Searching for Health Information Online (Part 4)

The last three parts of this series reviewed searching for online health information designed for patients. In part 1, I discussed Healthline's approach and the use of HealthMaps. In part 2, I discussed MedlinePlus and the individual web pages of physicians. In part 3, I compared UpToDate, Google Search, and Google Co-op. In this part, I'll look at two other ways of searching for more detailed, professional-level health information: PubMed and Google Scholar.

PubMed is a service of the National Library of Medicine. It is a search engine of the MEDLINE database, which covers over 5,000 biomedical journals dating back to the 1950's. Searching PubMed allows access to the primary medical literature for healthcare professionals and patients interested in recently updated, technical information.

PubMed has many advantages. It's more frequently updated than many other databases (citations can even be found that are "in process" and haven't yet been formally added); and it's powerful and customizable. However, for the busy clinician with little formal training in searching the medical literature, PubMed can be difficult to use, and therefore its powerful features are often wasted. And if professionals have a difficult time using it, then non-professionals and patients will also likely have a tough time.

Google Scholar is an attempt to preserve the power of PubMed, add additional features, and present the search interface simply. The advantages include:

• Papers are listed not in order of publication, but in order of relevance, which is determined by PageRank, the same system used in regular Google searches.
• Next to each publication is a link to other publications that cite it. This allows you to immediately determine whether a paper is influential and who it has influenced.
• Scholar also includes searches of publications that don't make it to Medline, like books, small journals, and private collections.
• Scholar uses the familiar uncluttered Google interface.
  

To use an example: our hypothetical patient with kidney stones from part 1 has heard that drinking lemonade may help prevent kidney stones and is interested in reading the original research. First he searches for ["kidney stones" AND lemonade] in PubMed:

PubMed initially only provides one link. After clicking on "show related searches," it expands the search and provides 100 entries in no obvious order.

Next, he searches Google Scholar for ["kidney stones" AND lemonade]:

While Google Scholar only provides 73 results, the results are listed in order of importance, and it's easy to see at a glance how many times each paper is cited by other papers.

This is a critical feature. First, it instantly introduces you to some of the most important papers in the field. Second, it allows you to follow the web of citations in the medical literature. Almost without exception, every published physician and scientist I've seen encounter Google Scholar for the first time has immediately "Scholared" themselves to see who is citing and reading their work.

Of course, as useful as Google Scholar is, it's not perfect. For an overview of the advantages and disadvantages of using Google Scholar see this discussion from the McMaster Health Sciences Library. And for more discussion of Google Scholar and searching the medical literature, see Dean Giustini's Google Scholar Blog.

Lastly, if you have access to a medical library, I encourage you to take advantage of it and learn from the people who work there.

Labels: google scholar, healthline, medical informatics, medlineplus, pubmed

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Searching for Health Information Online (Part 3)

In part 1, I introduced ways of searching for health information online and discussed Healthline's approach and the use of HealthMaps. In part 2, I discussed MedlinePlus and the individual web pages of physicians. In this part, I'll compare three other methods of searching for health information: UpToDate (a "top-down" approach), Google Search (a "bottom-up" approach), and Google Co-op (a "hybrid" approach).

UpToDate is a popular, frequently updated, online textbook of medicine for health care providers. It's unparalleled at giving a quick, high-level overview of many frequently encountered clinical situations and is widely used by physicians. UpToDate also offers a section of information designed for patients (which is less well-known). This information for patients on UpToDate is typically written by the same experts that write the reviews on the main site for health care providers. You might consider this a "top-down" approach to providing health information -- the site itself provides reviews of topics written by respected experts.

For example, our patient in part 1 with a kidney stone might navigate to UpToDate's "Table of contents for patient-level information," choose "kidney disease," then choose the section on "kidney stones." The reviews for patients on UpToDate are detailed and written at a high-level (which some people might find appealing and others might dislike), which reflects the main focus of UpToDate as a source of information for health care providers.

