Among the items featured in the collection are photographs of international nurse uniforms, dental cartoons, health and hygiene puzzle blocks from China, U.S. Army malaria pinup calendars, Adolf Hitler’s X-rays, and a volume on the art of palm reading. Each item highlighted in the book has been specially selected and is paired with a commentary from a scholar on the history and significance of the item. “Some things are charming and entertaining. Others are disturbing to look at, or document terrible things,” Sappol says. “There’s a lot in the book. In some cases it’s a document of human suffering, showing the diseases and afflictions people have. In other cases, it’s a document of ingenuity and coming up with treatments.”¹

Hidden Treasure is available as a free download from NLM’s Digital Collections or, if you’d like a hardcopy to entertain your guests, you can purchase it through major online booksellers. You can also find a review in The New York Times.

1 http://infocus.nlm.nih.gov/2012/07/new-book-reveals-nlm-hidden-tr.html

Book Cover: http://irp.nih.gov/catalyst/v20i2/hidden-treasures-at-nlm

UpToDate is now available both on and off campus.  Health practitioners are encouraged to register to gain continuing education (CME/CE/CPD ) credit and other benefits. However, users can skip registration and use UpToDate anonymously.

NOTE:  uptodate.com/online continues to work from devices connected to the university network and  does not prompt for user registration.

NOTE to Mobile Users: the UpToDate app does not work with our institutional license. When possible, use your mobile browser to access UpToDate.

NIH news release.

• The communication gap between physician and patient
• Encouraging full participation by patients
• The complexity of the healthcare system itself.

Talking to my doctor

In an article in the New York Times’ “Health” section, Pauline Chen, M.D., describes talking to a friend informally about her friend’s health condition and the latest research in the area. But when Chen suggested her friend discuss options with her primary care provider, her friend went quiet.

When she finally spoke again, her once-confident voice sounded nearly childlike. “I don’t really feel comfortable bringing it up,” she said. While her doctor was generally warm and caring, “he seems too busy and uninterested in what I feel or want to say.”

“I don’t want him to think I’m questioning his judgment,” she added. “I don’t want to upset him or make him angry at me!”

For many, including this writer, doctors are so highly regarded that it borders on intimidation. Couple that with a reimbursement system that necessitates seeing as many patients as possible in order to be successful, and you have a recipe for the physician-patient relationship demonstrated above. Recent efforts to make the healthcare decision making process a joint effort has improved medical visits, but it has failed to take into account the patient’s perspective. A recent study using patient focus groups sheds light on why some patients are reluctant to speak up for themselves:

• Even well-educated and well-to-do patients feel pressure to conform to social expectations, trapped into responding in certain ways to doctors
• Some physicians can be authoritarian
• Patients fear being labeled as a “difficult” patient

While most of the participants in this study were over 50 and lived in relatively affluent areas, it stands to reason that others from different socio-economic backgrounds would feel the same way.

Chen effectively sums up what’s needed:

Care organizations and doctors’ practices must be restructured to allow more in-depth conversations; clinicians need to be reimbursed for the time required for more meaningful conversations; and health care systems must adopt rigorous quality standards that measure and value real patient engagement in decisions.

Supporting healthy lifestyles

As we work to transform our healthcare system to improve patient-doctor communication, it must also undergo radical change to support wellness, rather than profiting by the quantity of sick people treated. As noted recently in The Atlantic, more research is needed on how to successfully motivate people to live healthier lives.

This is not as easy as it seems, for it requires walking a fine line between encouraging behavioral change and individual freedom. “For example, a program could let diabetic patients earn points toward more affordable insurance coverage by completing a self-taught module on diabetes” (from article in The Atlantic). There are even mobile tools to help manage diabetes, as previously noted in this column. Such methods for improving health literacy show promise, yet need confirmation by research with large samples over long periods of time.

Yet some people will not change their behavior no matter what positive incentives are offered. For these patients, it would be all-too tempting to tie insurance rates to blood test results obtained while visiting one’s primary care physician. While no one is currently suggesting turning doctors into health police, if it could be made profitable, somewhere it would be tried.

In a sense, what is needed is a kind of health literacy for physicians and insurers. They need to know and understand what works and what does not in encouraging healthier lifestyles in patients: modes of education, treatment regimens and combinations, incentives and more. Redistribute profitability so a greater share of reward is earned for wellness, rather than sickness.

A better system

No matter your political persuasion, most seem to agree that the current system should be made better. Simplifying the process of obtaining, utilizing and keeping health insurance coverage. We pay far more for healthcare than other industrialized countries, and yet our system is ranked 37th in the world. Reforms to the health care system are a step in the right direction, and more are needed. T. R. Reed’s book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, shows five different systems in other countries that provide a better healthcare system than we currently offer. Many in this country pride themselves on their ability to “go it alone.” It’s time we started learning from others successes.

The biggest drawback is price: $99 at the online Apple Store (or local Apple Store), and $75 online or at your local Walgreens for the peripheral, and it includes 50 initial test strips. Additional strips are $65 per 50 online through Walgreens. The app is free, and the manufacturer does offer a program to reduce the cost for the strips, down to about $20.

