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.

Medical crowdsourcing through social media

Berci, one of the most popular proponents of #HCSM, comments on being mentioned in TIME magazine: They described how crowdsourcing works through social media and used my story of crowdsourcing a rare diagnosis via Twitter as an example. Life is just great!" http://goo.gl/CxwgK

The Final Update of the Hospital Social Network List

Ed Bennett: "After a long run, I’ve decided to archive the Hospital Social Network List. The final update will be published at the end of August 2012" http://goo.gl/z0GTm

International Conference on Emergency Medicine (ICEM) 2012 Talks Free Online

Chris Nickson, from the EM blog Life in the Fast Lane, reports that the lectures from the 2012 International Conference on Emergency Medicine are now freely available: http://goo.gl/qIF9n

Johns Hopkins medical students have invented an app that checks your symptoms

Symcat (symptoms-based, computer-assisted triage) app allows the user to enter in various symptoms such as a fever, cough, swelling etc. and receive "an instant diagnosis" (more like a suggestion rather than a diagnosis) http://goo.gl/C0nYc

Instead of Asthma, Laryngospasm in a Child

The ENT surgeon and prolific medical blogger Dr. Christopher Chang special comments on how VCD can masquerade as asthma http://bit.ly/QGMJJJ

Computers can never replace physicians as diagnosticians - Dr. Centor explains why on his blog: http://goo.gl/SDx2L

Social media updates and the 2012 AAFP National Conference of Family Medicine Residents and Students

Dr. Mike Sevilla from published a #AAFPNC 2012 Wrap-up at: http://goo.gl/TCI7L

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

How Do Pain Relievers Work? TED-Education video

From TED Education series, Jun 26, 2012: Some people take aspirin or ibuprofen to treat everyday aches and pains, but how exactly do the different classes of pain relievers work? Learn about the basic physiology of how humans experience pain, and the mechanics of the medicines we've invented to block or circumvent that discomfort.



Lesson by George Zaidan, animated by Augenblick Studios.

Warning: Your reusable grocery bags can become contaminated with bacteria

97% of shoppers admit they never wash their reusable grocery bags. Dr. Susan Rehm from Cleveland Clinic talks about avoiding illness from contaminated grocery bags:



Another video: Viruses and Bacteria In Reusable Grocery Bags, from a local TV station, KOBITV:



Comments from Twitter:

SwoodLady @SwoodLady: Always something! RT @DrVes: Warning: Your reusable grocery bags can become contaminated with bacteria goo.gl/fb/sDOMs

Sherpaa's take on health insurance: 24/7 phone/email access to doctors, no need for clinic visit 70% of the time

From CBS News:

Dr. Jay Parkinson is trying to change healthcare business with Sherpaa. The company gives 24/7 phone and email access to a group of doctors in New York City. "You can call or email and 70 percent of the time," Parkinson said. "We will solve that problem over email or on the phone."

For example, if you've suffered a nasty cut, you snap a picture, email it to Sherpaa, and a doctor will respond immediately with instructions. If you need stitches, Sherpaa will schedule a same-day appointment with one of the 100 specialist they work with. That could cut out the expense, and long wait on average more than four hours of a visit to the emergency room. Parkinson said instead of getting charged $4,000, it could be a $1,000 charge.

Sherpaa doesn't replace health insurance, but instead works to weed out inefficiencies, while offering a kind of everyman's concierge service. Companies like Tumblr pay about $1,000 a year per employee.

References:

Doctor's company reimagines health care delivery - CBS News http://goo.gl/DLXUd

Spectrum of gluten-related disorders: consensus on new nomenclature and classification

A decade ago celiac disease was considered extremely rare outside Europe and, therefore, was almost completely ignored by health care professionals.

In only 10 years, key milestones have moved celiac disease from obscurity into the popular spotlight worldwide.

Now we are observing another interesting phenomenon that is generating great confusion among health care professionals. The number of individuals embracing a gluten-free diet (GFD) appears much higher than the projected number of celiac disease patients, fueling a global market of gluten-free products approaching $2.5 billion (US) in global sales in 2010.

This trend is supported by the notion that, along with celiac disease, other conditions related to the ingestion of gluten have emerged as health care concerns.

This review summarized the current knowledge about the 3 main forms of gluten reactions:

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

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



Key figures:

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

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:

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.
Non-coeliac gluten sensitivity | BMJ http://bit.ly/SlOTNO

Comments from Twitter:

Karen Price @brookmanknight: reflects well what we see in clinical practice, though haven't seen or dx'd too much derm herpetiformis.

