Monthly Archives: July 2010

Interview with Jennifer Hawkins from Medpedia

I had a very interesting interview with Jennifer Hawkins, a community manager at Medpedia who was able to discuss some of the very useful features of Medpedia.

JM: thanks for joining me today for this interview, can you start by saying a bit about your background?

JEH: Surely. I am a Community Manager at Medpedia. Graduated from Georgetown with the intent of going into some kind of public health field and stumbled upon Medpedia, based in downtown San Francisco. The site launched in February 2009, and I joined the team about a year ago, so I have seen it though many different stages.I joined the team because I truly believe in the mission — elevating high-quality medical and health information and making it freely available to the general public as well as to medical professionals. I love that the site is ad-free (unlike most other medical websites out there) and the integrity of the content is maintained because we have rather strict requirements for becoming a Medpedia Editor.

JM: Yes I agree there are a lot of great qualities in Medpedia. Can you tell us a bit more about how you stumbled into Medpedia?

JEH: I had been working in Peru for a non-profit  running sports programs for young girls in the Cusco region. The mission was to create a healthy, safe, and empowering environment for young girls to exercise and play sports. Upon return from Peru, I moved to San Francisco, a place I always wanted to live. I started looking for work with a company that I was passionate about and found an ad for this position on Craigslist. I had a couple interviews, and started right away. I’m delighted to work here and am happy to come to work every day.

JM: That’s a great story.

JM: Medpedia’s founder has had a lot of success in the commercial sector. Can you tell us, is Medpedia a commercial or non-profit organisation?

JEH: Medpedia.com Inc. is funded and maintained by Ooga Labs, a technology greenhouse in San Francisco developing several for-profit, mission-oriented companies to address worldwide needs in health, education, and activism.

JM: Ok. Thanks. Why was the emphasis on a for-profit rather than non-profit organisation and how is revenue generated?

JEH: Medpedia is a for-profit venture, and that was done by design. We didn’t want to have be raising money every few months instead of focusing on the product. Right now, we are funded by Ooga Labs and we can keep going for several years. The core platform of Medpedia will always be free and we are very committed to that. In the future, we may build custom services (like LinkedIn does), for organizations that request it. We do not not take any advertisements and do not want to be influenced by any pharmaceutical and/or tobacco companies, etc. That’s why Medpedia is build on a foundation of transparency, where everyone has a profile and all the activity is visible.

JM: So essentially all of the content produced by users of Medpedia will remain open access.

JEH: Yes, exactly.

JM: Will any of that information be sold?

JEH: No, it will not.

JM: How would you say Medpedia is different from Wikipedia in terms of content both in the ideal world and in practice?

JEH: Here’s a really thorough outline of the answer to that question: .  To add to that, Wikipedia only includes encyclopedic entries, and anyone can edit including anonymous people. On Medpedia, each contributor must have a profile with their real name and background. We also include many other content types including case studies, clinical trials, how-tos, etc.

JM: These other features are very interesting. I get the sense from Medpedia that the community is integral.

JEH: Yes, absolutely. There’s so much more to this project than just the wiki articles. There are also communities, group pages for organizations, profiles, etc.

JM: So one of the features is the ability for people to present questions and get answers from specialists

JEH: Yes, that is Medpedia Answers. It is a very popular feature on the site. It’s an easy way for people to contribute to the knowledge base, even if they are not yet comfortable editing the wiki.

JM: What features on Medpedia are proving to be the most popular with patients and with practitioners? Can you talk us through some of these features?

JEH: In addition to Medpedia Answers, Medpedia Communities are popular spaces for medical professionals, patients, caregivers, and anyone with a common health interest to share information, join discussions, and collaborate inside Medpedia. In the Medical Ethics Community, for example, we’ve had some really interesting discussions that you can see here. Our users have created communities around many diverse topics — Breast Cancer, Clinical Informatics, and Psychiatry, to name a few.  Within communities people can also discover other popular resources on Medpedia like related Clinical Trials or Medpedia News & Analysis which helps people find high-quality news sources and blogs organized by topic.

