how to loss factor program: 2012

Senin, 31 Desember 2012

Put down your phone - "Disconnect to connect" (video)

Here is a widely shared commercial from Thailand that is a part of a series of related videos on YouTube http://buff.ly/T8EoO8:

Sabtu, 29 Desember 2012

"We had a very simple idea, that's to see the warmth"

This ad was created for a Belgian natural gas company. The purpose was to show the TV audience what "warm looks like", says director Olivier Babinet.

"The idea of the film is simple. How to visualize the warmth of natural gas? By the use of the stop motion technic, we see how warmth spreads through the house as knitted wool."

Here is how they did it, carefully attaching yards of yarn to walls, radiators, and pipes, 40 people working 4 days and nights:

References:

It's December. Brrrr. Is My House Shivering? Krulwich Wonders. NPR http://n.pr/Y97YmJ
A house that knits itself | Colossal http://bit.ly/Y98xNl

Kamis, 27 Desember 2012

Rabu, 26 Desember 2012

A Best Friend Will Always Wait for You

Julian Burrett: "Watson the dog stands by while the boy does a quick assessment of the puddle situation. Could this be the cutest video ever? FAQs: Watson is a 12 year old Shar Pei." http://buff.ly/X2Jpr9

Sabtu, 22 Desember 2012

Long Live Rock 'n' Roll? Study Shows Risk to Stars (video)

A new study from the United Kingdom (BMJ) reveals just how risky rock-and-roll can be - WSJ:

The WSJ summarized the findings of the study published in BMJ:

The research examined 1,489 stars of pop, rock, hip-hop and punk, of whom 137, or 9.2%, died during the five-decade period covered by the study. Nearly 39% of those deaths were caused by factors related to violence or alcohol and drug intake.

North American pop stars were 87.6% as likely to be alive as normal people of the same age and ethnicity—the lowest survival rate of any group identified in the study.

In North America, 23% of solo performers died, versus 10% of band-only stars, the study found. The comparable figures for Europe were 10% versus 5%.

The study doesn't address a widely held belief that drummers are more prone to early death than other musicians.

References:

Long Live Rock 'n' Roll? Study Shows Risk to Stars - WSJ.com http://on.wsj.com/V8O79a

Kamis, 20 Desember 2012

Credit Card Germs: 1 of 10 of cards has fecal bacteria

Here is what a Cleveland Clinic ID specialist has to say: "You know all that money you're spending over the holidays? It's jam-packed with germs. So keep your hands clean and your credit cards wiped down. Avoid touching your eyes and mouth when out shopping."

What are the 8 germiest places in the mall?

The 8 germiest places in the mall, according to CNN, are:

1. Restroom sinks
2. Food court tables
3. Escalator handrails
4. ATM keypads
5. Toy stores
6. Fitting rooms
7. Gadget shops
8. Makeup samples

The filthiest area in a restroom (and therefore in the whole mall) isn't the toilet handle or the doorknob - it's the sink. The sink area is a moist environment, so bacteria can survive longer there.

Researchers found food, E. coli, urine, mucus, feces, and blood on escalator handrails. Where there is mucus, you may also find cold and flu viruses.

Each key on an ATM contains, on average, 1,200 germs. Protect yourself: "Knuckle" ATM buttons.

References:

The 8 germiest places in the mall. CNN.
12 Germiest Places in America According to Health Magazine
Dirty Money and Credit Card Germs - Health Hub from Cleveland Clinic http://bit.ly/TRLSoQ

Rabu, 19 Desember 2012

Senin, 17 Desember 2012

Physician Communication PEARLS from Cleveland Clinic

The video features my former colleagues and hospital medicine stars Drs. Moises Auron and Vj Velez:

Some key messages:

- Establish rapport and plan an encounter with the patient

- Elicit the patient perspective using FIFE (function, ideas, fears and
expectations)

- Apply PEARLS (partnership, empathy, acknowledgment, respect,
legitimation and support) to convey empathy

- Incorporate the patient into decision making and education using ART
(ask, respond, tell)

References:

Relationship-Centered Communication for Physicians (PDF) from Cleveland Clinic Academy

Jumat, 14 Desember 2012

The #FOAMed revolution (Free Open Access Medical education)

From Mike Cadogan:

"The net effect of #FOAM has taken me quite by surprise (editor's note: #FOAMed is Free Open Access Medical education). Despite a complete lack of evidence, peer review, mission statements OR Big Pharma backing – the FOAMed revolution continues to infiltrate the psyche of the everyday healthcare professional. The ability to intelligently review, discuss and develop hypotheses, guidelines and issues; the sense of community; the sense of rebellious augmented learning and the joy of independence is rife…and contagious.

There are now an amazing 180 emergency medicine and critical care blogs. Bloggers write from 21 different countries. GMEP – ‘the Facebook of Medicine’ has just welcomed it’s 800th new member, 2 weeks after launch." http://buff.ly/12lzWzs

Here is my comment: Congratulations, Mike! These are amazing stats that illustrate an inspiring success! "Facebook of medicine", indeed. Let's keep it growing.

Kamis, 13 Desember 2012

Solving the puzzle of the periodic table - TED Education video

Solving the puzzle of the periodic table - TED Education video. View the full lesson here: http://ed.ted.com/lessons/solving-the-puzzle-of-the-periodic-table-eric-rosado

Rabu, 12 Desember 2012

New additions to Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

From TIME:

Doctors use the the Diagnostic and Statistical Manual of Mental Disorders (DSM)'s definitions to diagnose more 300 other conditions. Insurance companies use it to justify reimbursements; without a DSM code, mental-health patients and doctors usually don't get paid. DSM-5 is already so famous that it has its own website: http://dsm5.org

On Dec. 1, the American Psychiatric Association approved the fifth edition of the DSM which took 13 years and 1,500 mental-health experts to complete. They tried to approach mental disorders less as discrete illnesses, like leukemia, and more as problems on a continuum, like hypertension.

