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

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

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

Top medicine articles for October 2012

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

Worldwide, 31% of adults are physically inactive, ranging from 17% in southeast Asia to 43% in Americas and eastern Mediterranean. The proportion of 13-15-year-olds doing fewer than 60 min of moderate physical activity per day is 80% http://goo.gl/3W6os -- The pandemic of physical inactivity: Physical inactivity is the fourth leading cause of death worldwide - The Lancet http://goo.gl/dL2uE -- Elimination of physical inactivity would increase the life expectancy of the world's population by 7 months http://goo.gl/mbUos -- Why are some people physically active and others not? Genetic factors contribute to propensity to be physically active http://goo.gl/jHuIk -- Evidence-based intervention in physical activity: lessons from around the world - The Lancet - http://goo.gl/eHniD

Snorkelling-related deaths in Australia: cardiac, surface drowning, drowning after prolonged breath-hold diving, trauma http://goo.gl/VT0Bs

Nearly half of U.S. doctors struggle with burnout: study http://goo.gl/T3fnx

Proton-pump inhibitors (PPIs) are associated with increased risk for Clostridium difficile infection http://goo.gl/wLi5v

Interactive atlas by CDC shows data about HIV, AIDS, hepatitis, TB, chlamydia, gonorrhea, syphilis http://goo.gl/aizZS and http://goo.gl/VYztM

Looking at human beings as ecosystems of collaborating/competing species could change practice of medicine http://goo.gl/3LX9R

Prevalence of Celiac Disease in U.S.: 0.7% (1 in 141), rare among minorities but affects 1% of non-Hispanic whites http://goo.gl/1qFwE

Future doctors will need to correct the postmodern tendency toward immune dysregulation http://nyti.ms/SG6nX7

The Search for a Baldness Cure: Vitamin D to Coax Dormant Follicles to Grow Hair http://goo.gl/82s4a

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

From physician frustration to physician satisfaction. "Oh we’re not gonna take it anymore", sings AMA http://goo.gl/SSWdQ

6 tips for marketing a practice outside social media - amednews http://goo.gl/AwGZ8

Many hospitals recruiting doctors continually. Contact them even if there isn't a job listing, say experts http://goo.gl/v8Oy7

EHR Report 2012: Physicians Rank Top EHRs http://buff.ly/QHeMqU

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.

Comments from Twitter:

Mike Cadogan @sandnsurf: More interesting, insightful and entertaining medical education links from @DrVes #FOAMed litfl.com/PBGoAv

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

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.

"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:

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.

Death is no impediment to continuing to be an author in prestigious medical journals - from the former BMJ editor Richard Smith: “One of the authors on the paper, the most distinguished of the several cardiologists, actually died before the study began. Yet that hasn’t stopped him being an author on a recently published letter that he cannot have read in response to another letter that he cannot have read about a paper that he cannot have read. Wilmshurst, it is clear, finds this absurdity amusing. Death is no impediment to continuing to be an author in prestigious medical journals.” http://buff.ly/QlJhBd

Healthcare CEO: She was on 2 medications at home, not the 22 "re-started" in hospital now. How did this happen? http://buff.ly/QlJ3tK

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

Dr. Wes: On The Promotion of "Hospital-Based Killing" http://bit.ly/TrhVPK

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

Why Do Academic Medical Centers Do Poorly on Quality Report Cards? http://buff.ly/PqeZwy

From physician to app entrepreneur, one perspective http://buff.ly/Pqfo2f

8 Things Medical School Failed to Teach Me About Being a Physician Executive - Kent Bottles http://buff.ly/QoLCOf

Tutorial showing Physicians how to set up their iPad for medical use http://bit.ly/RjsAbu

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

Comments from Twitter:

Mike Cadogan @sandnsurf: More great #FOAMed reading via @DrVes “Best of Medical Blogs - weekly review and blog carnival” litfl.com/RFNRK4

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.

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.

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.

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.

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

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.

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: