UBC Google Scholar Blog is Going on Hiatus

UBC Academic Search - Google Scholar Blog was the place to go for updates and insights on how medical librarians, physicians and patients are using search engines to sort out the staggering amount of information on the web. Now, Dean Giustini, the blog author is putting the site on hiatus for at least a year:

UBC Google scholar blog is going on hiatus. Well, let's just call it a sabbatical. As of January 2007, a sign will go up saying Gone fishing - see you in 2008. I am going to be immersing myself in learning theory for my 2007 sabbatical, and that means I won't be tracking trends in search. What will happen to GS blog? What about the wiki? All good questions.

I am pondering what to do next. Will I return here? Time will tell.

Last December, Dean wrote an interesting editorial for BMJ: How Google is changing medicine. He also interviewed several physician bloggers (including me) a few months ago.

I am not the only one waiting for Dean to start blogging again and that's why I will stay subscribed in Bloglines.

Update 01/29/2008:

Dean is blogging again.

References:
Physician Bloggers Talk to a Medical Librarian
BMJ: Build Google Medicine
Image source: UBC Academic Search - Google Scholar Blog

Updated: 01/29/2008

Free Audio and Video Podcasts for Health Professionals by Cleveland Clinic

Several months ago, Cleveland Clinic launched a video podcast for patients called HealthEdge. The next logical step was to have a similar service for health professionals.

Cleveland Clinic Center for Continuous Medical Educations now features free audio and video podcasts. The series starts with the Sessions from the 18th Annual Intensive Review of Internal Medicine. You can either listen/view podcasts online or subscribe with iTunes.

References:
Video Podcasts by The Cleveland Clinic
Cleveland Clinic Health Edge on Google Video
Cleveland Clinic Offers New Podcasts
Image source: Cleveland Clinic

RSS "Feeds That Matter"

So many feeds to read, so little time... Which are the good ones? There is a "proof-of-concept" website which helps you quickly browse the feeds which many people have already chosen.

Feeds That Matter is a tag cloud which lists the top 100 most popular RSS feeds by topic, for example, "health", "Google", "business", etc.

The tag cloud combines data from Bloglines users who chose to make their subscription choices public:

"There are about 83,000 publicly listed users on Bloglines and they have a combined 2,786,687 feed subscriptions. Roughly 35% of these publicly listed users organize their feeds into folders. On an average there are about 20 feeds per folder. By analyzing this data and combining merging folders that are very similar, we have come up with an automatic way of creating a taxonomy of popular topics and make it easy to find feeds that are most relevant to that topic."

Established media (Reuters, BBC, NYTimes, ABC) tops the list of the most popular "health" feeds but quite a few blogs are also present: Kevin, MD, Medpundit, The Health Care Blog, etc. Clinical Cases and Images - Blog (barely) makes the top 100 list at number 88. My blog rating jumps to number 15 in the list of medical feeds though. You can check your own blog rating, just for the fun of it.

Link via LifeHacker.com.

Should we use ACEi or ARBs for prevention of renal failure in patients with hypertension or diabetes?

Diabetes mellitus (DM) and hypertension (HTN) increase the risk for development of chronic kidney disease (CKD). Type 2 diabetes (DM 2) is the biggest single cause of ESRD in the United States which is reflected in the mnemonic for differential diagnosis of CKD.

Should we use ACE inhibitors (ACEi) or Angiotensin II Receptor Blockers (ARBs) for prevention of CKD in patients with HTN and/or DM?

According to UpToDate (subscription required):

ARBs have similar antiproteinuric activity as ACEi but it should not be assumed that ARBs are equivalent to ACEi. A medication from either group should be used in proteinuric nondiabetic kidney disease, although the strength of evidence favors the use of an ACEi.

Summary: ACEi is the medication of choice to prevent progression of CKD in HTN.

How about patients with DM?

Again, according to another UpToDate review:

The authors prefer initiating therapy with ACEi inhibitor in DM 1 nephropathy and either ACEi or ARBs in DM2 nephropathy.

