Parathyroid sestamibi scan
Read more on ClinicalCases.org....
Monday, January 30, 2006
Clinical Cases: Hypercalcemia due to Primary Hyperparathyroidism
A 58-year-old woman has elevated calcium levels detected incidentally during workup for high blood pressure. She complains of fatigue and musculoskeletal aches.
Parathyroid sestamibi scan
Read more on ClinicalCases.org....
Parathyroid sestamibi scan
Read more on ClinicalCases.org....
Sunday, January 29, 2006
Video iPod for Your Heart
The Arizona Heart Institute cardiovascular surgeon Grayson Wheatley uses video iPods to educate his patients. Before discharging patients from the hospital, he gives them iPods loaded with videos about diet, exercise and other information about their heart surgery."One of the biggest complaints in medicine is that patients don't get enough time with their doctors, and the iPod can be an extension of time that they get with their doctors," says Dr. Wheatley, "they can watch the videos several times, and they can get a true understanding of exactly some of the complex things that we're doing."
The Arizona Heart Institute in Phoenix is the first medical institution to use video iPods for patient education (press release). You can subscribe on CVMD.org . A video iPod costs about $ 300.
Other educational iPod projects
The Cleveland Clinic distributes medical news videos that can be downloaded to a video iPod. The service is called Health Edge.
iTunes U(niversity) aims at educating students by making lectures available at any time and from any computer with an Internet connection.
References:
iPods for Your Heart. Ivanhoe Broadcast News, Inc., January 20, 2006
iTunes U Released. The Krafty Librarian, January 26, 2006
Video Podcasts by The Cleveland Clinic
Johns Hopkins and Other Medical Podcasts
Image source: Wikipedia
Saturday, January 28, 2006
Clinical Cases: Artificial Disc for Degenerative Disc Disease
45 yo with severe degenerative disc disease (DDD) of the lumbar spine continues to complain of back pain. Physical therapy, NSAIDs and opioids relieve the pain only temporary. He has had lower back pain (LBP) for 9 months.What would you do?
The patient was referred to a spine surgeon who recommended an artificial disc.
Read more on ClinicalCases.org....
Image source: Medgadget
Tutorials: Search for Medical Information on Google and Pubmed
Google TutorialsIt is official, now even the medical journals publish directions for physicians to get better search results on Google. One such article is Using Search Engines to Find Online Medical Information by Mohammad Al-Ubaydli published in the open-access PLoS Medicine, Volume 2, Issue 9, Sep 2005. The access to the journal is free and, as usual, "free means that somebody else pays for it". In this case, authors pay around $ 1,500 to cover the cost of peer review and publishing in PLoS Medicine. Link via Notes from Dr. RW.
Pubmed Tutorials
PubMed Tutorials based on the NLM's one-day PubMed training course. The Krafty Librarian has more information in PubMed Updates.
Image source: OpenClipart, public domain
Thursday, January 26, 2006
Feed2Podcast Gives Your Blog a Voice
Feed2Podcast automatically converts blog text to audio via Text-to-Speech. It turns the last 7 items from your RSS feed into a podcast.Blog readers can listen to the posts immediately or subscribe to the automatically generated podcast and listen with an iPod later.
The text is read by a computer-generated voice but it sounds OK. Give it a try. Click on the button in the sidebar of this blog: "Blog2Podcast. Listen now"
References:
Feed2Podcast Blog
Text-to-Speech Programs and Continuous Medical Education
Image source: Feed2Podcast
Monday, January 23, 2006
Is the New Epocrates SxDx an Electronic Doctor?
The Epocrates formula is:
Sx --> Dx --> Tx
From Sx (Symptoms) to Dx (Diagnosis) and then Treatment (Tx). Doctors have been following this algorithm for ages but it was not computer generated.
Epocrates SxDx is a new PDA software that you can use to:
1. Enter your patient's symptoms (Sx), physical findings, lab results, and history
2. Generate a diagnosis index (Dx) organized by likelihood
3. Get the correct treatment (Tx) for the most likely diagnosis
I doubt that computers will ever be able to replace the clinical judgment that Robert Centor is
talking about on his blog.
Epocrates & iPhone. Link via Doctor Anonymous.
References:
On Clinical Judgment. DB's Medical Rants
Epocrates SxDx. The Krafty Librarian
Related:
An easy way to add new features to Google. Matt Cutts: Gadgets, Google, and SEO, 02/2008.
Updated: 02/26/2008
Sx --> Dx --> Tx
From Sx (Symptoms) to Dx (Diagnosis) and then Treatment (Tx). Doctors have been following this algorithm for ages but it was not computer generated.
Epocrates SxDx is a new PDA software that you can use to:
1. Enter your patient's symptoms (Sx), physical findings, lab results, and history
2. Generate a diagnosis index (Dx) organized by likelihood
3. Get the correct treatment (Tx) for the most likely diagnosis
I doubt that computers will ever be able to replace the clinical judgment that Robert Centor is
talking about on his blog.
Epocrates & iPhone. Link via Doctor Anonymous.
References:
On Clinical Judgment. DB's Medical Rants
Epocrates SxDx. The Krafty Librarian
Related:
An easy way to add new features to Google. Matt Cutts: Gadgets, Google, and SEO, 02/2008.
Updated: 02/26/2008
Sunday, January 22, 2006
Johns Hopkins and Other Medical Podcasts
Johns Hopkins Medicine has a health podcast which is described as "a lively discussion of the week'’s medical news and how it may affect you."The five-minute podcast features Rick Lange, M.D. who is the chief of clinical cardiology, and the director of the Hopkins radio news service.
eWeek features other prominent medical podcasts:
- The New England Journal of Medicine, Science, and Nature all have podcasts that summarize the contents of their most recent issues
- The Arizona Heart Institute offers audio and video podcasts focused on cardiology on CVMD.org
- Agency for Healthcare Research and Quality (AHRQ) has a podcast that gives consumers tips on obtaining the best medical care
- The National Institutes of Health has an unofficial podcast covering major research developments. The podcast blog is hosted on (where else?) Blogger/Blogspot.
As mentioned before on this website, The Cleveland Clinic has a video podcast called HealthEdge.
References:
Podcasting for Your Health. eWeek, January 20, 2006.