But the real test is whether or not it helps people achieve better glycemic control. Husain points out that while some evidence exists to support the claim that mobile devices help with glycemic control, a full clinical trial is needed to test the effectiveness of this device, perhaps in comparison with other devices as well.

Are you a person with diabetes who uses this or another mobile device to track your BG levels? Does it help improve your success at glycemic control? What strengths and weaknesses does your system have? Tell us about it!

• Cardiologists interpreting ECGs from paper
• Emergency room doctor interpreting from paper, and
• Cardiologist interpreting from mobile device

The first group made fewer major mistakes than the other two groups, as was expected. However, there was no statistically significant difference between the second and third groups. This suggests that “sending the ECG images via a multimedia message service may be a practical and inexpensive telecardiology procedure,” and could be a helpful aid in cardiology consultation. In practical terms, an ER physician working in a rural or remote area could consult with a cardiologist in a larger metropolitan area, and get a faster second opinion before proceeding with treatment. And while the iMedicalApps author points out that it would, indeed, be interesting to see this repeated with higher-resolution phone cameras, this technology could be implemented now, and begin helping to save lives sooner. While telemedicine cannot be a permanent substitute for in-person care, it could save lives in an emergency.

Reference:

Bilgi, M., Gulalp, B., Erol, T., Gullu, H., Karagun, O., Altay, H., & Muderrisoglu, H. (2012). Interpretation of electrocardiogram images sent through the mobile phone multimedia messaging service. Telemed J E Health, 18(2), 126-131. doi: 10.1089/tmj.2011.0108

Health care professionals must become “medically bilingual,” that is, learn to speak both medical jargon and plain language. I like to ask myself, “How would I explain this to my mother?”

When a physician is explaining her/his findings and recommendations, if the patient does not understand, he/she may not even ask for clarification out of fear of appearing ignorant. While medical schools are working to train doctors to speak using everyday language, patients can take some simple steps to avoid making this mistake: ask three simple questions:

1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?

And if your physician answers in a way that is confusing or loaded with unintelligible jargon, stop her/him and ask for them to explain in simpler language.

The National Patient Safety Foundation (NPSF) created the Ask Me 3^TM patient education program “to promote communication between health care providers and patients in order to improve health outcomes.” When patients clearly understand health information and instructions, they make fewer mistakes and can better manage their own healthcare. The NPSF offers patient brochures and other reference materials, and created this video to assist in improving patient-doctor communication.

While it is important that patients ask questions, and doctors answer using understandable language, it is also important to acknowledge that the current health system does not reward physicians for taking time to speak with patients. Regulation needs to be enacted or changed so that physicians can be reimbursed by health insurance, Medicare, Medicaid and other plans for the time spent. It will likely save the system money in the long run as well.

What other steps can be taken to improve doctor-patient communication? Tell us about it!

Looking for resources to improve health literacy and communication at your medical practice? The Health Literacy section of the AMA’s website toolkits, patient safety tip cards, and other resources to assist providers. Also, the Agency for Healthcare and Research Quality (AHRQ) of the U.S. Department of Health and Human Services has resources for addressing health literacy and cultural competency.

What tools have you found helpful in improving patient health literacy? Tell us about it!

Reference:

Pawlak, R. (2005). Economic considerations of health literacy. Nurs Econ, 23(4), 173-180, 147.

Villanueva-Whitman, E. (2012). Communication is key to better health care  Retrieved April 26, 2012, from http://www.DesMoinesRegister.com/article/20120410/LIFE/304100053

Do you use an app or other software to assist in making clinical decisions? What do you like and dislike about it? Tell us!

When talking about cancer or any other life-threatening medical condition, numbers about risk, results, etc. can begin to blur for any patient. Having a tool like this to provide a clear visualization can help any woman and her doctor think through medical decisions more carefully. The website does note that the calculations this tool is based on ” calculations result from a computer simulation model, not a clinical trial.” Long-term validation studies of this tool are needed to confirm its accuracy.

But a woman facing important decisions about breast cancer risk and prevention needs the best information available now, and this tool appears to be a good way to help visualize the risks and benefits of treatment options and timing, in consultation with a physician. And being online, rather than in print, it is free and immediately available. Kudos to Standford for developing this important resource!

First, the Center for Health Literacy Promotion Blog has a great story about “Esther,” a woman in the 1830′s whom the author calls “ahead of her time.” Too sick a 21 to help on the family farm or marry, she became a servant in a convent. When she became too sick to work there, she was sent home, where she founded a school, taught others to be teachers (who then started other schools), and broke social norms of the time to teach boys and girls together. At age 40, she and her teachers were recognized by the Catholic Church, becoming the Order of the Sisters of Saint Anne. While it may seem far afield to mention religious education in this context, closing words from the post make it a bit more relevant:

Aunt Esther was born two hundred years ahead of her time. Today her vision of literacy as the foundation for health, an escape route from poverty and the key to the advancement of women and society is an idea whose time has come. She inspires my work at the intersection of health and literacy.