Summary: Either ACEi or ARB can be used to prevent progression of CKD in DM 2. I would still prefer ACEi since they have been on the market longer and are generally less expensive due to the fact that generics are available.

References:
Prevention of the Development and Progression of Renal Disease. J Am Soc Nephrol 14:S144-S147, 2003 (free full text).
Antihypertensive therapy and progression of chronic kidney disease. UpToDate (subscription required).
Treatment and prevention of diabetic nephropathy. UpToDate (subscription required).
ACEi and ARBs links and images are from Wikipedia.

Executive Health Physicals. Are They Worth $ 3,000?

According to Forbes: "A sick CEO is bad for the company's health... executives who had a physical exam lost 45% fewer workdays than those who did not... generally executive health physicals cost between $1,000 and $3,000."

Cleveland Clinic, Mayo Clinic, Duke University and Mount Sinai all have executive health programs. I know personally 2 of the physicians who work in the Clinic program and they are excellent.



What you can expect on during your Executive Health Assessment - Cleveland Clinic video.

References:
Not So Routine Physicals. Forbes.com.
Welcome to Executive Health. Cleveland Clinic.com.

Complete List of Medical Abbreviations and Acronyms

"He had CP and SOB, was diagnosed w NSTEMI, had a PCI and is now in MICU."

Whether you like or not, medical jargon is part of health care. Years ago, before I started my clinical rotations, I assembled a comprehensive list of all medical abbreviations I could find and memorized them by heart. It may sound strange but I actually liked using them. Also, for a short while, I was known as the "mnemonics guy" since (due to lack of other ideas how to better spend my time) I had made up about 800 mnemonics. Abbreviations and acronyms are sort of mnemonics, they save time and... create confusion. Pretty much everybody who works in health care knows CHF and COPD but how about AOCD (anemia of chronic disease)?

When I started ClinicalCases.org (an online case-based curriculum of clinical medicine), I deliberately decided to use a lot of abbreviations. Why? Because this is how the real medicine looks like in patient charts. You have to know that "WNL" means within normal limits, otherwise you may never figure out what the note is about. Now, with EHR (electronic health records) and medical coding, the art of medical acronyms may come to an end. Computer-generated notes (with some human input) are infamously verbose, often with amazingly little substance. Who needs to write "WD/WN in NAD" when the computer lavishly puts "well-developed and well-nourished in no apparent distress"?

Every now and then, international readers of ClinicalCases.org ask what the different abbreviations in case descriptions mean. This is a link to a very detailed Wikipedia page which lists almost every medical acronym and abbreviation known to human kind. And the beauty of the wiki system is that if you find one which is not listed there, you can add it yourself.

Don't forget to check the difference between acronyms and abbreviations. For starters, all acronyms are abbreviations, but not all abbreviations are acronyms.... :-)

References:

A Comprehensive List of Medical Abbreviations http://goo.gl/0wW0R and  http://goo.gl/DQvEM
List of medical abbreviations, from Wikipedia, the free encyclopedia.
Translating the medical chart. KevinMD/blog.
Online Resources for Medical Abbreviations. DavidRothman.net.
Medical Mnemonics
100% of Greek philosopher named trials showed reduction in mortality, compared with 12% of trials with other acronyms. Lancet, 2011.
Image source: Openclipart.org

EmergiBlog Advice: So You Want to Host Grand Rounds?

EmergiBlog has some useful advice for future hosts of the venerable and well-respected Grand Rounds, the weekly collection of the best posts in medical blogosphere.

Coincidentally (or not), Kim of Emergiblog is this week's host after a 12-hour ER shift. It's amazing what sleep deprivation and caffeine can do to normally sane people. It can even lead them to assemble a 7-point checklist of things to do when you host Grand Rounds... :-)

Grand Rounds has become the contemporary weekly portrait of medicine through the eyes of the medical bloggers.

Pre-Rounds is an article series about the hosts of Grand Rounds on Medscape.com. Nick Genes of Blogborygmi, who writes the Medscape column, is the founder of GR and the archive host.

