6. Searching efficiently - finding what you're looking for

It is said that nowadays you can find whatever you want to find on the Internet, if you just search for long enough. That's a problem for doctors who are not searching to just find anything but looking for the right answers. We need quality much more than quantity. We want information from accredited sources and containing relevant information. A Google search for pneumonia will give you results in the count of millions, even veteran sites describing pneumonia in horses. Surely somewhere in there is the answer to your question but you will probably have had your own pneumonia when you finally find it! In this post I will try to help you get better search results, an essential IT skill for the modern physician.

I will be mentioning Google's search engine a lot since it is the one I use and know from inside and out. Most of what I write here below can be applied to other engines such as Bing or Yahoo.

Refine your question - what do you really want to know?

Googlin' for "pneumonia" is not very smart. Pneumonia is a broad topic and the facts and details are endless. Before blaming Google for stupid results, you might consider what is it exactly that you want to know and what kind of result are you willing to read? Is it the pathogenesis or just a general description? Or do you need a patient information leaflet?

To begin with, you might consider Wikipedia for a quick introduction to whatever you want to read about, Wikipedia's credentials are thought to be excellent and it's quality has been scientifically compared to Encyclopedia with good results. The medical topics in Wikipedia even have dedicated doctors onboard, scanning topics for obvious errors (see BMJs "Wikiproject medicine").

Google has a very powerful search engine and cleverly indexes all words within a website for best results. A special syntax (see below) allows us to use Google to search every open website there is and this can be useful for sites not having their own search function. Some sites have sloppy search engines where using the Google machine gives us much better results. Sometimes though you will want to use their own, advanced engines - the Pubmed search is definitely one of these.

Special syntaxes for advanced searching

Google will accept "human queries" such as "i need patient information about pneumonia" but let me introduce to you special search syntax parameters which give you the real power of web searching. The two most important to know are:

• "xxx" (quotation marks) will search for the exact term, without them (the default), pages will be found where words in the query are close to one another but not necessarily. This will filter out a lot of irrelevant results.
• minus (-) sign will exclude words, say for example you want to find a nice ABG calculator but online, not iPhone app: "abg calculator -iphone". This way you could exclude pneumonia in horses or even veterinary medicine.

All of the special syntaxes can be called through Google's advanced search page and by just taking a quick look you will quickly familiarize yourself with them. Some of these even are found on the left margin of Google's main search page. Those that I use regularly are:

• Order by time brings up newest results and can make your results much more relevant. Some months ago I read an extensive article about "posterior circulation stroke and HINTS", refining the search to display only results from the past year immediately brings up Scott Weingart's post and the CMAJ 2011 article I needed.
• site operator: As I actually remembered having the article on his blog, emcrit.org I could also have refined the search using "site:emcrit.org" which then reveals results from emcrit only. Now that is a very powerful function and worth knowing. Emedicine is every emergency physicians' darling and now you know how to get to their pneumonia article with one click only!
  Commonly I use the "site:.se" operator to find local, swedish guidelines.

Search all your favorite sites simultaneously!

The "site" operator can be used to search more than one source but a lot of "site:xxx" operators will make your query long and prone to errors. I have a few favorite websites I regularly use to find specialized answers, sites I've used for many years and have my full trust in. So the question arises - can they all be searched simultaneously? The answer is yes and the solution is Google custom search, click to read another post I've written about it - it will be one of your most powerful online tools.

Tricks & tips

Google has a lot special search features providing you with instant answers to special questions like weather, flight times and stock prices, some of them are definitely worth knowing. There are some I use very commonly in the ED:

• The built in calculator is a very time saving feature for instant calculations right from the search bar. Even better, you can use the calculator from insde Chrome. In the same way you can convert units on the instant eg 3 miles returns 4.83 kilometers
• Using "define xxx" you can in an instant look up word definitions, synonyms, translations or grammatics, very useful for an Icelander living in Sweden, trying to speak English! With the tilda sign I can ask for synonyms for a word eg "restricted~" revealing answers in just seconds.
• Conversion is ridiculously simple, try for instance
• "98.4 fahrenheit to celsius"
• "5 inches to meters"
• You can even use Google search to check spelling, right now I made a quick check to see if I had spelled "ridiculously" correctly, and got corrected!
• Finally, try putting this query in Google and see what the magic is all about
  sqrt(cos(x))cos(300x)+sqrt(abs(x))-0.7)(4-x*x)^0.01, sqrt(6-x^2), -sqrt(6-x^2)

=> list of all the special search features

The best the lot: ctrl+f and Quick scroll plugin for Chrome

Learning keyboard shortcuts is one of the best things you can to do boost your productivity. Ctrl+f is one of these I use every day to faster locate search results. Say I have searched for "erythromycin" and opened a page full of text, containing all there is to know about this antibiotic. Using ctrl+f  I can type "breast" and I will instantly see the chapter about breast-feeding to find out if there are any risks involved.

