Top medicine articles for August 2012

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

Sanofi Announces FDA Approval for Auvi-Q, First Voice-guided Epinephrine Auto-injector http://goo.gl/4GfPr

Medical Journal of Australia: "Clearly, we overestimate our ability to correctly deploy tests and interpret results" http://goo.gl/q8da8

Drug Resistance Claims Another Gonorrhea Treatment: the oral cephalosporin cefixime http://goo.gl/tR2LW

Social media continues to excel at reaching patients and medical peers http://goo.gl/odKGo

New drugs, procedures, and devices for hypertension : The Lancet http://goo.gl/IbwbL

Data challenge the concept that raising of plasma HDL cholesterol will reduce risk of myocardial infarction http://goo.gl/67eZF

10 Ways to Make EMR Meaningful and Useful http://goo.gl/KimDJ

Tiger snake (Notechis spp) envenoming: Australian Snakebite Project (ASP-13) | Medical Journal of Australia http://goo.gl/YCzRg

Bias in clinical history significantly influenced the accuracy of ECG interpretation http://goo.gl/JjRd6

9 Smartphone Apps to Improve Your Medical Practice http://goo.gl/nUjNP -- 15 Smartphone Apps to Improve Your Practice http://goo.gl/s3dnR

How to Raise Successful (and Happier) Children - NYTimes http://buff.ly/MT4BRr

When metformin alone is insufficient, consider adding a dipeptidyl peptidase-4 inhibitor, linagliptin - Lancet http://goo.gl/bdMkG

Ciprofloxacin for 7 days versus 14 d. in women with acute pyelonephritis: Short courses should be favored - Lancet http://goo.gl/oU3uC

Radiation exposure from CT scans in childhood increases subsequent risk of leukemia and brain tumors - Lancet http://goo.gl/44feV

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.

Rosacea - NHS Choices video

From NHS Choices YouTube channel: Rosacea is a common but poorly understood long-term skin condition that mainly affects the face. It most commonly affects fair-skinned people from northern Europe and is estimated to affect up to 1 in 10 people. In this video, an expert explains what rosacea is, the symptoms to look out for and the various treatments.



Cathelicidin dysfunction may be a central factor in the pathogenesis of several cutaneous diseases, including rosacea.

Cathelicidins are antimicrobial peptides (AMPs) that protect the skin through 2 pathways:

- antimicrobial activity
- cytokine release, inflammation, angiogenesis, and reepithelialization

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.

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

Searchable database of Clinical Examination Videos at Life in the FastLane EM blog http://goo.gl/VEf1

Physician blogger on assignment: Getting ready for the European Society of Cardiology Congress http://goo.gl/fGtpY

Life as a Healthcare CIO blog calls the Meaningful EHR Use Stage 2 "the most exciting time to be in healthcare IT" http://goo.gl/I6oNN

3 Things Medical Conferences Can Learn From Tech Events | MedCrunch http://bit.ly/RiefZk

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

Comments from Twitter:

Mike Cadogan @sandnsurf: More great stuff from @DrVes with “Best of Medical Blogs - weekly review and blog carnival” litfl.com/NwEUq1

Best of Medical Blogs http://goo.gl/kxLHa with @RonanTKavanagh @sandnsurf @medcrunch @EinsteinMed @drjohnm

Einstein Coll of Med @EinsteinMed: Honored. Thank you!

Carolyn Hastie @Thinkbirth: Awesome list

Dr. Ronan Kavanagh @RonanTKavanagh: Thanks @DrVes I'm in good company!

What are the New Risk Markers for Coronary Heart Disease?

Traditional CHD risk factors used in the Framingham risk score (FRS) predictions include:

- age
- gender
- systolic blood pressure
- treatment of hypertension
- total and high-density lipoprotein cholesterol levels
- smoking
- diabetes

The newer CHD risk factors include:

- N-terminal fragment of prohormone B-type natriuretic peptide levels
- von Willebrand factor antigen levels
- fibrinogen levels
- chronic kidney disease
- leukocyte count
- C-reactive protein levels
- homocysteine levels
- uric acid levels
- coronary artery calcium [CAC] scores
- carotid intima–media thickness
- peripheral arterial disease
- pulse wave velocity

Adding coronary artery calcium [CAC] scores to the FRS improved the accuracy of risk predictions.

