Sunday, April 30, 2006

Clinical Case: A patient with thrombocytopenia is scheduled for surgery. Does he need platelet transfusion?

67 yo CM with a myelodysplastic syndrome has a platelet count of 11/microL.

He is found to have pulmonary nodules on CT scan of the chest and is scheduled for a bronchoscopy with biopsy of the nodules tomorrow.

What is the safe platelet count for a surgical procedure?

Does he need platelet transfusion?

Continue reading on ClinicalCases.org.

Image: A 250 ml bag of newly collected platelets. Wikipedia.

Friday, April 28, 2006

NPR Health Stories

Nephrology:
Circle of Events: A New Kidney, a New Life

Geriatrics:
For Seniors, Little Questions Can Lead to Big Changes

ER:
Saving a Life

Cardiology:
Studies Raise Concerns Over Heart-Device Reliability

More:
Side Effects Noted with Bone-Loss Drugs

Medscape Nephrology Headlines

Chronic Kidney Disease, Volume 1

Highlights of the 26th Annual Dialysis Conference

Noncalcium-Based Phosphate Binder Therapy

The Indications for Partial Nephrectomy in the Treatment of Renal Cell Carcinoma

Anemia and Chronic Kidney Disease are Associated With Poor Outcomes in Heart Failure Patients

Shockwave Lithotripsy for Nephrolithiasis May Increase Risk for Diabetes and Hypertension

Image source: Wikipedia

A Medical Librarian Interviews Physician Bloggers to See Where the Medical Search is Going

The Librarian

The medical librarian is Dean Giustini who is the author of the excellent UBC Academic Search - Google Scholar Blog and the recent BMJ editorial How Google is changing medicine.

The Blogger

I am the blogger in this interview.

The Questions

The email interview questions are:

How important are Google and Google Scholar for you and how often do you use them?

If Google went belly-up tomorrow - what would you find the second most helpful tool that you have access to?

How do you keep up to the latest research in your specific area of medicine?

Do you know about RSS feeds, podcasting, e-alerts, and other "sharing" technologies like wikis, blikis, teaching portfolios?

Do you think your colleagues are opening up to these technologies? Or not?

The next one to be interviewed is our blogging nephrologist in New York City, the author of KidneyNotes.com.

Image source: OpenClipart

The Arms Race in the Search War

BuyGoogle.com has an interesting post on the "battle of giants" in the search field which increasingly looks like Google vs. Microsoft, with Yahoo left to decide which camp it should join:

"In short, Google has a huge head start. If Google keeps going fast, Microsoft can't catch up just by spending a lot of money.

For smaller competitors like Yahoo, eBay and Amazon, it's increasingly clear that none of them has the resources to participate in this arms race. For them, consolidation is coming."

Microsoft just announced that it will be spending $2 billion to build their own version of Google "cluster", the massive server farms that Google employs. To investors that meant: "we are hopelessly behind" and the MSFT stock took a 12% nose dive...


Image source: BuyGoogle.com

References:
'Management à la Google' — by Gary Hamel, WSJ. Bookofjoe.com.
Microsoft, Return of The Beast. GigaOm.com.

Wednesday, April 26, 2006

JAMA Podcast: Audio Commentary by the Editor-in-Chief

JAMA is the third journal from the group of "big five" in medical publishing to feature audio summary of content. "Big five" consists of NEJM, JAMA, Lancet, BMJ and Annals of Internal Medicine.

Feed:

http://jama.ama-assn.org/misc/jamapodcasts2006.rss

NEJM and Lancet have their own versions of weekly audio summaries. You can listen to the MP3 files directly or subscribe via iTunes.

It is a matter of time before almost all major journals feature audio summaries. I will email Brian Mandell of the Cleveland Clinic Journal of Medicine to see if he is interested.

In the meantime, you can always use text-to-speech to convert text from your favorite journal to mp3 files you can listen to on the go.

Updated: 08/18/2007

Monday, April 24, 2006

Lincoln's Gettysburg Address in PowerPoint? Not So Compelling...

