11 4 / 2014

Hopkins Global Health Leadership Fellow, Alex Billioux, shares his list of key papers in HIV Research

by Alexander Billioux (Docphin Ambassador)

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As an Afya Bora Fellow in Global Health Leadership at Johns Hopkins, I have sought to identify the key papers that changed the way the scientific community—and in many cases, the world—viewed HIV, its prevention, and treatment.  What follows is by no means a comprehensive list of all the major papers in HIV research as that list would be too large to be useful and would inevitably miss out on a number of important publications.

The first paper was the first public signal of the AIDS epidemic. This is the Center for Disease Control’s MMWR (Morbidity and Mortality Weekly Report) of 5 homosexual men in LA found to have a rare fungal pneumonia, pneumocystis pneumonia (PCP; first published AIDS cases).

Next we have the first academic article (published by same authors) describing the loss of cellular immunity typifying AIDS

Next we have two papers, the first by Luc Montagnier’s group in France and the second by Robert Gallo’s group in the US describing the isolation of the human immunodeficiency virus.  

Living in the era of antiretroviral medications, we often forget how scary the early days of HIV were. Though I was young, I remember vividly the panic associated with HIV that sparked national discussions on whether people living with HIV should be quarantined or allowed to continue to work and go to school. The fear and stigma surrounding HIV began to slowly decrease after the publication of this paper demonstrating the utility of AZT as the first drug to treat HIV infection.

Unfortunately, less than two years later this paper came out indicating that HIV in patients treated with AZT alone was rapidly developing resistance to AZT, making the drug ineffective. 

In response to this demonstration of rapid development of HIV resistance to antiretroviral monotherapy, groups began to combine antiretroviral drugs fresh from the FDA pipeline in the hope that using more than one drug would reduce the chances for HIV to develop resistance before the drugs had a chance to suppress the virus in the blood. This treatment trial conducted by Roy Gulick and colleagues compared treatment regimens consisting of a single protease inhibitor (PI; in this case indinavir), two nucleoside analogue reverse transcriptase inhibitors (NRTIs; zidovudine and lamivudine), and a combination of all three drugs. This study was instrumental in ushering in the era of Highly Active Antiretroviral Therapy (HAART) and setting one of the key paradigms of HIV treatment employed to this day(i.e., combination of two NRTIs with either a PI or a non-nucleoside reverse transciptase inhibitor)

Unfortunately, less than 2 months later Robert Silicano’s group demonstrated that despite suppression of HIV in the serum of patient’s on HAART, virus could still be detected and amplified in resting latent T-cells. This reservoir of HIV in resting cells is the reason that long-term treatment with antiretroviral drugs does not fully eradicate the virus from infected individuals

Having proven the efficacy of HAART in the suppression of HIV replication and development of AIDS, the next key question was when to initiate therapy. As early treatment regimens carried numerous annoying and sometimes dangerous side effects, HAART was held until an individual’s CD4 count reached 200 cells/mm3 or she developed an AIDS-defining illness such as PCP. However, a landmark retrospective study of patients in the NA-ACCORD database demonstrated a survival benefit to initiation of HAARTat or above 500 cells/mm3. This study eventually led to the current policy in most high-income countries of initiating HAART as soon as possible after diagnosis of HIV. 

While these dramatic advances were taking place in the treatment of HIV in high-income countries, a different story was evolving for the epidemic in low- and middle-income countries. In Africa, where simian immunodeficiency virus (SIV) jumped to humans in the early twentieth century resulting in the main HIV-1 epidemic, AIDS went largely unrecognized until a Ugandan group described the identification of HIV in a group of patients who had been suffering from a mysterious wasting disease called “Slim disease”. This paper would set off a chain of similar investigations throughout the continent that would begin to reveal the scale of the HIV epidemic in sub-Saharan Africa which would ultimately result in a new global focus on HIV.

This same group working in Uganda subsequently undertook one of the first (and to this day longest-lasting) cohort studies of HIV in Africa, demonstrating that unlike the Western epidemic that was largely centered among men who have sex with men (MSM), injection drug users (IDU), and individuals exposed to large volumes of blood products before the blood supplies were routinely screened for HIV; the main method of transmission in Africa was through heterosexual sex. The risk of HIV infection was found to be related to proximity to trading centers and by the number of sexual partners.

