Converting blood glucose measurements US > CA: case

Scenario

A young man tells me he would like to be able to convert US blood glucose levels (milligrams per deciliter: mg/DL) to Canadian (millimoles per liter: mmol/L).

Resolution

After much searching in various resources, and finally Google, I am able to find an online converter from Lifescan Inc., the people who make the OneTouch® System for monitoring blood glucose levels.

I would like to make it clear that I am in no way endorsing their products (I am not qualified to make any judgement about them), and usually I prefer to avoid information offered by such companies as it is likely biased, but in this case I decide to make an exception. The tool they provide is freely accessible and actually quite handy.

I would suggest that if you are looking for reliable information about diabetes there are other better resources. To list just a few:

Canadian Diabetes Association
recipes
Diabetes Quebec
Public Health Agency of Canada
Neuro-Patient Resource Centre
MedlinePlus - diabetes
UpToDate - diabetes

And now, without further ado, here is the link to the converter:

Blood glucose monitoring: converting measurements

Like other online converters, you can plug in the number you have and you will be given the number you want.

You can also use it to convert plasma results to whole blood results.

Prostate cancer treatment options and decision aids: case

I have gotten several requests for information on the topic of prostate cancer, both from patients and from health professionals, so I thought I would share what I found.

Before I do so, I thought it might be helpful to explain what a decision aid (or guide) is, in case anybody reading this has never seen one or is not sure what one is.

I had a hell of a time finding a definition. I checked MedlinePlus' medical dictionary and encyclopedia, and neither had one. Cambridge Dictionaries Online didn't list the term, and neither did the Merriam-Webster online medical dictionary. This time even Google failed me. (I am searching online since I am at the clinic and so don't have access to print resources, much as the average patient or family member wouldn't.) I am finally able to find one definition though. According to the US Department of Health and Human Services,

Decision aids are mechanisms or interventions that have been developed to improve communication between health professionals and patients, and to help involve patients in making decisions regarding their health care. Decision aids can include brochures, videotapes or interactive computer programs. Recent reviews have suggested that decision aids may be effective in supporting general health care decisions.

But what does that mean in plain English? You could say that any information that helps you make a decision could be considered a decision aid, but there two types of tools that are usually referred to using the term decision aid or decision guide.

One kind works like a sort of "choose your own adventure." At each step in the process you are given your options and depending on which you pick, or which is recommended based on test results, other choices are then offered and so on, branching out like a little tree. This makes it possible to see what might happen if you chose one treatment over another.

The other kind brings up important questions and help you make a list of pros and cons, much the same way you might do if you were making any other decision.

Scenario

Information on prostate cancer treatment options and decision aids.

Resolution

Here are a few resources that I found useful:

Treatment options:

National Cancer Institute: What you need to know about prostate cancer.

National Cancer Institute: Prostate cancer treatment

Family Doctor: Prostate cancer treatment options

Canadian Cancer Society: What is prostate cancer?


Decision aids:

Mayo Clinic: Prostate cancer guide

American Cancer Society: Detailed guide- prostate cancer

National Comprehensive Cancer Network treatment guidelines for patients: prostate cancer (for very advanced readers)


These are for screening but might still be of interest:

Centres for Disease Control and Prevention: Prostate cancer screening decision guide

Lab Tests Online: Prostate cancer tests

Staff requests: 2 cases and Ethics: challenge

It has recently been brought to my attention that there may be ethical problems with posting cases the way I have been, even though I have been very careful to remove any personally identifying information. Hopefully I will be able to continue once I have spoken to the ethics consultant at the hospital in order to confirm that all is indeed okay.

In the meantime I have taken the cases offline (hopefully temporarily), and today I will write about a couple of requests I've gotten from staff.

Case#1

Scenario

One of the health professionals (HP) at the clinic asks me to find some information regarding which vaccines that do not contain thimerosal (a mercury-based preservative used in multi-dose vials to prevent contamination) are available in Canada, as one of his patients has expressed concerns over the additive. He gives me a list of possible vaccines.

Resolution

I run several searches in Google which verify the correct spelling and allow me to narrow my results to those pertinent to Canada. Unfortunately, as I write this, I do not remember my exact searches, except that I did not include the vaccines from the list in my searches. I do remember running several relatively convoluted ones before I was able to find the information I was looking for. I have tried to reproduce my search for the purposes of this post and for some reason I am only able to find an older 1 March 2003 version of the 2007 document I am ultimately able to find for the HP:

Canada Communicable Disease Report
Volume 33 • ACS-6
1 July 2007 An Advisory Committee Statement (ACS) National Advisory Committee on Immunization (NACI)
Thimerosal: Updated Statement

Discussion

I find the older version by typing in thimerosal canada which is a search I know I would have run the last time, so I am doubly confused at to why I did not find the older version last time but have now found it so easily. Having found it there would have been no reason to keep looking as there is no indication that there is a more recent version available. This is yet another example of why searching for information using Google can be hit and miss. I have tried to reproduce searches before and have had similar problems, something I demonstrate in the Google course I developed for the Health Sciences Library: Google-eyed? Don't despair! How often do we take screen captures of our search results? It is way too easy for us to doubt ourselves and not the tool we have become so dependent on.