JM: So communities in Medpedia offer a place for groups to meet and exchange information. One of these communities has been created in conjunction with RARE, an organisation focusing on rare diseases. Can you say a little bit more about this?

JEH: RareSpace is an online knowledge sharing platform around rare childhood diseases (which affect 22.5 million American families). Designed in partnership with the R.A.R.E. Project and the Children’s Rare Disease Network, RareSpace provides a platform to advance research and share information on these diseases on Medpedia.  Parents, physicians, researchers, advocates and others interested in rare diseases are encouraged to participate in discussions and share information about genetic diseases, innovations in research, and standards of care. Medical professionals in RareSpace will answer questions about treatment, best practices, and how to best help these children and their families. Anyone with an interest in rare diseases is invited to join at http://www.medpedia.com/communities/274-RareSpace.

JM: Also just to clarify. If a group of people with a medical interest wanted to get together, how does Medpedia facilitate this and  how easy is it to set up a group in practice?

JEH: Communities are user-generated, meaning Medpedia users typically create the communities themselves.  It is very easy to create a community — simply create a professional Medpedia profile for yourself, then fill out a few fields describing the community you’d like to create (see screenshot).  Once a community is created, it is open for any other Medpedia user to join.

JM: If you set up a community can you link it in with other social media forums such as Twitter and facebook?

JEH:
Right now, you can add a badge to your blog or website featuring a Medpedia Community of which you are a member.  You can also see relevant Twitter feeds in select communities under the “Alerts” tab (see the RareSpace community as an example ).  You can see a comprehensive list of the various twitter channels in Medpedia Alerts.  We currently have a Facebook page but no integration from Medpedia  to facebook as of yet.

JM: I was reading on the site that over 100 organisations have contributed to the content. That’s an impressive number. Is this is an indication of how popular Medpedia is already?

JEH: Absolutely.  Lots of organizations have put tremendous effort into creating health-related content to educate the public.  Many have chosen to donate this content to the Medpedia platform in order to increase the visibility and reach of their content and their organization.

JM: Are there any plans to tie in with excellent resources like Schizophrenia forum and Alzforum?

JEH: Not officially, but users of the Medpedia platform are encouraged to discuss and share various resources like these.  If integration is something our users really want, we would absolutely be open to discussing it!

JM: One useful resource I’ve come across is Neurolex which is an effort to create a standardised language for use in the neurosciences. One thing I’ve found tricky is trying to incorporate the links into my own articles. Is there any way that Medpedia could cross-link with this resource?

JEH: That sounds like a very interesting resource!  We currently do not have cross-linking capability with this resource, but it is something we are always open to discussing.

JM: Are there any plans for a connection with Wikipedia? Can there be a useful collaboration between the two while still maintaining the strict boundaries around content generation on Wikipedia?

JEH: Currently, there are no plans to do so.  As I mentioned, Medpedia is a multi-functional platform and Wikipedia is strictly an encyclopedia.  In addition, I believe that less than 2% of Wikipedia’s content is about health/medicine and it is written by unknown/unverified contributors, thus making collaboration difficult.  That being said, our beliefs in open access to information and the power of collaboration are very much shared by both Medpedia and Wikipedia.

My Conflict of Interest

I am a volunteering member of the Medpedia community and this blog is listed on Medpedia’s site.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained.
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Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period.
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Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk.
Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Review: Persistence and Compliance to Antidepressant Treatment in Patients with Depression

The paper reviewed here is from the open-access journal BMC Psychiatry – and is titled  ‘Persistence and Compliance to Antidepressant Treatment in Patients with Depression: A Chart Review’ by Norifusa Sawada and colleagues and freely available here. In the introduction, the authors characterise adherence to medication as consisting of both persistence in taking treatment and compliance in following the instructions for taking the medication. They set out to investigate these two components and suggest from their examination of the literature that both components have seldom been examined. The study design was very simple and could be relatively easily reproduced by other interested groups. The researchers focused on people with depression who had been referred to a hospital clinician for treatment. There were a few exclusion criteria. For instance the researchers didn’t include people with comorbid mental illnesses as that would complicate the picture. They are primarily interested in adherence to medication in people with depression and as we see in the results section, this pays off. They look back retrospectively through the casenotes. This can be a source of bias particularly if you’ve got a very nice hypothesis that you want to test. I think it’s difficult to comment on this type of bias though just from reading the paper. In order to measure the components of adherence, the researchers have created quantitative proxy markers – medication possession rate (MPR) being one. The MPR is the ratio of number of days of medication divided by duration of treatment prescription is intended for. I was slightly confused by this figure because I thought it was determined primarily by what the doctor had prescribed and the date of the next clinic appointment both of which seem to be features of the medical system rather than the patient. However I assume that the patient has some degree of control over the date of the next appointment.