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.

What is FOAM? Free Open-Access Meducation

From Andy Neill’s blog: Instead of all those powerpoint slides and images resting on a decaying hard drive – get them out there – let someone else benefit and engage with them. You did a talk one time at rounds? Get it recorded and post it online. If it’s good you’ll hear about it. If you’re wrong someone will tell you and start a conversation on it. http://goo.gl/QwdQe

He recorded Mike Cadogan talk outlining the future of medical education - FOAM or Free Open-Access Meducation:



Why the Internet is More Attractive than the Library http://buff.ly/LxlNFu

Alternative journal impact factors – Eigenfactor, R-Factor, Y-Factor | The Search Principle blog http://goo.gl/EorHq

Impressive: @giustini 's 140 SlideShare presentations achieved more than 1 million viewings, with many of then focused on the use of social media in healthcare (#HCMS) and medlib http://goo.gl/qHmKR

The evolution of a physician's blog

Dr. Smith presents his research poster, which charts the tremendous growth of his eponymous blog, Dr Smith’s ECG blog. The blog is practically free to maintain, hosted by Google's service, Blogger.com, and will break 1,000,000 page views this year. The site itself represents a living and breathing, dynamic textbook: http://hqmeded-ecg.blogspot.com

Unipolar depression in adolescence is common worldwide but often unrecognized

Unipolar depressive disorder in adolescence is common worldwide but often unrecognised. The incidence, notably in girls, rises sharply after puberty and, by the end of adolescence, the 1 year prevalence rate exceeds 4%.

The burden of depression is highest in low-income and middle-income countries. Depression is associated with morbidity, and heightens suicide risk.

The strongest risk factors for depression in adolescents are:

- family history of depression
- exposure to psychosocial stress

Factors that interact to increase risk through hormonal and perturbed neural pathways include:

- inherited risks
- developmental factors
- sex hormones
- psychosocial adversity

References:

Depression in adolescence. Prof Anita Thapar et al. The Lancet, Volume 379, Issue 9820, Pages 1056 - 1067, 17 March 2012.

Image source: OpenClipArt.org

Top medicine articles for July 2012

Here are my suggestions for some of the top articles in medicine for July 2012:

Participation in sport is associated with a 20-40% reduction in all-cause mortality. Exercise is a fifth vital sign! http://goo.gl/gyxYf

Renal denervation to treat resistant hypertension: Guarded optimism - CCJM http://goo.gl/svAvZ

Dengue: A reemerging concern for travelers. There is no antiviral treatment - CCJM http://goo.gl/gY6DO

POLST: An improvement over traditional advance directives - CCJM http://goo.gl/NhhbX POLST = Physician Orders for Life-Sustaining Treatment

Tonsillectomy changes: More children are operated for sleep disordered breathing and fewer for recurrent pharyngitis http://goo.gl/UXTfO

Bariatric surgery provides sustained weight loss, major improvements in severely obese individuals with diabetes type 2 http://goo.gl/OkV61

Twitter Use at American Society of Clinical Oncology Annual Meetings: 14-40 doctors generated 29% of meeting dialogue http://goo.gl/fw94I

Tweeting the Meeting: An In-Depth Analysis of Twitter Activity at Kidney Week 2011 - PLoS ONE http://goo.gl/eOmLO

Is your cat hosting a human suicide parasite? Toxoplasma gondii in chicagotribune http://goo.gl/oMW8M

How safe is your hospital? Consumer Reports magazine rates best (and worst) hospitals http://goo.gl/uHcTh

Conservatives Are Happier Than Liberals, and Extremists Are Happiest of All - NYTimes http://goo.gl/h67w9

Chronic hyperglycaemia and microvascular disease contribute to cognitive dysfunction, mental and motor slowing in both DM 1 and 2 http://goo.gl/hTTcK

5-10% of people per year with prediabetes will progress to diabetes (same proportion converts back to normoglycemia) http://goo.gl/oYbTk

Suicide is second to only accidental death as the leading cause of mortality in young men across the world. High-lethality methods of suicide are preferred by young men: hanging and firearms in high-income countries, pesticide poisoning in the Indian subcontinent, and charcoal-burning in east Asia. Lancet, 2012, http://goo.gl/DqMfF

