Dr Shock MD PhD

Sunday, May 4, 2008

Goodbeye Gadgets,Hello Moleskine

Gadgets are nice, but are they worth all the trouble? Syncing, updating, charging, bloated software, to many features? Or should we go back to good old easy and fast notebooks of paper? Let me know in the comments.

Goodbye gadgets

After years spent tracking the latest gadget trends, handing over my credit card for a PDA upgrade every 4-6 months, and receiving odd glances in public for reading The Gawkish Geek’s Guide to Gadgets (monthly), I gave up my fancy gizmos and electronic organisers for good.
Hello Moleskine

In recognition of the intense effort it takes for a self-confessed gadget geek to drop his ‘habit’, I hope you won’t mind when I admit to replacing it with another: the love of Moleskine notebooks. These simple notebooks are both beautiful and relatively gentle on the wallet.

Moleskine Notebooks: The Ultimate Guide

Thanks Lifehacker.com

What Color is Your Mind

My Mind is Green
Of all the mind types, yours has the most balance.
You are able to see all sides to most problems and are a good problem solver.
You need time to work out your thoughts, but you don't get stuck in bad thinking patterns.
You tend to spend a lot of time thinking about the future, philosophy, and relationships (both personal and intellectual).

What Color Is Your Mind?

Thanks Dr Deb

Made It Into A Grand Round: Smack Down

Dr Shock appears in a grand round at Doc Gurley.

This week here at Doc Gurley is the Grand Rounds Smack Down edition, where the best contenders of the health care blogosphere wrestle down and dirty with tough, scary topics. Just like being in the ring, there’s no orderly progression of characters here – this ain’t ballet, folks. At any moment, something huge and impressive could come flying out of left field and hit you (ka-pow!) right between the eyes! There’s no first, no last – we’re here to entertain (and take out a few bad guys while we’re at it). We’ve got a lot of contestants, oops, I mean, submissions, vaulting into the ring. One thing’s for sure - if you hang with it to the end of this week’s match, right up to the point when the lights dim in the arena, you’ll be entertained.

And it is a Grand Round very well done, it covers all the best medblogs out there, go read it

Saturday, May 3, 2008

Genes Predict Reponse to Lithium Addition for Treatment Resistant Depression

Genotyping the serotonin transporter gene polymorphism could be a tool for predicting response to a certain treatment pathway. Patients with the s/s genotype who according to the literature seem to be at risk for a less favorable response to antidepressant monotherapy might particularly benefit from augmentation strategies.

Thus, early lithium augmentation in these patients (with the s/s genotype) could be a promising strategy and might help to reduce the occurrence of treatment resistance in depressive disorders.

There is evidence of interaction between a functional genetic variant in the serotonin transporter gene and life events.

Serotonin is an important neurotransmitter believed to play an important role in depression. The variant of this gene affects how much serotonin transporter protein is produced. This protein is involved in reuptake of serotonin in the synaps. Individuals with the short allelic form of this variant showed an increased risk of depression compared to those carrying the long allele but only when exposed to adverse life events or maltreatment. There have been some nonreplications, but these have been outnumbered by the number of replicated findings.

Moreover having the two short alleles of this serotonin transporter gene (s/s) results in poorer response to an antidepressant. According to this new research two short alleles also predict a better response to lithium addition if the antidepressant fails.

Although the definition of treatment resistant depression is not always clear, there are several options for treatment resistant depression resulting in 9 possible steps for treatment resistant depression. I am convinced that especially lithium addition is a very effective treatment strategy if an antidepressant fails and should be preferred above more experimental addition strategies such as atypical antipsychotics. Lithium addition can result in a response rate up to 50% in treatment resistant depression and has been studied in many RCT's, reviews and meta analysis.

In this published research patients had not responded to several antidepressants during an average of 32 days (SD 12.9):14 patients (30%) received tricyclic antidepressants, 15 patients (30%) SSRI, 15 patients (30%) venlafaxine, two patients (4%) atypical antidepressants (trazodone, nefazodone), one patient (2%) mirtazapine, another patient (2%) tranylcypromine and two patients (4%) antidepressant combination therapies (trimipramine plus paroxetine; amitriptyline plus tranylcypromine).

