In case you hadn't noticed, there is now a guideline for everything. It is impossible to keep up. FOAMed can be really useful in that respect because it should keep a finger on the pulse for you and give you a condensed version of the important things, allowing you to be selective about when you go into something in more detail. The way it works is that I read the guideline, just in case you don't get the chance. (insert cheeky winking emoji here)
Nor can you rely on guidelines, alerts and journals to cover everything, despite the sheer quantity of them. The nature of FOAMed is that it often covers the things that haven't earned a guideline, are not deemed worthy of an alert and have too little academic value to have a published article. Some things that are over-represented in practice are under-represented in paper. By way of example, I give you foreskins in children. I think that the lack of publications on the subject is surprising considering the number of children attending primary and secondary care with this problem, and considering how much is often misunderstood about foreskins in pre-pubertal children.
At some point in my medical training I remember being taught that uncircumcised penises should easily retract by about 3-4 years old and that they should be kept clean. Balanitis was seen as evidence of poor hygiene and so we were told that more cleaning was the solution. Foreskins that were ‘non-retractile’ were considered abnormal and if there was recurrent balanitis or ballooning, the child should be considered for circumcision. We now believe that all of this is untrue. It is quite normal for the foreskin to remain adhered to the glans until they hit puberty, whenever that may be. Ballooning is within normal limits and balanitis is often due to unnecessary attempts to retract or clean under a foreskin. Recurrent balanitis is usually an indication to leave the foreskin alone, rather than to cut it off.
So I know that I was taught something that later turned out to be untrue and I know that many clinicians in both primary and secondary care haven’t heard the good news. Why? Presumably because it isn't seen to be worth a guideline, alert or journal article. There is stuff out there, but not a lot. This was the best article that I found. (1)
But the lack of literature is not a problem in the brave new world of FOAMed. FOAMed comes in many different shapes and sizes. Often it takes the form of a written piece, but some have embraced the infographics approach. Most notably there is the excellent library of infographics that has come out of the Derby Emergency Department. (2) I was inspired by Ian Lewins making infographics sound like a good thing so I'm having a go with it. Here's the result:
Edward Snelson
President of the Sir Lancelot Spratt Association
@sailordoctor
References
- Drake T, Foreskin problems in boys, Trends in Urology and Men's Health, March/April 2014
- http://www.peminfographics.com
