Feed Reading, Three Ways (Part 2)

This is a series on how to read feeds more efficiently. (This is part two. Part one is here.)

To start, here are some initial questions to ask about any feed to which you're thinking of subscribing: "How important is this? Is this something I want to read every day? Is this website of sufficiently high importance and/or quality that I don't want to miss a single post?"

If you answer "Yes" to these questions, then the best way to read the feed is probably by email. (This is the first way of reading feeds that I'll discuss.) This might be counterintuitive (or even controversial). After all, isn't the purpose of feeds to provide a stream of information apart from the website itself and apart from your regular correspondence?

All true, but email remains the best way of ensuring that everything gets to you and nothing is lost. (And if you use gmail, forwarding feeds to email also ensure that all your feed content is forever archived and searchable).

However, reading feeds by email is also mixed blessing. If you aren't careful, feeds will clog up your inbox and you might become frustrated and not read them at all. Choose the feeds you read by email carefully.

My personal favorite service for converting RSS feeds to email is Feedburner -- it's fast, reliable, and the formatting is usually perfect. Certain websites, like BoingBoing, offer the option to subscribe by email through Feedburner on the main page. Other websites, like Tech Medicine, Kidney Notes, and The Efficient MD, also offer links to subscriptions by email. Most services like Feedburner offer the option to subscribe to the feed as a digest (one large, daily email of all posts) or as individualized emails. (I usually prefer the digest format.)

But what if the website doesn't offer the option to subscribe by email? Feedburner, as far as I know, doesn't allow you to subscribe by email unless the website allows it, but other services are available. Two popular services as Rssfwd and Feedblitz. After copying and pasting the feed's address, each website will then deliver the feeds to you by email. Rssfwd even offers a bookmark that you can place in your browser that allows you to automatically subscribe to the websites you visit. (I personally prefer Rssfwd to Feedblitz because the formatting on the iPhone is better.)

For medical news, two feeds that I subscribe to by email are Kevin, MD and The Wall Street Journal Health Blog. Non-medical sites that I subscribe to include Boing Boing and The Secret Diary of Steve Jobs.

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Home Hemodialysis

Hemodialysis is a process of cleaning and filtering the blood using a dialysis machine (a "man made kidney"). For people with renal failure, dialysis is lifesaving. (This posting will only discuss hemodialysis. Peritoneal dialysis is another form of dialysis that works equally well.)

Previously, hemodialysis was only performed in dialysis centers. Typically, dialysis centers are large rooms with twenty or more dialysis machines, nurses, technicians, doctors, and other staff. In the United States, patients usually travel to these centers three times a week and spend three to four hours per dialysis session.

In the last few years, hemodialysis performed at home has become more popular. Dialysis machines were previously large and difficult to transport. Recently, these machines have become more compact, making dialysis at home (or even mobile dialysis) more practical.

Home hemodialysis also offers more flexible treatment options than "in-center" dialysis. In addition to three times a week dialysis for three to four hours, other options include

• short daily dialysis, five or six times a week, for two to three hours a session
• nocturnal dialysis, performed while sleeping, for six to eight hours a night, three or more nights a week

Some data suggests that patient outcomes may be better with daily dialysis and nocturnal dialysis compared with three times a week dialysis.

The NxStage System One is an example of a compact, portable, easy to use home dialysis machine. The machine weighs about 75 pounds. More information may be found here.

Related Information: Kidney Replacement Therapies

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Review of Sandy (iwantsandy.com), An Online Personal Assistant

Okay, let's say you already have a calendar, a to-do list (or perhaps multiple to-do lists organized by context), and a watch with an alarm -- why might you want to use Sandy (www.iwantsandy.com), a new online personal assistant?

Sandy's goal is to replace all those other life-organizing technologies. And while there are plenty of imperfections, she/it does the job remarkably well. And for free.

Here are some illustrations to show you how it works. Let's say you need to take a medication twice daily, at 9 am and 5 pm. One option is to put it on your calender with an alarm, or set your watch alarm to 9 am to 5 pm, or put it on a daily to-do list.

Alternatively, you could email Sandy the following:

remind me to take medication at 9am @daily
remind me to take medication at 5pm @daily
[experienced users could shorten this to "r take medication 5pm @daily"]

Every day, at 9 am and 5 pm, Sandy would then text message your mobile phone and/or email you to remind you to take your medication. (Initially, Sandy sends you a confirmation email with an ical attachment so the reminder could also be imported into most calendar programs.)