If you are using Chrome you will wan't to use a great plugin which helps you scrolling directly to what you were searching for.


=> Quick search plugin for Chrome

Social media might be changing it all

The evolution of the social network has been so fast that even the king of search, Google, missed it and didn't realize it's potential until it came up with Google Plus in 2011. Social networking essentially means power to the people and in the context of finding relevant answers could mean the end of finding results through Internet-browsing robots but having the answers from the people around you - the ones you trust. That is the good old "before Google" way - remember the days when our grandparents knew anything and we'd ask them the complicated questions?

Technology surely is catching on. Facebook as the flagship of social networks has already taught us how we can ask our circles of e-friends and often get relevant answers within minutes.

Even better is Quora, started in 2009 and now rising to become one of the Web 2.0 titans. The idea of a Q & A web is simple and hundreds of others have been there before, it's just that Quora somehow has the easy yet powerful user interface and packed with features. The idea is simple: you ask a question and tag it so that followers of this particular interest ("specialists") are immediately there and answering it. You and others then vote up or down the answers and a powerful and user-moderated Q/A wiki is being built, growing every day. So that if you ask a question that Quora already thinks has been answered, you are hinted to check that one. The Quora concept is thus a mixture of Google's 'smart robots answer your questions" and Web 2.0's "power of users". A really exciting development.

I am waiting for more emergency physicians signing up but I have a feeling this could be a breakthrough technology for physicians all around the world since it allows for instant (or almost instant) expert answers from hundreds or thousands of online colleges. To be continued!

See also

• [AMIA Annu Symp Proc 2012] Emergency Department Physician Internet Use during Clinical Encounters

Have you met Linux?

Did you know that Linux powers some of the worlds biggest websites such as Facebook, Wikipedia and Google? Did you know that 95% of the world's supercomputers are powered by Linux? Or that Android is built on Linux? Have you heard about LiMux, the project of converting all IT systems in Munich (Germany) from Windows to Linux and that many others are now doing the same since it has been shown to be highly efffective?

Considering that the operating system (OS) is your one most important interface to your computer, don't you  think Linux deserves some of your attention? I used to be a Windows/Microsoft fan for many many years, digging deep into Windows as it was my programming platform. One day I wanted to try "this Linux" I had heard about on a 7 year old HP laptop I used as a media server in the kitchen, I got it for free from a friend who thought that it was too slow. Well, I haven't touched Windows again and for the first time I feel I am in total control of my computer and worries about malware and viruses are a thing of the past.

The Apple story

Increasingly Apple products are being seen, pushing ever more users out the Windows monopoly. Especially I noticed this at MEMC in Kos where many physicians spent their time between lectures gaming their gadgets instead of enjoying 30’ and sunny weather outside. Apple is certainly king of user-friendliness renowned for high-quality multimedia software. I have never had an Apple product my self and thus can't make any bold statements about it when comparing with Windows or Linux (actually, Mac OS X is based on Unix, a common ancestor to Linux). From what I've heard from friends and seen over their shoulders, OS X seems to be a pretty decent product, giving their users speed, stability and functionality, the main requirement for the productivity boost I want from my computer. So OSX might be better than Windows but still I think Linux rivals them both and I will now ask for a few minutes of your time to tell you why.

Why bother?

You are a busy physician and always in lack of time. Your computer probably is a very important tool in your daily life and you depend on it to start up smoothly every day, be fast and responsive, reliable and user friendly. Most importantly you need it to be immune to security threats since your important data resides inside it.  You may or may not be a geek but you want to be able to configure your computer and adjust to your own preferences. Without hacking the command line.
The description above is just that of Linux. It is one of the most secure OS:es made, so secure actually that  anti-virus software is not needed (but exists for the faint hearted - besides no OS will protect from human mistakes like opening bad attachments or links), sparing about 10-20% of CPU and memory resources. Not only are you free of viruses but annoying malware (ad-displaying banners and toolbars) will never plaque you on Linux. This article about the US military converting to Linux because of security issues really says it all!