That brings us immediately to the limitations of this study. The heterogeneity of the preceding antidepressant treatment and the short duration of antidepressant pretreatment. This short duration might not be sufficient to declare nonresponse to an antidepressive trial.

So next time a more homogenous patient sample with evident and clear definition of treatment resistant depression.

Results
In the Cox regression survival analysis, three factors remained as contributors to remission during the observation period: the 5-HTTLPR genotype, the diagnosis of a unipolar/bipolar depression and the existence of psychotic features, but only the 5-HTTLPR genotype reached statistical significance.

The gene coding for the serotonin transporter (5-HTT) has been located on chromosome 17q11.2. A polymorphic region (5-HTTLPR) has been identified upstream of the transcription starting point. It generally consists of either 14 or 16 repeated elements generating a long (l) or a short (s) allele. The s-allele is associated with lower gene expression activity in vitro. This genotype has been connected with the pathogenesis of affective disorders and suicidal behaviour and might be an interesting model for a genotype–environment relationship.

Besides these finding on the serotonin transporter gene,patients with a TRD had a larger number of risk genotypes than treatment responders, who in turn had a greater number of risk genotypes than the healthy controls. This finding supports a model in which the additive small effects of multile risk genes explain depression and treatment resistance

Stamm, T.J. (2008). Serotonin transporter gene and response to lithium augmentation in depression. Psychiatric Genetics, 18(2), 92-97.

Friday, May 2, 2008

Brain Fitness: Use it or Loose it

In this edition of our newsletter we bring a few articles and recent news pieces that shed light on what "Use It or Lose It" means, and why we can start going beyond that to say "Use It and Improve It."

On Sharp Brains

Picture from Sharp Brains

Deep Brain Stimulation for Treatment Resistant Depression

When other treatments fail, deep-brain stimulation (DBS) may offer hope to patients suffering from chronic and severe depression, according to a study presented here at the 76th Annual Meeting of the American Association of Neurological Surgeons (AANS).

On Doctor's Guide

Healthy Games

I like computer games, it keeps my mind of things, help me relax. It is suggested that in order to keep the brain fit as we age it is important to keep it stimulated. Use it or lose it applies to the mind as well as the muscles. It is also suggested recently that it may be possible to train people to be more intelligent, increasing the brainpower they had at birth.
Therefore these fun interactive anti-aging online memory games. To make your brain sweat. There is some advertising but Firefox captured just one pop-up. My favorite: Secret Files.

Or try Five Free Fun Games When Bored, my favorite: Mario Tetris

Thursday, May 1, 2008

Short-term Chocolate Effects on Health

In a placebo controlled trial of 6 weeks duration the consumption of dark chocolate had no beneficial effects on neuropsychological (e.g. memory, concentration) or cardiovascular (e.g. blood pressure, lipid levels) health related variables.

At least not when your healthy, well educated and above 60 (see the limitations).

Chocolate and cocoa products may promote cardiovascular and neurocognitive health and provide cardioprotective effects:

chocolate and cocoa-related products have been shown to decrease or inhibit both LDL oxidation and platelet activation or function

to enhance serum lipid profiles

to lower blood pressure

to promote vascular relaxation or dilation

to inhibit free radicals

cocoa flavanols or procyanidins may possess immunoregulatory effects and may help to modulate immune responses

flavanol-rich cocoa can increase cerebral blood flow in healthy elderly subjects, as measured by transcranial Doppler ultrasound

What they did was select a sample of healthy adults above 60 yers of age (see the figure above). And they were extremely healthy. They had to stop eating regular chocolate at least a week before the trial. They used flavanoid- and procyanidin-rich dark chocolate bars and artificial sweetened cocoa beverage, as well as low-polyphenol placebos of identical taste and appearance.

The findings from this double-blind, placebo-controlled, randomized, clinical trial failed to support the predicted beneficial effects of short-term (6 wk) consumption of dark chocolate and cocoa on any of the neuropsychological, hematologic, or physiologic variables included in the investigation. The null neuropsychological and mental energy findings were in contrast to past research involving laboratory animals and humans that has shown the beneficial neuronal, neurocognitive, and neuroprotective effects of herbal compounds that are rich in antioxidants and phytochemicals.

