Friday, December 30, 2005

Non Medical Interesting Links

City-specific Blogs

With more than 40 sites (and cities), Metroblogging is a growing network of city-specific blogs. "From San Francisco to Bangkok, from Karachi to Toronto, Metroblogs write what is going on in the city."

References: Metroblogging - Wikipedia


Aerosmith and NASA: "Dream On" Video

"Stay in school, study hard and dream on", this is the message of the legendary rockers from Aerosmith to the next generation of explorers. See the video here (QuickTime).

Source: NASA


Google Increases Ad Font Size

Now ads and true search results are more difficult to distinguish from one another, thus increasing the click-through rates of the ads. The similar font is more likely to fool the users into clicking on an ads instead of a search result link. What happened to "Do No Evil", Google?

Project Gutenberg founder tells the story of the new very business-oriented Google that was not very interested in collaborating to make public domain books available on their servers.

Links via Google Blogoscoped.


Bird's Eye Views on Windows Live Local (Virtual Earth)

Bill Gate's Mansion is a good example. Link via Digg.com: Get a close up view of Bill Gate's house using his technology :-)


NYTimes Starts Podcasting

Science Times podcast is now available. It is likely that more podcasts will follow soon.


6 Signs Your Boss Might Be Killing You - and 6 Ways to Fight Back

A slide show by FastCompany.com.


AJAX Translator

Watch it translate as you type. To translate a single word, append a space.


Why Boeing 737 Crashed Cars on the Highway in Chicago

RangelMD is a pilot and explains that many old inner city airports were not designed for modern jet traffic. These airports have "shorter runways and overruns (the areas at the very end of runways) that don't leave any margin for error." See the maps on GruntDoc.com This could have been the reason why a Southwest Airlines Boeing 737 slid off the runway at Chicago's Midway Airport. An official investigation is underway: Probe into Southwest Crash at Midway Under Way - NPR.

CNN reports on the likely causes of the accident and what can be done to prevent similar occurrences in the future. One of them is placing a special foam at the end of the runway which stops the plane. See the CNN video - A look at Midway's runways (3 min)

Residency Interview Advice from Big Mama Doc

Big Mama Doc (what a name!) is an attending at an internal medicine residency program and she has some advice for the applicants: Interviewing Prospective Residents.

She also shares some insights how it feels to be a supervising attending during the floor rotations and Working with Residents.

Big Mama Doc works in the Midwest and she is a self-described "famine resistant doctor, wife, mom, cynic and active daydreamer".

References:
Unsolicited Advice to Residency Applicants. Intueri, 2007.
Image source: fatdoctor.blogspot.com

Related reading:
How the Match Works(’Cause everyone’s been asking, “So did you get a job?”). Over My Med Body, 02/2008.

Thursday, December 29, 2005

The Danger of Being "Too Fast"

"You're slow. You have to be faster", this is what thousands of interns around the country probably hear daily from their residents urging them to be more efficient.

Being efficient is good, being "too fast" is not.

Doctors are not the 15-minute Jiffy Lube change. It takes time to:

- review patient records
- listen to the patient to elicit proper history
- do a focused physical exam
- discuss diagnosis and treatment plan
- make sure that the patient understands them

It is hard to cram all than in 7 minutes. Something has to give.

Unfortunately this something caused a patient's death at the office of an ENT doctor in Denver, Colorado.

The doctor did not review the patient's medical records, relied only on his examination and hastily removed her tracheotomy tube. The patient became short of breath and was taken to a hospital but before doctors could reinsert the tube, she suffered respiratory arrest and brain damage, and later died.

The doctor admitted to the police that he made a serious mistake: "She did need the tube for her airway ... because she had an obstructed airway, it means she did need the tube and I made a mistake."

It is possible that the doctor was busy and his schedule was overbooked. Cutting corners can make you "too fast" which potentially may lead to tragic consequences as in this case.

My advice to the young physicians is: be "slow", take your time, do your job properly. The efficiency will come with time. Take care of your patient the way you want others to take care of you.

I still remember the recommendation letter one cardiologist wrote for a resident: "I will be happy and very confident to refer a member of my family to the care of Dr. X".

Strive to be that doctor.

References:
Doctor is arrested in breathing-tube fatality - The Denver Post
Another Criminal Charge for a Colorado Health Care Provider - Aggravated DocSurg
Advice to young doctors from members of the BMJ editorial board
Off the Fast Track 'In Praise of Slowness' - NPR 1/06
Image source: Wikipedia

Further reading:
Therapeutic Spew. FatDoctor.org, November 2, 2007.

Updated: 11/06/2007

Wednesday, December 28, 2005

Kinja Card - Everything You Want to Know About a Blog

Each card "offers a snapshot picture of any blog. All you need is to tack the URL at the end of this address" (http://kinja.com/id.knj?url=blogsite.com), writes MicroPersuasion.

You can get all sorts of interesting info about your blog (or any blog):

- Snapshot shows similar websites

- Pubsub shows how many links a blog gets every day

- Check PageRank on Google. You can also check it on Live Pagerank or PageRank.net

- Latest Mentions

Clinical Cases: Complications of Central Line Placement


Anatomical landmarks for central line placement in IJ vein, anterior approach.