The second item worth noting is a wiki created by researchers at the University of Michigan that is a catalog of more than 100 medical devices and technologies that can be used in poorer areas of the world. Example include:

• Pedal-powered nebulizer for asthma treatments
• Using a hand-cranked salad spinner as a centrifuge for blood samples
• Small, wax-filled sleeping bags that could be used to keep premature babies warm

Finally, an article in the Wall Street Journal asks some challenging questions about mobile devices and the future of medicine. In short, with all of the add-ons that are being created for smartphones, how will this transform the practice of medicine? The author offers these examples:

You can get an add-on to a smartphone which does eye refraction and then texts [the prescription] to get your glasses made. If you’re an optometrist, you might be worried about that. Or you can get your skin lesion scanned and get a text back quickly that there’s nothing to worry about. If you’re a dermatologist, that’s a big part of your practice. You will be able to take a DNA sequence on a USB port and pop it into your smartphone and get data out of it. It just goes on and on.

For patients that live a distance from a specialist in one area of medicine or another, online appointments could be used to maintain communication and improve patient outcomes. And many yet-to-be-invented uses of technology will radically alter how medicine is practiced. Yet medicine, as a profession, is slow to change. Will technology change that, or will it leave traditional medicine behind?

What do you think of these different stories and what they have to offer? Tell us!

The number of incidents, when compared to the total number of disciplinary actions taken by medical boards, is small, but can be expected to grow as more physicians embrace and use social media.

In contrast, at Ohio State University (OSU), instructors recognize that today’s learners rely more heavily on technology to gain knowledge for a future career. A pilot study showed how social media (in this case, Twitter and Facebook) can be used to “push” helpful information to students on a daily basis. More than half of the participants had not used Twitter previously, and upwards of 80% found it a useful and helpful addition to their course.

Any tool can and will be used and misused, social media included. What is important is to learn from our mistakes, and remain open to new and novel ways to benefit all.

Recently, physicians at the University of Chicago published a research letter in the Archives of Internal Medicine detailing their experience with the routine use of iPads by internal medicine residents during their regular duties.

What they documented was that use of the mobile device was objectively associated with faster order entry after patient admission and the subjective assessment that it saves up to one hour per day for each resident.

Prior to initiating the program, investigators wisely met with hospital IT to determine their concerns and set up rules for usage of the devices. After initially having residents individually install apps via their own iTunes accounts, it was decided to work through a third-party vendor to standardize the devices — in this case, working with a company called Mobile Iron. Additional security protections included an eight-digit alphanumeric screen lock code (instead of the standard four-digit numeric code), and setting the iPads to automatically erase themselves after five unsuccessful attempts to log-in.

A great deal of interest has been generated since the research letter was published, and the authors plan to share what they’ve learned at conferences and workshops. In addition, the local ABC Television station did a segment on this event, which you can see below.

Have you used an iPad or other tablet computer in a medical setting? How did it work for you? Tell us about it!

The challenges faced by young people with various forms of cancer are difficult, to say the least: taking a variety of medications such as antibiotics, antiemetics, stool softeners, plus eating healthy when peers and the culture surrounding them are enjoying copious amounts of junk food. Roxxi the nanobot powers-up by following a real-life cancer regimen, and then she sets off to battle cancer.

Does this virtual-ly active role in battling cancer translate into increased motivation and empowerment for the young person playing it? According to a 2008 randomized control trial published in the journal Pediatrics, this video game intervention “significantly improved treatment adherence and indicators of cancer-related self-efficacy and knowledge in adolescents and young adults who were undergoing cancer therapy.”

For those who enjoy them, video games provide hours of satisfying play and escape from day-to-day challenges. A recent study examining the brain activity of patients who played this game provides a glimmer of how it translates into better adherence to the regimen necessary to battle cancer. Using functional magnetic resonance imaging technology to observe the reward circuits in their brains, 57 patients were assigned to either play or watch the Re-Mission video game. The result, as reported in a press release:

“Active involvement in video game play sparks positive motivation in a way that watching and hearing information does not,” said Steve Cole, Ph.D., Vice President of Research and Development at HopeLab, professor of medicine at the University of California, Los Angeles, and co-author of the article. “All participants in the study received the same information. It was the active participation in gameplay that made the big difference in motivation. This study helps refine our ‘recipe for success’ in harnessing the power of play in the service of health.”

Many libraries have embraced gaming as a way to connect to patrons. Imagine a library with a collection of video games with the artistry of the biggest sellers that promoted healthy living, and help young people cope with life’s challenges. Such an image gives this librarian hope that we might begin reversing the epidemics of obesity and other preventable diseases in this country.

Have you or someone you know played Re-Mission? What other health-inspiring video games would you like to see? Tell us about it!

• Download the new issue each Thursday, and store all downloaded issues in a personal library
• Bookmark articles, images & figures
• Watch clinical medicine videos
• Listen to an audio summary for each issue
• Capture and save article notes, and even share them via email, Facebook & Twitter

Non-subscribers view a fully functional free issue, preview the table of contents for each issue and read Online First articles. App-only subscriptions of the NEJM are $14.99 per month, and purchase of a single issue is $5.99 each. At first glance, it does not yet appear that institutional subscribers can use this app to access NEJM, which is a significant oversight. Many faculty, researchers and physicians here at the University of Utah rely on the NEJM, and if a clinical reference tool such as LexiComp can provide an institutional version of their software, so can a top-notch journal publisher.

In downloading the iPad app, I discovered the NEJM Career Center, an iPhone/iPad app that, like its website counterpart, will help physicians search listings of physician and locum tenens job listings by location, specialty or position type. It notifies users of new jobs that match their search criteria, and allows them to email or tweet jobs to themselves or their personal networks.

If you want to keep up on the latest researched published in NEJM, subscribe to their weekly audio summaries podcast, NEJM This Week. Each podcast is 20-25 minutes long, and includes new medical research findings, review articles, and editorial opinion pieces on topics related to biomedical science and clinical practice.

Do you use any of the NEJM apps? What do you like or dislike about them? Tell us about it!

The story goes on to cite the story of a 32-year old automobile accident victim, who could not move his left hand, arm or leg immediately after the injury. Use of the high-definition fiber tracking showed that the nerves serving the hand had greater damage than those for the arm and leg. The patient is now walking and using his arm, but cannot open his hand.

Knowledge is power, and for a person with TBI, it would be immensely helpful to know that a lack of progress in recovering is not due to a lack of effort on their part. In the future, scans like these might also be used to track and learn about how our brains grow new nerve connections.

The case report on this was published today in the Journal of Neurosurgery.

What scientific technological breakthroughs do you predict we will see in this decade? Tell us!

These are the kids that are learning independence, that are leaving the house more often, that aren’t eating right, or listening to their nagging parents. Now imagine them with a chronic illness such as diabetes. These kids are notorious for taking fewer and fewer blood glucose readings per day, eating improperly, and generally having a defiant streak in them.

Adolescents who used this device got points for compliance with the regular BG monitoring regimen, which earned them music and apps through the iTunes store. This pilot test of the system with twenty kids saw an increase in regular BG measurements of 49.5%, clearly demonstrating the need for a bigger study. The app also offered a Twitter-like microblog community capability for peer support and encouragement. Below is a video demonstrating use of the bant system.

One idea in this blog post caught my attention: their focus on developing an app to provide a solution in a way that can be clearly demonstrated:

Although we take the design and development of this smartphone platform very seriously, we aren’t interested in creating gadgets. As a research hospital, we take the opportunity cost of building such a system seriously. We need real tangible results. Hence, we spend more time and money evaluating the technologies that we develop than on building them. Our findings feed the next iteration of the technology. This is an example of evidence-based design. Consider it user-centered design on steroids.

After working for over two years to support evidence based research, it seems a natural next-step to consider applying such a standard to the development of medical devices and apps. I look forward to reading about a follow-up study on this devices.

Do you or someone you know struggle with juvenile diabetes? Would a system like this be helpful in encouraging healthy behavior? Why or why not? Tell us about it!

Use a Personal Health Record (PHR) system? You can “send your data to an authorized Third Party such as Microsoft HealthVault” (from the website). And Telcare claims they do not share or sell your personal data to marketers or advertisers, encouraging one to review their Privacy Policy. Unfortunately, at least on the FAQ page where they claim this, there is no link to that policy. It seems that a potential customer has to at least start the sign-up process before they can read the privacy policy, which makes for a rather ironic contradiction.

This mobile app is currently available for the iPhone/iPod touch.

Do you or anyone you know currently use this or a similar device? Or, if you are a person with diabetes, would you consider purchasing such a device? Tell us about it!

Copies of Ms. Harriman’s recently published book, Health Care in Mobile: An Oral History of the 1940s will be available for purchase and signing by the author. This work presents a small oral history of the delivery of health care in Mobile, AL, from the late 1930s to the early 1950s. It includes the beliefs, behaviors, expectations, and experiences of individuals whose lives have been entwined with community and health care.

Ms. Pearce also has ties to the Mobile area and underwent her nursing education in the region. She trained with the Daughters of Charity who have long been devoted to the elimination of disparities in health care. Ms. Pearce will share with us some of her personal experience and insights gained from her involvement with this organization.

• Date: Friday, January 27, 2012
• Time: 3:30 – 5:00 p.m.
• Where: Spencer S. Eccles Health Sciences Library (main floor)
• What: presentation and book signing
• Questions? Contact Christy Jarvis, Collections Librarian, at

Refreshments will be provided. Please join us for the first of what we hope will be a series of fun and informative public events.

Uganda’s multi-level health system served as the location for this proof-of-concept test. Using a traditional light microscope connected to a Java-enabled mobile phone with built-in camera, specially designed software for data transfer and labeling, and anonymous laboratory samples, researchers were able to capture interpretable images and video at different resolutions. Some phones worked better than others for this, and file size limited the number of images that can be sent at one time.

Another valuable aspect of this study is that it “used a bottom-up approach.”

End users and stakeholders were included in the design process and the initial testing of the system, increasing the chance of our concept to meaningfully improve laboratory services and support health workers and practitioners in their diagnosis and training.

Members of remote clinics expressed even expressed an interest in sharing slides between clinics for knowledge sharing and education. And health sciences students could benefit from having web access to multiple examples of similar conditions instead of a relative few in a textbook.

Reference:

Tuijn, C. J., B. J. Hoefman, et al. (2011). “Data and Image Transfer Using Mobile Phones to Strengthen Microscopy-Based Diagnostic Services in Low and Middle Income Country Laboratories.” PLoS ONE 6(12): e28348.

As noted in a review by iMedicalApps, InfantRisk Center has a user-friendly layout and design, along with a well-organized database of quality information. Medications are rated on a scale from “Safest” to “Hazardous,” with icons to help users visually differentiate between ratings. It also includes “quick access to the InfantRisk Center’s hotline for questions, a “Hot Topics” section, a personalized search function, as well as the ability to bookmark frequently used drugs and information for easy-access in the future” (from iMedicalApps review).

While the medication information base is broad, it is not comprehensive, and less-commonly-used drugs may not show up in a search. The alphabetical listing of drugs also lacks the helpful right-side A-Z listing to make switching between letters easier. While the $29.99 price may seem high for those used to purchasing apps for a few dollars, the potential time savings from this reference tool is worth serious consideration.

Have you used this app, or a similar one? How do you like it? Tell us about it!

While its design lacks visual appeal, its functionality and convenience allows users to keep up with new research in the field from the top journal in the field of Pediatrics. (For a more detailed look at the app, read the recent review in the iMedicalApps blog.) It is available for the iPad, iPhone and iPod touch. Best of all, its FREE.

Do you use this app? How has it worked for you? Tell us about it!

• Alt-Health Watch: A fulltext database of newsletters, newspapers and research reports focused on complementary, alternative and integrated approaches to health care and wellness — on both professional and consumer levels.
• AltBib (TOXNET): the intent of this bibliography is to assist in identifying methods and procedures helpful in supporting the development, testing, application, and validation of alternatives to the use of vertebrates in biomedical research and toxicology testing.
• NCCAM, National Center for Complementary and Alternative Medicince: The Federal Government’s lead agency for scientific research on complementary and alternative medicine (CAM).
• For students, faculty and staff at the University of Utah’s Health Sciences Center, our paid subscription to Natural Standard – The Authority on Integrative Medicine provides access to an international research collaboration that aggregates and synthesizes data on complementary and alternative therapies. Using a comprehensive methodology and reproducible grading scales, information is created that is evidence-based, consensus-based, and peer-reviewed.

The iMedicalApps blog summarizes the strengths of this application:

• If you’re looking for a portable way to study the top 300 most frequently prescribed drugs and are the type of person who is more likely to have a smart phone with you than a pile of flash cards, the Sigler’s app may be for you.
• The informational depth is adequate enough for utilization as a quick reference in the professional setting and could be a valuable tool for students and clinicians alike.
• It’s an expensive download ($29.99), but is priced within range of other traditional pharmacology flash cards, i.e. this list of popular drug cards found on Amazon.com: Brenners Flash Cards($29.99), Lange Flash Cards ($30.23), Range & Dales Flash Cards ($37.00), Pharm Phlash!: Pharmacology Flash Cards ($21.56).

Have you used this app? Tell us about it!

After developing a prototype, the team conducted a clinical trial at a hospital in South Africa using two different mobile phones: a Nokia 3110 Classic and an iPhone 3G, and compared them against the £400 3M Littmann Electronic Stethoscope.

They collected phonocardiograms from 150 volunteers with a range of cardiac conditions using the Littmann, the iPhone, and the Nokia 3100 Classic. The trial showed that the Nokia actually out-performed the Littmann in estimating heart rate, although it had to discard more low signal quality recordings. (from the Oxford blog)

The team is now working on an Android application to record and process the heart sound recordings.

Have any of our readers worked in poor countries where medical services is minimal or lacking completely? Would such a device be helpful based on your experience? Tell us about it!

1. Insist on plain language.
2. Focus on absolute risk.
3. Visualize your risk.
4. Consider risk as a frequency rather than as percentages.
5. Focus on the additional risk.
6. The order of information matters.
7. Write it down.
8. Don’t get hung up on averages.
9. Less may be more.
10. Consider your risk over time.

“suite of 3D interactive models of human anatomy. Intuitive controls allow the user to zoom, rotate and peel away layers to educate and communicate with an ease and directness that was never possible with print. A wealth of supporting media, MRIs, X-rays, live-action movies and animations are also included to supplement Anatomy.tv’s high resolution, computer-generated models” (from the website).

When you open Anatomy.tv, you are presented with an interactive image of a human skeleton. As you mouse over different areas, outlines of each area appear with a label naming it. You can add different layers, such as arteries and nerves, by clicking on folders to the right. Anatomy.tv also includes movies that show how different parts of the body work, such as “Abduction & adduction of the MCP joints.” Some areas of the body, such as the spine, also include images from MRI scans paired with computer-generated 3-D models for comparison. You can bookmark images, or save them to your computer. Finally, there is a “Clinical” button which brings up quick reference explanations about different aspects of anatomy such as related diseases, deformities, trauma and more.

Try it, and let us know what you think!

Detection

At Michigan State University, civil engineering professor Syed Hashsham is developing a device that performs genetic analysis on microRNAs and various other genetic markers, and can be operated by an iPod touch or Android-based tablet. Professor Hashsham received a grant from the Michigan Economic Development Cooperation to develop the “Gene-Z” along with Jim Tiedje from MSU and Erdogan Gulari from the University of Michigan. This device, if successfully developed, could provide a low-cost technology for early detection of cancer, which is sorely needed in less-affluent countries. (Thanks iMedicalApps!)

