AskDrWiki Logo

Our new logo is now finished!

We chose this as our new logo because we feel the different pieces of the caduceus represent all of the different contributions to AskDrWiki. It is our hope that these pieces through mass collaboration can collectively come together to advance medicine by creating an extraordinary wealth of information.

We are sure that there will be challenges with the use of medical wikis but we feel that we will also create tremendous opportunities. Medical wikis are more than just a piece of software that enable multiple people to add and edit articles. They are a tool that will bring together the talents of dispersed physicians to create a new era of collaborative medicine.

Wiki for physicians gains foothold

Nice article by Ken Terry in the Medical Economics Infotech Bulletin published about AskDrWiki discussing the differences between AskDrWiki and Evidenced Based Medicine Sites such as Uptodate, BMJ Clinical Evidence, and DynaMed.

The Full article can be found at the Medical Economics Website.

Wikitext Tutorial for Ask Dr Wiki

Since Medical Wikis have been attracting more attention this week we have received some great suggestions on ways we can improve this technology. We are always open minded to comments and we feel that the only way for this technology to succeed is to take input from the medical blogospshere and implement these changes.

The main complaint and concern we have heard is the difficulty in entering Wikitext. Wikitext language or wiki markup is a markup language that offers a simplified alternative to HTML and is used to write pages in wiki websites such as AskDrWiki and Wikipedia. Wikitext is very easy to learn, and most contributors can learn it quickly, but does present a hurdle that users have to cross before they start contributing.

Given this complaint we have made a short power point presentation to try to educate our users on how to enter Wikitext and we hope this will help some of our users get started.

We hope that in the future Mediawiki, which is the software that AskDrWiki and Wikipedia uses, will implement a good WYSIWYG (What You See Is What You Get) editor, but until then we will teach our medical contributors wikitext. After years of college, medical school, and postgraguate training we feel they can learn.

Ask Dr Wiki in the News

This week has been an exciting week for Brian Jefferson and I since the Plain Dealer article by Zachary Lewis was published on the front page. We have had an enormous number of visitors because of this article and we have received some great suggestions from visitors as well as from blogs. Over the next week we will start implementing some of these changes in the hopes of making a medical wiki that provides safe and up to date information.

Some changes and suggestions that we will implement.
1. Creation of an editorial policy as per the suggestion of David Rothman
2. Create a list of all contributing editors with their pertinent credentials
3. Creation of a New Logo
4. Protection of Pages on the Wiki that contain any medication dosages so these pages can not be altered.
5. Addition of a clinical pharmacist to the editorial board.
6. Addition of a AskDrWiki page on Wikipedia.
7. Addition of a General Surgery, ENT, Vascular Surgery, Dermatology, Emergency Medicine, and Basic Science Editors

We would also like to thank Ves Dimov from Clinical Cases and Images , David Rothman from davidrothman.net, and Bertalan Mesko from scienceroll.com for their advice.

Other comments this week on AskDrWiki include:
eHealth and The Krafty Librarian

EKG of the Week:Non Reentrant Fast/Slow Supraventricular Tachycardia

Characteristics:
This is an extremely rare tachycardia which occurs when a single sinus impulse conducts down an AV node with both a slow and fast pathway. When most impulses reach the AV node they conduct down both the slow and fast pathway. Since conduction is faster down the fast pathway it beats out the slow pathway conduction and depolarizes the ventricle. The impulse traveling down the slow pathway either collides with the impulse from the fast pathway that is now traveling back up the slow or the impulse traveling down the slow pathway reaches the ventricle and finds the ventricle refractory. In the above EKG the sinus impulse represented by the P wave in the beginning of the rhythm strip conducts down the fast pathway resulting in the first QRS complex; the impulse from the slow pathway also depolarizes the ventricle seen as the second QRS complex. You will notice that there is no p wave between the first and second QRS complexes. Therefore the first sinus beat results in a doubling of the ventricular sinus rate. This sequence is repeated again in the 7th and 8th QRS complex. It is an extremely rare tachycardia and is resistant to multiple antiarrhythmic medications. The above patient underwent ablation of their slow pathway and no further episodes were observed. See www.askdrwiki.com for more interesting EKGs.

Ask Dr Wiki Will Now Require Proof of Credentials

Since Brandon Keim published his article in Nature Medicine titled WikiMedia, the subject of crendentialing has been a topic that has been discussed on DavidRothman.net and meredith.wolfwater.com. After hearing their arguments we have decided that they are correct. In order to create an expert medical wiki we need to prove that future users have real medical credentials. We will now require users to submit their real names, degree, and hospital or medical school and will then confirm their credentials before we allow them to create or edit articles. The comments and suggestions from everyone who weighed in are appreciated!

Reference:
Brandon Keim: WikiMedia; News@Nature 13, 231-233

EKG of the Week: Primum Atrial Septal Defect

Characteristics
Patients with Atrial Septal Defects may have Atrial Fibrillation, Atrial Tachycardia, or Atrial Flutter, but these arrythmias are not usually seen until patients grow older. Features also seen on the EKG include Right Atrial Enlargement, PR prolongation and advanced AV block. When you suspect a patient has an ASD based on the findings of an incomplete Right Bundle Branch Block with a rSr' or rSR' the next thing you should do is examine the frontal plane QRS. The frontal plane QRS is the most helpful clue to help you differentiate Secundum ASD from Primum ASD. In Primum defects left axis deviation is seen in most patients with an axis of > -30 degrees and very few patients have right axis deviation. In contrast Secundum defects have an axis between 0 degrees and 180 degrees with most cases to the right of 100 degrees.

In the EKG above, you can see an example of the rSR' pattern in V1 with a R' greater than S with T wave inversion which is commonly seen in volume overload. See www.askdrwiki.com for more interesting EKGs

References
Pryor R, Woodwork MB, Blount SG: Electrocardiographic Changes in Atrial Septal Defects:Ostium Secundum versus Ostium Primum defect. Am Heart J 58:689, 1959.