Windows is a bloated OS with updates stacked one after another on older versions, eating up hard drive space, memory and CPU power. The sole reason Linux can be installed on a dusty, old laptop is that it is extremlely light on resources. My own laptop has Linux running on a cheap 4gb SD memory chip, no hard drive needed. Slick and smooth, from power on it's up and running in ca. 15 seconds. Chrome starts in 2-3 seconds and even then there's only mere 250mb of memory used, doing the same on a Windows 7 installation eats about 1,2gb of memory.

Windows also tends to grow fatter. One of the most common question I get from my friends is “why is my computer getting so slow”? Linux stays slim and fit for years, software you add is compartmentalized so that it's libraries and plugins don't leak into the big OS pool. No additional load is put on the core. Because of this you don't have to upgrade your computer hardware every two years or buy software to clean your computer, Linux will not grow old on you!

Linux is free. All applications on Linux are free. What's even better, installing software is so easy it will make you laugh. For instance if I want to install GIMP, a high quality (free!) image editor I can either go to the "software installer", browse to GIMP and click install or from the command line I could write "pacman -S gimp" and voila. Let me repeat this again; Linux is free - the installation is free, updates are free and you get assistance from a huge online user community for free.

In 5 minutes only you can put Linux to an USB stick and try it out without changing anything on your computer. If you like it you can install it alongside your Windows or OSX and choose on startup which one to go with. Linux does not take over your computer - it's your choice!

=> Why Linux is better, a very good, detailed and graphical summary of Linux's strengths.

So what is Linux?

Linux is one of the earliest operating systems made and has since been developed and updated by the worlds most active programmers and computer enthusiasts. Thus it has a word for being for computer geeks only and people commonly visualize someone with thick glasses writing complex commands in the terminal. It's true that Linux originated from a world of geeks but that is also it's strength, it is a community based OS.
Linux has endless of different versions for different requirements - there exists a very minimalistic command line driven Linux and a full-blown desktop version with advanced 3D user interface features and everything there between. Linux is commonly compared to Lego since the user has the power to choose how to put together the individual Linux bricks. The user can do it himself or have a ready built package, called “distros” (short for distributions).

You can choose a highly advanced distro where you build everything from scratch (Arch Linux) or a simple works-for-all distro which will run on every computer imaginable (Linux Mint is currently the most popular one). This is the elegance of Linux - the power of choice is left to the user. Compare this to Windows (and even Apple OS) where everything is pre-cooked and decided for you. In Linux, you decide if you want fancy 3D effects or just a plain, minimalistic interface to focus on your work. If you don’t like your choice, you can remove it just as easily as you installed it and try something else. Below is a short video of Ubuntu (very similiar to Mint) effortlessly running 3D desktop effects:

Another important distincting feature of Linux is that it is open-source, meaning there is no one commercial company behind it. Linux is a project “owned by nobody but managed by everybody”. The source code is open for anyone to read or edit - if you spot a missing feature you can whenever you wish join the team and design this as you wish to have it. If you accidentally dropped an error or misfeat the matrix of programmers all around the world will quickly fix it and the next time you choose to update your Linux all this is included. A great example of crowd-sourcing!

The open-source community thrives on a totally different way of thinking, since money and making income is not the driving force but rather the ambition to have software push technology to its limits and seeing the world enjoying it. In the Linux community, like in a symbiotic ecosystem, your ask for help is welcomed and newbie’s are well taken care of on multiple of forums and help channels. Compare this to the big M & A who will not lift a finger unless money is involved. I am not saying this is wrong, just that the Linux community is a much more friendly one, everyone equal... aarg I knew I couldn’t write this without getting political! To cut it short, all I wanted to say is that you should not be afraid of Linux - on the contrary, you will have more help available then ever before!

If Linux is so great why isn't it all over?