Another example. Let's say you're a physician, and John Smith is having a chest xray that you'd like to follow up on tomorrow. No problem. Email Sandy, "remind me to check JS cxr tomorrow at noon", and you're done. (Of course, remember to be careful about HIPAA privacy issues.)

And what if Sandy contacts you tomorrow at noon but you're too busy to check the xray at that time? Simply reply to her email with "snooze two hours" and she'll contact you again two hours later.

Sandy can also understand your voice by integrating with Jott.com, a service which converts spoken words to email. Let's say you're on your mobile phone and a colleague tells you about a meeting you have to attend tomorrow at 3pm. You're walking quickly and don't want to slow down, so you call Jott's toll-free number and have this conversation:

"Who do you want to Jott?"
"Sandy"
"Sandy. Is that correct?"
"Yes."
BEEP.
"Remind me about meeting tomorrow at 3pm."

And that's it. Sandy/Jott will email you a confirmation to ensure that they've heard you correctly (which in my experience, is practically 100% of the time), and then tomorrow before 3pm, you'll receive a text message reminding you about the meeting.

Sandy is also aimed at fans of David Allen's "Getting Things Done" methodology, as reminders can be extensively tagged by context. For example, if you needed to shop for a book for your friend Lucy's birthday either on Amazon.com or in a bookstore, you could email Sandy, "remind me to buy book for Lucy @todo @amazon @errand @bookstore @computer".

If you happen to be on Amazon.com, you could email Sandy, "lookup amazon", and she'll remind you about everything that you might want to purchase on Amazon, including Lucy's book.

Many online systems for GTD already exist. What makes Sandy interesting is that it has the potential, more than the others, to integrate a web interface, email, voice, calendars, and to do lists with a sophisticated reminder and tagging system that understands conversational English.

Currently, my to-do lists are either notes on the iPhone's notepad (@outside, @hospital) or are online in Gmail. (I use customized labels and filters in Gmail -- @office, @priority1, @timehigh, @toreply, etc. -- to organize both my emails and to-do lists. For more information on using Gmail to organize to-do lists, see here.)

Sandy is great for sending yourself reminders on-the-fly, but I'm not yet ready to use the service to manage my to-do lists. Compared with Gmail -- or with lists you create in a notepad or in a word processor -- Sandy is much slower and clunkier. The web interface, in particular, makes tagging and searching for multiple tags cumbersome. As far as I can tell, for example, you can't easily search for "@office @timehigh @priority1". Even so, I'm amazed by how well Sandy works for reminders, and I fully expect the web interface will improve with time.

Try it for yourself. It's a great product, and Sandy has the potential to become the most popular organizational system on the web.

(Also posted on The Efficient MD.)

Labels: gmail, iwantsandy, jott, personal assistant, sandy

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Thanks to Dr. Anonymous for Grand Rounds

Grand Rounds, this week's best posts of the medical blogosphere, is up at Doctor Anonymous. Thanks for including my post on handwashing.

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Feed Reading, Three Ways (Part 1)

Here's a simple version of the story of feeds.

First, the Internet had too much information. Then, RSS feeds came along, which were designed to reduce the torrent of information from the Internet into something more manageable. RSS feeds (or just "feeds") are simplified streams of information from websites: just the headlines, or if you want, the full text. No longer would you have to individually visit each site to read new content. By subscribing to the site's feed with an "feed reader," the content would now come to you. Quoting Wikipedia:

RSS is a family of Web feed formats used to publish frequently updated content such as blog entries, news headlines or podcasts. An RSS document, which is called a "feed," "web feed," or "channel," contains either a summary of content from an associated web site or the full text. RSS makes it possible for people to keep up with their favorite web sites in an automated manner that's easier than checking them manually.

RSS content can be read using software called an "RSS reader," "feed reader" or an "aggregator." The user subscribes to a feed by entering the feed's link into the reader or by clicking an RSS icon in a browser that initiates the subscription process. The reader checks the user's subscribed feeds regularly for new content, downloading any updates that it finds.

All good. But then, websites with useful information proliferated -- news, medical information, blogs -- and they all published feeds. And the feeds proliferated. And different feed readers also proliferated, each with their own advantages and disadvantages, some online (like Google Reader), some integrated with web browsers (like Firefox), and some standalone applications (like NewsGator).

And then, there were too many feeds. Even with feed readers, it seems impossible to keep up with all the potentially important information that's out there. Feeds, that were initially designed to solve the problem of information overload, have actually contributed to the problem because they're too easy to subscribe to and read.

Here's one solution. In the following sections, I'll propose three methods of reading feeds using three different systems: Google Reader, Email, and Netvibes. Each of these methods is appropriate in different situations. And together, they can make the torrent of information from feeds manageable again.