During the early epidemic, HAART was too costly for most low- and middle-income countries so the focus in these regions was on reducing the risk of viral transmission. One major area of interest was in decreasing transmission of HIV from mother to child. Initially only preventive methods (such as avoiding long labor, delivery by cesarean section and refraining from breast-feeding) were available, but the landmark ACTG 076 study demonstrated the benefit of a short course of zidovudine therapy during and after pregnancy in reducing vertical HIV transmission.  

Another key focus for prevention was reduction of HIV transmission among heterosexual couples. In 2006 and 2007, three separate landmark clinical trials (South AfricaUganda & Kenya) demonstrated the efficacy of medical male circumcision (MMC) in the prevention of HIV transmission, reducing the risk by roughly 60%. These studies led the World Health Organization (WHO) and CDC to prioritize MMC among sexually active men in endemic countries (especially sub-Saharan Africa).

Perhaps the most important of the HIV prevention trials to date was the HPTN 052 study. This very large, multi-center trial conducted in the US and a number of low- and middle-income countries demonstrated a 96% reduction in transmission of HIV among serodiscordant couples (couples in which one partner is infected with HIV and the other is not) when the HIV infected partner was treated with HAART immediately after enrollment rather than waiting for a decline in CD4 count below 250 cells/mm3. This paper is one of the key bases for the development of the ‘treatment as prevention’ strategy which argues that the most effective preventive strategy is to treat all HIV infected individuals to suppress their viral loads and dramatically reduce the likelihood of transmission through bodily fluids.

One of the most recent advances in HIV prevention is the administration of antiretroviral medications to uninfected individuals who are at high-risk for HIV infection, a strategy termed pre-exposure prophylaxis (PrEP). While three trials have clearly demonstrated the efficacy of this strategy (iPreX study of PrEP in MSMPartners PrEP study among heterosexual couples &TDF2 study of PrEP among heterosexual couples), the Fem-PrEP trial evaluating this strategy in heterosexual African women not necessarily in long-term relationships demonstrated no benefit. The Fem-PrEP findings have been attributed to the fact that women in this study might not have been taking their PrEP regularly while in-between sexual relationships or took the medication only after initiating a new sexual relationship, both resulting in a reduced likelihood of effectively preventing infection. These studies resulted in FDA approval of tenofovir-emtracitabine (the main drug tested in the PrEP studies) for prophylactic use in individuals at high-risk for HIV infection, but the Fem-PrEP study has dampened support for this strategy in the general population.

Despite these successes in treatment and prevention of HIV, the development of a widely reproducible cure for the infection (with most hopes pinned on a neutralizing vaccine) have thus far been unsuccessful. To date only two individuals have been declared cured of HIV infection. The first was the so-called Berlin patient, an HIV-infected man who developed acute myeloid leukemia and who underwent bone marrow transplantation in 2006 from a donor with a CCR5 delta32 mutation (a mutation in a key cell surface protein necessary for HIV entry into T-cells that renders the virus unable to infect these cells). After successful engraftment of the donor’s bone marrow, HAART was discontinued and repeated attempts to find HIV in his blood have detected no virus

The second HIV ‘cure’ was an infant born to an HIV-infected mother and treated with antiretrovirals early after birth because of risk of exposure. Initial laboratory studies indicated the infant had been infected with HIV in utero and so the infant was treated with three antiretrovirals rather than the standard two-drug regimen. The child received this cocktail for 18 months, but then the child and her mother failed to come to follow-up clinic visits for 5 months. When they were finally recovered in care, the infant no longer had any detectable virus in her blood. Thus far, subsequent attempts to detect virus have found no HIV in the blood. Recently a second infant with a similar clinical course to this child has also tentatively been declared cured of HIV, but more time is necessary to support this claim. As a result, a large trial in which early triple-drug HAART is administered to at-risk infants born to HIV infected mothers is being planned to evaluate the generalizability of this approach as a treatment strategy.

14 3 / 2014

We are honored and thrilled to be selected by Apple as one of the best new iOS for Medical Professionals!  Our mission has and always will be to provide doctors with the mobile solutions they need to take better care of their patients.  
Download our app today! http://bit.ly/14fe1Iu
Thanks for all your support!
-The Docphin Team

We are honored and thrilled to be selected by Apple as one of the best new iOS for Medical Professionals!  Our mission has and always will be to provide doctors with the mobile solutions they need to take better care of their patients.  