Via InsideGoogle:

"Google'’s head of research, Peter Norvig, created one of the most famous Powerpoints of all-time: A PPT version of Lincoln'’s Gettysburg Address.

Peter took the text, put it through Powerpoint'’s AutoContent Wizard, added some common PowerPoint actions, and, voila! Instant statement on how PowerPoint dulls your voice."

May be you should give the Lessig Method of Presentation a try...

Related:
How to create a great powerpoint without breaking the law. Medical Education Blog, 04/2008.
Image source: Wikipedia

Updated: 04/07/2008

Sunday, April 23, 2006

You don't have to be happy to do your job well

Joe who is the "world's most popular blogging anesthesiologist" writes that there is no correlation between how you feel and how well you do your job:

"Many of the excellent performers I know personally in various fields --— as disparate as law, gardening, sales, waitressing, medicine, airline pilot, coffee roaster, upscale real estate broker, and business school admissions committee member --— are not very thrilled with what they do."

He also gives a few examples of personal experiences.

Hmm... What happened to my happiness post that starts with "A happy doctor means happier patients (usually)" ?

You can be grumpy and still have patients that are happy with you, I guess...

References:
Attitude as it relates to job performance. BookOfJoe.
Six Tips for Happiness by a Harvard Teacher
Thinking About Medicine - Your Inner Peace
Image source: OpenClipart.org

Related:
Finding Happiness in PubMed, and Life. Open Medicine Blog, 09/2007.
Experienced happiness is largely set by personality, it will temporarily respond to changing circumstances. The Lancet, 2010. http://goo.gl/ot3Kx

Saturday, April 22, 2006

What is Boomeritis?

NYTimes describes the health problems of aging baby boomers who continue to exercise: osteoarthritis which needs "knee and hip replacements, surgery for cartilage and ligament damage, and treatment for tendinitis, arthritis, bursitis and stress fractures."

Some doctors call this phenomenon "boomeritis" or "Generation Ouch."

Related:
Baby Boomers Stay Active, and So Do Their Doctors. NYTimes.
Boomeritis, Man Flu & Salad Dodging Down Under. WSJ Health Blog, 01, 2008.
Image source: OpenClipart.org, public domain.

Updated: 01/11/2008

Another blogger quits due to "blog fatigue"

Russell Beattie writes that blogging has become too much of a burden and he decided to give himself a break and probably to start later at a new URL:

"For the rest of my readers, thanks for subscribing it's been great having you there to write for! Now please *unsubscribe* and give my poor server a break. :-)"

"Blog fatigue" seems to be a common phenomenon among veteran bloggers.

The RSS inventor and blog pioneer Dave Winer also wrote that he plans to stop blogging to free up time and become less of a public figure:

"I want some privacy, I want to matter less, so I can retool, and matter more, in different ways."

Jacob of Family Medicine Notes (started in 1999) also ponders quitting his blog:

"...blogging has matured, and so has medical blogging. Back in 1999 and 2000, there were a handful of medical bloggers (literally!) and we all had a bit of a role in educating each other and the world about what is is that physicians do, think, read, etc. This was - from my view - a primary purpose of medical blogging: to enhance the transparency of our profession.

But there's lots of that now. Hundreds (thousands?) of medical bloggers are posting daily and - frankly - I don't think the Internet needs me anymore..."

There is no sign that Kevin, M.D. will be stopping any time soon though... :-) I am just filling in for him on his blog for a little while.

Update 10/01/2007:
Russell Beattie is back in business, blogging again, because he "can't shut up" -- his new tag line.

Related:
TechMeme list heralds death of blogging? Scobleizer.com, 10/2007.
Celebrating seven years of blogging. Scobleizer, 12/2007.
Image source: Openclipart.org

Updated: 12/23/2007

Wednesday, April 19, 2006

Google Calendar for Patients: Monitor Your Medical Condition

LifeHacker reports that some patients are using Google Calendar to track the daily or weekly variations of their medical condition, for example, depression or insomnia. The color-coded approach looks complicated to me but some people find it helpful.

Google Calendar can potentially be useful for monitoring the progress of patients with other chronic conditions like asthma: daily sx, use of PRN inhalers, sx during the night, etc.