Well this as a shock to me, so let's look at the limitations of this study.
Limitations:

They surely used a to short period for their results, 6 weeks of chocolate is nothing

The relatively high mean levels of education (>15 y) of subjects in this study may have negatively affected the results. Specifically, higher levels of education, as compared with lower levels, have been associated with greater cognitive reserve and enhanced neuropsychological test performances.

They used a sample of healthy participants whose mean baseline serum HDL- and VLDL cholesterol, triacylglycerol, and ultrasensitive CRP concentrations fell within the "normal" reference ranges. Thus, it is possible that participants' baseline hematologic values were not elevated (or abnormal) to the degree necessary for the effects of short-term dark chocolate and cocoa to be observed

The sample size of the current trial may not have been of sufficient magnitude

The low quantity of dark chocolate and cocoa products consumed by participants in the present trial also may have contributed to the overall null findings

Since the participants were so healthy it is possible that participants from both treatment groups continued to consume a diversity of other fruit and vegetables containing antioxidants or phytochemicals (or both), which may have confounded the current results to some extent

So I welcome their suggestion for future research.

Also needed are longitudinal trials that involve the consumption of dark chocolate and cocoa over extended periods (ie, several months to ≥1 y) and that result in the consumption of larger quantities of such products, which will likely promote more potent antioxidant and phytochemical effects.

Moreover participants of all kinds of health status should be included.

Related posts on this blog.

Crews, D.W. (2008). A double-blind, placebo-controlled, randomized trial of the effects of dark chocolate and cocoa on variables associated with neuropsychological functioning and cardiovascular health: clinical findings from a sample of healthy, cognitively intact older adults.. American Journal of Clinical Nutrition, 87(4), 872-880.

Chocolate and Diabetes, New Research

Scientists are to investigate whether eating chocolate can reduce the risk of heart disease in women with diabetes.

Volunteers - postmenopausal women with type 2 diabetes - will be asked to eat a bar of chocolate a day for a year.

Cocoa is rich in compounds called flavonoids, which are thought to benefit the heart.

The University of East Anglia is using a specially formulated form of chocolate which contains more flavonoids than usual. The scientists are testing the theory that adding flavonoids to the diet may give added protection against heart disease on top of that provided by prescription drugs.

Deaths due to heart disease among women increase rapidly after the menopause and having type 2 diabetes increases this risk by a further three-and-a-half times.

If the trial confirms the hypothesis then it could have a far-reaching impact on the advice given to at-risk women.

On BBC News and CNN

Wednesday, April 30, 2008

Alzheimer Severity and Prevalence of Depression Not Associated

Comorbid depressive symptomatology or diagnosed depression is not more prevalent in early, mild or severe Alzheimer's disease. This is an important conclusion from a recent systematic review. Before theories existed about the relationship between Alzheimer's and depression. These theories said that the prevalence of depression either decreases or increases with the increasing severity of Alzheimer's disease.

This is comparable to the relationship between depression and personality, does personality predispose to depression or is personality affected by going through depression.

Previous reviews stated that no conclusions could be drawn due to large differences between studies. This review tried to overcome this problem.
They made sure all studies consisted of patients with Alzheimer, valid assessments of depression and severity of Alzheimer were performed.

Instead of a linear correlation between Alzheimer's disease and depression this result could be explained by a theory that neurological and psychosocial factors can reinforce or diminish each other, depending on the specific situation of a patient.

The real answer can only come from a longitudinal study with Alzheimer patients.

Some news about the relation between depression and Alzheimer on NYT:

A history of depression is associated with an increased risk for Alzheimer’s disease, a new study has found, especially when the depression develops before age 60.

Verkaik, R., Nuyen, J., Schellevis, F., Francke, A. (2007). The relationship between severity of Alzheimer's disease and prevalence of comorbid depressive symptoms and depression: a systematic review. International Journal of Geriatric Psychiatry, 22(11), 1063-1086. DOI: 10.1002/gps.1809

Tuesday, April 29, 2008

Personality of Online Game Players

Online game players score higher in openness, conscientiousness and extraversion compared to non players. They are eager to learn and master new challenges, they are motivated by competition and they enjoy social activities which can all be provided by online game playing.

