This page was originally posted on September 21, 2006. It has been the most viewed page on this blog. Updated February 22, 2013.  

The other day a student asked me where the phrase “red flag” originated. He had also heard of yellow flags, and suspected that there were other colours of flags to indicate barriers to recovery. Well, we looked in various glossaries of medical and medical education terms, without success. So I e-mailed Dr. Shawn Thistle, and, sure enough, he helped. It is difficult to find where these terms originated (try Googling blue flags!) and Dr. Thistle thinks they may just be part of every doctor’s vocabulary. (Ever since I wrote the title above, I can’t get Dr. Seuss’s One fish two fish red fish blue fish out of my head.)

Red flags/clinical red flags (biomedical factors) ~
These help identify potentially serious conditions, and are often listed in practice guidelines. Here is a description from Chapter 13 of the Clinical guidelines for chiropractic practice in Canada [Glenerin Guidelines]:
The main focus for the prevention of complications is the recognition of well-known and established indicators or “red flag” signs and symptoms which may require careful assessment and reassessment, changes in treatment plan, or other appropriate action, such as emergency care or referral to another health care specialist. Ignoring these “red flag” indicators increases the likelihood of patient harm. 

Yellow  flags/clinical yellow flags (psychological or behavioural factors/predictors) ~
These indicate psychosocial barriers to recovery. Here is a definition from
New Zealand acute low back pain guide: incorporating the Guide to assessing psychosocial yellow flags in acute low back pain:
Yellow Flags are factors that increase the risk of developing or perpetuating long-term disability and work loss associated with low back pain … Before proceeding to assess Psychosocial Yellow Flags it is important to differentiate between acute, recurrent and chronic presentations. Evidence suggests that treating chronic back pain as if it were a new episode of acute back pain can result in perpetuation of disability. 

Blue flags/occupational blue flags (social and economic factors) ~
These refer to conditions in the workplace that may inhibit recovery. Examples are monotony, low degree of control, poor relationships or high work demands. 

Black flags/socio-occupational black flags (occupational factors) ~
These are also used for workplace issues, but refer to organizational issues such as financial reliance on disability benefits, workers’ compensation issues, or employer attitudes to the sick worker.

References:

Helliwell PS, Taylor WJ. Repetitive strain injury. Postgrad Med J 2004;80(946):438-43.See An Approach to Diagnosis
Main CJ, Williams AC.  ABC of Psychological Medicine. Musculoskeletal pain. BMJ 2002;325(7363):534-7. 

Click on the image below for The clinical flags approach to obstacles to recovery from back pain and aspects of assessment.

From:  Main CJ, Williams AC.  ABC of Psychological Medicine. Musculoskeletal pain. BMJ 2002 Sep 7;325(7363):534-7. PMC version

Every year at this time, some of the major medical journals publish special Christmas issues. The BMJ and the CMAJ offer some open access articles for our holiday reading. From this year’s December issues of the British Medical Journal: – Christmas 2012

• Pain over speed bumps in diagnosis of acute appendicitis: diagnostic accuracy study
• Nutritional content of supermarket ready meals and recipes by television chefs in the United Kingdom: cross sectional study
• Why Rudolph’s nose is red: observational study [including video]
• Using a dog’s superior olfactory sensitivity to identify Clostridium difficile in stools and patients: proof of principle study
• The tooth fairy and malpractice

The CMAJ’s Holiday Reading [open access]

The Medical Journal of Australia‘s Christmas Crackers [scroll down the page; full text by subscription]

See older Christmas issue entries   especially Christmas Songs for Christmas Eve

I am the Web editor for ICL and still have involvement with CACHE:

• I administer facebook pages for Index to Chiropractic Literature  and CACHE/ACEMC
• Both of these facebook pages automatically produce Tweets for my Twitter accounts for Index to Chiropractic Literature  and CACHE/ACEMC. You can read all my Twitter accounts from the sidebars of this blog.
• I have Site Meters for Index to Chiropractic Literature, CACHE/ACEMC, and this blog. Check out the map of the last 500 visitors to Anne T.-V.s Blog.
• LinkedIn – groups for Index to Chiropractic Literature and for CACHE/ACEMC

CE Measure is the first peer-reviewed journal dedicated specifically to the art and science of healthcare educational outcomes measurement.

Original manuscripts that address outcomes methodologies, results, practice-based protocols, CE conference highlights and abstracts, and case histories will be published to promote vigorous academic scrutiny of this important subject.

Sample articles (all available free online):

• Changing Performance among Practicing Pharmacists through Comprehensive Educational Initiatives
• Use of Uniform Outcomes Methodologies to Measure Clinical Impact of Large-Scale CME Initiatives
• Measures of Perceived Self-Efficacy as a Method of Evaluating Educational Outcomes
• Case Report: Web-Based Commitment-to-Change Evaluation of an Annual CME Conference
• Taking the Plunge: A CME Provider’s Journey to the 21st Century
• Continuing Professional Education in Athletic Training: Is Knowledge Acquired and Retained?
• Improving Primary Care Management of Joint Pain through a PI/QI-CME Approach

I first created this post in 2007, and apart from the home page, it has been the most viewed page on my blog (over 6,000 views). So here it is again, with a link to the latest OED update.