It is not difficult to imagine diabetic patients using the calendar to monitor their blood glucose, hypertensive patients recording their blood pressure and so on.

Google Calendar has a nifty sharing feature that patients can use to keep in touch with their doctor. And if they need to make an appointment, they can always check if the doctors is available by subscribing to his/her calendar.

Update 03/10/2007:
Urologist Shares Robotic Surgery Schedule via Google Calendar

Update 5/24/2007:
Google launches calendar for mobile devices. Google Blog.

References:
Track medical conditions with Google Calendar. LifeHacker.
Google Calendar for Doctors: Help Patients See Your Practice Schedule and Make Appointments
Add Google Calendar to Your Site. Google Blogoscoped, 2006.

Monday, April 17, 2006

Medical Students Blogging on a "Massive Scale" at the University of Michigan

The University of Michigan Medical School encourages students at each level of the program to blog and to "give you an intimate look at their med school lives, —their insights, ‘"ah-ha’" moments, frustrations and excitement."

Currently, there are 12 blogs on the page. A part of the URL is medschool/reality, so this thing should be real.

Graham of Over!My!Med!Body!, who was one of the first blogging medical students at Stanford, suspects some censorship though:

"... look down at the footer:

This page is maintained by UMHS Public Relations & Marketing Communications.
The University of Michigan may monitor this blog about the information you’ll find or delete inappropriate content.

That’s some censorship I’m happy not to have."

References:
Blogging med school. Shelved in the W's, 09/2007.
Link via KevinMD.
Image source: OpenClipArt.org, public domain.

Related:
Why It Stinks To Be A Med Student. Over!My!Med!Body!

Updated: 02/24/2008

Google On-site Doctor Has a Blog

You probably know Dr. Taraneh Razavi from her occasional but well-written posts on the official Google blog, one of them was about travel-related DVT.

Dr. Razavi now has her own blog on Blogger.com (where else, Blogger is a Google property): Dr. Razavi's Good to Know Info.

Funny enough, the team members of her blog are:

A Googler
Eric (Schmidt, Google CEO?)
GooglePR (the Public Relations Department?)

Are the team member there just to help or to keep a close eye on the blogging doctor?

Whatever the answer is, I am sure that Dr. Razavi's blog will be worth-reading. After all, she lists the references to her posts just as I do :-)


Update 4/21/06:

To dispel any unsubstantiated rumors, Eric is not Eric Schmidt but Eric Case, a member of the Blogger team.


Link via Blogger Buzz.
Image source: Dr. Razavi's Good to Know Info
Directory of RSI Software. The Loose Wire Blog.

Saturday, April 15, 2006

Google Calendar for Doctors: Help Patients See Your Practice Schedule and Make Appointments

Google Calendar can be used to show open slots in your practice schedule to potential patients. See the screenshots below.


Figure 1. A physician's practice schedule (the master schedule) or what you can see. Make the appointment schedule as usual. Patient information will not be seen on "the other side" of the calendar that the patients subscribe to. Privacy note: the names in the screenshot above are fictional.


Figure 2. Share the calendar with potential patients. Choose the option "Share only my free / busy information (hide details).


Figure 3. A patient-accessible schedule or what the patients can see. Patients will see all open slots in your practice and can schedule an appointment at a time convenient for them. Lunch time from 12 PM to 1 PM is blocked. You need to place a "subscribe to our calendar" button on your practice website.

If you do not have a practice website yet, Google Pages or Blogger.com (with modifications) are good choices.

Update 03/10/2007:
Urologist Shares Robotic Surgery Schedule via Google Calendar

Update 5/24/2007:
Google launches calendar for mobile devices. Google Blog.

Update 10/03/2007:
Jay Parkinson, a doctor without an office, uses G Calendar to schedule appointments

References:
Google Calendar for Patients: Monitor Your Medical Condition
Interesting Ways to Use Google Calendar
How Can a Doctor Use Google Page Creator?
What is Protected Health Information (PHI) & Electronic Protected Health Information (ePHI)? Yale University
The future of Google Calendar. ZDNet, Googling Google.
An Open-Access Doctor's Office. BusinessWeek.com.
Add Google Calendar to Your Site. Google Blogoscoped, 2006.

Updated: 10/03/2007

Friday, April 14, 2006

Top 10 Best Jobs - Physicians Are Not on the Short List

"Physician assistant" made it to number 5. "Physician/Surgeon" is at number 30 on the list of top jobs.

Using the standard 4-grade system, the stress of a physician's job is rated as D, flexibility D, creativity B, and difficulty D. It looks pretty bad, doesn't it?

As a small consolation for your malpractice worries, "Lawyer" lags behind at number 37.


Job Stress is Rated as "D"

Shrinkette is a blogging psychiatrist who writes about a "very important doctor" who called about a patient with multiple complications after a fall. He prescribed the sleeping pill that probably made the patient dizzy before the fall:

Okay...what's the question?"

There's tension in his voice. He knows this woman, knows her family. He's treated her for years. She's so sick now. She might not make it. He gave her that med... this all started when he gave her that med. Everything went downhill after that... and now she's in a coma...

And finally, I get it. This call isn't for the patient. It's for the doctor.

I lay my pencil down. I shut my mouth. I listen."


References:
Top 10 best jobs. CNN Money.
"Hi, Shrinkette. Got a minute? I have this case."

Interesting Ways to Use Google Calendar

Google Calendar was launched just 2 days ago and there is already a long list of public calendars that you can add to your Google account:
  • History
  • US Holidays, plus the national holidays of more than 20 countries
  • Religious Holidays
  • Astronomy calendar
  • World Events Calendar
  • Celebrity Birthdays
  • DVD Releases
  • Movie Releases
See the complete list at Google Blogoscoped: Interesting Google Calendars.

It is funny to see how Google managed to cause a significant surge of interest and creativity by launching their calendar. Yahoo Calendar has been around for almost 10 years and nobody pays attention to it.

Google Calendar is Ajax-based and it works like a desktop application (and better). Somehow I never liked Outlook and I was not very impressed with 30Boxes, so it looks like this is the solution for me. The new calendar even has keyboard shortcuts that are logical and easy to remember: M for Month view, D for Day, W for Week, A for Agenda and C for Create.

I wonder if a medical office can use Google Calendar to show open slots in which patients can schedule their own appointments... It should not be that difficult to do.

Update 4/15/2006:
It's done: Google Calendar for Doctors: Help Patients See Your Practice Schedule and Make Appointments

Update 6/7/2007:
One can use Google Calendar to chronicle past events: Google Calendar as your long term memory. LifeHacker.com.

Update 10/03/2007:
Jay Parkinson, a doctor without an office, uses G Calendar to schedule appointments

References:
Google Calendar: Staying organized has never been so easy. The Unofficial Google Weblog.
An Open-Access Doctor's Office. BusinessWeek.com.

Updated: 10/03/2007

63% of comunity acquired staph skin infections due to MRSA. Get that Vancomycin ready...

A new study reports that 63% of staphylococcal skin and soft tissue infections are due to CA-MRSA (Community Acquired MRSA).

Empiric antibiotics were inadequate in 2/3 of cases simply because they did not cover CA-MRSA.

Notes from Dr. RW discusses the study in detail.

References:
Emergence of Community-Acquired Methicillin-Resistant Staphylococcus aureus USA 300 Clone as the Predominant Cause of Skin and Soft-Tissue Infections. March 7, 2006. Annals of Internal Medicine.
MRSA Is Striking Gay Men. NYTimes, 01/2008.
Image source: Wikipedia, CDC.

Related:

Wednesday, April 12, 2006

Hush up ladies!

reposted from my old blog

I have to admit that I've never read Daily Kos. I usually shy away from the A-listers as a habit. It's kinda like shunning the cheerleaders & the real nerds in high school. I went to a weird high school where the A-listers were either cheerleaders or the National Merit folks. I was neither.