Link via KidneyNotes.com
Image source: Johns Hopkins
Friday, January 20, 2006
Don't work (or browse) so hard. Beware of Internet addiction
The American Psychological Association still has doubts if the Internet addiction exists but it looks pretty much for real in this Google video:
"Don't work so hard." Link to original video, choose "Put on site" to to embed this video onto a your web page.
According to The New York Times, Internet addiction affects 10 percent of the web users in the U.S. The so-called "Onlineaholics" spend endless hours surfing the web to the point that their Internet activity disturbs their daily life.
A growing number of therapists are treating web addicts with the 12-step programs, used to treat chemical addictions.
The condition is not officially recognized as a psychiatric disorder and insurance companies do not pay for treatment.
The University of Massachusetts, Lowell has more information on the Internet addiction disorder:
- Take an Internet Addiction Survey Online
- Symptoms of Internet overuse and addiction
Check out the Center for Online and Internet Addiction for more information.
References:
Hooked on the Web: Help Is on the Way. NYTimes, published: December 1, 2005
Is Internet addiction real? American Psychological Association
Getting Entangled By Your Computer Use? UMASS Lowell
Internet addiction disorder. Wikipedia
Is Internet addiction a real problem? ArsTechnica.com
"Don't work so hard." Link to original video, choose "Put on site" to to embed this video onto a your web page.
According to The New York Times, Internet addiction affects 10 percent of the web users in the U.S. The so-called "Onlineaholics" spend endless hours surfing the web to the point that their Internet activity disturbs their daily life.
A growing number of therapists are treating web addicts with the 12-step programs, used to treat chemical addictions.
The condition is not officially recognized as a psychiatric disorder and insurance companies do not pay for treatment.
The University of Massachusetts, Lowell has more information on the Internet addiction disorder:
- Take an Internet Addiction Survey Online
- Symptoms of Internet overuse and addiction
Check out the Center for Online and Internet Addiction for more information.
References:
Hooked on the Web: Help Is on the Way. NYTimes, published: December 1, 2005
Is Internet addiction real? American Psychological Association
Getting Entangled By Your Computer Use? UMASS Lowell
Internet addiction disorder. Wikipedia
Is Internet addiction a real problem? ArsTechnica.com
Sunday, January 15, 2006
Wikipedia and Google are the Future of Medicine. And it's Good
Medical blogs often complement journal articles. Even the popular medical portal Medscape prominently features the best of the medical blogosphere on its front page.The Medscape founder himself says that "a variant of Wikipedia for medicine is the future -- and it's good."
User-created content has the power to expand and correct peer-reviewed content. Then, you need Google Medicine to find what you are looking for in this enormous mash-up of blogs/wikis/journals/books/sites that we call Web 2.0.
"Google, M.D." is not going to replace doctors but it will certainly help both physicians and patients to take care of each other.
It is nice to see that Medscape editors' opinion on medical blogs has evolved. As Nick Genes, the founder of Grand Rounds says, it only speaks of the quality of writing on medical blogs.
The Counterpoint
Wikipedia is based on the "Wisdom of Crowds" theory which claims that we all, together, know more than the best individual scholar. This may not apply to medicine though. Even Jimmy Wales, the Wikipedia founder says that "you would not like your brain surgeon to look up medical facts in Wikipedia".
Greg Linden of Findory talks about "Madness of the Crowds: Take a majority vote from people who don't know the answer, and you're not going to get the right answer. Summing collective ignorance isn't going to create wisdom."
Peer-reviwed literature is not going to be replaced by individual blogs. The Web 2.0 phenomenon is very new and we still have not figured out what is the best way to use it in medicine.
The idea of "open content" is great but what if the content itself is not that great?
References:
Who Cares About Medical Blogs? The Video Answer of a Medical Media Company
Are Traditional Peer-Reviewed Medical Articles Obsolete?. Medscape
BMJ: Build Google Medicine
Is a medical Wikipedia a good idea? Respectful Insolence.
Can Wikipedia conquer expertise? The New Yorker.
The only way to preserve the wisdom of the crowd is to protect the independence of the individual. WSJ, 2011.
Image source: Doctors Using Google by Philipp Lenssen, used with permission
Image source: Doctors Using Google by Philipp Lenssen, used with permission
Saturday, January 14, 2006
Better Information Technology Needed in Medicine - Blogger Opinions
Are medical records still in dark ages?Medical Informatics Insider writes that hospitals are still in the dark ages when it comes to record keeping in paper format. This does not apply to all hospitals though. Martin C. Harris, who is a CIO (chief informatics officer) at the Cleveland Clinic, admitted that when the hurricanes hit Florida offices of the Clinic last summer, no medical records were lost. They had already been safely stored in electronic format on the servers in Cleveland, Ohio.
"Inefficient" electronic medical records (EMR)
Graham is a medical student who shares his frustration with the current use of IT in medicine in his post Health IT: This Is The Best We've Got?:
"My frustration continues to grow and grow the more I work and work. I find it extraordinarily hard to believe that with all the great minds in computers and medicine, we don'’t have a system that makes practicing medicine quicker and error proof. Even at the VA, a hospital system that has arguably the best computerized medical record, things are incredibly inefficient."
Electronic medical records can be very useful
In my comment to Graham's post, I noted that most of the fixes for the problems he listed are already available.
The Cleveland Clinic uses EpicCare which is popular software for EMR. Admission notes and progress notes can be done electronically and the system automatically pulls out vital signs, laboratory results, medications lists, etc. and puts them in the note.
I did my residency at Case/St. Vincent and the nurses there used to record their assessment (interval history, vitals, physical exam) in the computer system. When the residents round in the morning, they can see everything that happened since they left the hospital the previous day. The electronic assessment is so comprehensive that we used to joke that you do not actually have to see the patient because everything is recorded in the computer. Do not take this as advice though, of course, you HAVE to SEE the real patient.
Both hospitals given as examples have computer terminals in patients rooms (portable or stationary).
I also used to use a progress note template (printed on paper) that you just fill out and then put in the chart.
Check out these Sample Admission Notes for the Most Common Conditions. They can be used as paper templates or saved in the computer system and completed electronically.
References:
EMR, the new threat to your medical privacy. ConsumerReports.org
EHRs Fix Everything - and Nine Other Myths. Family Practice Management, 2007.