Levels of N-terminal fragment of prohormone B-type natriuretic peptide also improved risk predictions but to a lesser extent.

Improvements in predictions with other newer markers were marginal.

References:

Evaluation of Newer Risk Markers for Coronary Heart Disease Risk Classification: A Cohort Study. Maryam Kavousi et al. Ann Intern Med. 20 March 2012;156(6):438-444.
Image source: Gray's Anatomy, 1918, public domain.

Comments from Twitter:

Michael Mirochna, MD @DocRockne:  unfortunately, no evidence they help with OUTCOMES

Bunions animation

From NHS Choices YouTube channel: A bunion is a bony deformity of the joint at the base of the big toe. This animation shows how a bunion forms and explains what could cause it. Find out how bunions are treated: http://nhs.uk/Conditions/Bunion/Pages/Treatment.aspx

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:

If you’re keen to experiment with social media, Twitter is a great place to start. The real value of many medicine-related tweets is the links to web pages - Medical Journal of Australia http://goo.gl/yVWhA

Doctor: Yammer had a positive effect on the work atmosphere and made the practice feel smaller http://goo.gl/yVWhA

Social media continues to excel at reaching patients and medical peers http://goo.gl/odKGo

Pharma Marketing and Social Media http://www.nejm.org/doi/full/10.1056/NEJMp1004986 - SoMe landscape changes quickly, NEJM was concerned about Google SideWiki in 2010 - it was discontinued about a year later.

9 Smartphone Apps to Improve Your Medical Practice http://goo.gl/nUjNP -- 15 Smartphone Apps to Improve Your Practice http://goo.gl/s3dnR

Harvard Medical School will teach doctors all about "Creating the Brand Called Dr. You: Media Training Boot Camp" http://buff.ly/OUBY1O

How medical doctors and students should use social media: a review of guidelines for proposing recommendations http://goo.gl/9LvkZ

Facebook friends with your doctor: good medicine or ethically 'icky'? The Seattle Times http://goo.gl/p8pCw

Patient.co.uk app allows you to to replace educational pamphlets for patients with an app http://goo.gl/KQcJH

Social-media tools can boost productivity - Dr. Luks uses Doximity for referrals and digital fax - USA Today http://goo.gl/hbFPZ

ASCO 2011 Twitter Analysis of Top Links Shared and Comments http://goo.gl/h8Dza

PharmARC - ASCO 2011 Twitter Analysis of Top Links Shared and Comments on Molecules (3rd through 7th june)

View more presentations from PharmARC

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.

Managing perioperative risk in patients undergoing elective non-cardiac surgery - BMJ review

Non-cardiac surgery has a low overall mortality but is associated with a large number of deaths because so many procedures are performed (250 million major surgical procedures worldwide per year).

Assuming a hospital mortality rate of 1%, non-cardiac surgery will be associated with 2.5 million deaths worldwide each year and complication rates at least five times this figure.

15% of people who undergo inpatient surgery are at high risk of complications, such as pneumonia or myocardial infarction.

Most deaths occur in a group of patients who are at high risk because of:

- advanced age
- comorbid disease
- major surgery

High risk surgical patients account for 80% of all perioperative deaths.

Further research is needed to identify the most effective approaches to perioperative medicine for high risk patients.

