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Joshua Schwimmer, MD, FACP, FASNTechnology in Medicine
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Hilarious Journal Articles and NCBI ROFL

Joshua Schwimmer, MD, FACP, FASN

A live frog levitates inside the Ø32mm vertica...Levitating Frog, Image via Wikipedia

Two years ago, I began collecting "hilarious journal articles" and posting them on kidneynotes.com. Here's a sample:
At last count, I had collected 98 articles. If you're interested, you can peruse the entire collection at delicious.com.

(Please note that sometimes these articles are about conditions that are deadly serious, and my intention is not to make fun of anyone, but to show appreciation for humor in scientific writing, which is often dry.)

Hilarious journal articles even have their own awards: the Ig Nobel Prizes, which has been presented at Harvard since 1991. You'll find the complete collection of prize winners here.

And since January of 2009, two Molecular and Cell Biology graduate students at UC Berkeley have written a blog devoted entirely to squirt-milk-out-your-nose grade scientific research. Their website is NCBI ROFL, which stands for National Center for Biotechnology Information — creators of PubMed, where most of the abstracts are published — Rolling On The Floor Laughing.

It's outstanding. Go have a look.

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Information Overload, the Index Medicus, and PubMed

Joshua Schwimmer, MD, FACP, FASN

index medicusImage by Nuevo Anden via Flickr

The growth of medical knowledge is difficult to visualize. One classic representation is the Index Medicus — a comprehensive index of medical journal articles — whose bound copies filled the shelves of medical libraries for 125 years. In 2004, however, the National Library of Medicine decided to stop publishing the Index. The first reason was practical: the Index Medicus had grown from 82 pounds in 1985 to an estimated 152 pounds in 2004. The second and more important reason was the widespread availability of the search engine PubMed — an electronic database of medical literature available for free via the Internet — which made the printed index obsolete. Compared to the Index Medicus, PubMed was more convenient, could be searched more easily, could be updated more quickly, and certainly weighed less. Copies of the Index Medicus are now a historical curiosity; many physicians now search the medical literature exclusively through PubMed.

The story of the Index Medicus and its successor, PubMed, illustrates three ideas.

First, the quantity of new medical information is more than any single physician can absorb, and keeping up to date with this expanding body of knowledge is challenging. As of April 2009, for example, PubMed contained information on 18,782,970 citations in the medical literature and was adding over 670,000 new entries per year. Doctors must not only absorb this flood of new ideas about treating, diagnosing, preventing, and understanding disease — deciding which information is relevant and which is not — but also learn how to apply and explain this knowledge to the patient sitting with them in the exam room or laying ill in a hospital bed.

Second, in parallel with this unprecedented expansion in medical knowledge, new media and technologies have emerged — of which PubMed is one example — which has made the task of searching, organizing, and retrieving relevant information easier. Potential sources of information for physicians include not only printed journal articles like those indexed in PubMed, but lectures, case conferences, and newer Internet resources such as reference tools (e.g., UpToDate), discussion groups, online expert systems, clinical resource tools, and podcasts.

Third, the expansion of medical information and proliferation of new technologies has required physicians to develop new skills and strategies to keep their knowledge current. Often, the availability of new knowledge overwhelms physicians’ ability to process it, a condition known as information overload. In physician’s offices, one symptom of information overload is the common spectacle of unread piles of medical journals stacked up on every available horizontal space.

While many medical schools now require classes on searching the medical literature and evidence-based medicine, few resources have been available designed to teach physicians how to learn and practice medicine more efficiently. (That's why, over two years ago, I started writing The Efficient MD blog.)

Since then, I'm glad to report that online resources for physicians have proliferated. Ways of improving efficiency and reducing information overload are now common topics on medical blogs. For example, see recents posts in Life in the Fast Lane, Clinical Cases and Images, and Musings of a Distractible Mind.

Thanks for reading!

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(Much appreciation to Jacque-Lynne Schulman, Stephen Greenberg, Margaret Vugrin, and Dean Giustini for helping me with an updated estimate of the weight of the Index Medicus. Any inaccuracies in this post are, of course, my own.)
(This post is also published on The Efficient MD blog.)

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Case Study of a Physician's Use of the iPhone 3GS (Part 1)

Joshua Schwimmer, MD, FACP, FASN
I recently upgraded my original iPhone, which I purchased two years ago, to the iPhone 3GS. Truthfully, I wasn't expecting much of a change. Sure, I read the marketing hype — faster processor! 3G speed! GPS! voice control! better camera! — but I didn't expect the new model to make much of a difference in my daily clinical practice as a nephrologist.