Here are a few of the new additions in DSM-5:

- Hoarding is included as a diagnosis, meaning those who can't get rid of ephemera can now seek reimbursement for therapy

- Binge eating was in the appendix for more than a decade, but now it's an official diagnosis

- Bereavement. The previous DSM said those in mourning don't necessarily qualify for depression therapy or medication. DSM-5 eliminates that exclusion.

- Excoriation, or skin picking, should be considered a mental illness according to DSM-5

References:

Redefining Mental Illness. TIME, 2012.

Selasa, 11 Desember 2012

Best of Medical Blogs - weekly review and blog carnival

The “Best of Medical Blogs - weekly review and blog carnival” is a weekly summary of the best posts from medical blogs. Please email your suggestions for inclusion to clinicalcases@gmail.com. Best of Medical Blogs (BMB) is published every Tuesday, just like the old Grand Rounds.

Is robotic surgery the “laser” of the 21st century? http://buff.ly/Vpbt6W

A Low-tech Solution to Keep Immunosuppressed Patients Safe: a green ball http://buff.ly/VjcoFM

Cardiologist: Physicians Beware on the Twittersphere: "I was left at a conversational disadvantage because of the loss of context that is inherent to 140-character interactions on Twitter. This is a complex issue, and surely not suitable for Twitter. Engaging on this medium on this topic was a mistake. I learned from it." http://buff.ly/YWDE3x

Best article first-author, maybe ever: Taco Monster http://buff.ly/YMVUfq

Celebrity Actors Who Have Received a Tracheostomy (Catherine Zeta Jones Included) | Fauquier ENT Blog http://buff.ly/YNhXmo

Productivity tips: TalkTyper and more http://buff.ly/VjmdUc

Epocrates finally fights back - a review of their iPad app http://buff.ly/Rz9AZs

Here is my PhD thesis, by Dr. Bertalan Meskó: “Two weeks ago, my childhood dream became true and I finished PhD therefore becoming a medical geneticist.” http://buff.ly/YWAmx7

If you’re going to purchase a medical ebook, go through the Kindle app (more flexibility and less buyers remorse) http://buff.ly/S01xFq

Chronic Disease and Social Networks http://buff.ly/REhcKp

Senin, 10 Desember 2012

There are patients with "gluten sensitivity" in whom neither allergic nor autoimmune mechanisms can be identified

There are 3 main forms of gluten reactions:

- allergic (wheat allergy)
- autoimmune (celiac disease, dermatitis herpetiformis and gluten ataxia)
- possibly immune-mediated (gluten sensitivity)

From BMJ:

It is now becoming clear that, besides those with celiac disease or wheat allergy, there are patients with gluten sensitivity in whom neither allergic nor autoimmune mechanisms can be identified. It has been estimated that, for every person with celiac disease, there should be at least six or seven people with non-celiac gluten sensitivity. Gluten sensitivity may therefore affect 6-10% of the general population.

Patients with gluten sensitivity have negative immuno-allergy tests to wheat and negative celiac disease serology; normal endoscopy and biopsy; clinical symptoms that can overlap with those of celiac disease, irritable bowel syndrome, and wheat allergy; and they show a resolution of symptoms when started on a gluten-free diet.

Currently there are no laboratory biomarkers specific for gluten sensitivity, and the diagnosis is based on exclusion criteria; elimination of gluten-containing foods from the diet followed by an open challenge is most often used to establish whether health improves with the elimination or reduction of gluten from the patient’s diet.

New nomenclature and classifications are proposed (see the figures below).

"Fibromyalgia of the gut"

Some physician have labeled "gluten sensitivity" "fibromyalgia of the gut" to reflect the presence of symptoms in the absence of pathological findings. The BMJ editor-in-chief reflected on these doubts in an editorial: Gluten sensitivity: real or not?.

Since there are no biomarkers, gluten sensitivity is the ultimate diagnosis of exclusion. The worldwide shift to the Mediterranean diet may explain the rising prevalence of gluten sensitivity. The has been an “explosion of requests” for serological testing for celiac disease since 2007.

3 million Americans are living with celiac disease

Celiac disease, an immune system reaction to gluten in the diet, is four times as common today as it was 50 years ago. Lack of awareness of celiac could be contributing to a delay of up to 11 years in diagnosis of adults in North America (http://goo.gl/sy778).

This is an informative and beautifully designed video by the University of Chicago Celiac Disease Center. It looks like an infographic made into video - have a look:

New classification is being proposed for gluten-related disorders: celiac disease; dermatitis herpetiformis; gluten ataxia; wheat allergy; gluten sensitivity. WSJ, 2012.

Recent studies support the existence of the new condition nonceliac gluten sensitivity which is defined as symptoms with negative celiac antibodies and biopsy (http://goo.gl/57IlB).

References:

Non-coeliac gluten sensitivity | BMJ, 2012.

Gluten sensitivity: real or not? | BMJ http://buff.ly/ZgKgK1

Does gluten sensitivity in the absence of coeliac disease exist? | BMJ http://buff.ly/RvC7zg

New nomenclature and classification of gluten-related disorders - http://www.biomedcentral.com/1741-7015/10/13/figure/F1

Algorithm for the differential diagnosis of gluten-related disorders, including celiac disease, gluten sensitivity and wheat allergy - http://www.biomedcentral.com/1741-7015/10/13/figure/F4

Spectrum of gluten-related disorders: consensus on new nomenclature and classification. Anna Sapone et al. BMC Medicine 2012, 10:13 doi:10.1186/1741-7015-10-13.

Image source: Colon (anatomy), Wikipedia, public domain.