In contrast to the "top-down" approach of UpToDate, the search engine Google provides a "bottom-up" approach. Rather than producing it's own content, Google provides a list of links chosen based upon an automated method which provides a ranking of quality. If the patient with a kidney stone in part 1 searches for "kidney stones" in Google, the first link provided is a review from the National Institutes of Health. The second is the review from Wikipedia (a public encyclopedia to which anyone can contribute).
While Google typically provides relevant, high-quality results, the links provided are not necessarily the most authoritative (take Wikipedia, for example) or safe (see McAfee Siteadvisor's analysis of the Safety of Internet Search Engines).

Google Co-op, a "hybrid" approach, is an attempt to address these concerns. Google Co-op combines the "bottom-up" search results from Google with the "top-down" expertise of various organizations and individuals. For example, the Google Co-op Health Section lists contributors such as the Centers for Disease Control, the National Library of Medicine, and the Cleveland Clinic. When searching for various health topics, the "labels" from these contributors are included as part of the search under the "Refine results" section. Searching for "kidney stones" on Google, for example, displays the following additional links:


Clicking "From medical authorities" provides only links that have been labeled by the contributors as being from reputable medical authorities. This is one way of combining the expertise of health care organizations with the results from Google's search engine.

In part 4, I'll conclude with a look at searching for more detailed health information using Google Scholar and PubMed.

Labels: google, google co-op, health information, healthline, medlineplus, uptodate, wikipedia

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Grand Rounds is up at Med Valley High

Grand Rounds, this week's best posts of the medical blogosphere, is up at Med Valley High. Thanks for including my post on The Value of Mind Mapping.

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Searching for Health Information Online (Part 2)

In part 1, I introduced ways of searching for health information online and discussed Healthline's approach and its innovative use of HealthMaps. In this post I'll discuss MedlinePlus.

MedlinePlus.gov is a service of the National Library of Medicine, part of the National Institutes of Health. From the website:

MedlinePlus will direct you to information to help answer health questions. MedlinePlus brings together authoritative information from NLM, the National Institutes of Health (NIH), and other government agencies and health-related organizations. Preformulated MEDLINE [medical literature] searches are included in MedlinePlus and give easy access to medical journal articles. MedlinePlus also has extensive information about drugs, an illustrated medical encyclopedia, interactive patient tutorials, and latest health news.

To use an example, having returned from the emergency department after having a kidney stone, our hypothetical patient from part 1 would see the following after searching for "kidney stones" on MedlinePlus:
The search results are divided into topics, including kidney stones, bladder diseases, and other diseases of the kidney. The section on "kidney stones" has a large amount of information (which some patients might find overwhelming). Links include patient information from the National Institutes of Diabetes & Digestive & Kidney Diseases, the American Medical Association, the American Urological Association, and many other sources.

Also included is a link to Clinicaltrials.gov -- this site, created by the National Library of Medicine, is a search engine for federally and privately supported clinical trials, and is the best place to go to answer the question, "What research trials are being done on this particular disease?" (At some time in the future, I'll write a post on Clinicaltrials.gov; it's a useful and underutilized resource.)

Finally, another possible source for medical information is the web pages of individual physicians. Services like Google Page Creator now make it easy for health care providers (or anyone, for that matter) to create simple websites inexpensively or for free, no programming knowledge required. For example, on my website, I've created a page linking to information on kidney disease. This links to another page which lists types of kidney diseases, which includes information on kidney stones and this link that I've chosen from the National Institutes of Health. Dr. Ves Dimov talks further about using Google Page Creator on the Clinical Cases and Images blog.

Part 3 will look at more useful sources of health information online.

Labels: clinical trials, healthline, medical informatics, medicine, medlineplus

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Searching for Health Information Online (Part 1)

Unexpectedly, I was recently quoted in this year's Google Annual Report (page 3) on searching the medical literature. The quote was based on an interview I gave to the Google Scholar Blog where I mused about the ease of finding health information on the Internet using Google Scholar and other tools.