Download our app today! http://bit.ly/14fe1Iu

Thanks for all your support!

-The Docphin Team

06 2 / 2014

By Kathy Miller

No matter who you are, or where you live, the threat of dementia is real. According to the World Health Organization, dementia currently afflicts 35.6 million people worldwide, and 7.7 million new cases are identified every year. This condition is characterized by a gradual reduction of cognitive functioning that can affect many aspects of life — not just mental comprehension but also emotions, social functioning and even physical characteristics. There’s no cure for dementia, but researchers have identified a number of lifestyle habits and behavior modifications that can reduce the risk of developing dementia — or slow its progression, if early stages of dementia are already present. If you’re looking to lower your own risk of dementia, here are some strategies that have scientific backing.

Change the foods you eat

According to research published in the journal Neurology, a diet low in iron could contribute to heightened risk of dementia. The study found that persons afflicted with the iron-deficiency, known as anemia, faced a 41 percent greater risk of developing dementia later in life. While it’s not entirely clear how iron contributes to dementia, the study suggests that a diet high in iron might be effective in reducing dementia risk.

The National Heart Lung and Blood Institute has published a list of iron-rich foods that individuals should try to eat when increasing their blood-iron levels. These foods include most meats, including chicken, beef, turkey, pork, shellfish and other fish, as well as non-meat foods like spinach, tofu, peas, soybeans, dried fruits, prune juice, green leafy vegetables, and other iron-fortified foods. Integrate these into your daily diet to elevate iron levels and guard against dementia.

Take up games that exercise the mind

Previous video game research has suggested that action-based games can stimulate cognitive function. A recent study published by the non-profit research publisher PLoS ONE has suggested that stimulation of cognitive functioning can be achieved through a wide range of game types, not only action-based games. The research found that the ways in which a given video game stimulates cognitive function could have a positive effect on similar functions in day-to-day life.

This is valuable information for individuals looking to combat dementia through brain exercises. Whether you’re looking for free game options or are willing to pay money, there are a variety of options at your disposal. For example, you can download games at iWin.com or search your phone’s app store for games that exercise and stimulate the mind. Seek out games types that have been shown to improve certain aspects of mental cognition, which according to the PLoS ONE research include action, match-3, hidden-object, spatial memory and agent-based simulations of real life.

Learn a second language

According to research published in the latest issue of Neurology, one of the best defenses against dementia may be learning a second language. A large study found that speaking two languages can delay the onset of dementia but an average of 4.5 years. One researcher said these benefits could result from the way learning language stimulates the brain’s executive functioning and attention tasks.

If you are interested in learning a second language as a form of dementia prevention or treatment, a number of options are available to you. Local community education often offers foreign language studies, and most community college or other post-secondary institutions will offer foreign language courses for students to choose from. You can even consider computer-based learning programs like Rosetta Stone, which help you develop fluency on your own time, and from the comfort of your own home.

*Kathy is a medical student, working on her degree. In the meantime, she’s a dental assistant and freelance health writer.

16 1 / 2014

Check out the latest issue of Choices from our partners at the AAMC


The latest news and advice about specialty choice and the residency selection process is now available in the Winter 2014 issue of the Choices newsletter, brought to you by the AAMC’s Careers in Medicine. Learn about orthopaedic surgery (it’s not sports medicine or just for jocks), how faculty evaluate residency candidates, whether a lower score on Step 2 will impact your residency applications, and how one physician switched from pediatrics to anesthesiology during residency.

Click here to learn more: https://www.aamc.org/cim/choices/all2014/winter2014/

*Editor’s note: With the launch of the new CiM Web site, you must now sign in with your AAMC Account. If you’ve signed in to the old CiM Web site or used other AAMC services such as MCAT, AMCAS, or ERAS, you have an AAMC Account. If you do not have access to CiM, you may need to ask your school for access or purchase a subscription to CiM. We apologize for any inconvenience.

02 1 / 2014

Regain Flexibility and Strength after Back Surgery

By James Humble (guest blogger)

Physical therapy (PT) is necessary for a patient to fully recover from surgeries related to the spine and neck, according to physical therapist Frank Zalesny. Zalesny also states that many times physical therapy is the most important aspect of recovery and that any patient who expects to return to normal activity must actively participate in physical therapy.