Ethics of mitochondrial donation discussed in The Lancet http://goo.gl/JAVFC

Hepatitis E virus (HEV) was discovered during the Soviet occupation of Afghanistan in the 1980s, after an outbreak of unexplained hepatitis at a military camp. A pooled faecal extract from affected soldiers was ingested by a member of the research team. He became sick, and the new virus (named HEV), was detected in his stool by electron microscopy. Globally, HEV is the most common cause of acute viral hepatitis. http://goo.gl/vkaGB

The seventh cholera pandemic began in 1961 and still affects 3-5 million people each year, killing 120 000 http://goo.gl/bz07X

Psychiatry's identity crisis - The Lancet http://goo.gl/XfsM6

Paralympic medicine - Lancet review - 20 sports at Summer Paralympic Games, 5 at Winter Paralympic Games http://goo.gl/rpJhI

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.

What EMRs will be expected to do in stage 2, year 2014

Physicians would need to use their EMRs to meet 20 functionality objectives at minimum levels to earn bonuses and avoid penalties.

Core set (must meet all objectives listed below)

Use computerized physician order entry for medication, lab and radiology orders
Prescribe electronically
Record patient demographics
Record and chart vital signs
Record smoking status
Use clinical decision support
Incorporate clinical lab results into EMR
Generate lists of patients by specific condition
Set patient reminders for preventive and follow-up care
Provide patient portal access
Provide clinical summaries for patients
Identify education resources for patients
Use secure messaging with patients
Use medication reconciliation
Send summary of care records for referrals and care transitions
Send electronic data to immunization registries
Ensure EMR privacy and security

Menu set (must select and meet 3 objectives from the list below)

Access imaging results
Record patient family histories as structured data
Send electronic syndromic surveillance data to public health agencies
Have ability to report cancer cases to state registries
Have ability to report noncancer cases to state registries

Electronic medical record (EMR) - review of pros and cons in the Cleveland Clinic medical journal

Some negatives regarding the use of EMR:

- So far, electronic systems are not interconnectable
- Do electronic records improve or worsen the quality of care?
- Accuracy vs copying and pasting
- A third party in the examination room
- Devoid of real medical thought

A contrasting view:

- Connectivity will improve
- Staying focused on the patient, even with a computer in the room
- Doctor-doctor communication is enhanced

References:

Centers for Medicare & Medicaid Services, Electronic Health Record Incentive Program -- Stage 2, Feb. 23, 2012.
First look at the next stage of meaningful use - amednews.com

The electronic medical record: Diving into a shallow pool? CCJM.
The electronic medical record: Learning to swim. CCJM.
"The iPatient is getting wonderful care across America. The real patient wonders, "Where is everybody?" NYTimes, 2011.

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.

Tips for doctors looking to engage with #HCSM: "a childlike playfulness, humility, politeness, and humour"

Dr. Ronan Kavanagh @RonanTKavanagh, a Galway based Rheumatologist, offers advice for those looking to engage better with patients in healthcare: it’s worth thinking about the power of just being nice….. Practice a childlike playfulness, humility, politeness, and humour which makes you instantly more human, likeable and accessible. Just like these rugby players http://goo.gl/zKZZ5 :



Explanation: The ad shows three famous Irish rugby players asking house owners permission to play, and for volunteers to join them in a game of rugby on the grassy area in front of their homes.

Dr. Kavanagh is an authentic, practicing physician, and a rising social media superstar. You should follow him on Twitter @RonanTKavanagh

11 Chronic Disease Technologies to Watch

Here is the list of 11 Chronic Disease Technologies to Watch, by John W. Sharp:

Extended Care eVisits, Home Telehealth, In-Car Telehealth, Medication Adherence Tools, Mobile Asthma Management Tools, Mobile Cardiovascular Tools, Mobile Clinical Decision Support, Mobile Diabetes Management Tools, Social Media Promoting Health, Tele-Stroke Care, Virtual Visits http://goo.gl/vilXQ

One Doctor’s Prescription to Avoid Social Media Overload

Mark Ryan, M.D. @RichmondDoc shares a post with the the blog of the Albert Einstein College of Medicine. Here is his Prescription to Avoid Social Media Overload (my comments are listed as Editor's notes) http://goo.gl/bdtPU:

- Stop trying to read every update (Editor's note: I read 95-99% of the Twitter updates but I only follow about 100 accounts - @RichmondDoc follows 1,500).

