4-16-10 Community E-Newsletter/Call
Welcome everyone to our community newsletter--Today we will consider an article from the New England Journal of Medicine about the patient's forgotten voice. Our Tech team will review progress on our Phase 2 development and request input from the community (see attachements).
This is an open invitation to get more involved with the world's first ever, unbiased, free license and dynamic medical/health knowledge base.
The "Democratization of Healthcare Information" project seeks to further the development of our free Medical Encyclopedia that has been a “Wikipedia Model” for health information. Our plans go beyond the public wiki approach and include a physican verifiable mechanism that will offer an accurate, non-partisan and free source of information that users can trust. This article serves as E-Newsletter as well as proposed agenda topics for today's OurMed Community telephone call. As we go forward with a newly signed contract with Blueliner, we are looking to organize the Content Committee in more detail. In constency with our mission, our non-profit community approach seeks your unbiased contributions to medicine and consumer knowledge on healthcare.
Time: Friday (Today!) 2 - 2:45pm EST
If you would like to opt out of these emails, please let me know. Thank you for your continued interest in the OurMed initiative--we couldn't make this happen without your participation and are grateful for you pitching in!
Greg Miller, Executive Director at OurMed.Org
Watch our OurMed YouTube Video:http://www.youtube.com/watch?v=zqgYfFxEkLk
The Missing Voice of Patients in Drug-Safety Reporting
Health Care Reform Center From the Publishers of the New England Journal of Medicine
The Missing Voice of Patients in Drug-Safety Reporting Posted by NEJM • March 10th, 2010 • Printer-friendly
Ethan Basch, M.D.
A patient wants to know about symptoms she may have from a prescription drug she is taking. Consulting the label’s “Adverse Reactions” section, she finds a wealth of data. Little does she realize that this information, largely collected during clinical trials, is based almost entirely on clinicians’ impressions of patients’ symptoms — not on patients’ own firsthand reports of their experiences with the drug.
The current drug-labeling practice for adverse events is based on the implicit assumption that an accurate portrait of patients’ subjective experiences can be provided by clinicians’ documentation alone. Yet a substantial body of evidence contradicts this assumption, showing that clinicians systematically downgrade the severity of patients’ symptoms, that patients’ self-reports frequently capture side effects that clinicians miss, and that clinicians’ failure to note these symptoms results in the occurrence of preventable adverse events.1,2
The prospective collection of data directly from patients about symptoms they have while taking a drug (so-called adverse symptom events) is an alternative approach that could add valuable information to current practice. Self-reports are more sensitive to underlying changes in patients’ functional status than are clinicians’ reports and tend to identify symptoms earlier during a course of treatment (see graph).3 Current methods for detecting adverse events in clinical trials are acknowledged to lack sensitivity,4 and worrisome symptoms might well come to light earlier in the drug-development cycle if reporting by patients were standard practice.
Patient-reported symptoms were collected directly from 467 persons with breast, lung, genitourinary, or gynecologic malignant conditions at a total of 4034 clinic visits at Memorial Sloan-Kettering Cancer Center, New York. Clinician-reported symptoms were recorded by physicians and nurses treating those patients at the same visits as a part of standard institutional documentation. Both patients and clinicians reported symptoms according to the National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE), the standard lexicon for adverse event reporting in oncology trials (http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm). The graphs reflect the incidence of moderate-severity symptoms according to the CTCAE and show that patients report symptoms earlier and more frequently than do clinicians.
Before a drug has received marketing approval from the Food and Drug Administration (FDA), direct reporting by patients could be used in phase 2 trials to screen for unexpected reactions and then in phase 3 trials to follow up on any detected signals and to characterize the incidence and severity of additional potential adverse symptom events. Although other inherent limitations of preapproval safety evaluations, such as narrow eligibility criteria and limited follow-up, would persist, the ability to detect adverse symptom events among study participants would improve. After FDA approval, both general screening to detect signals in observational cohorts and more targeted assessments in controlled trials could be used.
Such methods might have resulted in earlier detection of some serious adverse events that have been widely publicized, including suicidal ideation related to the use of selective serotonin-reuptake inhibitor antidepressants in younger patients and severe constipation and ischemic colitis associated with the use of the 5-hydroxytryptamine type 3 receptor antagonist alosetron, which resulted in temporary withdrawal of the drug from the market.