The clinical cases illustrate complications of central line placement:

- Pneumothorax

- AFib with RVR

- Massive Hematoma (originally posted on UnboundedMedicine.com)

Read more on ClinicalCases.org....

Tuesday, December 27, 2005

This Week's Grand Rounds

Check out the Grand Rounds (GR), a weekly summary of the best posts in the medical blogosphere.

GR is becoming the contemporary weekly portrait of medicine through the eyes of the medical bloggers.

Pre-Rounds is an article series about the hosts of Grand Rounds on Medscape.com. Nick Genes of Blogborygmi, who writes the Medscape column, is the founder of GR and he maintains the archive.

Sunday, December 25, 2005

Links: Medical History of Presidents and More

Medical History of American Presidents

Dr. Zebra (an interesting name!) has collected medical facts about the American Presidents from George Washington to George W. Bush.

Why is Dr. Zebra doing this?

He answers himself: "Reading the histories connects us to our Presidents in a very personal way. Sickness is a universal human experience. Reading about sick people makes us see them as people, and identify with them as people, not as remote figures in a history book."

The information was published in the public domain in most cases in the form of press releases (in modern times at least), so it looks like HIPAA does not apply.

KevinMD has reviewed the annual physicals of both the President Bush and and the Vice-President Cheney.

Image source: Wikipedia


A multimedia guide to genetic disorders

These interactive Flash-based presentations are a good educational tool for both patients and physicians. Videos featuring patients' testimonies are also included. See the sickle cell disease section as an example.

Image source: ygyh.org

Office Procedures by AFP: Joint Aspirations and Injections

American Family Physician is the official journal of the American Academy of Family Physicians. They have published a series of articles on Joint Aspirations and Injections:

- Diagnostic and Therapeutic Injection of the Wrist and Hand Region

- Diagnostic and Therapeutic Injection of the Elbow Region

- Diagnostic and Therapeutic Injection of the Shoulder Region

- Diagnostic and Therapeutic Injection of the Hip and Knee

- Diagnostic and Therapeutic Injection of the Ankle and Foot

- Knee Joint Aspiration and Injection

- Joint and Soft Tissue Injection

Image source: pueblo.gsa.gov

Friday, December 23, 2005

What is the right specialty/fellowship for you? Take a test to see

There are 2 options:

- Check this funny algorithm in BMJ. Just do not take it too seriously. Read more in Physician, know thyself, written by a resident at Yale School of Medicine.

- Take the formal aptitude test by the University of Virginia (15 minutes/130 questions): Medical Specialty Aptitude Test (MSAT)

Further reading:
Financial Advice for Residents and Fellows
What is like to be a FP, IM, EM, ObGyn (put your desired specialty here) doctor?
Read more about different fellowships at InternalMedicineDoctor.blogspot.com: an ER doctor lists the pros and cons of each specialty.
Hunting Season. Dr. Wes, 08/2007.
Related:
How the Match Works(’Cause everyone’s been asking, “So did you get a job?”). Over My Med Body, 02/2008.
Image source: sxc.hu

Updated: 02/02/2008

Thursday, December 22, 2005

BMJ: Build Google Medicine

"Build Google Medicine. The benefits to human health would be immeasurable."

British Medical Journal Editorial by Dean Giustini, BMJ 2005;331:1487-1488 (24 December)

The article is very interesting and I would tell you, just like Instapundit, "read the whole thing", not just the title.

User-created content

Our information world is changing and becoming broader every day. Anybody who has knowledge and interesting ideas can contribute. The Internet was created with the idea for free contribution but that was not easy to implement until the blogging tools circumvented the need to know HTML to make a professional website.

Tim Berners-Lee, the inventor of the internet, explains that the very first browser was able to do the same thing that blogs and wiki enable you to do now - to make and save changes on the web pages.

It takes 5 minutes to make a website on Google's Blogger.com and it is easier than email. All this information created by millions of users every day is easily searchable and updated at the same moment as you are reading this. The world never sleeps.

When I made my first website for the Case Western Reserve University (St. Vincent/St. Lukes) residency program, the motto was "for the residents, by the residents". The users (medical residents) loved the fact that they can request a feature (e.g. "how can I recognize the correct position of endotracheal tube on CXR?") and see it posted on their own website the same afternoon.

Two years and nine websites later, I can tell you from my limited experience: user-created content has a future. If you cannot find the information you are looking for, may be it is time to write it yourself. Research the question in Pubmed and the major journals, consult colleagues and write it down on your website. Somebody may find it useful.

Search is the king

Google often beats UpToDate in finding what you are looking for. UpToDate information is far more reliable but Google is much broader.

Just see who brings visitors to BMJ website, Google leads it closest competitor by a multiple of nine (450,000 as compared to 50,000). Many young people believe that "if something is not on Google, it just doesn't exist." User-created content often tops the search results and most people never look beyond the first ten results on the page. There are dangers of seeing the world through "Google eyes" but this is a topic for another discussion.

Our patients use the search engines all the time, we, as physicians, cannot lag far behind. Of course, there are credibility problems to be solved but may be one day Google (or somebody else) will really be able to "organize the world's information and make it universally accessible."