References:

Managing perioperative risk in patients undergoing elective non-cardiac surgery. BMJ 2011; 343 doi: 10.1136/bmj.d5759 (Published 5 October 2011), Cite this as: BMJ 2011;343:d5759

Image source: Wikipedia

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 http://goo.gl/ILrMh

EM and critical care physicians adopt social media at rapid pace

Here is the remarkable growth just in the last 18 months: 77% Twitter, 42% Facebook and 20% for Google Plus. An increasing number of blogs (21%) now have multiple authors. There is better identification of authors with 94% of blogs and podcasts citing the full name, credentials, contact form and geographical location of blog authors. http://goo.gl/MySga

Here is my comment: Remarkable summary, Mike. I’ve seen something similar (on a smaller scale) with the allergy and immunology accounts. In 2008, I was the only one tweeting from a major national scientific meeting (ACAAI) and it was a lonely experience. In 2011, there were 30 allergists reporting from a similar meeting, providing a rich and engaging feed of high-value updates in real time.

My guess is that the outstanding example provided by Life in The Fast Lane and a few others physician bloggers and podcasters encourage others to join in by showing them how to use use social media in practice and at the same time demonstrating the remarkable value both physicians and patients receive from using the two way street provided by these new communication channels.

Thank for you showing the way and maintaining the focus day after the day. I know it’s not easy for your guys to find the time but having Life in The Fast Lane and the other bloggers/podcasters is inspiring to many others. Keep up the great work.

"We are very fortunate to be physicians. Making our parents so happy is a wonderful unintended consequence." - Dr. Bob Centor http://goo.gl/sX88e

Life as a Healthcare CIO: Joyful Chaos. The Chief Information Officer of Beth Israel Deaconess Medical Center: “By pure happenstance, my Telecom manager is selling her herd of 8 alpaca. After meeting them, we purchased the entire herd - 3 males and 5 females. Realizing that alpacas need guardians because they do not defend themselves well against the coyotes, fisher cats, and other predators on our property, we researched llamas. We found an ideal guard llama who has lived with alpaca for many years. The female llama will guard the female alpaca.” http://goo.gl/ENlBA

The new TRIP medical search engine - Find Evidence Fast http://goo.gl/HSQxH

American Heft: What's Colorado's secret? The GlassHospital blog investigates: http://goo.gl/NwIz5

Phil Baumann comments on the "The Coming Catastrophe of Medical and Nursing Education: Today’s physicians don’t feel like they’re doing what they signed up to do. Today’s nurses don’t feel like they’re doing what they signed up to do. Each are fighting unnecessary wars." http://goo.gl/W5LyE

Obsessed with a Mark Knopfler song - db's Medical Rants http://goo.gl/7XI4b

Elsevier introduces a probable replacement for MDConsult - ClinicalKey website contains massive amount of books, journals, images, videos (paid access) - iMedicalApps.com http://goo.gl/iJp0K - Related: ClinicalKey Brief Review - Krafty Librarian http://goo.gl/UUXnO

The link between stress and heart disease

In this video from the Cleveland Clinic, Steven Nissen, MD, talks about the important lesson war has taught us about stress and its effect on the heart. One of the best ways to manage stress is regular exercise.



Tips for managing stress (watch the 2-minute BBC video embedded below)

- Take a few deep breaths
- Get plenty of exercise
- Socialize - don't stress alone, talk to someone and have a laugh
- Get out - go to the park



Read more: http://www.bbc.co.uk/scotland/brainsmart 

Participation in sport is associated with a with a 20—40% reduction in all-cause mortality compared with non-participation. Exercise might also be considered as a fifth vital sign, according to the Lancet: http://goo.gl/gyxYf

 If nothing else helps, consider this: Chewing gum may reduce stress and improve memory

Top medicine articles for August 2012

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

Contrary to marketing, there is no evidence that sports drinks are essential adjunct for anyone doing exercise - BMJ http://goo.gl/h6kg9

To drink or not to drink to drink during exercise - BMJ reviews the evidence http://goo.gl/vKGX0

Mythbusting sports and exercise products - BMJ: color of urine does not reflect hydration http://goo.gl/8q1Wc

Round table on the problems with sports product evidence - BMJ video:



Health-care law driving doctors away from small practices, toward hospital employment - Washington Post http://goo.gl/Uvb7f

Top 5 reasons why the independent physician practice is dying http://goo.gl/DMZGw

