Dear Foundation List Members, I'm writing to let everybody know more about the proposed Emergency Medicine Wikibook. I've met with board members and it seems at the present time that our main challenge is finding interested programmers to create templates and a special registration screen. The open-source Wikibook model is a strong fit with the rapidly changing and incredibly broad field of Emergency Medicine. Traditional textbooks simply can't cover all the little things which walk into an Emergency Room, everything from broken toes, to heart attacks and strokes, to stabbings and shootings. Please contact me if you want to be part of this, particularly if you're a Wiki programmer or Emergency doc or nurse or paramedic. All the details are below. Thanks, Paris Lovett "You must believe in free will; there is no choice." -- Isaac Bashevis Singer (1904-1991) ------------------------------- Emergency Medicine Wikibook Proposal Paris Lovett paris(a)pazzah.com Executive Summary 1) An open-source textbook of Emergency Medicine (EM) 2) The specialty of EM applies to doctors working in Emergency Departments and in Ambulance and Disaster services, known an Emergency Physicians (EPs). 3) EM focuses upon the first few hours of illness. The range of diseases is extremely broad. However, EPs do not focus upon exhaustive diagnosis and treatment. Rather they focus upon recognition and management of immediate threats to life and body function. 4) The EM Wikibook would share most core features of Wikimedia projects: open-source collaborative structure, minimizing barriers to participation, maximizing breadth of coverage and rapidly assimilating new areas of research and interest 5) The EM Wikibook would differ from other Wikimedia projects in a few important ways: a) Authors/editors would be required to state their name and credentials prior to contributing b) The structure of entries/pages in the EM Wikibook would follow a structured template. c) References in the EM Wikibook, where possible, would link out to PubMed/NLM 6) Getting the EM Wikibook started requires some technical feature enhancements, most importantly a) Registration screens for users, requiring medical credentials b) Creation of template 7) The EM Wikibook poses certain unique concerns and risks a) The usual concerns of plagiarism, copyright infringement, vandalism, edit wars b) Regarding accuracy of medical information, there are concerns about legal liability c) Posting of Private Health Information (PHI) either accidentally, or maliciously would also be a concern Introduction 1) Wikimedia is currently fostering the growth of a new set of open-source information resources: online textbooks. These textbooks are known as Wikibooks. There is no EM textbook currently in development. How would the EM Wikibook differ from the Wikipedia and other Wikimedia projects? 1) Most significantly, authors would be required to state their name and credentials. These would not be subject to verification routinely. However, in problematic situations those sysops would be able to request verification of identity and/or credentials and take corrective action for fraud or vandalism. 2) Templates would create a standardized format for discussion of diseases, diagnosis and management. A provisional template structure is shown below. Each subject would feature bullet summaries, table summaries, followed by longer narrative sections, a list of current controversies, and a large citation list. The citations/references would link out to PubMed and other large public medical databases. 3) Recruitment for an EM text would be aided by lines of communication via CORDEM, EMED-L, SAEM, and special interest groups in ACEP and EMRA. What is needed to get the EM Wikibook up and running? 1) We need programmers! To get the EM Wikibook up and running we need to create a registration screen and templates 2) The registration screen is where users can type in their name and medical credentials. This would follow a very similar pattern to eMedicine (an online textbook of medicine), which has a registration screen with drop-down menus covering all schools of medicine, dentistry, nursing, and other health disciplines. These menus are non-proprietary, and the information is public, so the menus could be ripped and modified. 3) The templates would create standardized subheadings and places for bullet summaries, and table summaries. Also, a majority of references/citations could be quickly added by simply supplying a Unique Identifier (UI). This creates an automatic link to medical references in PubMed. For instance, the UI = 14525742 can be used in the following URL: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&am… stract&list_uids=14525742 Special Concerns 1) Posting of Private Health Information (PHI). It is conceivable that physicians might accidentally or maliciously post images or text containing identified PHI. The concerns would be for both the wellbeing of patients whose PHI was thus distributed, and for any resultant liability. However, there is an inherent barrier to malicious or accidental posting can always be tracked back to the source, and in the USA the person posting the information would be liable under federal HIPAA laws. Other countries have similar laws covering illegal disclosure of health information. Wikimedia would need to use its legal resources to draft appropriate terms and conditions for contributors to protect both itself and any institution or individuals with roles as founders or sponsors. 2) Liability for Medical Information. Similarly, Wikimedia can create appropriate terms and conditions to make clear to users that sponsoring institutions and individuals "start the ball rolling" but offer no guarantees on the content. The disclaimer would emphasize that the medical information in the EM Wikibook cannot be guaranteed to be accurate, and is not a replacement for consulting with a doctor. Draft of the template structure: Quick Summary We need bullet points: . Like this . And this . And this . So that people can drop in and quickly grasp the essentials And more bullet points: . Like this . And this . And this . So that people can make a series of quick points Table Summaries Organism Other Vomiting Cramps Pain Tender Diarrhea Fever Rotavirus URI + + Watery Low Norwalk Abrupt; No URI + Watery Low Enteric Adeno + Watery Low ETEC Abrupt + Watery EHEC (0157:H7) + + + + watery -> bloody +/- Shigella +/- + Watery, green- High Salmonella + + + Watery, foul, + Campylobacter headache, myalgia, malaise + + + loose ??? Yersinia + + + Profuse watery + Clostridium Perfringens + Watery +/- Clostridium Difficile + Watery, +/- bloody + Historical Aspects Background Definition Pathophysiology / etiology Epidemiology Frequency Risk factors Morbidity and Mortality ED Presentations Diagnosis Symptoms (with NPV AND PPV) Signs (with NPV AND PPV) Investigations (with NPV AND PPV) Lab Imaging Bedside Invasive Other Consultations Differentials (and distinguishing features) Complications Therapy, with indications and evidence (WITH NNT OR SIMILAR) Prehospital ABCs Medication Procedures Disposition Admission criteria Type of admission Discharge (criteria) Follow-up (with timing) Prognosis Cost and impact of care Patient Education Leaflet EBM Controversies and Consensus Changes in practice Pitfalls Common questions on examinations Citations (PubMed/NLM links)