My small contribution

I feel humbled to be cited twice in the BMJ editorial in the same group with the New England Journal of Medicine, Canadian Medical Association Journal and Academic Medicine.

Our projects include:

- Clinical Cases and Images. A Case-Based Curriculum of Clinical Medicine. This project is supported by physicians in the Section of Hospital Medicine at the Cleveland Clinic and the Case Western Reserve University (St. Vincent/St. Lukes) Internal Medicine Residency Program. ClinicalCases.org was featured in BMJ.

- Procedure Skills collects slide shows with explanations of some common medical procedures like central line placement and thoracentesis. The procedure articles are referenced in Wikipedia, the world's largest online encyclopedia.

- Clinical Cases and Images - Blog. Casesblog features daily news, comments and ideas which have not reached the stage of completeness to be published on ClinicalCases.org.

- Clinical Notes collects information which is not related to clinical cases but represents practice tools, for example, Sample Admission Notes for the Most Common Conditions and A Systematic Approach to Reading an EKG.

- Computers and Internet is a website that collects the information technology stories from Casesblog relevant to medical practice.

- Hit the Road - See America and the World features photos and descriptions of interesting places to visit around Cleveland, Ohio and around the world.

Update 3/28/2007:

Adam Bosworth, Vice President of Engineering at Google Inc. covers similar topics in: How do you know you're getting the best care possible?

References:
How Google is changing medicine - BMJ 12/05 (extract). Dean Giustini's blog
Searching for the Right Search — Reaching the Medical Literature - NEJM 1/06
Google Medicine and open access: team players in knowledge-based healthcare (PDF)- Dean Giustini
So I have a blog - Tim Berners-Lee
Podcast May Be the Word of the Year, But Google Has Changed Medicine - KraftyLibrarian.blogspot.com
Web Search 101: Walt Mossberg, the world's best tech writer, offers a free introductory course - BookOfJoe.
Google Hires Physician - For Google Medicine? UBC Google Scholar Blog.
Wikis, blogs and podcasts: a new generation of web-based tools for virtual collaborative clinical practice and education. Boulos MNK, Maramba I, Wheeler S. BMC Med Educ 2006;6:41.
Image source: Doctors Using Google by Philipp Lenssen, used with permission

Do you order a CXR for Midline placement?

75 yo man with persistent bacteremia due to diverticulosis is discharged home with HIVAT (home IV antibiotics) for 2 weeks. A Midline is placed.

Do you order a CXR for Midline placement?
Usually not.

There are differences between PICC line and Midline.

PICC lines enter a large central vein and a CXR is mandatory before the line is used to make sure that there is no pneumothorax and the line is in the correct place - in the distal portion of superior vena cava. PICC line can stay in place up to one year.

The midline is a 7-inch catheter (shorter than PICC) inserted in the antecubital region with the tip located in the axillary region. Thus CXR is usually not needed. Midlines can be used up to 4 weeks and that is why this catheter was chosen for the 2-week HIVAT course of this particular patient.

Midlines are sometimes called halfway catheters because they end halfway to the superior vena cava. Midlines are not suitable for total parenteral nutrition or chemotherapy.

CXR of PICC line:


Correct postion of PICC line. CXR report: There is a right PICC line with its tip in the distal portion of the superior vena cava. There is poor inflation of the lungs with elevation of the left hemidiaphragm. There is tortuosity and minimal dilatation of the thoracic aorta.

The bottom line: Midline is a shorter line with a shorter life span (up to 4 weeks) as compared to PICC.

Read more about other venous catheters - Different Venous Catheters - What is PICC, Hickman, Quinton, and Port-A-Cath?

References:
New peripherally inserted midline catheter: a better alternative for intravenous antibiotic therapy in patients with cystic fibrosis. Pediatr Pulmonol. 1992 Apr;12(4):233-9.

Adverse Reactions Associated with Midline Catheters -- United States, 1992-1995 - CDC

PICC - Anatomy and Placement - rnceus.com

MidLine - bardaccess.com

PICC and Midlines - medformation.com

Wednesday, December 21, 2005

Cleveland Clinic Has a New Logo (and a Shorter Name)

The old logo of the Cleveland Clinic was developed in 1984 and was a gold square sitting atop of four green squares. Each square represents one of the Clinic four founders. The four squares also represent each of the major areas of the Foundation: Inpatient care, Outpatient care, Research, and Education.

The new logo is a white square sitting atop of four blue and green squares.

In addition, the hospital will change its name from "Cleveland Clinic Foundation" to the shorter "Cleveland Clinic".

Recently, HealthVoices.com and Dr. RW pointed out that the Clinic has a longstanding commitment to offering high quality free medical education on its CME website, including an online textbook called The Cleveland Clinic Disease Management Project.

References:
The Cleveland Clinic is about to perform some surgery on its logo - wkyc.com

Tuesday, December 20, 2005

Add Modules to Google Personalized Homepage

Philipp Lenssen of Google Blogoscoped has created GoogleModules.com, a directory of "modules" or widgets that you can add to your personalized Google.com/ig page.

Google already has a similar but much smaller directory.