Transcatheter aortic valve implantation (TAVI) is risky and costly - BMJ http://goo.gl/vYD9D

Brain MRI in COPD: In stable nonhypoxemic COPD there is white/gray matter disturbance, cognitive dysfunction? http://buff.ly/MnAIIN

A "New" Way to Prevent Hip Fractures: Cataract surgery may help prevent disabling hip fractures http://buff.ly/MnBw0h

Whooping Cough Comeback: more than twice as many cases of pertussis this year compared to last year http://buff.ly/PrZp0Z

Gout risk goes up as waistline expands: "The heavier you are, the greater your odds of getting gout" http://buff.ly/MnC9a9

Consider Cosmetics and Folk Remedies as Causes for Unexplained Lead Poisoning - CDC http://buff.ly/Ps0yWv

Dieting vs. Exercise for Weight Loss - NYTimes http://buff.ly/MnCJoo -- Weight loss predictor - A validated dynamic mathematical energy balance model that predicts weight change http://buff.ly/Ps1r1f

Find your Olympic athlete body structural match - BBC http://goo.gl/MhluY - Other calculators: http://goo.gl/K3akg

Doctors tend to enjoy classical music, while lawyers prefer jazz - Medical Journal of Australia http://goo.gl/OVjl5

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.

Guidelines for Management of Acute Bacterial Sinusitis by Infectious Diseases Society of America

A bacterial cause accounts for 2%-10% of acute rhinosinusitis cases.


Nose and nasal cavities. Image source: Wikipedia, public domain.

Recommendations for Management of Acute Bacterial Sinusitis by the Infectious Diseases Society of America (IDSA):

Bacterial rather than viral rhinosinusitis should be diagnosed when any of the following occurs:

- persistent symptoms lasting at least 10 days, without improvement
- symptoms or high fever and purulent nasal discharge or facial pain for 3–4 days at illness onset
- worsening symptoms after an initial respiratory infection, lasting 5–6 days, has started to improve.

Empirical therapy should be started as soon as acute bacterial rhinosinusitis is diagnosed clinically.

Amoxicillin-clavulanate, instead of amoxicillin alone, is recommended for both children and adults.

Macrolides and trimethoprim-sulfamethoxazole are not recommended as empirical therapy, because of high rates of antimicrobial resistance.

References:

Algorithm for the management of acute bacterial rhinosinusitis (figure)
Guideline Issued for Managing Acute Bacterial Rhinosinusitis - Physician's First Watch http://bit.ly/TGn6aM
IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults http://bit.ly/TGnaHB

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:

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

Avoiding the pitfalls of social media as a medical practitioner - NPR interview. Doctors are turning more and more to Facebook and Twitter to market their businesses. But some are overstepping the boundaries of doctor/patient confidentiality by discussing individual cases online and even offering medical advice to people they don't know. http://goo.gl/AzVHS

Impressive: @giustini 's 140 SlideShare presentations achieved more than 1 mln viewings - focused on #HCMS and medlib http://goo.gl/qHmKR

How to Save Time Doing Healthcare Social Media: A Primer for Physicians http://goo.gl/wIS34

How to Use a Free Blog by Blogger/Google for Business http://goo.gl/vAQcS

10 Places to Find Unique Content to Share http://goo.gl/zCCMB

SXSW PanelPicker - Digital Doctors http://goo.gl/G3qKz

Tips for doctors looking to engage with #HCSM by @RonanTKavanagh: "childlike playfulness, humility, politeness, and humour" http://goo.gl/zKZZ5

Smartphone use during inpatient attending rounds is common and there is potential for distraction (study) http://bit.ly/POqDEz

One Doctor’s Prescription to Avoid Social Media Overload http://goo.gl/bdtPU

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

Promises and Challenges of Virtual Learning Environment in Medicine - IAMSE Web Seminar http://goo.gl/CvpPg

Twitter Use at American Diabetes Association (ADA) Scientific Sessions http://goo.gl/NBjOL

American Diabetes Association Scientific Sessions Twitter Buzz Analysis by PharmARC

View more presentations from PharmARC

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.