Red Wine Can Prevent Stroke (in Mice)

According to Reuters, scientists from Johns Hopkins University fed mice resveratrol (a compound found in red grape skins and seeds) before inducing stroke-like damage. Animals suffered less brain damage than similarly damaged mice who were not treated with resveratrol.

Red wine contains approximately 5 mg/L of resveratrol, whilst white wine has much less - the reason being that red wine is fermented with the skins, allowing the wine to absorb the resveratrol, whereas white wine is fermented after the skin has been removed (source: Wikipedia)

It has not been sufficiently proven that red wine has a protective effect against stroke in humans but this does not stop people from buying resveratrol capsules on the Internet.

According to researchers, you have to drink about 2 glasses of wine in order to consume the "required" amount of resveratrol. Currently, the content of the food supplements is not FDA-regulated, which means that those resveratrol capsules you bought on the web for $ 30 may not contain resveratrol at all.

The "R" mnemonic:
Red wine
Res-vera-trol
Reduces stroke area in mice by 40%

References:
Red wine can help prevent stroke damage: study. Reuters.com.
Light-to-Moderate Alcohol Consumption and the Risk of Stroke among U.S. Male Physicians. NEJM, 1999.
Resveratrol: a molecule whose time has come? And gone? Clin Biochem. 1997 Mar;30(2):91-113.
A toast to lower cholesterol. U.S. News & World Report.
Images source:
Resveratrol, from Wikipedia, the free encyclopedia, public domain.
Wine, from Wikipedia, the free encyclopedia.
Health Blog Interview: CEO, Red Wine in a Pill, Inc. WSJ Health Blog, 11/2007.
Doubt on Anti-Aging Molecule as Resveratrol Trial Is Halted http://goo.gl/wpY0i

A Nephrology Wiki

The Nephron Information Center which started the wiki is "not connected to the Wikipedia Foundation, but uses the same software. The Center was founded in 1996 by Dr. Fadem as a public service."

This Nephrology Wiki includes:

1 Kidney Resources - NIC
2 Especially for Patients
3 General Kidney Resources
4 Issues in Nephrology
5 Clinical Wiki Projects
6 Essential Physician Resources
7 Organizations
8 Government Agencies
9 Vendor and other Sites
10 Index

More from "About Us" page:

"This site is managed by Stephen Z. Fadem, M.D., FACP, FASN who is the medical director of The Houston Kidney Center Integrated Service Network, Chief Medical Director of five DaVita dialysis facilities, medical director of DaVitaCare in Houston and is the CEO of Kidney Associates, PLLC.

In January, 2002, this site became nonprofit."

The Nephrology Wiki has been accessed only 212 times as of 10/12/2006. I doubt if this the total number of visits since 2002... probably not, because the front page itself was started on 10/6/2006.

The challenge of any wiki is to attract active contributors who keep the site "alive" and growing. I wonder if this website will do better than so many other started-and-abandoned wikis.

Wikipedia has its own WikiProject Nephrology.

Link via KidneyNotes.com.
Image source: Wikipedia.


Mike Cannon-Brookes has a nice presentation on Organisational Wiki Adoption on SlideShare (link via DavidRothman.net). This may convince your department or hospital to start a wiki, if you do not already have one.

Updated: 10/03/2007

Google Docs & Spreadsheets Could Replace Word & Excel for the Average User

I have always liked the online word processor Writely.com that Google bought a few months ago, and I have also found Google Spreadsheets to be useful for simple tasks. These 2 products are now combined in the newly-launched Google Docs & Spreadsheets. See the product tour here.

This "Google Office" is a part of the Google for Educators collection of useful websites and services.

These are the main advantages of Google Docs & Spreadsheets from my perspective:
  • Available anywhere. Documents are available from any place with an internet connection since they are hosted on Google servers. It does not matter if you are on the main campus of the Cleveland Clinic or in an internet cafe in Papua New Guinea.
  • Online collaboration. Several authors can collaborate on a paper in real time and the "central document" is stored online.
  • Free. There are few reasons for the average user to spend $ 200-400 for Microsoft Office.
Disadvantages:
  • Not available without an internet connection. If your connection is down, you cannot access your documents which are stored online. Of course, you can back them up on your local hard drive, and use the free Open Office to edit/create and upload them back to Google Docs & Spreadsheets, but this is a hassle.
  • Storing sensitive data on a 3rd party servers. For example, no HIPAA-identifiable information should be stored in Google Docs & Spreadsheets.
In conclusion, Google Docs & Spreadsheets could easily replace Word & Excel for the average user but this is far from where the main change is. The big advantage of the online platform is in sharing, collaboration and availability from anywhere.


