruled out," said Dr Donald Low, medical director of Ontario's public health lab. "But it sounds like a regular ... run of the mill cold." Police now say they don't believe the woman's death and the illness of other passengers are related.

Photo: National Post

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Welcome to the latest edition of the Medicine 2.0 blog carnival.

For those of you unfamiliar with the newfangled internet jargon, "Medicine 2.0" is typically defined as the application of so-called web 2.0 technologies to the field of medicine. "Web 2.0" technologies are interactive internet tools, like this blog, or like Wikipedia -- websites that allow and encourage participation from their users.

This is Canadian Medicine's first time hosting Medicine 2.0. Enjoy.

Your PubMed rage may not be calmed by watching this video (We wrote about this subject .) into the "semantic search" website , which is still in beta testing. Hakia isn't half bad, he explains, but Google's got it beat. " greatly surpasses Hakia’s effort here by including a greater number of recommended sites and greater value from having more authoritative recommenders than just the MLA." Gunning for a job at Google, Mr Rothman? I hear the perks are to die for.

A partnership between Ozmosis (an online MD-only community) and The Doctor's Channel (med ed videos) has Bertalan Meskó of of collaborative online medical resources.

Scientific American magazine whether the "open access" concept should be applied to raw data -- an aspect of what is being called Science 2.0. In theory, the idea sounds attractive; as in the case of Wikipedia, it sort of makes sense that two minds are better than one, and therefore a whole bunch of minds is even better still. But what about some researchers' very legitimate concerns about getting scooped if they publish preliminary results online, or about having their laboratory's website vandalized if their "open access" is too open? "Acceptance of such measures would require a big change in academic culture," admits the article. "But for Science 2.0 advocates, the real significance is the technologies’ potential to move researchers away from an obsessive focus on priority and publication toward the kind of openness and community that were the supposed hallmarks of science in the first place." I'm not holding my breath for that to happen anytime soon. Publish or perish is in full swing around the world, same as always. Will a few collaborative websites change that? Unlikely. But one note of positivity: when journals embrace collaborative research and ongoing updating of publications, as has happened with the very interesting PLoS One, we may begin to see some change.

Dr Steven Palter of docinthemachine.com at the National Association of Broadcasters meeting in Las Vegas late last month. Why, you ask? Because he's looking around for the next wave of video technology to be used in endoscopic surgeries. "The progress we make in medical video surgery is a direct trickle down of innovations from the broadcast arena. From the first CCD camera hooked to a laparoscope and suspended from the ceiling via a jerry-rigged boom to the first use of HDTV in the OR - broadcast and TV technology drives innovation in surgical video. I thrive on researching new technology and then extrapolating new solutions to medical problems using these developments. This meeting provides the raw material for my creative process." (Plus, it sounds as though he had an added incentive to go to the meeting: "I was honored to accept invitations from several major broadcast, video, computer, and even surgical companies to attend the meeting, walk the floor with them, brainstorm new ways of helping patients with new devices and predict future needs and uses for technology in medicine." Sounds lucrative!) The coolest stuff he saw: fancy new helicopters and "ultra HD" cameras and displays.

Electronic medical records are the way of the future... right? Well, maybe, but you might want to consider a recent study from Norway before you jump in head-first, Dr Alan Brookstone of CanadianEMR.ca: "GPs' use of EPRs [electronic patient records] were efficient and comprehensive, but have resulted in transfer of administrative work from secretaries to physicians." Dr Brookstone's post elicited several very thoughtful, thorough replies from doctors who use electronic records and have some complaints.

Second-year University of Alberta med student Daniel Kozan had a great idea that's beginning to really take off: . It's an online collection of multiple-choice medical education quizzes to help students study for their exams, and it's gained a lot of positive feedback so far. "The obvious benefit is that it gives you practice questions that you can use as a measure of your learning. The less obvious thing is that writing a good exam question takes considerable depth of knowledge. It’s actually quite difficult to write a decent exam question, so if students are putting questions together, then that’s real depth learning. It means that they have to know the material pretty well,” Dr David Rayner, the school's associate dean of undergraduate medical education, . “Really, the sky’s the limit in terms of where Daniel wants to take QuizMD... There are a lot of different types of online learning resources that could be incorporated into that. It has a lot of potential to be an amazing learning tool for medical students," said U of Alberta Medical Students' Association president Aaron Knox. Mr Kozan has big dreams: “I would really like to see it become the Wikipedia of practice exam questions, but along with that, I want to make it a legitimate medical resource.”

The med student behind My MD Journey waxes interrogative in . Among other things, he bemoans "the extremely low revenues" to be had from Google Adsense ads and wonders if you're all doing as badly as him. He also asks fellow bloggers whether he should reveal his secret blogging identity: "What should I do? continue blogging anonymously or just go public?"

John Sharp of the blog eHealth recently to Steve Case, whom you may remember from his days as the CEO of American Online. They talked about what features have contributed to Revolution Health's success , as well as a forthcoming initiative called "Mom Advocacy." No details on the project, unfortunately.

"Docs: At some point it will be 'evolve or die.' Phrased in kindler, gentler language, that’s ‘adapt or become obsolete.’" This comes courtesy of Jen McCabe Gorman and her Health Management Rx blog as part of a response to our fellow Canadian Ian Furst's (of ) comments on an earlier about the limitations of EMR. Sceptical as he is about the technology, he insists that it's coming, whether we like it or not. "That point may be 20 years off, it may be 50, or it may be 2, but it is coming. Here’s how I think it’ll progress - you won’t be able to get paid if you haven’t evolved to daily use of an integrated EMR/EHR/PHR system."

West Virginian health lawyer Bob Coffield about the nexus of healthcare and online social media, on his Health Care Law Blog. The report, called "," was written by a health economist from California (PDF). Mr Coffield summarizes: "Online health care is moving from one based on "health information retrieval" to patients and providers generating and sharing content online. This growing online collaboration is leading to unique approaches to care and a larger value proposition of harnessing the collective wisdom for other purposes including -- coordination of care, clinical insight, higher quality, prevention, etc. In the end, this may even lead to more cost efficient care." Also, see if you can decipher the deeper meaning of a link to a one-sentence entry about some sort of Pong and Nintendo Wii analogy... Also, the author of the report blogged about it .


The next edition of Medicine 2.0 will be hosted by on May 18. To read previous editions, check out the carnival's homepage .


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