Why PT is Essential

  • Your physical therapist does more than help you exercise, he or she educates you on which exercises are best for your recovery.
  • The exercises you do target the areas necessary to increase strength, decrease your pain and improve your flexibility.
  • If you do not improve your strength and flexibility directly following surgery, you risk re-injuring yourself.

When working with a physical therapist, you will have a program tailored specifically to your individual situation, but here is a typical idea of what to expect:

The Day After Surgery

With assistance from a physical therapist, you will likely begin walking.

1-Week Post-surgery

You will probably be asked to walk twice a day. These should be slow, short walks to start. You can slowly increase your time until you are walking 30 minutes each session.

The more you move around, the better. However, you need to avoid crawling, twisting, bending, stooping, kneeling, pulling, pushing and lifting anything that weighs more than eight pounds. To put this into perspective, according to the Alabama Dairy Producers, one gallon of milk weighs 8.6 pounds.

2-6 Weeks Post-surgery

You will most likely begin increasing your walking speed. Do not power walk, you are just trying to maintain your baseline muscle tone and increase your circulation.

Continue to avoid actions listed above. Do not lift anything that weighs more than 10 pounds.

6-12 Weeks Post-surgery

At this point, you may be asked to increase your walking speed and distance. You can walk up to two miles a day. Increase your pace to the point that you feel a bit winded.

If necessary, on rare occasions you may stoop, kneel, crawl, bend and lift. You should not lift anything heavier than 15 pounds. If you still have a back brace, continue to wear it as directed. You also may begin doing specific exercises at this point. You can watch videos that demonstrate the proper way to perform many spine exercises and stretches at sites like Laser Spine Institute.

3 Months Post-surgery

Once you finish your professional PT, you are most likely ready to continue exercising at home. To avoid injuring yourself, follow the program that your physical therapist taught you. After you exercise for a few months, your spine becomes stronger and you are less likely to re-injure it. Your exercise routine needs to be part of your daily regimen.

Exercises You Can Possibly Perform 3 Months After Surgery

  • Swimming
  • Walking/Jogging – Up to two miles per day
  • Bike riding

6 Months Post-surgery

You can probably begin to play non-collision sports like:

  • Tennis
  • Golf
  • Basketball

Weight lifting restrictions remain with 50 pounds generally being the limit.

One Year Post-surgery

Continue exercising and using good posture. Always lift using your legs to avoid putting pressure on your spine.

Your surgeon usually lifts the restrictions at this point. If your back’s rehabilitation is complete, you can play football, snow ski or weight lift. Just remember to use good judgment.

16 12 / 2013

Best of 2013 on Docphin

At Docphin, we are committed to developing technology that accelerates the use of evidence-based medicine in the clinical setting. In 2013, doctors and providers from over 15 countries used Docphin to access more than 1 million research articles. More than two-thirds of engagement came from our iPhone app, iPad app, and Android app. Many of the most active users come from the hospitals that use our licensed platform. We’ve gone through all the data and created a list of the Best of 2013 on Docphin. Here’s a countdown of the top 50 most viewed articles on Docphin.

50. Is It Ever Right to Choose Not to Do CPR?
by Christie Aschwanden, Washington Post

49.  Status Update: Whose Photo is That?
by  Karen Michelle Devon, JAMA

48.  Leading Clinicians and Clinicians Leading
by  Richard M J Bohmer, NEJM

47.  The Impossible Workload for Doctors in Training
by  Pauline Chen, New York Times

46.  How to Decide Whether a Clinical Practice Guideline is Trustworthy
by  David F Ransohoff et al, JAMA

45.  Only the Beginning - What’s Next at the Health Insurance Exchanges?
by  Henry J Aaron, NEJM

44.  Removing the “Me” from “MD”.
by  Ravi B Parikh, JAMA

43.  Debating Doctors Compensation
by  Uwe Reinhardt, New York Times

42.  Primary Prevention of Cardiovascular Disease with a Mediterranean Diet
by  Ramón Estruch et al, NEJM

41.  Doctors Badmouthing Other Doctors
by Pauline Chen, New York Times

Follow your favorite journals on Docphin

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40.  Residencies Roll Out New Training System
by Mike Mitka, JAMA