Also recently, a patient remarked that "On the Internet, you're always a few clicks away from certain death." He had searched online for his diagnosis and found a wealth of information, but he quickly realized that much of it was irrelevant, unduly alarming, or just plain wrong.

So I've been thinking a lot lately about health information on the Net. This series of posts will examine various ways that both patients and physicians can find reputable medical information online. To be clear: I'm not a medical librarian or a professional researcher, and this review will not be comprehensive, but it will touch upon some of my favorite methods of finding health information on the Internet.

Take kidney stones as an example. You're a patient, you've just spent most of the day in the emergency department in excruciating pain with your first kidney stone, and you come home and sit in front of your computer looking for more information. Where do you look?

A number of sites offer customized search engines which link to other websites carefully chosen to have reliable medical information. Healthline is one example of these specialized medical search engines and is certainly one of the best. (Full disclosure: I proudly blog here and consult for them.) Typing "kidney stones" in the search box on Healthline, our hypothetical patient receives a list of resources on kidney stones including an article on kidney stones reviewed by a physician, an entry on kidney stones in a medical encyclopedia, as well as information on kidney stones from outside sources including the Mayo Clinic.


In addition, glancing at the top of the page reveals "Search Ideas" -- these options include ways of broadening and refining the search, and also include a feature unique to Healthline called "HealthMaps."

A HealthMap, as I mentioned in a previous post on the value of mapping, is a visual representations of the epidemiology, diagnosis, and treatment of disease -- a "disease at a glance." Clicking on any of the components further refines the search to focus on that aspect of the disease. Clicking on "uric acid stones," for example, would automatically direct the patient to further information about that type of kidney stone.

More on searching for health information online in part 2.

Labels: healthline, medical informatics

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An Introduction to Medical Podcasts (Part 4)

In part 1, I briefly introduced podcasts and iTunes. In part 2, part 3, and in this post, I'll introduce some of my favorite medical podcasts. After logging in to the iTunes store, each of these podcasts can be found by typing the name of the podcast in the "Search iTunes Store" box in the upper right corner of the screen.


NPR (National Public Radio) "Your Health" podcast is an eclectic roundup of the best recent radio shows involving personal health and fitness. Recent topics have included monitoring food imports, pharmaceutical advertisements, restless legs syndrome, and autism.

Some stories in the NPR Health and Science podcast overlap with the "Your Health" podcast, but in addition to medical topics, it also includes items about science and space. Recent topics include states' role in funding stem cell research, sterilizing organ transplants, and efforts to control tuberculosis.

Science & the City is "The Webzine of the New York Academy of Sciences." Each week it features interviews and conversations with noted scientists and authors. Recent topics of interest have included professor Steven Pinker discussing the neurophysiology of the brain, conversations with the top competitors in the NYC Science and Engineering Fair, the science of bioluminescence, and an interview with Harriet Washington on "medical apartheid."

Sound Medicine is a high-quality, professional podcast produced by the Indiana University School of Medicine. Designed for a general audience, it's also interesting for health care professionals. Recent topics have included cell phones in hospitals, the neuroplasticity of the brain, tanning addiction, and medical tourism in Thailand.

More favorite podcasts can be found in this post on Kidney Notes.

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An Introduction to Medical Podcasts (Part 3)

In part 1, I briefly introduced podcasts and iTunes. In part 2 and in this post, I'll introduce some of my favorite medical podcasts. After logging in to the iTunes store, each of these podcasts can be found by typing the name of the podcast in the "Search iTunes Store" box in the upper right corner of the screen.


Mayo Clinic Medical Edge Radio is a professionally produced, non-technical discussion of common medical topics designed for a general audience. Recent topics include ear infections, depression as a brain disease, and the use of robots for urologic procedures.

NIH Research Radio is a twice monthly review of studies performed by and resources available from the National Institutes of Health. It's lively and relatively nontechnical. Recent topics have included using MRI to diagnose breast cancer, programs from the National Institute on Drug Abuse, and a visit to an NIH-funded clinical research center.