- Organize your incoming information in Twitter lists (Editor's note: I find Google Reader with folders more time efficient).

- Use time wisely. Glance at your stream whenever you have a few minutes (Editor's note: Don't forget your friends and family).

- Look into using a third-party Twitter client, such as TweetDeck or HootSuite .

- Leverage your e-mail newsletters (Editor's note: RSS feeds work better).

- Finally, if you do not have much time to be on social media, look for relevant Tweetchats (Editor's note: Twitter chats can be a huge time sink too, so be careful).

6 Inexpensive Ways to Stay in Shape - from Cleveland Clinic

It is great to see my former employer, the Cleveland Clinic, blogging useful tips to stay healthy http://goo.gl/peDXq :

- Walking
- Skipping rope
- Exercise balls
- Dumbbells
- Callisthenics
- Exercise DVDs

Is the Electronic Medical Record Full of Lies?

Cardiologist Dr. Wes comments on a a provocative piece in the Journal of the American Medical Association (JAMA) http://goo.gl/tjxGU

Physician Social Media Guide

Mike Sevilla, MD comments on the newly released Physician Social Media Guide by the Pennsylvania Academy of Family Physicians (PAFP) http://goo.gl/xjFUv. You can see the guide embedded below:

Open publication - Free publishing

Jon Lord (71), legendary Deep Purple keyboard player, "passes from Darkness to Light"

Performed in front of a live TV audience, Deep Purple storm through 'Child In Time', featuring the classic Mark II line up of Gillan/Glover/Lord/Paice/Blackmore:



From Jon Lord's official website:

Jon Lord has sadly passed away, July 16, 2012

It is with deep sadness we announce the passing of Jon Lord, who suffered a fatal pulmonary embolism today, Monday 16th July at the London Clinic, after a long battle with pancreatic cancer. Jon was surrounded by his loving family.

Jon Lord, the legendary keyboard player with Deep Purple co-wrote many of the bands legendary songs including Smoke On The Water and played with many bands and musicians throughout his career.

Best known for his Orchestral work Concerto for Group & Orchestra first performed at Royal Albert Hall with Deep Purple and the Royal Philharmonic Orchestra in 1969 and conducted by the renowned Malcolm Arnold, a feat repeated in 1999 when it was again performed at the Royal Albert Hall by the London Symphony Orchestra and Deep Purple.

Jon’s solo work was universally acclaimed when he eventually retired from Deep Purple in 2002.

Jon passes from Darkness to Light.

Jon Lord 9 June 1941 – 16 July 2012.

Here is a short clip of Jon Lord receiving and responding to the presentation of the Honorary Degree (Doctor of Music) from the University of Leicester, 2011:



I had the chance to see Jon Lord at a Deep Purple concert in 2001, and he was truly amazing.

Related reading:

Music Man http://goo.gl/8aYk0
Jon Lord obituary | Music | The Guardian - http://goo.gl/sohGI
BBC News - Deep Purple's Jon Lord dies at 71 - http://goo.gl/qvhiq
Malc Deakin talks to Jon Lord on Vimeo - http://goo.gl/cDvjU
Jon Lord death: Deep Purple founder dies aged 71 | Mail Online - http://goo.gl/G9FzX
Jon Lord & Steve Balsamo "Child In Time", May 2010 - YouTube http://goo.gl/SU231
BBC's Last Word: Ritchie Blackmore, Rick Wakeman, Geoff Barton pay tribute to Jon Lord. Also, Jon on how he'd like to be remembered. http://goo.gl/fW3VT
GTFM's Jon Lord Special by Andy Fox http://goo.gl/WqAcc
'80s - Jon Lord Interview - Anne Carlini - Exclusive Magazine http://bit.ly/Uoex79
Steve Morse on Jon Lord - YouTube http://bit.ly/16QmDMn

Hirsutism in women - literature review

Here some excerpts from the 2012 review of hirsutism in women in the journal American Family Physician:

Hirsutism is excess terminal hair that commonly appears in a male pattern in women.

Although hirsutism is generally associated with hyperandrogenemia, 50% of women with mild symptoms have normal androgen levels.

Causes of hirsutism

The most common cause of hirsutism is polycystic ovary syndrome (PCOS), which accounts for 3 out of every 4 cases.

Many medications can also cause hirsutism.