Anywho, so I got word that Daily Kos was in town and headed out to check out the new savior of the Progressive movement. You can identify the saviors by the book tours they travel on. I also wanted to ask him "THE QUESTION" in person. Yup, I did. First, Kos started in on why he wrote his book, why he has his blog, why we need a new way of looking at politics, and of course, a new way to organize and elect Democrats to office.

Again, I've never really read his site, but I heard about his dismissal of feminists and abortion rights as a key issue over the summer. As Kos says, "Why do groups like NARAL and HRC have a hard time grasping the big picture?"

At one point, he mentions something about feminists and about not dismissing them. I jump into his speech and ask, "But on your blog, you have been dismissive of feminists and abortion rights." He retorts, "No, I haven't. I'm as pro-choice as anyone else." I can't recall the exact words, but he essentially says that while he's all pro-choice and knows and sees that abortion rights are under attack ("Look at SD!") the thing is that we need to see the big picture.

Here's the big picture:

More Democrats = More rights for women

Gawd damn do I wish it were that simple!

Later in another topic, I interjected that Bob Casey was a bad candidate. Kos looked right at me and said, "He's only wrong on one issue." Meaning abortion. OK, so let's look at Bob Casey's stance on the issues. I'll use NOW issues as that's the organization I hang with the most:

Reproductive Justice (aka choice): opposes a woman's right to abortion, supports protecting human life from conception, supports pro-life pharmacists. F

Equal Rights (aka gay marriage): opposes same-sex marriage, supports hate crime leg that addresses crime again GBLT people. C (see, he's not wrong, just not completely right!)

Economic Justice: Won't support a living wage, opposes CAFTA, opposes universal health care. D (again, he gets partial credit!)

Violence Against Women: His issue page is silent.

Ending Racism: His issue page is silent.

OK, I know it's hard to address racism in a campaign, but it's one of our issues. Part of how you address racism is to address the lack of job training, punitive welfare reform, and other issues that overwhelmingly affect people of color.

sources: Lancaster County Action 2004 Scorecard, Pennacchio for Senate*, Bob Casey for U.S. Senate,

In the end, Bob Casey can't earn an A on one issue. Even his environmental page isn't up to snuff with this former Greenpeace canvasser. It seems pretty good, but investing in new technology won't cut it. We have to put the screws to the automakers to force their hand. OK, so I might give him a B.

But for Kos to say that he's only wrong on one issue is so very wrong. I know we can't get a perfect candidate, but come on, why do we need a candidate like Bob Casey? The only reason Kos and other Dems like him are harping on us feministas is that they know the truth:

"Bob Casey can't win a tough campaign against Rick Santorum without a strong turnout from the pro-choice majority in Pennsylvania," Pennacchio said last week. "Democrats should not repeat the mistake we made in 2000" with Ron Klink.
[link]

But by putting the screws on us now, if Casey loses, the blame put on us will happen so fast, it'll give us all whiplash. "Go ahead ladies, vote thinking only of your wombs! See where that gets you." Or vote for the anti-choice, anti-Roe v. Wade candidate and pray that he won't let yet another anti-abortion USSC Justice on the bench. Oh, wait...he WOULD support justices that have anti-abortion stances.

Just glancing at his opponents' issue pages^ makes it glaringly clear that either of these men would be a better and more progressive candidate than Casey.

In the end, I obviously didn't walk away with a signed copy of his book, but I don't hate the man either. We're in a moment where the DNC has to choose which path to take. And there are many paths to take. Kos just thinks that feminists get in the way with all our concern over abortion rights. I say my uterus takes precedent. So I say that we need a new t-shirt. Instead of this one. We need one that says, "Just say no to sex, with pro-Casey (insert anti-choice Democrat name here) Democrats". See, not just with anti-choice Dems, but with those who support them too.

I'll end quoting one of my favorite bloggers:

For us, this is the big boys selling out our freedom while we’re instructed to sit back and let those with real “commitment to women’s issues” call the shots. And if that doesn’t bring the funny, I don’t know what does.

* remind me that if I ever run for office to hire his oppositional researcher.
^ I *love* that Sandals has an issue chart. Great for skimmers like me.