Disclaimer: I am an Assistant Professor of Medicine and Pediatrics at University of Chicago.

Comments from Google Plus:

Neil Mehta: thanks for sharing this. Besides the content itself, Really like this type of articles where a patient can write about medical lessons learned.

Howard Luks: That's me :-) thanks for sharing this! My GI guy will see it in the AM

Kamis, 06 Desember 2012

Bell's palsy - NHS video

Bell’s palsy is the abrupt paralysis of the facial nerve (cranial nerve 7, CN7), resulting in an inability to control facial muscles on the affected side. A common condition, Bell’s palsy has an annual incidence of 11-40 cases per 100 ,000 population. Many patients recover without intervention; however, up to 30% have poor recovery of facial muscle control and experience facial disfigurement, psychological trauma, and facial pain.

From the NHS Choices YouTube channel: Bell's palsy is the temporary weakness or paralysis of the muscles in one side of the face. In this video, a speech therapist explains who is most at risk and describes common causes and treatment options available. Helen explains how she dealt with the condition and recovered from it:

Remember:

U MN damage
U pper face is OK (the patient is able to wrinkle his forehead)

LMN damage = patient is unable to wrinkle his forehead (our patient)

The examination of CN 7 palsy can be remembered by the mnemonic COWS:

C lose your eyes
O pen (the examining physician tries to open the patient's eyes)
W rinkle your forehead
S mile

Two main types of pharmacological treatment have been used to improve outcomes from Bell’s palsy:

- steroids
- antivirals.

The rationale for these treatments is based on the presumed pathophysiology of Bell’s palsy, namely inflammation and viral infection.

In a 2009 study published in the BMJ antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with Bell’s palsy.

References:

The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis | BMJ http://bit.ly/YD3iLG

Rabu, 05 Desember 2012

Selasa, 04 Desember 2012

Best of Medical Blogs - weekly review and blog carnival

Senin, 03 Desember 2012

The longevity of a rock singer

Here is Ian Gillan (age 67) from Deep Purple in a recent interview:

You have been screaming rock music for over 40 years. How do you do it?

I think it’s quite natural, I do a lot of it, and so I keep myself fairly fit. My mates who were singers they quit to enjoy their success or raise families and they didn’t continue. Then they tried to come back years later but it was very difficult because vocal cords, unlike guitar strings, are unforgiving, you can’t change them. So I think I’ve been singing all my life, and therefore I’m pretty much fit, so to speak. Most things are within my scope, I sing pretty naturally so it’s not a strain, never has been.

Here is Deep Purple with Maybe I'm a Leo, Mainz, Germany, July 2011:

This is the same band 40 years ago, in 1972:

I have been to two concerts of Deep Purple, the last one was in June 2011 and it was quite impressive. The audience age ranged from 5 to 75 and everyone rose to their feet to the sound of Smoke on the Water.

Here is Mick Jagger on staying fit: "You watch what you eat, you exercise, you have a bit of fun. You keep on going forward. Don’t stop. Do what makes you happy. Don’t look at the clouds of tomorrow through the sunshine of today. That’s it."

References:

Deep Purple but no blues: US legends top Dubai jazz festival line-up | Al Bawaba http://buff.ly/V520RZ

Mick Jagger's new supergroup with Joss Stone and Dave Stewart. DailyMail.

Redefining age 65 - when your job description is "rockstar"

Sabtu, 01 Desember 2012

Jumat, 30 November 2012

Myopia - 2012 Lancet review

From the Lancet:

Myopia (nearsightedness) has emerged as a major health issue in east Asia, because of:

- increasingly high prevalence in the past few decades. It now affacts 80-90% in school-leavers.
- sight-threatening pathologies associated with high myopia, which now affect 10-20% of those completing secondary schooling in east Asia.

Similar, but less marked, changes are occurring in other parts of the world.

The higher prevalence of myopia in east Asian cities seems to be associated with increasing educational pressures, combined with life-style changes, which have reduced the time children spend outside.

There are no reported major genes for school myopia, although there are several genes associated with high myopia. Any genetic contribution to ethnic differences may be small.

There are some optical and pharmacological interventions that seem promising for preventing the development of myopia or slowing its progression, but the evidence is still preliminary.

References:

Myopia. Prof Ian G Morgan PhD a b , Prof Kyoko Ohno-Matsui MD c, Prof Seang-Mei Saw PhD. The Lancet, Volume 379, Issue 9827, Pages 1739 - 1748, 5 May 2012.
Nearsighted kids may get worse in winter http://trib.in/VcvmC1 -- Myopia progression seem to decrease in periods with longer days and to increase in periods with shorter days. Children should be encouraged to spend more time outside during daytime to prevent myopia (study) http://buff.ly/X1cFSm
Image source: OpenClipArt.org

Rabu, 28 November 2012

Healthcare social media #HCSM - top articles

Here are my suggestions for some of the top articles related to healthcare social media (#HCSM) from the past 2-3 weeks:

You CAN enjoy Twitter without tweeting -- From AllergyNet: This tweet recently crossed my timeline: “If you don’t engage, there is no point having followers. Agree?” No. I don’t agree. Why? Because a comment like that immediately disenfranchises the 40% of those on Twitter who never tweet. These are the same people that go to public meetings and never ask questions. This is acceptable in a public meeting, and it should be on Twitter. Being inactive does not mean being disinterested. http://buff.ly/SL85DS

Potentials of Social Media for Tacit Knowledge Sharing Amongst Physicians (PDF) http://bit.ly/RFrAfj

Social media is an efficient and effective method for physicians to keep up-to-date http://buff.ly/TEHaxW

How the Mayo Clinic Maximizes Learning Opportunities Through Social Media http://buff.ly/PNCRPb