How Clinical IT is Transforming Hospital Care – For Better and Worse. Wachter's World, 01/2008.
An Introduction to Personal Health Records. American Academy of Family Physicians, 2006.
Image source: Wikipedia
Related:
EMR (Epic) primer: Our Most Expensive Typing Pool. Dr. Wes, 09/2008.
Updated: 09/04/2008
Top 10 Issues in Hospital Medicine in 2005
Notes from Dr. RW has compiled a list of the Top 10 Issues in Hospital Medicine in 2005:1. State of the hospitalist movement
2. Natrecor controversy
3. Emerging infections
4. Controversies in hypercoagulability
5. Emergency cardiac care
6. Electronic medical records and computerized physician order entry
7. Integration of multiple modalities in the treatment of sepsis
8. Quality, accountability and P4P
9. Inpatient glycemic control
10. Diagnosis of pulmonary embolism
References:
Definition of "Hospitalist" Added to Merriam-Webster Dictionary
Image source: sxc.hu
Tuesday, January 10, 2006
Grand Rounds
What is this?
Grand Rounds is a weekly summary of the best posts in the medical blogosphere. 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 Grand Rounds and he maintains the archive. If you would like to know more about the author of Clinical Cases and Images - Blog, see the Pre-Rounds interview here.
This week's Grand Rounds
I work in a large tertiary care center which is probably one of the biggest and busiest hospitals in the world. There are doctors from all sorts of subspecialties, nurses, supportive personnel and, of course, thousands of patients who make this whole endeavor worthwhile.
This organization is glued together by the continuous effort of all these thousands of people (30,000) who come to work and make a difference in somebody's life because it is part of what they do everyday.
The medical blog community reminds me of the hospital structure. It is very interesting to see that the medical blogosphere has spread well beyond the limits of doctors and nurses as authors (click on the diagram to see this week's authors according to job/topic description). Grand Rounds is a snapshot of the best posts and shows the wide variety of medical blogs. It takes all of us to make the miracle of healing happen everyday.
DOCTORS
How to treat hyperkalemia (high potassium)? The new 2005 CPR Guidelines are reviewed by a nephrologist
Treatments for hyperkalemia vary widely and and given the lack of standardization, it is not surprising that different doctors treat hyperkalemia in different ways. The new 2005 CPR guidelines from the American Heart Association provide recommendations for the treatment of hyperkalemia. KidneyNotes offers some criticisms to make a better use of the guidelines in the real world. KidneyNotes.com is a blog maintained by a nephrologist (a kidney doctor).
Should we do PSA screening? A urologist's opinion
Dr. Savatta of Robotic Surgery Blog reviews the pros and cons of PSA testing for prostate cancer. He critiques both the official guidelines and fellow bloggers.
Clinical judgment is the essence of medicine
DB’s Medical Rants writes that clinical judgment remains (and will remain) difficult to define and therefore even more difficult to measure. He discusses three clinical cases as examples.
The “Can-do” spirit of the American health system
No doubt the "can-do" attitude sometimes saves lives, helping some patients with impossible odds survive. Unfortunately, while such an attitude may work well for movie heroes, it does not always lead to victory in patient care. Ad Libitum blog discusses the pros and cons of “do something, don’t just stand there” versus “masterful inaction.” (part one and two)
On Ariel Sharon’s cerebral hemorrhage
Medical blogs follow the news of the day and often provide an explanation to the general public when a famous person is affected by an illness. Recently, Kevin, M.D. reviewed Tedy Bruschi's stroke and the President and the Vice-Presidents annual physicals exams. This week DB’s Medical Rants discusses the two strokes that the Israeli prime minister had - ischemic 2 weeks ago and hemorrhagic later. The first stroke was embolic and similar to the one that affected Tedy Bruschi . The second stroke was probably due to anticoagulation given to prevent the recurrence of the first. Dr. Bob (DB) writes that we must always remember that our treatments have both risks and benefits. Shrinkette reminds us that only about 17% of strokes are hemorrhagic but they account for 30% of stroke deaths.
Sharon had three brain surgeries to evacuate blood in less than 24 hours although there is no sufficient evidence that this approach is clearly beneficial. Medviews comments that taking care of politicians (and kings) is not easy. Frequently, because of their importance and prominence, they may paradoxically get poor care. Bioethics Discussion Blog also asks "Does Standards of Medical Practice Change for a King?" (part one and two).
We do not know all the details of Ariel Sharon's case and the above comments are just an expression of concern rather than a statement of fact.
Suicide bombers' damage lasts beyond the blast
Doc Around the Clock links to a BBC article about a suicide bomber with hepatitis who blew himself up and his body particles infected a survivor of the blast. "As a result of that case, all survivors of these attacks in Israel are now vaccinated for hepatitis B." (BBC)
Sago mine tragedy due to carbon monoxide poisoning
Miners' notes reveal their final moments: "It wasn't bad. I just went to sleep." The miners chose not to tell of their headaches, nausea, and dizziness, which are symptoms of carbon monoxide poisoning, as reported by Shrinkette.
The answer to the question "Why are you overweight?”
NHS Blog Doctor says that "the correct answer, the one that scores points, is straightforward: “Because I eat too much doctor.” We can work on that. The incorrect answer is “I don’t know, doctor, I don’t eat a thing.” Well, I am not sure about the situation on this side of the pond though. Just recently, a U.S. doctor was sued for telling a patient that she was too fat (KevinMD has a summary of the the blogosphere responses).
Minute Clinic opening up at a CVS Pharmacy near you
Bruce of Carolina Healthcare blog is worried that the new Minute Clinic is not only down the street from their office but it also competes directly with their urgent care: "This will impact our business! How should we respond?" "You're Sick. We're Quick" is the Minute Clinic's trademark motto, their discount health care locations are staffed only by nurse practitioners. RangelMD has more on this MiniDoc-in-Box concept which The Health Care Blog calls the Walmartization of health care.
ER Interruptions
GruntDoc shares his frustration with one of the most annoying things in the ER: interruptions while speaking to patients. "I don't expect anyone to wait through the Gettysburg address, but there are natural pauses in conversations when questions aren't completely disruptive, can we all try to wait for that?" Apparently, studies show that the average ER doctor gets interrupted 20 times an hour. Comments say it best: "Nice rant."