The New England Journal of Medicine produces two excellent podcasts each week. The first is NEJM This Week, a summary of the most recent issue of the NEJM. (For those who don't have time to look at the journal that week, the podcast provides an excellent alternative.) For example, this is a summary of the podcast for the week of April 12:

Featured are articles on optimal medical therapy with or without PCI for stable coronary disease, interleukin-1-receptor antagonist in type 2 diabetes mellitus, radiotherapy for glioblastoma in the elderly, inactivated poliovirus vaccine in Cuba, and retinal progenitor cells; a review article on strategies for safer liver surgery and partial liver transplantation; a case report of a man with neck pain, weakness in the arms, and cranial-nerve palsies; and Perspective articles on balancing disease prevention and economic development in China, on making smoking history worldwide, and on bridging the divide in diabetes treatment.

The second New England Journal of Medicine podcast is NEJM Interviews. These interviews with authors in the NEJM are detailed but accessible and are designed to appeal to both health care professionals and to a general audience. Recent topics have included tobacco control, tax-based health care proposals, and the U.S. market for human oocytes (human eggs).

The New York Times' Science Times podcast is a weekly highlight of articles in the Tuesday Science Times, and usually includes interviews with reporters or scientists on current topics. Recent podcasts have included an interview with a researcher who studies the neuroanatomy of love, medical ethics dilemmas, and an update on avian flu.

This "Introduction to Medical Podcasts" will conclude with part 4.

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An Introduction to Medical Podcasts (Part 2)

These posts are for two types of people: those who already own an iPod or other digital music player, are familiar with podcasts, and are interested in listening to new medical podcasts... and those who don't yet have an iPod and want a quick introduction to podcasts -- which, in my opinion, is a major reason to get one.


In Part 1, I briefly introduced podcasts and iTunes. In this section. I'll introduce some of my favorite medical podcasts. They vary widely. Some are technical and are designed for physicians and specialists; some are specifically designed to explain health issues to people with no medical background. I've included both types of podcasts to give a sense of the breadth available.

(All these podcasts can be easily found by typing the podcast name in the "Search iTunes Store" box in the upper right corner of the screen.)

ACC (American College of Cardiology) Conversations is a technical podcast designed primarily for cardiologists and other physicians interested in cardiovascular disease. Topics include the use of aspirin, cholesterol lowering medications, anti-hypertensives, and the implications of recent trials for the treatment and prevention of heart disease. The conversations are typically fast-paced, sharp, informative, and keep your attention. New podcasts are released every few months.

Every Monday, Jane Brody, the "Personal Health" columnist for the New York Times, releases the Health Update podcast. These are quick, focused, non-technical explanations of common medical issues. Recent podcast topics include communicating with physicians, concussions, and screening for Down Syndrome in pregnancy.

The Johns Hopkins Health News Podcast is a high-quality, entertaining round up of the week's medical news. Dr. Rick Lange, chief of clinical cardiology at Hopkins, and Elizabeth Tracey, director of the Hopkins Health NewsFeed, offer nontechnical commentary on the implications of current medical studies and recent news.

Listen to the Lancet is the podcast of the Lancet, a British medical journal. It includes lengthy, in-depth interviews with authors of recent articles in the journal. (The interviews vary in their technical nature.) Recent podcast topics include screening for cystic fibrosis, the nature of jet lag, and global efforts to control tuberculosis.

Introductions to more medical podcasts will follow in part 3.

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An Introduction to Medical Podcasts (Part 1)

This post is for two types of people: those who already own an iPod or other digital music player, are familiar with podcasts, and are interested in listening to new medical podcasts... and those who don't yet have an iPod and want a quick introduction to podcasts -- which, in my opinion, is a major reason to get one.

(Of course, you don't actually need an iPod to listen to podcasts -- but it certainly makes the morning commute easier. You can also listen to podcasts directly on iTunes, which can be downloaded for free here. More information below.)