Tuesday, April 11, 2006

How I Work

Bill Gates' Way

Bill Gates shares details about the way he works with CNN Money, for starters, the paper on his desktop is replaced by 3 monitors: "Paper is no longer a big part of my day. I get 90% of my news online, and when I go to a meeting and want to jot things down, I bring my Tablet PC. It's fully synchronized with my office machine so I have all the files I need."


MicroPersuasion

Steve Rubel of MicroPersuasion also lists the services he uses every day. The list is long and I'm not sure how he doesn't get tired just of signing-in/off of so many websites... I had somehow overlooked Google Bookmarks before I read Steve's posts. Since then, I switched my online bookmarks to Google (from Del.icio.us) and I like it better. Google is faster, the search is better (no surprise here) and I can use the bookmarks when I'm logged in my Gmail account, eliminating the need to have one more log-in (Del.icio.us). There is not much in terms of sharing the Google Bookmarks but I prefer them private anyway.


Free Alternatives to Bill Gates' Services

DownloadSquad made a list of all the free services and programs you can use instead of Bill Gates' proprietary choices. Does anybody actually use SharePoint in today's blog-enabled world?


References:
How I Work: Bill Gates. CNN Money/Fortune.
How I Work. Micro Persuasion
Roll your own Bill Gates workflow for free. Download Squad.

Monday, April 10, 2006

ABCD of Hypertension Treatment in Different Ethnic Groups

According to the BMJ, hypertension (HTN) in Caucasians is high renin (type 1) HTN and responds best to treatment with ACEi and beta-blockers (AB drugs).

HTN in young black people is low renin (type 2) HTN and responds better to calcium channel blockers and diuretics (CD drugs).

Morris Brown writes that "as for diabetes, hypertension can usefully be considered as of type 1 or type 2, each with its own preferred treatment."

AB = ACEi, BB for type 1 HTN

CD = CCB, Diuretics for type 2 HTN

This is the proposed ABCD of HTN treatment.

A study published in the Jan 2008 edition of Archives of Internal Medicine "failed to provide support for the selection of alpha-blockers, ACEi, or CCB over thiazide-type diuretics to prevent cardiovascular problems in patients with metabolic syndrome."

References:

Hypertension and ethnic group. Morris J Brown. BMJ 2006;332:833-836 (8 April)
New Debate on Some Blood Pressure Drugs. WebMD Medical News, 01/2008.
Personalised medicine for hypertension - measuring renin could refine treatment of resistant HTN http://goo.gl/MmZhs
Image source: Wikipedia

Saturday, April 8, 2006

How to make a flow chart for your research protocol? Free programs

Clear flow charts can go a long way in explaining the randomization arms of your study or any other group allocation. There are 2 free options:

Desktop Programs

RFFlow is a free program "for drawing flowcharts, organization charts, and many other kinds of diagrams." You can download a free demo version which does not expire but has a slight limitation on the number of figures in each chart (not a significant hurdle unless you plan to make very large diagrams).

Web-based Services

Gliffy is a web-based tool for flow chart design. Similar to the web word processor Writely, you can invite colleagues to collaborate on a diagram. "Gliffy also stores multiple revisions of the same chart making tracking changes easier. You can even link your flowcharts from your blog or wiki", writes the Digital Inspiration blog.

I used Gliffy to illustrate a post about DPP-4 Inhibitors for Treatment of Diabetes. The diagram is now on Wikipedia.

Draw Anywhere is another web site for making flowchart diagrams in the browser.

Related:
Gliffy: Web-based Microsoft Visio - Google interested? Digital Inspiration blog.
Quick and simple online drawing. LifeHacker.com
Bubbl.us - Easy 2 Make Flow Diagram. Go2web2.
Create Animated Charts and Flash Graphs for your Website. Digital Inspiration, 2007.
Make Flowchart Diagrams in the Browser with Draw Anywhere. Digital Inspiration, 2007.
How to Use Bubble.us to Make 2008 Your Most Productive Year Ever. LifeHack.org, 01/2008.