Patients’ reports are more highly concordant with overall health status than clinicians’ reports. Patient-reported symptoms were collected directly from 467 persons with breast, lung, genitourinary, or gynecologic malignant conditions at a total of 4034 clinic visits at Memorial Sloan-Kettering Cancer Center, New York. Clinician-reported symptoms were recorded by physicians and nurses treating those patients at the same visits as a part of standard institutional documentation. Both patients and clinicians reported symptoms according to the National Cancer Institute’s Common Terminology Criteria for Adverse Events. Overall health status was measured with the use of the EuroQoL EQ-5D instrument, with scores adjusted for U.S. population preference weights (http://www.ahrq.gov/rice/EQ5Dproj.htm). For each assessment of concordance, the Kendall tau rank-correlation coefficient is shown with 95% confidence intervals, with 0 representing independence and +1 representing perfect positive concordance.
Why isn’t the reporting of such events by patients a standard component of drug evaluation? Although safety evaluation once predominated over efficacy evaluation in the regulatory review of drugs, over time the comprehensiveness of efficacy measurement has progressed, while safety screening has remained largely dependent on ad hoc and retrospective reporting. It is in this context that the current clinician-based approach to adverse symptom reporting has evolved. This model remains in place largely because of inertia — but today’s patients are vocal partners in decisions about their own care, and there are commonly available technologies that permit reliable collection of information from them. Optimizing tactics for collecting this information is especially important because adverse symptom events are common: symptoms account for a large proportion of the adverse reactions listed in drug labels.
Objections to adopting a patient-focused approach to safety monitoring have included perceived regulatory constraints and concerns about feasibility, added administrative requirements, cost, and limitations of the available questionnaires. But these objections no longer seem insurmountable.
After all, there are no regulatory requirements that clinicians rather than patients report potential adverse symptom events in clinical trials. The FDA mandates only that sponsors provide safety data during drug development and approval. In fact, patient self-reporting as a data-collection method was recently embraced by the FDA in its “Guidance for Industry: Patient-Reported Outcome Measures Use in Medical Product Development to Support Labeling Claims,” in which “patient-reported outcomes” — a term that broadly refers to any data directly reported by patients without interpretation by someone else — are characterized as the standard method for assessing subjective phenomena that are best described by the patient, such as symptoms.
However, the scope of the FDA guidance is limited to the collection of data to support labeling “claims” (e.g., claims of efficacy or safety benefit based on comparative data); it does not address the use of patient-reported outcomes for adverse-event screening. For example, the guidance establishes that if a claim is sought for a symptom-based effect such as reduced shortness of breath in asthma or pain palliation in metastatic cancer, the end-point data should be reported directly by patients and not interpreted by anyone else. But if shortness of breath or pain is measured as a suspected adverse effect of a drug, the standard approach is still for clinicians, not patients, to interpret and document it. Nonetheless, the FDA guidance reflects substantial progress in bringing the patient’s voice into data compiled for regulatory consideration and paves the way for similar methods to be adopted for general screening for adverse symptom events.
Questions about the feasibility of collecting adverse-event information from patients have been raised, given the complexity of collecting data at disparate sites and times. Yet in myriad trials, instruments for outcome reporting by patients have been shown to be a practicable means of collecting data on health-related quality of life, compliance with a drug regimen, and patient satisfaction with care. Although capturing patients’ reports requires administrative resources, most of the necessary infrastructure is already in place, since adverse-event reportng is standard in clinical trials. Incremental costs can be minimized by using widely available, inexpensive reporting technologies that rely on the Internet or on patients’ telephones. In fact, administrative efficiency might actually improve if patients reported adverse events before clinical interactions (e.g., from home or in the waiting room) and this information was subsequently shared with clinicians, saving time that investigators would otherwise have to spend eliciting that information.
As for the availability of appropriate questionnaires, the field of instrument development has advanced substantially in recent years, with standards that are now encoded in the FDA guidance. There are multiple measures that could be immediately adopted or modified for this purpose, including the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE), which my colleagues and I developed as part of a National Cancer Institute (NCI) initiative to introduce patient-reported outcomes as a standard component of adverse-event monitoring in NCI-sponsored trials (http://outcomes.cancer.gov/tools/pro-ctcae.html).