There were lots of interesting findings. For the primary outcome measures though the reader is referred to Tables 1-4 (Table 2 is reproduced in part below). The persistence rates for medication drop off quite sharply in the first month and are then halved again in some cases by the third month. The stratification according to age and gender also provide interesting results and I wonder if there is a story here to be investigated in further studies. Table 2 shows the persistence levels across antidepressants. What I found really interesting here is that in the Japanese study they most commonly used Sulpiride as a licensed antidepressant. In the table below you can see that they’ve used Sulpiride as a reference point for comparison with the other antidepressants. Sertraline comes out with the highest persistence rates compared to Sulpiride and this result is both clinically and statistically significant and this reminded me of another study which was looking at tolerability and efficacy.

In their conclusions though, the authors do advise caution

However, these preliminary results should be interpreted with caution since we did not directly evaluate therapeutic and adverse effects of these medications in this study. In fact, the finding of varying persistence rates across medications could reflect confounding by the provider effect, and sertraline is the newest antidepressant that became available in 2006 in Japan

These comments got me thinking. Can we generalise from one culture or medical service to another. There are many factors that vary between cultures including diet, other aspects of lifestyle, role of the doctor and so on and yet many drug trials or research in other areas are included in meta-analyses on which further inferences are drawn. Maybe one useful approach would be to examine local differences in efficacy using this paradigm in order to test the appropriateness of generalisability. It may turn out that there are some interventions where the results are generalisable and others which are not.  Returning to the issue of retrospective bias, I would argue that this approach can be useful in identifying hypotheses for further testing using other approaches (e.g the RCT) so that even if there is bias it will most likely get uncovered when a more rigorous follow-up study methodology is used.

In terms of the compliance rates – the researchers used a cut-off threshold of 0.8 for the MPR for compliance and surprisingly the average score for all antidepressants is below this cut-off point. They respond by stating that even though the average is below this figure, some 55% of subjects scored at or above this level. In conclusion I thought the results were quite profound. The authors refer to schizophrenia and the emphasis that has been placed on ensuring compliance to aid recovery. The message here in this paper though is that the same emphasis needs to be placed on the treatment of depression. In summary, the researchers have produced a very simple study, easily reproduced with important results and a clear message – address adherence in depression. It will be interesting to see the follow-up studies in this area.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained.
Index: An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order.
Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link.
Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period.
TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link.
Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk.
Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

News Round-up: July 2010 4th Edition



In the news roundup this week Professor Rawlins from the Huntington’s Disease Association cites referral rates to the organisation as evidence that the prevalence of Huntington’s Disease in the UK is at least twice that of previous estimates. The PREDICT-HD study which follows up people with Huntington’s Disease has provided evidence that mild cognitive impairment can feature in the prodromal phase of the illness although the significance is not yet clear. There’s also a very small study which suggests that the risk of stroke in relation to alcohol consumption changes over the course of hours and days after consumption. However the sample size in this study was small and larger replication studies are needed before any firm conclusions can be drawn. There is also a remarkable story of a 100-year old doctor – an Obstetrician and Gygnaecologist – still doing the rounds!  Palaeoanthropologist Pat Shipman has come up with a very elegant hypothesis about human evolution in which she suggests that over 1.6 million years it has been our ability to care for other species that has played a vital role in our adaptation to different environments. This comes at the time of another find of an early dog specimen – from 14,000 years ago – although the domestication of dogs has a complex history with older specimens being discovered previously.