Briefly, podcasts are digital media files -- similar to radio programs -- downloaded automatically from "feeds" set up by "content providers." (A longer introduction on Wikipedia is here.) The New York Times, National Public Radio, CNN, many major medical journals, and countless other individuals and organizations offer podcasts on a wide variety of topics, and all these podcasts can be easily subscribed to and automatically downloaded to your computer and iPod through iTunes. Since iTunes (Apple's digital media software) is available for both PC and Mac, and since the 1 gigabyte iPod shuffle is becoming less expensive ever year, listening to podcasts is now relatively easy. (While there are other digital music players and ways of listening to podcasts, the iPod and iTunes are unquestionably the simplest and most user friendly.)


Once you've downloaded iTunes, clicking on "iTunes Store" followed by "Podcasts" in the left sidebar will take you to the main podcast directory. (Even though podcasts are found in the iTunes "Store," the overwhelming majority are free.)

The world of podcasts on iTunes is divided into categories: Arts, Business, Education, etc. Choose "Science & Medicine." (This category is further subcategorized into Natural Sciences, Social Sciences, and Medicine.) Like most things Mac, iTunes presents possibilities in an intuitive way, and the next window of medical podcasts is divided into "New and Notable," "Featured," and "Top [Most Popular] Podcasts."

Look around to see what's available. I'll recommend some of my favorite medical podcasts next week.

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The Value of Mind Mapping

Mapping is one way of visualizing ideas. (For a sense of how many ways there are, see "A Periodic Table of Visualization Methods.") Maps are most commonly used as graphical and textual representations of geographic data, but they may also be used to help teach and understand concepts.


When teaching medicine to other physicians and students (as well as patients), it's helpful to have new tricks up your sleeve -- because it's easy for an audience to become numb to the quantity, complexity, and non-intuitiveness of medical information. Mapping is one of these tricks. Instead of presenting ideas in the form of an outline, or a list, or a PowerPoint slide, ideas are presented as a hierarchical growing web of interconnected thoughts.


Mind Mapping, a term coined by Tony Buzan, refers to a brainstorming and learning technique where a central concept is linked to surrounding ideas, typically with the liberal use of colors, images, and connections.

While "mind mapping" refers to a specific technique, it it also sometimes used loosely to refer to diagrams with networks of concepts. (There is some overlap with flowcharts.) Examples of this idea are Healthline's "HealthMaps" which are visual representations of the components of the epidemiology, diagnosis, and treatment of disease. (A HealthMap of diabetes mellitus is below.)


Software to create mind maps is available. MindManager, by Mindjet software, is one popular program for the creation of mind maps, flowcharts, organizational charts, and other visual diagrams of ideas.

To illustrate the potential of MindManger, below is a teaching map outlining many options in the workup of high blood pressure (previously posted to kidneynotes.com).


Finally, a free alternative to MindManager is bubbl.us, which also allows the sharing and collaborative creation of maps online.

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Notes on the Technology Entertainment Design (TED) Conference

The Technology Entertainment Design Conference -- or TED -- is a 4 day meeting of 50 brilliant speakers from a wide range of fields. In the words of David Pogue, a technology columnist at the New York Times:

They are the most compelling, passionate, informed speakers you’ve ever heard (all right, maybe 45 of them are). Some bring back reports from the edge of medicine, archaeology, nanotech, neurology, psychiatry or the Web... But a good number of them bring you face to face with some of the most upsetting realities of human existence.

Pogue is not a writer who praises lightly, and he's right -- the lectures are fantastic. I haven't yet listened to all of them, but to give you a sense of the topics, here are brief introductions to a few I've seen:

Hans Rosling is a professor of international health at Sweden's Karolinska Institute, and founder of Gapminder, a way of visualizing differences in health, economics, and demographics of nations. It's an astonishing look at the differences between the "developed" and "developing" world. You've never seen information presented this way before.