Some of the modules are:

Del.icio.us

My del.icio.us

Google Video

10x10 image of the hour

Other Google Searches

Google Translate

Bookmark System

To-do List

ImageShack Hosting

KidneyNotes and Enoch Choi of Medmusings are probably the biggest Del.icio.us fans among the medical bloggers and they may enjoy the new Del.icio.us widgets. The modules work as plug-ins to Google Personalized page.

Subscribe to the RSS feed for new modules.

There are more widgets available on widQ.com.

Image source: googlemodules.com

Tuesday, December 13, 2005

Patient Blogs

Patient blogs are often very interesting and revealing. The give us the chance to understand how the person behind the label "patient number X" really feels.

It can be rather surprising for many physicians to realize that patients analyze their doctor through the small talk the same way the doctors do.

It is a two way street though: patients reading medical blogs are surprised to find that there is much more behind the "lab coat" than a well-memorized textbook.

Several years ago, the medical journal Lancet featured a series of disease descriptions through the patients' eyes.

No matter how exhausted medical residents feel during the never ending night calls, most of them realize than the things are always worse on the colder side of the stethoscope (where the patient is).

These are several patient blogs that I found recently:

- Amy Tenderich of DiabetesMine.com has been invited to join a trial of a new inhaled insulin, and is weighing the pros and cons.

- Joe lives with ALS and shares his daily thoughts.

- A patient blogs about his experience with LASIK eye surgery: "Having just come back from having the procedure done, I've chronicled the whole thing beginning to end. For those who are apprehensive of having this done, this may be an informative read." The story was posted on Digg.com and the comments are not less interesting than the patient's blog itself.

Related:
Lasik Surgery: When the Fine Print Applies to You. NYTimes, 03/2008.

- Podcast of an open heart surgery patient. A 64-year-old man tells his story about having AFib, going through DC cardioversion and a mitral valve repair. And it is all true - you can see the healing scar from the open heart surgery.

Image source:
Top image source: Stock.xchng
"Veni Vidi Vici" image used with permission: ekgwatch.com

Updated: 03/12/2008

Monday, December 12, 2005

Can You Trust Blogs? 10 Questions for Medical Bloggers

Blogs are popular but are they credible?

An attempt to answer this is to ask bloggers a few questions, mainly about their motivation to write and how they choose their sources.

The credibility issue is not limited to medical blogs. In fact, as usual, IT blogs are leading the way and I saw a similar series with questions to fellow bloggers on blog.coolz0r.com who interviewed one of my favorite IT bloggers, Philipp Lenssen of Google Blogoscoped.

The 10 questions for medical bloggers are based on an article from NCCAM, National Institutes of Health - 10 Things To Know About Evaluating Medical Resources on the Web:

1. Who runs this site?
2. Who pays for the site?
3. What is the purpose of the site?
4. Where does the information come from?
5. What is the basis of the information?
6. How is the information selected?
7. How current is the information?
8. How does the site choose links to other sites?
9. What information about you does the site collect, and why?
10. How does the site manage interactions with visitors?

Dr. Hsien-Hsien Lei decided to adapt the questions to medical bloggers and you can see some of the answers here:

- Hsien Hsien Lei, PhD of GeneticsAndHealth.com

- Notes from Dr. RW

- The Haversian Canal

- Enoch Choi of medmusings

- Dmitriy Kruglyak of HealthVoices.com

- The Biotech Weblog

- Emergiblog

- Rita Schwab of MSSP Nexus Blog

- Shrinkette - musings of a psychiatrist in the pacific northwest

The answers also make a good "About Me/FAQ/Disclaimer" page for a website.

If are writing a medical blog, please do not forget to make sure that your blog is HIPAA-compliant.

Update:
Dr. Lei has started an honor roll listing medical bloggers who answered the 10 questions.

References

Evaluating Web Pages: Techniques to Apply & Questions to Ask - UC Berkeley
Who Are the Medical Bloggers and Where to Find Them?
Case Reports and HIPAA Rules
Image source: Wikipedia

Related reading

Twitter, HIPAA, Privacy and Freedom of Speech. Phil Baumann, 07/2008.
As A Busy Physician, Why Do I Even Bother Blogging? http://goo.gl/fSF3 - Excellent summary.
HIPAA found in Hippocratic Oath: Keep the patients’ secrets a secret. Also: My colleagues will be my brothers and sisters http://bit.ly/pGObLI

Saturday, December 10, 2005

Portable Applications and Other News

Make Your Desktop Programs Portable

John Haller first made Portable Firefox which lets you run Firefox from a USB drive or from any desktop without installing. Portable Firefox was a great success and John seems to be on the roll now - he has just launched PortableApps.com which promises to make all your favorite desktop programs portable. Well, not all of them - just the good ones. "Your computer, without the computer" (TM).

If you really need to use Microsoft Excel, Word or PowerPoint but don't really want to spend a fortune buying them, the solution is here. Portable OpenOffice is free, small (just 70 MB), does not need install, works just like MS products, and you can save all files in your preferred MS format.

John Haller has some interesting quotes on his website: "You're not your job. You're not how much money you have in the bank. You're not the car you drive." The logical conclusion is that you are (or at least you should be) much more than that.