Boy, was I wrong. I've been using the 3GS so much that by the end of the day, I've not only burned through the iPhone's battery, but I often burn through the external battery in my Mophie Juice Pack Air case as well. (I highly recommend the Mophie, by the way, which removes a subtle disincentive to using the device because you're worried you may run out of battery life.)


The following is a multi-part description of my own use of the iPhone 3GS. In my experience, the best way to learn to use a new gadget is to look over the shoulders of others, watch how they use it, ask lots of questions, and experiment constantly. (Most iPhone owners are familiar with the phenomenon of having someone grab their phone, scroll through the applications they have installed and ask, "What's that one do?")

So if you have an iPhone, and are a health care professional or patient, this will hopefully be helpful. Even if you don't have an iPhone, some of the applications I describe are available for other PDAs — or they soon will be, since the iPhone has significantly raised the bar for what a mobile device can accomplish.

(Original drafts of these posts were written on the iPhone app BlogPress.)

(This post also appears on The Efficient MD.)

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Medical Apps for the iPhone: Diagnosaurus, ICD9 Consult, and WellAdult

Joshua Schwimmer, MD, FACP, FASN
As of this writing, there are over 400 medical applications in the iTunes App Store. Whether you're a health care provider or patient, and whether you have an iPhone or iPod Touch or not, it's worth exploring the impressive range of applications available for this new mobile platform. (Later this year, when iPhone 3.0 is introduced, these applications will be able to interact directly with compatible medical devices, like glucometers and blood pressure monitors.) Here's a brief introduction to three medical apps in the iTunes App Store.

Diagnosaurus. Many medical specialties—and Internal Medicine in particular—require working through a "differential" of possible causes of  a patient's clinical presentation. Diagnosaurus ($.99) provides a polished interface for searching differential diagnoses for over 1000 conditions, divided by organ systems, symptoms, and diseases. As a bonus, at the end of each list is provided a list of links to related differentials. For example, "acute hepatiis" and "cholestatis" are listed at the end of "AST/ALT increased." Much like Wikipedia, you can spent half an hour browsing and clicking through links. For $.99, it's a steal.

ICD9 Consult. Health care providers must frequently scramble to come up with ICD9 codes for unusual or complex diagnoses in order to bill appropriately. ICD9 Consult ($29.99) is an excellent solution for those moments when you don't have time to consult a thick book or spend time seaching online for the right code. It allows you to easily search through the different codes or browse by type of disorder (infections, circulatory, respiratory, etc.) or procedure. At $29.99, it's not cheap, but if it saves you enough time, it's worth it.

WellAdult. The guidelines for optional clinical preventive services for adults—when to perform cholesterol tests or colonoscopies, for example—are scattered among many different expert organizations and are sometimes contradictory. WellAdult ($2.99) provides an easily navigatable database of recommendations from all major organizations for adults of different ages. Click on "Women Ages 50 - 64," for example, and you can easily compare the reommendations of different organizations for testing lipids, blood pressure, vaccinations, and cancer screening. For $2.99, this app is well worth it.

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Dealing with Information Overload

Joshua Schwimmer, MD, FACP, FASN
Information overload is an occupational hazard of practicing medicine, especially if you spend time online. There's too much potentially useful stuff out there for one person to process effectively: journals, news sites, RSS feeds, wikis, blogs, webinars, Flickr, Facebook groups, CME courses, Google alerts... And don't get me started on Twitter.

Two of my favorite medical bloggers—Bertalan Meskó from ScienceRoll and Dr. Ves Dimov from Clinical Cases & Images—recently shared their methods for dealing with information overload.



Clinical Cases & Images uses Twitter innovatively, to share interesting items from his feed reader, which he then aggregates into blog posts: "Health News of the Day," for example, and "Selection of My Twitter Favorites." (What's Twitter? Twitter is an instant messaging service, a microblog, a social networking phenomenon, a chatroom, the best crowdsourcing utility ever invented, or a colossal waste of time — depending on who you ask.) Ves also discusses using Google Reader, Google Bookmarks, and shares his backup strategies.

Bertalan Meskó from ScienceRoll writes about using Tweetdeck to filter the 1000 (!) users he follows on Twitter. He also uses Friendfeed and the "best of the day" feature to identify interesting discussions. He mentions Microplaza, Twilerts, and Tweetbeep—three services I've never heard of—to filter out interesting discussions and posts. Bertalan also uses Google Alerts—of which I'm a great fan—to track any content published about him or other topics of interest. He ends with my Life Hacks for Doctors presentation, which has received more than 10,000 views to date. (w00t.)


What strategies and resources do you use to deal with information overload?

(Also posted on The Efficient MD.)

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