Updated: 01/01/2008

Web 2.0 Excel Applications

Do you really need Microsoft Excel anymore? The free OpenOffice has a spreadsheet application that you do not have to install since it can run from a USB drive.

The future belongs to mobility and therefore to web-hosted applications. Just a few examples of Web 2.0 Excel-clones:

- Google released online Google Spreadsheets in 6/2006.

- Numbler. DownloadSquad review.

- iRows. DownloadSquad review.


Thumbstacks.com is an online PowerPoint clone. It works OK but unfortunately it does not support import/export to PowerPoint yet. Zoho Show is more polished, it has a MS PowerPoint import feature but no export yet and this limits its usefulness.

You can also check the list of Most promising Web 2.0 software of 2006.


References:
Freeware alternatives for everything. Links via DownloadSquad.com.
ajaxXLS: Web-based spreadsheet from ajaxLaunch. DownloadSquad.com.
Now, Free Ways to Do Desktop Work on the Web. NYTimes.
Zoho releases Ajax presentation app - last piece of Web Office jigsaw? ZDNet.com.

Writing an Article? Try an Online Word Processor

"Who needs Microsoft Word anymore?" is the question that the creator of AjaxWrite is asking. Why do you need to pay $ 400 if you can get the same basic functionality for free?

Writely and Ajaxwrite are just 2 of the free online word processors that have been in the news recently:


Writely

Writely is very stable, secure and easy to use, it was bought by Google last month for $ 5 million and it was temporarily closed to new registrations until they migrate data to Google servers. If you already have a Writely account, you can invite up to 20 new users (similar to Gmail).

Writely keeps the documents online but you can export them ("save as") to your local hard drive. The interface is similar to MS Word, even the old Windows/Word keyboard shortcuts still work (Ctrl+C, copy; Ctrl+V, paste). Documents can be accessed from any computer with internet connection.

Writely is very well suited for scientific collaboration since it allows several authors to write an article at the same time. No more emailing back and forth different versions of one Word document.

I have used Writely since 11/05 and it works well for me. All my blog posts, articles, and study protocols (without HIPAA identifiers) are written with it.


AjaxWrite

No registration is required for this online word processor which works only with Firefox for now. AjaxWrite looks almost exactly like a 1997 version of MS Word and it saves the documents to your hard drive (no online storage).


References:
Meet Ajax Write. GigaOm.com.
Bye Bye Microsoft Word, Hello ajaxWrite. MichaelRobertson.com.
Web 2.0 Watch: ajaxWrite by Michael W. Muchmore.
Now, Free Ways to Do Desktop Work on the Web. NYTimes.

Friday, April 7, 2006

Chewing gum reduces stress and improves memory. Really?

BusinessWeek reports that studies sponsored by the world's largest chewing gum maker Wrigley show that chewing gum "activates certain chemicals in the brain that help improve short- and long-term memory, and even helps reduce stress."

The studies are small, involving less than 100 people and Wrigley has not promoted the results because the studies "had not been peer-reviewed." Pubmed returns 15 articles to the query "chewing gum, memory." One study claims that "recent reports suggest that enhancement of memory performance while chewing gum is a fairly robust phenomenon." Appetite, 2004 Oct.

So, is gum a health food now (if it is food at all)?

References:

Wrigley Chews Over Some Surprising News. Pallavi Gogoi. BusinessWeek.com
Chewing gum improves memory. NewScientist.com
20 Ways to Get and Stay Happy. Time, 2007.
Gum: The New Health Food? WSJ Health Blog, 2007.
Children chewing xylitol gum were 25% less likely to develop acute ear infections. NYTimes, 2011.
Image source: Chewing gum from Wikipedia, the free encyclopedia

Tuesday, April 4, 2006

Cleveland Clinic Pediatric Radiology Image Gallery

The image gallery "was designed by a radiologist and an educator, it includes a collection of multiple pediatric cases, all of which have been pathologically proven."

Each image includes "mouse over"” annotations to point out the findings. The correct diagnosis is included at the end of each case. You can browse the cases by system, diagnosis, or you can just enter a query in the search engine.