Management

The cancer information site Cancer.net has a free iPhone and iPad app for cancer patients and their families:

The free app allows cancer patients and their family members to look up pertinent information based on cancer type and download a wealth of oncology related information in the form of videos, podcasts, and up to date articles.

Where the app truly shines is in there key features: Ability to store questions, medications and symptoms. The way this app implements these key features is absolutely stunning, and makes the application a must have for cancer patients and their family members. (From the iMedicalApps blog.)

A full review of the app is available at the iMedicalApps blog.

As pointed out in the iMedicalApps blog, this study has several important shortcomings:

• Small sample size
• It does not take into account “more advanced fusion pumps which can simplify parts of the process.”
• One of the study’s primary authors is a contributor to the app’s development, though without financial investment.

From this author’s perspective, there are two important implications to this study. First, follow-up is needed, taking into account the typical equipment and stress present in the situation. Second, it appears we now trust computers and their programmers more than the writers of printed medical texts. Yet the only oversight of such devices comes from the medical professionals involved in their development. Is the current system sufficient to protect patients from technical problems and market-related pressures? If a book is dropped, its text does not change. Does dropping and repeated use of mobile devices affect the functioning of the software contained within? If it does, can that put a patient at risk?

What do you think? Tell us!

The horse is out of the barn folks, now let’s see which hospital IT departments evolve and which ones don’t. Technology has forced many professions to evolve, including the ones born of technology.

Have you used mobile technology in a medical setting? What device(s) do you use? What challenges have you faced in terms of security concerns by your institution’s IT department? Tell us about it!

The U.S. government’s Agency for Healthcare Research and Quality and the National Ad Council have teamed up to launch a national health campaign aimed at empowering Latinos to ask their doctors questions.

Television, radio, print and Web ads in $30 million worth of donated advertising space will run in Latino-centric media showing people with ailments such as a bad back getting conflicting advice in places such as the laundromat and the barbershop before going to the doctor (from Fox News Latino).

The campaign is called Conoce las Preguntas (Know the Questions), and the advertisements direct viewers to the campaign’s website, which provides a kind of “roadmap” to a doctor’s visit. For example, it encourages patients to be clear on prescription instructions, and offers suggested follow-up questions to medical diagnoses. And it includes humorous videos such as this one showing  one Latino man asking for advice on an earache, and getting a variety of answers. (Click on the triangle-shaped “play” button to show the video.)

Video Credit: REVOLUCIÓN

According to the Technology Review website published by MIT, using

a nanosensor “tattoo” and a modified iPhone, cyclists could closely monitor sodium levels to prevent dehydration, and anemic patients could track their blood oxygen levels.

A team at Northeastern University’s Department of Pharmaceutical Sciences is working to make this possible. They have created a specialized, invisible “tattoo” with nanosensors to detect sodium and glucose levels without breaking the skin. Once the tattoo is applied, the end user slips a case over their iPhone which contains “a nine-volt battery, a filter that fits over the iPhone’s camera, and an array of three LEDs that produce light in the visible part of the spectrum” which can read the tattoo. For now, researchers are exporting the data to a computer for analysis. In the future, it is hoped that an app can be developed to do this work.

No doubt diabetics and others who have to take their own blood samples on a regular basis would welcome an end to needle sticks! Do you have an idea for an app that could replace a regular and annoying medical procedure? Tell us about it!

(Thanks to the iMedicalApps blog for this information!)

Statistics from the 2011 National Diabetes Fact Sheet (link here) show that the prevalence of diabetes in the U.S. is 8.3% or 25.8 million people. In 2007, the total cost of diagnosed diabetes in the U.S. alone reached $174 billion. It is clear that diabetes is a major healthcare issue in modern medicine. On the basis of this, it is important that healthcare professionals are well informed about diabetes and its potential complications as it will have a significant impact on future practice.

Johns Hopkins and Skyscape have teamed up to offer the POC-IT Guide to Diabetes for iPhone, iPod touch and iPad, part of a series of apps that also include HIV and antibiotic guides. The app itself is free, but to use the guides requires a paid subscription to the online Johns Hopkins Guides service, which iMedicalApps reports as “usually $39.95.”

“The Diabetes Guide is designed to assist clinicians by distilling complex material into need-to-know information, easily accessible for rapid viewing and which can be frequently updated” (from the review). The information resides on your mobile device, so it is available whether or not you have an Internet connection. The iMedicalApps review goes into great detail about the features of this app, concluding that The Diabetes Guide is a “complete, easy to use mobile application that covers the majority of the clinical aspects and associated complications in great depth.”

Do you have access to this app? If so, how useful and user-friendly do you find it?

Their conclusion? “iResus improved junior doctors’ CASTest scores during a standardised simulated cardiac arrest scenario when compared with those applying purely their own knowledge and experience.” In addition, participants “stated that the iResus ‘app’ was easy to use, increased their confidence in making decisions, and that they would be prepared to use it in real clinical emergencies. From their own perspective, they did not think using such an ‘app’ would be unprofessional or indicate poor training.”