(Also posted on The Efficient MD.)

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Thoughts on Handwashing, MRSA, and C. Difficile Colitis

Here are some recent thoughts on handwashing, MRSA, and C. Difficile. (I know -- handwashing is low-tech -- but it's absolutely critical for infection control.)

I recently cared for two patients with methicillin resistant Staphlococcal aureus (MRSA) infections. Both had acquired these infections from the community, not from a hospital. Ten years ago, this would have been unusual -- as most MRSA infections were picked up in the hospital, often related to lack of handwashing -- but now MRSA infections in the community are common.

What was unusual was the MRSA patients' response. Recently, the press has been filled with stories of killer MRSA infections contracted by otherwise healthy people. One of the patients initially acted as if he was diagnosed with AIDS. Both were worried they would transmit the infection to family or friends. They worried they would be shunned by their communities if word got out they had the bacteria.

Providing reassurance was difficult.

Also recently, Donald Landry, Acting Chair of Medicine at Columbia, emailed an essay on handwashing. His conclusion: "We must surrender." These words were thoughtfully chosen. They imply that no alternatives to or arguments against handwashing exist. It's a behavioral change. And it must happen.

For hospitalized patients, I routinely use an alcohol based hand rub before and after the physical exam. (To be absolutely honest, like most health care providers, I have had difficulty complying 100% of the time. But I'm trying.) Previously, I felt that the alcohol-based sanitizer alone was adequate -- and it probably is -- but recently I've become aware that alcohol-based hand sanitizers do not kill C. Difficile -- a major cause of colitis -- as well as soap and water.

So as an experiment, in the last few weeks I've taken a different approach. This routine has more steps, but surprisingly, seems easier. For hospitalized patients, this has become my routine:

• Wash with alcohol-based hand sanitizer (from a dispenser outside patient's room)
• Put on non-latex examining gloves (usually from a box in patient's room)
• Examine patient
• Discard gloves
• Wash again with alcohol-based hand sanitizer

This might seem like overkill, but I've personally found that I'm more compliant with this handwashing routine. Having to think about whether to wash your hands makes it less likely that it will actually happen. But creating a routine that you're comfortable with takes the thinking out of it, and therefore it just gets done, every time.

And the combination of wearing gloves and handwashing at least provides some additional reassurance that I'm doing everything I can to prevent the spread of MRSA, C. Difficile, and other infections.

As Landry's essay discusses, this is a difficult issue for both health care providers (and patients!). Comments are welcome.

(Also posted on The Efficient MD.)

Labels: clostridium difficile, handwashing, mrsa

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10,000 Steps and Digital Pedometers

Most people find it difficult to make time to exercise, but exercising -- or at least, avoiding being sedentary -- is essential for weight loss and overall health. When I counsel patients on weight loss, I initially recommend small incremental changes, like not snacking between meals and walking for 30 minutes a day. I recommend small steps mainly because, for many people, they are more likely to result in sustained behavioral changes than dramatic lifestyle alterations. (Of course, for some people, more dramatic lifestyle changes may be more effective.)

For those who can't commit to walking 30 minutes a day, an alternative is to target 10,000 steps. (This is roughly equivalent to half an hour of walking). Since counting the steps yourself is impractical even for the truly obsessive, the best way to target 10,000 steps a day is to use a pedometer. From Wikipedia:

The Romans used an hodometer calibrated to steps to measure distances for military and civil purposes, though technically this is not a step counter. Leonardo Da Vinci envisioned a mechanical pedometer as a device with military applications. Later it was introduced to the Americas by Thomas Jefferson. In more recent times the device has been popularized in Japan as the manpo-meter by Y. Hatano.

Recently, I've tried the Omron Walking Style Pedometer (pictured above), which retails for about $20. While many pedometers require that you clip the pedometer to your belt, the Omron Walking Style also allows you to carry it in a pocket or bag. And it's tiny. Other useful features include a 7 day memory, mileage and calorie conversion, and a setting which allows you display the total amount and time of aerobic walking (not just, say, the amount of steps taken walking around the office).

For example, these are my readings for today, a typical work day, which included a walk from the office to the hospital:

• 13,196 steps
• 2733 "aerobic steps" for 24 minutes
• 320 kilocalories
• 2.91 miles

I'm very satisfied with the Omron and I'll be recommending this model pedometer to my patients.

More on Pedometers:

Shake Up America
10,000 Steps (Time Magazine)

Labels: fitness, pedometers

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