The responsibility for including patient-reported measures of adverse symptom events in a trial’s design before approval would fall to the study’s industry sponsor. Questionnaires would be administered by local site personnel, and the sponsor would analyze and report this information to the FDA and include it in the submitted label. After approval, the responsibility for including these end points would again fall to an industry sponsor if a trial were part of its postmarketing commitment to the FDA or related to seeking a new indication for an agent. In investigator-initiated studies, the principal investigator would take on these responsibilities.
The limitations of current safety-reporting mechanisms are well documented4,5 and have led the FDA to develop its recently announced Safe Use Initiative to reduce preventable harm from medicines. Patient self-reporting offers one solution that would enhance the capture of subjective elements of safety information. Given the clinical and scientific value of patient-reported adverse symptom events as well as the feasibility of collecting this information, one can make an ethical argument that patients are entitled to know the impressions of their peers — and that scientists, regulators, and clinicians should have access to those impressions when evaluating drugs. Such a change would lend all of us extra confidence when we reach into the medicine cabinet.
Disclosure forms provided by the author are available with the full text of this article at NEJM.org.
From the Health Outcomes Group, Memorial Sloan-Kettering Cancer Center, New York.
1. Pakhomov SV, Jacobsen SJ, Chute CG, Roger VL. Agreement between patient-reported symptoms and their documentation in the medical record. Am J Manag Care 2008;14:530-539. [Web of Science][Medline] 2. Weingart SN, Gandhi TK, Seger AC, et al. Patient-reported medication symptoms in primary care. Arch Intern Med 2005;165:234-240. [Free Full Text] 3. Basch E, Jia X, Heller G, et al. Adverse symptom reporting by patients versus clinicians: relationships with clinical outcomes. J Natl Cancer Inst 2009;101:1624-1632. [Free Full Text] 4. Institute of Medicine, National Academy of Sciences. The future of drug safety: promoting and protecting the health of the public. Washington, DC: National Academies Press, 2006. 5. Ioannidis JP, Evans SJ, Gøtzsche PC, et al. Better reporting of harms in randomized trials: an extension of the CONSORT statement. Ann Intern Med 2004
OurMed's Technology Update
OurMed's web design team lead by Vincent Navarro has been holding several in person meetings to infuse the OurMed community's input into a world class website, complete with a new look and expanded features--Not an easy task!
Several "wireframes" have been considered to be used with various configurations including a liquid design, two and three column layout. Key elements have been tested in various spots of the homepage to address their importance. Featured articles, A list of collaborative wiki categories, donate, latest posts are the main elements of the homepage.
The new design will be a grey-blue look, with sleek pictures and simple to navigate mechanisms. The latest technologies will be implemented to ensure web2.0 interactivity.
In today's community call, we'd like you wto give your feedback about the use of space on our homepage, particularly to a "Mission Focus" section in our upper right hand corner. An attachment distributed April 16th, details what 3 part dynamic use of video, mission and donor solitation might look like.
Here is the concept
File:OurMed Phase 2 HomePage Design-UpperRtBox.pdf
The other section that we must come to terms with is the Wiki Collaborative Portals that categorize our encyclopedic information. We submitted 10 categories to Blueliner but they feel we should consolidatee. healthlineplus.com and wrongdiagnosis.com are two sites that are similiar to whatOurMed's current wireframe draft looks like. To be successful we must develop a simple design that implements a smart use of space. One proposal distributed today uses such dynamic organization as on http://www.virginia.eduHere is the current homepage
Another suggestion has been to organize the icons (currently lower left hand boxes of V7 Homepage) so that they connect with the mission characteristic of "collaboration". We could do the traditional thing and have the icon images as a simple navigation tool or we could tie the concept into a graphic. Some images to consider are:
(instead of the computers in the above link, have our wiki category icons)
we could title the categories on each "arm"...too cheesy??
Have a wheel of information, that would spin around the world "community collaboratiion", "collaborative resources" or whatever we decide.
In addition to these wiki elements we want to include directories for hospitals, doctors, etc5
Our Diane Joiner, formerly of WebMD and current member of OurMed's Content Committee has earned OurMed's first Barn Star award. Stephen Press, chair of the content committee has implemented Wikipedia's method for awarding contributor's efforts. Diane has contributed ov Symper twenty medical articles under the OurMed Symbiosis Project.