Google Docs in Plain English

Update 1/17/2007:
According to Digital Inspiration:
"Users can simultaneously work on the same spreadsheet and see the changes made by each other in real time. They can even text chat with each other inside the spreadsheet webpage which makes it all the more useful. "

Update 4/18/2007:
Google Spreadsheets Adds Charts. Google Operating System.
Google Spreadsheets finally gets charts. Googling Google.

Update 07/31/2007:
Google Spreadsheets adds automatic sum, average, the minimum/maximum value and the number of selected values (see the screenshot below):



References:
Sharing an Excel Spreadsheet Online with Colleagues in a Collaborative Manner. Digital Inspiration.
More Sorting Options in Google Docs. Google Operating System, 07/2007.
What Do You Use Google Docs for? Google Operating System, 08/2007.
Image source: Google Operating System.
Google Presentations Launches Today, 9/18/2007.
Adobe joins rest of industry in going for Microsoft’s throat. Scobleizer.com, 09/2007.
For Educators: Teach Collaborative Revision with Google Docs. Google. 11/007.
Google Docs Mobile Released. Google Blogoscoped, 11/2007.
Office 2.0 Database: A list of Web 2.0 replacements for MS Office, 2007.
Video presentations: Novel concepts and easy-to-use web tools for researchers. European Molecular Biology Laboratory, 2006.

Updated: 12/08/2007

Unbounded Medicine Hosts This Week's Grand Rounds



Check out Grand Rounds (GR), the weekly summary of the best posts in the medical blogosphere.

GR has become the contemporary weekly portrait of medicine through the eyes of the medical bloggers.

Pre-Rounds is an article series about the hosts of Grand Rounds on Medscape.com. Nick Genes of Blogborygmi, who writes the Medscape column, is the founder of GR and the archive host.

Image source: Unbounded Medicine

Google Buys YouTube for $ 1,6 Billion - What the Founders Have to Say

Video is a compelling medium for delivering information or just pure emotion. So compelling, in fact, that Google decided that YouTube, which is the leading video sharing web site, is worth $ 1,6 billion.

According to GigaOM, "Sequoia Capital, which invested about $11.5 million in two rounds and owned 30% of the company", has made about $495 million from the transaction. "Steve, Chad, and Jawed - the three co-founders of You Tube, must be walking away with at least $200 million each. They own close to 50% of the company."

The founders have a video message (what else) about today's event which will change their lives forever, whether they admit it or not.



Going back to medicine, it is not a coincidence that leading medical journals like NEJM and JAMA started to offer video content. Cleveland Clinic is also there with HealthEdge videocast available for free on iTunes and Google Video.

Online video will likely radically change the way we get information and entertainment, the same way television did in the last century. Google realizes that and that's why they paid all those billions. It is probably cheaper to buy YouTube now rather that to wait a year and pay double that amount. Not a long time ago, Google had the chance to buy the social networking site MySpace.com for $ 300 million and they passed. Later, they paid $ 900 million -- not to buy it but for just for rights to deliver ads on the site. Google guys probably decided not to repeat the same mistake. It is a risky bet. Several years ago, Yahoo paid $ 5 billion to Marc Cuban and company for Broadcast.com and then they shut down the service.

One of the commenters on YouTube has some concerns:

"Google has bought youtube. If they buy Walmart next we might as well prepare for the end of the world."

Well, not really... :-)

References:
Goobed. GigaOM.
The reluctant co-founder: With YouTube, Student Hits Jackpot Again. NYTimes.