Larry Brilliant is an epidemiologist who was a major force in the World Health Organization's effort to eradicate smallpox. He talks about his background, smallpox, and using information technology to help fight disease.

Helen Fisher is an anthropologist who discusses gender differences and the biochemical foundation of love.

Richard Dawkins, a biologist, is an author and the Oxford professor for the public understanding of science. He discusses the "strangeness" of science and why human brains may not be able to understand the universe.

Steven Levitt wrote Freakonomics. He talks about the economics of an inner city gang.

Eva Vertes, a student at Princeton, discusses new ways of thinking about the treatment of cancer.

A. Degrey talks about aging as an "engineering problem."

Ray Kurzweil, a futurist at MIT, discusses the accelerating development of new technologies and how they change humanity.

Bjorn Lomborg, an economist, talks about ways of prioritizing the world's biggest problems, and lists AIDS prevention at the top.

Steve Johnson, author of the Ghost Map, talks about Dr. John Snow's identification of the source of the cholera outbreak in London in 1854 and the implications for public health.

Many more lectures are posted here.

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Grand Rounds is up at Urostream

Urostream is written by Keagirl, a urologist. She writes well, and her stories are often provocative and humorous. Her Grand Rounds is here. (She included my post on "The Use and Misuse of Automatic Blood Pressure Monitors.")

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Creating DNA Art

DNA stands for "deoxyribonucleic acid," the substance encoding the genetic instructions for living organisms. As DNA is the basic code of life, it is perhaps not surprising that artists have incorporated DNA into their work. One company, DNA 11, even offers prints (suitable for framing) of individualized "DNA portraits." In this post, I'll review the products offered by DNA 11 and describe methods for creating do-it-yourself DNA artworks.

If you Google "DNA Art," the first site on the list is DNA 11. They offer high quality prints of abstract representations of DNA in customized color schemes and sizes. A sample print (in the "infrared mirror" color scheme) is on the right.

Put simply, here's how it works. DNA 11 sends you a kit with instructions for swabbing the inside of your cheek for skin cells. The DNA in these cells is then cleaved at different parts using "restriction enzymes." Each person has a different sequence of DNA and will therefore have fragments of DNA of unique lengths. These fragments are placed on a gel, an electrical current is applied, and the fragments migrate to different parts of the gel. An animation of this process, called "gel electrophoresis," is here. The gel is then photographed, digitally enhanced and colorized, and printed on a high quality canvas. The result is beautiful, but expensive. (For more discussion of DNA 11, see the blog "easternblot.")

For those interested in creating their own visualizations of DNA, alternatives are available. Edward Weiss at the Center of Applied Genomics in Toronto will run a gel electrophoresis on DNA samples for minimal cost and mail back a high resolution image file. Detailed instructions and a description of the process can be found in the guide, "DNA Art on the Cheap."

A third method uses an image of DNA that is often already available: a karyotype. This is a photograph of the (usually) 23 pairs of human chromosomes displayed in a standard, numbered format. Karyotypes are performed for many reasons, but commonly, they are performed as part of an amniocentesis to identify chromosomal abnormalities such as Down Syndrome in the developing fetus. A normal karyotype is displayed on the right.

If an amniocentesis has been performed, the image of the karyotype should be available from the performing hospital's Department of Obstetrics & Gynecology or Division of Medical Genetics. Procedures for requesting records vary, so check with your institution. This may be an unusual request for them, so it goes without saying: ask nicely.

After the karyotype has been received, the next step is to scan it into a digital file (assuming it isn't already in digital format). Detailed instructions on how to manipulate and add color to the image are beyond the scope of this post, but the following are examples of a karyotype that has been colorized using Adobe Photoshop Elements. Options for adding color include changing the gradient, adjusting the color using color variation, and using a filter (in this case, glowing edges). The resulting images can then be uploaded to a site like Kodak Gallery, printed, and framed.

They make great gifts.





Digg this!

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