Wikipedia talk:WikiProject Clinical medicine/Archive 3

Hello
Hi, I've just recently decided to become a participant of this project, and I was wondering what everyone's take on the WikiHealthShoppe idea was. I really think that the goals of this project are by far larger than the 'pedia can contain, and I believe that it needs another wiki to itself, to create a comprehensive medical database. Please give me some feedback. DryGrain 02:48, 15 May 2004 (UTC)

DM unclarity -- help needed
I have, rather belatedly I am sorry to say, noticed that there are some rather severe limitations in the coverage of DM on WP. I will note the most prominent here, and trust that someone can make appropriate adjustments in the relevant articles. There is clinical relevance (ie, in re patient compliance (particularly w/ close control regimes)) to several of these.
 * what body cell classes can use glucose w/o need of insulin? And conversely, which require insulin? do either or any of these ever change status, ie normally use glucose but can use free fatty acids (eg, during ketosis)?
 * same question in re FFA.
 * same question in re ketone bodies.
 * is there anything else which can be used by any cell class as fuel? I don't count here glucose made elsewhere (ie, in the liver) from other sources as for instance protein degradation. When a muscle cell sees it, it just glucose. Or is there some systemic state which changes behavoir of cells when glucose is being produced from protein?
 * under what conditions do cells convert from glucose only (or glucose sometimes) to using other sources of energy (eg, FFA or ketone bodies)?
 * in the newly emerging research about gut signalling 'hormones', is there anything more than fragmentary understanding of the 'big picture'? It seems clear that the simple picture of BG level --> insulin secretion --> cell BG uptake is too simple. There are other inputs, many of them seemingly from gut hormones.
 * in the newly emerging research on 'helping factors' in glucose uptake or insulin action or insulin secretion, is there anything more than fragmentary understanding? Eg, magnesium and chromium (in appropriate ionic form of course) do what and with what importance? Or cinnamon (?!) in the diet has an effect as well. Is there any sense of what the mechanism is?

All of these (and there are surely more I've missed in a figure/ground perceptual hiatus) are similar in that they are background for understanding what's going on. A relevant issue, both clinically in some cases, and in re WP's mission of making clear the obscure.

Thanks. ww 15:12, 26 May 2004 (UTC)


 * You must realize that you are asking for the equivalent of a set of fairly broad-ranging yet detailed review articles in which these items would be many levels down, interesting as they are. What occurs to me is that if you are knowledgeable enough to ask these questions, you could probably help get the articles started. How about if you start and I'll follow? Alteripse 23:53, 26 May 2004 (UTC)


 * Alteripse, Sorry to have noticed your response so late. I don't have this page watchlisted.
 * I know enough about the questions I posed above to know they're important to diabetics, or at least that diabetics should ideally have some sense of what's going on so as to be sensibly involved in the management of their DM. But that's about all. If I started a page on any of these, it would be a very poor effort indeed and very likely to be riddled with invisible to me but risible to others errors of both omission and commission.
 * What I had in mind was a sentence or two (as needed) sprinkled throughout the diabetes mellitus article, with perhaps a paragraph on the new research and possible results. I agree that full articles may be appropriate for one or more of the questions I posed, but I didn't have that in mind.
 * Having now begged off of doing it myself (note prominent yellow streak), can I suggest someone who actually knows something have a go at it. I can help with phrasing and clarity, just not with the facts.
 * And I should note that the Diabetes article has been nominated for WP featured article status, so perhaps that might be reason to pitch in sooner than later? ww 16:20, 10 Jun 2004 (UTC)