"Allergy Action Plan: Bring The Paperwork To Life" (video) http://buff.ly/QN8tTW

The “most-tweeted” medical conference ever http://buff.ly/QQq0dI

The Smartphone in Medicine: A Review of Current and Potential Use Among Physicians and Students http://buff.ly/THrvOA

Mark Zuckerberg confirms: 'I wear the same thing every day' - NBC http://buff.ly/U9bwsE

ENT doctor: "Twitter is the best and most efficient way to get started learning from and sharing information" http://buff.ly/QVwjwS

How to automatically archive all the links you share to Twitter and Facebook http://bit.ly/SwanKI

Doctors Are Texting the Teenage Patient - NYTimes http://buff.ly/TczIUl

Virtually There -- following the 2012 ACEP meeiting via Twitter http://buff.ly/RgZ2fE

Web sites will soon fall into two categories: high audience low yield, low audience higher yield http://buff.ly/RVgLcW

Quantifying yourself: the apps I use to measure myself - Loic Le Meur http://buff.ly/Rld9R0

A History of Social Media [Infographic] http://buff.ly/RMC3t2

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive an acknowledgement in the next edition of this publication.

Selasa, 27 November 2012

Narcolepsy - NHS video

From NHS Choices YouTube channel: Samantha was 16 when diagnosed with narcolepsy, a chronic sleep disorder. She describes the symptoms and how it affects her daily life, and an expert discusses its causes and treatment:

Provigil (modafinil), used in narcolepsy, may be addictive http://tinyurl.com/c8cosm

Rabu, 07 November 2012

Selasa, 06 November 2012

Best of Medical Blogs - weekly review and blog carnival

Rabu, 31 Oktober 2012

Sickle cell anemia - NHS Choices video

From NHS Choices YouTube channel:

Sickle cell anaemia is a genetic (inherited) blood disorder where red blood cells develop abnormally. In this video a specialist nurse explains what it is, and Junior describes living with the condition:

The estimated survival at 18 years is now 94 percent for those with HbSS sickle cell disease or HbS/beta(0) thalassemia and 98 percent for those with HbSC or HbS/beta(+) thalassemia.

Related reading:

What's new in hematology from UpToDate http://bit.ly/Tm97Ee

Selasa, 30 Oktober 2012

Best of Medical Blogs - weekly review and blog carnival

The “Best of Medical Blogs - weekly review and blog carnival” is a weekly summary of the best posts from medical blogs. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best of Medical Blogs (BMB) is published every Tuesday, just like the old Grand Rounds.

Here are this week's top blog posts arranged in 4 broad categories:

Twitter as a new educational medium for doctors

ENT doctor: "Twitter is the best and most efficient way to get started learning from and sharing information" http://buff.ly/QVwjwS

Social media is a great way to connect with others at scientific meeting and share your personal experiences. The Chest 2012 meeting jumps in the social media pool with both feet and you must join them: http://buff.ly/Sb2h8S

Crowdsourcing Gout (with tweets). Here is how it works according to @RonanTKavanagh: This is why I love learning on Twitter. New drug, limited experience and 4 rheumatologists chipping in: http://buff.ly/RMK7HS

Health policy: what's on doctors' minds

Dr. Wes is worried about The Growing Culture of Hostile Dependency Toward Caregivers: http://bit.ly/SqnWti

The Joys Of Health Insurance Bureaucracy - Dr. Val from the blog Better Health shares her personal experience: http://bit.ly/T5Ncav

Dr. Wes: The Growing Residency Squeeze: While medical schools have increased their medical school positions by 30%, residency slots have only increased at a much slower rate of 8% http://buff.ly/Sb1HrB

Medical librarian provides a much needed critical look

Online Education Sites: and the Spam Goes on - Laika's MedLibLog from the Netherlands comments on her excellent and always well-referenced blog: http://bit.ly/WmTBwV

Why Publishing in the NEJM is not the Best Guarantee that Something is True - Laika's MedLibLog http://bit.ly/URfwgN

Inner well-being: The glass is half full

Patient-Centerness in Healthcare: Chief Experience Officer at Cleveland Clinic and e-Patient Dave: http://buff.ly/RMHupn

Healthcare CIO: After I started farming, my gray hair has disappeared. My optimism and equanimity are peaking... http://buff.ly/Sb10ie

Senin, 29 Oktober 2012

Social media: how can doctors contribute?

"Social media: how doctors can contribute" is a brief but valuable opinion piece in The Lancet, one of the "big five" journals in the medical publishing world. I have suggested some practical examples before (http://goo.gl/eG7M1) and my comments are in the text below.

Most social media guides for doctors emphasize the need to:

- maintain patient confidentiality
- provide accurate information
- treat colleagues with respect
- avoid anonymity online if writing in a professional capacity
- be aware of how content is shared
- review privacy settings and online presence
- declare conflicts of interest
- maintain separate personal and professional profiles

Here are some quotes from The Lancet article:

"Accepting Facebook friend requests from patients is, in general, not advised. But what of situations where doctors and patients are genuine friends? (then it's OK in many cases).

What, too, of the benefits of doctors providing medical information via blogs, Twitter, or Facebook? Current guidance focuses more on the risks than the benefits of doctors' use of social media."

Providing only negative examples of social media use by doctors is like teaching medical students only with "Morbidity and Mortality" conferences. Providing examples of positive outcomes and best practices is essential.

Patients use social networks to research their symptoms, their doctors, their treatments, and to set up support and information groups.

Doctors can use social media to drive awareness, to provide accurate information, and as a portal to communicate with other physicians.

"Much is said about the dangers of social media. Care about posting in a public space is, of course, needed. Doctors, though, should seize the opportunities provided by social networks to improve the health of their patients, and do their utmost to ensure that the highest quality of health information and access to treatment is there for all."

Finally, some common sense thinking about social media use by doctors has made it into a top 5 medical journal.