Selective abortion of 10 million female babies in Asia
PickledPolitics blog comments on a Lancet study which estimates that 500,000 female fetuses are aborted every year in parts of India, for no other reason than their gender.
Screening during the first trimester of pregnancy
The ObGyn doctor who runs the Red State Moron blog sorts out some inaccuracies in the lay press about the prenatal screening. For starters, first trimester screening (combination of nuchal translucency and serum) is a screening test, not a diagnostic test.
The Hidden Lives of Doctors: Weekend Rounds
Despite the entreaties of some anxious patients, in most cases their doctor is not available 365 days a year. Some other doctor (often unknown to the patient) has to "cover" the weekend for their regular physician. The Cheerful Oncologist has a three part commentary on The Hidden Lives of Doctors, this week's post reveals the mystery of weekend rounds in the hospital. Check out part one (The Art of Signing Out) and part two (The Tergiversator).
Fun with Medical Students
Maria of Intueri teaches medical students how to empathize with pshychotic patients. And she is pretty successful as you will see.
Do antidepressants increase suicide risk or not?
TreatmentOnline blog asks if the FDA warning about antidepressants was wrong.
Don’t be Shocked - Poor Outcomes for Inpatient Cardiac Arrests
LubbDub (a cardiology blog, what else) writes about what we can do to improve the dismal survival after a dreaded "code blue" in the hospital: "Codes have always amazed me in hospitals. As an intern, I felt the intense fear and sinking feeling of having to “perform” using what little knowledge I had to save a patient. I often saw interns running in the opposite direction rather than taking ownership of a dying patient. I quickly realized that the doctors role in a code was to be a calming force in an often chaotic situation."
Medical Consulting for Surgical Patients
The Internal Medicine Doctor writes about Medical Consulting requested by surgical services. The Doctor (formerly: Mad House Madman) has moved to a new domain (internalmedicinedoctor.blogspot.com), so please update your bookmarks and RSS reader. So, now the Madman is a regular internal medicine doctor? Nothings is lost: WebMD just launched a blog called Mad About Medicine.
How to dictate a radiology report?
Hint: use less "cannot be excluded" and "clinical correlation recommended." Sumer's Radiology Site links to the UCSF Radiology Department guidelines on dictating CXR, CT, and other reports.
Somebody sign the death certificate, already!
Respectful Insolence shares a personal story about his uncle who died of a heart attack but the death certificate was not signed for almost 3 days: "The lesson of this incident is that little things we doctors do, without even thinking about it, can, without our knowing it or necessarily appreciating it, cause enormous distress in patients or their families."
NURSES
When A Patient Gets A "Two-For-One" Deal
Emergiblog describes what we sometimes call "an interesting patient." You never, ever want to be an interesting patient. Happily, for this particular gentleman, the outcome was good.
Final Year Nerves
A 3rd year nursing student (Unimum209, whatever that name means) shares her anxiety about starting her first job: "Two semesters of hard work and I will actually be a RN... Is it normal for panic to set in after 3 years of hard work??... I really enjoy reading other nurses, graduates and students blogs' as it is inspiring and comforting to know I am not alone."
There is a community of nursing blogs on mediblogopathy.blogspot.com.
PATIENTS
Appendectomy in Japan
CrozierVision "puts himself at the mercy of the health services" in Japan and explains what it is to have an appendectomy in Tokyo.
A diabetic's take on some timely news
Amy of DiabetesMine comments on news, including the story that the CEO of Amylin Pharmaceuticals, Inc. (formerly of Eli Lilly) pricks her finger daily for a blood glucose test. The CEO is not a diabetic but she wants to know how the patients who buy their products feel every day. Oculir's glucose readings from the whites of the eyes may soon put an end to finger testing.
Did you know you can call?
Joan of Oasis of Sanity is a patient who gives advice who to call when you do not have health insurance but you do need medical advice.
Talking to a friend about his depression
Healthy Concerns blog writes about a friend's relapse into depression and alcohol abuse: "Talking to even a close friend about their alcohol consumption is a sensitive thing..." She did not how to say it. May be the psychiatrists bloggers will have a suggestion.
Medicare Part D - Killing two birds with one stone
AARP claims that the new Medicare Part D Drug Benefit will be cheaper than reimporting drugs from Canada but Healthy Policy blog has doubts.
INFORMATION TECHNOLOGY
Virtual Patient Care Via Internet
Nurses check on patients via Internet, reports the Healthcare IT guy. He is worried if the health IT will be able to correctly track all that information submitted by devices in patient homes. Well, that is why we have a medical connectologist blog.
eHealth blog writes that patients with minor ailments, like cold, get virtual eVisits at Palo Alto Medical Foundation.
The First Medical Blog Network Was Born
Some of you may be aware of the blogging networks like Weblogs, Inc. (bought by AOL for $ 30 million last month) and Gawker Media. Until recently medical blogs had just a RSS aggregator - Medlogs.com (a great aggregator by the way) but not a network. This has changed now. HealthVoice.com started the first medical blog network last week. They have 5 topical blogs in the Featured Columns section, and anyone can start a free blog on their site.
Subscribe to Medlogs RSS feed to get the updates from all medical blogs compiled into one feed.
SCIENTISTS
MRSA kills 90,000 Americans a year
Ruminating Dude lists a few things we can do the limit the spread of the deadly Methicillin-Resistant Staphylococus Aureus (MRSA).
Two potential rotavirus vaccines tested
Rotavirus-related diarrhea causes 70,000 hospitalizations per year in the U.S. The first vaccine against the virus called RotaShield was withdrawn from the market due to reports of an intestinal blockage (intussusception) associated with its use. Aetiology blog informs us about two new vaccines that may be able to take RotaShield’s place.
Individual Response to COX-2 Inhibitors Affected by Genes
Genetics and Health blog writes that genes may explain as much as 30 percent of the variation in individual responses to COX-2 pain killers. People have different adverse effects and to a different extent (for example, blood pressure increase) according to their genetic makeup. Pharmacogenomics is the science of investigating the genetic variations in response to medications.