 * Diabetes is one of my interests, but your questions are actually directed toward an area of physiology much more clinically related to metabolic causes of hypoglycemia in infancy, where the ability to switch between fuel sources and use ketone bodies can make a critical difference between brain damage or not when the post prandial period is prolonged. The answers to your questions are all "it varies by age, by circumstances, by organ." These questions are not applicable in a practical way to adults with diabetes. Obviously the brain can use glucose without insulin or we would see coma quickly with insulin deficiency. Obviously the adult brain cannot quickly utilize alternate fuel sources if the blood sugar falls or insulin-dependent people wouldn't have to treat hypoglycemia so often. There is an enormous amount of research generated over the last several decades on facilitators and enhancers of insulin sensitivity, far more than I can digest in available time (that not being an area of specific research interest for me). The way this info is usually disseminated and made available is by having those who do the research and keep up with the field in detail write the occasional review articles in the medical journals. With each additional clause you actually asked for a review of a whole new field of research. I'm not trying to sound dismissive--- I can only wish I had that comprehensive a grasp of it all. I'll see what I can do when I finish my current intentions, which are to complete the growth hormone series (nearly done), fix the intersex articles which are horribly inaccurate, and provide something accurate and meaningful on hypoglycemia, which isnt covered much better. Our diabetes coverage is already better than these other areas, but I'll try to amplify some of it later this year perhaps. Alteripse 22:48, 10 Jun 2004 (UTC)
 * Alteripse, Your reply illustrates the reasons for the yellow streak. I had no idea there was an issue in infants, though I suppose I should have been able to deduce it. Given my Sherlock Holmes genes are currently inhibited, I'm limited to taking a pass.
 * I see what you mean by suggesting review articles were needed. Nevertheless, some understanding of the (apparenly only surface is possible) issues would be of assistance to at least some diabetics in making sense of what's going on. I await your free time with considerable interest and will promptly vanish in the direction of growth hormone to learn something. Thanks. ww 15:28, 11 Jun 2004 (UTC)

WikiMD en MediWiki
As discussed with User:Anthere on IRC, two medical wikis have recently appeared. WikiMD.org is not affiliated with WikiMedia, and MediWiki.org is trying to become a wikipedia subproject. WikiMD has some wikipedia articles imported and enhanced it with USMLE examination questions and Gray's "Anatomy". At the moment, I am unsure what either project has to add, what their audience is and how they intend to keep their articles evidence-based and useful. This has been raised above, BTW... JFW | T@lk  11:53, 31 May 2004 (UTC)
 * A problem with WikiMD is that it's focused on the medical school crowd. This is a group that notoriously doesn't have much time to write articles and is transitory by nature.  While people may contribute after they have finished their exams, I don't see them writing for long periods afterwards.  It seems that the incentive is to get their books cheaper.  After they pass the exams, what's the incentive??? Ksheka 21:37, May 31, 2004 (UTC)


 * One question, though - If they copy articles from us, do they have to give an atribution back to the Wikipedia? If so, we can only win. If not, we are no worse off than before they existed. As for someone linking to their articles, I see no problem with it if their articles are better written than ours are.  Of course, I would wonder why we can't just make ours better... Ksheka 21:37, May 31, 2004 (UTC)


 * I see JFW has boldly culled the mini-mediwiki (MMW) pages from the medicine page. Fair enough too. But got me thinking the more pleuralistic way of approaching the MMW's may be to start a page on Health information and wiki or Medical wikis or something like that. On such a page we could explore topics including:
 * existing medical wiki's (and their history, features, strengths, weaknesses)
 * pros and cons of wiki as a media for health/medical informations, including comparisons with say textbooks, peer-reviewed journal, other web-souces etc
 * audience ambiguity
 * I was just about to create such a stubb with a link of the medicine page, when I paused and thought I'd float the idea here first - mainly cause I couldn't decide an appropriate name! thoughts most welcome. Erich 05:18, 5 Jun 2004 (UTC)

What to do with Category:Cardiology???
Category:Cardiology showed up on the top of a page I was working on (see the top of aortic dissection). Is this a new thing? I took a few days off, and everythings changed. Should I just list all the topics in cardiology there? Should I move Cardiology over there? What is everyone else doing with the categories? Ksheka 01:35, Jun 1, 2004 (UTC)


 * First off,, to write about a category, start with a colon, like this, category:cardiology and it will show up correctly without making the page you're typing on a member of that category. I had a go at trying to make a hierarchy for medicine (see links at top) but I have a feeling this is just going to grow organically and we'll have to see how it all shakes out. -- Nunh-huh 02:15, 1 Jun 2004 (UTC)


 * Just tried it. (added the category to the bottom of an article) Has a lot of possibilities. :-) Ksheka 10:26, Jun 1, 2004 (UTC)

Introducing myself (User:Aside)...
I'm a medical student (almost finished, at last) who would like to contribute in the project. I have training in anesthesiology and intensive care medicine. I must say I'm quite confused with all the categorization issues I read about in this page, and the general nature of the 'WikiProject'... I'd appreciate if you could point me in the right direction (things to be done, and how to do them) so I can try and write something. In other words, is there anything I should do (categorization, linking) beside the normal Wiki edit stuff to add content to the project?