OurMed thanks Richard Knipel for his five-part plan to enhance Ourmed's content by developing positive symbiotic relationships with existing open content communities.
- 1. Ensure our MediaWiki and WYSIWYG configuration is compatible with Wikipedia
- 2. Import high quality health and medical topics articles from Medpedia.com: Featured articles and Good articles.
Building content – What to write about?
Changes or additions can be made easily with our WYSYWIG editor (what you see is what you get), making it much easier than Wikipedia and cutting the volume ramp up rate to the new site significantly faster.
At times posting new material may be difficult to give attributions for so it may be easier to publish previously published work
Alternatively, you can choose content from one of the many free content ("copy left") sites such as much of the content on:
2. NIH's PubMedCentral.gov from the National Library of Medicine
4. GanFyd.org (original medical wiki site that claims Medpedia copied them and boasts 2000 site visitors per day)
7. Open.Michigan from the University of Michigan
Posting on OurMed.Org
In addition to the Symbiosis Project, OurMed offers writers of original work to publish a vast range of medical topics. Under the three pillar approach of 1) Being Referenced 2) Being Bold and 3) Being Polite, OurMed strives to be a forum through which multiple health and medical issues are presented and debated.
To write, you must have a free OurMed account. You can write about nearly anything, just keep your comments about new ideas,health and medicine.--It's really important that OurMed gets off the ground using a communities collaborative approach to building it, just as Wikipedia did nine years ago.
We are furthering our editorial policies to include a Style Guide. Feel free to suggest ideas to make this a global "go-to" resource for all healthcare needs fit for any patient or healthcare professional.
Please click on this link to make a small post about whatever's on your mind. You can suggest articles, design or features that you'd like to see on the site. http://ourmed.org/index.php/New_Ideas_for_Site
Most Active Authors in past month have been:
Most Active Authors
Passing messages on OurMed
OurMed's MedTool Project
As we develop OurMed's Phase 2 site, we want to announce a competition to inspire our content contributors to come up with the most useful healthcare diagnostic tools from around the world.
Submissions will eventually be open-sourced and written in Joomla so that it will "plug-in" to our new site as well as be available to all around the world in a copy-left offering. To contribute, a contestant need not be tech savy but only be familiar with common health and medical needs. Will it be a simple Body-Mass calculator, Symptom Disease matcher, Diabetic Insulin calculator--the list may go on and one but we want the most popular, best and easiest to use!
Just like the Wikimedia Foundation that created Wikipedia, OurMed will mostly be driven by volunteers. In addition to the occasional business or technology consultant, the profile for OurMed’s volunteer community will be talented professionals that want to make bring forward the OurMed mission to the end-goal of having a global impact.
To incentivize our founders, we have created the Founding Framer Program. To date, the following folks are eligible and working toward a goal to volunteer more than 100 Communty hours:
212 444 2633 vnavarro”at”pipeline.com
Research Specialist @ Weill Medical College
Online Database Manager @ Scientists Without Borders
I have done basic science research for over 15 years in the area of prostate cancer. During this time I have had the privilege of working on the development of monoclonal antibodies targeting prostate cancer from concept through clinical trials. This has afforded me a keen insight into development process of therapeutic drugs. In addition, a strong interest in computers has seen me pursue a graduate degree in computer science in addition to my undergraduate in Chemistry. As a result I have designed and developed a clinical trials management system in my laboratory. I am currently the Online Database Manager for Scientists Without Borders. There, I am responsible for the administration of the database and development of the web portal.
Eileen McGinn, MPH (OurMed Content Committee)
MPH/Certificate in Aging, qedeileen”at”aol.com
Worked in international health and development for 25 years, including several years living in Africa and Asia. Currently PT Research Manager for Nathan Kline Institute, working on the interrelation of poverty and mental health and health equity for persons with disabilities. PT tutor for immigrant high school students at Manhattan Comprehensive Night and Day High School. Volunteer work for many different agencies, including health, disability, immigrant, women's, peace, international. Have written for various websites on health issues. Especially interested in translating technical work into comprehensible language, community-based participatory research and the Capabilities Framework for development and justice.