Y.ah.oo Bought Del.icio.us, the Most Popular Social Bookmarking Site

Yahoo is not interested in Del.icio.us technology but in its 300,000 users who have millions of bookmarks. Yahoo reportedly paid $ 30M which comes down to roughly $ 100 per user.

InsideGoogle writes:

"Look at it this way: Yahoo owns the social web (Flickr + Del.icio.us), Google owns the information web, and Microsoft is slowly working to own RSS. The winner will be the one that holds onto their piece and makes it the most important piece on the board."

Blogger Celebrities Take the Front Row

There are now thousands (if not millions) of tech blogs and only a small percentage of them matter. Some bloggers are forming an elite group that is increasingly courted at news events.

"Reporters for the big mainstream newspapers and magazines, long accustomed to fawning treatment at corporate events, now show up and find that the best seats often go to the A-list bloggers", writes WSJ.

"It's not uncommon for mainstream reporters, including the occasional technology columnist, to lobby bloggers to include links to their print articles."

How has the news world changed in just a few years...

References:
Tech Blogs Produce New Elite to Help Track The Industry's Issues - WSJ
23 Things to Do With a Thumb Drive from the February 2006 issue of PC World magazine
Download of the Day: Portable Apps Suite. Lifehacker.com
Portable apps get a thumbs-up. Newsday.com
List of portable applications from Wikipedia
Portable Apps. White Coat Rants, 2010.

Friday, December 9, 2005

Clinical Case: Massive Lower Extremity DVT Treated with Thrombolysis

20 yo CM is admitted to the hospital with RLE pain for 1 week. The pain started when he was jumping on a trampoline and he thinks that he might have twisted his ankle. Two days later he noted swelling of his right leg, which is getting progressively worse.

He was admitted to a hospital and a Duplex of RLE showed a large DVT extending from the ankle to the femoral vein in the groin area. Heparin IV was started, overlapped with Coumadin 2 days later.

What happened?
Five days later, the RLE pain is the same or worse, and the circumference of the leg increased despite the anticoagulation treatment.

Read more on ClinicalCases.org....

Image source: Gray's Anatomy 1918, public domain

Merck Concealed Vioxx Data from NEJM

A NEJM editor found out that additional data linking Vioxx to cardiovascular risk was deleted from a major study (VIGOR) published five years ago. Merck researchers deleted the data 2 days before submitting the paper manuscript.

The authors underreported the number of heart attacks suffered by Vioxx patients, claiming that there were 17 heart attacks when there were actually 20.

The additional events were disclosed to the FDA in 2000.

NEJM Editor-in-chief Jeffery Drazen says: "There's a difference between the letter of the law and the spirit of the law, and what Merck did conformed with the letter of the law. But in my opinion, it broke the spirit of the law because you're using human subjects, participants in this trial, and you're putting them at risk".

On Dec 8, NEJM released an editorial entitled "Expression of Concern" which asks the VIGOR authors to submit a correction of the manuscript.

"Is this Watergate for Merck?", asks Kevin, M.D.

References:
Medical Journal Says Merck Concealed Vioxx Data - NYTimes
Merck's Deleted Data - Forbes.com
Medical Journal: Vioxx Paper Flawed - NPR
A Vioxx Bomb Drops. Or Does It? - In the Pipeline
Watergate scandal - Wikipedia
Rofecoxib - Wikipedia
Image source: Wikipedia

Thursday, December 8, 2005

Did Beethoven Died of Lead Poisoning (Plumbism) or Not?

Scientists examined six of Ludwig van Beethoven's hairs (15 cm long) and pieces of his skull, and found out that the famous composer likely died of lead poisoning.

Beethoven died in 1827 at age 56.

Listen to the NPR interview with Bill Walsh who headed the team that studied Beethoven's hair and skull samples.

How was the composer exposed to lead?

The lead exposure occurred over many years. The reason could have been Beethoven's love for wine which at that time was sweetened with lead-containing substances. His favorite wine goblet was also made of a lead based metal.

Another hypothesis is that Beethoven was slowly poisoned by Danube fish. One of his favorite dishes was the fish caught in a heavily polluted stretch of the river contaminated with lead.

How did the scientist get the samples?

The hair samples were from a lock of Beethoven's hair purchased by a collector several years ago.

The skull pieces belong to a California businessman who inherited them from his great-great uncle, who was a doctor in Austria.

What were the symptoms of lead poisoning?

Beethoven started to develop health problems in his twenties which grew worse over time. His chronic abdominal pain, irritability and depression, for example, were likely due to lead poisoning.

Beethoven saw physician after physician in search of a cure for illnesses. Nobody was able to help him. Ironically, in a letter to his brothers, he expressed the wish that after his death, "scientists would use his remains to find out the cause of his illness so that others would not have to suffer as he did".

"Lead poisoning made Beethoven grumpy", summarizes Chicago-Sun Times profoundly.

References:
Lead confirmed in Beethoven's death - USA Today
Study conlcudes Beethoven died from lead poisoning - amhersttimes.com
Plumbosis: The Cause of Beethoven's Illness -MedGadget
Investigating Beethoven's death - PBS
Beethoven Lead Poisoned by Danube Fish - lead.org.au
Lead poisoning seen as probable cause of Beethoven illnesses - CNN
Beethoven Suffered from Lead Poisoning - NPR
Ludwig van Beethoven - Wikipedia
Image source: Wikipedia

Related:
Checking Santa's Toys For Lead: Parents concerned about lead in their children's toys can buy a home testing kit. NPR, 12/2008.