Thanks in advance for the info,

Aside 10:29, 2 Jun 2004 (UTC)

Gedday - fantastic!! welcome aboard! what continent are you on? if you want somewhere to start you could have a look at the red links and the (blue ones) in Anesthetic drugs. Anesthetic equipment is embyonic - so could be expanded and the links populated. I shall ponder more. If you have a digital camera some photos for Anesthetic equipment would make the pages prerrty! best wishes Erich 15:07, 2 Jun 2004 (UTC)

Welcome! My suggestion: Find a topic you're interested in. Edit the article and make it as good as you can possibly make it. Use text books, online references, journals, etc, as reference material, but don't copy anything verbatim that isn't public domain (almost nothing is public domain ;-) ). As you save your changes, people who are "watching" the article will notice and may steer you in the corect direction if you are off track.  Once you have something you like, leave a message here (maybe in section two or three, above), and the rest of us will help you out to the best of our abilities. If you like how a different article in the wiki is formatted or how they do something, look at the source of the page to see you it's done. If you have questions, just ask right here to get the widest response. One last piece of advise: Start with topics that you know real well (ie: something that you presented or recently studied) Ksheka 17:56, Jun 2, 2004 (UTC)

New category: Pharmacologic agents...
Hi, guys. I just created a category Category:Pharmacologic agents. The purpose of this is to be an umbrella underwhich all the drugs we use (and many that we don't) go. Sub-categories should include Analgesic agents, Antipyretic agents, Antiarrhythmic agents, Beta blockers, Calcium channel blockers, etc. Maybe separate ones for Recreational drugs and stuff like that.

I mentioned it here to get your input and put some better wording in the actual text. :-) Ksheka 20:57, Jun 2, 2004 (UTC)


 * Well, a virus, water and sunlight also "have an effect on one or more tissues of the body." So does anything a child may put into their mouth ......  Perhaps it would be good to mention that pharmacological agents are "used clinically" or "used for their therapeutic effects" ?  Perhaps the words "bioactive compounds" are useful ? It depends how general the category is intended to be ......  Just a few thoughts from a non-MD viewer in Wikipedia. -- PFHLai 21:29, 2004 Jun 2 (UTC)


 * Heh...Good point. I like bioactive compounds, but it's not really used much in medicine, is it?  As for "used for their therapeutic effects" and "used clinically", a sun lamp would fit the bill, I think. :-)  Also, I'm not sure what exactly clinically means.  If it means 'by a physician', it leaves out agents that are not prescribed (ie: most recreational drugs). Ksheka 21:49, Jun 2, 2004 (UTC)


 * I think there are also Category:drugs and Category:medications. I think no matter how hard we try, there is going to be duplication. -- Nunh-huh 21:54, 2 Jun 2004 (UTC)


 * How about this as the description for the category ? "Pharmacologic agents / Medications are biologically active substances applied pharmacologically to the body for their therapeutic effects on one or more tissues or organs." Perhaps the word "pharmacologically" should be left out, or converted into a link to the Pharmacology page (where a long list of categories can be found, including one for euthanasia !!!) -- PFHLai 21:22, 2004 Jun 4 (UTC)


 * can I just have a winge about the term narcotic. nothing wrong with this term if you're discussing american law but otherwise we should avoid it! It is a term that adds little to to any clinical discussion. Generally what we really mean is opioid, and we certainly don't mean cocaine or LSD etc...


 * still have to get my head around categories (i'm a bit distracted by my own website) but I'm sure you smart docs will figure it out for me (hopefully before Mr NH plasters flashing neon categories for unproven placebos here and everywhere) ;-]  Erich 00:17, 3 Jun 2004 (UTC)


 * Isn't it reinventing the wheel ? There are ATC classification after all. Kpjas &#9764; 10:17, 3 Jun 2004 (UTC)


 * well, errr... now that you mention it there are a multitude of classications... in one of my past lifes I worked in this field... for an encyclopaedia the NLM's MeSH terms may be the best alrounder - although its pretty warty. There's also SNOMED, ICD9, ICD10, and ICPC (which is goodie). Once apon a time the UK NHS wasted a few million pounds on a system called the 'Read Codes'... Ultimately there are about 10 times as many ways of structuring things as there are people involved! Erich 11:56, 3 Jun 2004 (UTC)


 * Okay. I fixed up the categories a bit.  I guess antibiotics should go under antiinfectives (along with antituberculosis medications and antifungals, I guess).  One problem.  If I put #REDIRECT Category:Pharmacologic agents in the page for Category:Medications, it doesn't redirect.  If I remove the preceeding colon, it shows up as a subcategory of pharmacologic agents.  Any ideas on how to fix this?  Is this a known bug in the wiki code? Ksheka 10:44, Jun 4, 2004 (UTC)