Geoff Hayden, MD (OurMed Content Committee)
Geoffhayden”at”gmail.com 615.479.6499 (Cell)
I am a practicing Emergency Physician, splitting time between NYC and South Carolina. I have been in academic practice since 2005 (Residency at Vanderbilt University, Fellowship at University of Pennsylvania), with an emphasis on resident education and emergency ultrasound. My interest in OurMed.org stems from a dissatisfaction regarding the abysmal state of preventive care and a general lack of health care coverage in the U.S. I see OurMed.org as an essential resource to connect patients to health information and health providers.
I imagine my role with OurMed.org in terms of producing content, recruiting other physicians for ongoing contribution, and assisting Greg with the development of a user-friendly, comprehensive clearinghouse of useful health care information.
Geoffrey E. Hayden, MD, FAAEM, FACEP
Adjunct Clinical Professor Vanderbilt University Medical Center Department of Emergency Medicine Nashville, TN Piedmont Medical Center Emergency Department Attending
222 South Herlong Ave Rock Hill, SC 29732
Vanessa Moore (OurMed Recruitment Committee Chair)
MVanellen”at”ourmed.org 914-665-4534 (home) 914-751-9758 (cell)
Vanessa Moore is a native New Yorker who brings 7 years recruiting experience to the Ourmed recruitment effort. She would like to leverage her experience recruiting volunteers to Ourmed, a forward thinking and progressive approach to disseminating unbiased healthcare information to the public. She has worked in both corporate and nonprofit settings including a consulting engagement for the Department of Education and most recently at the Westchester Independent Living Center, an advocacy group for people with disabilities. She studied Social Sciences at the Lincoln Center campus of Fordham University.
Stephen Press, DC, PhD (OurMed Content Committee Chair)
A practicing Chiropractic physician (33 years). Was chief physician for the "Unified Team" (former USSR) at the XVIth Winter Olympic Games in Albertville, France in 1992. Founded the World Governing body for sports Chiropractic known as "FICS", for Fédération Internationale de Chiropratique du Sport, now headquartered in Lausanne, Switzerland at the Maison Internationale du Sports, and administered in Toronto, at the World Federation of Chropractic offices. I served on the Medical commission of two IOC recognized World Sports Governing bodies; 1st as Chairman for the Fed. Int'l de Roller Sports, and then as Vice-Chairman for FIDE (Chess). Founded the website IAOCO.org, and co-founded WikiChiro.org. Today, I serve as advisor for the International Sports Chiropractic Association, which is the liaison body interacting with the World Olympian's Association. I speak, English, French, Russian and Spanish, play the cello and clarinet, compete in pool, and follow biblical archeology and do artist blacksmithing, making swords and medieval armor as hobbies.
John Volpe (OurMed Tech Committee Content Liaison)
My background is primarily in accounting, finance and business operations, primarily in the financial services industry. While I'm not a technical professional, I have participated in and managed numerous technical and business projects, primarily involving financial systems. I also worked as a management consultant for a Virginia based company that I did consulting work for the federal and state governments. I am currently retired. In addition to playing tennis and engaging in other physical activities, I volunteer my time and an Account Director with an NYC based organization that provides service grants in the form of a volunteer project team that manages strategy, financial, marketing and development projects for non-profits. My interest in this project is really from the perspective of someone who is a consumer of medical information and is interested in the efficient delivery of medical information to the public.
Richard Knipel, OurMed Content Committee
I have been a volunteer for Wikipedia and other free culture efforts for several years, with a special focus on outreach initiatives to New York area cultural institutions, such as Wikipedia classes at the New York Public Library, museum photography with Wikipedia Loves Art, and urban photography with the TOPP nonprofit with Wikis Take Manhattan. I have served as President of the nonprofit Wikimedia New York City since September 2008. I hope to bring these experiences in helping to build Ourmed into an innovative and rich online healthcare community along the wiki model.
Elise Passikoff, OurMed Tech Committee
Elise Passikoff, OurMed Tech Committee
From a background in print and educational publishing, I entered the online world as an editor and technical writer at a start-up software company. There I learned the tools of the trade and gained valuable experience in writing, editing and posting online content. In 2000, I moved to the New York Academy of Sciences [www.nyas.org], where, first as online producer and then as web senior project manager I led the development, implementation, and maintenance of complex online projects, including the ground-breaking website Scientists Without Borders [[[scientistswithoutborders.org|scientistswithoutborders.org]]].
Diane Joiner, OurMed Content Committee
Diane, need your bio and committee form!