The iResus medical app is free in the iTunes store. iMedicalApps has a review of the app itself with plenty of screen shots to see what it looks like and how it works.

References:

Low, D., Clark, N., Soar, J., Padkin, A., Stoneham, A., Perkins, G. D., & Nolan, J. (2011). A randomised control trial to determine if use of the iResus©application on a smart phone improves the performance of an advanced life support provider in a simulated medical emergency*. Anaesthesia, 66(4), 255-262. doi: 10.1111/j.1365-2044.2011.06649.x

The medical students at the University of Minnesota’s Duluth campus have all been given iPads to help with medical education — adding to the growing list of medical schools implementing “iPad medical curriculums”.

Why the iPad?

The University of Minnesota’s Duluth medical school had received a $2.3 million Health Resources and Services Administration grant to fund efforts to increase the use of electronic learning in the medical school curriculum.

This article goes on to cite the reasons for the iPad’s continued leadership in this market:

• Numerous apps
• Portability
• Lagging competition

Check out this video of iPads being used by the medical students at UMD.

What do you think? If you own an iPad, how helpful have you found it in your education? Let us know!

• $1,000 AMEX Gift Card
• $1,500 Apple Store Gift Card
• Trip for two to New Orleans

Guidelines, rules and FAQs for the contest are available on line. (Thanks to the iMedicalApps blog for alerting us to this opportunity.)

Students enrolled in medical programs at the University of Utah have access to a number of mobile apps through the Eccles Health Sciences Library website.

Do you have a favorite mobile app? If so, tell us about it!

We believe that a portable, widely available, real-time communication solution — like MediBabble — has the potential for profound impact and is too important to sell. Which is why we’re giving it away.

I invite readers and subscribers to this blog to download and test this app, then add your comments to this post telling us how well this works for you!

Though the actual data seems to be conflicting, one statement I often heard was that my generation and those to come would be better prepared to learn these interventions simply because more of our time was spent playing video games.

Strangely enough, the argument went, many of the same skills to be good at Mario Kart or Call of Duty were important in manipulating laproscopic surgical instruments. In an odd way, what is being said is that visual-spatial thinking, hand-eye coordination, and other similar skills are becoming increasingly critical with minimally invasive interventions that require the operator to convert 2D images on a screen into 3D anatomy – a skill that means the difference between removing a gall bladder properly verse perforating the bowel. Virtual Cath Lab is a free app that is great example of how medical education can use new training modalities to prepare trainees for this shift.

It will be interesting to see if research will eventually support this idea, or if it will remain conflicted.

If you are or have been a medical student and have had to use training simulators that use a 2D image to represent a 3D space, how hard did you find it to make the mental translation?

Ganong’s Review of Medical Physiology, a trusted textbook for medical student education, was just released on the Inkling platform. Inkling is a textbook application that was built exclusively for the iPad platform and features “interactive textbooks” — basically, bringing textbooks alive.

The interactivity in this textbook includes helpful features such as quizzes at the end of each chapter; a “test yourself” feature where labels on diagrams can be hidden from view, then revealed with a single tap; and step-by-step guided tours of various physical processes. The full price of the textbook is $64.99, or you can purchase chapters for $1.99 each. You can even annotate and search the textbook as you go.

The idea of being able to purchase a chapter at a time is not just a cost-saving measure. It is also a feedback mechanism for textbook writers and publishers. Whether faculty require students to read particular book chapters, or students buy them based on peer recommendations, quality texts that are clearly understood by today’s students (“millenials”, etc.) have the potential to redefine what is considered “best” in any given field or specialty.

Finally, having all your medical texts on a 1-2 lb. device will ease the physical strain for faculty and students alike who previously had to carry textbooks typically weighing dozens of pounds. You can download the free Inkling app from the iTunes store. The video indicates there is a “free chapter” available for test-reading. If you have an iPad, take a look, then tell us what you think!

As Project Director of the Neuro-Ophthalmology Virtual Education Library, a collaboration between the Eccles Health Sciences Library and NANOS, Nancy presented the project update to the NANOS Executive Board on Saturday, February 5. In this session, new collections were outlined, as well as growth in existing collections. The Journal of Neuro-Ophthalmology is now completely archived within NOVEL. Every issue from volume 1 forward is indexed and available. Each current issue will be added as the one year publisher’s embargo is lifted. The papers and posters presented at the annual meeting are being added to NOVEL. Currently, 2009 and 2010 are available and the NOVEL team will be working back in time to develop a complete archive. The Walsh Society Meeting is also completed, covering the abstracts of meetings since 1969. Video collections by Shirley H. Wray, MD, PhD and David Newman-Toker, MD, PhD were highlighted. The new NOVEL Mobile site, with access to video and audio was demonstrated. The NOVEL Team members were recognized for their contributions to the project. They are Ray Balhorn, Stephen Mossbarger, Justin Barbour, Mike Thelin, and Maggie Dwenger. The Board was very appreciative of their efforts.

On Sunday, Nancy and Jeanne provided NOVEL, EndNote, and general technology consultations to NANOS members at a support table in the area outside the main meeting hall.