Good question and I cannot give you any good answer but as many will tell you, most probably it has to do with money. Microsoft with it's deep pockets presses manufacturers to have Windows preinstalled on every computer sold (the Windows tax). Linux is not a corporation pushing it's products actively (no ad campaigns for instance), it is community based and spreads by word of mouth. That's just the way it is today, money rulez.
 => MS struggles to discredit Linux

Nothing is perfect and there are two major issues with Linux which might keep some refrained; drivers and software. Unlike Windows, 99% of all drivers are built inside the "Kernel", the heart/core of Linux common to all distros. The Kernel is constantly being worked on and since version 2.6 driver issues are becoming a thing of the past. There are some peculiarities with older computers but support from the community is very good and with a few searches with Google this can almost always be fixed. Besides, Windows is no angel with regards to drivers either - last month I had to throw away my sons graphics card because it was not supported on Vista. Had no problems running it on Linux!

Software on the other hand is not straight forward. Since Linux is an open-source community, proprietary software is rare and the big software makers have very little profit of porting to Linux. In effect, you will have to revert to new software you have not worked with before. Not a problem really, just an inconvenience since it takes time to learn new software, just as it would on Windows or OSX. And so, LibreOffice  (previously OpenOffice) replaces MS Office, GIMP replaces Photoshop etc. All of these are absolutely free. The Alternativeto website is a great site for helping you finding alternatives.
If you insist using proprietary Windows/OSX software, you can always run the other OS from inside Linux with a so called “Virtual machine”. It will behave 100% as if your computer is running your other OS, just inside a window in Linux. There are both Windows and Apple OS emulators available making most proprietary software work. Another option is to install Linux alongside your other operating system and then you simply choose at startup which one your prefer for your session (see more on dual-bootin').

I have installed Linux on my friends' computers and unlike before when Windows was causing them pain and struggle, I haven't heard a word from them afterwards. Happy as hippos.

OK, you’ve got me excited - what next?

Before we continue, you might want to read this blog post from someone who tried installing Linux (Ubuntu) for the first time, it will give you a short introduction of what is to come.

You will first want to decide which distro is the most appropriate for you and this and this time only I will decide for you what is your best option. If you do your own research you will get drowned in thousands of different opinions.

Ubuntu is one of the best known distros and is famous for it’s easiness of use but recently has had criticism because of their choice of the standard user interface. Thus many are now going for Linux Mint and friends of mine who’ve tried it have been delighted. Here is a recent article comparing the major distros for 2011. If you want to run a distro even lighter on your resources (great for very old computers) I would like to recommend Lubuntu.

Now don't get me mistaken, all of these distros are Linux and they will all run the same software and have the same options under the hood. As said before, they are just different configurations of Lego bricks and you can always adjust their setup afterwards.

Just remember it's easiest to install from a USB drive and follow those instructions and you will be fine. When you feel comfortable, set aside a few gigabytes of your harddrive and make a full installation. Later on you can remove the Windows/OSX partition or just have it there for fun. By the way, Linux has no problems with reading your documents on that other partition.

Last year I switched from Ubuntu to ArchLinux which is has a very minimalistic user interface (desktop) and is intended for advanced users, providing total control of it's configuration and settings. It is by far the fastest Linux distro I have tried yet and after some fiddling learning by mistakes I now have it installed on all of my computers, faster and snappier than ever before, all running from a small 4gb SD memory card and without hard drives (my data is all in the cloud anyways!). Oh sweetness!

Finally

You're off to go! I would love to hear feedback from you in the comments if you go all the way. I might even lend you a helping hand. Now that I've finally written this long introductory post to Linux I will most likely be shedding off a few tips and thoughts every now and then from my own personal experiences so stay tuned.

I will end this post with a few recommended readings if you are eager to know more about Linux:

• A great site about the strengths of Linux and graphically explained
• [Lifehacker] An easily comprehended article about the first steps of starting Linux
• [MakeUseOf] Debian vs. Ubuntu vs. Linux Mint (and check out the user comments, lots of valuable feedback)
• No games for Linux? Not true!

Picking the right social network, storing your 'read articles' collection

I am currently updating my PEA blog as it was an aesthetic disaster. I have dwelled deep into Blogger's infrastructure and found a way to almost completely takeover the HTML code which allows for much more advanced layout. That along with CSS and jQuery has the potential to make it an awesome interactive site. I will post more details about this later.

I am now having the dilemma of choosing the one social network to "mini-blog" on the side column. Running the feeds from Twitter, Facebook, Google Plus (and even more!) is too much, my readers will end up with a randomized chaotic nystagmus.

Until now Twitter has been the obvious choice but with Google Plus on the rise as a highly advanced and professional (FB for me is the personal network) social networking tool I am tempted to use it not only to mini-blog but also to store all my favorited articles, read on the Internet.