In patients whose hirsutism is not related to medication use, evaluation is focused on testing for endocrinopathies and neoplasms, such:

- polycystic ovary syndrome (PCOS)
- adrenal hyperplasia
- thyroid dysfunction
- Cushing syndrome
- androgen-secreting tumors

Symptoms of hirsutism

Symptoms and findings suggestive of neoplasm include rapid onset of symptoms, signs of virilization, and a palpable abdominal or pelvic mass.

Patients without these findings who have mild symptoms and normal menses can be treated empirically.

For patients with moderate or severe symptoms, an early morning total testosterone level should be obtained, and if elevated, it should be followed by a plasma free testosterone level.

A total testosterone level greater than 200 ng per dL (6.94 nmol per L) should prompt evaluation for an androgen-secreting tumor.

Diagnosis of hirsutism

Laboratory workup may include:

- early morning total testosterone level
- plasma free testosterone level
- thyroid function tests
- prolactin level
- 17-hydroxyprogesterone level
- corticotropin stimulation test

Treatment of hirsutism

Treatment includes hair removal and pharmacologic measures.

Shaving is effective but needs to be repeated often. Evidence for the effectiveness of electrolysis and laser therapy is limited.

Laser treatment does not result in complete, permanent hair reduction, but it is more effective than other methods such as shaving, waxing, and electrolysis. It produces hair reduction for up to 6 months. The effect is enhanced with multiple treatments.

In patients who are not planning a pregnancy, first-line pharmacologic treatment should include oral contraceptives. Topical agents, such as eflornithine, may also be used.

Treatment response should be monitored for at least six months before making adjustments.

References:

Hirsutism in women. Bode D, Seehusen DA, Baird D. Am Fam Physician. 2012 Feb 15;85(4):373-80.

Management of Hirsutism (Excess Hair)

Image source: Skin layers. Wikipedia, public domain.

Simple iPad Tips and Tricks - Time magazine video

Get more from your iPad with these simple tips and tricks. Many of these work for your iPhone, too. From Time magazine tech editor:



Comments from Twitter:

JillofAllTrades,MD @JillAllTradesMD: Super neat!

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:

Twitter Use at American Society of Clinical Oncology Annual Meetings: 14-40 doctors generated 29% of meeting dialogue http://goo.gl/fw94I

8 free blog/website templates for Blogger by Google http://goo.gl/XqFsh

How to Build and Support Online Communities Within Facebook And Twitter http://goo.gl/shdP6

More than 50% of small businesses do not have a website - Google pushes GYBO: Get Your Business Online http://bit.ly/QYMxDd

Growth of Doctor Rating Websites Prompts Worries, more than 50 sites allow patients to post online about their doctors http://goo.gl/bsVaw

A "graveyard" of cancelled Google products, collected on Pinterest by a helpful Microsoft employee http://buff.ly/LX85Bv and http://buff.ly/N6Tm0R

Library’s New Role to Enhance Visibility of Researchers « Laika's MedLibLog http://buff.ly/PeyFYo

No medical social media strategy is complete without a plan for a blog. From Howard J. Luks, MD: Google Panda and Penguin Changes are Two More Reasons for Doctors to Blog http://goo.gl/PGlSx

Lamenting the end of iGoogle: iGoogle, a personalized dashboard, was a remnant of the age of Internet portals but for me it was my brain, at a glance. I might just learn to leave a dozen browser tabs open and skip around them while working during the day. Sure, that's the way a lot of people work, but it's still an unpleasant prospect. Without iGoogle, it seems, my brain might never again be the same. http://goo.gl/GrmjB

Sharing great content 15 times a day http://goo.gl/8pD8G

What are the ethics of crowdsourcing a diagnosis? http://goo.gl/Ez3wj

Richmond Doc: There could be great value in using social media as the world’s largest “curbside consult” in which we ask peers to provide suggestions and insight. Crowdsourcing would be like an enormous brainstorming session to help come up with ideas that the primary physician might have overlooked or failed to consider.

Robert West comments: Personally, I would prefer to have my own health conditions crowdsourced, than continue forever untreated or improperly treated. Not all people feel the same way, though.

Tech Companies Leave Phone Calls Behind - User not able to reach anyone at Twitter or Facebook http://goo.gl/P9d4a

Social media firm targets prospective patients - will provide "complete management" of Twitter/Facebook for dermatologist offices http://goo.gl/h8NX3

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.