On Monday, February 7, Nancy, Jeanne and Ed Fitzgibbon, MD, of the National Eye Institute, offered an Optional Symposium to the NANOS membership. This session provided an update to NOVEL, a demonstration of many mobile applications relevant to members, Google Sites, a free web-based collaborative workspace and an overview of EndNote features, as well as methods for sharing libraries with colleagues. Symposium attendance ranged from 55 to 70 participants

All programs were well received and Nancy was awarded an Associate Membership in NANOS in recognition for her collaboration with the organization through her work with Society members and NOVEL since 2000.

• Need to find a physician? With a few taps you can by physician name, specialty, disease or treatment, or browse by department or specialty.
• Need to locate the nearest clinic? Just tap to search by clinic name, city, or specialty. Nearby pharmacies can be located in a similar manner.
• Have a general health information question? Tap to enter their “Adult Health Library” or “Pediatric Health Library” and browse from several dozen general topic areas – from allergies and asthma to surgery and more.

This site is integrated with smartphone features like one-touch dialing and location mapping tools, and sports the familiar icons for Twitter and Facebook, inviting visitors to become fans of this top-notch healthcare system.

While this site is concise, clean, easy to read and navigate, it faces the same challenges that libraries and other organizations struggle with in this small-screen medium, such as presenting complex information, and labeling and organization.

While it is best for headings to be as concise as possible, being too terse can lead to humorous results. If one taps on the “Health Information” link, the next page is titled “Diseases and Conditions.” The options on this page lead one to observe (tongue-in-cheek) that “Adult Health Library” and “Pediatric Health Library” are each either a disease or a condition.

Browse to the health information topic on bleaching your teeth (Health Information -> Adult Health Library -> Oral Health -> Bleaching), and a table of useful information on who may or may not benefit from this procedure breaks. The headings appear presented in a vertical list while the table’s contents appear in a very narrow, three-column bulleted list.

With the proliferation of mobile devices capable of browsing the web, any organization that wants to stay relevant needs to create user-friendly sites for these visitors.

What do you think? Is this a site you would use? Add your comments and tell us!

What do you think? Would such devices help reduce the number of STIs in developed countries like the UK, USA, and others? What about the risks and impacts of false results, both positive and negative?

Lately, it seems almost anything medical regarding Apple’s iPad generates immediate interest. Nimble, the new iPad electronic health record (EHR) by Clear Practice, has been no exception. In the few short weeks since its release, this application has rapidly generated interest across medical blogs, mainstream press and, most importantly, from doctors themselves.

The demonstration pictures on the vendor’s website illustrate how a doctor can show a patient images that teach about their condition. From a medical librarian’s perspective, it is critically important to ask:

1. Where is the patient-focused information coming from? Is it evidence based or found through Google?
2. Can the patient access the same information themselves after leaving the doctor’s office?

Libraries have been providing information to patrons on all topics for centuries, and are uniquely qualified to offer critical evaluation of resources in this setting. The Eccles Health Sciences Library is currently working on including links to top-quality resources such as MedlinePlus for patients in the institutions we support. This requires collaboration with service providers and their vendors as well as taking steps to protect patient privacy. As our current project — a mashup combining Google Maps, and the locations of medical clinics and local libraries — comes online, watch this blog for updates.

In the meantime, the Library will be hosting its annual InfoFair on the topic of “The Personal Health Record: Possible, Portable, Private?” on Wednesday, December 1, 2010. Check the InfoFair 2010 website for more details.

Dr. Hsueh-Chia Chang, a distinguished professor at the University of Notre Dame, is working on using microfluidic technology in order to create a hand held device that can quickly detect pathogens in blood and toxins in food and water.

If successful, this tool will not only be mobile but also inexpensive, making it affordable and usable in developing countries. Watch the video.

A classic in the field of cardiac nursing, this well-recognized text and clinical reference has earned the reputation as “The Red Reference Book” for nurses caring for patients who have cardiac disease. Revised and updated, this edition reflects the latest procedures and techniques in cardiac nursing. This book incorporates the nursing process and critical thinking strategies, while also providing a foundation for the contents based on theory, anatomy and physiology. The liberal use of figures, tables, and authoritative references, makes this the ideal text for graduate students and a reference for any nurse interested in cardiac nursing.

This and other excellent titles are available through our new library catalog — check it out!

“addresses all the subtypes of dementia and associated psychiatric conditions such as agitation, psychosis, and depression. This edition features a new chapter on mild cognitive impairment and expanded coverage of Alzheimer disease and risk factors. Chapters offer advice on caregiver support and legal and ethical concerns.”

Another new title is Basic and Bedside Electrocardiography by Romulo F. Baltazar. Again, according to Amazon.com this book combines

“the basics of ECG interpretation with the most recent clinical guidelines for treating patients with ECG abnormalities. Each concise, bulleted chapter discusses a disease state, gives many tracings as examples, provides clear illustrations of pathophysiology, and offers guidelines for diagnosis and treatment of specific entities. More than 600 illustrations aid readers in recognizing commonly encountered ECG abnormalities. Diagrammatic illustrations at the end of most chapters summarize the different ECG abnormalities discussed, to help readers recognize the different arrhythmias more easily. An appendix provides quick-reference information on commonly used intravenous agents.”

These and eight other new titles will soon be available through our new and improved online catalog.