"Originally designed for radiology residents rotating through pediatric radiology, this site has now expanded and serves as a reference "text" required in many radiology residency programs across North America." The curriculum was reviewed by more than 70 national and international experts in pediatric radiology.

The project was created with grants by the SPR Research and Education Foundation and it is just one more example of the high-quality open access medical education provided by the Cleveland Clinic.

Image source and quotations:
CCHS.net/PediatricRadiology

Related:

Monday, April 3, 2006

The Lancet Features Weekly Audio Summary

The venerable medical journal The Lancet now offers an audio summary of its weekly content called "Listen to The Lancet."

Feed:

http://podcast.thelancet.com/lancet.xml

This is the second member of the "Big Five" in medical publishing which starts podcasting (sort of). The NEJM was the first medical journal to embrace podcasting as a form of content distribution.

Downloadable audio files (podcasts) and text-to-speech programs are significant developments in medical education because they make it portable and truly on demand.

An additional health benefit is that you can exercise while educating yourself about the latest medical developments across the pond.

Update 11/11/2006:

The Lancet launched a blog in October 2006.

References:
Text-to-Speech Programs and Continuous Medical Education
Medical Podcasts: A Complete List

Updated: 08/18/2007

Sunday, April 2, 2006

There is no such thing as online privacy and Google search is not your friend

The Bad

C|Net discusses the privacy implications of search engines' policy to keep one's search history forever:

"It's only a matter of time before attorneys realize that a person's entire search history is available for the asking, and the subpoenas begin to fly. This could happen in civil lawsuits or criminal prosecutions."

Google is not alone, Yahoo and MSN also keep records of every query entered in the search box. The search phrases are matched to the IP addresses. "You are what you search for" could be a winning argument in court sooner than you think.

It comes as no surprise that services that try to make surfing anonymous are proliferating. There is even a Firerfox-based browser which promises to increase your level of web anonymity. Read more in Outsmarting the Online Privacy Snoops, Washington Post.


The Good

Alternatively, user testimonials offer a very positive view on Google. Dr. Karuturi writes more on how the most popular search engine has changed people lives. On a lighter note, Opera April Fool's page shows how search helps in difficult situations: What you need. When you need it.


References:

FAQ: When Google is not your friend. February 3, 2006. CNET News.com

Saturday, April 1, 2006

Don't Rush Publications: A Journal Case Report Backfires in Court

A Rare Complication

Doctors from Baylor College of Medicine published 2 research papers describing the unusual case of a 38-year-old Honduran housekeeper with multiple comobordities who died from a disseminated parasitic infection. Upon autopsy, pathologists found that the patient's intestines, liver and lungs were infested with Strongyloides stercoralis.

The plaintiff's attorney argued that the doctor could have recognized the infection of they had thought about it in their differentials and quoted the published case reports.

The jury awarded close to $ 900,000 to the family of the deceased patient.

During her 48-hour hospitalization, she was seen by multiple subspecialists (rheumatology, GI, cardiology, radiology, surgery, neurology, internal medicine and dermatology) — 32 physicians and residents in all, but nobody was able to figure out the rare diagnosis.


What Was Missing?

The only consult missing? ID.

Patient's eosinophilia was a clue to the parasitic infection.

Of course, it is very easy to recognize the signs and symptoms of a diagnosis when you know the autopsy conclusion and you look back at the case. It is much more challenging to pinpoint the correct diagnosis in "real time" in patients who have several concurrent diseases.


A Case with a Bad Outcome - To Publish or Not To Publish?

Should you publish a case report during a course of a litigation dealing with the same case? It is probably not a good idea.

On the other hand, doctors have to learn from their or others' mistakes. That was the probable reason why the Baylor researchers decided to publish the case reports: to help other physicians reach the correct (and rare) diagnosis in time. Unfortunately those same reports backfired in court.


References:

Link via Kevin, M.D.
Baylor's own scholarship works against it in lawsuit. Research about a rare and possibly misdiagnosed case was used to show negligence. The Houston Chronicle, March 11, 2006.
Strongyloidiasis from Wikipedia, the free encyclopedia.
Image source: CDC, public domain.