39.  Health Care Needs a Steve Jobs
by Robert Gaboyes, USA Today

38.  Five Things You’re Getting Wrong About Weight and Weight Loss
by Alexandra Sifferlin, Time

37.  When Doctors Tell Patients What They Don’t Want to Hear
by Lisa Rosenbaum, The New Yorker

36.  10,000 Hours May Not Make a Master After All
by Maia Szalavitz, Time

35.  This is Your Brain on Coffee
by Gretchen Reynolds, New York Times

34.  Fever of Unknown Origin or Fever of Too Many Origins
by Harold W. Horowitz, New England Journal of Medicine

33.  Should Physician Pay Be Tied to Performance?
by Wall Street Journal

32.  The Composition of Intern Work While on Call
by Eugene Z Oddone, Journal of General Internal Medicine

31.  The Lies We Tell in the Exam Room
by Abigail Zugar, New York Times

Save PDFs from important articles using Docphin’s PDF Library

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30.  Googling a Patient
by Rebecca Volpe et al, The Hastings Report

29.  Should We Google It? Resource Use by Internal Medicine Residents for Point-of-Care Clinical Decision Making
by Alisa Duran-Nelson et al, Academic Medicine

28.  For New Doctors, 8 Minutes Per Patient
by Pauline Chen, New York Times

27.  Service: An Essential Component of Graduate Medical Education
by Jennifer C. Kesselheim et al, New England Journal of Medicine 

26.  Compensation of Chief Executive Officers at Nonprofit US Hospitals
by Karen E. Joynt et al, JAMA Internal Medicine

25.  The Residency Mismatch
by John Iglehart, New England Journal of Medicine

24.  Pitfalls with Smartphones in Medicine
by  Donald A Redelmeier et al, Journal of General Internal Medicine

23.  "Good" Patients and "Difficult" Patients - Rethinking Our Definitions
by  Louie Aronson, New England Journal of Medicine

22.  Healing the Overwhelmed Physician
by  Jerry Avorn, New York Times

21.  Health-Care Apps That Doctors Use
by  Jeanne Whalen, Wall Street Journal

Follow breaking medical research in the news using Medstream

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20.  The Darkest Year of Medical School
by  Danielle Ofri, Slate

19. The 3-Year Medical School - Change or Shortchange?
by  Stanley Goldfarb et al, New England Journal of Medicine

18. Why Doctors Need to be More Like Malcolm Gladwell
by  Kevin Pho, KevinMD

17. Meet the Safest Man in America to Have Sex With
by  Alice Truong, Fast Company

16. Teaching physicians to care amid chaos
by  Allen Detsky et al, Journal of the American Medical Association

15. The Biggest Mistake Doctors Make
by  Laura Landro, Wall Street Journal

14. Are We in a Medical Education Bubble Market?
by  David Asch et al, New England Journal of Medicine

13. Uncertainty Is Hard for Doctors
by  Danielle Ofri, New York Times

12. The Gulf Between Doctors and Nurse Practitioners
by  Pauline Chen, New York Times

11. Why Are Hospital CEOs Paid So Well?
by  Richard Gunderman, The Atlantic

Docphin can help accelerate the use of evidence-based medicine at your hospital or training program - Learn More

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10. Why I Changed My Mind on Weed
by  Sanjay Gupta, CNN

9. What Happened to the Doctors’ Lounge?
by  Richard Gunderman, The Atlantic

8. The Case for Changing How Doctors Work
by  Celine Gounder, The New Yorker

7. How Doctors Die: Showing Others the Way
by  Dan Gorenstein, New York Times 

6. White Coat Hype: Branding Physicians with Professional Attire
by  Mary Catherine Beach et al, JAMA Internal Medicine

5. Treating Acute Venous Thromboembolism - Shift with Care
by  Mary Cushman, New England Journal of Medicine

4. It’s Not You, Doctors Are Just Rude
by  Alexandra Sifferlin, Time

3. Why Doesn’t Medical Care Get Better When Doctors Rest More?
by  Lisa Rosenbaum, The New Yorker

2. Myths, Presumptions, and Facts About Obesity
by Krista Casazza, New England Journal of Medicine

1. States of Health
by Atul Gawande, The New Yorker

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02 12 / 2013

Debate Rages on About the New Cholesterol Guidelines

by BluefirePR (guest post)

A leading cardiologist is demanding a halt on a recently released online cholesterol risk calculator and cholesterol-lowering guidelines developed by the American Heart Association (AHA) and American College of Cardiology (ACC). The calculator may be seriously flawed and could overestimate cardiovascular risk by 75 to 150 percent, reports the New York Times. Both heart organizations, however, vehemently stand behind the cholesterol calculator and guidelines, stating that they relied on a broad range of patient data in its development and although the calculator is not perfect, it’s a big step forward.