The online game playing provides them with initial experiences of success and then provide them with more complex challenges creating a flow of immersed experience further satisfying their needs. This creates a positive spiral enhancing their online game experience.

Chin-I Teng the author of this articles says:"I also believe that skill of players matters in player intention to continuously play online games." Not only personality but also skills such as visuospatial memory,speed of reaction, problem solving skills play an important role.

Participants played various online games, including international popular games such as Warcraft3, Lineage2,Crazyracing, Rich Online, and Nostale.

Eight hundred three Taiwanese students were approached in high schools and universities, and 591 questionnaires were collected, producing an effective return ratio of 74%. The matched sample comprised 130 pairs of students, which was used for analysis. The two students in each pair were matched by gender and age because players and nonplayers were found significantly different in gender and age. A matched sample was used to minimize the confounding effects of gender and age. Seventy-one percent of participants were male, and all were between 12 and 22 years of age (Mean 16.06). Of the participants, 89% had a monthly income below U.S. $180,while 98% had access to a computer at home, reflecting the Taiwanese student population.

I wasn't sure about the design so I emailed the author and he confirmed that from the 591 students 130 pairs were formed matched for age and sexe consisting of an online gamer and someone not playing online games. The author:"Yes, each pair consist of a online game player and a non online game player."

The researchers used a scale to measure openness, conscientiousness and extracersion, the so called Mini-Marker scale of Saucier

This scale determines varying levels of introversion and extraversion. Along with introversion and extraversion the inventory also measures openness, conscientiousness, agreeableness, and neuroticism. The mini-marker asks participants to rate themselves according to 40 different measures (e.g. creative, extraverted, philosophical, and sloppy) using a Likert scale from 1 to 9, with 1 being extremely inaccurate and 9being extremely accurate. Although the mini-marker is a shortened version (about half the personality measures) of the NEO-5 factor, Saucier (1994) determined that it was representative of the full 100 trait NEO-5 factor inventory. The mini-marker was developed on behalf of many people who appreciated the fact that it was shorter and more efficient; however, Saucier (1994) stresses that because of the smaller version it may create lower reliabilities.

Online game players and non players didn't differ in agreeableness and neuroticism.

According to the authors this research shed some light on online game playing and personality, their suggestion for further research is to investigate personality to different online games.

The limitation of this study is the selection of personality traits, the change of finding what you are looking for is relatively large with this design. The selection of participants is relatively selective, students just aren't the average kid in the Internet cafe around the corner. These results can not be generalized to larger populations.So this research has some limitations nevertheless I like the outcome it counter balances all the negative publicity around internet addiction and game addiction.To my opinion these are just other disguises of the same problem and not a reason to hamper new developments such as Internet and gaming since this would lead to throw the baby out with the bath water.

Teng, C. (2008). Personality Differences between Online Game Players and Nonplayers in a Student Sample. CyberPsychology & Behavior, 11(2), 232-234. DOI: 10.1089/cpb.2007.0064

Monday, April 28, 2008

Computer Based Psychotherapy

Patients often improve more with computer based cognitive-behavioral psychotherapy than with conditions such as waiting list control or care as usual, says a recent review. This is coupled with an over 50% cut in usual therapist time. This review is published in a book: Hands-on Help Computer-aided Psychotherapy. A book review in the Am. J. Psychiatry

Hands-on Help is a narrative review of the mushrooming field of computer-aided psychotherapy for mental health problems as a whole, from the time it began in the 1960's through to the present day. The many types of computer-aided psychotherapy and how each might be accessed are detailed together with the pros and cons of such help and the functions it can serve. The authors review prevention as well as treatment.

Such a therapy for depression in the UK is called: Beating the Blues

Beating the Blues® is a computerised cognitive behavioural therapy (CCBT) program for depression and anxiety that is available via CD-ROM and the Internet. It has been shown to be a cost effective and time efficient way of helping people suffering from these conditions to get better and stay better. In Feb 2006 the National Institute of Health and Clinical Excellence (NICE) recommended Beating the Blues® as a treatment option for all people seen with mild or moderate depression.