Cycle of Patient Education (click here to enlarge the image). An editable copy for your presentation is available at Google Drive:

Cycle of Online Information and Physician Education (click here to enlarge the image). An editable copy for your presentation is available at Google Drive:

The two cycles work together as two interlocking cogwheels (TIC). Here is how to facilitate the Rise of the ePhysican who works hand in hand with the ePatient:

Products of the Cycle of Patient Education: EQUALS

- Energy!
- Quality of life is improved
- Understanding of patient condition is improved
- "Affinity" - better physician-patient relationship leads to increased referrals to the practice, e.g. 2-5 new patients per week per physician, increased revenue
- Lower rate of ER visits, hospital admissions, phone calls
- Savings for patient and health system

References:

Social media: how doctors can contribute. The Lancet, Volume 379, Issue 9826, Page 1562, 28 April 2012.
Social media in medicine: How to be a Twitter rockstar and help your patients and your practice

Related reading:

Howard Luks MD @hjluks: Many MDs and hospitalis are rushing into a So Me with a lack of proper offline preparation, and the lack of understanding buff.ly/LS5WHt

Comments from Twitter:

@mHIMSS: Nice breakdown! [GRAPHIC] How can #physicians contribute to #patient experience w/ #socialmedia? ow.ly/eQW0L via @DrVes

Laika (Jacqueline) @laikas: Social media: how can doctors contribute? j.mp/PD06fe #socialmedia by @DrVes (with nice Patient Education Cycles) HT @DrShock

Jumat, 26 Oktober 2012

Alopecia: Gita's story

NHSChoices: Hair loss, or alopecia, affects an estimated 8 million women in the UK. In this video Gita Mendis talks about her experience of alopecia areata, how she felt when she noticed her hair loss and the treatment she received.

http://www.youtube.com/watch?v=L5dp2t1JZXE

Rabu, 24 Oktober 2012

Healthcare social media #HCSM - top articles

Here are my suggestions for some of the top articles related to healthcare social media (#HCSM) in the past 2 weeks:

Tweets for Credit: Social Media’s Role in CME | The Doctor's Tablet http://goo.gl/QToLQ

"Many faculty members have a keen interest in learning how to better use Twitter. They are attracted to Twitter’s quick pace, easy learning opportunities and ability to help them control more carefully what they share publicly in social media."

Twitter and Medical Education: Information and Inspiration from Albert Einstein College of Medicine

Personal Analytics for Facebook by Wolfram|Alpha http://goo.gl/bRQG1

20 Symptoms of Internet Social Media Addiction. How many of those do you have? http://goo.gl/CkQFh

YouTube for information on rheumatoid arthritis - at least 30% of videos were misleading. A wakeup call? http://goo.gl/Rjzdv

#FOAM Party! (The Future of Medical Education) http://goo.gl/5qZXF

Randomized controlled trial of political messages delivered to 61 million Facebook users http://goo.gl/Q0QAi

Health Care Social Media List is now hosted by Mayo Clinic http://mayocl.in/QdWGxg and http://mayocl.in/QdWGNO

Medicine 2.0'12 - a set on Flickr http://goo.gl/VOekT

Creating the #FOAMed network (Free Online Medical Education) http://buff.ly/PqezX2

Life as a Healthcare CIO: Mobile Devices for Medical Education http://buff.ly/QoLsX2

Tweeting a Medical Meeting http://buff.ly/Pqfw1y

Your YouTube original videos now available in Google Takeout - Data Liberation http://buff.ly/PqiYcH

Happy science: Research Communication http://buff.ly/PNd0CB

The New Google Trends http://buff.ly/TT9nRV

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive an acknowledgement in the next edition of this publication.

Rabu, 17 Oktober 2012

"We can take care of you better if you understand your disease" - Cleveland Clinic's project for visual learners

In this White Board Series, Cleveland Clinic cardiothoracic surgeon Eric Roselli, MD, takes us on a tour of the heart that simply illustrates complex problems so everyone can understand. He says, "We can take care of you better if you understand your disease", and I could not agree more. The videos are below:

Selasa, 16 Oktober 2012

Best of Medical Blogs - weekly review and blog carnival

Senin, 15 Oktober 2012

Gout - Patrick's story - NHS video

From NHS Choices YouTube channel: Patrick, 54, was diagnosed with gout (a form of arthritis) 22 years ago. He describes the symptoms, treatment options and how he learned to live with the condition:

Here is a list of some of the new drugs for an old disease (gout):

Febuxostat is a non-purine-analogue inhibitor of xanthine oxidase that opened a new era in the treatment of gout.

Modified uricases

The use of modified uricases to rapidly reduce serum urate concentrations in patients with otherwise untreatable gout is progressing. Pegloticase, a pegylated uricase, is in development.

JAMA update, 08/2011: New Treatment Offers Hope for Patients With Severe Gout: pegloticase (Krystexxa) costs $2,500 per dose (http://goo.gl/gz9sO).

Drugs in development

Transport of uric acid in the renal proximal tubule and the inflammatory response to monosodium urate crystals (shown above) are targets for potential new treatments.

Several pipeline drugs for gout related to the targets above include:

- selective uricosuric drug RDEA594

- various interleukin-1 inhibitors. Canakinumab (trade name Ilaris) is a human monoclonal antibody targeted at interleukin-1 beta. It was rejected by the FDA panel in June 2011.

References:

Gout therapeutics: new drugs for an old disease. The Lancet, Volume 377, Issue 9760, Pages 165 - 177, 8 January 2011.
Diuretics, beta-blockers, ACEi, non-losartan ARBs associated with increased risk of gout vs. CCB lower risk. BMJ, 2012.
With FDA Approval, a Gout Drug Now Costs $5 Instead of Pennies - WSJ, 2011.
FDA Panel Rejects Gout Drug Canakinumab on Safety Concerns http://goo.gl/lO9uy
The strange story that links gout with the birth of the cocktail drinks. Lancet, 2012.

