[Foundation-l] Emergency Medicine Wikibook: seeking programmers and doctors, nurses, paramedics

Wed Jan 26 00:36:49 UTC 2005

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 at 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&dopt=Ab
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)