HEALTH INSURANCE and ADMINISTRATION
Hospital Wars
The nation's hospitals posted record profit margins this year but yet some for-profit hospitals are closing. "Efficiency is doing something right and effectiveness is doing the right thing. Sort of hard to sort them out sometime", writes Fixin' Healthcare.
2006 Forecast for Hospitals: The year of Consumer-Driven Healthcare
Hospital Impact blog lists a few predictions for 2006: patient volume will drop and become more erratic, more phone calls from hospital comparison shoppers, blurring between banks and health plans will continue, just to name a few.
Health Spending In Different Countries
EzraKlein argues that Americans pay more for health insurance and receive less than residents of other countries: "The fiction that we pay more but receive proportionately greater amounts of care is just that: a fiction."
Another Ethical Question
InsureBlog asks if we should pay for an operation for an Americal citizen who is about to permanently leave the country. Check his comments section.
LITERARY and OTHER BLOG POSTS (interesting posts not classified in the groups above)
Baby Boy
"For in that moment I saw my own birth and my own death, lived hundreds of years spanned by the lifetimes of my kin who came before me, and relinquished my bittersweet hope of being forever young." Who else but Dr. Charles?
What's a Rich Doctor To Do?
A medical student in Iran is asking this provocative question. Check out the answer on The Differential blog and if you do not agree, write your opinion in the comments section. Getting instant feedback right there on the web page is part of what makes blogging such a rewarding experience.
After years of shift ER work
Dr. Tony tells us a story which blends past, present and future and ends in a dream.
What I've Learned By Reading Blogs
Rita of MSSP Nexus Blog thinks that reading (and writing) medical blogs is an eye-opening experience. I could not agree more.
Check out Grand Rounds next week
The host of next week's Grand Rounds is GruntDoc, an ER physician in Texas. His blog was voted the Best Medical Weblog of 2004. The voting for 2005 Medical Weblog Awards is open now.
Grand Rounds is a weekly summary of the best posts in the medical blogosphere. 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 Grand Rounds and he maintains the archive. If you would like to know more about the author of Clinical Cases and Images - Blog, see the Pre-Rounds interview here.
This week's Grand Rounds
I work in a large tertiary care center which is probably one of the biggest and busiest hospitals in the world. There are doctors from all sorts of subspecialties, nurses, supportive personnel and, of course, thousands of patients who make this whole endeavor worthwhile.
This organization is glued together by the continuous effort of all these thousands of people (30,000) who come to work and make a difference in somebody's life because it is part of what they do everyday.
The medical blog community reminds me of the hospital structure. It is very interesting to see that the medical blogosphere has spread well beyond the limits of doctors and nurses as authors (click on the diagram to see this week's authors according to job/topic description). Grand Rounds is a snapshot of the best posts and shows the wide variety of medical blogs. It takes all of us to make the miracle of healing happen everyday.
DOCTORS
How to treat hyperkalemia (high potassium)? The new 2005 CPR Guidelines are reviewed by a nephrologist
Treatments for hyperkalemia vary widely and and given the lack of standardization, it is not surprising that different doctors treat hyperkalemia in different ways. The new 2005 CPR guidelines from the American Heart Association provide recommendations for the treatment of hyperkalemia. KidneyNotes offers some criticisms to make a better use of the guidelines in the real world. KidneyNotes.com is a blog maintained by a nephrologist (a kidney doctor).
Should we do PSA screening? A urologist's opinion
Dr. Savatta of Robotic Surgery Blog reviews the pros and cons of PSA testing for prostate cancer. He critiques both the official guidelines and fellow bloggers.
Clinical judgment is the essence of medicine
DB’s Medical Rants writes that clinical judgment remains (and will remain) difficult to define and therefore even more difficult to measure. He discusses three clinical cases as examples.
The “Can-do” spirit of the American health system
No doubt the "can-do" attitude sometimes saves lives, helping some patients with impossible odds survive. Unfortunately, while such an attitude may work well for movie heroes, it does not always lead to victory in patient care. Ad Libitum blog discusses the pros and cons of “do something, don’t just stand there” versus “masterful inaction.” (part one and two)
On Ariel Sharon’s cerebral hemorrhage
Medical blogs follow the news of the day and often provide an explanation to the general public when a famous person is affected by an illness. Recently, Kevin, M.D. reviewed Tedy Bruschi's stroke and the President and the Vice-Presidents annual physicals exams. This week DB’s Medical Rants discusses the two strokes that the Israeli prime minister had - ischemic 2 weeks ago and hemorrhagic later. The first stroke was embolic and similar to the one that affected Tedy Bruschi . The second stroke was probably due to anticoagulation given to prevent the recurrence of the first. Dr. Bob (DB) writes that we must always remember that our treatments have both risks and benefits. Shrinkette reminds us that only about 17% of strokes are hemorrhagic but they account for 30% of stroke deaths.
Sharon had three brain surgeries to evacuate blood in less than 24 hours although there is no sufficient evidence that this approach is clearly beneficial. Medviews comments that taking care of politicians (and kings) is not easy. Frequently, because of their importance and prominence, they may paradoxically get poor care. Bioethics Discussion Blog also asks "Does Standards of Medical Practice Change for a King?" (part one and two).
We do not know all the details of Ariel Sharon's case and the above comments are just an expression of concern rather than a statement of fact.
Suicide bombers' damage lasts beyond the blast
Doc Around the Clock links to a BBC article about a suicide bomber with hepatitis who blew himself up and his body particles infected a survivor of the blast. "As a result of that case, all survivors of these attacks in Israel are now vaccinated for hepatitis B." (BBC)
Sago mine tragedy due to carbon monoxide poisoning
Miners' notes reveal their final moments: "It wasn't bad. I just went to sleep." The miners chose not to tell of their headaches, nausea, and dizziness, which are symptoms of carbon monoxide poisoning, as reported by Shrinkette.
The answer to the question "Why are you overweight?”
NHS Blog Doctor says that "the correct answer, the one that scores points, is straightforward: “Because I eat too much doctor.” We can work on that. The incorrect answer is “I don’t know, doctor, I don’t eat a thing.” Well, I am not sure about the situation on this side of the pond though. Just recently, a U.S. doctor was sued for telling a patient that she was too fat (KevinMD has a summary of the the blogosphere responses).