Greg Miller, OurMed Executive Director
at OurMed firstname.lastname@example.org 212-740-1850
Have 17 years of Corporate Finance and Marketing experience for Fortune 500 companies including nine years abroad (Germany, England and Japan). I've been here in New York since 1996, always passionate about developing new brands, ideas and products. Did Marketing Analysis for ANA, a Japanese Airline, Finance for Cablevision's HD Satellite business and Revlon. Since 2005, I've been inspired by non-profits, created New York's Dance Parade and have worked on OurMed since the Fall of 2008. I'm inspired by the transparent, non-profit approach to the democratization of healthcare. OurMed has a small office at Columbia Medical Center's Audubon Business and Technology Building--Come by and visit us!
3960 Broadway (Entrance on 166th Street) Suite 301 o (212) 740-1850 c (917) 627-7155 email@example.com
Watch the OurMed Presentation: http://docs.google.com/present/edit?id=0Ad4ohgeyfGzCZGRoNnFuNW1fMzljMmh2OW5jdw&hl=en
OurMed's Board of Directors:
OurMed Board Member firstname.lastname@example.org
Florence Devouard served as one of the elected representatives to the Wikimedia Foundation Board starting June 2004, and was the Chair of the WMF Board from October 21, 2006 until July 16th, 2008. Florence was born in Versailles (France). She grew up in Grenoble, and has been living since then in several French cities, as well as Antwerpen in Belgium and Tempe in Arizona. She holds two masters, one in Agricultural Sciences (a 5-year degree in agronomical engineering (Diplome d'Ingénieur Grande Ecole) from ENSAIA and the other a postgraduate degree (DEA) in Genetics and Biotechnologies from INPL.She has been working in public research, first in flower plant genetic improvement, and second in microbiology to study the feasability of polluted soil bioremediation. She was employed until 2005 in a French company, to conceive decision-making tools in sustainable agriculture. She is now a consultant in Internet Communication Strategy. She joined the Wikipedia adventure in February 2002 and is known as a contributor under the pseudonym Anthere. Florence is 39, and lives in Clermont Ferrand with her husband Bertrand and her three children, Anne-Gaëlle aged nine, William eleven and Thomas two. On May 16 2008, Florence was made a knight in the French National Order of Merit, proposed by the Ministry of Foreign Affairs as "chair of an international foundation"
OurMed Board Secretary email@example.com
Alex Fotopoulos has served on the board since October 2008. He attended Rutgers College in New Brunswick, NJ and then received his Juris Doctor degree from Southwestern University in Los Angeles, California in 1990. He has experience as a litigation attorney and as an entrepreneur. He has held held positions as an attorney and as part of the management team of such high technology companies including AT&T Wireless, T-mobile, Nextel, Metricom, GTE Internetworking as well as small local start-up ventures. He is a licensed Attorney in New York, New Jersey and California.
OurMed Board Chair firstname.lastname@example.org
Stan Kachnowski is one of America’s distinguished scholars in health-care information policy and management having taught e-health and health-care e-business for nearly 20 years. He has authored over 100 scholarly papers and presentations for the world’s leading journals and societies in health-care technology management, informatics and e-governance. In 2003 he was elected as a Fellow in the Royal Society of Medicine in the United Kingdom for his research with the National Health Service in using handhelds to track patient data. In 1996 he was elected to the US-based College of Healthcare Information Management Executives. Stan is currently a visiting professor at the Indian Institute of Technology, New Delhi, India.
OurMed Board Treasurer Newsgirl_fl@hotmail.com
Oleta McHenry was born in Washington D.C. and grew up in Ohio. After graduating high school, she briefly attended Wright State University in Dayton, studying Political Science. She transferred to St. Petersburg College in St. Petersburg, FL and received her A.A. degree in Liberal Arts. Oleta earned her B.S. in Accounting from Florida Metropolitan University in Clearwater, FL in 2006.
Oleta worked for the Pulitzer prize winning newspaper, St. Petersburg Times as a circulation manager. After receiving her degree in accounting, she worked briefly in the insurance industry before joining the Wikimedia Foundation as the fulltime accountant of record. While at the Wikimedia Foundation, Oleta helped put in place accounting practices that would help the company in growth and development. She did not follow Wikimedia to San Francisco and now works for a large medical supply company managing the General Ledger for several regions within the United States. Oleta resides in St. Petersburg, FL and works as an accountant.