  1. Small study suggests apathy and depression associated with impaired memory and attention in MS http://bit.ly/bLd9N5
  2. Meta-analysis shows white matter integrity differences in Mild Cognitive Impairment and Alzheimer’s Disease – sub reqd http://bit.ly/agjMqb
  3. PREDICT-HD study suggests mild cognitive impairment is a valid part of the prodromal phase in Huntingtons Disease http://bit.ly/9GKAM7
  4. Rudeness at work and mistakes http://bit.ly/d8Kt7V
  5. Study suggesting people with dementia over age of 75 at risk of poor dental health http://bit.ly/96pdf8
  6. Study (n=312) suggests relationship between MRI findings and longitudinal cog function http://bit.ly/agVb2w
  7. Subscription needed – the LADIS study – white matter changes and CVA assoc with VaD and MTA with AD http://bit.ly/9FwLXt
  8. Another study suggests head circumference mitigates against cognitive decline even with cerebral atrophy http://bit.ly/b0aqVs
  9. Alzheimer’s Disease – desktop vs bedside diagnosis in the future? http://bit.ly/b69Q7D
  10. Small study which needs replication but suggests stroke risk may change for certain periods after alcohol consumption http://bit.ly/audCcC
  11. Apathy and depression associated with change from MCI to AD and LBD in one study http://bit.ly/9OfuDr
  12. Virtual universe support structural balance theory on human interactions http://bit.ly/cVaQ0h
  13. SIRT1 linked to cleavage of amyloid precursor protein http://bit.ly/aE3hvv
  14. Huntington’s Disease prevalence underestimated – recent study http://bit.ly/cqvZsQ
  15. Automated analysis of 3 million vocal utterances can help in language development research http://bit.ly/9i1P2g
  16. Report on study suggesting emotional response can be reduced in AD http://bit.ly/9XeXhV
  17. Analysing auditory information – possibly brain similarities between humans and chickens http://bit.ly/aoTPvq

Psychiatry 2.0

Twitter Round-Up

Here are my favourites from other people on Twitter

  1. markusdahlem soon 10 000 views — my Migraine aura simulation on Youtube http://youtu.be/XLJ00o-vmh0
  2. uyosemite Dementia: When Pneumonia Follows Severe Dementia – The New Old Age Blog … http://bit.ly/c3I0iP
  3. mariapage Interesting post: RT @sandygautam New Mouse Trap post Cognitive control: when less is more! http://goo.gl/fb/yS7Jy
  4. mariapage My “rostral PFC” search led me to this: “Neural substrates of irony comprehension: A functional MRI study” ( http://bit.ly/bMxTdv )
  5. mariapage “Prospective and retrospective memory in Alzheimer’s disease and vascular dementia: Similar patterns of impairment” ( http://bit.ly/cXPOMY )
  6. mariapage RT @researchblogs Disease as a byproduct of adaptation http://goo.gl/fb/6Wd42
  7. mariapage Interesting: RT @boraz #PLoS ONE: Learning in Autism: Implicitly Superb http://bit.ly/a9HISs
  8. ScienceNews24 Every dog has its day, but that day took more than 14,000 years to dawn for one canine. A jaw fragment found in… http://zmarter.com/817566
  9. sciencedaily Scientists confirm role for mysterious cell component — the nucleolinus: Scientists have confirmed the role in ce… http://bit.ly/a7MrRc
  10. CNSSpectrumsTo find every CNS Spectrums article from 2006, please visit — http://ow.ly/2fbsu
  11. CNSSpectrumsTo find every CNS Spectrums article from 2005, please visit — http://ow.ly/2fbrt
  12. scireltodayAre We Born With Brains Like Those of Apes? Jason Hill answers: http://bit.ly/a59EPn
  13. LabSpacesStudy links more time spent sitting to higher risk of death – http://is.gd/dCldN
  14. TechZader: RT @Mashable: Social Media Use in the Workplace on the Rise [STATS] http://bit.ly/9qPLXZ
  15. EvoMRI: Liked “Big Blog Theory Finalist: please vote” http://ff.im/nBrwu
  16. psydir: Apathy and depression predict progression from mild cognitive impairment http://goo.gl/fb/gosOw
  17. MDLinxMore than half the worlds population gets insufficient vitamin D: ScienceDaily http://bit.ly/cvG6bb
  18. noahWGPaint huffing hallucinations differ based on hue: http://bit.ly/btGgUn /via @mindhacksblog
  19. FasTakeWeaving Social Throughout Your Organization http://om.ly/ooSz
  20. BoraZExclusive first look at “revolutionary” social news iPad app: Flipboard — @Scobleizer http://bit.ly/aUKF8h
  21. BoraZAutism Science Federation’s YouTube Channel http://bit.ly/a0MYNb
  22. on Fluent News u need 2 click thru – oldest human remains in america suggest southeast asian origin RT @ScienceNews24: A scientific… http://bit.ly/9bMmyZ
  23. psydir Supportive Sibling Relationships: The Essential Ingredients http://goo.gl/fb/23cEk
  24. ScienceNews24 As physician-guided robots routinely operate on patients at most major hospitals, the next generation robot cou… http://zmarter.com/801119
  25. vaughanbell Why Do We Cry? Eight Half-Baked Ideas. http://is.gd/dzMvg by @Mark_Changizi
  26. rcpsych New podcast: Listen to Dr Louise Howard discussing her BJPsych paper on the effectiveness of supported employment http://bit.ly/9Trd1Z
  27. psych101 Jul 24, Psychology Research Participants http://goo.gl/fb/b81kf
  28. pdmstrong Mindfulness Meditation Therapy: YOUTUBE VIDEO CLIPS http://goo.gl/b/CF8O
  29. TechZader Open Source Collaboration Platform – TeamLab http://bit.ly/cGc2uJ
  30. BoraZTiny DNA circuits offer high speed – http://bit.ly/dw1WvV
  31. RT @drhenslin: Working Memory Capacity Reflected In Musical Skill, Practice Time http://bit.ly/dq0y4T
  32. Psydir 2010-07-23 Spike activity http://goo.gl/fb/HktaR