Minute Clinic opening up at a CVS Pharmacy near you
Bruce of Carolina Healthcare blog is worried that the new Minute Clinic is not only down the street from their office but it also competes directly with their urgent care: "This will impact our business! How should we respond?" "You're Sick. We're Quick" is the Minute Clinic's trademark motto, their discount health care locations are staffed only by nurse practitioners. RangelMD has more on this MiniDoc-in-Box concept which The Health Care Blog calls the Walmartization of health care.
ER Interruptions
GruntDoc shares his frustration with one of the most annoying things in the ER: interruptions while speaking to patients. "I don't expect anyone to wait through the Gettysburg address, but there are natural pauses in conversations when questions aren't completely disruptive, can we all try to wait for that?" Apparently, studies show that the average ER doctor gets interrupted 20 times an hour. Comments say it best: "Nice rant."
Selective abortion of 10 million female babies in Asia
PickledPolitics blog comments on a Lancet study which estimates that 500,000 female fetuses are aborted every year in parts of India, for no other reason than their gender.
Screening during the first trimester of pregnancy
The ObGyn doctor who runs the Red State Moron blog sorts out some inaccuracies in the lay press about the prenatal screening. For starters, first trimester screening (combination of nuchal translucency and serum) is a screening test, not a diagnostic test.
The Hidden Lives of Doctors: Weekend Rounds
Despite the entreaties of some anxious patients, in most cases their doctor is not available 365 days a year. Some other doctor (often unknown to the patient) has to "cover" the weekend for their regular physician. The Cheerful Oncologist has a three part commentary on The Hidden Lives of Doctors, this week's post reveals the mystery of weekend rounds in the hospital. Check out part one (The Art of Signing Out) and part two (The Tergiversator).
Fun with Medical Students
Maria of Intueri teaches medical students how to empathize with pshychotic patients. And she is pretty successful as you will see.
Do antidepressants increase suicide risk or not?
TreatmentOnline blog asks if the FDA warning about antidepressants was wrong.
Don’t be Shocked - Poor Outcomes for Inpatient Cardiac Arrests
LubbDub (a cardiology blog, what else) writes about what we can do to improve the dismal survival after a dreaded "code blue" in the hospital: "Codes have always amazed me in hospitals. As an intern, I felt the intense fear and sinking feeling of having to “perform” using what little knowledge I had to save a patient. I often saw interns running in the opposite direction rather than taking ownership of a dying patient. I quickly realized that the doctors role in a code was to be a calming force in an often chaotic situation."
Medical Consulting for Surgical Patients
The Internal Medicine Doctor writes about Medical Consulting requested by surgical services. The Doctor (formerly: Mad House Madman) has moved to a new domain (internalmedicinedoctor.blogspot.com), so please update your bookmarks and RSS reader. So, now the Madman is a regular internal medicine doctor? Nothings is lost: WebMD just launched a blog called Mad About Medicine.
How to dictate a radiology report?
Hint: use less "cannot be excluded" and "clinical correlation recommended." Sumer's Radiology Site links to the UCSF Radiology Department guidelines on dictating CXR, CT, and other reports.
Somebody sign the death certificate, already!
Respectful Insolence shares a personal story about his uncle who died of a heart attack but the death certificate was not signed for almost 3 days: "The lesson of this incident is that little things we doctors do, without even thinking about it, can, without our knowing it or necessarily appreciating it, cause enormous distress in patients or their families."
NURSES
When A Patient Gets A "Two-For-One" Deal
Emergiblog describes what we sometimes call "an interesting patient." You never, ever want to be an interesting patient. Happily, for this particular gentleman, the outcome was good.
Final Year Nerves
A 3rd year nursing student (Unimum209, whatever that name means) shares her anxiety about starting her first job: "Two semesters of hard work and I will actually be a RN... Is it normal for panic to set in after 3 years of hard work??... I really enjoy reading other nurses, graduates and students blogs' as it is inspiring and comforting to know I am not alone."
There is a community of nursing blogs on mediblogopathy.blogspot.com.
PATIENTS
Appendectomy in Japan
CrozierVision "puts himself at the mercy of the health services" in Japan and explains what it is to have an appendectomy in Tokyo.
A diabetic's take on some timely news
Amy of DiabetesMine comments on news, including the story that the CEO of Amylin Pharmaceuticals, Inc. (formerly of Eli Lilly) pricks her finger daily for a blood glucose test. The CEO is not a diabetic but she wants to know how the patients who buy their products feel every day. Oculir's glucose readings from the whites of the eyes may soon put an end to finger testing.
Did you know you can call?
Joan of Oasis of Sanity is a patient who gives advice who to call when you do not have health insurance but you do need medical advice.
Talking to a friend about his depression
Healthy Concerns blog writes about a friend's relapse into depression and alcohol abuse: "Talking to even a close friend about their alcohol consumption is a sensitive thing..." She did not how to say it. May be the psychiatrists bloggers will have a suggestion.
Medicare Part D - Killing two birds with one stone
AARP claims that the new Medicare Part D Drug Benefit will be cheaper than reimporting drugs from Canada but Healthy Policy blog has doubts.
INFORMATION TECHNOLOGY
Virtual Patient Care Via Internet
Nurses check on patients via Internet, reports the Healthcare IT guy. He is worried if the health IT will be able to correctly track all that information submitted by devices in patient homes. Well, that is why we have a medical connectologist blog.
eHealth blog writes that patients with minor ailments, like cold, get virtual eVisits at Palo Alto Medical Foundation.
The First Medical Blog Network Was Born
Some of you may be aware of the blogging networks like Weblogs, Inc. (bought by AOL for $ 30 million last month) and Gawker Media. Until recently medical blogs had just a RSS aggregator - Medlogs.com (a great aggregator by the way) but not a network. This has changed now. HealthVoice.com started the first medical blog network last week. They have 5 topical blogs in the Featured Columns section, and anyone can start a free blog on their site.
Subscribe to Medlogs RSS feed to get the updates from all medical blogs compiled into one feed.
SCIENTISTS
MRSA kills 90,000 Americans a year
Ruminating Dude lists a few things we can do the limit the spread of the deadly Methicillin-Resistant Staphylococus Aureus (MRSA).