 * It seems like redirects show up as subcategories, but they also do work. (The peculiar thing is that you can't see the page you are redirecting to on the redirect page). I suspect this is something that'll be fixed. - Nunh-huh 20:12, 4 Jun 2004 (UTC)

What's with all these see alternative medicine links?
A user, rather driven, Mr. Natural Health, has littered whole reams of Wikepedia with an irrelevant link to an alternative medicine page. The page isn't specific to anything in any article is in. Then there is a page with a discussion on arbitration and votes that are opaque in their meaning. What's up here? Steve Kd4ttc 04:40, 3 Jun 2004 (UTC)


 * Although I agree with the idea of achieving a balance between conventional and unconventional medicine in Wikipedia I protest against polluting medicine articles with irrelevant links and alternative medicine nav tables. I removed completely irrelevant alternative medicine linkage in List of medical symptoms. Kpjas &#9764; 10:15, 3 Jun 2004 (UTC)

A number of users, me included, has spent an inordinate amount of time editing out the CAM links from the medical articles. I think it is instructive that the links in articles that are CAM related were left in place. There were some pretty goofy CAM inclusions. I think the funniest was the inclusion of Minerals, which put volcanos in the CAM space. Notably, the CAM linker of note has actually contributed some content recently. He placed a bit in the depression page which was reasoonably well written. Unfortunately, he cited an irrelevent article. Ironically, the article was a review showing the ineffectiveness of a number of Alternative medical treatments. With the poor behavior displayed by the gentleman that is docmented on the arbitration pages he may be kicked out of Wikipedia. Kd4ttc 15:49, 9 Jun 2004 (UTC)

Diagrams
I put quite a cool diagram I made up on the stomach page that I made. Can people just give it the once to check it. I'm gonna have a bit more time coming up (exams are nearly over), so if people want any other diagrams done, I'll see what I can do. Prisonblues


 * Beautiful, Prisonblues. But... there is a page called gastric acid. Would you mind adding it there as well??? Is it "general" enough to remain on stomach? JFW | T@lk  19:37, 2 Jun 2004 (UTC)

Made the blank version, and updated the typo in blood. Moved to gastric acid too, but it's still on the stomach page. As a side-note, thought it would be quite cool to make it a clickable map, ie. if you click on M3, it takes you to cholinergic muscarinic receptor, I'm assuming this is impossible with the current software, but would be quite cool anyway. --Prisonblues 00:31, 3 Jun 2004 (UTC)

There are a few errors in the diagram. The pylorus is the exit of the stomach, not a region. The cardia surrounds the entry of the esophagus. The Antrum is about the distal 1/3 of the stomach, and the angulus incisura is not included. Stephen Holland, M.D. Kd4ttc 04:44, 3 Jun 2004 (UTC)


 * Good points Stephen, but that's not my diagram, it's Statkit1's, we were talking about this diagram. --Prisonblues 07:27, 3 Jun 2004 (UTC)


 * Ah! Oh that diagram is beautiful!  I used to lecture on GI physiology.  That is just a lovely diagram.  Nice work! Kd4ttc 16:15, 9 Jun 2004 (UTC)


 * Great diagram - good work! My only criticism is that perhaps there should be a small key for what the abbreviations used are. Alex.tan 18:20, 9 Jun 2004 (UTC)

Criticism
Well, as MNH and consorts were not doing it, I did! I wrote Medicine. Please fiddle around with this section, as I wrote it hurriedly and with a shocking lack of introspection. Ivan Illich does deserve a mention, Neil Postman possibly doesn't. JFW | T@lk  16:36, 9 Jun 2004 (UTC)


 * great stuff! I've been holding off writing a similar blurb. Given your section a quick go over. We should also discuss issues of: expense, error and elitism... (mmm the three e's!). i deleted the 'harmless' comment as alternative cancer treatments are big earner for their proponents! Erich 18:17, 9 Jun 2004 (UTC)

Navigating around the doctor's mess
I find the navigation menu at the top of the clinical medicine project pages (including this one) was a little distracting, so I've moved the navigation to a Template:WPCM navigation, and have replaced the original navigation menu with. IMO, this improves aesthetics and readability. If no one objects I'll assume there's general agreement, and in celebration I'll go buy myself a pint :-) --Diberri | Talk 02:03, Jun 10, 2004 (UTC)
 * I agree. nice! Erich 02:33, 10 Jun 2004 (UTC)

Beautiful, Dave. JFW | T@lk  10:32, 10 Jun 2004 (UTC)