Comments from Twitter:

francis berenbaum @Larhumato: Gout explained by a patient. Very informative for medical students.

Jumat, 12 Oktober 2012

Academic medical centers face shrinking profits - what to do?

Here are some suggestions from the official AMA newsletter for 5 recommendations to help academic medical centers evolve, with my comments:

1. Build a brand name by holding faculty accountable for cost and quality. Mayo Clinic has mastered that and they offer a "subscription service" allowing local hospitals to gain quick access to Mayo experts - and to advertise that in the local press.

2. Become part of a larger community network. This is part of the "spokes of a wheel" concept to generate referrals to the tertiary center from the peripheral clinics and hospitals.

3. Increase effectiveness by maximizing use of extenders such as telemedicine and simulation technology. Mayo Clinic has a TeleStroke unit. Cleveland Clinic offers an "all-electronic" second opinion for a base price of $600.

4. Become an information hub. MayoClinic.com, the online patient information portal of the Mayo organization, is a good example of that concept.

5. Align research efforts with clinical and business strategies.

Bart Demaerschalk, M.D., neurologist and medical director of Mayo Clinic Telestroke, shows us how the smartphone technology works:

References:

Academic medical centers may face shrinking profits. Amednews staff. Posted April 4, 2012.
Image source: openclipart.org, public domain.

Kamis, 11 Oktober 2012

The management of ingrowing toenails - BMJ review

Ingrowing toenails are common, cause serious disability, and affect mainly young men. Most patients with ingrowing toenails are usually male, between the ages of 15 and 40 years.

There is a spectrum to the clinical presentation with pain progressing to infection, hypergranulation, and finally chronic infection.

Ingrowing toenails can occur in normal or abnormally shaped nails.

Cases in abnormally shaped nails are more difficult to manage conservatively and usually require surgery

Historically, a recurrence rate of 13-50% has been reported after surgical treatment, although more recent papers have reported recurrence rates of less than 5%.

Symptoms are less likely to recur after partial nail avulsion and segmental phenol ablation than after simple nail avulsion or wedge excisions alone.

Podiatrist Dr. Matthew Neuhaus explains what an ingrown toenail is (video):

Ingrown toenail surgery by Dr. Leo Krawetz (video). Warning: graphic content, do not try this at home:

References:

The management of ingrowing toenails. BMJ, 2012;344:e2089.

Rabu, 10 Oktober 2012

The life of a science article: From submission to citation, see a manuscript pass through Nature's editorial process (video)

Source: Nature YouTube channel

Comments from Twitter:

Dean Giustini @giustini: Good one~

Link via the medical blog ScienceRoll.

Selasa, 09 Oktober 2012

Best of Medical Blogs - weekly review and blog carnival

The “Best of Medical Blogs - weekly review and blog carnival” is a weekly summary of the best posts from medical blogs. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best of Medical Blogs (BMB) is published every Tuesday, just like the old Grand Rounds.

Choosing Wisely - Good Medical Practice or Prelude to Rationing?

From the White Coat blog: “If we want to decrease the amount of “unnecessary” testing, we need to address all of the reasons that such testing is performed. Why doesn’t Choosing Wisely change the preamble of its campaign to include: “The following tests are medically unnecessary and no type of professional or legal liability should ever be imposed upon physicians for failing to order or perform them …”? http://goo.gl/gG0Qp

The Food Challenge Challenge

Remember: No one "fails" a food challenge. The test is either positive or negative. http://buff.ly/Ql0fCh

Urologist performed his own vasectomy

From A Cartoon Guide to Becoming a Doctor: "When I was a med student on my surgery rotation, there was one urologist in our department who had actually performed his own vasectomy. He apparently used local anesthesia and did the procedure with a colleague present in the room "just in case." There were no complications. I dare you to find a female ob/gyn who tied her own tubes." http://buff.ly/PZOm4v

Science-Based Medicine » Andrew Weil’s Seasonal Supplements http://bit.ly/O38fZc

Dr. Wes @doctorwes: In Defense of the American Cowboy http://goo.gl/L7fKZ

What is a Direct Care practice? http://goo.gl/wJpn8 and http://goo.gl/nVZK8

Ask Skeptical Scalpel: A college student has second thoughts about medical school http://goo.gl/yRUsx

Dr. Wes: Out-of-the-Box Thinking on Avoiding Hospital Readmissions. When intent of the measure is to cut payments http://buff.ly/PZQidh

Wisdom vs. knowledge http://buff.ly/PQtief

New Obstructive Sleep Apnea Guidelines: What Do They Mean For Your Child? | Craig Canapari, MD http://bit.ly/SMiaP4

"Allergy Action Plan: Bring The Paperwork To Life" (video) http://buff.ly/QN8tTW

Jumat, 05 Oktober 2012

Healthcare social media #HCSM - top articles

Here are my suggestions for some of the top articles related to healthcare social media (#HCSM) in the past 2 weeks:

EM and critical care physicians adopt social media at rapid pace - growth in 18 months: 77% Twitter, 42% Facebook http://goo.gl/MySga

All Students Need Blogs - Share what you have learned http://goo.gl/w9Utd

Are Twitter friends real friends? A rheumatologists' tweetup proves they're real, and yes, they're friends http://goo.gl/6oE93

4 ways for practices to benefit from a social media presence: Offer information beyond the appointment, Raise physician profiles, Influence online search, Marketing toolkit http://goo.gl/5mAz4

How Sanofi Is Writing The Social Media Rules For Big Pharma Without Running Afoul Of The FDA http://goo.gl/TNF4l