Mayo Clinic latest computer toy: "YES" Board patient tracking system

From Mayo Clinic YouTube channel:

Vernon Smith, M.D., an emergency room physician at Mayo Clinic in Arizona, discusses the benefits of the computerized YES Board patient tracking system which he developed over the course of several years and input from hundreds of doctors, nurses and emergency room staff while he worked at Mayo Clinic in Rochester, Minn.



According to Mayo Clinic, "the YES board reduces the time required to translate data, allowing physicians to forecast the needs of their patients and track progress. It has the capacity to walk physicians through current and past information for each patient — in addition to all patients collectively. Additionally, the YES Board helps to secure usable space and resources and detect the most at-risk patients and also helps forecast the needs of the patients in the emergency department. Plus, the YES Board can be viewed through any approved computer with an internet connection."

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.

No medical social media strategy is complete without a plan for a blog

From Howard J. Luks, MD @hjluks: Google Panda and Penguin Changes are Two More Reasons for Doctors to Blog: Patients naturally use search engines to ask questions, and a blog is a great way to answer those questions. You probably answer the same questions every day in the same way--put it in a blog post! Chances are many potential new patients have the same questions. Putting your answers down in a blog post will actually save you time, and establish you as an authority on the topic. http://goo.gl/PGlSx

What are the ethics of crowdsourcing a diagnosis?

Richmond Doc: There could be great value in using social media as the world’s largest “curbside consult” in which we ask peers to provide suggestions and insight. Crowdsourcing would be like an enormous brainstorming session to help come up with ideas that the primary physician might have overlooked or failed to consider. http://goo.gl/Ez3wj

Robert West comments: Personally, I would prefer to have my own health conditions crowdsourced, than continue forever untreated or improperly treated. Not all people feel the same way, though.

EMR impact: Are we retraining our doctors from care-givers to data providers? 

Dr. Wes @doctorwes describes a doctor completing an EMR: A little box pops up before him asking if he asked the patient about the exercise. He mumbles something under his breath, clicks a little box beneath the question, then moves on. This is what medicine has become: a series of computer queries and measures of clicks. It must be measurable, quantifiable, and justifiable or it didn't happen. Doctors are losing their motivation to diagnose in favor of sitting at a computer. Doctors, I also dare say, are losing their skills in favor of sitting at a computer. http://goo.gl/RrIhz

Publishing a medical journal is a very profitable activity, says former BMJ Editor-in-Chief and provides examples

Richard Smith @Richard56: “I used to be part of running a course for editors of medical journals, and on each course we’d encounter editors, usually distinguished professors, who worked evenings and weekends on journals for free. They did so as a contribution to their specialty and for a dollop of honour. In their naivety they imagined that the journals made little or no money. In fact some scientific journals are considerably more profitable than oilwells.” http://goo.gl/QeaKS

How to Save Time Doing Healthcare Social Media: A Primer for Physicians

Fauquier ENT Blog @FauquierENT: Colleagues of mine often think that I spend HOURS doing social media everyday. Nothing can be further from the truth. Beyond writing blog posts which does take time... I probably spend about 30 minutes daily reading and sharing. Subscribing to RSS feeds can also be used, but I find customized Twitter lists easier. And I automate nearly everything when it comes to sharing to save time. Here are my workhorse applications I use to save me time: Hootsuite, IFTTT, and Bufferapp. http://goo.gl/wIS34

How to Succeed in Residency: Tips for Studying

From the blog Wellness Rounds http://goo.gl/kJ6PN:

1. Record what you learn as you learn it. If you really want to learn clinical medicine, you have to make notes. Go to work every day with blank 3×5 cards in your pocket. (Editor's note: Better yet, make notes on your phone/Google Drive and consider a blog).

2. Be comprehensive. Get a major textbook in your field. (Editor's note: At a minimum, read UpToDate or Medscape Reference [eMedicine]).

3. Stay curious.

3. Repeat. Repeat. Repeat. Don’t make your notes, file them away and pull them out the week before the in-training exam. Sit down once a week and just glance through them all. Develop a system that lets you review them 24-48 hours after you make the notes, a week later, a month later, and 3 months later. (Editor's note: This really works. Recall information at 1 week, 1 month, 3 month, and if you still need it, 6 month-intervals).