Cognitive-behavioral psychotherapy is a form of psychotherapy that lends it self well for a computer based program. Computer based forms of Psychoanalytic Psychotherapy are far more complicated to my opinion. We recently discussed using a blog during psychodynamic psychotherapy, blogtherapy. Based on this review you can conclude that at least some patients may benefit from this kind of therapy. Nevertheless despite a lot of research questions about computer based psychotherapy remain.

As with other new developments healthcare companies are reluctant to pay for this kind of therapy. What should be the price and who do you have to pay. The developer of the program, the therapist working with patient and computer?

How much human contact with the therapist is best? No human contact at all in these programs are associated with large drop out rates.When should human contact be necessary, with intake or followup or during the program for monitoring progress?

How should human contact take place, by telephone, email, face to face?

What should be the background of the therapists? Psychologists trained in cognitive behavioral therapy, trained nurses, general practitioners, trained volunteers?

Most trials with CBT were with care as usual and waiting lists conditions. These trials suffer from a large placebo effect and high expectancy of the participants of the new treatment. Trials with comparison to other therapies are necessary. Knowledge of what works in this kind of psychotherapy is still fragmentary.

Some patients prefer live to computer-guided help. Not all depressions can be treated by computer psychotherapy. Mostly mild to moderate depression can benefit, more severe forms of depression will still need other forms of therapy of which medication is one.

Overall computer aided psychotherapy as an early option in the treatment of depression is opening up new possibilities. It can be a cost-effective treatment that can reduce chronicity and perhaps even prevalence of depression. Will computer-aided psychotherapy integrate smoothly into the palette of therapeutic options? A lot of research and time will tell.

Computer based cognitive-behavioral therapy is not only used in depression but also in other psychiatric conditions such as anxiety disorders, obsessive-compulsive disorders and problem drinking to name a few.

Advantages are:

No lengthy clinician contacts

Reduce waiting lists

No travel to a therapist

No stigma

Self-empowerment

What is Computer aided cognitive-behavioral therapy?

Computer-aided cognitive–behavioural therapy (CCBT) is any computing system that aids cognitive–behavioural therapy by using patient input to make at least some computations and treatment decisions. This definition excludes video conferencing and ordinary telephone and electronic mail consultations, chat rooms and support groups, which expedite communication and overcome the tyranny of distance but do not delegate any treatment tasks to a computer or other electronic device. It excludes, too, the electronic delivery of educational materials and electronic recording of clinical state or behaviour where those allow no more interaction than do paper leaflets and workbooks.

Computer-aided therapy may be delivered on a range of computing devices, such as stand-alone personal computers, internet-linked computers, palmtops and personal digital assistants, telephone interactive voice response systems, gaming machines, CD–ROMs, DVDs, cellphones and virtual reality devices.

This post was inspired by a recent editorial in the British Journal of Psychiatry.

Marks, I.M., Cavanagh, K., Gega, L. (2007). Computer-aided psychotherapy: revolution or bubble?. The British Journal of Psychiatry, 191(6), 471-473. DOI: 10.1192/bjp.bp.107.041152

Sunday, April 27, 2008

6 Sleep Aids Without Pills

Relaxation techniques such as deep breathing, progressive relaxation, and guided imagery help in improving the quality of sleep.

Behavior therapy includes cognitive therapy, stimulus control, and sleep hygiene, which helps in improving sleep.Of these I think sleep hygiene is the most important:Maintaining sleep routine, that is sleep and wake up times should be same every day, engaging in regular exercise workout, avoiding naps in daytime, preventing nicotine and caffeine 3 to 4 hours before bed time and keeping worries out of your bedroom before going to sleep are necessary for getting quality sleep.

Exercise, a sleep aid, not only helps you to sleep better but it also helps you to be alert and effective during day. You shouldn't exercise before you go to sleep. Before going to sleep do relaxation techniques

Hot bath is one of the sleep aids that relax your body. It raises your body temperature, which helps in getting sleep. It is another way to relax. The water shouldn't be to hot.

Diet to promote sleep. No caffeine of alcohol before bed time. Sleep inducing foods are: milk, oatmeal, bananas, almonds and turkey, most of them rich in trypthophan. Don't eat to much, this will keep you awake.

Bright light in the morning to set your internalclock.