Becoming a Clinical Assistant Professor of Medicine and Web 2.0 Projects

Not a long time ago, I was appointed as a Clinical Assistant Professor of Medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. That's a mouthful of a title, I know, but I am still proud of it... ;-)

The decisive factors for the appointment were undoubtedly my association with the Cleveland Clinic, publications, and the support of the Department Chair and the Section Head. Some online projects were also listed in my CV but I am not sure if they played any role in the mind of the Dean of Academic Affairs who evaluates the applications.

Who knows, may be one day the online Web 2.0 projects will have a similar value to the printed manuscripts. It may sound like a stupid idea now until you realize that some medical bloggers have more readers than some lesser known medical journals. Kevin, MD, for example, has about 2400 visitors per day.

I am happy to see that Cleveland Clinic realizes the power of Web 2.0 -- we have podcasts, videocasts and RSS feeds that constantly search all major outlets for news.

Just think about it. There are more than 58 million iPods sold since 2002, 8 million of them were sold just in the 3rd quarter of 2006. If you are a CEO of one of the top 5 hospitals in America, you definitely want to see the name of your institution when somebody scrolls down the list of podcasts/videocast on the iPod screen. ABC, BBC, CBS, CNN, NEJM, Lancet, JAMA, are all there. Mayo Clinic, Johns Hopkins and Cleveland Clinic also have their entries.

May be one day, any application for an academic appointment will have a special section: "What are your Internet projects?"

Until then, my advice to the medical blogger remains the same: keep on blogging, you make the web a better place.

References:
What IS Web 2.0? Future Tense from American Public Media.
Cleveland Clinic Lerner College of Medicine: Student Reflections of Class of 2012 - YouTube http://bit.ly/18cp7Ri
IPod, from Wikipedia, the free encyclopedia.

At the end of the road

Dr. Crippen describes how it sometimes feels to be a doctor. In any system, not only in NHS: What shall we do with grandad?

Dr Crippen is a fairly high-emotive doctor. This is good for most of his patients and bad for a few. It is not good for him. Two of my partners are low-emotive doctors. Don’t get me wrong. They are excellent doctors. I would happily see them if I were ill. But they are more dispassionate than I. They do not get involved as much.

....

This Medical Blog Promises To Be Interesting

Kendra is not your typical medical student. She is 27 and is a first-year medical student attending Ross University School of Medicine on the island country of Dominica. Her blog is called (naturally) Island Med Student and promises to be interesting:

"I can't claim that I've always "known" that I wanted to be a doctor. The truth is I've wanted to be a lot of different things throughout my life: a farmer, a singer in a chick band, a landscaper, a physicist, and even a trapeze performer.

...

Fast forward almost 7 years into the future, and here I am, about to begin a new chapter in my life. This fall, I will begin attending Ross University School of Medicine, located on Dominica, a small country in the Caribbean . There are many reasons why I chose to attend a Caribbean medical school, but I will share those in a later blog entry."

She also blogs on Medscape:

"Wow. If you had told me 5 years ago that I'Â’d be sitting here today, sipping my coffee, glimpsing out the window at lush, tropical island scenery, glancing around the room at medical textbooks and supplies, and writing a blog entry for Medscape, my jaw would have dropped in disbelief. In retrospect, though, it'Â’s probably best that I didn't know what lay ahead of me. Discovering your future is like opening a gift; it'Â’s more fun if you have no clue what it's going to be."

How did I find the blog? I was checking my SiteMeter statistics and saw the link to one of my web sites. The lesson is "link away, people will find you." Digital Inspiration writes about a similar concept: How To Get More Return Visitors ? Send Them Away.


Image source: Island Med Student

Medical Links

As voice fades, radio host tells of disease. The International Herald Tribune.
Listeners were concerned if Charles McPhee, a syndicated radio show host, was broadcasting his show while drunk... the answer turned out to be much more devastating - McPhee was suffering from amyotrophic lateral sclerosis.

Steven Tyler reveals he has hepatitis C. CNN.

5-year-old girl in coma after anesthesia for dental treatment, dies later. CNN.
Sedation a known risk in dentistry. Gary Post Tribune.
Autopsy: Anesthesia Administered By Dentist Killed Girl. WBBM.
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