Two potential rotavirus vaccines tested
Rotavirus-related diarrhea causes 70,000 hospitalizations per year in the U.S. The first vaccine against the virus called RotaShield was withdrawn from the market due to reports of an intestinal blockage (intussusception) associated with its use. Aetiology blog informs us about two new vaccines that may be able to take RotaShield’s place.
Individual Response to COX-2 Inhibitors Affected by Genes
Genetics and Health blog writes that genes may explain as much as 30 percent of the variation in individual responses to COX-2 pain killers. People have different adverse effects and to a different extent (for example, blood pressure increase) according to their genetic makeup. Pharmacogenomics is the science of investigating the genetic variations in response to medications.
HEALTH INSURANCE and ADMINISTRATION
Hospital Wars
The nation's hospitals posted record profit margins this year but yet some for-profit hospitals are closing. "Efficiency is doing something right and effectiveness is doing the right thing. Sort of hard to sort them out sometime", writes Fixin' Healthcare.
2006 Forecast for Hospitals: The year of Consumer-Driven Healthcare
Hospital Impact blog lists a few predictions for 2006: patient volume will drop and become more erratic, more phone calls from hospital comparison shoppers, blurring between banks and health plans will continue, just to name a few.
Health Spending In Different Countries
EzraKlein argues that Americans pay more for health insurance and receive less than residents of other countries: "The fiction that we pay more but receive proportionately greater amounts of care is just that: a fiction."
Another Ethical Question
InsureBlog asks if we should pay for an operation for an Americal citizen who is about to permanently leave the country. Check his comments section.
LITERARY and OTHER BLOG POSTS (interesting posts not classified in the groups above)
Baby Boy
"For in that moment I saw my own birth and my own death, lived hundreds of years spanned by the lifetimes of my kin who came before me, and relinquished my bittersweet hope of being forever young." Who else but Dr. Charles?
What's a Rich Doctor To Do?
A medical student in Iran is asking this provocative question. Check out the answer on The Differential blog and if you do not agree, write your opinion in the comments section. Getting instant feedback right there on the web page is part of what makes blogging such a rewarding experience.
After years of shift ER work
Dr. Tony tells us a story which blends past, present and future and ends in a dream.
What I've Learned By Reading Blogs
Rita of MSSP Nexus Blog thinks that reading (and writing) medical blogs is an eye-opening experience. I could not agree more.
Check out Grand Rounds next week
The host of next week's Grand Rounds is GruntDoc, an ER physician in Texas. His blog was voted the Best Medical Weblog of 2004. The voting for 2005 Medical Weblog Awards is open now.
Monday, January 9, 2006
Grand Rounds Announcement
What is this?
Grand Rounds is a weekly summary of the best posts in the medical blogosphere. This week's host is the excellent blog Random Acts of Reality.
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 Grand Rounds and he maintains the archive.
How can I take part?
Clinical Cases and Images - Blog has the privilege of hosting Grand Rounds next week, on January 10. Submit your posts to ClinicalCases@Gmail.com
Please check the Grand Rounds Submission Guidelines. Use "Grand Rounds" in the subject line and you will receive a confirmation email. The deadline for submissions is Monday, Jan 9, 10:00 PM, Eastern time.
What if I don't have a blog?
If you do not have a blog or posts to submit to Grand Rounds, just come here next Tuesday and check out the weekly best of medical blogosphere.
The host of next week's Grand Rounds will be GruntDoc, an ER physician in Texas. His blog was voted the Best Medical Weblog of 2004. The voting for 2005 Medical Weblog Awards is open now.
Grand Rounds is a weekly summary of the best posts in the medical blogosphere. This week's host is the excellent blog Random Acts of Reality.
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 Grand Rounds and he maintains the archive.
How can I take part?
Clinical Cases and Images - Blog has the privilege of hosting Grand Rounds next week, on January 10. Submit your posts to ClinicalCases@Gmail.com
Please check the Grand Rounds Submission Guidelines. Use "Grand Rounds" in the subject line and you will receive a confirmation email. The deadline for submissions is Monday, Jan 9, 10:00 PM, Eastern time.
What if I don't have a blog?
If you do not have a blog or posts to submit to Grand Rounds, just come here next Tuesday and check out the weekly best of medical blogosphere.
The host of next week's Grand Rounds will be GruntDoc, an ER physician in Texas. His blog was voted the Best Medical Weblog of 2004. The voting for 2005 Medical Weblog Awards is open now.
Wednesday, January 4, 2006
RSS Feeds for the Cleveland Clinic
You can keep up with all the medical news from the Cleveland Clinic by subscribing to the following feeds:Cleveland Clinic in the News
Subscribe to RSS to receive updates when the Cleveland Clinic is mentioned in any newspaper article or any other news outlet on the web.
Google News
Copy the URL address below in your RSS reader of choice:
http://news.google.com/news?hl=en&hs=XhE&lr=&client=opera&rls=en&tab=nn&ie=ISO-8859-1&q=cleveland+clinic&output=atom
Yahoo News
http://rds.yahoo.com/S=53720272/K=%22cleveland+clinic%22/v=2/SID=e/l=NRE/SIG=1304gqnc6/EXP=1124739601/*-http%3A//news.search.yahoo.com/news/rss?p=%22cleveland+clinic%22&ei=UTF-8&fl=0
MSN News
http://search.msn.com/news/results.aspx?q=%22cleveland+clinic%22&format=rss&FORM=RSNR
GYM (Google, Yahoo, MSN) can be used to monitor anything you are interested in. Just subscribe to the RSS feed for the search results. Whenever there is a new development about your topic of interest, you will get notified.
RSS Feed for the main Cleveland Clinic web page via FeedTier
You do not need to visit the website to check for updates, they will be delivered directly to you via RSS. Note: the official Cleveland Clinic website does not have a RSS feed yet, this service is provided by FeedTier. Copy the address below in your feed reader of choice:
http://feedtier.somee.com/?http://www.clevelandclinic.org/
RSS from "feed-less" websites
You can get RSS from any web page by changing the URL in FeedTier, for example:
http://feedtier.somee.com/?http://www.example.com
Change "example.com" to the address of the website you want to monitor for changes. Other free services that help you create RSS feeds from feedless websites are Ponyfish, FeedYes.com and Feed43.com.
New to RSS? See the tutorial "How to subscribe to medical RSS feeds on Bloglines" (PDF).