It’s fascinating to peruse the new words added to the OED. (Here is the latest update, December 2010.) Brand names often enter the language as generic terms, and I’ve listed a few of them below. (I wonder who they have in mind with the word “flip-flopper”. And what on earth is a cotylosaur? I thought “chicklet” meant a little piece of gum, but I was disappointed to discover that it means a small chick or girl.)

Google
Goo·gle – verb: to use the Google search engine to find information on the Internet.

Botox
bo·tox – noun or verb – A proprietary name for: a preparation of botulinum toxin which is injected into specific muscles to create temporary paralysis, as part of the treatment of various medical conditions and in the cosmetic treatment of wrinkles of the face (esp. frown lines and crow’s feet). Also: treatment by this means; a course of such treatment.

Popsicle
pop·sicle – noun – A proprietary name for: an ice lolly.

Hoover
hoo·ver – verb: to clean with a vacuum cleaner (Chiefly British)

Kleenex [see more ads]
klee·nex – noun: the proprietary name of an absorbent disposable cleansing paper tissue.

Xerox
xe·rox – noun or verb: a name for a copying machine or the act of reproducing printed, written, or pictorial matter by xerography.

Thermos
ther·mos –noun: a vacuum bottle or similar container lined with an insulating material, such as polystyrene, to keep liquid hot or cold

Prozac
pro·zac -noun: a brand of fluoxetine hydrochloride
Spandex
span·dex –noun: a synthetic fiber composed of a long-chain polymer, used chiefly in the manufacture of garments to add elasticity

JELL-O
jell·o -noun: brand of dessert made from a mixture of gelatin, sugar, and fruit flavoring, dissolved in hot water and chilled until firm

Band-Aid
band·aid -noun: adhesive bandage with a gauze pad in the center, used to cover minor abrasions and cuts

Viagra
vi·ag·ra -noun: sildenafil citrate, used to treat impotence

Frigidaire
frig·i·daire – noun: the proprietary name of a brand of refrigerator.

Clear evidence of falsification of data should now close the door on this damaging vaccine scare
In a series of articles starting this week, and seven years after first looking into the MMR scare, journalist Brian Deer now shows the extent of Wakefield’s fraud and how it was perpetrated.

The  alleged MMR/autism fraud was exposed this week by the British Medical Journal. Below are the links to the main documents in this case.

The original article:
Wakefield AJ, Murch SH, Anthony A, Linnell, Casson DM, Malik M, et al. Ileal lymphoid nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998;351:637-41.  Full Text

The retraction:
Retraction–Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 2010 Feb 6;375(9713):445.

The BMJ editorial:
Godlee F, Smith J, Marcovitch H. Wakefield’s article linking MMR vaccine and autism was fraudulent [editorial]. BMJ January 5, 2011;   342:c7452.

Journalist Brian Deer’s article in the BMJ:
Deer, Brian. Secrets of the MMR scare: How the case against the MMR vaccine was fixed. BMJ January 5, 2011;342:c5347

Brian Deer’s blog entry:
Piltdown medicine: The missing link between MMR and autism. Jan. 6, 2011.

Globe & Mail article:
Picard A.  Medical fraud revealed in discredited vaccine-autism study. The Globe and Mail, Jan. 6, 2011.

Determination on Serious Professional Misconduct (SPM) and sanction [of] Dr Andrew Jeremy WAKEFIELD. This case is being considered by a Fitness to Practise Panel applying the General Medical Council’s Preliminary Proceedings Committee and Professional Conduct Committee (Procedure) Rules 1988. Date: 24 May 2010
Fitness to Practice Hearing – General Medical Council. Date: 28 January 2010

• Bell H. Test anxiety. Minn Med 2010 Nov;93(11):24-8.

• Mettner J. Grand rounds’ growing pains. Minn Med 2010 Nov;93(11):8-10.

• Kiser K. Credit for change. Minn Med 2010 Nov;93(11):14-6.

• Peota C. Learning styles. Minn Med 2010 Nov;93(11):11-3.

• Meyer CR. Searching for relevance in a sea of CME. Minn Med 2010 Nov;93(11):4.

• Deye DL. CME ASAP. Minn Med 2010 Nov;93(11):30-1.

• Brandt B, Shanedling J. Is the CME system obsolete? Minn Med 2010 Nov;93(11):35-7.

• Patow CA, Bryan DJ. Engaging physicians in CME: the power of theater. Minn Med 2010 Nov;93(11):38-40.

View the PubMed records for the above articles.    View Minnesota Medicine.

Wordle is pretty addictive.  Below are a couple of word clouds I created from the facebook and Twitter accounts for the Index to Chiropractic Literature and the Canadian Association of Continuing Health Education.

Index to Chiropractic Literature

• Wordle
• The facebook RSS feed

Canadian Association of Continuing Health Education

• Wordle
• The Twitter RSS feed