Ultrafiltration as New Treatment for Congestive Heart Failure Exacerbation

Image Hosted by ImageShack.usThe mainstay of acute CHF exacerbation is removing the excess fluid from the patient via diuresis with loop diuretics, like Lasix.

Diuretics have been used to treat fluid overload for over 50 years but they have adverse metabolic effects (hypokalemia, stimulation of renin-angiotensin system) and do not work very well in patients with advanced chronic kidney disease.

Fluid removal via ultrafiltration in a new approach for treating CHF exacerbation. Ultrafiltration (also called "aquafiltration") can be done via peripheral line and on a regular medical floor. Commercially available devices can remove 500 cc of fluid per hour.

The RAPID-CHF trial is the first RCT of ultrafiltration for acute decompensated heart failure. The trial included just 40 patients which were randomized to receive either usual care (diuretic) or a single eight-hour ultrafiltration, in addition to usual care.

18 from the 20 patients undergoing ultrafiltration had more fluid removed and improved symptoms of heart failure and shortness of breath at 48 hours.

You can download the 2 ultrafiltration studies and the editorial from the ACC website (free full text, published in the 12/6/05 issue of the Journal of the American College of Cardiology).

Ultrafiltration makes physiological sense for CHF treatment but a larger trial is needed to prove its safety and efficacy. The two studies discussed here are just small pilot trials and definitive studies are in progress.

References:
Ultrafiltration, Congestive Heart Failure, & the RAPID-CHF Trial - KidneyNotes.com
The System 100 - CHF Solutions, Inc.
Less-Invasive Ultrafiltration Device May Be Practical Alternative to Diuretics - ACC News Release
Ultrafiltration May Be Practical Alternative to Diuretics - MedGadget
Image source: Wikipedia

Wednesday, December 7, 2005

Archives of Clinical Cases and Images - Blog

I have been writing on Clinical Cases and Images - Blog since March 2005. The case curriculum website Clinical Cases and Images was started a few months earlier. In fact, the whole purpose of the blog was to post links to the new and updated cases from the teaching curriculum. Little did a knew that the blog would start a life of his own -- expanding to technology, travel and other interesting topics. Clinical Cases and Images - Blog ties together most of the projects I am involved in, right at the top of every page. If you want to know more, the full blog archives are listed below. Do not forget to use the Custom Google Search Engine box in the top right corner of this page -- it searches across most of the websites I manage.

View archives by month (click below to select):

August 2009

July 2009

June 2009

May 2009

April 2009

March 2009

February 2009

January 2009

Click below for the blog archives from 2005 to 2008:





Image source: Archive of the AMVC (Archive and Museum for the Flemish Cultural Life), Wikipedia, GNU Free Documentation License.

Can You Trust Wikipedia? A Journalist Was Falsely Implicated in Kennedy Assassination

I still think that for the most part Wikipedia is credible but a recent highly-publicized story was an embarrassment for the free online encyclopedia:

In May 2005, an anonymous user created a Wikipedia article for the respected journalist John Seigenthaler Sr. which claimed that he was involved in the assassinations of Robert and John Kennedy. This version of the article was active until September, when Seigenthaler found out about the malicious act. He called the Wikipedia founder Jimmy Wales and the content was immediately deleted. The Wikipedia editors created a new entry which is now protected.

The incident prompted Seigenthaler to write in Op-Ed for USA Today that "Wikipedia is a flawed and irresponsible research tool...for four months, it depicted me as a suspected assassin."

On December 5, Seigenthaler appeared on CNN with Wikipedia founder Jimmy Wales to discuss the problem (you can watch the 10-minute video on CNN website).

To prevent similar occurrences in the future, Wikipedia will now require users to register before they can create an article. The largest encyclopedia in the world was launched in 2001 and currently has 850,000 articles in English. The servers are based in St. Petersburg, Florida.

As long as the Wikipedia can keep the vandals out or have the editors/contributors correct the erroneous entries, it will continue to be a valuable tool.

Disclaimer: I am also a registered contributor to Wikipedia.

Update 12/11/05:
A man in Nashville has admitted that he put false information into a Wikipedia entry about John Seigenthaler Sr. Read more in A Little Sleuthing Unmasks Writer of Wikipedia Prank - NYTimes.

In conclusion, Wikipedia now has an article about the whole John Seigenthaler Sr. Wikipedia Biography Controversy.

References:
Online encyclopedia tightens rules - CNN
A false Wikipedia 'biography' - USA Today
Wikipedia tightens online rules - BBC
Wikipedia Changes a Policy - Google Blogoscoped
Wikipedia to Require Contributors to Register - NPR
Make the Largest Encyclopedia in the World Better. I already did (I hope)
Jimmy Wales: A public talk on Wikipedia at ibiblio.com - download video of the lecture
Some of the text of this post is based on Wikipedia
Image source: Wikipedia

Tuesday, December 6, 2005

Patient Education: Virtual Coronary Arteries Anatomy, PCA, CABG and Other Procedures

Mercy Medical Center in Canton, Ohio has Flash-based patient education tutorials which are very informative and easy to understand:

VIRTUAL ANATOMY - The Human Heart

VIRTUAL PROCEDURES - Heart Surgery

The center also links to graphical presentations of surgeries, procedures, and tests, provided by ADAM.com: "The presentations feature full-color medical illustrations, labels and other visual explanations."