Comments from Twitter:

Mike Cadogan @sandnsurf: More great healthcare and social media articles #FOAM #HCSM - via @DrVes litfl.com/OkCtnd

Dr John Weiner @AllergyNet: 13 excellent links RT @DrVes: Healthcare social media #HCSM - top articles goo.gl/St4NL

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.

The Most Hopeful Job in the World

From Craig Canapari, MD: His "academic achievement would be impressive in anyone. But when you realize that he could not even pick up a pencil, this is really stunning." http://bit.ly/NkPOik

Setting an Example: Eating Well

The “classic” fare of residency (donuts or muffins for breakfast, pizza for lunch, and some fast food on the way home) doesn’t really give you much credibility when you are talking to patients. http://goo.gl/fQlAs

10 Ways to Make EMR Meaningful and Useful 

From Dr. Rob Lamberts http://goo.gl/KimDJ:

- Require all visits to have a simple summary.
- Allow coding gibberish to be hidden.
- Require all ancillary reports to be available to the patient.
- Require integration with a comprehensive and unified patient calendar.
- Put most of the chart in the hands of the patient.
- Pay for e-visits and make them simple for all involved.
- Allow e-prescription of all controlled drugs.
- Require patients’ records to be easily searchable.
- Standardize database nomenclature and decentralize it.
- Outlaw faxing.

Bedside manner in the days of EHR

The $47 billion Kaiser Permanente managed healthcare company has even gone so far as to develop a training methodology for EHR etiquette. It's designed to teach practitioners how to both use electronic tools and be aware there's a patient in the room. http://goo.gl/2LFuk

Called LEVEL, it has five steps:

L -- Let the patient look on
E -- Eye contact
V -- Value the computer
E -- Explain what you’re doing
L -- Log off

Electronic health records changing the character of the family doctor http://goo.gl/iw36b

Are Olympic athletes superhuman? BMJ readers comment: http://goo.gl/bYIRt

The Colonoscopy Experience of a Healthcare CIO http://goo.gl/n2K4D

Fauquier ENT Blog: How Can Nasal Obstruction CAUSE Clogged Ears? http://bit.ly/QGN0ft

Hospitals, Social Media and Compliance - an excellent presentation by Ed Bennett from the blog Found In Cache http://goo.gl/g3qys

Hospitals, Social Media and Compliance

View more PowerPoint from Ed Bennett

7 healthy traits linked to lower death risk but only 2% of people have all 7 - are you one of them?

People who meet the 7 healthy goals recommended by the American Heart Association are less likely to die of cardiovascular causes.

Here there are:

- not smoking
- moderate exercise at least 5 times a week
- untreated blood pressure under 120/80
- HbA1c under 5.7%
- total cholesterol under 200 mg/dL
- BMI less than 25
- a diet high in produce, fish, and whole grains, and low in sodium and sugary beverages

Less than 2% of people reached all 7 ideals.

Those who met 6-7 goals had reduced risks for all-cause mortality (hazard ratio, 0.49), compared with participants meeting zero or one goal.

References:

Healthy Habits Associated with Reduced Mortality Risk - Physician's First Watch http://bit.ly/N9x8ha
Trends in Cardiovascular Health Metrics and Associations With All-Cause and CVD Mortality Among US Adults - JAMA http://bit.ly/N9xzYO
Image source: OpenClipart.org, public domain.

How Do Nerves Work? TED-Ed video

At any moment, there is "an electrical storm" coursing through your body. Discover how chemical reactions create an electric current that drives our responses to everything in this 5-minute video:



Read more and customize this lesson at TED-Ed website: http://ed.ted.com/lessons/how-do-nerves-work

Only 60% of the eligible U.S. population gets screened for colon cancer

Only 61% of the eligible population in the USA gets screened for this common cancer, according to The Lancet.

Here are some excerpts from the new guidance for colorectal cancer screening by the American College of Physicians (ACP):

- colorectal cancer screening should start at the age of 50 years for people at average risk, and at 40 years (or 10 years before the age of the youngest case of colorectal cancer in a family) for people at high risk

- stool-based tests, flexible sigmoidoscopy, and optical colonoscopy are all acceptable screening options for people at average risk

- the gold standard—optical colonoscopy—is recommended for people at high risk

- screening should be stopped for adults aged over 75 years or who have a life expectancy of less than 10 years

Colorectal cancer screening can lead to harmful outcomes such as perforation, bleeding, and false-negative results.

10 Questions You Need to Ask About Colonoscopy

From The NYTimes:

1. Why is effective bowel preparation important?
2. How can I maximize my chance of an effective bowel preparation?
3. Are there certain medications I should stop taking before colonoscopy?
4. Are all colonoscopists equally effective at finding polyps and cancers during colonoscopy?
5. How can I be sure that my colonoscopist will do a careful examination?
6. How can I reduce the risk of a complication during colonoscopy?
7. Should I try colonoscopy without sedation?
8. If I undergo sedation, should it be given by an anesthesiologist?
9. Do all colonoscopists follow the same rules to determine when my colonoscopy should be repeated?
10. Why aren’t the problems with the delivery of colonoscopy already solved?

Questions # 1, 2, 3, 6, 7 are very important, question # 10 probably not so much.

17% of U.S. hospitals now provide virtual colonoscopy


Medicare does not currently reimburse routine screening with virtual colonoscopy, but it does cover evaluations with "regular" colonoscopy.

References:

New guidance for colorectal cancer screening. The Lancet, Volume 379, Issue 9820, Page 978, 17 March 2012.
Virtual Colonoscopy Gains in Popularity. Is It Right for You? TIME.
Colonoscopy Developer Dies at 94 - NYTimes http://goo.gl/iBnOp - Dr. Wolff was unconventional and surely made headlines in his day.
When President Obama underwent his first-ever colon cancer screening last year, he chose virtual colonoscopy. USA Today.
Cleveland Clinic Colorectal Cancer Risk Assessment Tool. Get your score in 2 minutes (free).
Image source: Colon (anatomy), Wikipedia, public domain.

Top medicine articles for July-August 2012

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

Where are you on the global fat scale? BBC calculator: http://goo.gl/ZnI6D

Drug cheating at the Olympics: who, what, and why? 7% of elite athletes admitted to doping ~ 1000 people at each Games http://bit.ly/Mcc1bz

Risk of pneumonia decreased with use of angiotensin converting enzyme (ACE) inhibitors - BMJ meta-analysis http://goo.gl/dE9Ks

One Doctor’s Prescription to Avoid Social Media Overload http://goo.gl/bdtPU

Cents and Sensitivity - Teaching Physicians to Think about Costs - NEJM http://goo.gl/aUQE3

How fat is fat? The Lancet compares CTs with visceral fat vs. subcutaneous fat deposits http://goo.gl/iO9sa

Increasing contraceptive use in developing countries has cut the number of maternal deaths by 40% - The Lancet http://goo.gl/hHjIO

Qsymia is the second new drug for obesity approved by the FDA in the last month, after Belviq http://goo.gl/wCqi7

Mass General knocks Johns Hopkins out of the top hospital spot it's held for 21 years, while at the same time Cleveland Clinic is closing in on Mayo Clinic - U.S. News & World Report's 2012 list of the best U.S. hospitals http://goo.gl/URpei

Feedback of DNA based risk assessments does not motivate behaviour change - BMJ http://goo.gl/3HaRy

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.

Munchausen's syndrome - NHS video

From the NHS Choices YouTube channel: A psychiatrist explains the motivation behind Munchausen's syndrome, also known as factitious illness, where someone pretends to be ill or causes symptoms in themselves. This can include inflicting wounds or tampering with blood and urine samples. He also explains the importance of getting treatment and describes another form of the condition where a person fabricates an illness in someone in their care (Munchausen's syndrome by proxy):



Comments from Twitter:

Julie Meadows-Keefe @esq140: Fascinatingly & disturbingly real.