From an excellent website about Sleep Disorders

Related posts on this blog:
Better sleep without pills

Saturday, April 26, 2008

Med School is Hell

Regularly I write posts about medical education.Medical education is not alway fun. Female students suffer sexual harassment, during clerkship they sometimes have to stay late, which isn't always such a good idea.
In my time most students dropped out at the first years. Don't know if that is still the case. But how do you prepare your self for choosing med school?
MedSchool Hell has: 101 Things You Wish You Knew Before Starting Medical School.

Some examples:

You won’t be a medical student on the surgery service. You’ll be the retractor bitch.

Residents will probably ask you to retrieve some type of nourishment for them.

Most of your time on rotations will be wasted. Thrown away. Down the drain.

You’ll look forward to the weekend, not so you can relax and have a good time but so you can catch up on studying for the week.

You’ll meet a lot of cool people, many new friends, and maybe your husband or wife.

# If you piss off your intern, he or she can make your life hell. If your intern pisses you off, you can make his or her life hell.

You’ll probably change your specialty of choice at least 4 times.

Very typical but sometimes true.

Messi

This is a serious blog but so is soccer. Man United draws 0-0 at Barcelona. Barcelona, looking for its second Champions League title in three seasons both Lionel Messi and Samuel Eto’o had good chances. This is a video of Lionel Messi, one of the best players today according to Dr Shock. An artist.This rush is often compared with the rush by Maradonna.

Friday, April 25, 2008

Where does creativity come from?

Novelist Amy Tan digs deep into the creative process, journeying through her childhood and family history and into the worlds of physics and chance, looking for hints of where her own creativity comes from. It's a wild ride with a surprise ending.

There is even some neuroscience in this excellent talk.

Thursday, April 24, 2008

Shocking Lightning reaction Handheld

This new portable device brings a shocking experience to your playfull-life. Enjoy this game with your friends, be quick and you won’t be the one who suffers from a tiny electric shock wave.

Each of the four players keep their hands on the base of the device. You push the center button and the music starts to play accompanied with red light flashes. Suddenly, the music stops and the light turns green, and if you’re not quick enough to hit your button you’ll be the one that will receive the electric shock.

Thanks Gizmodo
For English please read here

Cocaine addiction, web based information useless

The quality of information on cocaine addiction on the web is generally poor, confirming previous studies on other health issues. Furthermore, universities seem to be poorly active in proposing websites (8.2%), while commercial organizations hold 55.7% of the studied websites.

This seems a little of topic but for depression the quality of websites for information about depression and it's treatment is also poor. Wouldn't it be nice to have a quality scale for health websites?

The authors used quality indicators. They looked at: quality of content, design and aesthetics of the site, readability, dating of information, authority of source, ease of use, accessibility and disclosure of authors and sponsors.

Health on the Net foundation (HON) has issued a code of conduct for medical sites covering much of the above mentioned and attributes a quality label taking into account the following points: disclosure of authorship, sources, updating of information, disclosure of editorial and publicity policy, as well as confidentiality.

Sites having the HON label scored higher.

The global score seems to be a direct content quality indicator. It could be helpful for people to be informed by this quality indicator. It remains however a complex measure.

Further larger studies on websites, including more sites with the HON label may help to conclude about its usefulness as a content quality indicator.

Another quality measure used was the Silberg measure. This measure used accountability standards (disclosure of authorship, ownership and currency of information). They may be useful indicators of the quality of web health information. These accountability criteria have been widely assumed to reflect web site quality. But it doesn't account for website content.

The third measure used was DISCERN.

DISCERN is a brief questionnaire which provides users with a valid and reliable way of assessing the quality of written information on treatment choices for a health problem. DISCERN can also be used by authors and publishers of information on treatment choices as a guide to the standard which users are entitled to expect.