Image source: Wikipedia

Monday, December 5, 2005

Rate Your M.D. on, well... RateMDs.com

RateMDs.com collects patient ratings on more than 16,500 doctors in the U.S. and the database is growing daily. The "Overall Quality" of a doctor is rated on a scale from 1 to 5.

According to the website director of public relations: "doctors are often unhappy with what we are doing, but patients approve almost unanimously, as evidenced by the steadily increasing website traffic by 10% per month"

RateMDs.com, which bills itself as the Internet's largest free listing of physician ratings, was founded in March 2004.

Using RateMDs.com is free, the website owners make money from the AdSense ads at the top of the page.

MSSP Nexus Blog also writes about RateMDs.com:

"The potential for abuse is obvious given that posters may remain anonymous.

I looked up a couple of different physicians I know, one rated positively one negatively; and I have to say that the comments accurately reflected my personal views and experience.

This site, or others like it that follow, will no doubt begin to be checked as part of a routine credentialing process, so the implications to healthcare providers are considerable."

RateMDs.com gets 1 million visitors per month, and has been growing at 50-100% each year since it was started in 2004.

If a doctor ends up with a total of 25 or more ratings — which is considered "suspicious activity" on the site — users who want to rate that doctor are forced to log in.

Comments from Twitter:

@DrVes: Only 12% of adults have "consulted" online rankings or reviews of physicians http://goo.gl/4binq

@vara411 (Dan Ramirez): They're too fragmented and many require "pay to play." But Google Places and CitySearch have growing collections of reviews.

@DrVes: When you "google" the majority of doctors the first few results are review sites - not their practice site, etc. Not optimal.

@vara411 (Dan Ramirez): Agreed. Though I'm not sure safeguards are in place to protect physicians from slander.

References:

When the Doctor Is in, but You Wish He Weren't - NYTimes
Analysis of 4,999 Online Physician Ratings: most patients gave positive reviews (2011 study) http://goo.gl/LgG5L - It begs the question: couldn't researchers add 1 more for a round number 5,000?
Sites Offering Data, Reviews of Doctors - WSJ
RateMDs.com Receives its 10,000th Doctor Rating - emediawire.com
Doctor rating with an attitude. Notes from Dr. RW.
As Angry Patients Vent Online, Doctors Sue to Silence Them - WSJ.
Googling Ourselves — What Physicians Can Learn from Online Rating Sites. NEJM, 2010.
Is That Review a Fake? Cornell University develops algorithm that finds deceptive hotel/product online reviews http://goo.gl/9mdCD
"If a patient bashes a physician on rating websites there is little that doctor can do", says Medscape, 2012.
Image source: RateMDs.com.

A Lesson in Company Management. Give the Power Back to the People, the Google Way

The Engineer Who Turned Off Google for Most of France

Xooglers.blogspot is a blog by former Google employees. Today, they talk about the power given to the regular folks at the company. Ray was an engineer at Google who had to deal with Google spammers performing automated queries with the real threat to slow down or block Google:

"Ray took unauthorized automated queries very personally. If the ISP wasn't responsive enough, he might block all of the ISP's other IP addresses, too. That's how Ray turned off access to Google for most of France one day.

One engineer holding that kind of power speaks to the assumptions inherent in Google'’s culture. Individuals were considered capable of weighing the effects of their actions and presumed to have the best interests of the company (and Google'’s users) at heart.

In previous jobs I'’d held, no one did anything of significance without first getting approval from two or more layers of management. Memos would be written, committees would form, discussions would be held and all aspects considered before steps could be taken. Time would pass.

Google emphasized acting over deciding."


In the Comments Section

"Google does "Ready, fire" and it works. Other companies do "Ready, aim aim aim aim aim aim fire". The idea is so watered down by committees and slow to market, when they finally "fire" (if they EVER do), the idea is shadow of what it started out as."


Some Common Sense

Unfortunately, giving the power to make management decisions back to the regular employees (without supervision) can also be dangerous.


References:
Say hey, it'’s Ray - Xooglers.blogspot.com
Just do it! - Xooglers.blogspot.com
Google: Ten Golden Rules - Newsweek

Sunday, December 4, 2005

Non Medical Interesting Links

Odeo Studio = Record Audio
Record audio on Odeo (both are pronounced the same way) without any equipment, just with your browser.

The privacy levels of the recorded audio can be:

- public - you can make a podcast to broadcast to the world

- private - record a private message for your friends. This works like voice email.

Listen to Ev, Biz and Noah from Odeo talking about the new features.


Evaluating Web Pages: Techniques to Apply & Questions to Ask - UC Berkeley


The Brain Surgeon at Google
Google is so complex that they have both a brain surgeon and a rocket scientist working on it, writes Xoogler.