And the last but not least entry in this week's Best of Medical Blogs is: Library’s New Role to Enhance Visibility of Researchers « Laika's MedLibLog http://buff.ly/PeyFYo

An App for Medical Emergencies - EmergencyLink - WSJ video

EmergencyLink is a free service that provides medical information and personal contacts to emergency responders - Mossberg for WSJ:



Here is the URL: http://www.emergencylink.com

The company explains how it can help if:

- You Are In An Accident. A first responder locates the EmergencyLink ID and calls EmergencyLink as instructed. EmergencyLink provides the first responder with your emergency medical information and contacts your “Emergency Contacts” as you have instructed.

- Your Child Is Missing. You can quickly create a a Missing Person report and forward it to the police. The police can immediately act on the information maximizing their chances of locating your child quickly and safely.

- Sharing Information with a Caregiver. You are able to electronically share all of the information the caregiver will need in case of an emergency. Whenever your child's profile is updated, everyone with whom you are sharing the information will be updated, no need to constantly update everyone.

- A Friend is in an Accident. If your friend is an EmergencyLink Member and is "sharing" their info with you, you can access their emergency medical information (allergies, medications, medical insurance) and forward them to the first responder.

- Co-Workers Are On A Project Away From Home. Each Member in the group agrees to share their emergency contact information with each other. If there is an emergency situation, the group has the information needed to reach each others emergency contacts.

EmergencyLink is a free 24-Hour Emergency Response Service that helps you store your important information in one location, share emergency information with family and friends and has a 24-Hour Emergency Response center to aid you in an emergency:

Top medicine articles for June-July 2012

Here are my suggestions for some of the top articles in medicine for June-July 2012:

Should You Put Sunscreen on Infants? It’s best not to use sunscreen on infants under age 6 months - FDA http://buff.ly/LxmJ0u

Guillain-Barre Syndrome - NEJM review http://buff.ly/LxmC55

Long-term use of low-dose azithromycin as an attractive adjunct treatment option for COPD http://buff.ly/LAoNVi

71% of doctors believe quality of healthcare will deteriorate over the next 5 years (19-page survey summary, PDF) http://goo.gl/Sl0wd

Americans' confidence in the U.S. medical system is around the historical average of 39% http://goo.gl/KoTqI

FDA Approves Diet Pill Belviq http://bit.ly/LCvE0o

What is So Good About Growing Old: mind gets sharper at a number of vitally important abilities http://goo.gl/6xI8M

A Lithium Battery in a Hotdog: the picture burns itself into mind - keep out of reach of small children http://buff.ly/LSmPBS

People who remember being pushed or slapped as children more likely to have depression or anxiety later in life http://goo.gl/oTt7p

Physical Punishment Has Long-Lasting Consequences on Children's Mental Health (study) http://buff.ly/LKGrl6

GSK once-daily lung drug LAMA/LABA (umeclidinium/vilanterol) showed positive results in COPD http://goo.gl/s1o0P

1 in 5 Nurses is Depressed - 18% of hospital-employed nurses have depression; twice the rate of the general public http://goo.gl/aioSn

The Medication Generation: Many young people today have now spent most of their lives on antidepressants - WSJ http://on.wsj.com/LLDuVE

Publishing a medical journal is a very profitable activity, says former BMJ Editor-in-Chief and provides examples http://goo.gl/QeaKS

Health Care Mandate Puts a "Cranky Uncle" in Every Exam Room - NYTimes http://goo.gl/v0PpH

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 acknowledgement in the next edition of this publication.

More than 50% of injuries on Fourth of July are related to fireworks

The eyes are the most frequently injured body parts, followed by the fingers and hands. Here is a video from the Cleveland Clinic with some advice how to prevent these injuries:



This video discusses ways to prevent and identify heat-related illness in senior citizens:

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.

Top 9 tips for exercsing in the heat

A cardiologist’s top 9 tips for exercsing in the heat http://goo.gl/9GjRP, also known as the Nine Mandrola rules for dealing with the heat:

1. Hydrate immediately upon awakening.
2. Drink an entire bottle of water BEFORE the run or ride.
3. Limit caffeine intake on hot days.
4. Talk to yourself during a hot ride/run. Keep telling yourself to drink fluids.
5. Colored water can help on long rides/runs on hot days (??).
6. Avoid Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Do not take NSAIDs while dehydrated.
7. Don’t push through sickness. Never add inflammation.
8. Exercise in the morning.
9. Be alert for signs of heat-illness in yourself or your buddies.