There is also a quick reference guide to DISCERN

The biggest problem is how to evaluate content. In this study they used the following criteria:

Content quality was examined around the following five points: frequency of cocaine addiction and cocaine abuse; possible somatic, social and psychological complications of cocaine addiction and abuse; cocaine withdrawal; pharmacological treatment options and limitations; motivational and psychotherapeutic treatments. Comparison of information found was done in consensus with field experts (American Psychiatric Association, 2006: Practice guidelines for the treatment of substance use disorders). Coverage and correctness of medical information were evaluated. The coverage of a topic was characterized as “none”, “minimal” and “sufficient” (0–2 points). Correctness of information was characterized as “mostly not”, “mostly” and “completely right” (0–2 points)

They reviewed 120 websites. There was a sensible overlap in the sites identified by the two search engines (Google, Yahoo) and the three keywords: cocaine, cocaine addiction and cocaine dependence (35/120). This left 85 websites. Of these, 24 were excluded for the following reasons: 6 contained no information on cocaine addiction; 3 were inaccessible, 2 required an access fee; 13 were not websites (only external links or books). They included 61 sites in our study.

In the article on depression they used the following content assessment:

Concordance between site information and best practice was assessed using a 43-item rating scale based on the evidence-based AHCPR clinical practice guidelines for treating depression

Does anyone know a better way to score the quality of content of health websites, please let me know in the comments.

KHAZAAL, Y., CHATTON, A., COCHAND, S., ZULLINO, D. (2008). Quality of web-based information on cocaine addiction. Patient Education and Counseling DOI: 10.1016/j.pec.2008.03.002

Wednesday, April 23, 2008

11 Reliable Websites about ECT per Country or Continent

Vermont, USA (With an interview of Anne Donahue)
Vermont hospitals bring back ECT therapy to treat depression

USA
InfraPsych

ECT in the elderly, a cochrane review

ECT for Schizophrenia, a cochrane review

AUSTRALIA

Australia, the black dog institute

SANE, Australia

Better Health Channel, Australia

GREAT BRITTAIN

ECT Online, Great Brittain

SEAN, the latest information on ECT (Electroconvulsive Therapy) in Scotland.

THE NETHERLANDS
Hulp Gids, The Netherlands

Patienten voorlichting

Related posts on this blog:
9 Videos on ECT
Video lecture on ECT

Tuesday, April 22, 2008

9 Email Tips

Email has it's advantages. It is a fast way to communicate. Writing a good clear email message is something you will have to learn. Pushing the send button to quick can lead to embarrassing situations.
But don't get stuck to much to email. Sometimes it is better to talk to someone about something. Not all topics lend themselves for email. Besides the number of emails in your inbox can be overwhelming. It can ruin your life. So use email right and appropriate.
An important reason email is plaguing so much of your time is the amount of unnecessary or badly written email being sent.

From the book: Upgrade Your Life some suggestions for proper email writing:

Write descriptive subject lines. Descriptive subject lines are essential to being able to process email quickly. It saves time from having to open each email just to figure out what it’s about, you can’t prioritize their responses as efficiently. E.g. subject:IMPORTANT isn't very descriptive but Subject: Questions about Monday's presentation is.

Don't write long emails. If your message is longer than one page trim it down. Only when explaining complicated concepts or providing detailed instructions make it longer than one page if absolutely necessary

Make it easy to read by using line breaks and bullet points. Reading from a computer monitor is more tiring than from paper.

Don't CC if it is not necessary. Only do it when the recipient has to act on something don't do it just to keep him informed. While there are sometimes cases where this is a good idea, for the most part you shouldn’t send someone an email unless you want them to take action on it. If you do CC make it clear why everybody received the message.

Reply all is not always necessary. Use it only for a good reason.

More on email etiquette see also lifehacker.org

Coping with email overload can be a challenge. I am a fan of the method described in Getting Things Done. But there are some tools available to read and send emails. There are filtering and processing methods and software tweaks that make email less stressful and time-consuming. Some email productivity tips:

Filter the emails that are not directly addressed to you. You can use filters in outlook and thunderbird. You can differentiate between need-to-see-it direct mail and emails not directly for you but mostly the ones "to keep you informed".

Use Gmail, you can keep your messages and use the Gmail's search functionality. You can even set up persistent searches, and you won't have to spend time again digging through scads of messages to find the right one.

Use gmail for all your email accounts. You can import mail from nearly any account into a common Gmail. You can even send and reply to mail from those same addresses.
Process and organize your email with a system. There are a lot of systems for organizing email, getting things done is one of them. Based on this is the trusted trio system at lifehacker. Or the Zero Email Bounce for Outlook.