Previously it was easy to do with Google Reader's Shared items function whereas you could mark each favorited item (article) in your subscriptions and export this as a special RSS feed. That way widgets and gadgets could grab that feed and display it on your blog aka 'I am now reading:' list in a box on the sidebar. Well in nov 2011 Google made a unpredicted and very unpopular decision to remove this feature (previous items fortunately are found through Google's Dashboard and can even be exported). Most probably their intentions were benign and to have the crowd use Google Plus instead which is not a bad idea considering it is their main social media platform. But as we speak, half a year after Google Plus entered the scene, there has been none official RSS export function introduced [april 2012: this function is now available through a 3rd party solution!]. There are hacks but the only way to be sure it will continue working tomorrow and the day after tomorrow is to have an official version from Google and thus I have not used these.

Now why do I want to obsessively pin my online readings and share this way? Actually sharing is a lesser important feature, I can live without it, but I have repeatedly found my self going back to my previous readings to find again "just that great article" I read some months ago (like this great piece of work on things that will more likely kill you than sharks).  This commonly happens while writing a blogpost or just having a gust of inspiration to kill the writer's block. I am aware there are other options for this like Evernote and StumbleUpon.com but they are not Google services and thus require another sign up and login which is against my idea of minimalism and one key to all doors. Besides I want smooth integration with Google Reader which despite all is still my favorite RSS reader. I am sure you will eyeball my decision but this is my choice after years of trying different services, loosing data and trying to port data between them, an awkward waste of time.

Wanting the Google Reader integration I have found a relatively painful new way for pinning by creating a special "Pinned articles" circle in Google+ and using the G+ share function in GR, it allows the pinned circle to be selected specifically (and is remembered next time as default choice). You can then decide if you want to invite your friends to this circle or just keep it publicly readable for everyone. This is an ok solution to the problem but I really miss an RSS export feature to create some magic from my feed, eg displaying it on the blog.

The search will continue - please comment if you have any thoughts!

Of Android, e-readers and tablets

I have decided to loosen up a little and do more of spontaneous think-a-loud on my blog. Since I started blogging I have always had the feeling that I should stick to facts and facts only and skip personal opinions and thoughts. After all, my readers - mostly emergency physicians I believe - are constantly short of time. What I have found out is that this format makes me nervous and stiffens my fingers, leaving a dozen of unfinished or drafted blogposts because I feel 'they don't meet the right format'. From now on, I will never again force my self to separate the left and right side of my brain!


Therefor, you will in the future see more of personal thoughts from my daily life of information technology and emergency medicine. With a dash of uninhibited ideas from the right hemisphere and without the expectations of a scientifically correct format, they will be the perfect IT-EM-rants. Phew... I feel unrestrained already!!

I love my Android and have found lots of use for it in my daily EM work, most importantly easy access to Google docs where I have all my notes and books in a electronic book-shelf. I thought I would never need a tablet computer but now that I am reading almost everything electronically (see my post about Crocodoc, the perfect tool for your PDF/article collection) I really feel the need for a bigger screen. For highlighting and annotating my books or documents the small-screen Android keyboard just doesn't do it. Although I have very small 10" netbook, speedy and snappy with Linux installed, it feels clumsy and noisy and so the urge to try a tablet has grown. And it won't fit into my pockets at work.

Today I stumbled upon an Android e-reader which also has a highlight feature - something that has been missing until now and kept me away from the e-reader buzz. It's the Mantano reader and judging from the online reviews I've found it seems to be welcomed by the market. In the same review you will see the Moon+ reader also providing highlighting/annotating features but it doesn't support PDF files which in my opinion makes it unusable.

However, being a minimalist, I suspect I will continue to use the online Crocodoc (and patiently wait for Google to implement highlighting feature to Google Docs), after all it's free, incredibly featured and has the same look and feel wether accessed from a mobile or tablet device or a computer. Besides, all notes and highlights will be saved in the cloud so that they are still there when I login next time from somewhere else.

So once again, I prefer the power of web applications instead of local applications. Running Crocodoc on a tablet has thus become a dream, let's see if we can find a juicy plate to try out,BRB!

Addendum:
The Moon+ reader is for me a fail since it doesn't read (and highlight) PDF files, that's 99% of my electronic book shelf! That leaves Mantano as the winner.