Dell CEO's security shut down his daughter’s Twitter account, revealed too many specifics about family’s whereabouts http://goo.gl/BrgwK

“Most essential app for Physician Residents is not medical and is free - Evernote” http://goo.gl/U8AfC

How to Automatically Archive Your Life with IFTTT and Evernote http://goo.gl/ocAOM

What is #FOAM? Free Open Access Meducation http://goo.gl/ILrMh

How physician practices can stir up Pinterest - amednews http://goo.gl/4BFgU

Social media and health care: opportunities and obstacles (interactive graph) http://pwc.to/OaRWHX

10 Social Media Tips for Physicians http://bit.ly/OaS5Lz

Facebook’s Gen Y Nightmare http://buff.ly/PqgMli

A Tweet Meme Farewell - they were the first to create the retweet button http://bit.ly/UvKAht

How Twitter connects Mayo Clinic and patients - Lee Aase's presentation http://goo.gl/7LNde

Tweetcamp for New Connections

View more presentations from Lee Aase

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive an acknowledgement in the next edition of this publication.

Rabu, 03 Oktober 2012

Mayo Clinic uses smartphone images to evaluate stroke patients in remote locations through telemedicine

A new Mayo Clinic study confirms the use of smartphones medical images to evaluate stroke patients in remote locations through telemedicine. The study, the first to test the effectiveness of smartphone teleradiology applications in a real-world telestroke network, was recently published in Stroke, a journal of the American Heart Association.

Bart Demaerschalk, M.D., neurologist and medical director of Mayo Clinic Telestroke, shows us how the smartphone technology works:

Selasa, 25 September 2012

Best of Medical Blogs - weekly review and blog carnival

The “Best of Medical Blogs - weekly review and blog carnival” is a weekly summary of the best posts from medical blogs. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best of Medical Blogs (BMB) is published every Tuesday, just like the old Grand Rounds.

Putting the “A” Back in SOAP Notes: Time to Tackle An Epic Problem

From the inventor of the word “hospitalist”, @Bob_Wachter: “At UCSF Medical Center, we went live with our version of the Epic electronic medical record three months ago. It beats pen and paper, and it beats the EMR system that we traded out (at a cost of a hundred million dollars or so) by a long shot. But the effect I witnessed on patient care and education was less positive.” Read why here: http://goo.gl/HuvUd

Whatever happened to personal contact?

From the surgeon who writes Skeptical Scalpel blog @Skepticscalpel: "No one has time for lunch nowadays and the hospitalist movement has succeeded in eliminating the primary care doctors from the hospital environment. I have been practicing at the same hospital for over three years and have never even met 95% of the local primary care docs. Something is lacking when you aren’t able to attach a face to a name." http://goo.gl/MTS3Z

ACP: Stop making laws telling physicians how to practice medicine

From db's Medical Rants, ACP President, David Bronson, had this to say: "Government doesn't belong in the physician-patient relationship. It's a one-on-one, very personal, very private relationship. The patient has to have confidence the physician is giving them their very best professional advice and judgment." http://goo.gl/3NpOl

On Outcomes

Dr. Wes @doctorwes: It is difficult to follow pre-defined guidelines when there are many, many independent variables that weigh on patient management decisions. Payers want perfect outcomes or they will not pay for care, as if people are widgets on a production line with interchangeable parts. But for the majority of individuals who fall outside the center of normative data sets upon which standards, guidelines, protocols and checklists are based, the doctor and patient must face the reality that there are often no perfect answers for treatment. http://goo.gl/xQFQn

How To Integrate Twitter into Your Workflow

Krafty Librarian: If you have tried to do Twitter for professional communication but you use it through Twitter’s site and it hasn’t gone well, try TweetDeck or Hootsuite. http://goo.gl/3Dw0a

Sherpaa founder: How $1.85M in the bank are not enough to buy 2 Apple workstations http://goo.gl/J6yht

#FOAM Party! (The Future of Medical Education) http://goo.gl/5qZXF

Tweet Pearls of the Week

A good tweet is a terrible thing to waste. The blog Academic Life in Emergency Medicine (@m_lin) started collecting and posting important Twitter pearls in Emergency Medicine and Critical Care from the past week. Here is an example: http://bit.ly/RBhcbo