The Debate

The calculator provides a cholesterol risk assessment and estimates a patient’s risk of having a heart attack or stroke within a 10-year period. At the root of the heated debate is concern over millions of people mistakingly and excessively being prescribed statins, cholesterol-lowering drugs. Physicians prescribe statins as reasonable treatment for a majority of patients with high cholesterol to reduce their risk of having a heart attack or stroke.

Not only do the inaccuracies of the calculator create concerns that patients would unnecessarily take statins based on a false assessment, miscalculations can also have the opposite effect. Patients could become even more skeptical about statins. The distrust could discourage high-risk patients with diabetes or a history of heart disease from taking the medication when it’s in their best interest to do so.

Two professors from Harvard Medical School, Dr. Paul M. Ridker and Dr. Nancy Cook, identified the calculator as problematic earlier this year. The National Institutes of Health’s National Heart, Lung, and Blood Institute originally developed the guidelines. After reviewing the drafts, the professors were unsatisfied, yet their concerns were ignored.

"We need to pause to further evaluate this approach before it is implemented on a widespread basis," Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic and past president of the American College of Cardiology, said to the Times.

The Rebuttal

During the annual American Heart Association meeting in November, the AHA and ACC explained the calculator is for patients and doctors to use as a guide while considering treatment options. The organizations “advised against blind adherence to the calculator,” Time magazine reported. Doctors are still encouraged to follow the guidelines.

Officials also responded to statin concerns by saying the calculator is merely a suggestion for people who would benefit from the medication. The calculator is intended to prompt conversation between a patient and his doctor about options for lowering cholesterol. Based on the guidelines, patients are advised to take statins if they qualify under risk factors such as having heart disease, extremely high LDL cholesterol or type 2 diabetes

After Dr. Nissen advocated a delay in implementing these guidelines, Dr. Sidney Smith, a cardiologist at the University of North Carolina at Chapel Hill and former AHA president, told U.S. News & World Report, “We intend to move forward with these guidelines and develop effective strategies to implement them.”

Healthy Cholesterol

The controversy highlights the dangers of high cholesterol and heart disease. More than 100 million Americans are at risk for clogged arteries, heart attacks and strokes because of high cholesterol, according to Health.com. Take control of your cholesterol and reduce your risk of heart disease with the following lifestyle changes and treatments:

15 8 / 2013

Choosing your sources on Docphin

We’ve made it super easy for you to choose your sources.  

1. Once you’ve logged in, click on the “Journals” tab in the left navigation bar

2. Click on “Add Journal”

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3. From the available sources window, simply search for a specific journal OR review a suggested journal list (sorted alphabetically).  There are over 5000 sources to choose from on Docphin.  

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If you don’t see your preferred journal, shoot us an email at info@docphin.com and we will make sure to add it for you! 

And you’re done!  Time to customize your page! Download the free iPad/iPhone app today: http://bit.ly/14fe1Iu

15 8 / 2013

How to Save your Proxy on the Docphin App

Saving your proxy is very easy to do from your iPad or iPhone.

1. On the left navigation panel, click on your name

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2. Select your institution from the institution list

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3. Add your Library/Proxy username and password.  (Your information is encrypted and stored only your device).

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4. Save your settings and you’re done!

We hope that you will find the new interface easy to use. Let us know if you have any questions.

Thanks for being part of the Docphin community!

The Docphin Team

Make medical research practical.  Download the free iPad/iPhone app today! http://bit.ly/14fe1Iu

15 8 / 2013

Getting Seamless Access to Full Text Articles on the Docphin app

Once you’ve linked with your institution, Docphin users can seamlessly access full text articles for free with one click.  

1. After reading an abstract or summary of an article on Docphin, you may choose to read the full text.  Simply click on the “View PDF” button in the bottom center of your screen.

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2. If you’ve saved your proxy you’ll be take directly to the full text PDF of the article!

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Throughout your session on the web, iPhone and Android apps, enjoy one click access to free full text articles!  

Make medical research practical.  Download the free iPad/iPhone app today! http://bit.ly/14fe1Iu