Total time: 30 mins

Case#2

Scenario

One of the GPs at the clinic asks me where he can find decision aids to use with his patients and their families.

Resolution

I happen to have a very useful site already bookmarked in MyHq so I show it to him: Ottawa health research Institute A-Z Inventory of Patient decision aids.

I also show him a really neat one I have found recently during an encounter with a family member in the Gynecologic Oncology department: Ovarian Cancer Treatment Guidelines for Patients– Version III, April 2007. The reason I like this one so much is that is not just a list you can print out and tick off, but rather a fully interactive tool that works something like a choose you own adventure.

Total time: 5 mins

Pediatric MS: case

Case

Scenario

One of the Herzl health professionals (HP) comes to see me while I am working in the library. She has a young patient, a nine year child, who has been diagnosed with pediatric MS. She would like some information for the family.

Resolution

This diagnosis is relatively rare and we are both thinking it may be difficult to find information. As she will be visiting the Montreal Children's Hospital that Friday I suggest they go to the Family Resource Library there, which is excellent, in case they have any special resources on the topic. I tell the HP I will follow up when I am at the Herzl and ask her to write up an InfoRx and leave it for me so that I can fill out a consult.

The next day I call the Family Resource Library at the Children's to see if they do in fact have any special resources on the topic, which it turns out they do not. I decide to do a quick Google search first thing Monday to see what might be out there. I don't normally turn to Google first unless I looking for the US name of a drug before looking it up in a US resource, but this time it seems like the thing to do. I am surprised to see how many excellent resources come up right off the bat:

Search: pediatric multiple sclerosis

Results:

For the health professional:

MS Society of Canada
Hospital for Sick Children Paedetric Multiple Sclerosis (MS) Clinic

National MS Society (US)
Pediatric MS

Quebec chapter of MS Society of Canada


For the patient and family:

MS Society of Canada publications on young persons with MS
Includes an activity book for children with MS, a guide for parents, and answers to FAQ

University of California Children's Hospital
Pediatric MS Center

National MS Society (US)
About MS: Pediatric (Childhood) MS

Children's Hospital of Philadelphia
Neurology: Pediatric Multiple Sclerosis Clinic

National Pediatric MS Center at Stony Brook University Hospital

I also search NOAH (New York Online Access to Health), as well as the default MedlinePlus, to see what they have on the topic. Noah has a couple of links to to the National Multiple Sclerosis Society, ones I have already found, but MedlinePlus does not have anything at all on the topic.

Discussion

(Also see Challenges post for today)

I recently gave a course to hospital staff on using Google wisely and well, and one of the things I made a point of stressing is that Google is just a means to an end. There is a lot of controversy surrounding the use of Google as a diagnostic tool, and especially on its use by consumers to find health information. I believe that *if* you know what you're doing, and more importantly *if* you know how to evaluate what you find, then it can be a really useful, if unreliable, tool for finding information quickly in multiple resources.

Nutrition information in Cantonese: case

Scenario

A middle aged man is referred to me. He leaves a phone message telling me he is interested in information on Type II Diabetes and diet in Cantonese for his father who is a patient at the Herzl.

Resolution

I search the following resources*:

The 24 languages project
Health Information Translations
Healthy Roads Media
HICUP
NLM Consumer Health Information in Many Languages Resources
SPIRAL

I am able to find some good information in Chinese on the SPIRAL site:

SPIRAL > Patient information by language > Chinese > select "diabetes"

Unfortunately I am not able to determine whether this information is specifically in Cantonese (health information is generally available in either traditional or simplified Chinese). I call the man back and he asks me to email the links and says he will ask his father whether he is able to read the information. I tell him I will be happy to continue looking if necessary. He then asks if I can find something that might help his father understand the different food groups and portion sizes. I do a web search using Google: canadian food guide chinese. The first hit is a copy of the guide translated into Chinese (pdf).

I email these links to the man including some information about navigating the SPIRAL site.

I place a copy of the consultation form in the attending physician's mailbox.

*All of these resources have been bookmarked in the list of public MyHq bookmarks I have created for myself and the Herzl health staff.

Total time: 20 mins

Discussion

I consider every encounter an opportunity to teach people how to find information and not just hand it over. At the very least I show the path from the resource's home page to the desired information. This also minimizes dead links.