View the story "Tweet Pearls of the Week 8/24 to 8/31" on StorifyTweet Pearls of the Week 8/24 to 8/31Storified by Javier Benítez · Sun, Sep 02 2012 18:09:54Worth repeating: Default 1gm vancomycin dose usually not enough. Use 15-20mg/kg (actual body wt) X 1 and adjust for renal function later.Bryan D. HayesWhat is real time (dynamic) imaging?ED Ultrasound Q&AType of imaging in which the image is created so many times per second that a cinematic view of the tissues is obtained.ED Ultrasound Q&AQOD: A child presents w/ a diffuse, maculopapular rash. He recently had a fever of 104 for about 4 days and just got better. Dx?Robert CooneyaQOD: Roseola or Exanthem Subitum or Sixth's Disease, caused by HHV6; tx with antipyretics and timeRobert CooneyQOD: What is the most common source(s) of orbital cellulitis? Bonus: common pathogens?Robert CooneyaQOD: Causes: direct skin inoculation or direct extension from sinuses; pathogens: S. pneumo, H. flu, M. cat, anaerobes, StaphRobert CooneyWhat's the most accurate outcome predictor w/ ICH a.Hematoma volume b. rate of growth c.initial exam d.time of onset to presentation (3) INREMedHomeAnd QoD Hematoma volumes are associated with higher morbidity and mortality; hematoma volume is the most accurate predictor of outcomeEMedHomeWhat are the signs of increased ICP on CT? Watch Dr. Josh Broder’s Video Pearls in Emergency Radiology: http://cloud.emedhome.com/features/5168.mp4EMedHomeAtropine (dl-hyoscyamine) is found in the Deadly Nightshade (Atropa belladonna) plant, and is a cornerstone in autonomic pharmacology. #AACTBryan D. HayesWhat is the knee?ED Ultrasound Q&ARegion of the curve where the slope changes markedly.ED Ultrasound Q&AQ: What sign is seen in this gallbladder? What disease process does it suggest? #radiology #MedEd #ultrasound http://pic.twitter.com/DgBR5FVVRadiology SignsA: Comet tail sign (ring down artifact) of adenomyomatosis http://goo.gl/d9PCT WINNERS @snotdok @BasemBahakeem @camnapper @elwoodiusRadiology SignsKeep waiting 24 hrs after tPA to give aspirin in ischemic stroke. Early admin has more bleeding and no added benefit. http://www.ncbi.nlm.nih.gov/pubmed/22748820Bryan D. HayesWhat is the near gain control?ED Ultrasound Q&AThis knob regulates the amplification of echoes returning from the near field.ED Ultrasound Q&A#UCSFtox ocular atropine can last for 3-4 days. Longer than predicted from published 2.5 hr half life.Derrick LungQ: Ultrasound in a two month old with vomiting. What sign is seen? Diagnosis? #radiology #ultrasound #MedEd #doctors http://pic.twitter.com/W6kCDUHORadiology SignsA: Cervix sign (or Antral nipple sign) of Hypertrophic pyloric stenosis http://dlvr.it/23ghvv WINNERS @camnapper @dr_canales & nipple :)Radiology SignsWhat are slide pots?ED Ultrasound Q&ATGC controls can be adjusted in short segments with the use of slide pots. Use for fine tuning.ED Ultrasound Q&AQOD: A pt presents w/ a swollen tender parotid gland. You suspect suppurative parotitis; What is your management?Robert CooneyaQOD: hydration, sialogogues (gotta love lemon drops), and antibioticsRobert CooneyTeaching pearl: "Feedback should deal with decisions and actions, rather than assumed intentions or interpretations." - Dr. Jack EndeBryan D. HayesWhat is the slope rate?ED Ultrasound Q&AThe rate at which echoes are suppressed or amplified as the depth varies.ED Ultrasound Q&AQOD: A pt presents with refractory hypotension, lethargy, hyponatremia, hyperkalemia, & hypoglycemia. Dx & management?Robert CooneyaQOD: Adrenal crisis; tx with 100mg of IV hydrocortisone and fluids; don't forget to look for an underlying causeRobert CooneyQ: Post contrast T1 image. Name 3 features of this lesion that favor ependymoma over astrocytoma. #radiology #MedEd http://pic.twitter.com/NMZITtaPRadiology SignsA: Well-circumscribed, centrally positioned, dense reasonably homogeneous enhancement http://goo.gl/lHPRv WINNER @camnapper Good job :)Radiology SignsIn hypothermic patients, insulin is ineffective below 30 degrees C.Bryan D. HayesWhy is proper adjustment of the gain important?ED Ultrasound Q&AIt can vary the strength of the echoes throughout the image and make structures more clearly visibleED Ultrasound Q&AQOD: In a patient with an inferior STEMI, what does ST elevation greater in III than II suggest?Robert CooneyaQOD: If you see III elevated more than II in an inferior STEMI, think RCA occlusionRobert CooneyUniv of Maryland conf pearl of the day: after failed resus's, review all documentation & make sure times of crit actions agree w/each otherAmal MattuUMEM pearl of day #2: approx half of malpractice cases turn on the basis of the quality of d/c instructsAmal MattuObese ED patients are frequently underdosed when given antbiotics. And, this study didn't include vancomycin! Aim high. http://www.ncbi.nlm.nih.gov/pubmed/22169576Bryan D. HayesQ: Sagittal MRI of the knee. What sign is seen? Diagnosis? #radiology #orthopedics #MRI #MedEd http://pic.twitter.com/QrOGim1fRadiology SignsA: Celery stalk sign of ACL mucoid degeneration http://dlvr.it/24P8kw Very common - NOT ACL TEAR!! No winner today :(Radiology SignsPts given charcoal in ambulance receive it >50 minutes sooner than pts who receive it in the ED. Recommend prehospital admin if appropriate.Bryan D. HayesQOD: A pt presents with fever, significant tachycardia, confusion, hypertension, and a CHF pattern on CXR. Suspected dx & tx?Robert CooneyaQOD: Think thyroid storm in the given case, get labs & start tx with beta-blockers, PTU, & iodine; remember: look for an underlying causeRobert CooneyHydrogen cyanide was detected in blood samples from 169 of 285 fire-related deaths (59%) during enclosed-space fires. http://www.ncbi.nlm.nih.gov/pubmed/22882141Bryan D. HayesQ: What important sign is seen on this non contrast CT brain? Diagnosis? #radiology #MedEd #medstudent http://pic.twitter.com/bMI5pjcnRadiology SignsA: Hyperdense MCA sign of hyperacute thrombus http://goo.gl/HYRWM WINNERS @camnapper @AndyNeill @AndrewACNP1 @ahmednagui @yasiralthubaitiRadiology SignsAlthough an elevated osmol gap is a potential early surrogate marker of toxic alcohol poisoning, it is neither sensitive nor specific.Bryan D. Hayes

I think "Tweet Pearls" summary is a good idea although the perceived usefulness of the tweets will obviously vary according to your interest in the topic. The slideshow uses Storify and considering Twitter, Inc.'s increasingly restrictive approach, the ability of some 3rd party services (Storify, Flipboard, etc.) to display tweets may be limited in the future. The easiest approach is to copy/paste the text of the interesting tweets in a blog post but that may be against the Twitter guidelines for the use of their content (tweets) which is actually ours.