Health Information on YouTube

When searching for heart health information on YouTube, patients have to sift through vast information and run the risk of being misinformed. http://goo.gl/6N2Gx and http://onlinelibrary.wiley.com/doi/10.1002/clc.21981/full

Dr. Wes reiterates one more time: "Hence, why doctors need to be on social media. Another take-home message from this study: professional societies need to make their videos shorter and use patient experiences to bring their message home."

A Lithium Battery in a Hotdog

A Lithium Battery in a Hotdog: the picture burns itself into mind: http://buff.ly/LSmPBS. From the official blog of the journal Pediatrics: Dr. Marcus placed a lithium battery inside a sliced hot dog and when both poles came in contact with the frankfurter, the result is a picture that burns itself into your mind — and perhaps your patients’ minds as well if you show it to them as a means of encouraging them to keep these batteries secured inside the small electronics, and to keep the spares out of reach of small children.

2012 Physicians Survey reveals dissatisfaction and gloomy outlook - Orthopedic surgeon Howard J. Luks, shows the way forward http://goo.gl/eBzUA

Dr. Luks: "Establish a deep digital presence. 95% of online health related discussions take place without a physician being present. When ready and capable, root that presence deeply in social media. These enable the basic tenets of outbound marketing efforts. Take advantage of what a deep digital presence offers.  Humanize your Organization. Foster your relevance, Educate, Engage and help patients clear that windshield of doubt. Embed enabling technologies such as Zocdoc, Avado and Twistle to allow patients to schedule visits at a time of their choosing, enable them to manage their PHI online, communicate with your staff digitally and provide them with a secure, intelligent email system which will streamline the communication workflow within your practice. Physicians who are not interested in establishing their own digital presence, but want to try and build an online presence can consider participating in one of the many Q&A platforms like Sharecare, Avvo and Healthtap."

UMEM Emergency Physician and EKG enthusiast, Dr. Amal Mattu gives you weekly advice that will help you save lives http://goo.gl/BrNJa

Evolution of the White Coat - A Cartoon Guide to Becoming a Doctor http://goo.gl/VLrwL

Exclusive interview with NEJM Editor-in-Chief, Jeffrey Drazen, for MedGadget medical blog http://goo.gl/w4fr2

Three things about Healthcare Social Media

Ed Bennett shares three things he's learned about Healthcare Social Media: Our patients are ahead of us, Real change start at the top, Social media is more than the sum of its parts http://goo.gl/fD2Sj

Three things I've learned about Healthcare Social Media

View more PowerPoint from Ed Bennett

Drowning Prevention Guidelines

Here is a video from the Cleveland Clinic:



Key risk factors for drowning are:

- male sex
- age of less than 14 years
- alcohol use
- low income
- poor education
- rural residency
- aquatic exposure
- risky behavior
- lack of supervision

For people with epilepsy, the risk of drowning is 15 to 19 times as high as the risk for those who do not have epilepsy.

For every person who dies from drowning, another four persons receive care in the emergency department for nonfatal drowning.

Drowning Doesn’t Look Like Drowning

- Except in rare circumstances, drowning people are physiologically unable to call out for help. The respiratory system was designed for breathing. Speech is the secondary or overlaid function. Breathing must be fulfilled, before speech occurs.

- Drowning people’s mouths alternately sink below and reappear above the surface of the water.

- The mouths of drowning people are not above the surface of the water long enough for them to exhale, inhale, and call out for help. When the drowning people’s mouths are above the surface, they exhale and inhale quickly as their mouths start to sink below the surface of the water.

- Drowning people cannot wave for help. Nature instinctively forces them to extend their arms laterally and press down on the water’s surface. Pressing down on the surface of the water, permits drowning people to leverage their bodies so they can lift their mouths out of the water to breathe.

- Throughout the Instinctive Drowning Response, drowning people cannot voluntarily control their arm movements. Physiologically, drowning people who are struggling on the surface of the water cannot stop drowning and perform voluntary movements such as waving for help, moving toward a rescuer, or reaching out for a piece of rescue equipment.

- From beginning to end of the Instinctive Drowning Response people’s bodies remain upright in the water, with no evidence of a supporting kick. Unless rescued by a trained lifeguard, these drowning people can only struggle on the surface of the water from 20 to 60 seconds before submersion occurs.

References:

Drowning Doesn’t Look Like Drowning. Mario Vittone.On Scene Magazine: Fall 2006 (page 14)
Drowning - free NEJM review, 2012 http://goo.gl/xSqLu