Update 2/24/2006:
1. It looks like the FeedTier service is no longer working.
2. The Cleveland Clinic uses this page text and ideas on the its official website (permitted by me): RSS Feeds for the Cleveland Clinic.
Update 3/15/2007:
Feedity is another service for creating RSS from feed-less web pages.
References:
A really simple guide to a powerful tool: RSS. BMJ Career Focus 2006;332:244.
Google Alerts Tutorial To Help You Stay Ahead of the Curve. DigitalInspiration.
Google Reader Tutorial. DavidRothman.net.
Dynamically create RSS feeds for RSS-less Web sites. LifeHack.org.
Image sources: public domain.
Tuesday, January 3, 2006
Video Podcasts by The Cleveland Clinic
The Cleveland Clinic distributes medical news videos that can be downloaded to a video iPod. You can subscribe to the regular RSS feed to watch the videos on your computer or you can download them directly to an iPod via iTunes. The service is called Health Edge. Videos are available on Google Video, just search for "Cleveland Clinic".RSS feed:
http://feeds.feedburner.com/ClevelandClinicHealthEdge
Copy the feed address above in your RSS reader of choice.
Just a few months ago I predicted that it will not be long before the major medical institutions in the country will start using Web 2.0 applications. Just to recapitulate what we have so far:
- Johns Hopkins professors are blogging on Yahoo
- Mayo Clinic has a podcast. It is called Medical Edge vs. the Cleveland Clinic's Health Edge.
- Cleveland Clinic just launched a video podcast. There was no such thing as medical video podcast before Apple unveiled the video iPod in the last quarter of 2005.
- Harrison's Online has a podcast
- New England Journal of Medicine Audio Interviews and NEJM This Week
References:
Newspapers Making Podcasts Now
Doctors from the Top Medical University are Blogging on Yahoo
Medical Podcasts - Direct Links to Subscribe on iTunes
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: Cleveland Clinic Health Edge.
A Cleveland Clinic Physician Helps the Victims of the South Asian Earthquake and Documents His Trip on Flickr
Dr. Jaffer is a staff physician at the Section of Hospital Medicine at the Cleveland Clinic and the director of the perioperative center at the Clinic. In December 2005, he participated in a relief operation for the victims of the earthquake in Pakistan.
In the refugee camps, Dr. Jaffer encountered medical conditions not commonly seen in the developed world. He took photos to document the trip and the variety of diagnoses in the local population after the earthquake.
You can review this photo documentary on Flickr and offer feedback regarding the diagnosis and treatment:
It can also serve as a preparation guide for health workers who will participate in similar operations in the future.
In the refugee camps, Dr. Jaffer encountered medical conditions not commonly seen in the developed world. He took photos to document the trip and the variety of diagnoses in the local population after the earthquake.
You can review this photo documentary on Flickr and offer feedback regarding the diagnosis and treatment:
It can also serve as a preparation guide for health workers who will participate in similar operations in the future.
Monday, January 2, 2006
Neurology Cases, Physical Exam Videos and Google Medicine
University of Nebraska School of Medicine and University of Utah School of Medicine have created a comprehensive neurology curriculum (free):
- NeuroLogic Exam: An Anatomical Approach - well-illustrated with many QuickTime video files
- Neurology cases to accompany NeuroLogic Exam
Videos are also available on Google Video which is quite convenient since you can just search for the physical exam maneuver you are interested in, for example, "cranial nerve 3 exam."
Google Videos seem to be one more step towards Google Medicine, as named by Dean Giustini.
"Google, M.D.", is what I call the way patients use search engines to look for medical information. Instead of going to the doctor, they check Google first, get the facts (or pseudo-facts), and then (hopefully) check with their doctor. Google functions as a "physician assistant". It is important to be aware that your patients will be seeing "Google, M.D." first. Be prepared for their informed questions.
References:
Physical Examination Videos
How Google is changing medicine - BMJ 12/05 (extract). Dean Giustini's blog
Top Five 2005 Search Trends in Medicine - UBC Google Scholar Blog
Google, M.D. In Action - Part II
Google in Medicine
More Google videos:
Medicare Prescription Drug Coverage
On Our Own Terms: Moyers on Dying. The Mount Sinai Medical Center, 45 min, $ 5
Image source: Google Video
- NeuroLogic Exam: An Anatomical Approach - well-illustrated with many QuickTime video files
- Neurology cases to accompany NeuroLogic Exam
Videos are also available on Google Video which is quite convenient since you can just search for the physical exam maneuver you are interested in, for example, "cranial nerve 3 exam."
Google Videos seem to be one more step towards Google Medicine, as named by Dean Giustini.
"Google, M.D.", is what I call the way patients use search engines to look for medical information. Instead of going to the doctor, they check Google first, get the facts (or pseudo-facts), and then (hopefully) check with their doctor. Google functions as a "physician assistant". It is important to be aware that your patients will be seeing "Google, M.D." first. Be prepared for their informed questions.
References:
Physical Examination Videos
How Google is changing medicine - BMJ 12/05 (extract). Dean Giustini's blog
Top Five 2005 Search Trends in Medicine - UBC Google Scholar Blog
Google, M.D. In Action - Part II
Google in Medicine
More Google videos:
Medicare Prescription Drug Coverage
On Our Own Terms: Moyers on Dying. The Mount Sinai Medical Center, 45 min, $ 5
Image source: Google Video
Epocrates Online Pharmacopeia is Now Free
Epocrates made its name as an easy to use free pharmacopoeia for Palm and Pocket PC. Now Epocrates offers the same features online:https://rxonline.epocrates.com
After a free registration, you can access drug information from any computer connected to the internet. The most commonly used features are adult doses, price information and adverse effects.
Extra information, like pill photos and tables, is available to the paid subscribers.
Epocrates & iPhone. Link via Doctor Anonymous.
Related:
An easy way to add new features to Google. Matt Cutts: Gadgets, Google, and SEO, 02/2008.
(link via PalmDoc)
Review of Epocrates on the iPhone. Tech Medicine, 07/2008.
Updated: 07/18/2008
Sunday, January 1, 2006
Who? Me?
A red squirrel on Flickr.Also, check out this squirrel photo collection.
Image source:
Marko_K's photostream, Creative Commons license
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