Poll: What happens when you Google your own name?
The options are:
"- Your web site comes up - There are no matching results - A bunch of stuff about someone else with your name comes back - A site you don't control lists you - Your company's web site is returned - An article you wrote for your college paper 10 years ago comes up"

Check the poll results (via LifeHacker.com)


The Washington Post Mashups
News Cloud and more (via Micro Persuasion.com)


Future-proof your email address - LifeHacker.com


A New Beatles Biography
NPR looks behind the myth


iiiiiiiiiiiiiiii.com
This is silly but fun. Check out the i-i-i website, click iiiiiiii.com to see what I am talking about. Speakers required; monitor, probably not.


Image source: sxc.hu

Clinical Case: Hypercalcemia due to Multiple Myeloma

60 year old female presented to the ER complaining of back pain, weakness and decreased appetite for one week.

PMH:
Diverticulitis

Physical examination:
VSS
Limited movement in the lumbar spine
No focal neurological changes

Laboratory results:
H/H of 7.7/23
Platelets of 106
BUN of 35, Cr of 2.7
Ca of 16.6, repeated Ca is still 16.2

Survey radiographs of the skull, spine, ribs, pelvis and upper and lower extremities (large bones):

X-ray of skull, CXR, spine

Read more on ClinicalCases.org....

Saturday, December 3, 2005

Interesting Links

"My Experience with Laser Eye Surgery"
A patient blogs about his experience with LASIK surgery: "Having just come back from having the procedure done, I've chronicled the whole thing beginning to end. For those who are apprehensive of having this done, this may be an informative read."

The story was posted on Digg.com and the comments are not less interesting than the patient's blog itself.

Related:
Aging eyes. CNN, 03/2008.

From the Curbside to Court
The SoundPractice podcast cites three court decisions involving physicians who provided an informal or "curbside" consultation.

Government Pushes for Keychain Medical Records - Medgadget
The contra point: "This doesn't make sense. Every ER I've worked in has net access. A centralized web app could not be lost, whereas I've lost a dozen of these dongles in the past year", writes enochchoi.

Do-it-yourself PAP smear - Daily Mail, UK
At-home HIV testing will soon be available as well.

Lifesaving move: CPR made easier - USA Today
The new guidelines seem to put much more emphasis on chest compressions as opposed to rescue breaths. AHA advises CPR performers to give 30 compressions for every two rescue breaths, i.e. 30:2 (the old ratio was 15:2).

It's not ABC anymore, DocAroundTheClock half-jokingly writes, it's ACB (airway, compressions, breathing). Learn your ACBs. KidneyNotes links to the New CPR Guidelines from the American Heart Association published in Circulation, Nov 29, 2005.

Listen to the NPR interview with an editor for the newly released 2005 CPR Guidelines: New CPR Guidelines Stress More Reps. Read more in Time: A Better CPR.

Image source: Wikipedia

Updated: 03/31/2008

Thursday, December 1, 2005

How do people find medical blogs?

How did you find me?

Most people find medical blogs the same way they find everything else on the web -- by searching. Google brings 70-80% of the traffic to any blog, including the medical ones.

One of the funny things about being a medical blogger is reviewing the site tracker logs. There, you can see how people came to your website or, to be exact, what search queries they used to find it.

Dr. Charles has a special page called In Search of Dr. Charles where he collects "the most interesting search phrases that people use to randomly find my site (through search engines like Google and Yahoo). I find this fascinating, disturbing, embarrassing, and hilarious."

Some poor guy tried to search for the answer on Google: "name of pill two active my wife wild" and reached GruntDoc blog. His reply: "Not found here, but send me an email when you do."

Nothings tops KidneyNotes who as a true physician (and a nephrologist) always tries to help:

"To the person who found this blog by searching for "If you hold up your pee too long can your kidney burst?" -- The short answer is "No."


More examples:
Colonoscopy prep, coumadin, bananas and chocolate. Barbados Butterfly

Image source: Wikipedia

Clinical Case: Pneumoperitoneum Due to Sexual Activity

A 27 yo CF is admitted to the hospital with CC: periumbilical abdominal pain and fever for 2 days.

PMH:
cholelithiasis

SH:
Smoker, IVDA - heroin, uses cocaine. Failed several rehab programs.

Physical examination:
VSS
Chest: CTA (B)
CVS: Clear S1S2
Abdomen: Soft, diffuse tenderness, no rebound, ND, +BS
Ext: no c/c/e

She spiked fever and a CXR was ordered as part of the fever work-up.


Pneumoperitoneum - air under the left hemidiaphragm


Close-up view of the pneumoperitoneum

Read more on ClinicalCases.org.....

Funny Videos

An elderly lady's fight with a Mercedes Benz - Google Video

A CNN weatherman loose his cool - YouTube.com.
You may be relieved to know that it looks like the weather anchor (Chad Myers) kept his job. The news anchor in the video clip is Carol Costello.

Mohammed Ali: Don't even think about it, Mr. President - YouTube.com

ER nurses rap video - link via GruntDoc.com


How Zoos Work by HowStuffWorks.com - Google Video

References:
HOW TO Quickie: Embedded Google Videos - PaulStamatiou.com
Chad Myers: The science -- and art -- of forecasting tornadoes - CNN, mhking.mu.nu