Human Evolution/Origins of Civilisation

  1. Team undertaking 3-d analysis of 1.5 million year old footprints probably Homo Erectus
  2. 2nd 4000 year old figurine from Orkneys discovered
  3. 200,000 year old stone ‘knives’ found in Israel
  4. Extinct but interesting monkey species found in underwater carribean dive
  5. Wooden henge near stonehenge – big discovery
  6. New theory of human evolution involving caring relationship for other species
  7. Google funds 1 yr project to open out ancient texts online

Resources

  1. Rv of studies on antioxidants and cognitive decline http://bit.ly/a2F4rH
  2. RCT of tx of behavioural problems in LBD http://bit.ly/8YWG8Y
  3. Study investigating EMF exposure in Swedish twins and dementia risk http://bit.ly/9SkeAl
  4. Case study of SSRI, donepezil and hippocampal volume http://bit.ly/cU8okO
  5. Open access – pathology of medial temporal lobe epilepsy http://bit.ly/aGUtnL
  6. Subscription review article on MRI in PD http://bit.ly/aa14AS
  7. Subscription review article on vascular risk factors and dementia http://bit.ly/dkvhxC
  8. Study investigating characteristics of dementia with and without diabetes http://bit.ly/99iTSF
  9. “Public Sensationalism and Clinical Trials: How to Address the Challenges of Science?” ( http://bit.ly/dz1ra2 )
  10. Study investigates LDL range in men in relation to depression and cardiovascular disease http://bit.ly/cHLBqe
  11. APOE4 and susceptibility to Alzheimer’s Disease in the Indian population (open access) http://bit.ly/b542pj
  12. Proteome analysis of Wernicke’s area in pple with schizophrenia (open access) http://bit.ly/9pRcsc
  13. Epidemiology of depression stigma in an Albertan population (open access) http://bit.ly/c1TQNW
  14. Tool for assessment of medically unexplained symptoms (open access) http://bit.ly/dfJoAQ
  15. Case report of Brazilian lady with Down syndrome and depression (open access) http://bit.ly/ddb5Su

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained.
Index: An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order.
Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link.
Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period.
TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link.
Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk.
Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.